hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|DC,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,,,,,,,,,,,,,,,,,, Sibley Memorial Hospital,4/1/2026,3.0.0,Sibley Memorial Hospital,"5255 Loughboro Rd Nw, Washington, DC 20016",1366492977,HFD01-0213,TRUE,Sharlene Seidman,,,,,,,,,,,,,,,,,, description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement,modifiers,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],8397.53,8397.53,8397.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. New Technology - Level 32 ($7001-$7500),1532,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],50.76,50.76,50.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tissue marker, detectable",2055,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],18988.44,18988.44,37349.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",38365.35,38365.35,50981.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,68324.94,68324.94,68324.94,1 through 10,percent of total billed charges,,, "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Brachytx, non-str,Yttrium-90",2616,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",727.15,180.43,1639,87,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",457.31,152.54,1791.28,74,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],41.24,18.68,127.62,33,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",441.42,345.44,493.09,94,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",421.35,329.74,477.3,122,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],98,48,144.23,147,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],106.7,96.3,193.89,2990,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",110,108.9,110,760,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",110,109.25,110,61,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,114.14,114.14,581,1 through 10,percent of total billed charges,,, Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,133.6,133.6,133.6,1 through 10,percent of total billed charges,,, Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,121.32,109.3,496.98,88,percent of total billed charges,,, Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],156.14,141.43,156.14,56,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,116.9,116.52,617.02,87,percent of total billed charges,,, Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],103.24,99.08,1715.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],148.71,118.95,148.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",425.05,323.52,461.64,39,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,142,107.46,648,1 through 10,percent of total billed charges,,, Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,110,109.75,110,26,percent of total billed charges,,, Clinic Visits and Related Services,5012,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",88.56,88.56,88.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",272.51,45.39,866.11,38,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",365.72,256.93,823.85,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],252.04,252.04,252.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",436.8,329.13,806.1,66,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",422.78,317.83,682.8,111,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],314.82,314.82,330,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],326.7,168,330,150,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",591.03,365.4,867,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",368,368,381.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,158.3,158.3,158.3,1 through 10,percent of total billed charges,,, Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],106.68,106.68,106.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,319.12,258.3,1055.6,1 through 10,percent of total billed charges,,, Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],319,319,319,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],91.39,91.39,91.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",408.99,308.2,671.78,71,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,821.17,821.17,867,1 through 10,percent of total billed charges,,, Level 1 Type A ED Visits,5021,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",348.5,151.29,1217.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",875.99,422.7,3033.19,298,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1004.92,463.37,2823.5,171,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],195.47,82.25,461.25,44,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",455.73,342.78,988.05,335,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",473.86,322.89,1008.04,660,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],598.5,450,745,65,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],740.5,398,748,1243,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",814.19,567,867,268,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",867,503,1148.03,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,3167.7,3167.7,3167.7,1 through 10,percent of total billed charges,,, Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,890.3,890.3,890.3,1 through 10,percent of total billed charges,,, Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,746.98,201.44,3208.36,31,percent of total billed charges,,, Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],194.07,191.87,465.04,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,1041.43,596.33,3848.6,15,percent of total billed charges,,, Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],1248,715.48,1347.25,40,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],183.84,68.66,335.03,26,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",464.82,308.2,1131.82,277,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,736.94,736.94,867,1 through 10,percent of total billed charges,,, Level 2 Type A ED Visits,5022,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",308.73,280.44,1296.42,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2169.66,862.61,6167.39,519,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",2463.64,947.62,7648.14,290,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],602.87,332.29,1820.84,110,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",771.47,411.16,2213.37,466,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",769.46,393.59,2045.5,1075,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1417.68,518.75,1541,121,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1570.69,1182,1591,2298,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1156.5,909,1159,453,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1269.07,890.42,3900,78,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,709.53,316.15,723.32,1 through 10,percent of total billed charges,,, Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,1433.2,1433.2,1433.2,1 through 10,percent of total billed charges,,, Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,2614.4,681.02,6356.09,75,percent of total billed charges,,, Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2254.44,986.25,10038.42,33,percent of total billed charges,,, Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],543.64,403.41,1424.34,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],2500,989,2600,80,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],562.63,313.32,1307.18,64,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",732.37,386.15,1953.43,389,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,879.84,400,8244.13,1 through 10,percent of total billed charges,,, Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,1113,985.16,1159,15,percent of total billed charges,,, Level 3 Type A ED Visits,5023,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1571.94,502.25,5037.27,33,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",5484.86,2285.46,11646.24,140,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6453.96,2362.26,12510.91,77,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1193.34,617.79,3177.51,56,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1718.43,578.65,2691.87,180,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1769.21,628.92,2642.78,393,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2827.5,1714.99,3072,40,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3062.72,2581,3072,740,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2225,1753.92,3850,155,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",2549.86,1794.88,5602.23,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,150,150,150,1 through 10,percent of total billed charges,,, Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,5206.68,1619.38,11394.51,21,percent of total billed charges,,, Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,4930.98,3648.64,11533.13,15,percent of total billed charges,,, Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1863.98,1258.31,8229.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],4034,1743.3,4084,50,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],1180.7,679.92,2221.4,73,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1432.78,640.68,2435.01,164,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,1892.12,1892.11,2226,1 through 10,percent of total billed charges,,, Level 4 Type A ED Visits,5024,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3617.29,988.45,6977.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",12876.83,12876.83,12876.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",7010.43,7010.43,7010.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3235.45,1431.89,7723.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2253.65,2099.48,3948.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1921.15,711.8,3405.15,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4238,4100.4,4824.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3456,3238.51,3990,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1010.35,1010.35,1010.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],3934,3934,3934,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],1967.82,1509.02,2941.37,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2585.18,1770.84,3698.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Type A ED Visits,5025,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2594.02,2594.02,2594.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4774,4774,4774,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3644.62,3644.62,3644.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Critical Care,5041,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",568.47,568.47,3478.11,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",633.62,633.62,633.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",951.48,950.86,1157.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",907.34,907.34,1088.81,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],597,326.7,748.01,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",868.88,868.88,10272.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",737.91,737.91,737.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",890.01,890.01,1084.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Skin Procedures,5051,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1117,523.54,3462.01,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],940.25,940.25,940.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1209.02,783.57,1950.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1431.02,1142.42,3146.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1084.25,907.34,1816.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],748,400,1591,47,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",867,635,1253.93,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1163.4,1163.4,1163.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],1040.75,1040.75,1040.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1400.52,890.01,1782.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Skin Procedures,5052,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",580.62,580.62,580.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2464,2464,2594.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1588.5,748,5602.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4038.5,4038.5,4038.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",407.69,407.69,407.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Skin Procedures,5053,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3232,2035.5,9603.28,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4848,4848,6011,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3295.89,3295.89,3295.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],4290,4290,4290,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4090,3155.29,6892.85,41,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4046,3544,10331.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4850.14,4850.14,4850.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,12228.88,12228.88,12228.88,1 through 10,percent of total billed charges,,, Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],3169.88,3169.88,3169.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,16476.92,16476.92,23168.58,1 through 10,percent of total billed charges,,, Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Skin Procedures,5054,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4709.29,3581,11520.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",8693.79,8693.79,8693.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],5565,5565,5565,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],7410.94,5364.9,12848.53,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",10572,8161.78,11344,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,13356.91,13356.91,13356.91,1 through 10,percent of total billed charges,,, Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Skin Procedures,5055,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1986,927.61,3728.75,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",3668.59,1406.89,17682.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],845.66,845.66,956.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2164.3,2164.3,3338.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",907.34,907.34,2222,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2058,880.6,2343.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2364.45,1144.98,3068.5,81,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2630,834.85,3905.55,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1390.89,1390.89,1390.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4443.61,4443.61,4443.61,1 through 10,percent of total billed charges,,, Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2961.22,2416.42,3858.4,1 through 10,percent of total billed charges,,, Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Excision/ Biopsy/ Incision and Drainage,5071,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2033.96,1117,3022.5,112,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4004,1793,4848,36,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1948.17,1944.43,6983.83,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3587.34,3582.46,4179.9,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3332.57,1786.39,4362.2,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2058,2058,10410.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2738.69,2058,4141.56,425,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4043,2624.74,6173,93,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4046,2982.74,4855,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4748.03,3632.9,10935.88,20,percent of total billed charges,,, Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],3550.75,3550.75,3550.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,8064.07,4465.57,10455.04,11,percent of total billed charges,,, Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],1198,1198,1198,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3157.7,2509.05,6301.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,2017.63,2017.63,2017.63,1 through 10,percent of total billed charges,,, Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,3538.68,3538.68,3538.68,1 through 10,percent of total billed charges,,, Level 2 Excision/ Biopsy/ Incision and Drainage,5072,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2459.07,2036,4848,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4847.25,1793,7272,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3434.71,3434.71,3470.77,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3050.87,3050.87,10200.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5805.94,4364.12,9575.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],3430,3430,4215,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4928.5,3694,8890,91,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5316,2630,10572,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3870.71,3870.71,3870.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,11889.01,11889.01,11889.01,1 through 10,percent of total billed charges,,, Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,13448.43,13448.43,13448.43,1 through 10,percent of total billed charges,,, Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4786.59,4786.59,4786.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Excision/ Biopsy/ Incision and Drainage,5073,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6713.58,6713.58,6713.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3332,2217.6,5827.13,44,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6332.25,3478.52,7097.43,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],4596.47,4596.47,4596.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5536.9,5536.9,5536.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7998.57,3332.57,12048.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],6451.94,5389.96,11265.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],6503.36,5241.2,11325.45,156,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",6462.55,4046,14812.12,33,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",6439.51,6433,8114.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,19127.48,17123.31,19631.23,1 through 10,percent of total billed charges,,, Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,19512.77,14214.53,27917.08,12,percent of total billed charges,,, Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,3000,3000,3000,1 through 10,percent of total billed charges,,, Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Breast/Lymphatic Surgery and Related Procedures,5091,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",5446.24,3054,28890.85,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],7826.33,7826.33,7826.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",8435,6969.85,10929.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19492.56,19492.56,19492.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",27143.18,27143.18,27143.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],9320.72,9276,10300,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],10732.18,7075.51,19375.36,124,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",11207.34,7399.27,32583.47,35,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",8529.08,7513.5,13524.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,26360.74,17523.28,44493.78,12,percent of total billed charges,,, Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,28728.84,28728.84,28728.84,1 through 10,percent of total billed charges,,, Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",26626.17,26626.17,26626.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Breast/Lymphatic Surgery and Related Procedures,5092,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",5332.2,3599.2,9264.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",11086.01,7023.67,20617.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12003.5,12003.5,15627.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7998.57,7998.57,7998.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],12272.55,12272.55,12272.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],17996.79,11879.18,38939,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",18346.15,7080.5,31919.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",24916.9,24916.9,24916.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,14394.76,14394.76,14394.76,1 through 10,percent of total billed charges,,, Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,29534.34,29534.34,29534.34,1 through 10,percent of total billed charges,,, Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Breast/Lymphatic Surgery and Related Procedures,5093,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",47518.62,6450.07,68133.6,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22120.03,22120.03,27143.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],26787.7,26787.7,26787.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],41028.86,23489.51,67529.44,45,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",50582.57,30292.07,60478.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",54549.05,54549.05,54549.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,31951.67,31951.67,31951.67,1 through 10,percent of total billed charges,,, Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,63355.04,63355.04,63355.04,1 through 10,percent of total billed charges,,, Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3947.93,3947.93,3947.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Breast/Lymphatic Surgery and Related Procedures,5094,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",10966.01,10966.01,10966.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",858.69,858.69,858.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],118,118,118,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],314.82,314.82,328.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",399,399,399,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Strapping and Cast Application,5101,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",899.85,729.46,1212.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1669.61,1669.61,1669.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],744.9,478.4,11111.77,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",6623.42,6623.42,6623.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],1298,1298,1298,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1158,1158,1158,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Musculoskeletal Procedures,5111,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2463.4,2439.32,2558.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",3111.29,3111.29,3643.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],4290,4290,4290,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1591,1195.81,3941.5,28,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5009,5009,5009,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1157.08,1157.08,1157.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],2600,2600,2600,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2605.61,2605.61,2605.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Musculoskeletal Procedures,5112,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",5799.65,3022.5,8434.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",7279,7279,8709.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3904.09,3904.09,3904.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],8745.76,8745.76,8745.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],7706,5353.64,15273.9,42,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5818,4046,63192.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",8467.8,8467.8,8467.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,17468.18,15452.35,24115.77,1 through 10,percent of total billed charges,,, Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],3469.26,3469.26,3469.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,12887.9,12887.9,21896.89,1 through 10,percent of total billed charges,,, Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13781.88,13781.88,13781.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Musculoskeletal Procedures,5113,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",8302.95,2464,24867.05,38,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",11014.03,7014,29742.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],8576.42,8574.4,8576.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17209.73,17209.73,17209.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13669.91,13669.91,13669.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],19182.29,13596.37,27708.58,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],17609.97,9276,30585.46,173,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",10251.06,4046,23130.82,35,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",13972.7,8334.71,33654.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,32441.27,20502.91,58049.19,1 through 10,percent of total billed charges,,, Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],8779.27,8779.27,8780.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,28867.41,19683.57,92219.78,1 through 10,percent of total billed charges,,, Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,22920.77,22920.77,22920.77,1 through 10,percent of total billed charges,,, Level 4 Musculoskeletal Procedures,5114,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",12351.43,7174.26,31927.8,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],15641.36,15567.18,15697.93,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",16427.18,12467.34,28747.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],17891.43,15723.78,19790.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],18885.96,15493.03,24998.5,131,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",30470.42,24587.72,36595.66,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",28990.76,28990.76,29887.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,38698.35,38698.35,38698.35,1 through 10,percent of total billed charges,,, Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,30647.93,30647.93,30647.93,1 through 10,percent of total billed charges,,, Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],15741.55,14612.28,15851.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,34096.74,28320.43,39357.62,20,percent of total billed charges,,, Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19412.43,19412.43,19412.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,32203.76,32203.76,34481.82,1 through 10,percent of total billed charges,,, Level 5 Musculoskeletal Procedures,5115,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",6142.16,6142.16,6142.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",21744.32,21744.32,21744.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],23150.21,13652.6,33339.31,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",33678.97,33678.97,33678.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",14284.35,14284.35,14284.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Musculoskeletal Procedures,5116,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],823,823,823,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",683.88,683.88,683.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Airway Endoscopy,5151,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1183,1183,1183,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Airway Endoscopy,5152,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1817.84,1817.84,1832.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4848,4848,4848,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],2069.51,2069.51,2069.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],6123.33,6123.33,6123.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3352.4,818,3944,39,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5307.24,5307.24,5888.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3544,3544,3544,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,6453.25,6453.25,6453.25,1 through 10,percent of total billed charges,,, Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],1729.52,1729.52,1729.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Airway Endoscopy,5153,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3054,3047.09,4072,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6902.5,6006,7999.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],6765.88,4058.14,8493.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],6417,3636,8828,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],5836.64,472,10150,72,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",12344,10572,15002,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",14812.5,14812.5,14812.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,8951.78,8951.78,8951.78,1 through 10,percent of total billed charges,,, Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],8390.26,4469.99,8391.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,27836.66,27836.66,27836.66,1 through 10,percent of total billed charges,,, Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9223.5,9223.5,9223.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,4348.69,4348.69,4348.69,1 through 10,percent of total billed charges,,, Level 4 Airway Endoscopy,5154,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],18833.27,16648.5,21755.85,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",14511.79,14511.79,14511.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,22802.86,22802.86,22802.86,1 through 10,percent of total billed charges,,, Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Airway Endoscopy,5155,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4028.47,4028.47,4028.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],467.3,467.3,467.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 ENT Procedures,5161,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",375.63,375.63,375.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 ENT Procedures,5162,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",10022.61,10022.61,10022.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3944,3936.11,5323.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 ENT Procedures,5163,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4990,1828.13,6007.99,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",7324.5,7324.5,7511.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3908.99,3908.99,3908.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],4290,4140,9218.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],8038.5,3990,11141.39,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5433.46,5009,11299.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",5009,5009,11825.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,11026.28,11026.28,11026.28,1 through 10,percent of total billed charges,,, Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 ENT Procedures,5164,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",6582.41,5419.5,7249,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],7103.05,7103.05,7103.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12935.2,12935.2,12935.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],12374.14,5271.12,19069.16,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",16476,13962.5,23314.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,21269.27,21269.27,21269.27,1 through 10,percent of total billed charges,,, Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 ENT Procedures,5165,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1117,21.78,1444.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1144.12,1144.12,1144.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],741.97,741.97,745.71,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1963,1963,1963,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2450.71,2450.71,2450.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2368,2058,2827.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2118,1958,2368,27,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2627.37,1715.35,4559.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3156,3156,3156,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4904.83,4904.83,4904.83,1 through 10,percent of total billed charges,,, Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,783.3,783.3,783.3,1 through 10,percent of total billed charges,,, Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2358.95,2358.95,2358.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Vascular Procedures,5181,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1117,753.11,2651.88,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1789.41,1395.11,2130.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1864.26,1864.26,1864.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2021.16,2021.16,2021.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1791.36,1791.36,3749.81,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2058,2058,2058,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2368,1958,2521.9,60,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2630,2530,3934.82,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3474.72,3474.72,3474.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,2497.06,2497.06,3093.05,1 through 10,percent of total billed charges,,, Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2889.54,1021.46,3332.38,1 through 10,percent of total billed charges,,, Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1757.17,1757.17,1757.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Vascular Procedures,5182,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2451.28,1284.46,2464,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4848,3435.01,6961.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3777.27,3377.98,3784.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6177.4,6172.22,6540.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5212.45,5212.45,5212.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],5901,5901,5901,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],6878.1,5901,7167.84,73,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4046,4043,13572.02,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4855,4046,4855,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,16991.9,16991.9,29476.13,1 through 10,percent of total billed charges,,, Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],3500,3500,3500,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,14880.46,14880.46,14880.46,1 through 10,percent of total billed charges,,, Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],3524.2,3524.2,3524.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5113.16,5113.16,5113.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Vascular Procedures,5183,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2464,2464,2464,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10614.8,10614.8,10614.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1430.33,1430.33,7583,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5009,5009,5009,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Vascular Procedures,5184,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15643.48,15643.48,15643.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Endovascular Procedures,5192,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",31024.45,31024.45,31024.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",32288.04,32288.04,32288.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],17607.96,5669.74,21501.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",22820,22820,22820,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",17730,17730,17730,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Endovascular Procedures,5193,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],21581.05,21581.05,21581.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Endovascular Procedures,5194,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],13194.4,13194.4,13194.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18834.44,18834.44,18834.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pacemaker and Similar Procedures,5222,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",11072.58,11072.58,11072.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pacemaker and Similar Procedures,5223,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3436.23,1820.51,5338.59,72,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",2909.54,2081.43,5920.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],828.64,785.36,895.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1125.35,1125.35,3490.54,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2430,1712.99,8049.16,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1445.78,822.87,2453.4,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2045.02,905.12,6164,145,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2076,1059.85,4154.93,76,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3680.51,2397.04,5023.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4911.75,2583.29,6379.04,1 through 10,percent of total billed charges,,, Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2174.9,2174.9,2174.9,1 through 10,percent of total billed charges,,, Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],4034,4034,4034,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2282.01,1680.23,4428.38,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Blood Product Exchange and Related Services,5241,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",6334.34,6334.34,107717.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4290,4290,4290,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Blood Product Exchange and Related Services,5242,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2035.6,1116.5,3054,83,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4004,2886.6,6006,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1125.16,844.71,1672.23,15,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3934.29,3304.85,5166.09,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2437.77,2422.47,2891.67,33,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2053,1808,2058,35,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2364.45,1910.92,3433.6,469,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3518.03,2595,3849.22,113,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4235.07,3156,4272.48,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,6265.89,6265.89,6265.89,1 through 10,percent of total billed charges,,, Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4411.86,2901.25,12681.67,23,percent of total billed charges,,, Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1138.29,1138.29,1690.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,5099.02,3912.51,7556.23,27,percent of total billed charges,,, Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],5963.79,5963.79,5963.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],2631.09,2631.09,2631.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2391.35,1752.4,4668.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,5308.03,5308.03,5316,1 through 10,percent of total billed charges,,, Level 1 Upper GI Procedures,5301,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4330.26,4330.26,4330.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2518.21,1832.4,4580.5,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],2276.68,2276.56,2286.15,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",5993.99,3979.02,6838.26,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4308.69,4308.69,4471.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2437.77,2437.77,4596.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],3180,2058,4459,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3552,2355.8,5647.9,196,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4242.37,3315.05,6938,58,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4253.01,3012.4,9107.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,7103.5,5275.44,11062.73,1 through 10,percent of total billed charges,,, Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],2301.96,2301.96,2301.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,7496.59,4032.63,9293.92,1 through 10,percent of total billed charges,,, Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2731.85,2731.85,2731.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,5832.72,5832.72,5832.72,1 through 10,percent of total billed charges,,, Level 2 Upper GI Procedures,5302,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5939.38,5939.38,5939.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4050,3696,4796.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6846.5,6846.5,8832.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6534.66,6534.66,10926.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],8479.5,6161.19,14196.79,23,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",10083.28,7368.17,10155.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,9790.58,9790.58,9790.58,1 through 10,percent of total billed charges,,, Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],4618.25,4618.25,4618.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,10226.26,10226.26,10226.26,1 through 10,percent of total billed charges,,, Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Upper GI Procedures,5303,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2036,1936,2036,77,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4004,2422.47,4004,44,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1094.13,1094.13,1414.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3364.81,3290.05,3742.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2422.47,2422.47,4053.69,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2058,1658,2368,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2368,2058,2368.01,326,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3544,2628.21,3544,82,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4253,3544,16090,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,3952.79,3952.79,3952.79,1 through 10,percent of total billed charges,,, Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,3769.36,3140.9,6085.12,12,percent of total billed charges,,, Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1104.66,977.89,1690.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,3407.93,3004,4209.84,38,percent of total billed charges,,, Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2376.3,2376.3,6253.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Lower GI Procedures,5311,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2036,2033.96,4004,124,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4004,3997.99,6006,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1414.99,1250.6,2568.52,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3323.37,3290.05,4670.37,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2422.47,2422.47,3633.7,31,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2058,2055.5,3087,25,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2368,2058,3552,615,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3544,3533.37,5316,130,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3944.55,3541.5,5316,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,6685.82,6685.82,6685.82,1 through 10,percent of total billed charges,,, Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,4782.28,4782.28,4782.28,1 through 10,percent of total billed charges,,, Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4926.3,3897.5,6459.61,24,percent of total billed charges,,, Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1428.6,1428.6,1997.75,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,4647.3,3374.08,6539.78,46,percent of total billed charges,,, Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2376.3,2376.3,2376.3,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,3466.3,3466.3,5316,1 through 10,percent of total billed charges,,, Level 2 Lower GI Procedures,5312,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1130.26,1130.26,1130.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2188.93,2011,4072,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3291.1,3291.1,3291.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4439.81,1793,6011,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5581.32,5581.32,5581.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],6301,6301,6301,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4931,4102.4,7235.2,52,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5008,3944.85,11189.92,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],3328.16,3328.16,3328.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,8995.48,7597.37,15393.2,1 through 10,percent of total billed charges,,, Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6301.97,6301.97,6301.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,5009,5009,5009,1 through 10,percent of total billed charges,,, Level 3 Lower GI Procedures,5313,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4928,3482,12604.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",12578.92,12578.92,12578.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15261.46,15261.46,15261.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16390.37,16390.37,16390.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],11977.25,11977.25,11977.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],13451.76,9873.99,16519.31,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",13877.89,9514.83,19902.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",13468.26,13468.26,13468.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,34168.67,34168.67,34168.67,1 through 10,percent of total billed charges,,, Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9765.83,9765.83,9765.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex GI Procedures,5331,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2461.54,1117,4568.99,15,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",5982.09,5982.09,5982.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],4238.93,4238.93,4239.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7534.38,7534.38,7534.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],6701,6701,6701,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],7348,2604,10196.06,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",8623.79,3543.51,21144,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",12685.8,12685.8,12685.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,30568.7,30568.7,30568.7,1 through 10,percent of total billed charges,,, Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],7233.99,7233.99,7233.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Abdominal/Peritoneal/Biliary and Related Procedures,5341,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3664.8,3664.8,3664.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6011,6011,6011,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],7709.21,7709.21,7709.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18718.48,18718.48,18718.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],4052.1,4052.1,4052.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],7809.51,7412.79,12938.61,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",15296,15296,15296,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Abdominal/Peritoneal/Biliary and Related Procedures,5342,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3004,1711.19,5721.27,105,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",5715.55,3688.36,10824.99,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],7001.74,7001.74,7016.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14012.72,13170.61,15918.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9524.94,8822.83,11468.42,15,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],7883,2696.62,10322.88,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],10233.69,2722,14708.72,505,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",9894.38,5000.4,16361.93,129,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",9186.3,5009,18280.6,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,19712.46,15753.96,22323.88,1 through 10,percent of total billed charges,,, Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],7072.88,7072.88,7072.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,16462.83,10850.55,23611.62,1 through 10,percent of total billed charges,,, Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],4084,4084,4084,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10886.67,10566.47,13606.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,13415.99,13415.99,17478.91,1 through 10,percent of total billed charges,,, Level 1 Laparoscopy and Related Services,5361,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3495.44,1765.45,10688.35,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",5846,3510.02,9492.86,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],12509.23,12494.37,12542.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15986.16,14201.26,18773.8,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],15193.17,14262.5,20070,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],16805.71,14010.97,24100.8,209,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",14767,10559.97,25182.23,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",25982.36,25713.11,29236.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,26265.7,10856.25,39197.22,13,percent of total billed charges,,, Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],12462.66,12462.66,12617.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,27156.39,25173.5,33659.49,1 through 10,percent of total billed charges,,, Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],27398.37,27398.37,27398.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18416.12,18416.12,18416.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Laparoscopy and Related Services,5362,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],635.8,329.34,746.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",867,867,867,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,3464.44,3464.44,3464.44,1 through 10,percent of total billed charges,,, Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],192.97,192.97,192.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Urology and Related Services,5371,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1947.64,1782.03,2046.92,68,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1793,1793,1911.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],801.02,801.02,801.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1140.79,1140.79,1140.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",970.65,970.65,970.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],846.76,412,873.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],947,788.35,973.2,165,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2630,1652.92,2630,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",2630,2630,2630,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,2238.08,2238.08,2238.08,1 through 10,percent of total billed charges,,, Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],811.93,811.93,811.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Urology and Related Services,5372,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2032.5,1563.88,2036,30,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4000,3273.54,4004,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],2460.9,2458.39,2463.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6234.09,6234.09,6234.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4952.71,4163.16,6981.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1432,412,4287,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3938.08,3087,4290,140,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3544,2835.2,3544,30,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3627.4,3538.68,5891,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],2485.23,2485.23,2485.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,14031.88,12536.05,27058.84,1 through 10,percent of total billed charges,,, Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4153.45,4153.45,4153.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,3538.68,3538.68,3544,1 through 10,percent of total billed charges,,, Level 3 Urology and Related Services,5373,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2546.39,2006.38,7225.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4848,4848,4848,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],4148.94,4148.94,4148.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7033.69,7033.69,7033.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6110.69,6110.69,6110.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],4286,4286,4286,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],6154.75,4931,7733.21,47,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4252.79,3529.92,15272.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",7418.89,7418.89,7418.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,12818.47,12818.47,12818.47,1 through 10,percent of total billed charges,,, Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],4182.06,3865.26,4185.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,27630.91,19877.34,27881.76,1 through 10,percent of total billed charges,,, Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3741.69,3741.69,3741.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,13920.83,13920.83,13920.83,1 through 10,percent of total billed charges,,, Level 4 Urology and Related Services,5374,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3050.95,2469.03,4793.06,27,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6011,6005.69,9007.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],6105.02,6100.78,6112.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16212.05,14176.13,16227.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10167.84,10167.84,15251.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],8062.12,3903.21,10919.08,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],8499.92,3430,10899.72,146,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",12689.66,10569.5,15858,37,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",10572,6881.62,54247.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,18799.75,18799.75,18799.75,1 through 10,percent of total billed charges,,, Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,16658.79,12028.89,20187.64,13,percent of total billed charges,,, Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],4927.87,4927.87,4927.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10920.22,10920.22,10920.22,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,14721.02,14721.02,14721.02,1 through 10,percent of total billed charges,,, Level 5 Urology and Related Services,5375,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],19923.66,15844.19,24039.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",26162.5,26162.5,26162.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Urology and Related Services,5376,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3620.9,3620.9,3620.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1591,1591,1591,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dialysis,5401,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1519.6,1264.3,2427.42,115,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1559.88,1330.84,2491.77,48,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",502.12,502.12,1246.12,28,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",479.3,479.3,575.16,76,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],404.92,404.92,471.05,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],496.37,404.92,874.55,352,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1012.67,883.15,1362.94,82,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1215,1215,1215,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,1463.61,1329.38,2060.44,19,percent of total billed charges,,, Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,755.3,755.3,831.6,1 through 10,percent of total billed charges,,, Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",470.17,470.17,564.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,2177.17,2177.17,2177.17,1 through 10,percent of total billed charges,,, Level 1 Gynecologic Procedures,5411,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1675.5,1675.5,2033.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",863.2,863.2,863.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",458.36,458.36,458.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],464.08,464.08,464.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2358.9,947,2970,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Gynecologic Procedures,5412,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4437.59,3173,6880.71,15,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6256.96,6256.96,6256.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1050.1,1050.1,1050.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2274.54,1000.33,3486.3,51,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4000.98,3285.94,5662.83,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4916,4916,4916,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Gynecologic Procedures,5413,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2217.6,1292.2,3811.06,104,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4472.02,3392.94,5307.55,48,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],3815.71,3490.35,3815.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8120.81,8118,9144.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5753.45,4315.15,7448.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],3594.51,2540.4,5356.5,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4417.5,3320.41,5167,367,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4046,3236.81,7173.9,100,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4253,3840,7065.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,10714.58,8821.68,12449.52,11,percent of total billed charges,,, Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],3855.6,3855.6,3855.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,19123.03,19123.03,19123.03,1 through 10,percent of total billed charges,,, Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5643.78,5643.78,5643.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,4046,4039.93,5887.5,1 through 10,percent of total billed charges,,, Level 4 Gynecologic Procedures,5414,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2460.5,1891.2,5639.86,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4699.89,3980.65,6471.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13376.4,13376.4,13376.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10094.1,10094.1,10094.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],17357.13,17357.13,17357.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],7703.5,6550.1,12355.84,80,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",5489.16,4037.66,17637.3,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3720.12,3720.12,3720.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,19015.15,19015.15,22358.52,1 through 10,percent of total billed charges,,, Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,7511.02,7511.02,7511.02,1 through 10,percent of total billed charges,,, Level 5 Gynecologic Procedures,5415,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],20681.05,20681.05,20681.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],24717.07,20529.41,31190.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Gynecologic Procedures,5416,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4500,4500,4500,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4926.07,3935.84,7694.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3544,3544,3544,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Procedures,5431,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",82106.75,82106.75,86892.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11940.17,11940.17,11940.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],70248.24,44843.17,76331.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",87652.92,87652.92,87652.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Procedures,5432,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2215.48,2215.48,2215.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1012.05,1012.05,1012.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1066.91,1066.91,1066.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1081.56,601.48,2357.77,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],740.52,740.52,740.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],818.64,599.75,1432,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",885.1,885.1,885.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,1184.5,1184.5,1184.5,1 through 10,percent of total billed charges,,, Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nerve Injections,5441,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1117,1114.77,4199.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",5015.42,5015.42,5015.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],831.09,831.09,831.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3935.27,3935.27,3935.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4042.42,3703.93,4605.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2831,2831,2831,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2365.5,1432,3072,27,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2630,2630,3559.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",13916.65,13916.65,13916.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,5985.81,5985.81,6195.37,1 through 10,percent of total billed charges,,, Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],525.48,525.48,525.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,16335.64,16335.64,16335.64,1 through 10,percent of total billed charges,,, Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1816.03,1816.03,1816.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nerve Injections,5442,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3068.5,3068.5,3068.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nerve Injections,5443,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9145.08,9145.08,9145.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Neurostimulator and Related Procedures,5463,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",24031.25,24031.25,24031.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],49823.25,49823.25,49823.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",47233.33,47233.33,47233.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Neurostimulator and Related Procedures,5464,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",52937.76,52937.76,52937.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],52383.49,52383.49,52383.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],54721.07,44935.04,56340.37,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,19245.87,19245.87,19245.87,1 through 10,percent of total billed charges,,, Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Neurostimulator and Related Procedures,5465,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],365.38,365.38,365.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 1 Extraocular, Repair, and Plastic Eye Procedures",5501,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4848,4848,7635,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6291.76,6291.76,6291.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4289.8,2197.61,7791.78,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4712.79,4712.79,4712.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],18678.23,18678.23,18678.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 3 Extraocular, Repair, and Plastic Eye Procedures",5503,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1232,1232,1232,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],4101.33,4101.33,4101.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],7706,5458.24,9678,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],10384.14,10384.14,10384.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Level 4 Extraocular, Repair, and Plastic Eye Procedures",5504,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",731.96,382.68,1476.14,268,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],105.67,96.55,106.75,53,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",751.37,384.5,1856.2,118,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",212.04,141.36,724.03,30,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",264.54,134.93,567.21,84,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],569.53,135.1,878.92,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],334.04,122.17,797.85,1157,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",346.95,152.57,1206.7,263,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",222.54,128.28,1206.7,40,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,500,500,500,1 through 10,percent of total billed charges,,, Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,482.92,276.8,1405.97,81,percent of total billed charges,,, Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],106.9,85.35,225.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,626.5,359.1,1643.6,81,percent of total billed charges,,, Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",132.33,132.33,426.72,27,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,558,558,558,1 through 10,percent of total billed charges,,, Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,241.83,151.19,1043.69,1 through 10,percent of total billed charges,,, Level 1 Imaging without Contrast,5521,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1083.84,508.23,2235.88,984,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1015.9,521.16,1946.01,426,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],127.62,127.62,269.48,87,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",381.21,254.14,634.41,235,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",363.9,242.6,665.3,471,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],628.52,287.76,1753.93,59,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],612.18,258.19,1217.92,3700,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",825.23,194.18,1737,856,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",706.81,446.14,2079.83,78,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,1632,1107.2,3645.6,1 through 10,percent of total billed charges,,, Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,1049.17,506.37,1857.9,215,percent of total billed charges,,, Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],129.11,100.57,260.13,28,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,794.5,326.2,1963.5,103,percent of total billed charges,,, Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],532,532,1715.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],122.71,122.71,122.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",356.86,179.62,652.55,147,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,691.22,194.18,1671.63,22,percent of total billed charges,,, Level 2 Imaging without Contrast,5522,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1637.36,924.35,3223.21,282,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1659.99,960.15,4051.61,140,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],290.67,262.33,652.38,40,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",419.84,254.14,1419.41,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",430.71,242.6,1368.45,98,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],806.09,600,3379.68,32,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1126.58,773.05,2497.85,1245,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",867,572.41,2908,268,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1144.2,691.78,3357.27,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,3080,3080,3080,1 through 10,percent of total billed charges,,, Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,2286.9,892.78,5082,74,percent of total billed charges,,, Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],293.87,234.3,864.24,15,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2695,2354.8,5660.9,33,percent of total billed charges,,, Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",732.67,362.94,2271.78,38,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,4523,4523,4523,1 through 10,percent of total billed charges,,, Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,2901.82,1104.28,2908,11,percent of total billed charges,,, Level 3 Imaging without Contrast,5523,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2797.65,1873.3,8078.66,109,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",2636.66,1873.3,5750.23,54,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],660.69,658,3291.51,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1193.2,721.9,3861.55,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1138.97,628.44,3075.6,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1126.85,751.93,2090.36,23,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1260.06,753.93,2731.02,510,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2280.1,1629.97,3347.97,142,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1892.19,110,3535.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,479.72,479.72,479.72,1 through 10,percent of total billed charges,,, Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,3016.48,2471.04,4534,25,percent of total billed charges,,, Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],665.68,664.33,1395.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,3202.5,2620.8,3525.2,17,percent of total billed charges,,, Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],4084,4084,4084,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],3246.68,3246.68,3246.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2473.25,1117.21,4028.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,3019.5,3019.5,3019.5,1 through 10,percent of total billed charges,,, Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Imaging without Contrast,5524,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3278,641.66,4057.4,156,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],522.18,213.95,525.18,67,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",3850,1857.66,4643.57,85,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",815.17,815.17,1269.03,33,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",778.11,778.11,1135.62,76,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],4355.77,369.28,5709.05,27,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],4474.03,400,5680.96,987,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1737,450,1907.64,191,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1752.87,883.85,2597.65,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,2250.56,621.47,8620.65,36,percent of total billed charges,,, Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],527.21,311.02,827.96,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2567.51,661.5,8077.91,27,percent of total billed charges,,, Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],588.27,588.27,588.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",763.32,763.32,2095.24,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,1476.45,1476.45,1679.64,1 through 10,percent of total billed charges,,, Level 1 Imaging with Contrast,5571,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2168.46,1704.8,6527.28,580,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",2539.13,1925,7023.41,249,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],429.24,407.66,1153.49,100,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1434.91,1024.69,2509.6,122,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1369.69,978.12,2288.81,259,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1589.53,599.5,6916.78,77,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3501.27,1341.93,4849.69,2652,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2908,867,2943.98,541,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",2908,1156.5,5620.23,67,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,5102.54,1005,6810.98,1 through 10,percent of total billed charges,,, Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,9238.37,9238.37,9238.37,1 through 10,percent of total billed charges,,, Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,3989.22,2895.37,7690.41,74,percent of total billed charges,,, Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],437.12,415.67,1166.33,26,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,4153.21,3413.72,8418.87,49,percent of total billed charges,,, Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],2500,2100,3429.91,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],1026.66,920.51,2450,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1270.08,959.43,2143.13,106,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,400,400,400,1 through 10,percent of total billed charges,,, Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,2471.8,985.15,2943.98,14,percent of total billed charges,,, Level 2 Imaging with Contrast,5572,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4694.22,4694.22,5465.28,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",29695.32,29695.32,29695.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",2851.48,2851.48,2851.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],950.07,950.07,950.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1441.58,1441.58,1441.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2145.19,2145.19,2145.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1971.45,412,6539.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3192.94,3192.94,3192.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",3597.57,3597.57,3597.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,3927.17,3927.17,3927.17,1 through 10,percent of total billed charges,,, Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Imaging with Contrast,5573,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1117,871.06,5623.79,55,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1791.07,1179.26,5951.84,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],482.24,482.24,1006.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",938.26,938.26,1345.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",895.61,895.61,895.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],5092.63,849.06,6395.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],913.79,722.46,6395.85,207,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1679,964,3431.87,55,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1061,973.7,2968.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,2270.45,1969.36,9387.5,1 through 10,percent of total billed charges,,, Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],389.5,389.5,745.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,9143.21,1301.33,9153.27,1 through 10,percent of total billed charges,,, Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",878.59,878.59,878.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Nuclear Medicine and Related Services,5591,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1604.04,1401.58,7036.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],647.28,645.97,2034.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1566.68,1254.6,4916.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",797.53,797.53,797.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1154.57,895.61,3573.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1355.41,666.64,2829,52,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1679,1672.34,1831.72,15,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",2016.71,2016.71,2016.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,2596.46,2596.46,2596.46,1 through 10,percent of total billed charges,,, Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],521.74,521.74,1930.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2756.57,2756.57,2851.12,1 through 10,percent of total billed charges,,, Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],1336.8,1336.8,1336.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Nuclear Medicine and Related Services,5592,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1795.58,1757.06,1927.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1840.93,1840.93,1840.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1566.7,1566.7,1569.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2207.34,2207.34,2207.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1704.82,1347.02,2590.56,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2522.08,1675.5,6699.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,3979.98,1924.33,4777.58,1 through 10,percent of total billed charges,,, Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1584.99,1584.99,1584.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,5660.42,5660.42,5817.23,1 through 10,percent of total billed charges,,, Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2165.3,2165.3,2165.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Nuclear Medicine and Related Services,5593,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3930.61,3222.55,4884.54,57,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1750.44,1456.44,5138.67,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4501,17.42,4913.81,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3547.04,3547.04,3547.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3385.82,3385.82,3774.88,26,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2794.06,2671.67,2980.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3904.47,2954.3,10850.41,282,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2917.92,2826.3,4921.77,54,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",2973.47,2973.47,2973.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,6168.12,6141.68,17340.48,1 through 10,percent of total billed charges,,, Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1769.76,1595.76,7741.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,10067.15,6513.91,18409.83,18,percent of total billed charges,,, Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],7348,7348,7348,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3321.28,3321.28,3702.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Nuclear Medicine and Related Services,5594,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",29170.68,29170.68,48249.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",8963.46,8963.46,8963.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],22981.95,22981.95,22981.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",43670.92,43670.92,43670.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],30515,694.56,85042.17,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",17542.85,1018.25,21654.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",26367.27,26367.27,26367.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,46956,46956,80161.2,1 through 10,percent of total billed charges,,, Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7774.59,7774.59,7774.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Therapeutic Radiation Treatment Preparation,5611,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15650.52,15650.52,15650.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",3663.87,1518.28,14704.06,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",5010.36,1699.16,32428.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],439.31,439.31,5365.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1037.75,1037.75,1037.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",517.6,517.6,1215.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],648.99,648.99,648.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1256.98,632.08,4463.94,115,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2968.27,1484.13,12364.26,23,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",4294.8,3029.55,57227.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,5610.92,5610.92,5610.92,1 through 10,percent of total billed charges,,, Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],552.22,552.22,552.22,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,1877.02,1705.9,5187.7,1 through 10,percent of total billed charges,,, Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],4416.72,4416.72,6033.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2024.3,2024.3,2024.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Therapeutic Radiation Treatment Preparation,5612,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1998.6,1998.6,2199.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",13151.8,10506.67,20142.78,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",13606.14,11747.37,15063.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],2579.01,1642.03,55284.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3299.01,3141.62,3819.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3946.36,3857.4,5953.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],8261.61,5356.96,12900.19,128,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",12412.03,10404.16,18007.47,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",16979.98,11270.61,20468.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,14323.98,14054.7,22397.1,1 through 10,percent of total billed charges,,, Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,13161.4,11362.4,17792.8,1 through 10,percent of total billed charges,,, Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],10591.78,10591.78,10591.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6494.4,6494.4,6494.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,10999.17,10999.17,10999.17,1 through 10,percent of total billed charges,,, Level 3 Therapeutic Radiation Treatment Preparation,5613,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7639.94,6494.4,9625.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",20809.22,8169.7,26708.93,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",8678.74,1946.02,25933.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1769.8,1769.8,1769.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3624.39,3624.39,3624.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],6961.33,1065.92,17396.96,82,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",12359.66,2193.75,30211.27,30,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1342.48,1342.48,21542.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,32146.41,4073.52,32794.08,1 through 10,percent of total billed charges,,, Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],5938.03,5938.03,5938.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,32499.62,15460.7,33055.4,1 through 10,percent of total billed charges,,, Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1421.94,1421.94,10686.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Radiation Therapy,5622,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",34012.58,7092.83,53885.78,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",44550.21,22074.7,51890.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],11585.51,5175.82,14526.8,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6346.25,1606.96,26593.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8653.68,6675.3,25095,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],47932.53,47932.53,47932.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],27221.19,4740.49,59756.97,196,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",15435.71,2036.5,48420.37,41,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",24761.88,9121.6,33725.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,8928.48,8928.48,19817.78,1 through 10,percent of total billed charges,,, Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,27474.88,22477,52029.6,1 through 10,percent of total billed charges,,, Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],34613.82,5827.84,44786.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4526.72,4526.72,4526.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Radiation Therapy,5623,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2778.16,2760.12,42030.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",14515.74,14515.74,14515.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],2845.42,2845.42,2845.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],16033.15,16033.15,16033.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],15530.34,10549.73,20539.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",7431.63,7431.63,14806.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,8847.1,8847.1,8847.1,1 through 10,percent of total billed charges,,, Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4813.36,4813.36,4813.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Radiation Therapy,5624,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",22544.84,4956.7,94192.44,25,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",56800.05,8485.28,77762.49,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],24969.67,10875.14,26181.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",33500.31,28120.07,46753.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",84384.6,39257.08,84558.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],56045.9,24257.76,82870.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],42403.55,5208.3,96979.66,271,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",44157.37,4703.99,97432.69,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",57728,6495.62,90928.5,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,84157.99,69638.66,120869.76,1 through 10,percent of total billed charges,,, Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],28300.53,28300.53,29255.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,40880,5110,106881.6,18,percent of total billed charges,,, Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",43639.7,21359.5,90980.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 5 Radiation Therapy,5625,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",33360.47,2993,60391.1,21,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",70290.78,70290.78,71356.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",50985.32,48320.82,73479.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],9598.75,9598.75,9598.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17779.03,17779.03,17779.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],55468.04,55468.04,55468.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],23676.59,7205.71,41621.24,47,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",55730.61,55730.61,55730.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,45859.44,45859.44,45859.44,1 through 10,percent of total billed charges,,, Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,74170.6,74170.6,74170.6,1 through 10,percent of total billed charges,,, Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,1568.97,1568.97,1568.97,1 through 10,percent of total billed charges,,, Level 6 Radiation Therapy,5626,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22946.88,22946.88,22946.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",39056.39,39056.39,39056.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,45802.74,45802.74,45802.74,1 through 10,percent of total billed charges,,, Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 7 Radiation Therapy,5627,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],51876.99,51876.99,53369.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,93175.6,93175.6,102325.49,1 through 10,percent of total billed charges,,, Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapeutic Nuclear Medicine,5661,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2463,2036,3686.76,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",4842.5,3385.47,26342.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],960.65,960.65,960.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15791.76,15791.76,15791.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2422.47,2422.47,2422.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],4110.3,4110.3,4110.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],3430,99.88,18414.98,45,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",8653.27,3872.19,19611.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",6177.67,6177.67,6177.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,5218.13,4888.52,6258.16,1 through 10,percent of total billed charges,,, Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,791,791,791,1 through 10,percent of total billed charges,,, Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2376.3,2376.3,2376.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Pathology,5671,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1434.4,1183.88,3409,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",57683.45,57683.45,57683.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],205.85,205.85,2016.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",334.11,215.32,5753.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],3383.47,3383.47,3383.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],947,196.47,9988.24,48,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",943.96,253.7,18775,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,6509.49,4498.64,37506.17,1 through 10,percent of total billed charges,,, Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Pathology,5672,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1804.56,1226.28,9755,39,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1875.74,1476.41,3797.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],431.69,431.69,830.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2270.34,868.41,3698.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1461.93,774.16,21785.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1458.45,1134.58,31049.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1319.65,467.13,15646.15,87,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1634.16,99,12772,25,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",5183.38,5183.38,5183.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,24863.03,24863.03,35338.84,1 through 10,percent of total billed charges,,, Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],435.85,435.85,435.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],14229.65,14229.65,14229.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5643.78,5643.78,5643.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Pathology,5673,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],6136.25,6136.25,6136.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",19812,19812,19812,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Pathology,5674,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1479.6,1043.49,2415.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1680.74,1386.26,4322.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],373.6,373.6,373.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2147.74,1844.49,2375.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3592.8,3592.8,3592.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1441,1065.64,15819.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1609.89,1031.29,16167.22,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2015.55,1168.88,21489.21,15,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",12105.31,12105.31,12105.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,4037.69,4037.69,4037.69,1 through 10,percent of total billed charges,,, Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,2332.19,1532.54,20109.98,1 through 10,percent of total billed charges,,, Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],4034,4034,4084,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],5624.85,5624.85,5624.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2108.32,440.95,2182.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,11882.07,11069.6,12161.13,14,percent of total billed charges,,, Level 1 Drug Administration,5691,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",2345.08,204.47,20555.97,255,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",2315.59,204.47,6514.15,126,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],639.73,74.66,9807.11,91,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11060.44,1067.89,11140.63,26,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2446.62,143.34,10634.25,51,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],6271.03,373.76,14748.61,30,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1230.91,482.53,12493.62,1165,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1492.05,455.95,6441.03,337,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1218.46,716.92,1451.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,558.06,160.23,6729.04,26,percent of total billed charges,,, Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,3570.06,868.28,12180.87,23,percent of total billed charges,,, Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],620.6,452.81,1207.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],26726.56,26726.56,26726.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10356.62,427.8,10778.34,58,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,2983.36,2983.36,3029.26,1 through 10,percent of total billed charges,,, Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,1015.39,638.61,1112.79,12,percent of total billed charges,,, Level 2 Drug Administration,5692,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1534.12,353.51,18312.26,265,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1301.73,355.72,2684.66,83,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],364.87,252.84,12502.26,84,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1247.12,178.71,1702.02,61,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1190.43,125.27,1849.7,130,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],509.51,357.15,831.41,65,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],780.85,390.59,6397.65,1083,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",850.42,281.59,12329.38,226,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",862.53,739.89,1125.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,5740.05,801.89,8552.69,1 through 10,percent of total billed charges,,, Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,1902.39,336.5,13613.59,31,percent of total billed charges,,, Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,1602.17,909.66,28203.72,21,percent of total billed charges,,, Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],255.79,204.21,825.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],1248,1048,1348,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],766.32,766.32,926.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",728.03,129.01,1929.27,44,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,869.9,869.9,869.9,1 through 10,percent of total billed charges,,, Level 3 Drug Administration,5693,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",308.73,308.73,308.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",8657.36,1429.73,30797.7,459,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",5832.68,1836,32487.6,223,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1679.29,630.63,15796.13,194,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",3389.07,1303.36,15867.3,106,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12871.3,688.13,19500.91,282,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],5125.65,1064.51,20562.05,191,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],5332.2,1200.16,24135.99,2483,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",4664.69,1401.34,26980.39,772,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",6498.92,2707.21,28317.1,52,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,7864.08,3916.48,16593.5,1 through 10,percent of total billed charges,,, Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,12408.3,2220.42,30208.35,101,percent of total billed charges,,, Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1892.97,616.01,22323.28,60,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,14254.71,5025.24,36026.21,70,percent of total billed charges,,, Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1869.7,674.96,10069.98,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,36255.2,36255.2,36255.2,1 through 10,percent of total billed charges,,, Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,7317.9,2082.51,45778.68,11,percent of total billed charges,,, Level 4 Drug Administration,5694,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1339.16,830.61,1369.09,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1333.52,892.2,19641.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",389.54,389.54,389.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",371.83,371.83,695.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],368.96,349.16,16973.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],402.32,362.72,14146.77,93,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",510.95,505.95,10297.04,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",678.91,678.91,678.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,553.19,498.37,553.74,1 through 10,percent of total billed charges,,, Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],151.65,151.65,151.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,587.3,587.3,1174.6,1 through 10,percent of total billed charges,,, Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,507.68,507.68,507.68,1 through 10,percent of total billed charges,,, Level 1 Diagnostic Tests and Related Services,5721,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",499.38,449.86,551.35,110,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",576.63,565.96,576.63,34,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",946.65,946.65,946.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1167.86,1167.86,1167.86,35,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],391.24,375.48,411.24,296,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",538.2,494.51,844.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,3089.61,3089.61,3089.61,1 through 10,percent of total billed charges,,, Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],378.07,378.07,378.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,530.4,530.4,1060.8,35,percent of total billed charges,,, Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],539.28,539.28,539.28,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Diagnostic Tests and Related Services,5722,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1570.53,1421.09,1570.53,95,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],637.21,592.66,1263.12,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1612.01,1570.53,1612.16,33,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",325.72,325.72,325.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1167.86,1167.86,1167.86,55,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],1651.49,1651.49,1651.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],1823.43,1607.65,1858.07,396,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1009,1007.49,1500.44,53,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1867.91,1862.81,1867.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],643.69,603.69,643.69,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Diagnostic Tests and Related Services,5723,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1338.91,1207.8,1340,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",1340,1338.66,1340,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1220.96,1220.96,1220.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1949.64,1949.64,1949.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1861.03,1861.03,1861.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2097.6,1267.93,2297.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2619.21,2099.57,2863.01,70,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3781.28,3762.03,4477.52,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4093.84,4093.84,4594.94,1 through 10,percent of total billed charges,,, Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,4878.3,4878.3,4878.3,1 through 10,percent of total billed charges,,, Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],1235.21,1235.21,1235.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1825.58,1825.58,1825.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,3775.61,3775.61,3775.61,1 through 10,percent of total billed charges,,, Level 4 Diagnostic Tests and Related Services,5724,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],9266.72,3936.11,102607.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 1 Minor Procedures,5731,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2212.11,2212.11,2212.11,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 2 Minor Procedures,5732,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",482.79,186.36,935.46,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",195.05,185.98,836.96,39,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],71.79,71.39,2994.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",131.24,131.24,231.54,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",125.27,125.27,832.54,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],151.26,117.42,568.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],135.07,105.01,236.17,254,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",208.02,167.48,418.94,79,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",314.19,193.05,386.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,220,220,220,1 through 10,percent of total billed charges,,, Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,214.08,181.5,742.16,12,percent of total billed charges,,, Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],72.11,72.11,72.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,658.7,192.5,1708.7,1 through 10,percent of total billed charges,,, Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,801.9,801.9,1113,1 through 10,percent of total billed charges,,, Level 3 Minor Procedures,5733,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",665.11,391.37,1721.54,302,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],154.69,135.57,156.27,47,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",646.81,425.2,1776.21,107,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",230.96,62.95,645.94,53,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",227.29,185.1,312.8,54,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],178.59,101.63,673.51,38,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],225.07,106.25,947,1455,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",125.99,66.96,900.04,447,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",139.13,83.32,1088.96,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,902.7,902.7,902.7,1 through 10,percent of total billed charges,,, Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,834.24,461.79,2147.37,39,percent of total billed charges,,, Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],156.18,13.1,156.18,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,702.1,344.4,2082.5,19,percent of total billed charges,,, Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],721.06,721.06,721.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",199.43,6.08,356.86,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,794.7,794.7,794.7,1 through 10,percent of total billed charges,,, Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,194.29,155.91,256.1,1 through 10,percent of total billed charges,,, Level 4 Minor Procedures,5734,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",877.81,877.81,877.81,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1531.98,1531.98,1531.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1946.32,1946.32,1946.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2831,2785.99,4659.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],697.36,697.36,697.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Resuscitation and Cardioversion,5781,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",6011,6011,6011,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1260.32,1260.32,1260.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,15882.57,15882.57,15882.57,1 through 10,percent of total billed charges,,, Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Treatment,5791,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",6935.91,6935.91,6935.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventilation Initiation and Management,5801,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",356.48,322.88,926.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],14633.41,14633.41,14633.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],458.47,369.38,15119.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",315,315,1512.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Covid-19 Vaccine Administration,9398,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2259.58,2259.58,2259.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukocytes reduced,9512,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",5357.87,5357.87,5357.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2552.39,2552.39,2552.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2035.91,1146.09,9470.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",1874.42,1874.42,1874.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",2107.89,2107.89,2107.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. RBC leukoreduced irradiated,9522,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",2310.54,2310.54,2310.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Plate pheres leukoredu irrad,9530,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",4376.77,2915.56,6157.66,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],1721.76,1721.76,1721.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",6203.35,6203.35,6203.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1104.4,1104.4,1104.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4528.67,4528.67,4528.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],2215.83,1927.07,4061.53,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],2960.62,1910.26,4153.77,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",3492.21,2226,6165.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Platelets pheresis path redu,9536,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",9741.61,8475.52,20010.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",216,174.96,2539.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",395.48,345.44,493.09,73,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",422.78,329.74,511.68,92,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],97.5,48,106.13,119,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],106.7,85.6,107,2530,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",110,108.9,110,638,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",110,109.25,110,50,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,98.6,98.6,98.6,1 through 10,percent of total billed charges,,, Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,133.6,133.6,133.6,1 through 10,percent of total billed charges,,, Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,110.22,109.3,121.44,62,percent of total billed charges,,, Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],156.14,156.14,156.14,31,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,116.9,116.52,128.8,72,percent of total billed charges,,, Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],103.24,99.08,103.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],148.71,118.95,148.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",425.05,323.52,461.64,34,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,107.46,107.46,142,1 through 10,percent of total billed charges,,, Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,110,109.75,110,25,percent of total billed charges,,, Non-OPPS Clinic Services,N700,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",88.56,88.56,88.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",561.21,174.1,1397.51,799,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",567.03,153.34,1438.13,403,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],39.6,13.99,102.53,221,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",54.92,26.91,213.55,118,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",364.4,329.74,1369.69,18,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],128.22,28.09,334.28,98,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],151.02,45.43,491.86,3991,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",110,34.72,501.94,862,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",114.84,50.45,800.58,99,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,23008.11,23008.11,23008.11,1 through 10,percent of total billed charges,,, Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,3982.1,3160.5,4194.1,1 through 10,percent of total billed charges,,, Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,700.33,83.08,1937.76,314,percent of total billed charges,,, Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],47.14,13.76,156.14,96,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,615.3,240.8,1988.7,155,percent of total billed charges,,, Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],608.22,387.5,16900.73,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],104.12,22.61,154.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",6.08,6.08,323.52,46,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,574.34,565.64,747.75,1 through 10,percent of total billed charges,,, Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,111.1,80.59,397.18,26,percent of total billed charges,,, Clinical Diagnostic Lab Services,N800,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",314.47,63.14,816.41,23,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",470.08,77.41,2206.07,361,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],277.77,79.94,669.28,70,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",501.64,79.46,2244.99,158,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",712.18,395.91,2474.46,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",566.87,500.68,2645.39,151,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],78.88,50.16,100.32,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],412.4,52.92,1883.52,1670,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",450,69.43,2250,285,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",540,69.43,3240,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,435.6,60.72,2233.84,194,percent of total billed charges,,, Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],144.91,61,558.98,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,636.62,119.7,2982.7,53,percent of total billed charges,,, Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1297.52,556.08,2780.4,51,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,382.5,377.62,2246.63,1 through 10,percent of total billed charges,,, Therapy Services,N801,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",466.09,413.9,715.66,548,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",469.08,456.96,734.64,277,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],137.14,137.14,150.09,73,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",178.52,178.52,178.52,39,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",170.4,170.4,170.4,82,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],402.09,319.84,518.1,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],402.09,319.84,514.21,2678,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",673,641.78,859.75,642,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",673,641.88,741,65,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,605.7,605.7,1044.9,1 through 10,percent of total billed charges,,, Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,538.4,538.4,538.4,1 through 10,percent of total billed charges,,, Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,444.18,444.18,623.74,149,percent of total billed charges,,, Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,518.7,471.1,737.8,119,percent of total billed charges,,, Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],138.47,138.47,152.15,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],652.17,437.45,653.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",167.26,167.26,167.26,26,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,284.17,284.17,284.17,1 through 10,percent of total billed charges,,, Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,673,575.25,741,13,percent of total billed charges,,, Mammography Services,N804,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",14722.08,14722.08,14722.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",408.99,408.99,408.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Durable Medical Equipment,N805,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",14447,14447,14447,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",16895.48,16895.48,16895.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",1532.89,1532.89,1532.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10595.7,10595.7,10595.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],10814.03,10814.03,10814.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],12052.4,1445.59,23141.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",20642.42,20642.42,20642.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",2226,2226,2226,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Observation, Other",N811,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",177.38,177.38,19147.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",253.44,253.44,253.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],214,107,294,142,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",110,110,155.9,55,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",110,110,110,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,585.42,585.42,585.42,1 through 10,percent of total billed charges,,, Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,709.8,709.8,709.8,1 through 10,percent of total billed charges,,, Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-covered Services,N900,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",1440.95,1440.95,14261.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],7692.55,7692.55,7692.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],17124.94,388.61,36148.33,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,1423.99,1423.99,1423.99,1 through 10,percent of total billed charges,,, Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12043.52,12043.52,12043.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Packaged Services,N902,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Aetna,Hmo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1406] [Cardiac Cath (%BC): 70.5] [Observation ($): 933] [Emergency Department (%BC): 65.4] [Other Cardiac Testing (%BC): 70.5] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 70.5] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4849] [Radiology (%BC): 68.0] [Laboratory (%BC): 68.0] [Hemodialysis (%BC): 70.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.5] [Occupational Therapy (%BC): 68.0] [Physical Therapy (%BC): 68.0] [Speech Therapy (%BC): 68.0] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 68.0]",968.64,718.57,1531.83,54,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Aetna,Ppo,,,"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1679] [Cardiac Cath (%BC): 72.2] [Observation ($): 933] [Emergency Department (%BC): 68.0] [Other Cardiac Testing (%BC): 72.2] [Sleep Studies ($): 1546] [Chemotherapy (%BC): 73.9] [CT Scan OP ($): 2030] [MRI OP ($): 2639] [Positron Emission Tomography ($): 4748] [Radiology (%BC): 69.6] [Laboratory (%BC): 69.6] [Hemodialysis (%BC): 72.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 72.2] [Occupational Therapy (%BC): 69.6] [Physical Therapy (%BC): 69.6] [Speech Therapy (%BC): 69.6] [OP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [Other Outpatient Implant ($): 0 Charge Threshold 1999.99 (%BC): 73] [All Other OP (%BC): 69.6]",994.32,921.06,1381.59,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 35],,,,0,other,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",375.21,375.21,634.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",605.58,605.58,605.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 43.3] [Observation ($): 479] [ED Level 1--99281 ($): 330] [ED Level 2--99282 ($): 623] [ED Level 3--99283 ($): 1488] [ED Level 4--99284 ($): 2941] [ED Level 5--99285 ($): 4611] [Critical Care ($): 4611] [Urgent Care ($): 102] [Clinic Visit ($): 102] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP ECT Mental Health ($): 777] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 43.3],196,196,196,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,,,[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47.4] [Observation ($): 705] [ED Level 1--99281 ($): 343] [ED Level 2--99282 ($): 777] [ED Level 3--99283 ($): 1653] [ED Level 4--99284 ($): 3192] [ED Level 5--99285 ($): 5012] [Critical Care ($): 5012] [Urgent Care ($): 111] [Clinic Visit ($): 111] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy Fee Schedule: FEE SCHEDULE] [Physical Therapy Fee Schedule: FEE SCHEDULE] [Speech Therapy Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 39] [All Other OP (%BC): 47.4],214,194.04,933.06,143,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Cigna,Hmo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 15514] [Cardiac Cath (%BC): 58.5] [Hip Replacement ($): 24606] [Knee Replacement ($): 19538] [Laminectomy/Diskectomy ($): 6296] [Observation ($): 4200] [ED Level 1--99281 ($): 910] [ED Level 2--99282 ($): 910] [ED Level 3--99283 ($): 1217] [ED Level 4--99284 ($): 2337] [ED Level 5--99285 ($): 4190] [Critical Care-99291 ($): 7823] [Clinic Visit ($): 110] [Chemotherapy (%BC): 58.5] [Nuclear Medicine ($): 1763] [Radiation Therapy (%BC): 58.5] [CT Scan OP ($): 1824] [MRI OP ($): 3053] [Positron Emission Tomography ($): 3053] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 58.5] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 58.5] [Occupational Therapy ($): 473] [Physical Therapy ($): 473] [Respiratory Services/Therapy (%BC): 58.5] [Speech Therapy ($): 473] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 58.5]",869.65,809.65,1253.07,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Cigna,Ppo,,,"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 18617] [Cardiac Cath (%BC): 70.2] [Hip Replacement ($): 29527] [Knee Replacement ($): 23447] [Laminectomy/Diskectomy ($): 7555] [Observation ($): 5040] [ED Level 1--99281 ($): 1092] [ED Level 2--99282 ($): 1092] [ED Level 3--99283 ($): 1461] [ED Level 4--99284 ($): 2805] [ED Level 5--99285 ($): 5027] [Critical Care-99291 ($): 9387] [Clinic Visit ($): 116] [Chemotherapy (%BC): 70.2] [Nuclear Medicine ($): 2116] [Radiation Therapy (%BC): 70.2] [CT Scan OP ($): 2188] [MRI OP ($): 3665] [Positron Emission Tomography ($): 3665] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 70.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 70.2] [Occupational Therapy ($): 567] [Physical Therapy ($): 567] [Respiratory Services/Therapy (%BC): 70.2] [Speech Therapy ($): 567] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant ($): 0 Charge Threshold 4768 (%BC): 60.2] [All Other OP (%BC): 70.2]",1043.58,902.21,1590.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,First Health/Coventry,First Health Ppo,,90,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,942.48,942.48,1412.31,1 through 10,percent of total billed charges,,, Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Kaiser,All Commercial Plans,,,[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 62] [Observation (%BC): 62] [ED Level 1--99281 ($): 632] [ED Level 2--99282 ($): 1348] [ED Level 3--99283 ($): 2600] [ED Level 4--99284 ($): 4084] [Critical Care (%BC): 100 Maximum Reimbursement 4084] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[APC ($): FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Not Recognized by OPPS,N905,APC,,,,,facility,outpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. HC CELLSEARCH CIRC TUMOR CEL,10001116097,CDM,301,RC,86152,HCPCS,facility,both,,,,1501,1501,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FOLIC ACID 82746,10001116117,CDM,300,RC,82746,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALICYLATE-UR-Q80196,10001116119,CDM,300,RC,80196,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FATTY AC FREE 82725,10001116121,CDM,300,RC,82725,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CTC TEST W I&R,10001116123,CDM,301,RC,86153,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN B-1 84425,10001116127,CDM,300,RC,84425,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-DEOXY-NASE 86225,10001116135,CDM,300,RC,86225,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PSA (PROST SPEC ANTIG) SC,10001116145,CDM,300,RC,,,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PSA (PROST SPEC ANTIG) SC,10001116181,CDM,301,RC,,,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCULT BLD FECAL SCREENIN,10001116185,CDM,301,RC,,,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALICYLATE-UR-Q80196,10001116193,CDM,300,RC,80196,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUCOPROTEIN-BLD,10001116195,CDM,300,RC,83872,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FATTY AC FREE 82725,10001116199,CDM,300,RC,82725,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUCOPROTEIN-UR,10001116207,CDM,300,RC,83872,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOGLOB-IGD 82784,10001116217,CDM,300,RC,82784,HCPCS,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIBODY TITRATION,10001116223,CDM,300,RC,86886,HCPCS,facility,both,,,,708,708,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF RBC MOLECULAR PHENO T,10001116225,CDM,300,RC,86901,HCPCS,facility,both,,,,296,296,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTIBODY TITER,10001116227,CDM,300,RC,86886,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIRECTED BLOOD DONOR COLL,10001116229,CDM,300,RC,86890,HCPCS,facility,both,,,,351,351,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTIGEN SCR RGT COMPAT UN,10001116231,CDM,300,RC,86902,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTIGEN SCR PT SERUM COMP,10001116233,CDM,300,RC,86904,HCPCS,facility,both,,,,121,121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THAWING PLASMA,10001116235,CDM,300,RC,86927,HCPCS,facility,both,,,,91,91,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THAWING CRYOPRECIPITATE,10001116237,CDM,300,RC,86927,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREFIX RBCS INC W/CHEM/DR,10001116239,CDM,300,RC,86970,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREFIX RBCS DENSITY GRAD,10001116241,CDM,300,RC,86972,HCPCS,facility,both,,,,307,307,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ATYPICAL AB 86870,10001116243,CDM,300,RC,86870,HCPCS,facility,both,,,,438,438,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENZYME ANTIBODY IDENTIFIC,10001116245,CDM,300,RC,86870,HCPCS,facility,both,,,,438,438,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AUTOLOGOUS BLOOD COLLECT,10001116247,CDM,300,RC,86890,HCPCS,facility,both,,,,384,384,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLOOD PRODCT IRRADTN 8694,10001116249,CDM,300,RC,86945,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC ELUTION,10001116251,CDM,300,RC,86860,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIRECT COOMBS 86880,10001116253,CDM,300,RC,86880,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CROSS MATCH-SPIN 86920,10001116255,CDM,300,RC,86920,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CROSS MATCH-INCUBATION,10001116257,CDM,300,RC,86921,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CROSS MATCH-ANTIGLOBIN,10001116259,CDM,300,RC,86922,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXTENDED DONOR TESTING,10001116261,CDM,300,RC,86890,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ABO IMMUNE ANTI 86850,10001116263,CDM,300,RC,86850,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TYPING-RH SUBGR 86906,10001116265,CDM,300,RC,86906,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ABO CELL GROUP 86900,10001116269,CDM,300,RC,86900,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ABO GROUP 86900,10001116271,CDM,300,RC,86900,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TYPING,RHO ONLY 86901",10001116273,CDM,300,RC,86901,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TYPING, NOT ABO 86905",10001116275,CDM,300,RC,86905,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOTYPING-EA,10001116277,CDM,300,RC,86905,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INDIRECT COOMBS 86885,10001116279,CDM,300,RC,86885,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C-PEPTIDE 84681,10001116281,CDM,300,RC,84681,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC L.E. CELL PREP 85999,10001116283,CDM,300,RC,85999,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALDOSTERON-RIA 82088,10001116285,CDM,300,RC,82088,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP BE ANTIBODY,10001116287,CDM,300,RC,86707,HCPCS,facility,both,,,,304,304,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNOGLOBULINS(IGA,IGG,I",10001116293,CDM,300,RC,82784,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCULT BLD FECAL SCREENIN,10001116295,CDM,301,RC,,,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASPIRIN TOLER 80196,10001116297,CDM,300,RC,80196,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-DEOXY-NASE86225,10001116299,CDM,300,RC,86225,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROSTATE SAT BX,1-20 SPEC",10001116305,CDM,314,RC,,,facility,both,,,,1123,1123,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ASSAY, IG/IGD/IGG/IGM EA",10001116307,CDM,300,RC,82784,HCPCS,facility,both,,,,39,39,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENIPUNCTURE,10001116309,CDM,300,RC,36415,HCPCS,facility,both,,,,29,29,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTOPORPHYRINES QT 84202,10001116311,CDM,301,RC,84202,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN B-2 84252,10001116315,CDM,301,RC,84252,HCPCS,facility,both,,,,143,143,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BM PANEL 80048 W/ CALCIUM,10001116317,CDM,301,RC,80048,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMP PANEL 80053 W/ CO2 &,10001116319,CDM,301,RC,80053,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RENAL FUNCTION PANEL 8006,10001116321,CDM,301,RC,80069,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATIC PANEL 80076 W/ PR,10001116323,CDM,301,RC,80076,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PSA DIAGNOSTIC TOTAL,10001116325,CDM,301,RC,84153,HCPCS,facility,both,,,,91,91,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEAVY METAL QNT EACH,10001116327,CDM,301,RC,83018,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN ELECT OTHER FLUID,10001116329,CDM,301,RC,84166,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROLYTE PANEL,10001116335,CDM,301,RC,80051,HCPCS,facility,both,,,,39,39,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIPID PROFILE 80061,10001116341,CDM,301,RC,80061,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETAMINOPHINE,10001116343,CDM,301,RC,82003,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEOTIDASE - 83915,10001116345,CDM,301,RC,83915,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG SCREEN, URINE QL",10001116347,CDM,301,RC,80100,HCPCS,facility,both,,,,268,268,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URINE TESTOSTERONE TOTAL,10001116349,CDM,301,RC,84403,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROSTATE SAT BX,21-40 SPE",10001116351,CDM,314,RC,,,facility,both,,,,1764,1764,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMITRIPTYLENE 80152,10001116353,CDM,301,RC,80152,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LECITHIN-SPHING 83661,10001116355,CDM,301,RC,83661,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMINOPHYL LEVEL 80198,10001116357,CDM,301,RC,80198,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLINEST&DDIBUC 82638,10001116359,CDM,301,RC,82638,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACENTAL LACTO 83632,10001116361,CDM,301,RC,83632,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CPK ISOENZYMES82552,10001116363,CDM,301,RC,82552,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROLACTIN LEVEL 84146,10001116365,CDM,301,RC,84146,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESTROGEN RECEPT 84233,10001116367,CDM,301,RC,84233,HCPCS,facility,both,,,,715,715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCITONIN RIA 82308,10001116369,CDM,301,RC,82308,HCPCS,facility,both,,,,202,202,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALCOHOL METHYL 84600,10001116371,CDM,301,RC,84600,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIO-CONV,10001116373,CDM,301,RC,82164,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URIC ACID (URINE),10001116375,CDM,301,RC,84560,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ZINC 84630,10001116377,CDM,301,RC,84630,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARBAMAZE 80156,10001116379,CDM,301,RC,80156,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC FOLATE,10001116381,CDM,301,RC,82747,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T-4 - FREE,10001116383,CDM,301,RC,84439,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUCOSE-UR-QT,10001116385,CDM,301,RC,82945,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMIPRAMINE 80174,10001116387,CDM,301,RC,80174,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THIAMINE,10001116389,CDM,301,RC,84425,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOBRA PK 80200,10001116391,CDM,301,RC,80200,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOBRA 80200,10001116393,CDM,301,RC,80200,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THEOPHYLLINE-HP 80198,10001116395,CDM,301,RC,80198,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYOGLOBIN 83874,10001116397,CDM,301,RC,83874,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEMOGLOBIN, FETA 83030",10001116399,CDM,301,RC,83030,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLASMA HGB,10001116401,CDM,301,RC,83051,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN ELECT 84165 SERUM,10001116403,CDM,301,RC,84165,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC QUINIDINE,BLOOD 80194",10001116405,CDM,301,RC,80194,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IRON SAT % 83540,10001116407,CDM,301,RC,83540,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SODIUM, URINE 84300",10001116411,CDM,301,RC,84300,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POTASSIUM-URINE 84133,10001116413,CDM,301,RC,84133,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POTASSIUM 24 HR UR 84133,10001116415,CDM,301,RC,84133,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOS-PROSTAT-AC 84066,10001116417,CDM,301,RC,84066,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PHOSPHATASE, AL 84075",10001116419,CDM,301,RC,84075,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPORUS-UR 84105,10001116421,CDM,301,RC,84105,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PORPHOBILINOG QUAL 84106,10001116423,CDM,301,RC,84106,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PORPHOBINOG - QUANT 84110,10001116425,CDM,301,RC,84110,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OSMOLARITY-UR 83935,10001116427,CDM,301,RC,83935,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACID MUCOLYSA 83864 QT,10001116429,CDM,301,RC,83864,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNESIUM-UR83735,10001116431,CDM,301,RC,83735,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MEPROBAMATE, BLD 83805",10001116433,CDM,301,RC,83805,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEAD UR-QT 83655,10001116435,CDM,301,RC,83655,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LDH, URINE 83615",10001116437,CDM,301,RC,83615,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRXYPRLN FREE 83500,10001116439,CDM,301,RC,83500,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALPHAIFETOPROP SERUM 8210,10001116441,CDM,301,RC,82105,HCPCS,facility,both,,,,121,121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRXPRLN TOT 83505,10001116443,CDM,301,RC,83505,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CALCIUM, IONIZE 82330",10001116445,CDM,301,RC,82330,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BICARBONATE-CO2 82374,10001116447,CDM,301,RC,82374,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACIDYL,10001116449,CDM,301,RC,82690,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYANIDE 82600,10001116451,CDM,301,RC,82600,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYSTINE,QL-UR 82615",10001116453,CDM,301,RC,82615,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYSTINE,QT-UR",10001116455,CDM,301,RC,82131,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DELTA AMINO LEV82135,10001116457,CDM,301,RC,82135,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARBOXY HBG SAT 82375 QT,10001116459,CDM,301,RC,82375,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATINE-URINE-24HRS.8254,10001116461,CDM,301,RC,82540,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLINEST SERUM 82480,10001116465,CDM,301,RC,82480,HCPCS,facility,both,,,,707,707,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROGESTERONE RECEPTOR ASS,10001116467,CDM,301,RC,84234,HCPCS,facility,both,,,,784,784,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORIDES-CSF 82438,10001116469,CDM,301,RC,82438,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETONE-QL 82009,10001116471,CDM,301,RC,82009,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GG TRANSPEPTID 82977,10001116473,CDM,301,RC,82977,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUTETHIMIDE-BL 82980,10001116475,CDM,301,RC,82980,HCPCS,facility,both,,,,147,147,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROSTATE SAT BX,41-60 SPE",10001116477,CDM,314,RC,,,facility,both,,,,3046,3046,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMIKACIN PEAK/TROGH 80150,10001116479,CDM,301,RC,80150,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ICD-ISOCITRIC 83570,10001116481,CDM,301,RC,83570,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C-6-PD,10001116483,CDM,301,RC,82955,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAROTENE 82380,10001116485,CDM,301,RC,82380,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC XYLOSE TOLERANC 84620,10001116487,CDM,301,RC,84620,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATINE CLEAR 82575,10001116489,CDM,301,RC,82575,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMINO ACIDS-BLD,10001116491,CDM,301,RC,82131,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CRYOGLOBULIN,QUAL/SEMIQT",10001116493,CDM,301,RC,82595,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SGP TRANSAMINAS 84460,10001116495,CDM,301,RC,84460,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRIGLYCERIDES 84478,10001116497,CDM,301,RC,84478,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENYLALANIE 84030,10001116499,CDM,301,RC,84030,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LDH ISOZYMES 83625,10001116501,CDM,301,RC,83625,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CERULOPLASMIN,Q82390",10001116505,CDM,301,RC,82390,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROPHOR-HGB83020,10001116507,CDM,301,RC,83020,HCPCS,facility,both,,,,121,121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALDOLASE 82085,10001116511,CDM,301,RC,82085,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASES PCO2 82803,10001116515,CDM,301,RC,82803,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASES, PO2 82803",10001116517,CDM,301,RC,82803,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ART BLOOD GASES 82803,10001116519,CDM,301,RC,82803,HCPCS,facility,both,,,,195,195,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BILIRUBIN,DIREC82250",10001116521,CDM,301,RC,82248,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALBUMIN SERUM 82040,10001116523,CDM,301,RC,82040,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DILANTIN,QT 80185",10001116525,CDM,301,RC,80185,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OSMOLALITY-BLD 83930,10001116527,CDM,301,RC,83930,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATININE-UR OR OTHR SOU,10001116529,CDM,301,RC,82570,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HDL LIPOPROTEIN 83718,10001116531,CDM,301,RC,83718,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CK MB 82553,10001116533,CDM,301,RC,82553,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LITHIUM-BLOOD 80178,10001116535,CDM,301,RC,80178,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMYLASE-BLD 82150,10001116537,CDM,301,RC,82150,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN C 82180,10001116539,CDM,301,RC,82180,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETONE-QT 82010,10001116541,CDM,301,RC,82010,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALCOHOL-ETHYL 82055,10001116543,CDM,301,RC,82055,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BILIRUBIN,TOTA",10001116545,CDM,301,RC,82247,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METAL SCREEN 83015,10001116547,CDM,301,RC,83015,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEUCINE AMINOPE 83670,10001116549,CDM,301,RC,83670,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIDOCAINE 80176,10001116551,CDM,301,RC,80176,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LDH 83615,10001116553,CDM,301,RC,83615,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SGO TRANSAMINAS 84450,10001116555,CDM,301,RC,84450,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NORTRIPTYLINE 80182,10001116557,CDM,301,RC,80182,HCPCS,facility,both,,,,135,135,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCIUM-BLD 82310,10001116559,CDM,301,RC,82310,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORIDES-BLD 82435,10001116563,CDM,301,RC,82435,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALDOSTERONE 82088,10001116565,CDM,301,RC,82088,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHOLESTEROL,TOT 82465",10001116567,CDM,301,RC,82465,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COPPER 82525,10001116571,CDM,301,RC,82525,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATININE-BLD 82565,10001116573,CDM,301,RC,82565,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYSTINE, QT BLD 82131",10001116575,CDM,301,RC,82131,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN A QUAN 84590,10001116579,CDM,301,RC,84590,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HB-METH, SULF, ET 83050",10001116581,CDM,301,RC,83050,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LACTIC AC BLD=Q 83605,10001116583,CDM,301,RC,83605,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIPASE-BLD 83690,10001116585,CDM,301,RC,83690,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNESIUM-BLD 83735,10001116587,CDM,301,RC,83735,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPHORUS BLD 84100,10001116589,CDM,301,RC,84100,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PH,10001116591,CDM,301,RC,82800,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POTASSIUM-BLD 84132,10001116593,CDM,301,RC,84132,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALK PHOS ISOENZ 84080,10001116595,CDM,301,RC,84080,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHANESPHRINES 83835,10001116597,CDM,301,RC,83835,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMMONIA 82140,10001116599,CDM,301,RC,82140,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SODIUM-BLD 84295,10001116601,CDM,301,RC,84295,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT-EACH ADD SP 82952,10001116605,CDM,301,RC,82952,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROTEIN, TOTAL 84155 SERU",10001116609,CDM,301,RC,84155,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN E ASSAY 84446,10001116611,CDM,301,RC,84446,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UREA NITROGEN 84520 QUANT,10001116613,CDM,301,RC,84520,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UREA CLEARANCE 84545,10001116615,CDM,301,RC,84545,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URIC ACID - BLD 84550,10001116617,CDM,301,RC,84550,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T-3 UPTAKE 84479,10001116619,CDM,301,RC,84479,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCULT BLOOD 82270 3 CARD,10001116621,CDM,301,RC,82270,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROSTATE SAT BX, >60 SPEC",10001116623,CDM,314,RC,,,facility,both,,,,3688,3688,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRYPSIN, QUAL 84488",10001116625,CDM,301,RC,84488,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROBLINO-FEC 84577 QUANT,10001116627,CDM,301,RC,84577,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRYPSIN, SEMI 84490 QT",10001116629,CDM,301,RC,84490,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTAMINE 83088,10001116631,CDM,301,RC,83088,HCPCS,facility,both,,,,337,337,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACTH 82024,10001116633,CDM,301,RC,82024,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FERRITIN ASSAY 82728,10001116635,CDM,301,RC,82728,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATECHOLAMINES BLOOD 8238,10001116637,CDM,301,RC,82383,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VMA 84585,10001116639,CDM,301,RC,84585,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOMOVANILIC ACI 83150,10001116641,CDM,301,RC,83150,HCPCS,facility,both,,,,216,216,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 17-HYDROXYCORT,10001116643,CDM,301,RC,83491,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KETOSTEROIDS 17 TOTAL,10001116645,CDM,301,RC,83586,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HAPTOGLOBIN 83010 QT,10001116647,CDM,301,RC,83010,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ESTROGEN,TOTAL 82672",10001116649,CDM,301,RC,82672,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BENZODIAZEPINE 80154,10001116651,CDM,301,RC,80154,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENCYCLIDINE,10001116653,CDM,301,RC,83992,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARBON MONOXIDES QUANT 82,10001116655,CDM,301,RC,82375,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ARSENIC 82175,10001116657,CDM,301,RC,82175,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRONESTYL LEVEL 80190,10001116659,CDM,301,RC,80190,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC N-ACETYL PROCAINAMIDE 801,10001116661,CDM,301,RC,80192,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATECHOLAMINES FRECTIONAT,10001116663,CDM,301,RC,82384,HCPCS,facility,both,,,,310,310,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOGLOBIN GYLC 83036,10001116665,CDM,301,RC,83036,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREGNANETRIOL 84138,10001116667,CDM,301,RC,84138,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREGNANEDIOL QU 84135,10001116671,CDM,301,RC,84135,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HCG QUAL -- SPECIAL 89630,10001116673,CDM,301,RC,84703,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IRON, TOTAL BIND 83550",10001116675,CDM,301,RC,83550,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALICYLATE-BLD 80196,10001116677,CDM,301,RC,80196,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IRON, TOTAL-BLD 83540",10001116679,CDM,301,RC,83540,HCPCS,facility,both,,,,37,37,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATECHOLAMINES TOT URINE,10001116681,CDM,301,RC,82382,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEAD BLD-QT 83655,10001116683,CDM,301,RC,83655,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 5-HIAA QT 83497,10001116685,CDM,301,RC,83497,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCIUM TOLER 82331,10001116687,CDM,301,RC,82331,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OXALATE (URINE) 83945,10001116691,CDM,301,RC,83945,HCPCS,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IRON UNSAT BNG 83550,10001116693,CDM,301,RC,83550,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FATTY AC FREE Q 82725,10001116695,CDM,301,RC,82725,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFERRIN 86329,10001116697,CDM,301,RC,84466,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNO-IGG-CSF 82784,10001116699,CDM,301,RC,82784,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ORINASE TOLER 82953,10001116701,CDM,301,RC,82953,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUCOSE-CSF-QT,10001116703,CDM,301,RC,82945,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC COPPER,URINE 82525",10001116705,CDM,301,RC,82525,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCIUM-FECES 82310,10001116707,CDM,301,RC,82310,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FECAL FAT QUAL.,10001116709,CDM,301,RC,82705,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IGA, IGG, IGM-QT EACH 827",10001116711,CDM,301,RC,82784,HCPCS,facility,both,,,,195,195,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUTETHIMIDE-UR 82980,10001116713,CDM,301,RC,82980,HCPCS,facility,both,,,,147,147,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MAPROBAMATE, UR 83805",10001116715,CDM,301,RC,83805,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROBILINOGUR-UR-QUAL 8457,10001116717,CDM,301,RC,84578,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROPORPHYRINS-QUANT 84120,10001116719,CDM,301,RC,84120,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNNGLOB-IGD 82784,10001116725,CDM,301,RC,82784,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGE-QUANT 82785,10001116727,CDM,301,RC,82785,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYSOLINE LEVEL 80188,10001116729,CDM,301,RC,80188,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FAT, FECAL, TOTAL 82710QT",10001116731,CDM,301,RC,82710,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROPHOR-CSF84165,10001116733,CDM,301,RC,84166,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN B-12 82607,10001116737,CDM,301,RC,82607,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN B-6 NPYR 84207,10001116741,CDM,301,RC,84207,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FOLIC ACID SER 82746,10001116743,CDM,301,RC,82746,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LACTOSE TOL EA 82952,10001116745,CDM,301,RC,82952,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYELIN BASIC PROTIEN-CSF,10001116747,CDM,301,RC,83873,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ERYTHROPOETIN 82668,10001116749,CDM,301,RC,82668,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CEA 82378,10001116751,CDM,301,RC,82378,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESTRADIOL BY RI82670,10001116753,CDM,301,RC,82670,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLASMA SEROTONIN 84260,10001116755,CDM,301,RC,84260,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TESTOSTERONE TOTAL 84403,10001116757,CDM,301,RC,84403,HCPCS,facility,both,,,,147,147,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLOOD DIGOXIN 80162,10001116759,CDM,301,RC,80162,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASTTRI BY RIA 82941,10001116761,CDM,301,RC,82941,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSULIN LEVEL - TOTAL 835,10001116763,CDM,301,RC,83525,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC L-H BY RIA 83002,10001116765,CDM,301,RC,83002,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RENIN BY LEVEL 84244,10001116767,CDM,301,RC,84244,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CORTISOL PLASMA TOTAL 825,10001116769,CDM,301,RC,82533,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T-4 BY RIA,10001116771,CDM,301,RC,84436,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GROWTH HORMONE 83003,10001116775,CDM,301,RC,83003,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANDROSTENDIONE82157,10001116777,CDM,301,RC,82157,HCPCS,facility,both,,,,248,248,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TSH BY RIA 84443,10001116779,CDM,301,RC,84443,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PTH BY RIA 83970,10001116781,CDM,301,RC,83970,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACID PHOS RIA 84060,10001116783,CDM,301,RC,84060,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THY BNG GLOB - R 84442,10001116785,CDM,301,RC,84442,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THY BNG GLOB - R 84442,10001116787,CDM,301,RC,84442,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-GAMMA GLOB,10001116789,CDM,301,RC,82784,HCPCS,facility,both,,,,195,195,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYFIBRINOGEN 82585,10001116791,CDM,301,RC,82585,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STONE XRAY DIFF 82370,10001116793,CDM,301,RC,82370,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FAT STAIN QT,10001116795,CDM,301,RC,82715,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PH, REACTION 83986",10001116797,CDM,301,RC,83986,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOSIDERIN QUAL 83070,10001116799,CDM,301,RC,83070,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCULT BLOOD 82273,10001116801,CDM,301,RC,82271,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DAU SCREEN QL,10001116803,CDM,301,RC,80100,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYME INDEX CSF*,10001116805,CDM,301,RC,82040,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRYPTASE,10001116807,CDM,301,RC,83520,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BOTULINUM TOXIN A AB,10001116809,CDM,301,RC,84182,HCPCS,facility,both,,,,746,746,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYCLOSPORIN,10001116811,CDM,301,RC,80158,HCPCS,facility,both,,,,282,282,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CMV QUAL PCR,10001116813,CDM,301,RC,87910,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN B-2 84252,10001116815,CDM,301,RC,84252,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARBITURATE SCREEN 80101,10001116817,CDM,301,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC JAK2 MUTATION*,10001116821,CDM,301,RC,81270,HCPCS,facility,both,,,,862,862,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HLA TYPING CELIAC DISEASE,10001116823,CDM,301,RC,81376,HCPCS,facility,both,,,,1742,1742,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LAMATRIGINE,10001116825,CDM,301,RC,80299,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARIETAL CELL ANTIBODY,10001116827,CDM,301,RC,83516,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TISSUE TRANSGLUTIMANASE,10001116829,CDM,301,RC,83516,HCPCS,facility,both,,,,195,195,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYRIOD STIM IMMUNOGLOB T,10001116831,CDM,301,RC,84445,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MICROALBUMIN (URINE)*,10001116833,CDM,301,RC,82043,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHAQUALONE,10001116835,CDM,301,RC,82542,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPIATE SCREEN URINE,10001116837,CDM,301,RC,,,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC S505 MUTATION ANALYSIS*,10001116839,CDM,301,RC,81402,HCPCS,facility,both,,,,888,888,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TAMOXIFEN P450*,10001116841,CDM,301,RC,81226,HCPCS,facility,both,,,,984,984,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP C VIRUS FIBROSURE*,10001116843,CDM,301,RC,82172,HCPCS,facility,both,,,,417,417,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEOCOMP PARANEOPLASTIC PR,10001116845,CDM,301,RC,84181,HCPCS,facility,both,,,,5930,5930,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAGUIDE 5FU,10001116847,CDM,301,RC,81479,HCPCS,facility,both,,,,2702,2702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTHROMBIN GENE ANALYSIS,10001116849,CDM,301,RC,81240,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI MULLERIAN ASSESSR TM,10001116851,CDM,301,RC,83520,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BM PANEL 80048 W/CALCIUM,10001116853,CDM,301,RC,80048,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHYLOMICRONS (FLUID),10001116855,CDM,301,RC,82664,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMP PANEL 80053 W/CO2&AL,10001116857,CDM,301,RC,80053,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALPHA GLOBIN GENE SEQ*,10001116859,CDM,301,RC,81479,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN 14 CSF,10001116861,CDM,301,RC,82397,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIPOPROFILE NMR*,10001116863,CDM,301,RC,83704,HCPCS,facility,both,,,,244,244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INHIBIN B,10001116865,CDM,301,RC,83520,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NASH FIBROSURE*,10001116867,CDM,301,RC,82947,HCPCS,facility,both,,,,729,729,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SULFATIDE ANTIBODY TEST,10001116869,CDM,301,RC,83520,HCPCS,facility,both,,,,814,814,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RENAL FNCTNPANEL 80069,10001116871,CDM,301,RC,80069,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FUNGITEL(R)(1-3) BDGLUCAN,10001116873,CDM,301,RC,84311,HCPCS,facility,both,,,,528,528,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VOLTAGE GATED CALCIUM CHN,10001116875,CDM,301,RC,83519,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIGITOXIN,10001116877,CDM,301,RC,83520,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ETHYLENE GLYCOL, BLOOD",10001116879,CDM,301,RC,82693,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATIC PANEL 80076 W/PRO,10001116881,CDM,301,RC,80076,HCPCS,facility,both,,,,215,215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARNITINE TOTAL,10001116883,CDM,301,RC,82131,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARNITINE FREE,10001116885,CDM,301,RC,82131,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FENTANYL,10001116887,CDM,301,RC,,,facility,both,,,,310,310,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ADMARK TAU, CSF",10001116889,CDM,301,RC,83520,HCPCS,facility,both,,,,2175,2175,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG ABUSE SCREEN, MECONI",10001116891,CDM,301,RC,,,facility,both,,,,151,151,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRICYCLICS (GEN) G0431,10001116893,CDM,301,RC,,,facility,both,,,,574,574,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENYTOIN FREE,10001116897,CDM,301,RC,80186,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TACROLIMUS,10001116899,CDM,301,RC,80197,HCPCS,facility,both,,,,440,440,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GABAPENTIN,10001116901,CDM,301,RC,80299,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMIODARONE,10001116903,CDM,301,RC,80299,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC QUANTITATIVE ASSAY, DRUG",10001116905,CDM,301,RC,80299,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAFFEINE,10001116907,CDM,301,RC,80299,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOMIPRAMINE LEVEL,10001116909,CDM,301,RC,82482,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DESMETHYCLOMIPROMINE LEVE,10001116911,CDM,301,RC,80299,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SIROLIMUS,10001116913,CDM,301,RC,80299,HCPCS,facility,both,,,,268,268,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEVETIRACETAM,10001116915,CDM,301,RC,80299,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BETA HYDROXYBUTYRATE,10001116917,CDM,301,RC,82010,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALPHA 1 ANTRYPSIN PHENOTY,10001116919,CDM,301,RC,82104,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFP AMNIO FLUID*,10001116921,CDM,301,RC,82106,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALUMINUM WHOLE BLOOD,10001116923,CDM,301,RC,82108,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMINO ACIDS-QUANT,10001116925,CDM,301,RC,82139,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BETAMICROGLOBULIN URINE,10001116927,CDM,301,RC,82232,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B2 MICROGLOBULIN BLD,10001116929,CDM,301,RC,82232,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRAIN NATRIURETIC PEPTIDE,10001116931,CDM,301,RC,83880,HCPCS,facility,both,,,,572,572,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI GLIADIN 1ST,10001116933,CDM,301,RC,83520,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI GLIADIN 2ND,10001116935,CDM,301,RC,83520,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OXYCODONE CONFIRMATION,10001116937,CDM,301,RC,80102,HCPCS,facility,both,,,,386,386,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIPROPROTEIN,10001116939,CDM,301,RC,82172,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APOLIPOPROTEIN A,10001116941,CDM,301,RC,82172,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APOLIPOPROTEIN B,10001116943,CDM,301,RC,82172,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BILE ACIDS,10001116945,CDM,301,RC,82239,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMOGRANIN A,10001116947,CDM,301,RC,82397,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORIDE - URINE 82436,10001116949,CDM,301,RC,82436,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HOMOCYSTINE, QUAN.",10001116951,CDM,301,RC,83090,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCITONIN,10001116953,CDM,301,RC,82308,HCPCS,facility,both,,,,411,411,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROZAC (FLUOXETINE),10001116955,CDM,301,RC,82742,HCPCS,facility,both,,,,329,329,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FREE PSA,10001116957,CDM,301,RC,84154,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PSA DIAGNOSTIC TOTAL,10001116959,CDM,301,RC,84153,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHYLMALONIC QT,10001116961,CDM,301,RC,83921,HCPCS,facility,both,,,,147,147,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THIOPURINE METABOLITES 6T,10001116963,CDM,301,RC,82492,HCPCS,facility,both,,,,735,735,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMIUM SERUM,10001116965,CDM,301,RC,82495,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLLAGEN CROSS LINK,10001116967,CDM,301,RC,82523,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ROHYPNOL,10001116969,CDM,301,RC,82542,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLLAGEN CROSS LINK OTHER,10001116971,CDM,301,RC,82570,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIT B12 UNSAT. BNDNG CAPA,10001116973,CDM,301,RC,82608,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DHEA-S,10001116975,CDM,301,RC,82627,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDROCODONE LEVEL URINE,10001116977,CDM,301,RC,82646,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HYDROMORPONE, UR",10001116979,CDM,301,RC,82649,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIHYDROTESTOSTERONE,10001116981,CDM,301,RC,82651,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADENOSINE DEAMINASE BLOOD,10001116983,CDM,301,RC,84311,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TPMT ENZYME ACTIVITY,10001116985,CDM,301,RC,82657,HCPCS,facility,both,,,,718,718,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROPHORETIC TECHNIQUE,10001116987,CDM,301,RC,82664,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESTRONE,10001116989,CDM,301,RC,82679,HCPCS,facility,both,,,,222,222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FETAL FIBRONECTIN 82731,10001116991,CDM,301,RC,82731,HCPCS,facility,both,,,,790,790,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOGLOBULIN M QT REF,10001116993,CDM,301,RC,82784,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOGLOBULIN SUBCLASSES,10001116995,CDM,301,RC,82787,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUCAGON,10001116999,CDM,301,RC,82943,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FRUCTOSAMINE,10001117001,CDM,301,RC,82985,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COBALT SERUM/PLASMA QT,10001117003,CDM,301,RC,83018,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 17-HYDROXYPROGESTERONE,10001117005,CDM,301,RC,83498,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOMIC ONCOTYPE DX TEST,10001117007,CDM,301,RC,84999,HCPCS,facility,both,,,,6260,6260,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTINE ANTIBODY,10001117009,CDM,301,RC,83516,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PTH-RELATED PROTEIN,10001117011,CDM,301,RC,83519,HCPCS,facility,both,,,,248,248,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRYPSIN IMMUNOASSAY,10001117013,CDM,301,RC,83519,HCPCS,facility,both,,,,276,276,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRYPSINOGEN IMMUNOASSAY,10001117015,CDM,301,RC,83519,HCPCS,facility,both,,,,326,326,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUTAMIC ACID DECARBOXYLA,10001117017,CDM,301,RC,83519,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI GMB ANTIBODY,10001117019,CDM,301,RC,83520,HCPCS,facility,both,,,,193,193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GANGLIOSIDE GM1 FIRST,10001117021,CDM,301,RC,83520,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GANGLIOSIDE GM1 SECOND,10001117023,CDM,301,RC,83520,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETYLCHOLINE BLOCKING AB,10001117025,CDM,301,RC,83519,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETYLCHOLINE MODULATING,10001117027,CDM,301,RC,83519,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSULIN FREE,10001117029,CDM,301,RC,83527,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LACTOFERRIN, STOOL",10001117031,CDM,301,RC,83630,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VAP CHOLESTOROL,10001117033,CDM,301,RC,83701,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GONADOTROPIN RELEASING HO,10001117035,CDM,301,RC,83727,HCPCS,facility,both,,,,824,824,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MANGANES LEVEL,10001117037,CDM,301,RC,83785,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYPOGLYCEMIC PANEL,10001117039,CDM,301,RC,83788,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHODONE LEVEL URINE,10001117041,CDM,301,RC,83840,HCPCS,facility,both,,,,543,543,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C1 ESTERRASE INHIBITION,10001117043,CDM,301,RC,83883,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FREE LIGHT CHAINS UR,10001117045,CDM,301,RC,83883,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FREE LIGHT CHAINS BL,10001117047,CDM,301,RC,83883,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEIC ACID EXTRACTION*,10001117049,CDM,301,RC,81479,HCPCS,facility,both,,,,451,451,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULAR DX ENZYME DIGES,10001117051,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULAR DX ENZYME DIGES,10001117053,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEIC ACID PROBE 1,10001117055,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEIC ACID PROBE 2,10001117057,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEIC ACID PROBE 3,10001117059,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEIC ACID PROBE 4,10001117061,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEIC ACID AMPLIFICATIO,10001117063,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEIC ACID AMPLIFICATIO,10001117065,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WARFARIN SENSITIVITY DETE,10001117067,CDM,301,RC,83900,HCPCS,facility,both,,,,726,726,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOCHROMATOSIS DNA/MUTAT,10001117069,CDM,301,RC,81256,HCPCS,facility,both,,,,498,498,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTHROMBIN GENE INTERPRE,10001117071,CDM,301,RC,81240,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MORPHINE,10001117073,CDM,301,RC,83925,HCPCS,facility,both,,,,340,340,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OSTEOCALCIN,10001117075,CDM,301,RC,83937,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE SPECIFIC ALKPHOS,10001117077,CDM,301,RC,84075,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREALBUMIN 84134,10001117079,CDM,301,RC,84134,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYCLIC CITRULLIN PEPTIDE,10001117081,CDM,301,RC,84140,HCPCS,facility,both,,,,310,310,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROINSULIN,10001117085,CDM,301,RC,84206,HCPCS,facility,both,,,,238,238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMNISURE PLACENTAL A1 MIC,10001117087,CDM,301,RC,84112,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETYLCHOLINE RECEPTOR AN,10001117089,CDM,301,RC,84238,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SELENIUM LEVEL,10001117091,CDM,301,RC,84255,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SEX HORMONE BINDING GLOBU,10001117093,CDM,301,RC,84270,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADENOSINE DEAMINASE FLUID,10001117095,CDM,301,RC,84311,HCPCS,facility,both,,,,1374,1374,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FECAL REDUCING SUBSTANCE,10001117097,CDM,301,RC,84376,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLYCOMARK,10001117099,CDM,301,RC,84378,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T3-FREE,10001117101,CDM,301,RC,84481,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T3 REVERSE,10001117103,CDM,301,RC,84482,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TROPONIN-I QUANT 84484,10001117105,CDM,301,RC,84484,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UREA NITROGEN URINE,10001117107,CDM,301,RC,84540,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ARGININE VASPORESSIN,10001117109,CDM,301,RC,84588,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NIACIN,10001117111,CDM,301,RC,84591,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROLYTE PANEL,10001117117,CDM,301,RC,80051,HCPCS,facility,both,,,,209,209,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIPID PROFILE 80061,10001117123,CDM,301,RC,80061,HCPCS,facility,both,,,,384,384,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETAMINOPHINE,10001117125,CDM,301,RC,82003,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIP,10001117127,CDM,301,RC,84586,HCPCS,facility,both,,,,268,268,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ERYTHROPOIETIN,10001117129,CDM,301,RC,82668,HCPCS,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KLONOPIN,10001117131,CDM,301,RC,80154,HCPCS,facility,both,,,,244,244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEOTIDASE-5 83915,10001117133,CDM,301,RC,83915,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG SCREEN,URINE",10001117135,CDM,301,RC,80100,HCPCS,facility,both,,,,648,648,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TESTOSTERONE FREE,10001117137,CDM,301,RC,84402,HCPCS,facility,both,,,,394,394,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URINE TESTOSTERONE TOTAL,10001117139,CDM,301,RC,84403,HCPCS,facility,both,,,,394,394,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRO-PREDICTR METABLITES*,10001117141,CDM,301,RC,80299,HCPCS,facility,both,,,,846,846,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARBITURATE SCREEN G0431,10001117143,CDM,301,RC,,,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMITRIPTYLENE 80152,10001117145,CDM,301,RC,80152,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESTRIOL 82677,10001117147,CDM,301,RC,82677,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LECITHIN-SPHING 83661,10001117149,CDM,301,RC,83661,HCPCS,facility,both,,,,481,481,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMINOPHYL LEVEL 80198,10001117151,CDM,301,RC,80198,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DDIBUC 82638,10001117153,CDM,301,RC,82638,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXTROGEN-FRACTIONATED 826,10001117155,CDM,301,RC,82671,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOTENSION CSF 82164,10001117157,CDM,301,RC,82164,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACENTAL LACTO 83632,10001117159,CDM,301,RC,83632,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CPK ISOENZYMES 82552,10001117161,CDM,301,RC,82552,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROLACTIN LEVEL 84146,10001117163,CDM,301,RC,84146,HCPCS,facility,both,,,,402,402,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C-PEPTIDE 84681,10001117165,CDM,301,RC,84681,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALCOHOL METHYL 84600,10001117169,CDM,301,RC,84600,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-SM MUSCLE,10001117171,CDM,301,RC,83516,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIO-CONV BLD,10001117173,CDM,301,RC,82164,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CSF OLIG BANDIN 83916,10001117175,CDM,301,RC,83916,HCPCS,facility,both,,,,478,478,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VITAMIN D, 25-HYDROXY",10001117177,CDM,301,RC,82306,HCPCS,facility,both,,,,578,578,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATHARTIC LAXATIVE PROFIL,10001117179,CDM,301,RC,82489,HCPCS,facility,both,,,,416,416,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URIC ACID (URINE),10001117181,CDM,301,RC,84560,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VITAMIN D,1,25-DIHYDROXY",10001117183,CDM,301,RC,82652,HCPCS,facility,both,,,,776,776,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ZINC 84630,10001117185,CDM,301,RC,84630,HCPCS,facility,both,,,,236,236,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARBAMAZE 80156,10001117187,CDM,301,RC,80156,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHYMOPAPAI,10001117189,CDM,301,RC,83520,HCPCS,facility,both,,,,420,420,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DISOPYRAM 80299,10001117191,CDM,301,RC,80299,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC FOLATE,10001117193,CDM,301,RC,82747,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T - 4 - FREE,10001117195,CDM,301,RC,84439,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROGLOBULIN 84432,10001117197,CDM,301,RC,84432,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PH CORD BLOOD 82800,10001117199,CDM,301,RC,82800,HCPCS,facility,both,,,,135,135,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUCOSE;24 HR UR,10001117201,CDM,301,RC,82945,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMIPRAMINE 80174,10001117203,CDM,301,RC,80174,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THIAMINE,10001117205,CDM,301,RC,84425,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOBRAMYCIN PEAK,10001117207,CDM,301,RC,80200,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOBRAMYCIN THROUGH,10001117209,CDM,301,RC,80200,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THEOPHYLLINE-HP 80198,10001117211,CDM,301,RC,80198,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VALIUM,10001117213,CDM,301,RC,80154,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ZOLOFT,10001117215,CDM,301,RC,80299,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PYRUVIC ACID 84210,10001117217,CDM,301,RC,84210,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYOGLOBIN 83874,10001117219,CDM,301,RC,83874,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEMOGLOBIN,FETA 83030",10001117221,CDM,301,RC,83030,HCPCS,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOT PROTIEN-UR 84156,10001117223,CDM,301,RC,84156,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLASMA HGB,10001117225,CDM,301,RC,83051,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LORAZEPAM,10001117227,CDM,301,RC,80154,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN ELECT 84165 UR,10001117229,CDM,301,RC,84166,HCPCS,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DESIMPRAMINE 80160,10001117231,CDM,301,RC,80160,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC QUINIDINE,BLOOD 80194",10001117233,CDM,301,RC,80194,HCPCS,facility,both,,,,351,351,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IRON SAT % 83540,10001117235,CDM,301,RC,83540,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LAC BL SET 82951,10001117237,CDM,301,RC,82951,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SODIUM, URINE 84300",10001117239,CDM,301,RC,84300,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SODIUM, 24 HR UR 84300",10001117241,CDM,301,RC,84300,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SODIUM NOT SERUM OR URINE,10001117243,CDM,301,RC,84302,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POTASSIUM-URINE 84133,10001117245,CDM,301,RC,84133,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC POTASSIUM, 24 HR UR 84133",10001117247,CDM,301,RC,84133,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOS-PROSTAT-AC 84066,10001117249,CDM,301,RC,84066,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PHOSPHATASE, AL 84075",10001117251,CDM,301,RC,84075,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPHORUS-UR 84105,10001117253,CDM,301,RC,84105,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PORPHOBILINOG QUAL 84106,10001117255,CDM,301,RC,84106,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PORPHOBILINOG-QUANT 84110,10001117257,CDM,301,RC,84110,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OSMOLARITY-UR 83935,10001117261,CDM,301,RC,83935,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MERCURY-UR-QT 83825,10001117263,CDM,301,RC,83825,HCPCS,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PEPSINOGEN,10001117265,CDM,301,RC,83519,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IBD STEP GENERATION II SO,10001117267,CDM,301,RC,83520,HCPCS,facility,both,,,,454,454,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IBD IMMONOASSAY QT,10001117269,CDM,301,RC,83520,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IBD IMMUNOASSAY QT,10001117271,CDM,301,RC,83520,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IBD IMMONOASSAY QT,10001117273,CDM,301,RC,83520,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACID MUCOLYSA QT 83864,10001117275,CDM,301,RC,83864,HCPCS,facility,both,,,,389,389,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNESIUM-UR83735,10001117277,CDM,301,RC,83735,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MEPROBAMATE,BLD83805",10001117279,CDM,301,RC,83805,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEAD UR-QT 83655,10001117281,CDM,301,RC,83655,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LDH,URINE 83615",10001117283,CDM,301,RC,83615,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LDH (CSF) 83615,10001117285,CDM,301,RC,83615,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNESIUM,10001117287,CDM,301,RC,83735,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MTHFR MOLEC ISOLATE NUCLE,10001117289,CDM,301,RC,81479,HCPCS,facility,both,,,,752,752,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLASMINOGEN ACTIVATOR*,10001117291,CDM,301,RC,81400,HCPCS,facility,both,,,,478,478,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NUCLEIC ACID, HI RESOLUTE",10001117293,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENETIC EXAMINATION,10001117295,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUTATION ID,10001117297,CDM,301,RC,81401,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRXYPRLN FREE 83500,10001117299,CDM,301,RC,83500,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALPHAIFETOPROP SERUM 8210,10001117303,CDM,301,RC,82105,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRXYPRLN TOT 83505,10001117305,CDM,301,RC,83505,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPHORUS(INORGANIC),10001117307,CDM,301,RC,84100,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CALCIUM, IONIZE 82330",10001117309,CDM,301,RC,82330,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYCLIC AMP 82030,10001117311,CDM,301,RC,82030,HCPCS,facility,both,,,,402,402,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENOTHIAZINES 84022,10001117313,CDM,301,RC,84022,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BICARBONATE-CO2 82374,10001117315,CDM,301,RC,82374,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACIDYL,10001117317,CDM,301,RC,82690,HCPCS,facility,both,,,,304,304,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYANIDE 82600,10001117319,CDM,301,RC,82600,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYSTINE,QT-UR",10001117323,CDM,301,RC,82131,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DELTA AMINO LEV82135,10001117325,CDM,301,RC,82135,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARBOXY HBG SAT QT 82375,10001117327,CDM,301,RC,82375,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATINE-URINE-24 HRS.825,10001117329,CDM,301,RC,82540,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COPROPORPH QL U84119,10001117331,CDM,301,RC,84119,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLINEST SERUM 82480,10001117333,CDM,301,RC,82480,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORIDES-CSF 82438,10001117335,CDM,301,RC,82438,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETONE-QL 82009,10001117337,CDM,301,RC,82009,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GG TRANSPEPTID 82977,10001117339,CDM,301,RC,82977,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUTETHIMIDE-BL82980,10001117341,CDM,301,RC,82980,HCPCS,facility,both,,,,357,357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OSMOLALITY - STOOL,10001117343,CDM,301,RC,84999,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCRN URINE G0431,10001117345,CDM,301,RC,,,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMIKACIN PEAK/TROGH 80150,10001117347,CDM,301,RC,80150,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLONESTERASE RBC 82482,10001117349,CDM,301,RC,82482,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ICD-ISOCITRIC 83570,10001117351,CDM,301,RC,83570,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C-6-PD,10001117353,CDM,301,RC,82955,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAROTENE 82380,10001117355,CDM,301,RC,82380,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC XYLOSE TOLERANC84620,10001117357,CDM,301,RC,84620,HCPCS,facility,both,,,,329,329,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATINE CLEAR 82575,10001117359,CDM,301,RC,82575,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMINO ACIDS-BLD QT,10001117361,CDM,301,RC,82131,HCPCS,facility,both,,,,1046,1046,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CRYOGLOBULIN,QU82595",10001117363,CDM,301,RC,82595,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SGP TRANSAMINAS84460,10001117365,CDM,301,RC,84460,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRIGLYCERIDES 84478,10001117367,CDM,301,RC,84478,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENYLALANIE 84030,10001117369,CDM,301,RC,84030,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LDH ISOZYMES 83625,10001117371,CDM,301,RC,83625,HCPCS,facility,both,,,,745,745,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GALACTOSE 82760,10001117373,CDM,301,RC,82760,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CERULOPLASMIN,Q82390",10001117375,CDM,301,RC,82390,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROPHOR-HGB83020,10001117377,CDM,301,RC,83020,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALDOLASE 82085,10001117381,CDM,301,RC,82085,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASES,BLOOD 82803",10001117385,CDM,301,RC,82803,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASES PCO2 82803,10001117387,CDM,301,RC,82803,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASES, PO2 82803",10001117389,CDM,301,RC,82803,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ART BLOOD GASES 82803,10001117391,CDM,301,RC,82803,HCPCS,facility,both,,,,476,476,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BILIRUBIN,DIRECT 82248",10001117395,CDM,301,RC,82248,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALBUMIN SERUM 82040,10001117397,CDM,301,RC,82040,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DILANTIN,QT 80185",10001117399,CDM,301,RC,80185,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OSMOLALITY-BLD 83930,10001117401,CDM,301,RC,83930,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATININE-UR OR OTHR SOU,10001117403,CDM,301,RC,82570,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALPHA-1-ANTITRY82103,10001117405,CDM,301,RC,82103,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HDL LIPOPROTEIN 83718,10001117407,CDM,301,RC,83718,HCPCS,facility,both,,,,304,304,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CK MB 82553,10001117409,CDM,301,RC,82553,HCPCS,facility,both,,,,235,235,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATINE PHOSPH 82550,10001117411,CDM,301,RC,82550,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LITHIUM-BLOOD 80178,10001117413,CDM,301,RC,80178,HCPCS,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMYLASE 82150,10001117415,CDM,301,RC,82150,HCPCS,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN C 82180,10001117417,CDM,301,RC,82180,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETONE-QT 82010,10001117419,CDM,301,RC,82010,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALCOHOL-ETHYL 82055,10001117421,CDM,301,RC,82055,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BILIRUBIN,TOTAL 82247",10001117423,CDM,301,RC,82247,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METAL SCREEN 83015,10001117425,CDM,301,RC,83015,HCPCS,facility,both,,,,802,802,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARBITURATE QUANT/CANNA,10001117427,CDM,301,RC,82205,HCPCS,facility,both,,,,536,536,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEUCINE AMINOPE 83670,10001117429,CDM,301,RC,83670,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATINE 82540,10001117431,CDM,301,RC,82540,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIDOCAINE 80176,10001117433,CDM,301,RC,80176,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LDH 83615,10001117435,CDM,301,RC,83615,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SGO TRANSAMINAS 84450,10001117437,CDM,301,RC,84450,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHOTREXATE 80299,10001117439,CDM,301,RC,80299,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NORTRIPTYLINE 80182,10001117441,CDM,301,RC,80182,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENOBARBITAL 80184,10001117443,CDM,301,RC,80184,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BROMIDES-BLD 80299,10001117447,CDM,301,RC,80299,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCIUM 82310,10001117449,CDM,301,RC,82310,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GALACTOSE TOLER 82760,10001117451,CDM,301,RC,82760,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORIDES-BLD 82435,10001117453,CDM,301,RC,82435,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALDOSTERONE 82088,10001117455,CDM,301,RC,82088,HCPCS,facility,both,,,,588,588,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHOLESTEROL, TOT 82465",10001117457,CDM,301,RC,82465,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIPOPROTEIN PHE 83012,10001117459,CDM,301,RC,83700,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT 1ST 3 OF 5,10001117461,CDM,301,RC,82951,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT 1ST 3 OF 6,10001117463,CDM,301,RC,82951,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT 1ST 3 OF 7,10001117465,CDM,301,RC,82951,HCPCS,facility,both,,,,354,354,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT EACH ADD,10001117467,CDM,301,RC,82952,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT EACH ADD 5TH,10001117469,CDM,301,RC,82952,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT EACH ADD 6TH,10001117471,CDM,301,RC,82952,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT EAD ADD 7TH,10001117473,CDM,301,RC,82952,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COPPER 82525,10001117475,CDM,301,RC,82525,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CREATININE-BLD,10001117477,CDM,301,RC,82565,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYSTINE, QT BLD 82131",10001117481,CDM,301,RC,82131,HCPCS,facility,both,,,,384,384,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN A QUAN 84590,10001117485,CDM,301,RC,84590,HCPCS,facility,both,,,,202,202,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HB-METH, SULF, QT 83050",10001117487,CDM,301,RC,83050,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LACTIC AC BLD=Q83605,10001117491,CDM,301,RC,83605,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIPASE 83690,10001117493,CDM,301,RC,83690,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNESIUM-BLD 83735,10001117495,CDM,301,RC,83735,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASES, OXYGEN SA 82792",10001117497,CDM,301,RC,82810,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPHORUS BLD 84100,10001117499,CDM,301,RC,84100,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC P H OTHER THAN BLOOD 8398,10001117501,CDM,301,RC,83986,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASTRICE PH FREE & TOTAL,10001117503,CDM,301,RC,82930,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POTASSIUM-BLD 84132,10001117505,CDM,301,RC,84132,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALK PHOS ISOENZ84080,10001117507,CDM,301,RC,84080,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METANEPHRINES (FRACTIONAT,10001117509,CDM,301,RC,83835,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMMONIA 82140,10001117511,CDM,301,RC,82140,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SODIUM-BLD 84295,10001117515,CDM,301,RC,84295,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUCOSE QUANT,10001117517,CDM,301,RC,82947,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GTT-FIRST 3,10001117519,CDM,301,RC,82951,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROTEIN, TOTAL OTHER SOUR",10001117521,CDM,301,RC,84157,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOT PROT A/G-BL,10001117523,CDM,301,RC,84155,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN E ASSAY84446,10001117525,CDM,301,RC,84446,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UREA NITROGEN QT 84520,10001117527,CDM,301,RC,84520,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UREA CLEARANCE 84545,10001117529,CDM,301,RC,84545,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URIC ACID-BLD 84550,10001117531,CDM,301,RC,84550,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOSIDERIN QUANT 83071,10001117533,CDM,301,RC,83071,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T-3 UPTAKE 84479,10001117535,CDM,301,RC,84479,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCULT BLOOD; FECES 82270,10001117537,CDM,301,RC,82270,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MARIJUANA SCREEN G0431,10001117539,CDM,301,RC,,,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRYPSIN, QUAL 84488",10001117541,CDM,301,RC,84488,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROBLINO-FEC QT 84577,10001117543,CDM,301,RC,84577,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FAT,FECAL,QUANT 48 HRS 82",10001117545,CDM,301,RC,82710,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRYPSIN,SEMI QT 84490",10001117547,CDM,301,RC,84490,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTOPPRPHY FEC 84202,10001117549,CDM,301,RC,84202,HCPCS,facility,both,,,,370,370,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTAMINE 83088,10001117551,CDM,301,RC,83088,HCPCS,facility,both,,,,812,812,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACTH 82024,10001117555,CDM,301,RC,82024,HCPCS,facility,both,,,,692,692,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FERRITIN ASSAY 82728,10001117557,CDM,301,RC,82728,HCPCS,facility,both,,,,304,304,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATECHOLAMINES BLOOD 8238,10001117559,CDM,301,RC,82383,HCPCS,facility,both,,,,581,581,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VMA 84585,10001117561,CDM,301,RC,84585,HCPCS,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOMOVANILIC ACI 83150,10001117563,CDM,301,RC,83150,HCPCS,facility,both,,,,519,519,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 17-HYDROXYCORT 83491,10001117565,CDM,301,RC,83491,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LDL (LOW DENSITY LIPOPRO),10001117567,CDM,301,RC,83721,HCPCS,facility,both,,,,302,302,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KETOSTEROIDS 17 TOTAL,10001117569,CDM,301,RC,83586,HCPCS,facility,both,,,,363,363,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DHA-DEHYDROAND,10001117571,CDM,301,RC,83520,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HAPTOGLOBIN 83010 QUANT,10001117573,CDM,301,RC,83010,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ESTROGEN,TOTAL 82672",10001117575,CDM,301,RC,82672,HCPCS,facility,both,,,,363,363,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BENZODIAZEPINE 80154,10001117577,CDM,301,RC,80154,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BROMIDES 80299,10001117579,CDM,301,RC,80299,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTIEN ELECTROPHARISM SE,10001117581,CDM,301,RC,84165,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENCYCLIDINE,10001117583,CDM,301,RC,83992,HCPCS,facility,both,,,,260,260,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARBON MONOXIDES QUANT 82,10001117585,CDM,301,RC,82375,HCPCS,facility,both,,,,236,236,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ARSENIC 82175,10001117587,CDM,301,RC,82175,HCPCS,facility,both,,,,417,417,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCAINAMIDE 80190,10001117589,CDM,301,RC,80190,HCPCS,facility,both,,,,429,429,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC N-ACETYL - PROCAINAMIDE,10001117591,CDM,301,RC,80192,HCPCS,facility,both,,,,429,429,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATECHOLAMINES FRACTIONAT,10001117593,CDM,301,RC,82384,HCPCS,facility,both,,,,746,746,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VANCOMYCIN 80202,10001117595,CDM,301,RC,80202,HCPCS,facility,both,,,,293,293,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOGLOBIN GYLC83036,10001117597,CDM,301,RC,83036,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VALPROIC ACID 80164,10001117599,CDM,301,RC,80164,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOPRIMATE LEVEL,10001117601,CDM,301,RC,80201,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREGNANETRIOL 84138,10001117603,CDM,301,RC,84138,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREGNANEDIOL QU 84135,10001117607,CDM,301,RC,84135,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SUGAR, INDETIFY84375",10001117609,CDM,301,RC,84375,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HCG QUAL 84703,10001117611,CDM,301,RC,84703,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IRON, TOTAL BIND83550",10001117613,CDM,301,RC,83550,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALICYLATE 80196,10001117615,CDM,301,RC,80196,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IRON, TOTAL-BLD 83540",10001117617,CDM,301,RC,83540,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATECHOLAMINES TOT URINE,10001117619,CDM,301,RC,82382,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEAD BLD-QT 83655,10001117621,CDM,301,RC,83655,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 5-HIAA QT 83497,10001117623,CDM,301,RC,83497,HCPCS,facility,both,,,,244,244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MERCURY-BLD-QT 83825,10001117625,CDM,301,RC,83825,HCPCS,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCIUM TOLER 82331,10001117627,CDM,301,RC,82331,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STONE ANALYSIS QL 82355,10001117629,CDM,301,RC,82355,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OXALATE (URINE) 83945,10001117631,CDM,301,RC,83945,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORAMPHENICOL82415,10001117633,CDM,301,RC,82415,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENOLPHTHALEIN (STOOL),10001117635,CDM,301,RC,84311,HCPCS,facility,both,,,,362,362,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BUTORPHANOL SCR UR REF,10001117637,CDM,301,RC,,,facility,both,,,,508,508,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OB GLUCOSE CHALLENGE,10001117639,CDM,301,RC,82951,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUCOSE 2HE 82950,10001117641,CDM,301,RC,82950,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFERRIN,10001117647,CDM,301,RC,84466,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNESIUM (STOOL),10001117649,CDM,301,RC,83735,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYCLIC CITRULLIN PEPTIDE,10001117651,CDM,301,RC,83520,HCPCS,facility,both,,,,248,248,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC L S D SCREEN 82205,10001117653,CDM,301,RC,82205,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORAL HYDRATE80299,10001117655,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIBRIUM-BLD 80299,10001117657,CDM,301,RC,80299,HCPCS,facility,both,,,,456,456,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MARIJUANA QUANT,10001117659,CDM,301,RC,82542,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ORINASE TOLER 82953,10001117661,CDM,301,RC,82953,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUCOSE-CSF-QT,10001117663,CDM,301,RC,82945,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC COPPER, URINE 82525",10001117665,CDM,301,RC,82525,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUCOPROTEIN-SYN,10001117667,CDM,301,RC,83872,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALCIUM-FECES 82310,10001117669,CDM,301,RC,82310,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FECAL FAT QUAL.,10001117673,CDM,301,RC,82705,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IGA,IGD,IGG,IGM,EACH 8278",10001117677,CDM,301,RC,82784,HCPCS,facility,both,,,,476,476,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG SCREEN, BLOOD",10001117679,CDM,301,RC,80100,HCPCS,facility,both,,,,1106,1106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMPHETAMINE 82145,10001117681,CDM,301,RC,82145,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLORALHYDRATE 80299,10001117683,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLUTETHIMIDE-UR82980,10001117685,CDM,301,RC,82980,HCPCS,facility,both,,,,357,357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 10-HYRDROXYCARBAZEPINE,10001117687,CDM,301,RC,80299,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BUPROPRION BL,10001117689,CDM,301,RC,80299,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIBRIUM-UR 80299,10001117691,CDM,301,RC,80299,HCPCS,facility,both,,,,456,456,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MEPROBAMATE, UR 83805",10001117693,CDM,301,RC,83805,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROBILINOGUR-UR-Q84578,10001117697,CDM,301,RC,84578,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROPORPHYRINS-QT84120,10001117699,CDM,301,RC,84120,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SUGAR-UR-QT,10001117701,CDM,301,RC,82945,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CORTICOSTEROIDS 83491,10001117707,CDM,301,RC,83491,HCPCS,facility,both,,,,216,216,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PORPHYRINS, QUAL 84119",10001117709,CDM,301,RC,84119,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCREEN SINGLE,10001117711,CDM,301,RC,,,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BUTAZOLADINE 80299,10001117713,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGE-QUANT 82785,10001117715,CDM,301,RC,82785,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG LEVEL ANAL80299,10001117717,CDM,301,RC,80299,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRIMIDONE 80188,10001117719,CDM,301,RC,80188,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FAT,FECAL,QUANT 72 HRS 82",10001117721,CDM,301,RC,82710,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROPHOR-CSF84165,10001117723,CDM,301,RC,84166,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALBUMIN REF,10001117727,CDM,301,RC,82040,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGG INDEX REF,10001117729,CDM,301,RC,82784,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALBUMIN CSF REF,10001117731,CDM,301,RC,82042,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGG SERUM REF,10001117733,CDM,301,RC,82784,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGG CSF REF,10001117735,CDM,301,RC,82784,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOZAPINE/METABOLITE REF,10001117737,CDM,301,RC,82492,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DESOXYCORTOCOSTERONE REF,10001117739,CDM,301,RC,82633,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCREEN SINGLE,10001117741,CDM,301,RC,,,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN B-12 82607,10001117743,CDM,301,RC,82607,HCPCS,facility,both,,,,330,330,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN B-6 NPYR 84207,10001117747,CDM,301,RC,84207,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FOLIC ACID SER 82746,10001117749,CDM,301,RC,82746,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUSK ANTIBODY*,10001117751,CDM,301,RC,83519,HCPCS,facility,both,,,,1412,1412,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC METHYL, MALON AC",10001117753,CDM,301,RC,83921,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LUDIMIL LEVEL 80299,10001117755,CDM,301,RC,80299,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYELIN BASIC PROTEIN-CSF,10001117757,CDM,301,RC,83873,HCPCS,facility,both,,,,533,533,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROGESTERONE LEVEL,10001117759,CDM,301,RC,84144,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALPHA SUB UNIT,10001117761,CDM,301,RC,83519,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPIATES QUANT,10001117763,CDM,301,RC,83925,HCPCS,facility,both,,,,193,193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT GLUCOSE QT BLD,10001117765,CDM,301,RC,82948,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT FECAL OCCULT BLD,10001117767,CDM,301,RC,82272,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT PH BODY FLUID,10001117769,CDM,301,RC,83986,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT CREATININE W/EFGR,10001117771,CDM,301,RC,82565,HCPCS,facility,both,,,,143,143,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ERYTHROPOETIN 82668,10001117773,CDM,301,RC,82668,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CEA 82378,10001117775,CDM,301,RC,82378,HCPCS,facility,both,,,,362,362,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESTRADIOL BY RI82670,10001117777,CDM,301,RC,82670,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLASMA SEROTONI84260,10001117779,CDM,301,RC,84260,HCPCS,facility,both,,,,552,552,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TESTOSTERONE TOTAL 84403,10001117781,CDM,301,RC,84403,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIGTOXIN-RIA-B 80299,10001117783,CDM,301,RC,80299,HCPCS,facility,both,,,,389,389,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIGOXIN LEVEL 80162,10001117785,CDM,301,RC,80162,HCPCS,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASTRI 82941,10001117787,CDM,301,RC,82941,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSULIN LEVEL- TOTAL 8352,10001117789,CDM,301,RC,83525,HCPCS,facility,both,,,,351,351,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC L-H BY RIA 83002,10001117791,CDM,301,RC,83002,HCPCS,facility,both,,,,452,452,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROGESTERONE-QT 84144,10001117793,CDM,301,RC,84234,HCPCS,facility,both,,,,399,399,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RENIN BY LEVEL 84244,10001117795,CDM,301,RC,84244,HCPCS,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CORTISOL PLASMA TOTAL 825,10001117797,CDM,301,RC,82533,HCPCS,facility,both,,,,259,259,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T-4 TOTAL,10001117799,CDM,301,RC,84436,HCPCS,facility,both,,,,235,235,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T3 84480,10001117801,CDM,301,RC,84480,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENTAMYCIN BY R 80170,10001117803,CDM,301,RC,80170,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GROWTH HORMONE 83003,10001117805,CDM,301,RC,83003,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANDROSTENDIONE82157,10001117807,CDM,301,RC,82157,HCPCS,facility,both,,,,594,594,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TSH 84443,10001117809,CDM,301,RC,84443,HCPCS,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FSH BY RIA 83001,10001117811,CDM,301,RC,83001,HCPCS,facility,both,,,,456,456,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROT-SPINAL FLU,10001117813,CDM,301,RC,84157,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PTH BY RIA 83970,10001117815,CDM,301,RC,83970,HCPCS,facility,both,,,,722,722,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PTH INTACT,10001117817,CDM,301,RC,83970,HCPCS,facility,both,,,,730,730,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACID PHOS RIA 84060,10001117819,CDM,301,RC,84060,HCPCS,facility,both,,,,236,236,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSULIN TOL RIA 80434,10001117821,CDM,301,RC,80434,HCPCS,facility,both,,,,1002,1002,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THY BNG GLOB-RI84442,10001117823,CDM,301,RC,84442,HCPCS,facility,both,,,,351,351,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HCG,SERUM QT 84702",10001117825,CDM,301,RC,84702,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESTROGENS(BLOOD) TOTAL,10001117827,CDM,301,RC,82672,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SOMATOMEDIN-C,10001117829,CDM,301,RC,84305,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VITAMIN K1,10001117831,CDM,301,RC,84597,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-GAMMA GLOB82150,10001117833,CDM,301,RC,82150,HCPCS,facility,both,,,,501,501,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYFIBRINOGEN 82585,10001117835,CDM,301,RC,82585,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYOGLOBULIN QUAL/SEMIQT,10001117837,CDM,301,RC,82595,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MICRO SATELLITE INSTABILI,10001117839,CDM,301,RC,81301,HCPCS,facility,both,,,,992,992,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA EXTRACT SO 1,10001117841,CDM,301,RC,81403,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA EXTRACT SO 2,10001117843,CDM,301,RC,81403,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PCR AMPLIFIED SO 1,10001117845,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PCR AMPLIFIED SO 2,10001117847,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SEP GEL ELECTROPHORESIS S,10001117849,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SEP GEL ELECTROPHORESIS S,10001117851,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LOSS OF HETEROZYGOSITY 18,10001117853,CDM,301,RC,81479,HCPCS,facility,both,,,,1059,1059,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ABL KINASE*,10001117855,CDM,301,RC,81401,HCPCS,facility,both,,,,776,776,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SYNOVIAL CARCINOMA*,10001117857,CDM,301,RC,81479,HCPCS,facility,both,,,,1077,1077,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOGLOBIN GENE REARANG,10001117859,CDM,301,RC,81479,HCPCS,facility,both,,,,574,574,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T CELL RECEPTOR GENE*,10001117861,CDM,301,RC,81402,HCPCS,facility,both,,,,648,648,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET DERIVED GRO FCT,10001117863,CDM,301,RC,81404,HCPCS,facility,both,,,,842,842,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EML4-ALK GENE FUSION BY P,10001117865,CDM,301,RC,81401,HCPCS,facility,both,,,,530,530,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PML/RARA T 15.17 QT PCR C,10001117867,CDM,301,RC,81315,HCPCS,facility,both,,,,352,352,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NRAS MUTATION ANALYSIS*,10001117869,CDM,301,RC,81404,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRAF MUTATION ANALYSIS*,10001117871,CDM,301,RC,81210,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA EXTRACT SO,10001117873,CDM,301,RC,81403,HCPCS,facility,both,,,,706,706,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PCR AMPLIFIED 1 SO*,10001117875,CDM,301,RC,81479,HCPCS,facility,both,,,,890,890,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PCR AMPLIFIED 2 SO,10001117877,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KRAS MUTATION ANALYSIS*,10001117879,CDM,301,RC,81275,HCPCS,facility,both,,,,647,647,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGRF MUTATION ANALYSIS*,10001117881,CDM,301,RC,81235,HCPCS,facility,both,,,,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MGTM GENE METHYLATION ASS,10001117883,CDM,301,RC,81331,HCPCS,facility,both,,,,1208,1208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STONE XRAY DIFF 82370,10001117885,CDM,301,RC,82370,HCPCS,facility,both,,,,222,222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FAT STAIN QT,10001117887,CDM,301,RC,82705,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PH, REACTION OTH THAN BLD",10001117889,CDM,301,RC,83986,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOSIDERIN QUAL 83070,10001117891,CDM,301,RC,83070,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCREEN SINGLE,10001117893,CDM,301,RC,,,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCREEN SINGLE,10001117895,CDM,301,RC,,,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BENCE-JONES PRO 82044,10001117897,CDM,301,RC,82044,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYPERIMMUNE ANT,10001117899,CDM,636,RC,,,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VIII HUMAN PER IU,10001117903,CDM,636,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY OF URINE ALBUNIM,10001117907,CDM,301,RC,82042,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY OF APOLIPROTEIN,10001117909,CDM,301,RC,82172,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BILIRUBIN TOTAL,10001117911,CDM,301,RC,82247,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMILUMINESCENT ASSAY,10001117913,CDM,301,RC,82397,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ASSAY, BLD/SERUM CHOLOEST",10001117915,CDM,301,RC,82465,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY OF GGT,10001117917,CDM,301,RC,82977,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY OF HAPTOGLOBIN QT,10001117919,CDM,301,RC,83010,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOASSAY NONANTIBODY,10001117921,CDM,301,RC,83516,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY NEPHELOMETRY NES,10001117923,CDM,301,RC,83883,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULE NUCLEIC AMPLI 2,10001117925,CDM,301,RC,81383,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY PROTEIN URINE,10001117927,CDM,301,RC,84156,HCPCS,facility,both,,,,17,17,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN EPHORESIS/URINE/C,10001117929,CDM,301,RC,84166,HCPCS,facility,both,,,,71,71,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECTROPHOTOMETRY,10001117931,CDM,301,RC,84311,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFERASE (AST)(SGOT),10001117933,CDM,301,RC,84450,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALANINE AMINO ALT SGPT,10001117935,CDM,301,RC,84460,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY OF TRIGLYCERIDES,10001117937,CDM,301,RC,84478,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SSP POTASSIUM 84132,10001117939,CDM,301,RC,84132,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY OF URINE CREATININE,10001117941,CDM,301,RC,82570,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RIA NONANTIBODY,10001117943,CDM,301,RC,83519,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULE DOT/SLOT/BLOT,10001117945,CDM,301,RC,81479,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYSIS OF TISSUE CELLS,10001117947,CDM,301,RC,81479,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN WESTERN BLOT TEST,10001117949,CDM,301,RC,84182,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULE MUTATION ID,10001117951,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULE MUTATION ID 2ND,10001117953,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULE MUTATION ID 3RD,10001117955,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLECULE MUTATION ID 4TH,10001117957,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NUCLEIC ACID, HI RESOLUTE",10001117959,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NUCLEIC ACID, HI RESOLUTE",10001117961,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NUCLEIC ACID, HI RESOLUTE",10001117963,CDM,301,RC,81479,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-MOLECULAR DIAG; INTER,10001117969,CDM,301,RC,81479,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-MOLEC DIAG;AMP NUC AC,10001117971,CDM,301,RC,81479,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-MOLEC DIAG;ISOLAT/EXT,10001117973,CDM,301,RC,81240,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-AUTO ANTI-IGA QT,10001117975,CDM,301,RC,83519,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C I Q,10001117977,CDM,302,RC,86162,HCPCS,facility,both,,,,349,349,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA IGM TITER,10001117979,CDM,302,RC,86713,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIRUS (CFT) 86171,10001117981,CDM,302,RC,86171,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOPLASMA PNEU IGM,10001117983,CDM,302,RC,86738,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLAMDIA PNEUM TWAR IGM,10001117985,CDM,302,RC,86632,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FLU, 3 ANT-ST 86710",10001117987,CDM,302,RC,86710,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAN T CD3,10001117991,CDM,302,RC,86359,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI - DNA,10001117993,CDM,302,RC,86225,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOELECTRO-Q 86320,10001117995,CDM,302,RC,86320,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC A-MITOCHON,10001117997,CDM,302,RC,86256,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-SM MUSCLE,10001117999,CDM,302,RC,86256,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC T CELL, CD4, CD8, RATIO",10001118001,CDM,302,RC,86360,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FTA-BLOOD,10001118003,CDM,302,RC,86780,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC COMPLEMENT, C-3 86160",10001118005,CDM,302,RC,86160,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPLEMENT TOTAL,10001118007,CDM,302,RC,86162,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNDELECTROPHARISM,10001118009,CDM,302,RC,86325,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPLEMENT C - 4 86160,10001118011,CDM,302,RC,86160,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B-J PROT ELEC-B 86320,10001118013,CDM,302,RC,86320,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CA 15-3,10001118015,CDM,302,RC,86300,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP A AB-IGG,10001118017,CDM,302,RC,86708,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B CORE ANTIBODY,10001118019,CDM,302,RC,86704,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B SURFACE ANTIBODY,10001118021,CDM,302,RC,86706,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP BE ANTIBODY,10001118023,CDM,302,RC,86707,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP A AB-IGM,10001118025,CDM,302,RC,86709,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B ANTIBODY 86707,10001118031,CDM,302,RC,86707,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC V.D.R.L. CSF 86592,10001118033,CDM,302,RC,86592,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-NUCLEAR TITER 86256,10001118035,CDM,302,RC,86256,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RA LATEX-QL 86430,10001118037,CDM,302,RC,86430,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMES DISEASE TITER 86618,10001118039,CDM,302,RC,86618,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AGGLUT FEB EA 86000,10001118041,CDM,302,RC,86000,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHAGAS DISEASE SCREEN 860,10001118043,CDM,302,RC,86063,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-NUCLEAR AN 86225,10001118045,CDM,302,RC,86255,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STS. VDRL OR RP QUAL 8659,10001118047,CDM,302,RC,86592,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-STREPTOLY TITER 8606,10001118049,CDM,302,RC,86060,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROGLOB ANTI,10001118051,CDM,302,RC,86800,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AGGLUT TRICHINA,10001118053,CDM,302,RC,86784,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLD AGGULT TITER,10001118055,CDM,302,RC,86157,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MONO-SCREEN TST 86308,10001118057,CDM,302,RC,86308,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RA LATEX-QT,10001118059,CDM,302,RC,86431,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASO - SCREEN 86063,10001118061,CDM,302,RC,86063,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C - REACTIVE PROT 86140,10001118063,CDM,302,RC,86140,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPLEMENT FIXA,10001118065,CDM,302,RC,86171,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HETEROPHIL TITE 86310,10001118067,CDM,302,RC,86310,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STS, VDRL OR RP QUANT 865",10001118069,CDM,302,RC,86593,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CA 125,10001118071,CDM,302,RC,86304,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TB GOLD(QUANTIFERON),10001118073,CDM,302,RC,86480,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENCEPHALITIS PANEL(MENIN,10001118075,CDM,302,RC,86603,HCPCS,facility,both,,,,2594,2594,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TYPHOID SEROLOGY*,10001118077,CDM,302,RC,86768,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HELICOBACTOR PLYORI AB IG,10001118079,CDM,302,RC,86677,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TORCH TOTER PANEL*,10001118081,CDM,302,RC,86778,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MENINGOENCEPHALITIS PNL S,10001118083,CDM,302,RC,86603,HCPCS,facility,both,,,,2542,2542,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TULAREMIA ANTIBODY,10001118085,CDM,302,RC,86668,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PNEUMO SCRN IMMUNGL EA-AN,10001118087,CDM,302,RC,86403,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STREP PNEUMO AG(URINE),10001118089,CDM,302,RC,86403,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STREP PNEUMO ANTIGEN BLOO,10001118091,CDM,302,RC,86403,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PNEUMONIA SCREEN - ASPERG,10001118093,CDM,302,RC,86606,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PNEUMOCOCCAL ANTIBODY,10001118095,CDM,302,RC,86609,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARTONELLA ANTIBODY PANEL,10001118097,CDM,302,RC,86611,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B QUINTANA IGG,10001118099,CDM,302,RC,86611,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B HENSELAE IGM,10001118101,CDM,302,RC,86611,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B QUINTANA IGM,10001118103,CDM,302,RC,86611,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COCCIDIOIDES IMMITIS ANTI,10001118105,CDM,302,RC,86635,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EHRLICHIA,10001118107,CDM,302,RC,86666,HCPCS,facility,both,,,,785,785,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FRANCISELLA ANTIBODY,10001118109,CDM,302,RC,86668,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYSTICERCUS ANTIBODY ELIS,10001118111,CDM,302,RC,86682,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES SIMPLEX AB 1,10001118113,CDM,302,RC,86695,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA AB IGG,10001118117,CDM,302,RC,86713,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUMPS ANTIBODY IGG,10001118119,CDM,302,RC,86735,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARVOVIRUS IGG,10001118121,CDM,302,RC,86747,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARVOVIRUS IGM,10001118123,CDM,302,RC,86747,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMOEBA ANTIBODY,10001118125,CDM,302,RC,86753,HCPCS,facility,both,,,,121,121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTOZOA ANTIBODY NOS,10001118127,CDM,302,RC,86753,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WEST NILE VIRUS AB IGM,10001118129,CDM,302,RC,86788,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WEST NILE VIRUS ANITBODY,10001118131,CDM,302,RC,86789,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIRUS NOT ELSEWHERE SPECI,10001118133,CDM,302,RC,86790,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIRUS ANTIBODY NOS,10001118135,CDM,302,RC,86790,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA IGM TITER,10001118139,CDM,302,RC,86713,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CMV, IGM TITER 86645",10001118141,CDM,302,RC,86645,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VAR. ZOST TITER 86787,10001118143,CDM,302,RC,86787,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TEICHOIC ACID TITER 86329,10001118145,CDM,302,RC,86329,HCPCS,facility,both,,,,412,412,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CIE - BACT ANTIGEN,10001118147,CDM,302,RC,86185,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RUBELLA IGM TIT 86762,10001118149,CDM,302,RC,86762,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COXSACKIE B1-6/ENTEROVIRU,10001118151,CDM,302,RC,86658,HCPCS,facility,both,,,,1271,1271,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMOEBA AGGLUTN 86753,10001118153,CDM,302,RC,86753,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTOPLAS AN 86698,10001118155,CDM,302,RC,86698,HCPCS,facility,both,,,,352,352,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA EIA 86713,10001118157,CDM,302,RC,86713,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RUBEOLA 86765,10001118159,CDM,302,RC,86765,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RUBELLA 86762,10001118161,CDM,302,RC,86762,HCPCS,facility,both,,,,268,268,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOXOPLASMA 86777,10001118163,CDM,302,RC,86777,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOXOPLASMA IGM 86778,10001118165,CDM,302,RC,86778,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WEST NILE VIRUS IGG,10001118167,CDM,302,RC,86789,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WEST NILE VIRUS IGM,10001118169,CDM,302,RC,86788,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BABESIA MICROTI IGG/IGM*,10001118171,CDM,302,RC,86753,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DENQUE FEVER ANTIBODY PAN,10001118173,CDM,302,RC,86790,HCPCS,facility,both,,,,394,394,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIRUS (CFT) 86171,10001118175,CDM,302,RC,86171,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VIRUS,FLUORES 86255",10001118177,CDM,302,RC,86790,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADENOVIRUS 86603,10001118179,CDM,302,RC,86603,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMPHOCYTIC 86727,10001118181,CDM,302,RC,86727,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMPHOGRAN VEN,10001118183,CDM,302,RC,86729,HCPCS,facility,both,,,,193,193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POLIO-CFT 86658,10001118185,CDM,302,RC,86658,HCPCS,facility,both,,,,438,438,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC Q FEVER 86638,10001118187,CDM,302,RC,86638,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ROCKY MTN SPOT 86000,10001118189,CDM,302,RC,86000,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENCEPH, EAST EQ 86652",10001118191,CDM,302,RC,86652,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARAINFLUENZA 86790,10001118193,CDM,302,RC,86790,HCPCS,facility,both,,,,421,421,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENCEPH/ST. LOUIS 86653,10001118195,CDM,302,RC,86653,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENCEPH, WEST EQ 86654",10001118197,CDM,302,RC,86654,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOPLAMS TITER 86738,10001118199,CDM,302,RC,86738,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CMV IGG TITER,10001118201,CDM,302,RC,86644,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENCEPH/CAL EQ,10001118203,CDM,302,RC,86651,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUMPS (CFT) 86735,10001118205,CDM,302,RC,86735,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PSITTASCOSIS-CFT 86631,10001118207,CDM,302,RC,86631,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HELIOCOBACTER AB TITTER I,10001118209,CDM,302,RC,86677,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOPLASMA PNEU IGM,10001118211,CDM,302,RC,86738,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOPLASMA PNEUM IGG,10001118213,CDM,302,RC,86738,HCPCS,facility,both,,,,283,283,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLMDIA PNEUM TWAR IGG,10001118215,CDM,302,RC,86631,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLAMDIA PNEUM TWAR IGM,10001118217,CDM,302,RC,86632,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FLU, 3 ANT-ST 86710",10001118219,CDM,302,RC,86710,HCPCS,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FLU, 3 ANT-2ND 86710",10001118221,CDM,302,RC,86710,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EBV IGM NA 86664,10001118223,CDM,302,RC,86664,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EBV IGM VCA 86665,10001118225,CDM,302,RC,86665,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EBVIGG NA 86664,10001118227,CDM,302,RC,86664,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EBV IGG VCA 86665,10001118229,CDM,302,RC,86665,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES SIMPLEX OTHER 8669,10001118231,CDM,302,RC,86694,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HERPES SIMPLEX TYPE 1, 86",10001118237,CDM,302,RC,86695,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLASTOMYCES COMP FIX,10001118239,CDM,302,RC,86612,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLASTOMYCES 1MM DIFF,10001118241,CDM,302,RC,86612,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SACCHAROMYCES IGG,10001118243,CDM,302,RC,86671,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SACCHAROMYCES IGA,10001118245,CDM,302,RC,86671,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INHIBIN A,10001118247,CDM,302,RC,86336,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CELIAC DISEASE SEROLOGY*,10001118249,CDM,302,RC,86255,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTIPHOSPOLIPID AB PANEL*,10001118251,CDM,302,RC,86148,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHYPHATADYLSERINE AB*,10001118253,CDM,302,RC,86148,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET ANTIBODY INDIREC,10001118255,CDM,302,RC,86022,HCPCS,facility,both,,,,405,405,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPHATIDYLSERINE AB*,10001118257,CDM,302,RC,86148,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLATELET ASSOC AB IGG,IGM",10001118259,CDM,302,RC,86023,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTIPROTEINASE 3 AB,10001118261,CDM,302,RC,86021,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RESPIRATORY DISEASE PANEL,10001118263,CDM,302,RC,86003,HCPCS,facility,both,,,,334,334,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FOOD ALLERGY PROFILE*,10001118265,CDM,302,RC,86003,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HGA ANAPLASMOSIS*,10001118267,CDM,302,RC,86666,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN ELECTRPHORESIS UR,10001118269,CDM,302,RC,86335,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STRONGYLOIDES IGG ANTIBOD,10001118271,CDM,302,RC,86682,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIVER KIDNEY MICROSOME IG,10001118273,CDM,302,RC,86376,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LUPUS ERYTHEMATOSIS PROFI,10001118275,CDM,302,RC,86038,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROMETHEUS IBD DX W CHROH,10001118277,CDM,302,RC,86140,HCPCS,facility,both,,,,1115,1115,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SCLERODERMA AB SCL-70,10001118279,CDM,302,RC,86235,HCPCS,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTICARDIOLIPIN A/B,10001118281,CDM,302,RC,86147,HCPCS,facility,both,,,,634,634,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTINEURONAL A/B,10001118283,CDM,302,RC,86255,HCPCS,facility,both,,,,849,849,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CRP, QUAN",10001118285,CDM,302,RC,86140,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FECAL ELECTROLYTES*,10001118287,CDM,302,RC,84302,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GRANULOCYTE ANTIBODY,10001118289,CDM,302,RC,86021,HCPCS,facility,both,,,,508,508,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SERONTONIN RELEASE ASSAY,10001118291,CDM,302,RC,86022,HCPCS,facility,both,,,,588,588,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRP CARDIO (HI SENS),10001118295,CDM,302,RC,86141,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BETA2 GLYCOPROTIEN I,10001118297,CDM,302,RC,86146,HCPCS,facility,both,,,,222,222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C1 ESTARRASE FUNCTIONAL,10001118299,CDM,302,RC,86161,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC JO-1 ANTIBODY,10001118301,CDM,302,RC,86235,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRINSIC BLOCKING FACTOR,10001118303,CDM,302,RC,86340,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PNH BY FLOW CYTOMETRY,10001118305,CDM,302,RC,86356,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAN T CD3,10001118307,CDM,302,RC,86359,HCPCS,facility,both,,,,252,252,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BORDETELLA ANTIBODY1,10001118309,CDM,302,RC,86615,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BORDETELLA ANTIBODY2,10001118311,CDM,302,RC,86615,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HELMINTH SEROLOGY,10001118313,CDM,302,RC,86682,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PNEUMONITIS HYPERSENSITIV,10001118315,CDM,302,RC,86744,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CA 27.29,10001118317,CDM,302,RC,86300,HCPCS,facility,both,,,,285,285,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANCA PANEL,10001118319,CDM,302,RC,86021,HCPCS,facility,both,,,,1211,1211,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI - DNA,10001118321,CDM,302,RC,86225,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEOXYRIBONUCLEASE ANTIBOD,10001118323,CDM,302,RC,86215,HCPCS,facility,both,,,,202,202,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOELECTRO-Q 86320,10001118325,CDM,302,RC,86320,HCPCS,facility,both,,,,533,533,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC A-MITOCHON,10001118327,CDM,302,RC,86256,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC T CELLS, CD4, CD8, RATIO",10001118329,CDM,302,RC,86360,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FTA - BLOOD,10001118331,CDM,302,RC,86780,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC COMPLEMENT,C-3 86160",10001118335,CDM,302,RC,86160,HCPCS,facility,both,,,,434,434,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPLEMENT TOTAL,10001118337,CDM,302,RC,86162,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPLIMENT C-4 FLUID,10001118339,CDM,302,RC,86160,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDOMYSIAL ANITBODY SCREE,10001118341,CDM,302,RC,86255,HCPCS,facility,both,,,,193,193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BORDETELLA PERTUSSIS IGG/,10001118343,CDM,302,RC,86615,HCPCS,facility,both,,,,274,274,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEPTOSPIRA AB SCREEN,10001118345,CDM,302,RC,86720,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HLA-B27,10001118347,CDM,302,RC,86812,HCPCS,facility,both,,,,434,434,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOELECT-FLDS 86325,10001118349,CDM,302,RC,86325,HCPCS,facility,both,,,,569,569,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOELECTROPHARISM,10001118351,CDM,302,RC,86325,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPLEMENT C-4 86160,10001118355,CDM,302,RC,86160,HCPCS,facility,both,,,,434,434,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B-J PROT ELEC-B86320,10001118357,CDM,302,RC,86320,HCPCS,facility,both,,,,533,533,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SJORGRENS ANTIBODY FIRST,10001118359,CDM,302,RC,86235,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SJORGENS ANTIBODY SECOND,10001118361,CDM,302,RC,86235,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEURONAL NUCLEAR (HU) AB,10001118363,CDM,302,RC,86255,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEURONAL NUCLEAR (RI) AB,10001118365,CDM,302,RC,86255,HCPCS,facility,both,,,,326,326,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PURKINKE CELL CYTOPLAS AB,10001118367,CDM,302,RC,86255,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CA 15-3,10001118369,CDM,302,RC,86300,HCPCS,facility,both,,,,362,362,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CA 19-9,10001118371,CDM,302,RC,86301,HCPCS,facility,both,,,,336,336,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CA 125,10001118373,CDM,302,RC,86304,HCPCS,facility,both,,,,362,362,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP E ANTIBODIES*,10001118375,CDM,302,RC,86790,HCPCS,facility,both,,,,339,339,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP A AB-IGG,10001118377,CDM,302,RC,86708,HCPCS,facility,both,,,,216,216,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLD AUTO ABSOR86978,10001118379,CDM,302,RC,86978,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATITIS BC ANTIBODY IGM,10001118381,CDM,302,RC,86705,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B CORE ANTIBODY,10001118383,CDM,302,RC,86704,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B SURFACE ANTIBODY,10001118385,CDM,302,RC,86706,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATITIS D 86692,10001118387,CDM,302,RC,86692,HCPCS,facility,both,,,,121,121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP SCREEN-HBCAB,10001118389,CDM,302,RC,86704,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP SCREEN-HAAB,10001118391,CDM,302,RC,86709,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP SCREEN-HCAB,10001118393,CDM,302,RC,86803,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP BE ANTIBODY,10001118395,CDM,302,RC,86707,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP C AB,10001118397,CDM,302,RC,86803,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP A AB-IGM,10001118399,CDM,302,RC,86709,HCPCS,facility,both,,,,244,244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI HIV 86703,10001118401,CDM,302,RC,86703,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WESTERN BLOT 86689,10001118403,CDM,302,RC,86689,HCPCS,facility,both,,,,559,559,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI HTLVI,10001118405,CDM,302,RC,86687,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIV 1,10001118407,CDM,302,RC,86701,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIV 2,10001118409,CDM,302,RC,86702,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HBNEUT,10001118411,CDM,302,RC,86382,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HCVRIB,10001118413,CDM,302,RC,86804,HCPCS,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HTLV II AB 86688,10001118415,CDM,302,RC,86688,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HLA TYPING - A,B,C",10001118417,CDM,302,RC,86813,HCPCS,facility,both,,,,2075,2075,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEUKOCYTE AB 86021,10001118419,CDM,302,RC,86021,HCPCS,facility,both,,,,215,215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET ANTIBODY DIRECT,10001118421,CDM,302,RC,86022,HCPCS,facility,both,,,,215,215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI PLATELET AB INDIRECT,10001118423,CDM,302,RC,86022,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPERIN INDUCED PLATELET,10001118425,CDM,302,RC,86022,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI PLATELET AB DIRECT,10001118427,CDM,302,RC,86023,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B SURF ANTI,10001118429,CDM,302,RC,86706,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC V.D.R.L. CSF 86592 QUAL,10001118431,CDM,302,RC,86592,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGM ANTIBODY HEPATITER,10001118433,CDM,302,RC,86709,HCPCS,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WBLYME IGG,10001118435,CDM,302,RC,86617,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-THYROID PEROXIDASE A,10001118437,CDM,302,RC,86376,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WBLYME IGM,10001118439,CDM,302,RC,86617,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RA LATEX-QL 86430,10001118443,CDM,302,RC,86430,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMES DISEASE TITER 86618,10001118445,CDM,302,RC,86618,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENA IGG & IGM,10001118447,CDM,302,RC,86235,HCPCS,facility,both,,,,352,352,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AGGLU TULAREMIA86668,10001118451,CDM,302,RC,86668,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AGGLUT FEB EA 86000,10001118453,CDM,302,RC,86000,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AGGLUT-BRUCELLA,10001118457,CDM,302,RC,86622,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-NUCLEAR ANTIBODY 860,10001118459,CDM,302,RC,86038,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANA, TITER 86039",10001118461,CDM,302,RC,86039,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MICROSOMAL ANTI85385,10001118463,CDM,302,RC,86376,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STS. VDRL OR RP86592 QUAL,10001118465,CDM,302,RC,86592,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-STREPTOLY 86060,10001118467,CDM,302,RC,86060,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROGLOB ANTI,10001118469,CDM,302,RC,86800,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AGGLUT TRICHINA,10001118471,CDM,302,RC,86784,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLD AGGULT TITER,10001118473,CDM,302,RC,86157,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAST TEST EACH,10001118477,CDM,302,RC,86003,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MONO-SCREEN TST 86308,10001118479,CDM,302,RC,86308,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RA LATEX-QT,10001118481,CDM,302,RC,86431,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANITBODIES, FTA BLOOD",10001118483,CDM,302,RC,86780,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASO-SCREEN 86063,10001118485,CDM,302,RC,86063,HCPCS,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C-REACTIVE PROT86140,10001118487,CDM,302,RC,86140,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AGG LEPTO DEFIN86597,10001118489,CDM,302,RC,86720,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HETEROPHIL TITE86310,10001118493,CDM,302,RC,86310,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STS,VDRL OR RP86593 QUANT",10001118495,CDM,302,RC,86593,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BENCE-JONES QUANT*,10001118497,CDM,302,RC,86335,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALLERGEN SPECIFIC IGE,10001118499,CDM,302,RC,86003,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOGLOBULIN ASSAY,10001118501,CDM,302,RC,86023,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C-REACTIVE PROTEIN,10001118503,CDM,302,RC,86140,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GLYCOPROTEIN ANTIBODY,10001118505,CDM,302,RC,86146,HCPCS,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARDIOLIPIN ANTIBODY,10001118507,CDM,302,RC,86147,HCPCS,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPHOLIPID ANTIBODY,10001118509,CDM,302,RC,86148,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA ANTIBODY,10001118511,CDM,302,RC,86225,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA ANTIBODY SIGNLE STRAN,10001118513,CDM,302,RC,86225,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NUCLEAR ANTIGEN ANTIBODY,10001118515,CDM,302,RC,86235,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOURESCENT ANTIBODY SCRE,10001118517,CDM,302,RC,86255,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYME DISEASE ANTIBODY,10001118519,CDM,302,RC,86618,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CMV ANITBODY,10001118521,CDM,302,RC,86644,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CMV ANTIBODY, IGM",10001118523,CDM,302,RC,86645,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENCEPHALITIS AB CALIFORNI,10001118525,CDM,302,RC,86651,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENCEPHALITIS AB EASTERN,10001118527,CDM,302,RC,86652,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENCEPHALITIS AB ST LOUIS,10001118529,CDM,302,RC,86653,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENCEPHALITIS AB WESTERN,10001118531,CDM,302,RC,86654,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENTEROVIRUS ANTIBODY,10001118533,CDM,302,RC,86658,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EHRLICHIA ANTIBODY,10001118535,CDM,302,RC,86666,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES SIMPLEX TEST,10001118537,CDM,302,RC,86694,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES SIMPLEX TYPE 1 TES,10001118539,CDM,302,RC,86695,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES SIMPLEX TYPE 2,10001118541,CDM,302,RC,86696,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFLUENZA VIRUS ANTIBODY,10001118543,CDM,302,RC,86710,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMPH CHORIOMENINGITIS AB,10001118545,CDM,302,RC,86727,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUMPS ANTIBODY,10001118547,CDM,302,RC,86735,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RUBELLA ANTIBODY,10001118549,CDM,302,RC,86762,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RUBEOLA ANTIBODY,10001118551,CDM,302,RC,86765,HCPCS,facility,both,,,,41,41,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALMONELL ANTIBODY,10001118553,CDM,302,RC,86768,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOXOPLASMA ANTIBODY,10001118555,CDM,302,RC,86777,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VARICELLA-ZOSTER ANTIBODY,10001118557,CDM,302,RC,86787,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNODIFFUSION OUCHTERLO,10001118559,CDM,302,RC,86331,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNODIFFUSION OUCHTERLO,10001118561,CDM,302,RC,86331,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASPERGILLUS AB 1,10001118563,CDM,302,RC,86606,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASPERGILLUS AB 2,10001118565,CDM,302,RC,86606,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASPERGILLUS AB 3,10001118567,CDM,302,RC,86606,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FUNGUS AB 1,10001118569,CDM,302,RC,86671,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FUNGUS AB 2,10001118571,CDM,302,RC,86671,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP E IGG,10001118573,CDM,302,RC,86790,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-DIFF ABSORBTIONS,10001118575,CDM,302,RC,86978,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-INHIBITION STUDIES,10001118577,CDM,302,RC,86977,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-TITRATION OF ANTIBODY,10001118579,CDM,302,RC,86976,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-DRUG STUDIES,10001118581,CDM,302,RC,86975,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PLATELET AB XM,10001118583,CDM,302,RC,86022,HCPCS,facility,both,,,,684,684,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PLATELET AB SCREEN,10001118585,CDM,302,RC,86022,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PLATELET ANTIBODY ID,10001118587,CDM,302,RC,86022,HCPCS,facility,both,,,,527,527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PLATELET ANTIGEN TYPE,10001118589,CDM,302,RC,86022,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PLATELET ANTIGEN TYPE,10001118591,CDM,302,RC,86022,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PLATELET ANTIGEN TYPE,10001118593,CDM,302,RC,86849,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-SERUM SCR CYTOTOX PRA,10001118595,CDM,302,RC,86807,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-SERUM SCR CYTOTOX PRA,10001118597,CDM,302,RC,86808,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-FLOW CYTOMETRY FOR AB,10001118599,CDM,302,RC,86849,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-SERUM SCR CYTOTOX PRA,10001118601,CDM,302,RC,86807,HCPCS,facility,both,,,,181,181,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-SERUM SCR CYTOTOX PRA,10001118603,CDM,302,RC,86808,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-FLOW CYTOMETRY FOR AB,10001118605,CDM,302,RC,86849,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-HLA TYPING-SEROLOGICA,10001118607,CDM,302,RC,86813,HCPCS,facility,both,,,,350,350,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FIBRINOGEN, ACTIVITY 8538",10001118609,CDM,305,RC,85384,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VISCOSITY, SERUM 85810",10001118611,CDM,305,RC,85810,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACID HEMOLYSIS 85475,10001118613,CDM,305,RC,85475,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE MARROW EXAM,10001118615,CDM,305,RC,85097,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALKPHOS SMEAR 85540,10001118619,CDM,305,RC,85540,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ERYTHROCYTE CNT 85041,10001118623,CDM,305,RC,85041,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOGLOBIN,10001118625,CDM,305,RC,85018,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WBC ONLY,10001118629,CDM,305,RC,85048,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEMOGLOBIN, CYAN 85018",10001118631,CDM,305,RC,85018,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE MARROW 85097,10001118633,CDM,305,RC,85097,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMATROCRIT,10001118635,CDM,305,RC,85014,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RETICULOCYTE CN AUTO,10001118639,CDM,305,RC,85045,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SED RATE NON AUTO,10001118641,CDM,305,RC,85651,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SICKLE CELL PRE 85660,10001118643,CDM,305,RC,85660,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOGLOBIN FETA 85460,10001118645,CDM,305,RC,85460,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACT PTT SUB 85732,10001118647,CDM,305,RC,85732,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EUGLOGULIN CLOT 85360,10001118649,CDM,305,RC,85360,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR II ASSAY 85210,10001118651,CDM,305,RC,85210,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VIII ASSAY 85240,10001118653,CDM,305,RC,85240,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR IX ASSAY,10001118655,CDM,305,RC,85250,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR X ASSAY 85260,10001118657,CDM,305,RC,85260,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTO XI ASSAY 85270,10001118659,CDM,305,RC,85270,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR XII ASSAY 85280,10001118661,CDM,305,RC,85280,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR XIII ASSAY 85290,10001118663,CDM,305,RC,85290,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CIRCULATION ANT 85300,10001118665,CDM,305,RC,85300,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FIBRIN PR 85362,10001118667,CDM,305,RC,85362,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTAMINE SULF 85530,10001118669,CDM,305,RC,85530,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARTIAL THROMBO 85730,10001118671,CDM,305,RC,85730,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR V ASSAY 85220,10001118673,CDM,305,RC,85220,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VII ASSAY 85230,10001118675,CDM,305,RC,85230,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOT RETRACTION 85170,10001118677,CDM,305,RC,85170,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THROMBIN TIME PLASMA 8567,10001118679,CDM,305,RC,85670,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTHROMBIN TIM 85610,10001118681,CDM,305,RC,85610,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR III ASSAY 85300,10001118683,CDM,305,RC,85300,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTHRO SUM TST 85612,10001118685,CDM,305,RC,85611,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C B C,10001118687,CDM,305,RC,85025,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOGLOBIN 85018,10001118689,CDM,305,RC,85018,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR 5 LEIDEN,10001118691,CDM,305,RC,85220,HCPCS,facility,both,,,,440,440,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LUPUS ANTICOAGULANT,10001118693,CDM,305,RC,85705,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN C ACTIVITY,10001118695,CDM,305,RC,85303,HCPCS,facility,both,,,,302,302,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN S TOTAL,10001118697,CDM,305,RC,85305,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACTIVATED PROTEIN C RESIS,10001118699,CDM,305,RC,85307,HCPCS,facility,both,,,,185,185,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN S FREE,10001118701,CDM,305,RC,85306,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KAOLIN CLOTTING TIME,10001118703,CDM,305,RC,85347,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLASMINOGEN FIBRINOLYTIC,10001118705,CDM,305,RC,85420,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APT,10001118707,CDM,305,RC,85460,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RUSSELLS VIPER VENOM TIME,10001118709,CDM,305,RC,85612,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RISTOCETIN COFACTOR,10001118711,CDM,305,RC,85245,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ART HEMOGLOBIN 85018,10001118713,CDM,305,RC,85018,HCPCS,facility,both,,,,121,121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FIBRINOGEN, QUA 85384 ACT",10001118715,CDM,305,RC,85384,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VISCOSITY, SERUM 85810",10001118717,CDM,305,RC,85810,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACID HEMOLYSIS 85475,10001118719,CDM,305,RC,85475,HCPCS,facility,both,,,,135,135,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPARIN ANTI-XA ASSAY,10001118721,CDM,305,RC,85520,HCPCS,facility,both,,,,420,420,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION REACTION,10001118723,CDM,305,RC,86078,HCPCS,facility,both,,,,91,91,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VON WILLEBRAND FACTR VIII,10001118727,CDM,305,RC,85246,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC D-DIMER QUANT,10001118729,CDM,305,RC,85379,HCPCS,facility,both,,,,222,222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC D-DIMER QUAL/SEMIQT 8537,10001118731,CDM,305,RC,85378,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET NEUTRALIZATION,10001118733,CDM,305,RC,85597,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET COUNT 85049,10001118735,CDM,305,RC,85049,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALK PHOS SMEAR 85540,10001118737,CDM,305,RC,85540,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IN/OUT BLOOD CT85027,10001118739,CDM,305,RC,85027,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MORPH RBC OTHER 85008,10001118741,CDM,305,RC,85008,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ERYTHROCYTE CNT85041,10001118743,CDM,305,RC,85041,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOGLOBIN,10001118745,CDM,305,RC,85018,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLD CT; MANUAL DIFF WBC C,10001118747,CDM,305,RC,85007,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WBC & DIFF BLD 85025,10001118749,CDM,305,RC,85025,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WBC ONLY,10001118751,CDM,305,RC,85048,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEMOGLOBIN,CYAN85018",10001118753,CDM,305,RC,85018,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMP BLOOD CNT 85025,10001118755,CDM,305,RC,85025,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOTAL EO COUNT 85048,10001118757,CDM,305,RC,85048,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMATOCRIT,10001118759,CDM,305,RC,85014,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RETICULOCYTE CN AUTO 8504,10001118763,CDM,305,RC,85045,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SED RATE NON AUTO,10001118765,CDM,305,RC,85651,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SICKLE CELL PRE85660,10001118767,CDM,305,RC,85660,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMOGLOBIN FETA85460,10001118769,CDM,305,RC,85460,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VON WILLEBRAND MULTIMERS,10001118773,CDM,305,RC,85247,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR 13,10001118775,CDM,305,RC,85290,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTITHROMBIN III,10001118777,CDM,305,RC,85300,HCPCS,facility,both,,,,108,108,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN C ANTIGEN,10001118779,CDM,305,RC,85302,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN S (TOTAL),10001118781,CDM,305,RC,85305,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTEIN S (FREE),10001118783,CDM,305,RC,85306,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR 8 INHIBITOR,10001118785,CDM,305,RC,85335,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACT PTT SUB 85732,10001118787,CDM,305,RC,85732,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EUGLOGULIN CLOT85360,10001118789,CDM,305,RC,85360,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR II ASSAY85210,10001118791,CDM,305,RC,85210,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VIII ASS85240,10001118793,CDM,305,RC,85240,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR IX ASSAY85250,10001118795,CDM,305,RC,85250,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR X ASSAY 85260,10001118797,CDM,305,RC,85260,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR XI ASSAY85270,10001118799,CDM,305,RC,85270,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR XII ASSA85280,10001118801,CDM,305,RC,85280,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR XIII ASS85290,10001118803,CDM,305,RC,85290,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CIRCULATING ANT85300,10001118805,CDM,305,RC,85300,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET AGGREG,10001118807,CDM,305,RC,85576,HCPCS,facility,both,,,,376,376,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET MANUAL COUNT 855,10001118809,CDM,305,RC,85032,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FIBRIN SPLIT PR85362,10001118811,CDM,305,RC,85362,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTAMINE SULF 85530,10001118813,CDM,305,RC,85530,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARTIAL THROMBO85730,10001118815,CDM,305,RC,85730,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THROMBOPLASTIN SUBSTITUTI,10001118817,CDM,305,RC,85732,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR V ASSAY 85220,10001118819,CDM,305,RC,85220,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VII ASSA85230,10001118821,CDM,305,RC,85230,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLEEDING TIME 85002,10001118823,CDM,305,RC,85002,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR I ASSAY 85384,10001118827,CDM,305,RC,85384,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOT RETRACTION85170,10001118829,CDM,305,RC,85170,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THROMBIN TIME PLATELET 85,10001118831,CDM,305,RC,85670,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTHROMBIN TIM85610,10001118833,CDM,305,RC,85610,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR III ASSA85300,10001118835,CDM,305,RC,85300,HCPCS,facility,both,,,,302,302,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTHRO SUB TST 85611,10001118837,CDM,305,RC,85611,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SSP HEMOGRAM 85021,10001118839,CDM,305,RC,85027,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-UNIT SICKLING RBC RED,10001118841,CDM,305,RC,85660,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA CULTURE,10001118845,CDM,306,RC,87040,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES CULT 87252,10001118847,CDM,306,RC,87252,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANAROBIC CULT 87075,10001118849,CDM,306,RC,87075,HCPCS,facility,both,,,,108,108,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONCENTRATION T 87015,10001118851,CDM,306,RC,87015,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYPT ANTGEN SCRN,10001118853,CDM,306,RC,87328,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOCHEM, 1ST PANEL",10001118855,CDM,306,RC,87077,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOCHEM, EA ADD'L PANEL",10001118857,CDM,306,RC,87077,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULT STOOL VIBRIO,10001118859,CDM,306,RC,87046,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULT STOOL E COLI,10001118861,CDM,306,RC,87046,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLOOD CULTURE 87040,10001118863,CDM,306,RC,87040,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB SMEAR ONLY 87206,10001118865,CDM,306,RC,87206,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB ID 87118,10001118867,CDM,306,RC,87118,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB CULT CONC/ID,10001118869,CDM,306,RC,87116,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB SENST 87190,10001118871,CDM,306,RC,87190,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIRAL CULTURE 87252,10001118875,CDM,306,RC,87252,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BACT.CULT,URINE, ID KIT",10001118877,CDM,306,RC,87088,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VIRUS LD;TISS CUL,ADDL ST",10001118879,CDM,306,RC,87253,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FUNGUS YEAST ID 87106,10001118881,CDM,306,RC,87106,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SENSITIVITY MIC,10001118883,CDM,306,RC,87186,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SENSITIVITY KB,10001118885,CDM,306,RC,87184,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MACROSCOPIC EXAM;ARTHROPO,10001118887,CDM,306,RC,87168,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DARKFIELD 87164,10001118889,CDM,306,RC,87164,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BACT, SMEAR, STA",10001118891,CDM,306,RC,87205,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FUNGUS CULT NOT SKIN HAIR,10001118893,CDM,306,RC,87102,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULTURE BACTERIA 87070,10001118895,CDM,306,RC,87070,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULT FUNGI DEF LD;MOLD,10001118897,CDM,306,RC,87107,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLONY CNT-URI 87086 QT,10001118899,CDM,306,RC,87086,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B SURFACE AG,10001118901,CDM,306,RC,87340,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP BE ANTIGEN,10001118903,CDM,306,RC,87350,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSTRIDIUM TOXIN,10001118905,CDM,306,RC,87324,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MALARIA SMEARS 87207,10001118907,CDM,306,RC,87207,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B SURF ANTI,10001118909,CDM,306,RC,87340,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COCCIDIO AGGLUT,10001118911,CDM,306,RC,87899,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC O&P STOOL EXAM,10001118913,CDM,306,RC,87177,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PIN WORM SLIDE,10001118915,CDM,306,RC,87172,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIM OR MAT I 87210,10001118917,CDM,306,RC,87210,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRICHOMONADS, WE 87210",10001118919,CDM,306,RC,87210,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TAPEWORM INDENT,10001118921,CDM,306,RC,87169,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SERUM BACTERICIDE,10001118927,CDM,306,RC,87197,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFUENZA A/B PCR REFLEX H,10001118931,CDM,306,RC,87798,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFUENZA A H1N1*,10001118933,CDM,306,RC,87798,HCPCS,facility,both,,,,464,464,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AZITHROMYCIN SUSCEPTIBILI,10001118935,CDM,306,RC,87186,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SUSCEPTIBILITY TEST 2 DRU,10001118937,CDM,306,RC,87186,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADENOVIRUS PCR/DNA PROBE,10001118939,CDM,306,RC,87798,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYCLOSPORA/ISOSPORA*,10001118941,CDM,306,RC,87015,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BABESIA BY PCR,10001118943,CDM,306,RC,87798,HCPCS,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC JC POLYOMA VIRUS DNA PCR,10001118945,CDM,306,RC,87798,HCPCS,facility,both,,,,255,255,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B PERTUSSIA/PARAPERTUSSIA,10001118947,CDM,306,RC,87798,HCPCS,facility,both,,,,569,569,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HUMAN HERPES VIRUS 8 DNA,10001118949,CDM,306,RC,87798,HCPCS,facility,both,,,,338,338,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARVOVIRUS B19 DNA PCR,10001118951,CDM,306,RC,87798,HCPCS,facility,both,,,,268,268,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BABESIA MICROTI DNA PCR,10001118953,CDM,306,RC,87798,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EBV DNA QT PCR,10001118955,CDM,306,RC,87799,HCPCS,facility,both,,,,595,595,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VZV DNA QL PCR,10001118957,CDM,306,RC,87798,HCPCS,facility,both,,,,498,498,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HSV TYPE 1&2 DNA PCR*,10001118959,CDM,306,RC,87529,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES SIMPLEX 1,10001118961,CDM,306,RC,87529,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENTEROVIRUS PCR,10001118963,CDM,306,RC,87498,HCPCS,facility,both,,,,544,544,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANTHRAX SCREEN, BLOOD CUL",10001118965,CDM,306,RC,87040,HCPCS,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTHRAX BLOOD CULT ONLY S,10001118967,CDM,306,RC,87040,HCPCS,facility,both,,,,373,373,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANTHRAX SCREEN, NASAL CUL",10001118969,CDM,306,RC,87070,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADENO VIRAL CULTURE,10001118971,CDM,306,RC,87254,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STREP A CULT 87081,10001118973,CDM,306,RC,87081,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CMV AMTOGENEMIA,10001118975,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HSV RAPID CULTURE,10001118977,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VZV VIRAL CULTURES,10001118979,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFLUENZA A VIRAL CULTURE,10001118981,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFLUENZA B,10001118983,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARAINFLUENZA VIRAL CULTU,10001118985,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RSV VIRAL CULTURE,10001118987,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENTEROVIRUS VIRAL CULTURE,10001118989,CDM,306,RC,87252,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONCETRATION PLUS ISOLATI,10001118991,CDM,306,RC,87116,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOBACTERIUM ID,10001118993,CDM,306,RC,87118,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ETEST MIC AEROBE,10001118995,CDM,306,RC,87181,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ETEST ANAEROBE,10001118997,CDM,306,RC,87181,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SUSCEPTIBILITY YEAST PANE,10001118999,CDM,306,RC,87186,HCPCS,facility,both,,,,644,644,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SYNERGY STUDIES (EA),10001119001,CDM,306,RC,87186,HCPCS,facility,both,,,,354,354,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FUNGI, EA DRUG 87192",10001119003,CDM,306,RC,87181,HCPCS,facility,both,,,,336,336,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLRCNT STAIN FOR BCTRIA/F,10001119005,CDM,306,RC,87206,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASPERGILLUS ANTIGEN,10001119007,CDM,306,RC,87305,HCPCS,facility,both,,,,253,253,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CMV ANTIGENT DETECTION DF,10001119009,CDM,306,RC,87332,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTO AG IMMUNO UR,10001119011,CDM,306,RC,87385,HCPCS,facility,both,,,,301,301,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RSV RAPID TEST,10001119013,CDM,306,RC,87420,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ROTAVIRUS BY EIA,10001119015,CDM,306,RC,87425,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RPD FLU ANTIBODY (AREADY,10001119017,CDM,306,RC,87400,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLU - RAPID A,10001119019,CDM,306,RC,87400,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLU RAPID B,10001119021,CDM,306,RC,87400,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA UR ANTIGEN,10001119023,CDM,306,RC,87449,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLAMYDIA PNEUM TWAR,10001119025,CDM,306,RC,87486,HCPCS,facility,both,,,,426,426,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHLAMYDIA TRACHOMATIS,AMP",10001119027,CDM,306,RC,87491,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSTRIDIUM DIFF (PCR),10001119029,CDM,306,RC,87493,HCPCS,facility,both,,,,215,215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CMV QUANT PCR,10001119031,CDM,306,RC,87496,HCPCS,facility,both,,,,712,712,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENTEROVIRUS, DNA, AMP PRO",10001119033,CDM,306,RC,87498,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCROBCTR TB AMPLFD PROBE,10001119035,CDM,306,RC,87556,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOBACERIA AVIUMINTERCEL,10001119037,CDM,306,RC,87561,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEISSERIA GONORROHEAE AMP,10001119039,CDM,306,RC,87591,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STAPH A, DNA, AMP PROBE",10001119041,CDM,306,RC,87640,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MR-STAPH, DNA, AMP PROBE",10001119043,CDM,306,RC,87641,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STREP B, DNA, AMP PROBE",10001119045,CDM,306,RC,87653,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WEST NILE CSF PCR,10001119047,CDM,306,RC,87798,HCPCS,facility,both,,,,1110,1110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA DNA PROBE,10001119053,CDM,306,RC,87540,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA CULTURE,10001119055,CDM,306,RC,87040,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STREP SCREEN 87081,10001119057,CDM,306,RC,87880,HCPCS,facility,both,,,,128,128,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLAMYDIA CULT 87110,10001119059,CDM,306,RC,87110,HCPCS,facility,both,,,,281,281,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES CULT 87252,10001119061,CDM,306,RC,87252,HCPCS,facility,both,,,,508,508,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLAMIDIA SMEAR 87207,10001119063,CDM,306,RC,87207,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANAEROBIC CULT 87075,10001119065,CDM,306,RC,87075,HCPCS,facility,both,,,,244,244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC H.PYLORI STOOL ANTIGENS,10001119067,CDM,306,RC,87338,HCPCS,facility,both,,,,352,352,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHLMYDIA PNEUM CULT 87110,10001119069,CDM,306,RC,87110,HCPCS,facility,both,,,,486,486,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYME PCR BLOOD,10001119071,CDM,306,RC,87476,HCPCS,facility,both,,,,673,673,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYME PCR FLUID,10001119073,CDM,306,RC,87476,HCPCS,facility,both,,,,673,673,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CULTURE, TISSUE",10001119075,CDM,306,RC,87070,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONCENTRATION T87015,10001119077,CDM,306,RC,87015,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEGIONELLA DFA ANTGN,10001119079,CDM,306,RC,87278,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYPT ANTGEN SCRN,10001119081,CDM,306,RC,87328,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYPT ANTGN TITER,10001119083,CDM,306,RC,87328,HCPCS,facility,both,,,,384,384,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GIARDIA,AG,EIA,STOOL",10001119085,CDM,306,RC,87329,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOCHEM, 1ST PANEL",10001119087,CDM,306,RC,87077,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOCHEM, EA ADD'L PANEL",10001119089,CDM,306,RC,87077,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULT STOOL VIBRIO,10001119091,CDM,306,RC,87046,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULT STOOL E COLI,10001119093,CDM,306,RC,87046,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLOOD CULTURE 87040,10001119095,CDM,306,RC,87040,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYPTOSPORDIOSIS(STOOL)*,10001119097,CDM,306,RC,87015,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TICK ID,10001119099,CDM,306,RC,87168,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SMEAR(FLOURESCENT/ACID),10001119101,CDM,306,RC,87206,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFLUENZA VIRUS CULTURE,10001119103,CDM,306,RC,87254,HCPCS,facility,both,,,,253,253,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SHIGA TOXINS, STL",10001119105,CDM,306,RC,87427,HCPCS,facility,both,,,,143,143,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHLM TRACHMTS, DIR PROB 8",10001119107,CDM,306,RC,87490,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYPTOSPORIDIUM,10001119109,CDM,306,RC,87272,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB SMEAR ONLY 87206,10001119111,CDM,306,RC,87206,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB ID 87118,10001119113,CDM,306,RC,87118,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB CULT CONC/ID 87117,10001119115,CDM,306,RC,87116,HCPCS,facility,both,,,,225,225,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AFB SENST 87190,10001119117,CDM,306,RC,87186,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BACT. CULT, THROAT 87060",10001119119,CDM,306,RC,87070,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BACT. CULT, OTHER, DEFIN",10001119121,CDM,306,RC,87070,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BACT.CULT, STOOL 87045",10001119123,CDM,306,RC,87045,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VIRAL CULTURE 87252,10001119125,CDM,306,RC,87252,HCPCS,facility,both,,,,304,304,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BACT.CULT URIN ID KIT EA,10001119129,CDM,306,RC,87088,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BACT CULT, ANAEROBIC 8707",10001119131,CDM,306,RC,87075,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VIRUS LD;TISS CUL,ADDL ST",10001119133,CDM,306,RC,87253,HCPCS,facility,both,,,,347,347,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FUNG CULT, SKIN 87101",10001119135,CDM,306,RC,87101,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLONY CNT-WATE00000,10001119137,CDM,306,RC,87102,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FUNG CULT, BLOOD 87103",10001119139,CDM,306,RC,87103,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SENSITIVITY MIC,10001119141,CDM,306,RC,87186,HCPCS,facility,both,,,,644,644,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SENSITIVITY KB,10001119143,CDM,306,RC,87184,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SERUMBACTERICID,10001119145,CDM,306,RC,87197,HCPCS,facility,both,,,,304,304,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MACROSCOPIC EXAM;ARTHROPO,10001119147,CDM,306,RC,87168,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DARKFIELD 87164,10001119149,CDM,306,RC,87164,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FUNGUS,SMEAR 87220",10001119151,CDM,306,RC,87220,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BACT, SMEAR, STAI",10001119153,CDM,306,RC,87205,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FUNGCULT NOT SKINHAIRNAIL,10001119155,CDM,306,RC,87102,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FUNGUS ID 87106,10001119157,CDM,306,RC,87106,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULTURE BACTERI87070,10001119159,CDM,306,RC,87070,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BETA STREP B 87081,10001119161,CDM,306,RC,87081,HCPCS,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CULT FUNGI DEF LD; MOLD,10001119163,CDM,306,RC,87107,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TYPING, POLYVAL 87151",10001119165,CDM,306,RC,87147,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLONY CNT-URI 87086,10001119167,CDM,306,RC,87086,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOPLASMS CULTURE 87109,10001119169,CDM,306,RC,87109,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSTRIDIUM OX,10001119171,CDM,306,RC,87324,HCPCS,facility,both,,,,421,421,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HELICOBCTR SCRN,10001119173,CDM,306,RC,87081,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOPLASMA PNEUM CULT,10001119175,CDM,306,RC,87109,HCPCS,facility,both,,,,846,846,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYCOPPLAMA GENITAL CULT,10001119177,CDM,306,RC,87109,HCPCS,facility,both,,,,456,456,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HERPES SIMPLEX 2 86696,10001119179,CDM,306,RC,87529,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHL/GC DNA PROBE,10001119189,CDM,306,RC,87660,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT SMEAR WET PREP,10001119191,CDM,306,RC,87210,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STOOL VRE SCREEN,10001119193,CDM,306,RC,87081,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRSA SCREEN,10001119195,CDM,306,RC,87081,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NOROVIRUS RNA/PCR,10001119197,CDM,306,RC,87081,HCPCS,facility,both,,,,623,623,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WEST NILE BLOOD PCR,10001119199,CDM,306,RC,87798,HCPCS,facility,both,,,,1110,1110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MICROSPORIDIA EXAM*,10001119201,CDM,306,RC,87015,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATITIS B DNA PCR QT,10001119203,CDM,306,RC,87517,HCPCS,facility,both,,,,657,657,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TREPONEMA PALLIDUM PCR,10001119205,CDM,306,RC,87798,HCPCS,facility,both,,,,473,473,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIV1 GENOTYPE/VIRTUAL PHE,10001119207,CDM,306,RC,87901,HCPCS,facility,both,,,,1016,1016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIV1 DNA BY PCR,10001119209,CDM,306,RC,87535,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HCV GENOTYPE,10001119211,CDM,306,RC,87902,HCPCS,facility,both,,,,763,763,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP B SURFACE AG,10001119213,CDM,306,RC,87340,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP SCREEN-HBSAG,10001119215,CDM,306,RC,87340,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP BE ANTIGEN,10001119217,CDM,306,RC,87350,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIV P24 ANTIGEN,10001119219,CDM,306,RC,87390,HCPCS,facility,both,,,,391,391,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIV- 1 RNA QT,10001119221,CDM,306,RC,87536,HCPCS,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HCVRNA QT,10001119223,CDM,306,RC,87522,HCPCS,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIV RNA QUAL,10001119225,CDM,306,RC,87535,HCPCS,facility,both,,,,599,599,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSTRIDIUM TOXIN,10001119227,CDM,306,RC,87324,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MALARIA ID 87207,10001119231,CDM,306,RC,87207,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FILARIA ID 87207,10001119233,CDM,306,RC,87207,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BLOOD PARASITES 87207,10001119235,CDM,306,RC,87207,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATITIS B SURFACE ANTIG,10001119237,CDM,306,RC,87340,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HPV AMPLIFIED PROBE*,10001119239,CDM,306,RC,87621,HCPCS,facility,both,,,,295,295,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HPV DNA AMP PROBE,10001119241,CDM,306,RC,87621,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARTONELLA HENSELAE PCR,10001119243,CDM,306,RC,87798,HCPCS,facility,both,,,,1550,1550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC O&P STOOL EXAM,10001119245,CDM,306,RC,87177,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TAPEWORM INDENT 87208,10001119247,CDM,306,RC,87169,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PIN WORM SLIDE 87208,10001119249,CDM,306,RC,87172,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIM OR MAT I 87210,10001119251,CDM,306,RC,87210,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRICHOMONADS,WE 87210",10001119253,CDM,306,RC,87210,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HSV DNA AMP PROBE,10001119257,CDM,306,RC,87529,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DETECT AGENT NOS, DNA, QU",10001119259,CDM,306,RC,87798,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENOTYPE INFECT AGENT DR,10001119261,CDM,306,RC,87900,HCPCS,facility,both,,,,515,515,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SMEAR SPECIAL STAIN,10001119263,CDM,306,RC,87207,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VIIA 1.2 MG J7189/,10001119265,CDM,636,RC,,,facility,both,,,,3105,3105,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VOLUME MEASURE 81050 URIN,10001119267,CDM,307,RC,81050,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOMOGETISIC AC 81005,10001119269,CDM,307,RC,81005,HCPCS,facility,both,,,,121,121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UA SCREEN 81003,10001119275,CDM,307,RC,81003,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC URINE, MICROSCOP 81015",10001119277,CDM,307,RC,81015,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SUGAR, QUANT",10001119279,CDM,307,RC,81002,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC URINALYSIS,ROUT 81001",10001119281,CDM,307,RC,81001,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ALBUMIN, QUAL 81005",10001119283,CDM,307,RC,81005,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BILE,QUAL 81005",10001119285,CDM,307,RC,81005,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URINALYSIS 81001,10001119287,CDM,307,RC,81001,HCPCS,facility,both,,,,24,24,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MELANIN,10001119291,CDM,307,RC,81005,HCPCS,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOMOGETISIC AC 81005,10001119293,CDM,307,RC,81005,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIFIC GRAVITY,10001119299,CDM,307,RC,81002,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VOLUME MEASURE 81050 URIN,10001119301,CDM,307,RC,81050,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETONE CONFIRM 81005,10001119303,CDM,307,RC,81005,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCULT BLOOD; URINE 82273,10001119305,CDM,307,RC,81002,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IN/OUT URINE 81003,10001119307,CDM,307,RC,81003,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UA SCREEN 81003,10001119309,CDM,307,RC,81003,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC URINE, MICROSCOP 81015",10001119311,CDM,307,RC,81015,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GLUCOSE, QUAL",10001119313,CDM,307,RC,81002,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC URINALYSIS,ROUTINE 81001",10001119315,CDM,307,RC,81001,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ALBUMIN, QUAL",10001119317,CDM,307,RC,81002,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BILE, QUAL",10001119319,CDM,307,RC,82239,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT URINE HCG QL,10001119321,CDM,307,RC,81025,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SSP URINALYSIS 81003,10001119323,CDM,307,RC,81003,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTISPERMAT ANT 89325,10001119335,CDM,309,RC,89325,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUID CELL COUNT 89051,10001119337,CDM,309,RC,89051,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SEMEN ANALYSIS POST VAS 8,10001119339,CDM,309,RC,89321,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANTHRAX,NASAL EOSINOPHIL",10001119341,CDM,309,RC,89190,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTISPERMAT ANT 89325,10001119355,CDM,309,RC,89325,HCPCS,facility,both,,,,236,236,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUID CELL COUNT 89051,10001119357,CDM,309,RC,89051,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SEMEN ANALYSIS POST VAS 8,10001119359,CDM,309,RC,89321,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NASAL SMEAR, EOS89190",10001119361,CDM,309,RC,89190,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WBC STOOL 89055,10001119363,CDM,309,RC,89055,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC JOINT FLUID CRY 89060,10001119365,CDM,309,RC,89060,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPLITTING PC,10001119367,CDM,309,RC,86985,HCPCS,facility,both,,,,139,139,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AUTOLOGOUS BLOOD,10001119369,CDM,309,RC,86890,HCPCS,facility,both,,,,278,278,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PEDI-PACK ALIQ,10001119371,CDM,309,RC,86985,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THAWING CRYO,10001119373,CDM,309,RC,86927,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THAWING FFP,10001119375,CDM,309,RC,86927,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THAWING COAGULUM,10001119377,CDM,309,RC,86927,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THAWING FP24,10001119379,CDM,309,RC,86927,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RECONSTITUTING RBC & FFP,10001119381,CDM,309,RC,86965,HCPCS,facility,both,,,,39,39,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-RETIC SEPARATION,10001119383,CDM,309,RC,86972,HCPCS,facility,both,,,,721,721,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PRETREATMENT OF RBC'S,10001119385,CDM,309,RC,86970,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-HEMO/AGGLUTININ SCRN,10001119387,CDM,309,RC,86940,HCPCS,facility,both,,,,236,236,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-ANTIGLOBULIN XM,10001119389,CDM,309,RC,86922,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-INCUBATION XM,10001119391,CDM,309,RC,86921,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-IMMEDIATE SPIN,10001119393,CDM,309,RC,86920,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-RH PHENOTYPE COMPLETE,10001119395,CDM,309,RC,86906,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PT ANTIGENS,10001119397,CDM,309,RC,86905,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-UNIT ANTIGN SCR W/PT,10001119399,CDM,309,RC,86904,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-UNIT ANTIGN SCRN W/RE,10001119401,CDM,309,RC,86902,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-RH TYPE,10001119403,CDM,309,RC,86901,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-ABO TYPE,10001119405,CDM,309,RC,86900,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-DIRECT COOMBS,10001119407,CDM,309,RC,86880,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-ANTIBODY ID RBC,10001119409,CDM,309,RC,86870,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-RBC ELUTION,10001119411,CDM,309,RC,86860,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-ANTIBODY SCREEN,10001119413,CDM,309,RC,86850,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREEN PER UN,10001119415,CDM,309,RC,86905,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREEN PER UN,10001119417,CDM,309,RC,86905,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREEN PER UN,10001119419,CDM,309,RC,86905,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREEN PER UN,10001119421,CDM,309,RC,86905,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREEN PER UN,10001119423,CDM,309,RC,86905,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 1,10001119425,CDM,309,RC,86905,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 2,10001119427,CDM,309,RC,86905,HCPCS,facility,both,,,,253,253,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 3,10001119429,CDM,309,RC,86905,HCPCS,facility,both,,,,293,293,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 4,10001119431,CDM,309,RC,86905,HCPCS,facility,both,,,,434,434,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 5,10001119433,CDM,309,RC,86905,HCPCS,facility,both,,,,494,494,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 6,10001119435,CDM,309,RC,86905,HCPCS,facility,both,,,,664,664,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 7,10001119437,CDM,309,RC,86905,HCPCS,facility,both,,,,750,750,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 8,10001119439,CDM,309,RC,86905,HCPCS,facility,both,,,,850,850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF ANTIGEN SCREENED 9,10001119441,CDM,309,RC,86905,HCPCS,facility,both,,,,1024,1024,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEMS AUTOANTIBODY,10001119451,CDM,310,RC,88342,HCPCS,facility,both,,,,858,858,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RETICULUM STAIN,10001119453,CDM,310,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERIODIC ACID SCHIFF STAI,10001119455,CDM,310,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMYLOID,10001119457,CDM,310,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUCICARMINE,10001119459,CDM,310,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACID FAST BACILLI STAIN,10001119461,CDM,310,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALCIAN BLUE STAIN,10001119463,CDM,310,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GROSS INTRAOP, 2ND SPECIM",10001119465,CDM,310,RC,88329,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GROSS, 2ND DISTINCT SPECI",10001119467,CDM,310,RC,88300,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HER2 FISH CYTGEN DNA PROB,10001119469,CDM,310,RC,88271,HCPCS,facility,both,,,,1353,1353,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYTOGENETICS, 25-99 REF",10001119471,CDM,310,RC,88274,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T & B CELL LYMPHOCYTES,10001119473,CDM,311,RC,88182,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY,10001119477,CDM,311,RC,88184,HCPCS,facility,both,,,,2278,2278,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYTOLOGY, OTHER 88161",10001119479,CDM,311,RC,88161,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BUCCAL SMEAR 88130,10001119485,CDM,311,RC,88130,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMOSOME ANAL/KAROTYPE1,10001119489,CDM,311,RC,88262,HCPCS,facility,both,,,,1373,1373,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOLOGY CENTRI 88104,10001119491,CDM,311,RC,88104,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYTOLOGY, VAGINAL 88151",10001119495,CDM,311,RC,88141,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FNA-CYTO HIST 88172,10001119503,CDM,311,RC,88172,HCPCS,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FNA-INTERPRET & REPORT 88,10001119507,CDM,311,RC,88173,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAP SMEAR,10001119515,CDM,311,RC,88141,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MULTIPLE MYELOMA FISH/REF,10001119521,CDM,311,RC,88271,HCPCS,facility,both,,,,357,357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMPHOMA DIAGNOSTIC PANEL,10001119523,CDM,311,RC,88189,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAROXYSMAL NOCTURNAL HEMO,10001119525,CDM,311,RC,88188,HCPCS,facility,both,,,,434,434,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMOSOME ANALYSIS CLL/L,10001119527,CDM,311,RC,88280,HCPCS,facility,both,,,,222,222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PNH WITH FLAER*,10001119529,CDM,311,RC,88188,HCPCS,facility,both,,,,442,442,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TISSUE CULTURE LYMPHOCYTE,10001119531,CDM,311,RC,88230,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TISSUE CULTRE SKN/SOLID B,10001119533,CDM,311,RC,88233,HCPCS,facility,both,,,,1234,1234,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMO AMNIO FLUID*,10001119535,CDM,311,RC,88235,HCPCS,facility,both,,,,406,406,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC T & B CELL LYMPHOCYTES,10001119537,CDM,311,RC,88182,HCPCS,facility,both,,,,415,415,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMOSOME ANLYSIS 2 KARY,10001119539,CDM,311,RC,88262,HCPCS,facility,both,,,,492,492,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMO AMNIO FLUID 1 KARY,10001119541,CDM,311,RC,88269,HCPCS,facility,both,,,,657,657,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FISH PRENATAL SCR DNA PRO,10001119543,CDM,311,RC,88271,HCPCS,facility,both,,,,531,531,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGENETICS DNA PROBE,10001119545,CDM,311,RC,88271,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGENETICS DNA PROBE,10001119547,CDM,311,RC,88271,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGENETICS DNA PROBE,10001119549,CDM,311,RC,88271,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMO AMNIO FLUID ADDL K,10001119551,CDM,311,RC,88280,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMO ANALYSIS ADD HI RE,10001119553,CDM,311,RC,88289,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CML/FISH*,10001119561,CDM,311,RC,88271,HCPCS,facility,both,,,,344,344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGENETICS 100-300,10001119563,CDM,311,RC,88275,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGENETICS 100-300,10001119565,CDM,311,RC,88275,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGENETICS 100-300,10001119567,CDM,311,RC,88275,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALK FISH*,10001119569,CDM,311,RC,88275,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LUNG CANCER MUTATION PANE,10001119571,CDM,311,RC,88275,HCPCS,facility,both,,,,1059,1059,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B-CELL LYMPHOMA FISH*,10001119573,CDM,311,RC,88275,HCPCS,facility,both,,,,1188,1188,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY*,10001119577,CDM,311,RC,88184,HCPCS,facility,both,,,,129,129,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 2ND,10001119579,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 3RD,10001119581,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 4TH,10001119583,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 5TH,10001119585,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 6TH,10001119587,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 7TH,10001119589,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 8TH,10001119591,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 9TH,10001119593,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 10TH,10001119595,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 11TH,10001119597,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 12TH,10001119599,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 13TH,10001119601,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 14TH,10001119603,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 15TH,10001119605,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 16TH,10001119607,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 17TH,10001119609,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 18TH,10001119611,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 19TH,10001119613,CDM,311,RC,88185,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA PLOIDY SOLID-TUMOR,10001119615,CDM,311,RC,88182,HCPCS,facility,both,,,,646,646,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYTOLOGY, OTHER 88161",10001119617,CDM,311,RC,88161,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYELOMA DNA PROBE(FISH)*,10001119619,CDM,311,RC,88271,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BUCCAL SMEAR 88130,10001119621,CDM,311,RC,88130,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMOSOME ANAL/KAROTYPE1,10001119623,CDM,311,RC,88262,HCPCS,facility,both,,,,2190,2190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOLOGY CENTRI 88104,10001119625,CDM,311,RC,88104,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYTOLOGY, VAGINAL 88151",10001119627,CDM,311,RC,88141,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FNA-CYTO HIST 88172,10001119633,CDM,311,RC,88172,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FNA-INTERPRET & REPORT 88,10001119635,CDM,311,RC,88173,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLOW CYTOMETRY 1ST,10001119637,CDM,311,RC,88184,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TISSUE CULTURE, BONE MARR",10001119639,CDM,311,RC,88237,HCPCS,facility,both,,,,508,508,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHROMOSOME ANALYSIS, 20-2",10001119641,CDM,311,RC,88264,HCPCS,facility,both,,,,502,502,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMOSOME KARYOTYPE STUD,10001119643,CDM,311,RC,88280,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPEC STAIN MICR GRP 1,10001119645,CDM,312,RC,88312,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTOCHEM - CHEM COMP GRP,10001119651,CDM,312,RC,88313,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOPEROXIDASE SIBLEY P,10001119653,CDM,312,RC,88342,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNOPEROXIDASE,REFERRED",10001119655,CDM,312,RC,88342,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGFR IMMUNO 88342,10001119657,CDM,312,RC,88342,HCPCS,facility,both,,,,1207,1207,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADDITIONAL CONSULT-FROZEN,10001119659,CDM,312,RC,88332,HCPCS,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC COMP CONSULT, SO REF-88",10001119663,CDM,312,RC,88325,HCPCS,facility,both,,,,668,668,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT REF SLI 88321,10001119665,CDM,312,RC,88321,HCPCS,facility,both,,,,117,117,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT NO FROZ 88329,10001119667,CDM,312,RC,88329,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GROSS PATH, LEVEL I",10001119669,CDM,312,RC,88300,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL II",10001119673,CDM,312,RC,88302,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL III",10001119677,CDM,312,RC,88304,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC G&M LEVEL III 88304,10001119681,CDM,312,RC,88304,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL IV",10001119683,CDM,312,RC,88305,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL IV",10001119685,CDM,312,RC,88305,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL IV",10001119687,CDM,312,RC,88305,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M PROSTATE EA SPEC, 1-5",10001119691,CDM,312,RC,88305,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M PROSTATE, EA SPEC, 6",10001119693,CDM,312,RC,88305,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL V",10001119695,CDM,312,RC,88307,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL VI",10001119699,CDM,312,RC,88309,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TISSUE DECACIF 88311,10001119703,CDM,312,RC,88311,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT W/FROZE 88331,10001119709,CDM,312,RC,88331,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PATH CONSULT SLIDES 88321,10001119711,CDM,312,RC,88321,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOMIC ALT OLIGO SNP ARR,10001119713,CDM,312,RC,81229,HCPCS,facility,both,,,,2906,2906,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ERA (PRA BILLED SEPARATE),10001119715,CDM,312,RC,88342,HCPCS,facility,both,,,,546,546,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CELLSEARCH/BREASTCENTER*,10001119717,CDM,312,RC,88346,HCPCS,facility,both,,,,2790,2790,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRA (ERA BILLED SEPARATE),10001119719,CDM,312,RC,88342,HCPCS,facility,both,,,,524,524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA FLOW CYTOMETRY 88358,10001119721,CDM,312,RC,88358,HCPCS,facility,both,,,,924,924,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC B. MARROW 88305,10001119723,CDM,312,RC,88305,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOLOGY CONSULT MISC SO,10001119727,CDM,312,RC,88325,HCPCS,facility,both,,,,825,825,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MSI BY IHC ONLY FOR MMR*,10001119729,CDM,312,RC,88342,HCPCS,facility,both,,,,1030,1030,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRA,10001119731,CDM,312,RC,88342,HCPCS,facility,both,,,,622,622,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RENAL BX,COMPLETE CONSULT",10001119733,CDM,312,RC,88325,HCPCS,facility,both,,,,1940,1940,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MUSCLE BX, CONSULTATION A",10001119735,CDM,312,RC,88325,HCPCS,facility,both,,,,1166,1166,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NERVE BX, CONSULTATION AF",10001119737,CDM,312,RC,88325,HCPCS,facility,both,,,,856,856,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WARTHIN STARRY STAIN 8831,10001119741,CDM,312,RC,88312,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRICHROME STAIN 88312,10001119743,CDM,312,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TYSON'S ELASTIC 88312,10001119745,CDM,312,RC,88312,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOSPHOTUNGSTIC ACID STAI,10001119747,CDM,312,RC,88312,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTOCHEM-CHEM COMP GRP 2,10001119749,CDM,312,RC,88313,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GIEMSA STAIN 88312,10001119751,CDM,312,RC,88312,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BROWN & BRENN STAIN 88312,10001119753,CDM,312,RC,88312,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPEC STAIN GROUP 1,10001119755,CDM,312,RC,88312,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HISTOCHEM - CHEM COMP GRP,10001119757,CDM,312,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOPEROXIDASE SIBLEY 8,10001119759,CDM,312,RC,88342,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNOPEROXIDASE, ADD'L",10001119761,CDM,312,RC,88342,HCPCS,facility,both,,,,238,238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOPEROXIDASE REFERRED,10001119765,CDM,312,RC,88342,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGFR IMMUNO 88342,10001119767,CDM,312,RC,88342,HCPCS,facility,both,,,,1714,1714,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IRON STAIN 88313,10001119769,CDM,312,RC,88313,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADDITIONAL CONSULT-FROZEN,10001119773,CDM,312,RC,88332,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPRHNSV CONSULT SO REF-,10001119777,CDM,312,RC,88325,HCPCS,facility,both,,,,756,756,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT REF SLIDE PREP 88,10001119779,CDM,312,RC,88323,HCPCS,facility,both,,,,604,604,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT REF SLI88321,10001119781,CDM,312,RC,88321,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT SO REF SLIDE 8832,10001119783,CDM,312,RC,88321,HCPCS,facility,both,,,,553,553,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT NO FROZ88329,10001119785,CDM,312,RC,88329,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GROSS PATH, LEVEL I",10001119787,CDM,312,RC,88300,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G&M, LEVEL II",10001119789,CDM,312,RC,88302,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G& M, LEVEL III",10001119791,CDM,312,RC,88304,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G & M, LEVEL IV",10001119793,CDM,312,RC,88305,HCPCS,facility,both,,,,260,260,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC G & M, LEVEL V",10001119797,CDM,312,RC,88307,HCPCS,facility,both,,,,342,342,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC G & M LEVEL VI,10001119799,CDM,312,RC,88309,HCPCS,facility,both,,,,474,474,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC G & M LEVEL VI,10001119801,CDM,312,RC,88309,HCPCS,facility,both,,,,474,474,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIAL STAIN SO,10001119803,CDM,312,RC,88312,HCPCS,facility,both,,,,360,360,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HER2(FISH) REFERRED,10001119805,CDM,312,RC,88368,HCPCS,facility,both,,,,1714,1714,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSITU HYBRIDIZATION FISH,10001119807,CDM,312,RC,88365,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOFLOURESCENCE DIRECT,10001119809,CDM,312,RC,88346,HCPCS,facility,both,,,,654,654,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTRN MCRSCPY 88348,10001119811,CDM,312,RC,88348,HCPCS,facility,both,,,,1881,1881,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXM/SLCT RETRIEVED ARCHIV,10001119813,CDM,312,RC,88363,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ISH FOR EBV VIRUS SO,10001119815,CDM,312,RC,88365,HCPCS,facility,both,,,,606,606,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TISSUE DECACIF 88311,10001119817,CDM,312,RC,88311,HCPCS,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT W/FROZE 88331,10001119819,CDM,312,RC,88331,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARASITE STAIN 88312,10001119823,CDM,312,RC,88312,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIAL STAIN GROUP 2,10001119825,CDM,312,RC,88313,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOHISTOCHEMISTRY,10001119827,CDM,312,RC,88342,HCPCS,facility,both,,,,108,108,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOFLOURESCENT STUDY,10001119829,CDM,312,RC,88347,HCPCS,facility,both,,,,101,101,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSITU HYBRIBIZATION MANU,10001119831,CDM,312,RC,88368,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOFLOURESCENT STUDY E,10001119833,CDM,312,RC,88346,HCPCS,facility,both,,,,108,108,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TUMOR IMMUNOHISTOCHEMISTR,10001119835,CDM,312,RC,88361,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIAL STAIN GROUP1 8,10001119837,CDM,312,RC,88312,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIAL STAIN GROUP 2 88,10001119839,CDM,312,RC,88313,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PATHCONSULT OUTSIDE SLIDE,10001119841,CDM,312,RC,88321,HCPCS,facility,both,,,,281,281,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PATH CONSULT W PREP 88323,10001119843,CDM,312,RC,88323,HCPCS,facility,both,,,,312,312,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPRHNSVE PATH CONSULT 8,10001119845,CDM,312,RC,88325,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOPEROXIDASE IHC 883,10001119847,CDM,312,RC,88342,HCPCS,facility,both,,,,169,169,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VIIA 2.4 MG J7189/,10001119853,CDM,636,RC,,,facility,both,,,,6210,6210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR VIIA 4.8 MG J7189/,10001119855,CDM,636,RC,,,facility,both,,,,12419,12419,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONSULT ON OUTSIDE X-RAY,10001119857,CDM,320,RC,76140,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHOLE BLOOD ACQUISITION C,10001119889,CDM,390,RC,,,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHOLE BLOOD IRRAD DIRECT,10001119891,CDM,390,RC,,,facility,both,,,,675,675,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHOLE BLOOD IRRAD,10001119893,CDM,390,RC,,,facility,both,,,,454,454,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHOLE BLOOD DIRECTED,10001119895,CDM,390,RC,,,facility,both,,,,484,484,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYO ACQUISITION COST EA,10001119897,CDM,390,RC,,,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC LEUKOCYTE REDUCED PC,10001119899,CDM,390,RC,,,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC LEUKOCYTE REDUCED PCA,10001119901,CDM,390,RC,,,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC PC DIRECT LEUKO REDUC,10001119903,CDM,390,RC,,,facility,both,,,,530,530,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FFP ACQUISITION COST,10001119905,CDM,390,RC,,,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET RANDOM,10001119907,CDM,390,RC,,,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS RICH PLASMA,10001119909,CDM,390,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PACKED CELLS, ACQUISITION",10001119911,CDM,390,RC,,,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC DIRECTED,10001119913,CDM,390,RC,,,facility,both,,,,484,484,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC ADSOL,10001119915,CDM,390,RC,,,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WASHED CELLS RBC,10001119917,CDM,390,RC,,,facility,both,,,,476,476,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS RANDOM LR,10001119919,CDM,390,RC,,,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS RANDOM IRRAD,10001119921,CDM,390,RC,,,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLATELETS RANDOM LR, IRRA",10001119923,CDM,390,RC,,,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELET PHERESIS SDP,10001119925,CDM,390,RC,,,facility,both,,,,669,669,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS PHERESIS SDP LR,10001119927,CDM,390,RC,,,facility,both,,,,669,669,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS PHERESIS IRRAD,10001119929,CDM,390,RC,,,facility,both,,,,786,786,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS PHERE SDP LR IR,10001119931,CDM,390,RC,,,facility,both,,,,786,786,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS PHERE DIR LR IR,10001119933,CDM,390,RC,,,facility,both,,,,1062,1062,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC IRRADIATED DIRECT,10001119935,CDM,390,RC,,,facility,both,,,,675,675,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC IRRAD,10001119937,CDM,390,RC,,,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC ADSOL IRRAD,10001119939,CDM,390,RC,,,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC DEGLYC,10001119941,CDM,390,RC,,,facility,both,,,,594,594,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC LEUKO REDUC IRRAD,10001119943,CDM,390,RC,,,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC ADSOL LEUKOREDUC IRRA,10001119945,CDM,390,RC,,,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC PC DIRECT LEUKOREDUC,10001119947,CDM,390,RC,,,facility,both,,,,614,614,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GRANULOCYTES PHERESIS,10001119949,CDM,390,RC,,,facility,both,,,,5291,5291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RBC, LR, CMVNEG",10001119951,CDM,390,RC,,,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS SDP-HLA LR,10001119953,CDM,390,RC,,,facility,both,,,,832,832,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS SDP-HLA LR IRR,10001119955,CDM,390,RC,,,facility,both,,,,1109,1109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLATELETS SDP LR CMVNEG,",10001119957,CDM,390,RC,,,facility,both,,,,824,824,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC LR DEGLY WASHED,10001119959,CDM,390,RC,,,facility,both,,,,754,754,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLATELETS SDP LR CMVNEG,10001119961,CDM,390,RC,,,facility,both,,,,620,620,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHOLE BLOOD LR IRRAD,10001119963,CDM,390,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC FROZEN DEGLY WASH LR,10001119965,CDM,390,RC,,,facility,both,,,,559,559,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC LR CMVNEG IRRAD,10001119967,CDM,390,RC,,,facility,both,,,,334,334,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLASMA FROZEN WITHIN 24 H,10001119969,CDM,390,RC,,,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FFP DONOR RETESTED,10001119971,CDM,390,RC,,,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT FERN TEST,10001119973,CDM,301,RC,,,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAPID HIV KIT,10001119975,CDM,272,RC,,,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HANDLING CHARGE 00000,10001119985,CDM,300,RC,,,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PPD/TB TEST- SUNRISE EMPL,10001119993,CDM,306,RC,,,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AUTO RBC ADSOL,10001120009,CDM,390,RC,,,facility,both,,,,388,388,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REF-PHENOTYPED UNIT ACQUI,10001120017,CDM,390,RC,,,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPHLEBOTOMY99195,10001120019,CDM,940,RC,99195,HCPCS,facility,both,,,,268,268,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UPC - ATLAS STUDY,10001120023,CDM,999,RC,,,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE TRICHOMONAS RAPID VAGINALIS,10001173493,CDM,306,RC,87808,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FETAL HEMORRHAGE,10001173652,CDM,305,RC,85461,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEP SCREEN HAAB TOTAL,10001173653,CDM,302,RC,86708,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RHEUMATOID FACTOR QT RF,10001173654,CDM,302,RC,86431,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FISH LOCUS SPECIFIC PROBE,10001174013,CDM,311,RC,88275,HCPCS,facility,both,,,,728,728,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAIN MGMT PROFILE UR*,10001174014,CDM,301,RC,83986,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COCAINE & METABOLITES,10001174015,CDM,301,RC,82520,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TOXICOLOGY SCREEN, GASTRI",10001174016,CDM,301,RC,,,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FACTOR 8, VWF HUMATE-P",10001174385,CDM,636,RC,,,facility,both,,,,2,2,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HCG TUMOR MARKER QUANT,10001174626,CDM,301,RC,84702,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARBAPENEMASE RESISTANT ENTEROBACTERIACEAE,10001174628,CDM,306,RC,87081,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROTEIN ELECTROPHORESIS, URINE",10001175084,CDM,301,RC,84166,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC C-TELOPRPTIDE, SERUM",10001176627,CDM,301,RC,82523,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MED/SURG/GYN PRIVATE,1110001,CDM,111,RC,,,facility,both,,,,2743,2743,,,,,,,,,,,,,Gross Charge Type: SMH SNF FEE SCHEDULE HC MED/SURG/GYN PRIVATE,1110001,CDM,111,RC,,,facility,both,,,,3141,3141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MED/SURG/GYN PRIVATE MEDICAL NECESSITY,1110012,CDM,111,RC,,,facility,both,,,,3705,3705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MED/SURG/GYN PRIVATE MEDICAL NECESSITY,1110012,CDM,111,RC,,,facility,both,,,,2743,2743,,,,,,,,,,,,,Gross Charge Type: SMH SNF FEE SCHEDULE HC OB PRIVATE ROOM,1120001,CDM,112,RC,,,facility,both,,,,3141,3141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MED/SURG GYN-SEMI-PRIV,1210001,CDM,121,RC,,,facility,both,,,,2743,2743,,,,,,,,,,,,,Gross Charge Type: SMH SNF FEE SCHEDULE HC MED/SURG GYN-SEMI-PRIV,1210001,CDM,121,RC,,,facility,both,,,,3141,3141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OB SEMI-PRIVATE ROOM,1220001,CDM,122,RC,,,facility,both,,,,3141,3141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE PSYCH ROOM DAILY,1240001,CDM,124,RC,,,facility,both,,,,4462,4462,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MED/SURG/GYN PRIVATE DELUXE,1410001,CDM,111,RC,,,facility,both,,,,3141,3141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEWBORN 1 ROOM DAILY,1710001,CDM,171,RC,,,facility,both,,,,2844,2844,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEWBORN 2 ROOM DAILY,1720001,CDM,172,RC,,,facility,both,,,,5052,5052,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEWBORN 3 ROOM DAILY,1730001,CDM,173,RC,,,facility,both,,,,7235,7235,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE ICU ROOM,2000001,CDM,200,RC,,,facility,both,,,,7820,7820,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE ICU SURG ROOM DAILY,2010001,CDM,201,RC,,,facility,both,,,,7820,7820,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE ICU CARD ROOM DAILY,2100001,CDM,210,RC,,,facility,both,,,,6174,6174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CCU CCU/INTERMEDIATE,2140001,CDM,214,RC,,,facility,both,,,,6174,6174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADMISSION CHARGE,22100001,CDM,221,RC,,,facility,both,,,,843,843,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRATION IV INFUSION 1ST HOUR,26000001,CDM,260,RC,96360,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC HYDRATION IV INFUSION 1ST HOUR,26000001,CDM,260,RC,96360,HCPCS,facility,both,,,,978,978,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRATION IV INFUSION EACH ADDL HOUR,26000002,CDM,260,RC,96361,HCPCS,facility,both,,,,177,177,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRATION IV INFUSION EACH ADDL HOUR,26000002,CDM,260,RC,96361,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC IV INFUSION DRUG THERAPY 1ST HOUR,26000003,CDM,260,RC,96365,HCPCS,facility,both,,,,1369,1369,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IV INFUSION DRUG THERAPY 1ST HOUR,26000003,CDM,260,RC,96365,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INFUSION DRUG THERAPY EA ADDL HOUR,26000004,CDM,260,RC,96366,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INFUSION DRUG THERAPY EA ADDL HOUR,26000004,CDM,260,RC,96366,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, ADDL SEQ UP TO 1 HOUR",26000005,CDM,260,RC,96367,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, ADDL SEQ UP TO 1 HOUR",26000005,CDM,260,RC,96367,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC IV INFUSION, CONCURRENT",26000006,CDM,260,RC,96368,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, CONCURRENT",26000006,CDM,260,RC,96368,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC THER/PROPH/DIAG INJ, SC/IM",26000007,CDM,260,RC,96372,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THER/PROPH/DIAG INJ, SC/IM",26000007,CDM,260,RC,96372,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC THER/PROPH/DIAG INJ, SC/IM",26000007,CDM,260,RC,96372,HCPCS,facility,both,,,,239,239,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE "HC THER/PROPH/DIAG INJ, IV PUSH",26000008,CDM,260,RC,96374,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC THER/PROPH/DIAG INJ, IV PUSH",26000008,CDM,260,RC,96374,HCPCS,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, NEW",26000009,CDM,260,RC,96375,HCPCS,facility,both,,,,344,344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, NEW",26000009,CDM,260,RC,96375,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, SAME",26000010,CDM,260,RC,96376,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, SAME",26000010,CDM,260,RC,96376,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC SPINE/BRAIN PUMP REFILL PHYS,26000011,CDM,260,RC,95991,HCPCS,facility,both,,,,993,993,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IRRIGATION OF IMPLANTED VAD,26000012,CDM,260,RC,96523,HCPCS,facility,both,,,,303,303,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REFILL/MAINT PORTABLE PUMP,26000049,CDM,260,RC,96521,HCPCS,facility,both,,,,1862,1862,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SYSTEMIC,26000050,CDM,260,RC,96522,HCPCS,facility,both,,,,903,903,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SPINAL/BRAIN,26000051,CDM,260,RC,95990,HCPCS,facility,both,,,,889,889,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APPLICATION OF ON-BODY INJECTOR FOR TIMED SUBQ INJECTION,26000052,CDM,260,RC,96377,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 04/16/2021 HC IV INFUSION, BAMLANIVIMAB XXXX, INCLUDES INFUSION AND POST ADMINISTRATION",26000053,CDM,771,RC,,,facility,both,,,,825,825,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 4/1/2025 HC IV INFUSION, CASIRIVIMAB & IMDEVIMAB, INCL INFUSION & POST ADM MONITOR",26000054,CDM,771,RC,,,facility,both,,,,1043,1043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 4/1/2025 HC IV INFUSION, BAMLANIVIMAB AND ETESEVIMAB, INCLUDES INFUSION AND POST ADMIN MONITORING",26000055,CDM,771,RC,,,facility,both,,,,1043,1043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 4/1/2025 HC IV INFUS/SUBSQ INJ, CASIRIVIMAB & IMDEVIMAB W/POST ADM MONITOR, REPEAT DOSES",26000056,CDM,771,RC,,,facility,both,,,,1024,1024,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRATION IV INFUSION 1ST HOUR,26091101,CDM,260,RC,96360,HCPCS,facility,both,,,,484,484,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRATION IV INFUSION EACH ADDL HOUR,26091102,CDM,260,RC,96361,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IV INFUSION DRUG THERAPY 1ST HOUR LEVEL 1,26091103,CDM,260,RC,96365,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IV INFUSION DRUG THERAPY 1ST HOUR LEVEL 2,26091104,CDM,260,RC,96365,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IV INFUSION DRUG THERAPY HOURS LEVEL 3,26091105,CDM,260,RC,96365,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IV INFUSION DRUG THERAPY 1ST HOUR LEVEL 3,26091106,CDM,260,RC,96365,HCPCS,facility,both,,,,750,750,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFUSION DRUG THERAPY EA ADDL HOUR LEVEL 1,26091107,CDM,260,RC,96366,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFUSION DRUG THERAPY EA ADDL HOUR LEVEL 2,26091108,CDM,260,RC,96366,HCPCS,facility,both,,,,191,191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, ADDL SEQ 0.5 HOUR LEVEL 1",26091109,CDM,260,RC,96367,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, ADDL SEQ UP TO 1 HOUR LEVEL 1",26091110,CDM,260,RC,96367,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, ADDL SEQ 0.5 HOUR LEVEL 2",26091111,CDM,260,RC,96367,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, ADDL SEQ UP TO 1 HOUR LEVEL 2",26091112,CDM,260,RC,96367,HCPCS,facility,both,,,,191,191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, CONCURRENT LEVEL 1",26091113,CDM,260,RC,96368,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, CONCURRENT LEVEL 2",26091114,CDM,260,RC,96368,HCPCS,facility,both,,,,191,191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IV INFUSION, CONCURRENT LEVEL 3",26091115,CDM,260,RC,96368,HCPCS,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THER/PROPH/DIAG INJ, SC/IM",26091116,CDM,260,RC,96372,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THER/PROPH/DIAG INJ, IV PUSH",26091117,CDM,260,RC,96374,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, NEW DRUG 1",26091118,CDM,260,RC,96375,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, NEW DRUG 2",26091119,CDM,260,RC,96375,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, NEW DRUG 3",26091120,CDM,260,RC,96375,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX/PRO/DX INJ EA ADDL SEQ, SAME",26091121,CDM,260,RC,96376,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IRRIGATION OF IMPLANTED VAD,26091122,CDM,260,RC,96523,HCPCS,facility,both,,,,117,117,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IRRIGATION OF IMPLANTED VAD,26091123,CDM,260,RC,96523,HCPCS,facility,both,,,,117,117,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYDRATION IV INFUSION ADDL 0.5 HOUR,26091124,CDM,260,RC,96361,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IV INFUSION DRUG THERAPY 0.5 HOUR LEVEL 1,26091125,CDM,260,RC,96365,HCPCS,facility,both,,,,442,442,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IV INFUSION DRUG THERAPY 0.5 HOUR LEVEL 2,26091126,CDM,260,RC,,,facility,both,,,,543,543,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HC IV INFUSION, ADDL SEQ UP TO 1 HOUR LEVEL 3",26091129,CDM,260,RC,96367,HCPCS,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITIAL, STANDARD, MONAURAL, ITC",27000060,CDM,270,RC,,,facility,both,,,,1700,1700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITIAL, STANDARD, BINAURAL, ITC",27000061,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, STANDARD, MONAURAL, CIC",27000062,CDM,270,RC,,,facility,both,,,,1700,1700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, STANDARD, MONAURAL, RITE",27000063,CDM,270,RC,,,facility,both,,,,1800,1800,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, ADVANCED, MONAURAL, ITE",27000064,CDM,270,RC,,,facility,both,,,,2450,2450,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, ADVANCED, MONAURAL, CIC",27000065,CDM,270,RC,,,facility,both,,,,2450,2450,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, ADVANCED, BINAURAL CIC",27000066,CDM,270,RC,,,facility,both,,,,4900,4900,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, PREMIUM, MONAURAL BTE",27000067,CDM,270,RC,,,facility,both,,,,3350,3350,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, PREMIUM, MONAURAL CIC",27000068,CDM,270,RC,,,facility,both,,,,3275,3275,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RECEIVER,27000069,CDM,990,RC,,,facility,both,,,,95,95,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCKET TALKER,27000070,CDM,990,RC,,,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, MONAURAL, IN THE EAR (ITE)",27000071,CDM,270,RC,,,facility,both,,,,1700,1700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, MONAURAL, IN THE CANAL (ITC)",27000072,CDM,270,RC,,,facility,both,,,,1700,1700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, MONAURAL,BEHIND THE EAR (BTE)",27000073,CDM,270,RC,,,facility,both,,,,1750,1750,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, BINAURAL, ITE/ITE",27000074,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, BINAURAL, ITE/ITC",27000075,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, BINAURAL, ITE/BTE",27000076,CDM,270,RC,,,facility,both,,,,3500,3500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, BINAURAL, ITC/ITC",27000077,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, BINAURAL, ITC/BTE",27000078,CDM,270,RC,,,facility,both,,,,3500,3500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEARING AID, BINAURAL, BTE/BTE",27000079,CDM,270,RC,,,facility,both,,,,3500,3500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC MONAURAL, CIC",27000155,CDM,270,RC,,,facility,both,,,,1100,1100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC MONAURAL, ITC",27000156,CDM,270,RC,,,facility,both,,,,1100,1100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC MONAURAL, ITE",27000157,CDM,270,RC,,,facility,both,,,,1100,1100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC MONAURAL, BTE",27000158,CDM,270,RC,,,facility,both,,,,1125,1125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC MONAURAL, RITE",27000159,CDM,270,RC,,,facility,both,,,,1250,1250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC BINAURAL, CIC",27000160,CDM,270,RC,,,facility,both,,,,2200,2200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC BINAURAL, ITC",27000161,CDM,270,RC,,,facility,both,,,,2200,2200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC BINAURAL, ITE",27000162,CDM,270,RC,,,facility,both,,,,2200,2200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC BINAURAL, BTE",27000163,CDM,270,RC,,,facility,both,,,,2250,2250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DIGITAL, BASIC BINAURAL, RITE",27000164,CDM,270,RC,,,facility,both,,,,2500,2500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THUMB BRACE,27080000,CDM,270,RC,,,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HAND HELPER EXERCISER,27080001,CDM,270,RC,,,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LORDOLOC BACK BRACE,27080002,CDM,270,RC,,,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINGER SPLINT, EXTEND-IT",27080003,CDM,270,RC,,,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC WRIST SPLINT, FUTURO",27080004,CDM,270,RC,,,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINGER SPLINT, OVAL EIGHT",27080005,CDM,270,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VAG STIM SENSOR,27080006,CDM,270,RC,,,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THUMB SPLINT, MICROWAVABL",27080007,CDM,270,RC,,,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HAND SPLINT,27080009,CDM,270,RC,,,facility,both,,,,77,77,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HAND SPLINT, PREMOLDED",27080010,CDM,270,RC,,,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERABAND FLEXBAR,27080011,CDM,270,RC,,,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THUMB SUPPORT, AIR SOFT",27080012,CDM,270,RC,,,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NASAL CANNULA,27080014,CDM,270,RC,,,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HIGH HUMIDITY O2 THERAPY (SUPPLY),27080016,CDM,270,RC,,,facility,both,,,,254,254,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PEAK FLOW RATE (SUPPLY),27080017,CDM,270,RC,,,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MDI SPACER,27080019,CDM,270,RC,,,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, ADVANCED, MONAURAL, ITC",27080021,CDM,270,RC,,,facility,both,,,,2450,2450,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, PREMIUM, MONAURAL, ITC",27080022,CDM,270,RC,,,facility,both,,,,3275,3275,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, STANDARD MONAURAL, ITE",27080023,CDM,270,RC,,,facility,both,,,,1700,1700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, ADVANCED, MONAURAL, BTE",27080024,CDM,270,RC,,,facility,both,,,,2550,2550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, MONAURAL, BTE .5, BETTER",27080025,CDM,270,RC,,,facility,both,,,,2450,2450,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, ADVANCED, MONAURAL, BTE, RITE",27080026,CDM,270,RC,,,facility,both,,,,2650,2650,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, PREMIUM, MONAURAL, BTE, RITE",27080027,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, STANDARD MONAURAL, BTE",27080028,CDM,270,RC,,,facility,both,,,,1750,1750,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, MONAURAL, BTE, GOOD 0.5",27080029,CDM,270,RC,,,facility,both,,,,1700,1700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITIAL, STANDARD BINAURAL, CIC",27080030,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, PREMIUM, BINAURAL, CIC",27080031,CDM,270,RC,,,facility,both,,,,6550,6550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, ADVANCED, BINAURAL, ITC",27080032,CDM,270,RC,,,facility,both,,,,4900,4900,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, PREMIUM, BINAURAL, ITC",27080033,CDM,270,RC,,,facility,both,,,,6550,6550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, ADVANCED, BINAURAL, ITE",27080034,CDM,270,RC,,,facility,both,,,,4900,4900,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, PREMIUM, BINAURAL, ITE",27080035,CDM,270,RC,,,facility,both,,,,6550,6550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, STANDARD BINAURAL, ITE",27080036,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, STANDARD BINAURAL, BTE",27080037,CDM,270,RC,,,facility,both,,,,3500,3500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, BINAURAL, BTE, GOOD, 0.5",27080038,CDM,270,RC,,,facility,both,,,,3400,3400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, STANDARD BINAURAL, BTE, RITE (RECEIVER IN THE EAR)",27080039,CDM,270,RC,,,facility,both,,,,3600,3600,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, ADVANCED, BINAURAL, BTE",27080040,CDM,270,RC,,,facility,both,,,,5100,5100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, BINAURAL, BTE .5, BETTER",27080041,CDM,270,RC,,,facility,both,,,,4900,4900,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, ADVANCED, BINAURAL, BTE, RITE",27080042,CDM,270,RC,,,facility,both,,,,5300,5300,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, PREMIUM, BINAURAL, BTE",27080044,CDM,270,RC,,,facility,both,,,,6700,6700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA, DIGITAL, PREMIUM, BINAURAL, BTE, RITE",27080045,CDM,270,RC,,,facility,both,,,,6800,6800,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EAR MOLD/INSERT NON DISP, EA",27080046,CDM,270,RC,,,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BATTERY FOR HEARING DEVICE, EA",27080047,CDM,270,RC,,,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BATTERY FOR HEARING DEVICE, BOX",27080048,CDM,270,RC,,,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEARING AID SUPPLY/ACCESSORIES NOS,27080049,CDM,270,RC,,,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALD FM/DM TRANSMITTER,27080050,CDM,270,RC,,,facility,both,,,,1000,1000,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ALD FM/DM RECEIVER, NOS",27080051,CDM,270,RC,,,facility,both,,,,1150,1150,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY FORCEPS,27280001,CDM,272,RC,,,facility,both,,,,800,800,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOLOGY BRUSH,27280002,CDM,272,RC,,,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WANG NEEDLE,27280003,CDM,272,RC,,,facility,both,,,,371,371,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ARTERIAL SAMPLNG TRAY,27280004,CDM,272,RC,,,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MICROBRUSH,27280006,CDM,272,RC,,,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SMALL AQUAPLAST MASK 1.6,27291101,CDM,272,RC,,,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LARGE AQUAPLAST MASK 2.4,27291102,CDM,272,RC,,,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MEDIUM VAGINAL DILATOR 29,27291103,CDM,272,RC,,,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LARGE VAGINAL DILATOR 35M,27291104,CDM,272,RC,,,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACCUFORM HEAD/NECK SUPPORT,27291105,CDM,272,RC,27291105,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LARGE ALPHA CRADLE,27291106,CDM,272,RC,,,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SMALL ALPHA CRADLE,27291107,CDM,272,RC,,,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEARING AID VENDOR REPAIR LEVEL 1,27300050,CDM,990,RC,,,facility,both,,,,263,263,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEARING AID VENDOR REPAIR LEVEL 2,27300051,CDM,990,RC,,,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEARING AID VENDOR REPAIR LEVEL 3,27300052,CDM,990,RC,,,facility,both,,,,373,373,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/19/2022 HC WIDEX WARRANTY,27300053,CDM,990,RC,27300053,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEARING AID VENDOR REPAIR LEVEL 4,27300054,CDM,990,RC,,,facility,both,,,,441,441,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RECHARGEABLE BATTERY,27300055,CDM,270,RC,,,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RECHARGEABLE BATTERY CASE,27300056,CDM,270,RC,,,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OTICON WARRANTY/EAR,27380001,CDM,990,RC,,,facility,both,,,,210,210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHONAK OR RESOUND WARRANT,27380002,CDM,990,RC,,,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IN-OFFICE WARRANTY,27380003,CDM,990,RC,,,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRACHYTX NON STR HDR IR-192, PER SOURCE",27846004,CDM,278,RC,,,facility,both,,,,1294,1294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOSP GRADE ELEC BREAST PUMP,29100001,CDM,291,RC,,,facility,both,,,,95,95,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ROUTINE VENIPUNCTURE,30000001,CDM,300,RC,36415,HCPCS,facility,both,,,,39,39,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CAPILLARY BLOOD DRAW,30000002,CDM,300,RC,36416,HCPCS,facility,both,,,,39,39,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRAW BLOOD OFF VENOUS DEVICE,30000003,CDM,300,RC,36591,HCPCS,facility,both,,,,1077,1077,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC METABOLIC PANEL TOTAL CA,30000004,CDM,301,RC,80048,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC METABOLIC PANEL TOTAL CA,30000004,CDM,301,RC,80048,HCPCS,facility,both,,,,313,313,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPREHENSIVE METABOLIC PANEL,30000005,CDM,301,RC,80053,HCPCS,facility,both,,,,366,366,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPREHENSIVE METABOLIC PANEL,30000005,CDM,301,RC,80053,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC RENAL FUNCTION PANEL,30000006,CDM,301,RC,80069,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RENAL FUNCTION PANEL,30000006,CDM,301,RC,80069,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEPATIC FUNCTION PANEL,30000007,CDM,301,RC,80076,HCPCS,facility,both,,,,289,289,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATIC FUNCTION PANEL,30000007,CDM,301,RC,80076,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC GH SUPPRESSION PANEL,30000008,CDM,301,RC,80430,HCPCS,facility,both,,,,1165,1165,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CARNITINE QUAN EA,30000009,CDM,301,RC,82379,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLORIDE; OTHER,30000010,CDM,301,RC,82438,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VERY LONG FATTY ACID CHAINS,30000011,CDM,301,RC,82726,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF IGE,30000012,CDM,301,RC,82785,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INSULIN; TOTAL,30000013,CDM,301,RC,83525,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INSULIN; TOTAL,30000013,CDM,301,RC,83525,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC TESTOSTERONE; TOTAL,30000014,CDM,301,RC,84403,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TESTOSTERONE; TOTAL,30000014,CDM,301,RC,84403,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC T3; REVERSE,30000015,CDM,301,RC,84482,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FETAL HGB SCREENING TEST,30000016,CDM,305,RC,85461,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SICKLING OF RBC REDUCTION,30000017,CDM,305,RC,85660,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALLERG SP IGE; QUAN OR SEMIQUAN,30000018,CDM,302,RC,86003,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB ID; LEUKOCYTE AB,30000019,CDM,300,RC,86021,HCPCS,facility,both,,,,1211,1211,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COLD AGGLUTININ; SCREEN,30000020,CDM,302,RC,86156,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COLD AGGLUTININ; TITER,30000021,CDM,300,RC,86157,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ID; GEL QUAL; EA AB/AG,30000022,CDM,302,RC,86331,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LYMPHOCYTE MITOGEN RESPONSE,30000023,CDM,302,RC,86353,HCPCS,facility,both,,,,580,580,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NITROBLUE TETRAZOLIUM DYE TEST,30000024,CDM,302,RC,86384,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HEMOPHILUS INFLUENZA,30000025,CDM,302,RC,86684,HCPCS,facility,both,,,,188,188,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HIV-2,30000026,CDM,302,RC,86702,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; HIV-2,30000026,CDM,302,RC,86702,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC AB ELUTION EA,30000027,CDM,300,RC,86860,HCPCS,facility,both,,,,278,278,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB ID RBC EA PANEL EA TECHN,30000028,CDM,300,RC,86870,HCPCS,facility,both,,,,884,884,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COOMBS; DIRECT,30000029,CDM,300,RC,86880,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC COOMBS; DIRECT,30000029,CDM,300,RC,86880,HCPCS,facility,both,,,,185,185,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COOMBS TEST INDIRECT TITER,30000030,CDM,300,RC,86886,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COOMBS TEST INDIRECT TITER,30000030,CDM,300,RC,86886,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC BLOOD TYPING; ABO,30000031,CDM,300,RC,86900,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD TYPING; RH D,30000032,CDM,300,RC,86901,HCPCS,facility,both,,,,135,135,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD TYPE ANTIGEN DONOR EA,30000033,CDM,300,RC,86902,HCPCS,facility,both,,,,449,449,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLD TYPE; RBC AG NOT ABO/RHD,30000034,CDM,300,RC,86905,HCPCS,facility,both,,,,449,449,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLD TYPE; RH PHENOTYPE,30000035,CDM,300,RC,86906,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPATIBILITY TEST ANTIGLOB,30000036,CDM,300,RC,86922,HCPCS,facility,both,,,,254,254,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPATIBILITY TEST ELECTRIC,30000037,CDM,300,RC,86923,HCPCS,facility,both,,,,420,420,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IRRADIATE BLD PRODUCT EA UNIT,30000038,CDM,300,RC,86945,HCPCS,facility,both,,,,321,321,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VOL REDUCTION OF BLOOD/PROD,30000039,CDM,300,RC,86960,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VOL REDUCTION OF BLOOD/PROD,30000039,CDM,300,RC,86960,HCPCS,facility,both,,,,420,420,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POOL PLATELETS OR BLD PRODUCT,30000040,CDM,300,RC,86965,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRETREAT RBC; ENZYMES,30000041,CDM,300,RC,86971,HCPCS,facility,both,,,,449,449,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPLIT BLD PRODUCT EA UNIT,30000042,CDM,300,RC,86985,HCPCS,facility,both,,,,281,281,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DONATH-LANDSTEINER TEST,30000043,CDM,300,RC,86999,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTO RED CELL PROCESS FEE,30000044,CDM,300,RC,86999,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIFF CELL COUNT NOT BLOOD,30000045,CDM,300,RC,89051,HCPCS,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEMEN ANAL STRICT CRITERIA,30000046,CDM,300,RC,89322,HCPCS,facility,both,,,,229,229,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEUKOREDUCTION,30000047,CDM,300,RC,86999,HCPCS,facility,both,,,,765,765,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRICH. VAGINALIS AMP PROBE,30000048,CDM,306,RC,87661,HCPCS,facility,both,,,,1482,1482,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NFCT DS CHRNC HCV 6 ASSAYS (153),30000049,CDM,300,RC,81596,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AUTOLOG BLOOD PREDEPOSITED,30000100,CDM,300,RC,86890,HCPCS,facility,both,,,,561,561,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPATIBILITY TEST INCUBATE,30000101,CDM,300,RC,86921,HCPCS,facility,both,,,,254,254,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRETREAT RBC; CHEM OR DRUGS,30000102,CDM,300,RC,86970,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERUM PRETX; RC ABSORPT,30000103,CDM,300,RC,86978,HCPCS,facility,both,,,,223,223,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BILIRUBIN TOTAL TRANSCUT,30000104,CDM,300,RC,88720,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FECAL LEUKO CNT QUAL/SEMIQUAN,30000105,CDM,300,RC,89055,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EXAM SYNOVIAL FLUID CRYSTALS,30000106,CDM,300,RC,89060,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PSA SCREENING,30000107,CDM,301,RC,,,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOLOG BLOOD OP SALVAGE,30000108,CDM,300,RC,86891,HCPCS,facility,both,,,,1077,1077,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MEAT FIBERS FECES,30000109,CDM,300,RC,89160,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLD TYPE; AG SCRN W PT SERUM,30000125,CDM,300,RC,86904,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HAMS; AUTO SCRN EA,30000127,CDM,300,RC,86940,HCPCS,facility,both,,,,477,477,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FETAL SCREEN,30000128,CDM,300,RC,86941,HCPCS,facility,both,,,,216,216,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRETREAT RBC; DGS,30000129,CDM,300,RC,86972,HCPCS,facility,both,,,,1457,1457,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERUM PRETX; DILUTION,30000130,CDM,300,RC,86976,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERUM PRETX; INHIBITOR INCUBATE,30000131,CDM,300,RC,86977,HCPCS,facility,both,,,,804,804,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SECRETIONS FAT STAIN,30000132,CDM,300,RC,89125,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC N EOSINOPHIL SMEAR,30000133,CDM,300,RC,89190,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE OOCYTE(S)/EMBRYO(S) < 4 DAYS,30000134,CDM,300,RC,89250,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSIST EMBRYO HATCH MICROTECH,30000135,CDM,300,RC,89253,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OOCYTE ID FOLLICULAR FLUID,30000136,CDM,300,RC,89254,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EMBRYO TRANSFER PREP,30000137,CDM,300,RC,89255,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPERM ID FROM ASP,30000138,CDM,300,RC,89257,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYOPRESERVATION EMBRYO(S),30000139,CDM,300,RC,89258,HCPCS,facility,both,,,,3081,3081,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYOPRESERVATION; SPERM,30000140,CDM,300,RC,89259,HCPCS,facility,both,,,,683,683,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPERM ISOLATION; SIMPLE PREP,30000141,CDM,300,RC,89260,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPERM ISOLATION; CMPLX PREP,30000142,CDM,300,RC,89261,HCPCS,facility,both,,,,683,683,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPERM ID FROM TESTIS FRESH/CRYOPRESERVE,30000143,CDM,300,RC,89264,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EXT OOCYTE(S)/EMBRYO(S) CULTURE 4-7 DAYS,30000144,CDM,300,RC,89272,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSIST OOCYTE FERTILIZ <= 10 OO,30000145,CDM,300,RC,89280,HCPCS,facility,both,,,,3081,3081,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSIST OOCYTE FERTILIZ >10 OO,30000146,CDM,300,RC,89281,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BX OOCYTE POLAR BODY <= 5 EMBRY,30000147,CDM,300,RC,89290,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BX OOCYTE POLAR BODY > 5 EMBRY,30000148,CDM,300,RC,89291,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEMEN; PRESENCE & MOTILITY,30000149,CDM,300,RC,89300,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEMEN; MOTILITY & COUNT,30000150,CDM,300,RC,89310,HCPCS,facility,both,,,,128,128,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEMEN ANAL VOL/COUNT/MOT,30000151,CDM,300,RC,89320,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC SEMEN ANAL VOL/COUNT/MOT,30000151,CDM,300,RC,89320,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEMEN ANAL SPERM DETECTION,30000152,CDM,300,RC,89321,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPERM ANTIBODIES,30000153,CDM,300,RC,89325,HCPCS,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STORAGE/YEAR; EMBRYO(S),30000155,CDM,300,RC,89342,HCPCS,facility,both,,,,683,683,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STORAGE/YEAR; SPERM/SEMEN,30000156,CDM,300,RC,89343,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THAW CRYOPRESERVED; EMBRYO(S),30000157,CDM,300,RC,89352,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THAW CRYOPRESERVED; SPERM/ALIQUOT,30000158,CDM,300,RC,89353,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRANCSCUTANEOUS CARBOXYHB,30000162,CDM,300,RC,88740,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNOASSAY, NOS PART OF PANEL",30000164,CDM,300,RC,83520,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (25),30000165,CDM,300,RC,83520,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (35),30000166,CDM,300,RC,83520,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (40),30000167,CDM,300,RC,83520,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (115),30000170,CDM,300,RC,83520,HCPCS,facility,both,,,,342,342,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (170),30000174,CDM,300,RC,83520,HCPCS,facility,both,,,,505,505,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (65),30000175,CDM,300,RC,83520,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (45),30000176,CDM,300,RC,83520,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (45),30000176,CDM,300,RC,83520,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (240),30000179,CDM,300,RC,83520,HCPCS,facility,both,,,,713,713,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (130),30000180,CDM,300,RC,83520,HCPCS,facility,both,,,,386,386,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 12/31/2023 HC HOSPITAL OUTPATIENT CLINIC-COVID-19 SPEC COLLECT NON-MARYLAND,30000181,CDM,300,RC,,,facility,both,,,,95,95,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB,30000184,CDM,300,RC,83520,HCPCS,facility,both,,,,565,565,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IAD BY NUCLEIC ACID (DNA OR RNA); BORRELIA MIYAMOTOI, APT (41)",30001856,CDM,300,RC,87478,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(12)",30001858,CDM,300,RC,83520,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(32)",30001859,CDM,300,RC,83520,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (184),30001860,CDM,300,RC,83520,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FACTOR XIII QUEST,30060007,CDM,300,RC,85290,HCPCS,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LYME(B.BURGDORFERI)PCR,CSF QST",30060011,CDM,300,RC,87476,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT AUTOM URINALYSIS WO MICRO,30070001,CDM,307,RC,81003,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT AUTOM URINALYSIS WO MICRO,30070001,CDM,307,RC,81003,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POCT OCCULT BLD FECES 1-3 TESTS,30070002,CDM,301,RC,82272,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT OCCULT BLD FECES 1-3 TESTS,30070002,CDM,301,RC,82272,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POCT ASSAY PH BODY FLUID NOS,30070003,CDM,301,RC,83986,HCPCS,facility,both,,,,13,13,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POCT ASSAY PH BODY FLUID NOS,30070003,CDM,301,RC,83986,HCPCS,facility,both,,,,13,13,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT URINE HCG VISUAL COLOR,30070004,CDM,307,RC,81025,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT URINE HCG VISUAL COLOR,30070004,CDM,307,RC,81025,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POCT CREATININE; BLOOD,30070005,CDM,301,RC,82565,HCPCS,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT CREATININE; BLOOD,30070005,CDM,301,RC,82565,HCPCS,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POCT SMEAR - INFECTIOUS WET MOUNT,30070006,CDM,306,RC,87210,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT SMEAR - INFECTIOUS WET MOUNT,30070006,CDM,306,RC,87210,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POCT GLUCOSE; BLOOD REAGENT STRIP,30070007,CDM,301,RC,82948,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT GLUCOSE; BLOOD REAGENT STRIP,30070007,CDM,301,RC,82948,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC POCT FERN TEST,30070008,CDM,301,RC,,,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POCT FERN TEST,30070008,CDM,301,RC,,,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRANSCUTANEOUS BILIRUBIN,30070009,CDM,300,RC,88720,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRANSCUTANEOUS BILIRUBIN,30070009,CDM,300,RC,88720,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LAB CHEMISTRY,30100000,CDM,301,RC,,,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ELECTROLYTE PANEL,30100001,CDM,301,RC,80051,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ELECTROLYTE PANEL,30100001,CDM,301,RC,80051,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPID PANEL,30100002,CDM,301,RC,80061,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC LIPID PANEL,30100002,CDM,301,RC,80061,HCPCS,facility,both,,,,514,514,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMIKACIN,30100003,CDM,301,RC,80150,HCPCS,facility,both,,,,460,460,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMITRIPTYLINE,30100004,CDM,301,RC,80152,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC BENZODIAZEPINES, 1-12",30100005,CDM,301,RC,80346,HCPCS,facility,both,,,,392,392,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CARBAMAZEPINE; TOTAL,30100006,CDM,301,RC,80156,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CARBAMAZEPINE; TOTAL,30100006,CDM,301,RC,80156,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CARBAMAZEPINE; FREE,30100007,CDM,301,RC,80157,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYCLOSPORINE,30100008,CDM,301,RC,80158,HCPCS,facility,both,,,,379,379,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DESIPRAMINE,30100009,CDM,301,RC,80160,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIGOXIN QUANTITATIVE,30100010,CDM,301,RC,80162,HCPCS,facility,both,,,,564,564,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIPROPYLACETIC ACID,30100011,CDM,301,RC,80164,HCPCS,facility,both,,,,367,367,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIPROPYLACETIC ACID,30100011,CDM,301,RC,80164,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC GENTAMICIN,30100012,CDM,301,RC,80170,HCPCS,facility,both,,,,692,692,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HALOPERIDOL ASSAY,30100013,CDM,301,RC,80173,HCPCS,facility,both,,,,217,217,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMIPRAMINE,30100014,CDM,301,RC,80174,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIDOCAINE,30100015,CDM,301,RC,80176,HCPCS,facility,both,,,,419,419,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LITHIUM,30100016,CDM,301,RC,80178,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC LITHIUM,30100016,CDM,301,RC,80178,HCPCS,facility,both,,,,221,221,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NORTRIPTYLINE,30100017,CDM,301,RC,80182,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHENOBARBITAL,30100018,CDM,301,RC,80184,HCPCS,facility,both,,,,367,367,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHENYTOIN; TOTAL,30100019,CDM,301,RC,80185,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHENYTOIN; FREE,30100020,CDM,301,RC,80186,HCPCS,facility,both,,,,259,259,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRIMIDONE,30100021,CDM,301,RC,80188,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROCAINAMIDE W METABOLITES,30100022,CDM,301,RC,80192,HCPCS,facility,both,,,,722,722,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUINIDINE,30100023,CDM,301,RC,80194,HCPCS,facility,both,,,,593,593,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF SIROLIMUS,30100024,CDM,301,RC,80195,HCPCS,facility,both,,,,452,452,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SALICYLATE,30100025,CDM,301,RC,80196,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TACROLIMUS,30100026,CDM,301,RC,80197,HCPCS,facility,both,,,,742,742,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THEOPHYLLINE,30100027,CDM,301,RC,80198,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOBRAMYCIN,30100028,CDM,301,RC,80200,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOPIRAMATE,30100029,CDM,301,RC,80201,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VANCOMYCIN,30100030,CDM,301,RC,80202,HCPCS,facility,both,,,,493,493,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DABIGATRAN ASSAY,30100031,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACETAZOLAMIDE (DIAMOX),30100032,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BUPROPION,30100033,CDM,301,RC,80299,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ZONISAMIDE,30100034,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ATAZANAVIR LEVEL SERUM,30100035,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC ITRACONAZOLE, HPLC",30100036,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC KALETRA, QUANTITATION",30100037,CDM,301,RC,80299,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUANTITATION OF DRUG NES,30100038,CDM,301,RC,80299,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOM URINE DIP W MICRO,30100039,CDM,307,RC,81001,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOM URINE DIP W MICRO,30100039,CDM,307,RC,81001,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC N-AUTOM URINALYS WO MICRO,30100040,CDM,307,RC,81002,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOM URINALYSIS WO MICRO,30100041,CDM,307,RC,81003,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AUTOM URINALYSIS WO MICRO,30100041,CDM,307,RC,81003,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC URINALYSIS; QUAL NOT IA,30100042,CDM,307,RC,81005,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC URINALYSIS - MICRO ONLY,30100043,CDM,307,RC,81015,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACETAMINOPHEN,30100044,CDM,301,RC,82003,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUANT SERUM ACETONES/KETONES,30100045,CDM,301,RC,82010,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACETYLCHOLINESTERASE,30100046,CDM,301,RC,82013,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACYLCARNITINES; QUAN,30100047,CDM,301,RC,82017,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACTH,30100048,CDM,301,RC,82024,HCPCS,facility,both,,,,928,928,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF SERUM ALBUMIN,30100049,CDM,301,RC,82040,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALBUMIN; QUAN,30100050,CDM,301,RC,82042,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALBUMIN; URINE QUANT,30100051,CDM,301,RC,82043,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ETHANOL (ALCOHOL); NOT BREATH,30100052,CDM,301,RC,82055,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALDOSTERONE,30100053,CDM,301,RC,82088,HCPCS,facility,both,,,,790,790,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALPHA-FETOPROTEIN SERUM,30100054,CDM,301,RC,82105,HCPCS,facility,both,,,,394,394,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALPHA-FETOPROTEIN AMNIOTIC,30100055,CDM,301,RC,82106,HCPCS,facility,both,,,,393,393,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMINO ACIDS; MULTI QUAL EA,30100056,CDM,301,RC,82128,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMINO ACIDS 6/> QUAN EA,30100057,CDM,301,RC,82139,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMMONIA,30100058,CDM,301,RC,82140,HCPCS,facility,both,,,,301,301,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMYLASE,30100059,CDM,301,RC,82150,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMYLASE,30100059,CDM,301,RC,82150,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ASCORBIC ACID BLOOD,30100060,CDM,301,RC,82180,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BARBITURATES,30100061,CDM,301,RC,80345,HCPCS,facility,both,,,,718,718,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BETA-2 MICROGLOBULIN,30100062,CDM,301,RC,82232,HCPCS,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOTAL BILIRUBIN,30100063,CDM,301,RC,82247,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOTAL BILIRUBIN,30100063,CDM,301,RC,82247,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC DIRECT BILIRUBIN,30100064,CDM,301,RC,82248,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIRECT BILIRUBIN,30100064,CDM,301,RC,82248,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC OCCULT BLOOD FECES,30100065,CDM,301,RC,82270,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OCCULT BLD FHG QUAL 1-3,30100066,CDM,301,RC,82274,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CADMIUM,30100067,CDM,301,RC,82300,HCPCS,facility,both,,,,275,275,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN D 25 HYDROXY,30100068,CDM,301,RC,82306,HCPCS,facility,both,,,,776,776,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN D 25 HYDROXY,30100068,CDM,301,RC,82306,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CALCITONIN,30100069,CDM,301,RC,82308,HCPCS,facility,both,,,,552,552,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CALCIUM; TOTAL,30100070,CDM,301,RC,82310,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CALCIUM; TOTAL,30100070,CDM,301,RC,82310,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CALCIUM; IONIZED,30100071,CDM,301,RC,82330,HCPCS,facility,both,,,,21,21,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CALCIUM; IONIZED,30100071,CDM,301,RC,82330,HCPCS,facility,both,,,,207,207,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CALCIUM; URINE QUAN TIMED,30100072,CDM,301,RC,82340,HCPCS,facility,both,,,,73,73,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STONE; IR SPECTROSCOPY,30100073,CDM,301,RC,82365,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CARBON DIOXIDE (CO2),30100074,CDM,301,RC,82374,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY CARBOXYHB QUANT,30100075,CDM,301,RC,82375,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CEA,30100076,CDM,301,RC,82378,HCPCS,facility,both,,,,486,486,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLORIDE; BLOOD,30100077,CDM,301,RC,82435,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLORIDE; URINE,30100078,CDM,301,RC,82436,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERUM/WB TOT CHOLEST,30100079,CDM,301,RC,82465,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC SERUM/WB TOT CHOLEST,30100079,CDM,301,RC,82465,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MUCOPOLYSACCHARIDE(MPS) TLC,30100080,CDM,301,RC,82489,HCPCS,facility,both,,,,416,416,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CATHARTIC LAXATIVE STOOL SCR,30100081,CDM,301,RC,82489,HCPCS,facility,both,,,,414,414,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAL THIN LYR CHROMATOGR NES,30100082,CDM,301,RC,82489,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C CHROMATOGR QUAN ANALYT NES,30100083,CDM,301,RC,82491,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C CHROMOTOGR QUAN; MULTI ANALY,30100084,CDM,301,RC,82492,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROMIUM,30100085,CDM,301,RC,82495,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COLLAGEN CROSS LINKS,30100086,CDM,301,RC,82523,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COLLAGEN CROSS LINKS,30100086,CDM,301,RC,82523,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC COPPER,30100087,CDM,301,RC,82525,HCPCS,facility,both,,,,334,334,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CORTICOSTERONE,30100088,CDM,301,RC,82528,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CORTISOL; FREE,30100089,CDM,301,RC,82530,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CORTISOL; TOTAL,30100090,CDM,301,RC,82533,HCPCS,facility,both,,,,348,348,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CC/MS; QUAN SS & MP,30100091,CDM,301,RC,82542,HCPCS,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CC/MS - SGL ANALYTE QUAN,30100092,CDM,301,RC,82543,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CC/MS - MULTI ANALYTES QUAN,30100093,CDM,301,RC,82544,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CPK; TOTAL,30100094,CDM,301,RC,82550,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CPK; TOTAL,30100094,CDM,301,RC,82550,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CPK: MB FRACTION ONLY,30100095,CDM,301,RC,82553,HCPCS,facility,both,,,,16,16,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CPK: MB FRACTION ONLY,30100095,CDM,301,RC,82553,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CREATININE; BLOOD,30100096,CDM,301,RC,82565,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CREATININE; BLOOD,30100096,CDM,301,RC,82565,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CREATININE; NOT BLOOD,30100097,CDM,301,RC,82570,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CREATININE; NOT BLOOD,30100097,CDM,301,RC,82570,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CREATININE; CLEARANCE,30100098,CDM,301,RC,82575,HCPCS,facility,both,,,,207,207,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYOFIBRINOGEN,30100099,CDM,301,RC,82585,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYOGLOBULIN - QUAL/SEMI QUAN,30100100,CDM,301,RC,82595,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN B-12 LEVEL,30100101,CDM,301,RC,82607,HCPCS,facility,both,,,,444,444,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN B-12 LEVEL,30100101,CDM,301,RC,82607,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CYSTATIN C,30100102,CDM,301,RC,82610,HCPCS,facility,both,,,,162,162,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIT D 1 25-DIHYDROXY,30100103,CDM,301,RC,82652,HCPCS,facility,both,,,,1040,1040,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIT D 1 25-DIHYDROXY,30100103,CDM,301,RC,82652,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC PANCREATIC ELASTASE FECAL,30100104,CDM,301,RC,82656,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENZYME ACTIVITY BC; NOT RA, EACH SPECIMEN",30100105,CDM,301,RC,82657,HCPCS,facility,both,,,,962,962,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ESTRADIOL; TOTAL,30100106,CDM,301,RC,82670,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ESTRADIOL; TOTAL,30100106,CDM,301,RC,82670,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ESTRIOL UNCONJUGATED,30100107,CDM,301,RC,82677,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FAT/LIPIDS FECES; QUAN,30100108,CDM,301,RC,82710,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FERRITIN,30100109,CDM,301,RC,82728,HCPCS,facility,both,,,,408,408,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FETAL FIBRONECTIN CV SEMIQUAN,30100110,CDM,301,RC,82731,HCPCS,facility,both,,,,1060,1060,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FOLIC ACID; SERUM,30100111,CDM,301,RC,82746,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC FOLIC ACID; SERUM,30100111,CDM,301,RC,82746,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FOLIC ACID; RBC,30100112,CDM,301,RC,82747,HCPCS,facility,both,,,,293,293,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FRUCTOSE SEMEN,30100113,CDM,301,RC,82757,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY IGA/IGD/IGG/IGM EACH,30100114,CDM,301,RC,82784,HCPCS,facility,both,,,,147,147,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IGG 1 2 3 OR 4 EACH,30100115,CDM,301,RC,82787,HCPCS,facility,both,,,,207,207,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD GAS MIXED WO O2 SAT,30100116,CDM,301,RC,82803,HCPCS,facility,both,,,,448,448,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD GASES W/02 SATURATION,30100117,CDM,301,RC,82805,HCPCS,facility,both,,,,336,336,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD GASES O2 SAT ONLY,30100118,CDM,301,RC,82810,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMOGLOBIN-OXYGEN AFFINITY,30100119,CDM,301,RC,82820,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUCOSE BODY FLUID NOT BLOOD,30100120,CDM,301,RC,82945,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUCOSE; QUAN BLOOD,30100121,CDM,301,RC,82947,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC GLUCOSE; QUAN BLOOD,30100121,CDM,301,RC,82947,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUCOSE; POST GLUCOSE DOSE,30100122,CDM,301,RC,82950,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECM,30100123,CDM,301,RC,82951,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GTT-ADDED SAMPLES,30100124,CDM,301,RC,82952,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUTAMINE,30100125,CDM,301,RC,82975,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUTAMYLTRANSFERASE GAMMA,30100126,CDM,301,RC,82977,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUTAMYLTRANSFERASE GAMMA,30100126,CDM,301,RC,82977,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC GROWTH HORMONE HUMAN,30100127,CDM,301,RC,83003,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HAPTOGLOBIN; QUAN,30100128,CDM,301,RC,83010,HCPCS,facility,both,,,,392,392,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEAVY METAL; QUAN,30100129,CDM,301,RC,83018,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HGB FRACT & QUAN; EP,30100130,CDM,301,RC,83020,HCPCS,facility,both,,,,394,394,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HGB CHROMATOGRAPHY,30100131,CDM,301,RC,83021,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HGB; FETAL CHEMICAL,30100132,CDM,301,RC,83030,HCPCS,facility,both,,,,258,258,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HGB; FETAL QUAL,30100133,CDM,301,RC,83033,HCPCS,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLYCOSYLATED HEMOGLOBIN TEST,30100134,CDM,301,RC,83036,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC GLYCOSYLATED HEMOGLOBIN TEST,30100134,CDM,301,RC,83036,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HBG; METHEMOGLOBIN QUAN,30100135,CDM,301,RC,83050,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMOGLOBIN; UNSTABLE SCREEN,30100136,CDM,301,RC,83068,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMOSIDERIN; QUAL,30100137,CDM,301,RC,83070,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC B-HEXOSAMINIDASE EA ASSAY,30100138,CDM,301,RC,83080,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF HOMOCYSTINE,30100139,CDM,301,RC,83090,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC 5-HIAA,30100140,CDM,301,RC,83497,HCPCS,facility,both,,,,327,327,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNOASSAY NONANTIBODY,30100141,CDM,301,RC,83516,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RIA NONANTIBODY,30100142,CDM,301,RC,83519,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (20),30100143,CDM,301,RC,83520,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (25),30100144,CDM,301,RC,83520,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC CAFFEINE,SERUM",30100145,CDM,301,RC,83520,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GROWTH HORMONE BINDING PROTEIN,30100146,CDM,301,RC,83520,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTHROMBIN FRAGMENT 1.2,30100149,CDM,301,RC,83520,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (94),30100153,CDM,301,RC,83520,HCPCS,facility,both,,,,372,372,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RNA POLYMERASE I-III IGG,30100155,CDM,301,RC,83520,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (180),30100159,CDM,301,RC,83520,HCPCS,facility,both,,,,534,534,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SULFATIDE ANTIBODY TEST,30100160,CDM,301,RC,83520,HCPCS,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VGKC ANTIBODY TEST,30100164,CDM,301,RC,83520,HCPCS,facility,both,,,,502,502,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACHR/MUSK REFLEX ANTIBODY,30100167,CDM,301,RC,83520,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARANEOPLASTIC PROFILE,30100173,CDM,301,RC,83520,HCPCS,facility,both,,,,592,592,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IRON,30100175,CDM,301,RC,83540,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LACTATE,30100176,CDM,301,RC,83605,HCPCS,facility,both,,,,308,308,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LACTATE,30100176,CDM,301,RC,83605,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC LACTATE DEHYDROGENASE,30100177,CDM,301,RC,83615,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC LACTATE DEHYDROGENASE,30100177,CDM,301,RC,83615,HCPCS,facility,both,,,,254,254,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LACTOFERRIN FECAL (QUAL),30100178,CDM,301,RC,83630,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEAD,30100179,CDM,301,RC,83655,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FETAL LUNG - FLUORESC POLARIZ,30100180,CDM,301,RC,83663,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FETAL LUNG - LB DENSITY,30100181,CDM,301,RC,83664,HCPCS,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPASE,30100182,CDM,301,RC,83690,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPASE,30100182,CDM,301,RC,83690,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ASSAY OF LIPOPROTEIN(A),30100183,CDM,301,RC,83695,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ASSAY OF LIPOPROTEIN(A),30100183,CDM,301,RC,83695,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPOPROTEIN BLD HR FRACTION,30100184,CDM,301,RC,83701,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPOPROTEIN BLD BY NMR,30100185,CDM,301,RC,83704,HCPCS,facility,both,,,,328,328,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPOPROTEIN; HDL,30100186,CDM,301,RC,83718,HCPCS,facility,both,,,,408,408,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPOPROTEIN; HDL,30100186,CDM,301,RC,83718,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ASSAY OF BLOOD LIPOPROTEIN LDL,30100187,CDM,301,RC,83721,HCPCS,facility,both,,,,406,406,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MAGNESIUM,30100188,CDM,301,RC,83735,HCPCS,facility,both,,,,219,219,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MAGNESIUM,30100188,CDM,301,RC,83735,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC QUALIT MASS SPECT EA SPECIM,30100189,CDM,301,RC,83788,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN",30100190,CDM,301,RC,83789,HCPCS,facility,both,,,,216,216,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC METANEPHRINES,30100191,CDM,301,RC,83835,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC METHEMALBUMIN,30100192,CDM,301,RC,83857,HCPCS,facility,both,,,,128,128,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MUCOPOLYSACCH ACID; QUAN,30100193,CDM,301,RC,83864,HCPCS,facility,both,,,,522,522,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MUCOPOLYSACCH ACID; SCREEN,30100194,CDM,301,RC,83866,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MYOGLOBIN,30100195,CDM,301,RC,83874,HCPCS,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NATRIURETIC PEPTIDE,30100196,CDM,301,RC,83880,HCPCS,facility,both,,,,768,768,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NATRIURETIC PEPTIDE,30100196,CDM,301,RC,83880,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC NUCLEIC ACID HIGH RESOLUTE,30100220,CDM,301,RC,83909,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOM SYNDROME DNA,30100229,CDM,301,RC,83912,HCPCS,facility,both,,,,2906,2906,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HHT KNOWN FAMILIAL MUTATION,30100239,CDM,301,RC,83912,HCPCS,facility,both,,,,498,498,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACADM EXON 11 SEQUENCING,30100248,CDM,301,RC,83912,HCPCS,facility,both,,,,862,862,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C-KIT MUTATION ANALYSIS,30100273,CDM,301,RC,83912,HCPCS,facility,both,,,,1742,1742,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPINAL MUSCULAR ATROPHY DNA,30100278,CDM,301,RC,83912,HCPCS,facility,both,,,,478,478,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC HI RESOLUTION HLA DNA (A,B,C)",30100279,CDM,301,RC,83912,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SCA5 SELECT EXON DNA TEST,30100280,CDM,301,RC,83912,HCPCS,facility,both,,,,888,888,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANTLEY BIXLER-LIKE SYNDROME,30100281,CDM,301,RC,83912,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AAT6 GENE ASSAY,30100282,CDM,301,RC,83912,HCPCS,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC T CELL ENGRAFTMENT FOLLOWUP,30100294,CDM,301,RC,83912,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SH3TC2 DNA SEQUENCING TEST,30100295,CDM,301,RC,83912,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC KCNJ11(CH) DNA SEQUENCING,30100298,CDM,301,RC,83912,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CORONAL SYNOSTOSIS DNA,30100299,CDM,301,RC,83912,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RAPID RFLP FOR BMT FOLLOW-UP,30100304,CDM,301,RC,83912,HCPCS,facility,both,,,,43,43,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PREIFFER SYNDROME,30100309,CDM,301,RC,83912,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IGVH MUTATION ANALYSIS (CLL),30100310,CDM,301,RC,83912,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TMP1 GENE TEST TROPOMYSIN,30100314,CDM,301,RC,83912,HCPCS,facility,both,,,,363,363,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FAM AMYOTROPHIC LAT SCHLERO,30100316,CDM,301,RC,83912,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SURFAC PROTEIN C DEFICIENCY,30100318,CDM,301,RC,83912,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LOEYS-DIETZ TYPE 1C GENE SMAD3,30100323,CDM,301,RC,83912,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NPM 1 PANEL,30100331,CDM,301,RC,83912,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DEMYELINAT NEUROPATHY PROFILE,30100332,CDM,301,RC,83912,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF NUCLEOTIDASE,30100412,CDM,301,RC,83915,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OLIGOCLONAL BANDS,30100413,CDM,301,RC,83916,HCPCS,facility,both,,,,642,642,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUANTITATIVE ORGANIC ACIDS EA SPECIMEN,30100414,CDM,301,RC,83918,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ORGANIC ACID SINGLE QUANTITATIVE,30100415,CDM,301,RC,83921,HCPCS,facility,both,,,,197,197,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OPIATES 1 OR MORE,30100416,CDM,301,RC,80361,HCPCS,facility,both,,,,258,258,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD OSMOLALITY,30100417,CDM,301,RC,83930,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OSMOLALITY; URINE,30100418,CDM,301,RC,83935,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PARATHORMONE,30100419,CDM,301,RC,83970,HCPCS,facility,both,,,,980,980,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY FOR CALPROTECTIN FECAL,30100420,CDM,301,RC,83993,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANTIPSYCHOTIC, NOS 1-3",30100421,CDM,301,RC,80342,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHENYLALANINE BLOOD,30100422,CDM,301,RC,84030,HCPCS,facility,both,,,,255,255,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROSTATIC ACID PHOSPHATASE,30100423,CDM,301,RC,84066,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALKALINE PHOSPHATASE,30100424,CDM,301,RC,84075,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALKALINE PHOSPHATASE,30100424,CDM,301,RC,84075,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HT STBL ALKALINE PHOSPHATASE,30100425,CDM,301,RC,84078,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHOSPHATE,30100426,CDM,301,RC,84100,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC PHOSPHATE,30100426,CDM,301,RC,84100,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC URINE PHOSPHATE,30100427,CDM,301,RC,84105,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PORPHOBILINOGEN URINE; QUAL,30100428,CDM,301,RC,84106,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF SERUM POTASSIUM,30100429,CDM,301,RC,84132,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF SERUM POTASSIUM,30100429,CDM,301,RC,84132,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC URINE POTASSIUM,30100430,CDM,301,RC,84133,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC URINE POTASSIUM,30100430,CDM,301,RC,84133,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PREALBUMIN,30100431,CDM,301,RC,84134,HCPCS,facility,both,,,,241,241,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROLACTIN ASSAY,30100432,CDM,301,RC,84146,HCPCS,facility,both,,,,540,540,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PSA; TOTAL,30100433,CDM,301,RC,84153,HCPCS,facility,both,,,,344,344,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PSA; TOTAL,30100433,CDM,301,RC,84153,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC PSA; FREE,30100434,CDM,301,RC,84154,HCPCS,facility,both,,,,344,344,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF PROTEIN SERUM,30100435,CDM,301,RC,84155,HCPCS,facility,both,,,,219,219,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF PROTEIN SERUM,30100435,CDM,301,RC,84155,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC URINE TOTAL PROTEIN,30100436,CDM,301,RC,84156,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC URINE TOTAL PROTEIN,30100436,CDM,301,RC,84156,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOTAL PROTEIN OTHER SPECIMEN,30100437,CDM,301,RC,84157,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTEIN; EP FRACT & QUAN,30100438,CDM,301,RC,84165,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTEIN E-PHORESIS/URINE/CSF,30100439,CDM,301,RC,84166,HCPCS,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTEIN WESTERN BLOT,30100440,CDM,301,RC,84181,HCPCS,facility,both,,,,7954,7954,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTEIN WB; IM ID FOR BANDS,30100441,CDM,301,RC,84182,HCPCS,facility,both,,,,1362,1362,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RENIN,30100442,CDM,301,RC,84244,HCPCS,facility,both,,,,556,556,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF RIBOFLAVIN (VITAMIN B-2),30100443,CDM,301,RC,84252,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SELENIUM,30100444,CDM,301,RC,84255,HCPCS,facility,both,,,,227,227,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF SERUM SODIUM,30100445,CDM,301,RC,84295,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SODIUM; URINE,30100446,CDM,301,RC,84300,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SODIUM; URINE,30100446,CDM,301,RC,84300,HCPCS,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC SODIUM OTHER SOURCE,30100447,CDM,301,RC,84302,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SOMATOMEDIN,30100448,CDM,301,RC,84305,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SOMATOMEDIN,30100448,CDM,301,RC,84305,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC SPECTROPHOTOMETRY ANALYTE NES,30100449,CDM,301,RC,84311,HCPCS,facility,both,,,,709,709,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SUGARS CHROMOTOGR TLC/PAPER,30100450,CDM,301,RC,84375,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC URINE SULFATE,30100451,CDM,301,RC,84392,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TESTOSTERONE; FREE,30100452,CDM,301,RC,84402,HCPCS,facility,both,,,,529,529,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THIOCYANATE,30100453,CDM,301,RC,84430,HCPCS,facility,both,,,,55,55,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THROMBOXANE URINE,30100454,CDM,301,RC,84431,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THYROGLOBULIN,30100455,CDM,301,RC,84432,HCPCS,facility,both,,,,354,354,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THYROGLOBULIN,30100455,CDM,301,RC,84432,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC THYROXINE; TOTAL,30100456,CDM,301,RC,84436,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC THYROXINE; TOTAL,30100456,CDM,301,RC,84436,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FREE THYROXINE,30100457,CDM,301,RC,84439,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC FREE THYROXINE,30100457,CDM,301,RC,84439,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THYROXINE BINDING GLOBULIN,30100458,CDM,301,RC,84442,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THYROXINE BINDING GLOBULIN,30100459,CDM,301,RC,84442,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THYROID STIMULATING HORMONE,30100460,CDM,301,RC,84443,HCPCS,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THYROID STIMULATING HORMONE,30100460,CDM,301,RC,84443,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AST OR SGOT,30100461,CDM,301,RC,84450,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AST OR SGOT,30100461,CDM,301,RC,84450,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRANSFERASE; ALANINE AMINO,30100462,CDM,301,RC,84460,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRANSFERASE; ALANINE AMINO,30100462,CDM,301,RC,84460,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC TRANSFERRIN,30100463,CDM,301,RC,84466,HCPCS,facility,both,,,,334,334,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRIGLYCERIDES,30100464,CDM,301,RC,84478,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRIGLYCERIDES,30100464,CDM,301,RC,84478,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC T3 OR T4 OR THBR,30100465,CDM,301,RC,84479,HCPCS,facility,both,,,,344,344,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC T3; TOTAL,30100466,CDM,301,RC,84480,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC T3; TOTAL,30100466,CDM,301,RC,84480,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TROPONIN QUAN,30100467,CDM,301,RC,84484,HCPCS,facility,both,,,,313,313,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TROPONIN QUAN,30100467,CDM,301,RC,84484,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC UREA NITROGEN; QUAN,30100468,CDM,301,RC,84520,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC UREA NITROGEN; QUAN,30100468,CDM,301,RC,84520,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UREA NITROGEN URINE,30100469,CDM,301,RC,84540,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC URIC ACID; BLOOD,30100470,CDM,301,RC,84550,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC URIC ACID; BLOOD,30100470,CDM,301,RC,84550,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC URIC ACID; NOT BLOOD,30100471,CDM,301,RC,84560,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UROBILINOGEN URINE; QUAL,30100472,CDM,301,RC,84578,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VMA URINE,30100473,CDM,301,RC,84585,HCPCS,facility,both,,,,532,532,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN NOS,30100474,CDM,301,RC,84591,HCPCS,facility,both,,,,246,246,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN K,30100475,CDM,301,RC,84597,HCPCS,facility,both,,,,615,615,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VOLATILES,30100476,CDM,301,RC,84600,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC VOLATILES,30100476,CDM,301,RC,84600,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC XYLOSE ABSORPTION BLOOD &/OR URINE,30100477,CDM,301,RC,84620,HCPCS,facility,both,,,,442,442,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ZINC,30100478,CDM,301,RC,84630,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C-PEPTIDE,30100479,CDM,301,RC,84681,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HCG; QUAN,30100480,CDM,301,RC,84702,HCPCS,facility,both,,,,434,434,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HCG; QUAN,30100480,CDM,301,RC,84702,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC UNLISTED CHEMISTRY (10),30100481,CDM,301,RC,84999,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IA QUANT; CA 15-3 (27.29),30100484,CDM,302,RC,86300,HCPCS,facility,both,,,,393,393,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INHIBIN A,30100485,CDM,302,RC,86336,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LYMES AMPLIFIED NA PROBE,30100486,CDM,306,RC,87476,HCPCS,facility,both,,,,994,994,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMPHETAMINE SCREEN,30100487,CDM,301,RC,80301,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG ABUSE PROFILE 1,30100488,CDM,301,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG ABUSE PROFILE 2,30100489,CDM,301,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC DRUG ABUSE PROFILE 3, EMERG",30100490,CDM,301,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC DRUG ABUSE PROFILE 4, EMERG",30100491,CDM,301,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BUPRENORPHINE + METAB SCREEN,30100492,CDM,301,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN QUANT CAFFEINE,30100494,CDM,301,RC,80155,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN QUANT CLOZAPINE,30100495,CDM,301,RC,80159,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN QUANT EVEROLIMUS,30100496,CDM,301,RC,80169,HCPCS,facility,both,,,,162,162,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN QUANT GABAPENTIN,30100497,CDM,301,RC,80171,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN QUAN LAMOTRIGINE,30100498,CDM,301,RC,80175,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCRN QUAN LEVETIRACETAM,30100499,CDM,301,RC,80177,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCRN QUAN MYCOPHENOLATE,30100500,CDM,301,RC,80180,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCRN QUANT OXCARBAZEPIN,30100501,CDM,301,RC,80183,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROCAINAMIDE,30100502,CDM,301,RC,80190,HCPCS,facility,both,,,,720,720,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN QUANT ZONISAMIDE,30100503,CDM,301,RC,80203,HCPCS,facility,both,,,,157,157,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACTH STIM; ADRENAL INSUFF,30100504,CDM,301,RC,80400,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INSULIN T PANEL; ACTH INSUFF,30100505,CDM,301,RC,80434,HCPCS,facility,both,,,,1678,1678,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BCR/ABL1 GENE MAJOR BP,30100509,CDM,310,RC,81206,HCPCS,facility,both,,,,2931,2931,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BCR/ABL1 GENE MINOR BP,30100510,CDM,310,RC,81207,HCPCS,facility,both,,,,2577,2577,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BCR/ABL1 GENE OTHER BP,30100511,CDM,310,RC,81208,HCPCS,facility,both,,,,2862,2862,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BRAF GENE,30100513,CDM,310,RC,81210,HCPCS,facility,both,,,,2339,2339,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYP2D6 GENE COM VARIANTS,30100519,CDM,310,RC,81226,HCPCS,facility,both,,,,5888,5888,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYP2D6 GENE COM VARIANTS,30100519,CDM,310,RC,81226,HCPCS,facility,both,,,,5888,5888,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGEN M ARRAY COPY NO&SNP,30100522,CDM,310,RC,81229,HCPCS,facility,both,,,,5842,5842,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EGFR GENE COM VARIANTS,30100523,CDM,310,RC,81235,HCPCS,facility,both,,,,4302,4302,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FMR1 GENE DETECTION,30100525,CDM,310,RC,81243,HCPCS,facility,both,,,,816,816,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLT3 GENE,30100527,CDM,310,RC,81245,HCPCS,facility,both,,,,2163,2163,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HFE GENE,30100532,CDM,310,RC,81256,HCPCS,facility,both,,,,1165,1165,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IGH GENE REARRANGE AMP METH,30100535,CDM,310,RC,81261,HCPCS,facility,both,,,,3522,3522,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IGH VARI REGIONAL MUTATION,30100536,CDM,310,RC,81263,HCPCS,facility,both,,,,1135,1135,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHIMERISM ANAL NO CELL SELEC,30100539,CDM,310,RC,81267,HCPCS,facility,both,,,,3689,3689,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHIMERISM ANAL W/CELL SELECT,30100540,CDM,310,RC,81268,HCPCS,facility,both,,,,961,961,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC JAK2 GENE,30100541,CDM,310,RC,81270,HCPCS,facility,both,,,,1740,1740,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC KRAS GENE,30100542,CDM,310,RC,81275,HCPCS,facility,both,,,,2576,2576,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MLH1 GENE DUP/DELETE VARIANT,30100547,CDM,310,RC,81294,HCPCS,facility,both,,,,2486,2486,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MICROSATELLITE INSTABILITY,30100548,CDM,310,RC,81301,HCPCS,facility,both,,,,5152,5152,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG CONFIRMATION,30100551,CDM,301,RC,80102,HCPCS,facility,both,,,,386,386,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAL SERUM ACETONE/KETONES,30100552,CDM,301,RC,82009,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MICROALBUMIN; URINE SEMIQUAN,30100553,CDM,301,RC,82044,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMPHETAMINE/METHAMPH,30100554,CDM,301,RC,82145,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BILE ACIDS; TOTAL,30100555,CDM,301,RC,82239,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OCCULT BLD FECES 1-3 TESTS,30100556,CDM,301,RC,82272,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STONE; X-RAY DIFFRACTION,30100557,CDM,301,RC,82370,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHEMILUMINESCENT ASSAY,30100558,CDM,301,RC,82397,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHOLINESTERASE; RBC,30100559,CDM,301,RC,82482,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CPK: ISOENZYMES,30100560,CDM,301,RC,82552,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DESOXYCORTICOSTERONE 11,30100561,CDM,301,RC,82633,HCPCS,facility,both,,,,384,384,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ELECTROPHORESIS NES,30100562,CDM,301,RC,82664,HCPCS,facility,both,,,,227,227,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ESTROGENS; TOTAL,30100563,CDM,301,RC,82672,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLURAZEPAM,30100564,CDM,301,RC,82742,HCPCS,facility,both,,,,329,329,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD GAS PH ONLY,30100565,CDM,301,RC,82800,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEAVY METAL; SCREEN,30100566,CDM,301,RC,83015,HCPCS,facility,both,,,,1077,1077,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMOSIDERIN; QUANT,30100567,CDM,301,RC,83071,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IRON BINDING CAPACITY,30100568,CDM,301,RC,83550,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FETAL LUNG MATURITY; QUAN,30100569,CDM,301,RC,83661,HCPCS,facility,both,,,,646,646,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEUCINE AMINOPEPTIDASE,30100570,CDM,301,RC,83670,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LUTEINIZING RELEASING FACTOR,30100571,CDM,301,RC,83727,HCPCS,facility,both,,,,1106,1106,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAL ORGANIC ACIDS EA SPECIM,30100572,CDM,301,RC,83919,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PCP QUAN ASSAY,30100573,CDM,301,RC,83992,HCPCS,facility,both,,,,348,348,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PREGNANEDIOL,30100574,CDM,301,RC,84135,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PYRUVATE KINASE,30100575,CDM,301,RC,84220,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THYROID STIMULATING IMMUNOGLOBULINS,30100576,CDM,301,RC,84445,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CANNABINOID EXLUS/TEST,30100577,CDM,301,RC,80301,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC DRUGS SCR, SINGLE X 6",30100578,CDM,301,RC,,,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC URINE DRUG SCREEN (8TEST),30100579,CDM,301,RC,80301,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN MULTI DRUG CLASS,30100580,CDM,301,RC,,,facility,both,,,,63,63,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYP2C19 GENE COM VARIANTS,30100581,CDM,310,RC,81225,HCPCS,facility,both,,,,3804,3804,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYP2C19 GENE COM VARIANTS,30100581,CDM,310,RC,81225,HCPCS,facility,both,,,,3804,3804,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC F2 GENE,30100582,CDM,310,RC,81240,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC F5 GENE,30100583,CDM,310,RC,81241,HCPCS,facility,both,,,,1093,1093,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MTHFR GENE,30100584,CDM,310,RC,81291,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALPHA-1-ANTITRYPSIN; PHENOTYPE (40),30100585,CDM,301,RC,82104,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMINO ACIDS; 2-5 QUAN EA,30100586,CDM,301,RC,82136,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COCAINE OR METABOLITE ASSAY,30100587,CDM,301,RC,82520,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STONE; QUALITATIVE ANALYSIS,30100588,CDM,301,RC,82355,HCPCS,facility,both,,,,232,232,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC STONE; QUANTITATIVE ANALYSIS, CHEMICAL",30100589,CDM,301,RC,82360,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CATECHOLAMINES; TOTAL URINE,30100590,CDM,301,RC,82382,HCPCS,facility,both,,,,433,433,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY CARBOXYHB QUAL,30100591,CDM,301,RC,82376,HCPCS,facility,both,,,,71,71,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHOLINESTERASE; SERUM,30100592,CDM,301,RC,82480,HCPCS,facility,both,,,,255,255,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ENZYME ACTIVITY BC; RA,30100593,CDM,301,RC,82658,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIBUCAINE NUMBER,30100594,CDM,301,RC,82638,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUCOSE; BLD BY MONITOR DEVICE,30100595,CDM,301,RC,82962,HCPCS,facility,both,,,,27,27,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HGB; METHEMOGLOBIN QUAL,30100596,CDM,301,RC,83045,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GASTRIC ANALY W/PH EA SPEC,30100597,CDM,301,RC,82930,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FREE INSULIN,30100598,CDM,301,RC,83527,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC KETOSTEROIDS 17; FRACTIONATION,30100599,CDM,301,RC,83593,HCPCS,facility,both,,,,312,312,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LIPOPRO BLD ELECTROPHORETIC,30100600,CDM,301,RC,83700,HCPCS,facility,both,,,,580,580,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC H PYLORI (C-13) BREATH TEST,30100601,CDM,301,RC,83013,HCPCS,facility,both,,,,795,795,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NON-URINE SPECIFIC GRAVITY,30100602,CDM,301,RC,84315,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SUGARS; MULTI QUAL EA SPECIMEN,30100603,CDM,301,RC,84377,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNOASSAY DIPSTICK,30100604,CDM,301,RC,83518,HCPCS,facility,both,,,,101,101,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ISOCITRIC DEHYDROGENASE,30100605,CDM,301,RC,83570,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC KETOGENIC STEROIDS FRACTIONATION,30100606,CDM,301,RC,83582,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC KETOSTEROIDS 17; TOTAL,30100607,CDM,301,RC,83586,HCPCS,facility,both,,,,484,484,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LACTOGEN MATERNAL SERUM HPL,30100608,CDM,301,RC,83632,HCPCS,facility,both,,,,535,535,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MEPROBAMATE,30100609,CDM,301,RC,83805,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC ANTIEPILEPTICS, NOS 1-3",30100610,CDM,301,RC,80339,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MUCIN SYNORVIAL FLUID,30100611,CDM,301,RC,83872,HCPCS,facility,both,,,,210,210,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ONCOPROTEIN DCP,30100612,CDM,301,RC,83951,HCPCS,facility,both,,,,762,762,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOTAL ACID PHOSPHATASE,30100613,CDM,301,RC,84060,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHOSPHATIDYLGLYCEROL,30100614,CDM,301,RC,84081,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EVAL AMNIOTIC FLUID PROTEIN,30100615,CDM,301,RC,84112,HCPCS,facility,both,,,,762,762,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAL URINE PORPHYRINS,30100616,CDM,301,RC,84119,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAN FECAL PORPHYRINS,30100617,CDM,301,RC,84126,HCPCS,facility,both,,,,302,302,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PREGNANETRIOL,30100618,CDM,301,RC,84138,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROCALCITONIN (PCT),30100619,CDM,301,RC,84145,HCPCS,facility,both,,,,317,317,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROSTAGLANDIN EACH,30100620,CDM,301,RC,84150,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PSA - COMPLEXED,30100621,CDM,301,RC,84152,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ERA,30100622,CDM,301,RC,84233,HCPCS,facility,both,,,,762,762,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRA,30100623,CDM,301,RC,84234,HCPCS,facility,both,,,,767,767,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SUGARS; SINGLE QUAL EA SPECIMEN,30100624,CDM,301,RC,84376,HCPCS,facility,both,,,,65,65,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SUGARS; SINGLE QUAN EA SPECIMEN,30100625,CDM,301,RC,84378,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRANSCORTIN,30100626,CDM,301,RC,84449,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRYPSIN; DUODENAL FLUID,30100627,CDM,301,RC,84485,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRYPSIN; FECES QUAL,30100628,CDM,301,RC,84488,HCPCS,facility,both,,,,157,157,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRYPSIN; FECES QUAN 24-HR,30100629,CDM,301,RC,84490,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TROPONIN QUAL,30100630,CDM,301,RC,84512,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UREA NITROGEN CLEARANCE,30100631,CDM,301,RC,84545,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UROBILINOGEN FECES QUAN,30100632,CDM,301,RC,84577,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UROBILINOGEN URINE QUAN TIMED SPEC,30100633,CDM,301,RC,84580,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYCLIC ADP OR AMP,30100634,CDM,301,RC,82030,HCPCS,facility,both,,,,305,305,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANDROSTANEDIOL GLUCURONIDE,30100635,CDM,301,RC,82154,HCPCS,facility,both,,,,342,342,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BILE ACIDS; CHOLYLGLYCINE,30100636,CDM,301,RC,82240,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CALCIUM; AFTER CALCIUM INFUSION,30100637,CDM,301,RC,82331,HCPCS,facility,both,,,,654,654,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CATECHOLAMINES; BLOOD,30100638,CDM,301,RC,82383,HCPCS,facility,both,,,,776,776,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLORAMPHENICOL,30100639,CDM,301,RC,82415,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CPK; ISOFORMS,30100640,CDM,301,RC,82554,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIHYDROCODEINONE QUAN,30100641,CDM,301,RC,82646,HCPCS,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYSTINE & HC URINE QUAL,30100642,CDM,301,RC,82615,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIHYDROMORPHINONE QUAN,30100643,CDM,301,RC,82649,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ETHCHLORVYNOL,30100644,CDM,301,RC,82690,HCPCS,facility,both,,,,274,274,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FAT DIFFERENTIAL FECES QUAN,30100645,CDM,301,RC,82715,HCPCS,facility,both,,,,105,105,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GALACTOSE,30100646,CDM,301,RC,82760,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUCOSE; TOLBUTAMIDE TOLERANCE,30100647,CDM,301,RC,82953,HCPCS,facility,both,,,,209,209,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC G6PD; SCREEN,30100648,CDM,301,RC,82960,HCPCS,facility,both,,,,73,73,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUTETHIMIDE,30100649,CDM,301,RC,82980,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HYDROXYPROLINE; FREE,30100650,CDM,301,RC,83500,HCPCS,facility,both,,,,380,380,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HYDROXYPROLINE; TOTAL,30100651,CDM,301,RC,83505,HCPCS,facility,both,,,,381,381,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CREATINE,30100652,CDM,301,RC,82540,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NPM1 GENE,30100653,CDM,310,RC,81310,HCPCS,facility,both,,,,3223,3223,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PML/RARALPHA COM BREAKPOINTS,30100654,CDM,310,RC,81315,HCPCS,facility,both,,,,3688,3688,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PTEN GENE FULL SEQUENCE,30100655,CDM,310,RC,81321,HCPCS,facility,both,,,,7833,7833,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PTEN GENE KNOWN FAM VARIANT,30100656,CDM,310,RC,81322,HCPCS,facility,both,,,,764,764,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PTEN GENE DUP/DELET VARIANT,30100657,CDM,310,RC,81323,HCPCS,facility,both,,,,1143,1143,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERPINA1 GENE,30100663,CDM,310,RC,81332,HCPCS,facility,both,,,,777,777,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRG GENE REARRANGEMENT ANAL,30100664,CDM,310,RC,81342,HCPCS,facility,both,,,,3585,3585,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VKORC1 GENE,30100665,CDM,310,RC,81355,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HLA I TYPING COMPLETE LR (150),30100666,CDM,310,RC,81372,HCPCS,facility,both,,,,3929,3929,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA I TYPING 1 ANTIGEN LR (150),30100667,CDM,310,RC,81374,HCPCS,facility,both,,,,1295,1295,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA II TYPING AG EQUIV LR (170),30100668,CDM,310,RC,81375,HCPCS,facility,both,,,,3927,3927,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA II TYPING 1 LOCUS LR (40),30100669,CDM,310,RC,81376,HCPCS,facility,both,,,,3503,3503,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA I TYPING COMPLETE HR (290),30100670,CDM,310,RC,81379,HCPCS,facility,both,,,,5964,5964,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA I TYPING 1 ALLELE HR,30100671,CDM,310,RC,81381,HCPCS,facility,both,,,,1684,1684,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA II TYPING 1 LOCUS HR (40),30100672,CDM,310,RC,81382,HCPCS,facility,both,,,,2198,2198,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA II TYPING 1 ALLELE HR,30100673,CDM,310,RC,81383,HCPCS,facility,both,,,,1943,1943,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 1,30100674,CDM,310,RC,81400,HCPCS,facility,both,,,,961,961,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 2,30100675,CDM,310,RC,81401,HCPCS,facility,both,,,,191,191,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 3,30100676,CDM,310,RC,81402,HCPCS,facility,both,,,,1793,1793,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 4,30100677,CDM,310,RC,81403,HCPCS,facility,both,,,,257,257,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 5,30100678,CDM,310,RC,81404,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED MOLECULAR PATHOLOGY,30100683,CDM,310,RC,81479,HCPCS,facility,both,,,,1321,1321,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DISOPYRAMIDE,30100684,CDM,301,RC,80299,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LORAZEPAM,30100685,CDM,301,RC,80299,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOMIPRAMINE,30100686,CDM,301,RC,80299,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLUOXETIN,30100687,CDM,301,RC,80332,HCPCS,facility,both,,,,442,442,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMIODARONE,30100688,CDM,301,RC,80299,HCPCS,facility,both,,,,155,155,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN SINGLE,30100690,CDM,301,RC,80301,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN SINGLE X 12,30100691,CDM,301,RC,80301,HCPCS,facility,both,,,,508,508,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VALPROIC ACID FREE,30100692,CDM,301,RC,80165,HCPCS,facility,both,,,,367,367,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALCOHOL,30100693,CDM,301,RC,80320,HCPCS,facility,both,,,,406,406,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALCOHOL,30100693,CDM,301,RC,80320,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ANTIDEPRESSANT 1 OR 2,30100694,CDM,301,RC,80335,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROPOXYPHENE,30100695,CDM,301,RC,80367,HCPCS,facility,both,,,,258,258,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BUPRENORPHINE,30100696,CDM,301,RC,80348,HCPCS,facility,both,,,,258,258,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALKALOIDS NOS,30100697,CDM,301,RC,80323,HCPCS,facility,both,,,,282,282,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC METHADONE,30100698,CDM,301,RC,80358,HCPCS,facility,both,,,,728,728,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC ANABOLIC STEROIDS, 1 OR 2",30100699,CDM,301,RC,80327,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC ANALGESICS,NON-OPIOD 1 OR 2",30100700,CDM,301,RC,80329,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG CLASS A SCREEN IEA;5 DRUG,30100701,CDM,301,RC,80301,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC CANNABINOIDS,NATURAL",30100702,CDM,301,RC,80349,HCPCS,facility,both,,,,398,398,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PREGABALIN,30100703,CDM,301,RC,80366,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUANTITATIVE ASSAY DRUG (25),30100709,CDM,301,RC,80299,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC QUANTITATIVE ASSAY DRUG (30),30100710,CDM,301,RC,80299,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUANTITATIVE ASSAY DRUG (35),30100711,CDM,301,RC,80299,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC QUANTITATIVE ASSAY DRUG (35),30100711,CDM,301,RC,80299,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUANTITATIVE ASSAY DRUG (75),30100714,CDM,301,RC,80299,HCPCS,facility,both,,,,374,374,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC QUANTITATIVE ASSAY DRUG (85),30100721,CDM,301,RC,80299,HCPCS,facility,both,,,,423,423,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC ANTI-DEPRESS,SEROTO 1-2 (70)",30100727,CDM,301,RC,80332,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANTI-DEPRESS, NOS (60)",30100735,CDM,301,RC,80338,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG/SUBST DEFINITIVE QUAL/QUANT,30100738,CDM,301,RC,80375,HCPCS,facility,both,,,,632,632,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG SCRN,NOS PRESUMPTIVE",30100739,CDM,301,RC,80304,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCRN OXYCODONE,30100740,CDM,301,RC,80365,HCPCS,facility,both,,,,632,632,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAPPA SERUM,30100741,CDM,301,RC,84163,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HCG FREE BETA CHAIN,30100742,CDM,301,RC,84704,HCPCS,facility,both,,,,85,85,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (10),30100746,CDM,301,RC,83520,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC DRUG SCREEN, INSTRUMENT SINGLE DRUG",30100748,CDM,301,RC,80307,HCPCS,facility,both,,,,296,296,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG SCREEN, INSTRUMENT 8 DRUG",30100749,CDM,301,RC,80307,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE "HC DRUG SCREEN, INSTRUMENT 8 DRUG",30100749,CDM,301,RC,80307,HCPCS,facility,both,,,,296,296,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG SCREEN, INSTRUMENT 9 DRUG",30100750,CDM,301,RC,80307,HCPCS,facility,both,,,,511,511,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC DRUG SCREEN, INSTRUMENT 12 DRUG",30100751,CDM,301,RC,80307,HCPCS,facility,both,,,,682,682,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRUG SCREEN, INSTRUMENT 12 DRUG",30100751,CDM,301,RC,80307,HCPCS,facility,both,,,,42,42,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE "HC DRUG SCREEN, INSTRUMENT 5 DRUG",30100752,CDM,301,RC,80307,HCPCS,facility,both,,,,296,296,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCREEN MASS SPEC INSTR,30100753,CDM,301,RC,80307,HCPCS,facility,both,,,,632,632,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (270),30100754,CDM,301,RC,83520,HCPCS,facility,both,,,,802,802,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALCOHOLS BIOMARKERS 1 OR 2,30100755,CDM,301,RC,80321,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (135),30100756,CDM,301,RC,83520,HCPCS,facility,both,,,,401,401,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (50),30100757,CDM,301,RC,83520,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (50),30100757,CDM,301,RC,83520,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC QUANT ASSAY DRUG (265),30100758,CDM,301,RC,80299,HCPCS,facility,both,,,,1281,1281,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC QUANT ASSAY DRUG (265),30100758,CDM,301,RC,80299,HCPCS,facility,both,,,,1281,1281,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY LIPOPROTEIN PLA2 (35),30100759,CDM,301,RC,83698,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY LIPOPROTEIN PLA2 (35),30100759,CDM,301,RC,83698,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG/SUBSTANCE NOS 7/MORE (40),30100761,CDM,301,RC,80377,HCPCS,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG/SUBSTANCE NOS 7/MORE (30),30100762,CDM,301,RC,80377,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG/SUBSTANCE NOS 7/MORE (135),30100763,CDM,301,RC,80377,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEROIN METABOLITE (25),30100764,CDM,301,RC,80356,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KETAMINE AND NORKETAMINE (25),30100765,CDM,301,RC,80357,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPIOIDS AND OPIATE ANALOGS 1/2 (30),30100766,CDM,301,RC,80362,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRAMADOL (30),30100767,CDM,301,RC,80373,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALC GENE COM VARIANTS (210),30100768,CDM,310,RC,81219,HCPCS,facility,both,,,,807,807,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GLUCOSIDASE, BETA",30100769,CDM,301,RC,82963,HCPCS,facility,both,,,,95,95,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUMOASSAY QUANT NOS NONAB (205),30100770,CDM,301,RC,83520,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIHYDROTESTOSTERONE (DHT),30100771,CDM,301,RC,82642,HCPCS,facility,both,,,,152,152,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (354),30100772,CDM,301,RC,83520,HCPCS,facility,both,,,,1052,1052,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNOASSAY QUANT NOS NONAB (354),30100772,CDM,301,RC,83520,HCPCS,facility,both,,,,1052,1052,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHYLENEDIOXYAMPHETAMINES (29),30100773,CDM,301,RC,80359,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CANNABINOIDS,NATURAL (19)",30100774,CDM,301,RC,80349,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BENZODIAZEPINES, 1-12 (19)",30100775,CDM,301,RC,80346,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARBITURATES (9),30100776,CDM,301,RC,80345,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCREENING COCAINE (6),30100777,CDM,301,RC,80353,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPIATES 1 OR MORE (7),30100778,CDM,301,RC,80361,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCRN OXYCODONE (7),30100779,CDM,301,RC,80365,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHADONE (22),30100780,CDM,301,RC,80358,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG ASSAY ADALIMUMAB (265),30100785,CDM,301,RC,80145,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG ASSAY POSACONAZOLE (30),30100786,CDM,301,RC,80187,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG ASSAY INFLIXIMAB (165),30100787,CDM,301,RC,80230,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG ASSAY LACOSAMIDE (80),30100788,CDM,301,RC,80235,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG ASSAY VORICONAZOLE (45),30100789,CDM,301,RC,80285,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NFCT DS CHRNC HCV 6 ASSAYS (55),30100790,CDM,310,RC,81596,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALCOHOLS BIOMARKERS 1 OR 2 (63),30100791,CDM,301,RC,80321,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED CHEM PROC (1),30100792,CDM,301,RC,84999,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG SCREENING FENTANYL (38),30100793,CDM,301,RC,80354,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETOMINOPHEN,30100795,CDM,301,RC,80143,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AMIODARONE,30100796,CDM,301,RC,80151,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CARBAMAZEPINE;10,11-EPOXIDE",30100797,CDM,301,RC,80161,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FELBAMATE,30100798,CDM,301,RC,80167,HCPCS,facility,both,,,,95,95,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALICYLATE,30100799,CDM,301,RC,80179,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ITRACONAZOLE,30100801,CDM,301,RC,80189,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LEFLUNOMIDE,30100802,CDM,301,RC,80193,HCPCS,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC METHOTREXATE,30100803,CDM,301,RC,80204,HCPCS,facility,both,,,,119,119,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RUFINAMIDE,30100804,CDM,301,RC,80210,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY SPEC XCP UR&BREATH IA,30100805,CDM,301,RC,82077,HCPCS,facility,both,,,,406,406,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY DIR MEAS FR ESTRADIOL,30100806,CDM,301,RC,82681,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG ASSAY HYDROXYCHLOROQUINE,30100811,CDM,301,RC,80220,HCPCS,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EL-1 FECAL QUANTITATIVE,30100812,CDM,301,RC,82653,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IG LIGHT CHAINS FREE EACH,30100813,CDM,301,RC,83521,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASSAY OF INTERLEUKIN-6 (IL-6),30100814,CDM,301,RC,83529,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA",30100815,CDM,301,RC,86596,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRUG ASSAY ADALIMUMAB,30100817,CDM,301,RC,80145,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SYNTHETIC GLUCOCORTICOID SCREEN, SERUM(91)",30100820,CDM,301,RC,80299,HCPCS,facility,both,,,,313,313,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANTI-MULLERIAN HORMONE (AMH),30100823,CDM,301,RC,82166,HCPCS,facility,both,,,,157,157,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENZYME EVAL; ALPHA GALA, EACH SPECIMEN",30100831,CDM,301,RC,82657,HCPCS,facility,both,,,,253,253,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INHIBIN-B QUEST,30160029,CDM,301,RC,83520,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SOLUBLE LIVER ANTIGEN QUEST,30160037,CDM,301,RC,83520,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACUTE HEPATITIS PANEL,30200001,CDM,301,RC,80074,HCPCS,facility,both,,,,934,934,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DOXEPIN,30200002,CDM,302,RC,80166,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ETHOSUXIMIDE,30200003,CDM,301,RC,80168,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALDOLASE,30200004,CDM,301,RC,82085,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALPHA-1-ANTITRYPSIN; TOTAL,30200005,CDM,301,RC,82103,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALPHA-1-ANTITRYPSIN; TOTAL,30200005,CDM,301,RC,82103,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ALUMINUM ASSAY,30200006,CDM,301,RC,82108,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMINO ACIDS; SGL QUAN EA,30200007,CDM,301,RC,82131,HCPCS,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DELTA ALA,30200008,CDM,301,RC,82135,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANDROSTENEDIONE,30200009,CDM,301,RC,82157,HCPCS,facility,both,,,,797,797,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANGIOTENSIN II,30200010,CDM,301,RC,82163,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANGIOTENSIN I - CONVERTING ENZYME,30200011,CDM,301,RC,82164,HCPCS,facility,both,,,,444,444,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC APOLIPOPROTEIN EACH,30200012,CDM,301,RC,82172,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC APOLIPOPROTEIN EACH,30200012,CDM,301,RC,82172,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ARSENIC,30200013,CDM,301,RC,82175,HCPCS,facility,both,,,,560,560,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BIOTINIDASE EA SPECIMEN,30200014,CDM,301,RC,82261,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CAROTENE,30200016,CDM,301,RC,82380,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CATECHOLAMINES FRACTIONATED,30200017,CDM,301,RC,82384,HCPCS,facility,both,,,,1000,1000,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CERULOPLASMIN,30200018,CDM,301,RC,82390,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CITRATE,30200019,CDM,301,RC,82507,HCPCS,facility,both,,,,328,328,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYANIDE,30200020,CDM,301,RC,82600,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIT B-12; UNSATURATED BC,30200021,CDM,301,RC,82608,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DHEA,30200022,CDM,301,RC,82626,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DHEA-S,30200023,CDM,301,RC,82627,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DEOXYCORTISOL 11,30200024,CDM,301,RC,82634,HCPCS,facility,both,,,,345,345,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIHYDROTESTOSTERONE,30200025,CDM,302,RC,82651,HCPCS,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ERYTHROPOIETIN,30200026,CDM,301,RC,82668,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ESTROGENS; FRACTIONATED,30200027,CDM,301,RC,82671,HCPCS,facility,both,,,,580,580,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ESTRONE,30200028,CDM,301,RC,82679,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ETHYLENE GLYCOL,30200029,CDM,301,RC,82693,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FAT/LIPIDS FECES; QUAL,30200030,CDM,301,RC,82705,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FATTY ACIDS NONESTERIFIED,30200031,CDM,301,RC,82725,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GALACTOKINASE RBC,30200032,CDM,301,RC,82759,HCPCS,facility,both,,,,254,254,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GALACTOSEMIA; QUAN,30200033,CDM,301,RC,82775,HCPCS,facility,both,,,,248,248,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GASTRIN,30200034,CDM,301,RC,82941,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLUCAGON,30200035,CDM,301,RC,82943,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC G6PD; QUAN,30200036,CDM,301,RC,82955,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GLYCATED PROTEIN,30200037,CDM,301,RC,82985,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HISTAMINE,30200038,CDM,301,RC,83088,HCPCS,facility,both,,,,1090,1090,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HOMOVANILLIC ACID,30200039,CDM,301,RC,83150,HCPCS,facility,both,,,,696,696,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC 17-OHCS,30200040,CDM,301,RC,83491,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HYDROXYPROGESTERONE 17-D,30200041,CDM,301,RC,83498,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LDH; ISOENZYMES,30200042,CDM,301,RC,83625,HCPCS,facility,both,,,,999,999,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MANGANESE,30200043,CDM,301,RC,83785,HCPCS,facility,both,,,,227,227,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MERCURY QUAN,30200044,CDM,301,RC,83825,HCPCS,facility,both,,,,532,532,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC METHADONE,30200045,CDM,302,RC,83840,HCPCS,facility,both,,,,543,543,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MYELIN BASIC PROTEIN CSF,30200046,CDM,301,RC,83873,HCPCS,facility,both,,,,715,715,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NEPHELOMETRY EA ANALYTE NES,30200047,CDM,301,RC,83883,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NICOTINE,30200048,CDM,302,RC,83887,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OSTEOCALCIN,30200049,CDM,301,RC,83937,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OSTEOCALCIN,30200049,CDM,301,RC,83937,HCPCS,facility,both,,,,48,48,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC OXALATE,30200050,CDM,301,RC,83945,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALKALINE PHOSPHATASE ISOENZYM,30200051,CDM,301,RC,84080,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PORPHOBILINOGEN URINE; QUAN,30200052,CDM,301,RC,84110,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAN URINE PORPHYRINS,30200053,CDM,301,RC,84120,HCPCS,facility,both,,,,334,334,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PREGNENOLONE,30200054,CDM,301,RC,84140,HCPCS,facility,both,,,,417,417,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC 17-HYDROXYPREGNENOLONE,30200055,CDM,301,RC,84143,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTOPORPHYRIN RBC; QUAN,30200056,CDM,301,RC,84202,HCPCS,facility,both,,,,496,496,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROINSULIN,30200057,CDM,301,RC,84206,HCPCS,facility,both,,,,319,319,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN B6,30200058,CDM,301,RC,84207,HCPCS,facility,both,,,,524,524,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PYRUVATE,30200059,CDM,301,RC,84210,HCPCS,facility,both,,,,334,334,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY NONENDOCRINE RECEPTOR,30200060,CDM,301,RC,84238,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEROTONIN,30200061,CDM,301,RC,84260,HCPCS,facility,both,,,,741,741,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEX HORMONE BINDING GLOBULIN,30200062,CDM,301,RC,84270,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY OF THIAMINE (VITAMIN B-1),30200063,CDM,301,RC,84425,HCPCS,facility,both,,,,404,404,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOCOPHEROL ALPHA (VIT E),30200064,CDM,301,RC,84446,HCPCS,facility,both,,,,432,432,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC T3; FREE,30200065,CDM,301,RC,84481,HCPCS,facility,both,,,,31,31,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC T3; FREE,30200065,CDM,301,RC,84481,HCPCS,facility,both,,,,46,46,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIP - VASOACTIVE INTESTINAL PEPTIDE,30200066,CDM,301,RC,84586,HCPCS,facility,both,,,,359,359,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VASOPRESSIN,30200067,CDM,301,RC,84588,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VITAMIN A,30200068,CDM,301,RC,84590,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MURAMIDASE,30200069,CDM,305,RC,85549,HCPCS,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AGGLUTININS FEBRILE,30200070,CDM,302,RC,86000,HCPCS,facility,both,,,,227,227,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALLERG SP IGG QUAN OR SEMIQUAN,30200071,CDM,302,RC,86001,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALLERGEN SPECIFIC IGE,30200072,CDM,302,RC,86005,HCPCS,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB ID; PLATELET AB,30200073,CDM,302,RC,86022,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANTINUCLEAR AB (ANA);,30200074,CDM,302,RC,86038,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC ANTINUCLEAR AB (ANA);,30200074,CDM,302,RC,86038,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANTINUCLEAR AB (ANA); TITER,30200075,CDM,302,RC,86039,HCPCS,facility,both,,,,134,134,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C-REACTIVE PROTEIN,30200076,CDM,302,RC,86140,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC C-REACTIVE PROTEIN,30200076,CDM,302,RC,86140,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C-REACTIVE PROTEIN HS,30200077,CDM,302,RC,86141,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C-REACTIVE PROTEIN HS,30200077,CDM,302,RC,86141,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC BETA 2 GLYCOPROTEIN I AB EA,30200078,CDM,302,RC,86146,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CARDIOLIPIN AB EA IG CLASS,30200079,CDM,302,RC,86147,HCPCS,facility,both,,,,852,852,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPLEMENT; AG EA,30200080,CDM,302,RC,86160,HCPCS,facility,both,,,,583,583,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPLEMENT; FCN ACTIVITY EA,30200081,CDM,302,RC,86161,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPLEMENT; TOT HEMOLYTIC (CH50),30200082,CDM,302,RC,86162,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CCP ANTIBODY,30200083,CDM,302,RC,86200,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CCP ANTIBODY,30200083,CDM,302,RC,86200,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC DNA AB,30200084,CDM,302,RC,86215,HCPCS,facility,both,,,,271,271,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DNA AB; NATIVE OR DS,30200085,CDM,302,RC,86225,HCPCS,facility,both,,,,276,276,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ENA ANY METHOD,30200086,CDM,302,RC,86235,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLUORESCENT AB; SCRN EA AB,30200087,CDM,302,RC,86255,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLUORESCENT AB; SCRN EA AB,30200087,CDM,302,RC,86255,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC FLUORESCENT AB; TITER EA AB,30200088,CDM,302,RC,86256,HCPCS,facility,both,,,,400,400,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IA QUANT; CA 19-9,30200089,CDM,302,RC,86301,HCPCS,facility,both,,,,450,450,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IA QUANT; CA 125,30200090,CDM,302,RC,86304,HCPCS,facility,both,,,,486,486,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAL HETEROPHILE AB,30200091,CDM,302,RC,86308,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IA; OTHER TUMOR AG QUAN EA,30200092,CDM,302,RC,86316,HCPCS,facility,both,,,,246,246,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IA INFECTIOUS AGENT AB QUAN,30200093,CDM,302,RC,86317,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE DEAC 01/01/2025 HC IEP; CROSSED,30200094,CDM,302,RC,86327,HCPCS,facility,both,,,,268,268,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNE COMPLEX ASSAY;,30200095,CDM,302,RC,86332,HCPCS,facility,both,,,,290,290,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERUM IMMUNOFIXATION ELECTROPHORES,30200096,CDM,302,RC,86334,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNFIX E-PHORSIS/URINE/CSF,30200097,CDM,302,RC,86335,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INSULIN AB,30200098,CDM,302,RC,86337,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INTRINSIC FACTOR AB,30200099,CDM,302,RC,86340,HCPCS,facility,both,,,,308,308,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ISLET CELL AB,30200100,CDM,302,RC,86341,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ISLET CELL AB,30200100,CDM,302,RC,86341,HCPCS,facility,both,,,,22,22,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CELL FUNCTION ASSAY W/STIM,30200101,CDM,302,RC,86352,HCPCS,facility,both,,,,1606,1606,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MONONUCLEAR CELL ANTIGEN,30200102,CDM,302,RC,86356,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC T CELLS; TOTAL COUNT,30200103,CDM,302,RC,86359,HCPCS,facility,both,,,,338,338,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC T CELLS; TOTAL COUNT,30200103,CDM,302,RC,86359,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC T CELLS; ABSOL CD4 AND CD8,30200104,CDM,302,RC,86360,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC T CELLS; ABSOL CD4 AND CD8,30200104,CDM,302,RC,86360,HCPCS,facility,both,,,,357,357,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC T CELLS; ABSOL CD4 COUNT,30200105,CDM,302,RC,86361,HCPCS,facility,both,,,,317,317,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MICROSOMAL AB EACH,30200106,CDM,302,RC,86376,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC MICROSOMAL AB EACH,30200106,CDM,302,RC,86376,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIRAL NEUTRALIZATION,30200107,CDM,302,RC,86382,HCPCS,facility,both,,,,292,292,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PA; TITER EA AB,30200108,CDM,302,RC,86406,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAL RHEUM FACTOR,30200109,CDM,302,RC,86430,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAL RHEUM FACTOR,30200109,CDM,302,RC,86430,HCPCS,facility,both,,,,14,14,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC TB TEST CELL IMMUN MEASURE,30200110,CDM,302,RC,86480,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC TB TEST CELL IMMUN MEASURE,30200110,CDM,302,RC,86480,HCPCS,facility,both,,,,180,180,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SYPHILIS TEST NON-TREP QUAL,30200111,CDM,302,RC,86592,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SYPHILIS TEST NON-TREP QUANT,30200112,CDM,302,RC,86593,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ADENOVIRUS,30200113,CDM,302,RC,86603,HCPCS,facility,both,,,,293,293,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ASPERGILLUS,30200114,CDM,302,RC,86606,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; BACTERIUM NES,30200115,CDM,302,RC,86609,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; BARTONELLA,30200116,CDM,302,RC,86611,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; BLASTOMYCES,30200117,CDM,302,RC,86612,HCPCS,facility,both,,,,149,149,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; BORDETELLA,30200118,CDM,302,RC,86615,HCPCS,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; LYME'S (WB) CONFIRM,30200119,CDM,302,RC,86617,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; LYME'S DISEASE,30200120,CDM,302,RC,86618,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; BRUCELLA,30200121,CDM,302,RC,86622,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; CANDIDA,30200122,CDM,302,RC,86628,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; CHLAMYDIA,30200123,CDM,302,RC,86631,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; CHLAMYDIA IGM,30200124,CDM,302,RC,86632,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; COCCIDIOIDES,30200125,CDM,302,RC,86635,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; COXIELLA BRUNETII,30200126,CDM,302,RC,86638,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; CMV,30200127,CDM,302,RC,86644,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; CMV IGM,30200128,CDM,302,RC,86645,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; DIPHTHERIA,30200129,CDM,302,RC,86648,HCPCS,facility,both,,,,181,181,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ENCEPHALITIS CALIF,30200130,CDM,302,RC,86651,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ENCEPHALITIS E EQUINE,30200131,CDM,302,RC,86652,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ENCEPHALITIS ST. LOUIS,30200132,CDM,302,RC,86653,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ENCEPHALITIS W EQUINE,30200133,CDM,302,RC,86654,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ENTEROVIRUS,30200134,CDM,302,RC,86658,HCPCS,facility,both,,,,1705,1705,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; EPSTEIN BARR VCA,30200135,CDM,302,RC,86665,HCPCS,facility,both,,,,196,196,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ERLICHIA,30200136,CDM,302,RC,86666,HCPCS,facility,both,,,,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; FUNGUS NES (70),30200137,CDM,302,RC,86671,HCPCS,facility,both,,,,155,155,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HELICOBACTER PYLORI,30200138,CDM,302,RC,86677,HCPCS,facility,both,,,,211,211,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HELMINTH NES,30200139,CDM,302,RC,86682,HCPCS,facility,both,,,,178,178,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HTLV-I,30200140,CDM,302,RC,86687,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HTLV-II,30200141,CDM,302,RC,86688,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HTLV OR HIV WB,30200142,CDM,302,RC,86689,HCPCS,facility,both,,,,750,750,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HTLV OR HIV WB,30200142,CDM,302,RC,86689,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; HEPATITIS D,30200143,CDM,302,RC,86692,HCPCS,facility,both,,,,162,162,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HSV 1,30200144,CDM,302,RC,86695,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HSV TYPE 2,30200145,CDM,302,RC,86696,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HIV-1,30200146,CDM,302,RC,86701,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HIV-1,30200146,CDM,302,RC,86701,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; HBCAB - TOTAL,30200147,CDM,302,RC,86704,HCPCS,facility,both,,,,177,177,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB: HBCAB - IGM AB,30200148,CDM,302,RC,86705,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB: HBCAB - IGM AB,30200148,CDM,302,RC,86705,HCPCS,facility,both,,,,33,33,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB: HBSAB,30200149,CDM,302,RC,86706,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB: HBSAB,30200149,CDM,302,RC,86706,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HBEAB,30200150,CDM,302,RC,86707,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HAAB - TOTAL,30200151,CDM,302,RC,86708,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB: HAAB - IGM,30200152,CDM,302,RC,86709,HCPCS,facility,both,,,,327,327,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB: HAAB - IGM,30200152,CDM,302,RC,86709,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; INFLUENZA VIRUS,30200153,CDM,302,RC,86710,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; LEGIONELLA,30200154,CDM,302,RC,86713,HCPCS,facility,both,,,,222,222,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; LEISHMANIA,30200155,CDM,302,RC,86717,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; LEPTOSPIRA,30200156,CDM,302,RC,86720,HCPCS,facility,both,,,,633,633,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; LCM,30200157,CDM,302,RC,86727,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; MUMPS,30200158,CDM,302,RC,86735,HCPCS,facility,both,,,,293,293,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; MUMPS,30200158,CDM,302,RC,86735,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; MYCOPLASMA,30200159,CDM,302,RC,86738,HCPCS,facility,both,,,,402,402,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; NEISSERIA MENINGITIDIS,30200160,CDM,302,RC,86741,HCPCS,facility,both,,,,157,157,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; PARVOVIRUS,30200161,CDM,302,RC,86747,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BABESIA MICROTI ANTIBODY,30200162,CDM,302,RC,86753,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRYPANOSOMA CRUZI IGG,30200163,CDM,302,RC,86753,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AB; PROTOZOA NES,30200164,CDM,302,RC,86753,HCPCS,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; RSV,30200165,CDM,302,RC,86756,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; RICKETTSIA,30200166,CDM,302,RC,86757,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; RUBELLA,30200167,CDM,302,RC,86762,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; RUBELLA,30200167,CDM,302,RC,86762,HCPCS,facility,both,,,,349,349,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; RUBEOLA,30200168,CDM,302,RC,86765,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; RUBEOLA,30200168,CDM,302,RC,86765,HCPCS,facility,both,,,,312,312,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; SALMONELLA,30200169,CDM,302,RC,86768,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; TETANUS,30200170,CDM,302,RC,86774,HCPCS,facility,both,,,,175,175,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; TOXOPLASMA,30200171,CDM,302,RC,86777,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; TOXOPLASMA IGM,30200172,CDM,302,RC,86778,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TREPONEMA PALLIDUM,30200173,CDM,302,RC,86780,HCPCS,facility,both,,,,255,255,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; TRICHINELLA,30200174,CDM,302,RC,86784,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; VARICELLA-ZOSTER,30200175,CDM,302,RC,86787,HCPCS,facility,both,,,,313,313,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; VARICELLA-ZOSTER,30200175,CDM,302,RC,86787,HCPCS,facility,both,,,,11,11,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC WEST NILE VIRUS AB IGM,30200176,CDM,302,RC,86788,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC WEST NILE VIRUS ANTIBODY,30200177,CDM,302,RC,86789,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC DENGUE FEVER ANTIBODY, IGG",30200178,CDM,302,RC,86790,HCPCS,facility,both,,,,564,564,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS E ANTIBODY IGG,30200179,CDM,302,RC,86790,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS E ANTIBODY IGM,30200180,CDM,302,RC,86790,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHIKUNGUNYA ANTIBODY W REFLEX,30200181,CDM,302,RC,86790,HCPCS,facility,both,,,,290,290,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "DEAC 2/8/2017 HC PARAINFLUENZA AB TYPE 1,2,3",30200184,CDM,302,RC,86790,HCPCS,facility,both,,,,421,421,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; VIRUS NES,30200185,CDM,302,RC,86790,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB: THYROGLOBULIN,30200186,CDM,302,RC,86800,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB: THYROGLOBULIN,30200186,CDM,302,RC,86800,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEPATITIS C AB,30200187,CDM,302,RC,86803,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEPATITIS C AB,30200187,CDM,302,RC,86803,HCPCS,facility,both,,,,241,241,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS C CONFIRMATION,30200188,CDM,302,RC,86804,HCPCS,facility,both,,,,5614,5614,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA TYPE; A B C SGL AG,30200189,CDM,302,RC,86812,HCPCS,facility,both,,,,583,583,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COOMBS TEST INDIRECT QUAL,30200191,CDM,300,RC,86885,HCPCS,facility,both,,,,278,278,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FFP THAWING EA UNIT,30200192,CDM,300,RC,86927,HCPCS,facility,both,,,,1412,1412,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERUM PRETX; DRUG INCUBATE,30200193,CDM,300,RC,86975,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS DELTA AG EIA,30200194,CDM,306,RC,87380,HCPCS,facility,both,,,,216,216,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLAMYDIA P DIR NA PROBE,30200195,CDM,306,RC,87485,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEP-C NA QUAN,30200196,CDM,306,RC,87522,HCPCS,facility,both,,,,108,108,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEP-C NA QUAN,30200196,CDM,306,RC,87522,HCPCS,facility,both,,,,972,972,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HERPES 6 AMPLIF NA PROBE,30200197,CDM,306,RC,87532,HCPCS,facility,both,,,,460,460,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-1 NA QUAN,30200198,CDM,306,RC,87536,HCPCS,facility,both,,,,972,972,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-1 NA QUAN,30200198,CDM,306,RC,87536,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC MYCOPLASMA AMPLIF NA PROBE,30200199,CDM,306,RC,87581,HCPCS,facility,both,,,,460,460,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HPV HI RISK TYPES,30200200,CDM,306,RC,87624,HCPCS,facility,both,,,,215,215,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DRUG SCREEN MULTIPLE CLASS,30200201,CDM,301,RC,,,facility,both,,,,162,162,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ELISA HIV-1/HIV-2 SCREEN,30200202,CDM,302,RC,,,facility,both,,,,162,162,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANTI-PHOSPHATIDYLSERINE AB,30200250,CDM,302,RC,86148,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPLEMENT FIXATION EA AG,30200251,CDM,302,RC,86171,HCPCS,facility,both,,,,293,293,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COUNTER IEP EA AG,30200252,CDM,302,RC,86185,HCPCS,facility,both,,,,459,459,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HETEROPHILE AB; TITER AFTER ABSORPT,30200253,CDM,302,RC,86310,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IA INFECTIOUS AGENT SGL STEP,30200254,CDM,302,RC,86318,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IEP; SERUM,30200255,CDM,302,RC,86320,HCPCS,facility,both,,,,713,713,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IEP; NOT SERUM,30200256,CDM,302,RC,86325,HCPCS,facility,both,,,,474,474,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IMMUNODIFFUSION; NES,30200257,CDM,302,RC,86329,HCPCS,facility,both,,,,552,552,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PA; SCREEN EA AB,30200258,CDM,302,RC,86403,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAN RHEUM FACTOR,30200259,CDM,302,RC,86431,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; CRYPTOCOCCUS,30200260,CDM,302,RC,86641,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; EB EARLY AG VIRUS,30200261,CDM,302,RC,86663,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; EBNA,30200262,CDM,302,RC,86664,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; FRANCISELLA TULARENSIS,30200263,CDM,302,RC,86668,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HSV NON-SPECIFIC,30200264,CDM,302,RC,86694,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; HISTOPLASMA,30200265,CDM,302,RC,86698,HCPCS,facility,both,,,,472,472,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-1/HIV-2 SINGLE RESULT,30200266,CDM,302,RC,86703,HCPCS,facility,both,,,,382,382,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASO ; TITER,30200268,CDM,302,RC,86060,HCPCS,facility,both,,,,240,240,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DNA AB; SS,30200269,CDM,302,RC,86226,HCPCS,facility,both,,,,143,143,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMAGGLUT INHIBITION TEST,30200270,CDM,302,RC,86280,HCPCS,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; ACTINOMYCES,30200271,CDM,302,RC,86602,HCPCS,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CELL ENUMERATION & ID,30200272,CDM,302,RC,86152,HCPCS,facility,both,,,,2014,2014,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB ID; LEUKOCYTE AB,30200275,CDM,302,RC,86021,HCPCS,facility,both,,,,289,289,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INVESTIG TRANSFUS REACTION,30200276,CDM,302,RC,86078,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CELL ENUMERATION PHYS INTERP,30200277,CDM,302,RC,86153,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC QUAN HETEROPHILE AB,30200278,CDM,302,RC,86309,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LHR TEST,30200279,CDM,302,RC,86343,HCPCS,facility,both,,,,147,147,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SKIN TEST; TB ID,30200280,CDM,302,RC,86580,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; CAMPYLOBACTER,30200281,CDM,302,RC,86625,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; LYMPHOGRANULOMA VENEREUM,30200282,CDM,302,RC,86729,HCPCS,facility,both,,,,202,202,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; NOCARDIA,30200283,CDM,302,RC,86744,HCPCS,facility,both,,,,308,308,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; YERSINIA,30200284,CDM,302,RC,86793,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRA SCREEN,30200285,CDM,310,RC,86807,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRA SCREEN; QUICK METHOD,30200286,CDM,310,RC,86808,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA TYPE; DR/DQ SGL AG,30200287,CDM,310,RC,86816,HCPCS,facility,both,,,,330,330,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA TYPE; MLC,30200288,CDM,310,RC,86821,HCPCS,facility,both,,,,668,668,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC S CEREVISIAE AB,30200289,CDM,302,RC,86671,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC E HISTOLYTICA AB,30200290,CDM,302,RC,86753,HCPCS,facility,both,,,,162,162,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC AB, VRUS NES (50)",30200292,CDM,302,RC,86790,HCPCS,facility,both,,,,368,368,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TB AG RESPONSE T-CELL SUSP,30200293,CDM,302,RC,86481,HCPCS,facility,both,,,,105,105,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TB AG RESPONSE T-CELL SUSP,30200293,CDM,302,RC,86481,HCPCS,facility,both,,,,52,52,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AB; FUNGUS NES (5),30200295,CDM,302,RC,86671,HCPCS,facility,both,,,,73,73,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; FUNGUS NES (60),30200296,CDM,302,RC,86671,HCPCS,facility,both,,,,423,423,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; VIRUS NES (15),30200299,CDM,302,RC,86790,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; VIRUS NES (35),30200300,CDM,302,RC,86790,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HC AB, VIRUS NES (20)",30200302,CDM,302,RC,86790,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HC AB, VIRUS NES (20)",30200302,CDM,302,RC,86790,HCPCS,facility,both,,,,128,128,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC AB, VIRUS NES (165)",30200303,CDM,302,RC,86790,HCPCS,facility,both,,,,710,710,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AB; PROTOZOA NES (20),30200304,CDM,302,RC,86753,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB; PROTOZOA NES (20),30200304,CDM,302,RC,86753,HCPCS,facility,both,,,,72,72,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ALLG SPEC IGE RECOMB EA,30200305,CDM,302,RC,86008,HCPCS,facility,both,,,,124,124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANTIBODY; ZIKA VIRUS, IGM",30200306,CDM,302,RC,86794,HCPCS,facility,both,,,,710,710,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC AB; SAR SYNDROME CORONAVIRUS 2 (SARS-COV-2) COVID-19, MULTIPLE STEP",30200307,CDM,302,RC,86769,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACTIN ANTIBODY EACH,30200308,CDM,302,RC,86015,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANCA SCREEN EACH ANTIBODY,30200309,CDM,302,RC,86036,HCPCS,facility,both,,,,289,289,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AQUAPORIN-4 ANTB CBA EACH,30200310,CDM,302,RC,86052,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMA EACH IG CLASS,30200311,CDM,302,RC,86231,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DGP ANTIBODY EACH IG CLASS,30200312,CDM,302,RC,86258,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOG-IGG1 ANTB CBA EACH,30200313,CDM,302,RC,86362,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TISS TRNSGL TMNASE EA IG CLASS,30200314,CDM,302,RC,86364,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MITOCHONDRIAL ANTIBODY EACH,30200315,CDM,302,RC,86381,HCPCS,facility,both,,,,322,322,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MOG-IGG1 ANTIBODY FLOW CYTOMETRY, EA",30200323,CDM,302,RC,86363,HCPCS,facility,both,,,,491,491,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (49)",30200327,CDM,302,RC,86596,HCPCS,facility,both,,,,99,99,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (33)",30200328,CDM,302,RC,86596,HCPCS,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY,30200333,CDM,302,RC,86041,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETYLCHOLINE RECEPTOR (ACHR); BLOCKING ANTIBODY,30200334,CDM,302,RC,86042,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY,30200335,CDM,302,RC,86043,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MUSCLE-SPECIFIC KINASE (MUSK) ANTIBODY,30200336,CDM,302,RC,86366,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STREP PNEUMONIAE IGG AB, 23 SEROTYPES, MULTI IA, QUANT",30200344,CDM,302,RC,86581,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STREP PNEUMONIAE IGG AB, 14 SEROTYPES, MULTI IA, QUANT",30200346,CDM,302,RC,86581,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCULT BLOOD OTHER SOURCES,30500001,CDM,301,RC,82271,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GONADOTROPIN; FSH,30500002,CDM,301,RC,83001,HCPCS,facility,both,,,,612,612,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GONADOTROPIN; FSH,30500002,CDM,301,RC,83001,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC GONADOTROPIN; LUTEINIZING HORMONE,30500003,CDM,301,RC,83002,HCPCS,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC GONADOTROPIN; LUTEINIZING HORMONE,30500003,CDM,301,RC,83002,HCPCS,facility,both,,,,607,607,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HGB; PLASMA,30500004,CDM,301,RC,83051,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASSAY PH BODY FLUID NOS,30500005,CDM,301,RC,83986,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROGESTERONE ASSAY,30500006,CDM,301,RC,84144,HCPCS,facility,both,,,,58,58,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HCG; QUAL,30500007,CDM,301,RC,84703,HCPCS,facility,both,,,,219,219,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HCG; QUAL,30500007,CDM,301,RC,84703,HCPCS,facility,both,,,,17,17,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC WBC W AUTO DIFF,30500008,CDM,305,RC,85004,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BL SMEAR W/DIFF WBC COUNT,30500009,CDM,305,RC,85007,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC BL SMEAR W/DIFF WBC COUNT,30500009,CDM,305,RC,85007,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BL SMEAR W/O DIFF WBC COUNT,30500010,CDM,305,RC,85008,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MANUAL DIFF WBC COUNT B-COAT,30500011,CDM,305,RC,85009,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMATOCRIT,30500012,CDM,305,RC,85014,HCPCS,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEMATOCRIT,30500012,CDM,305,RC,85014,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMOGLOBIN,30500013,CDM,305,RC,85018,HCPCS,facility,both,,,,162,162,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPL CBC W PLT W AUTOM DIFF,30500014,CDM,305,RC,85025,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPL CBC W PLT W AUTOM DIFF,30500014,CDM,305,RC,85025,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC COMPL AUTOM CBC W PLT,30500015,CDM,305,RC,85027,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC COMPL AUTOM CBC W PLT,30500015,CDM,305,RC,85027,HCPCS,facility,both,,,,198,198,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOMATED RETICULOCYTE COUNT,30500016,CDM,305,RC,85045,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOMATED WBC,30500017,CDM,305,RC,85048,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOMATED PLATELET COUNT,30500018,CDM,305,RC,85049,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RETICULATED PLATELET ASSAY,30500019,CDM,305,RC,85055,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BM SMR INTERP,30500020,CDM,305,RC,85097,HCPCS,facility,both,,,,815,815,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROMOGENIC SUBSTRATE ASSAY,30500021,CDM,305,RC,85130,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR II PROTHROMBIN SPECIF,30500022,CDM,305,RC,85210,HCPCS,facility,both,,,,244,244,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR V,30500023,CDM,305,RC,85220,HCPCS,facility,both,,,,540,540,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR VII,30500024,CDM,305,RC,85230,HCPCS,facility,both,,,,356,356,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD CLOT FACTOR VIII TEST,30500025,CDM,305,RC,85240,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR VIII RISTOCETIN COFACT,30500026,CDM,305,RC,85245,HCPCS,facility,both,,,,543,543,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING: FACTOR VIII VW FACTOR AG,30500027,CDM,305,RC,85246,HCPCS,facility,both,,,,261,261,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FACTOR 8 VWF MULTIMRIC,30500028,CDM,305,RC,85247,HCPCS,facility,both,,,,209,209,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR IX,30500029,CDM,305,RC,85250,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR X,30500030,CDM,305,RC,85260,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR XI,30500031,CDM,305,RC,85270,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR XII,30500032,CDM,305,RC,85280,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR XIII SCREEN SOLUBLE,30500033,CDM,305,RC,85291,HCPCS,facility,both,,,,96,96,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING: PREKALLIKREIN ASSAY,30500034,CDM,305,RC,85292,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANTITHROMBIN III ACTIVITY ASSAY,30500035,CDM,305,RC,85300,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANTITHROMBIN III ANTIGEN ASSAY,30500036,CDM,305,RC,85301,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANTITHROMBIN III ANTIGEN ASSAY,30500036,CDM,305,RC,85301,HCPCS,facility,both,,,,130,130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOTTING INHIBITOR; PROTEIN C AG,30500037,CDM,305,RC,85302,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING INHIBITOR; PROTEIN C ACTIVITY,30500038,CDM,305,RC,85303,HCPCS,facility,both,,,,406,406,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING INHIBITOR; PROTEIN S TOTAL,30500039,CDM,305,RC,85305,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING INHIBITOR PROTEIN S FREE,30500040,CDM,305,RC,85306,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ACTIVATED PROTEIN C RESISTANCE,30500041,CDM,305,RC,85307,HCPCS,facility,both,,,,248,248,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FACTOR INHIBITOR TEST,30500042,CDM,305,RC,85335,HCPCS,facility,both,,,,227,227,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC D-DIMER - QUAN,30500043,CDM,305,RC,85379,HCPCS,facility,both,,,,298,298,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC D-DIMER - QUAN,30500043,CDM,305,RC,85379,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC FIBRINOGEN; ACTIVITY,30500044,CDM,305,RC,85384,HCPCS,facility,both,,,,17,17,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC FIBRINOGEN; ACTIVITY,30500044,CDM,305,RC,85384,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FIBRINOGEN; ANTIGEN,30500045,CDM,305,RC,85385,HCPCS,facility,both,,,,101,101,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FIBRINOLYSINS OR COAG SCREEN,30500046,CDM,305,RC,85390,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING FUNCT ACTIVITY,30500047,CDM,305,RC,85397,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ALPHA-2-ANTIPLASMIN,30500048,CDM,305,RC,85410,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLASMINOGEN ACTIVATOR,30500049,CDM,305,RC,85415,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FUNCTIONAL PLASMINOGEN,30500050,CDM,305,RC,85420,HCPCS,facility,both,,,,420,420,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLASMINOGEN ANTIGEN LEVEL,30500051,CDM,305,RC,85421,HCPCS,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEINZ BODIES; DIRECT,30500052,CDM,305,RC,85441,HCPCS,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC K-B STAIN FOR FETAL HGB,30500053,CDM,305,RC,85460,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEMOLYSIN ACID,30500054,CDM,305,RC,85475,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPARIN ASSAY,30500055,CDM,305,RC,85520,HCPCS,facility,both,,,,564,564,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPARIN NEUTRALIZATION,30500056,CDM,305,RC,85525,HCPCS,facility,both,,,,141,141,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IRON STAIN PERIPHERAL BLOOD,30500057,CDM,305,RC,85536,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEUKOCYTE ALK PHOS W COUNT,30500058,CDM,305,RC,85540,HCPCS,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OSMOTIC FRAGILITY RBC; INCUBATED,30500059,CDM,305,RC,85557,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLT AGGREGATION (IN VITRO) EA AGENT,30500060,CDM,305,RC,85576,HCPCS,facility,both,,,,503,503,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLATELET NEUTRALIZATION,30500061,CDM,305,RC,85597,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTHROMBIN TIME;,30500062,CDM,305,RC,85610,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROTHROMBIN TIME;,30500062,CDM,305,RC,85610,HCPCS,facility,both,,,,8,8,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC RUSSELL VIPER VENOM TIME; UNDILUTED,30500063,CDM,305,RC,85612,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RUSSELL VIPER VENOM TIME; DILUTED,30500064,CDM,305,RC,85613,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC REPTILASE TEST,30500065,CDM,305,RC,85635,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NONAUTO ERYTHROCYTE SED RATE,30500066,CDM,305,RC,85651,HCPCS,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOM ERYTHROCYTE SED RATE,30500067,CDM,305,RC,85652,HCPCS,facility,both,,,,6,6,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC AUTOM ERYTHROCYTE SED RATE,30500067,CDM,305,RC,85652,HCPCS,facility,both,,,,32,32,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THROMBIN TIME; PLASMA,30500068,CDM,305,RC,85670,HCPCS,facility,both,,,,114,114,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PTT; PLASMA OR WHOLE BLOOD,30500069,CDM,305,RC,85730,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC PTT; PLASMA OR WHOLE BLOOD,30500069,CDM,305,RC,85730,HCPCS,facility,both,,,,143,143,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VISCOSITY,30500070,CDM,305,RC,85810,HCPCS,facility,both,,,,260,260,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AB ID; PLATELET IG ASSAY,30500075,CDM,302,RC,86023,HCPCS,facility,both,,,,132,132,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC B CELLS TOTAL COUNT,30500076,CDM,302,RC,86355,HCPCS,facility,both,,,,447,447,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NK CELLS TOTAL COUNT,30500077,CDM,302,RC,86357,HCPCS,facility,both,,,,447,447,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STEM CELLS TOTAL COUNT,30500078,CDM,302,RC,86367,HCPCS,facility,both,,,,447,447,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC AB SCRN EA TECHIQ,30500079,CDM,300,RC,86850,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CONCENTRATION FOR INFECT AGNT,30500080,CDM,306,RC,87015,HCPCS,facility,both,,,,139,139,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SMEAR FOR EOSINOPHIL,30500081,CDM,305,RC,85999,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLEEDING TIME,30500150,CDM,305,RC,85002,HCPCS,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MANUAL RETICULOCYTE COUNT,30500151,CDM,305,RC,85044,HCPCS,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR XIII - FS,30500152,CDM,305,RC,85290,HCPCS,facility,both,,,,154,154,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FIBRIN DEGRADATION PRODUCTS,30500153,CDM,305,RC,85362,HCPCS,facility,both,,,,236,236,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC D-DIMER- QUAL/SEMIQUAN,30500154,CDM,305,RC,85378,HCPCS,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEXAGNAL PHOSPH PLTLT NEUTRL,30500155,CDM,305,RC,85598,HCPCS,facility,both,,,,213,213,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THROMBOPLASTIN INHIBITION TISSUE,30500156,CDM,305,RC,85705,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIFFICULT CROSS MATCH,30500157,CDM,305,RC,86077,HCPCS,facility,both,,,,175,175,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PT; SUBSTITUTION PLASMA FRACTIONS EA,30500158,CDM,305,RC,85611,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PTT; SUBSTITUTION PLASMA FRACTIONS EA,30500159,CDM,305,RC,85732,HCPCS,facility,both,,,,220,220,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPUN HEMATOCRIT,30500160,CDM,305,RC,85013,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MANUAL CELL COUNT EACH,30500161,CDM,305,RC,85032,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AUTOMATED RBC COUNT,30500162,CDM,305,RC,85041,HCPCS,facility,both,,,,101,101,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RETICYTE/HGB CONCENTRATE,30500163,CDM,305,RC,85046,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOT RETRACTION,30500164,CDM,305,RC,85170,HCPCS,facility,both,,,,88,88,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; FACTOR VIII RELATED ANTIGEN,30500165,CDM,305,RC,85244,HCPCS,facility,both,,,,242,242,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOTTING; HMW KININOGEN ASSAY,30500166,CDM,305,RC,85293,HCPCS,facility,both,,,,224,224,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THROMBOMODULIN,30500167,CDM,305,RC,85337,HCPCS,facility,both,,,,123,123,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COAG TIME; ACTIVATED,30500168,CDM,305,RC,85347,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EUGLOBULIN LYSIS,30500169,CDM,305,RC,85360,HCPCS,facility,both,,,,158,158,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEINZ BODIES; INDUCED,30500170,CDM,305,RC,85445,HCPCS,facility,both,,,,68,68,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPARIN-PROTAMINE TOLERANCE TEST,30500171,CDM,305,RC,85530,HCPCS,facility,both,,,,168,168,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OSMOTIC FRAGILITY RBC; UNINCUBATED,30500172,CDM,305,RC,85555,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OCCULT BLD IA SCRN,30500173,CDM,305,RC,,,facility,both,,,,188,188,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASO; SCREEN,30600001,CDM,302,RC,86063,HCPCS,facility,both,,,,176,176,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AEROB BACTERIAL BLOOD CULTURE,30600002,CDM,306,RC,87040,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AEROB BACTERIA CULTURE STOOL,30600003,CDM,306,RC,87045,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AEROBIC STOOL CULTR ADDTL PATHOG EA PLATE,30600004,CDM,306,RC,87046,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BACTERIAL CULTURE - OTHR SOURCE,30600005,CDM,306,RC,87070,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC BACTERIAL CULTURE - OTHR SOURCE,30600005,CDM,306,RC,87070,HCPCS,facility,both,,,,258,258,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BACT CULT; QUAN AEROBIC,30600006,CDM,306,RC,87071,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC BACT CULT; QUAN AEROBIC,30600006,CDM,306,RC,87071,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ANAEROB BACT CULTURE W ID,30600007,CDM,306,RC,87075,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BC - ANAEROBE - ADDTL ID,30600008,CDM,306,RC,87076,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BC - AEROBIC - ADDTL ID,30600009,CDM,306,RC,87077,HCPCS,facility,both,,,,179,179,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BC - AEROBIC - ADDTL ID,30600009,CDM,306,RC,87077,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC CULTURE P PATHOG - SCREEN,30600010,CDM,306,RC,87081,HCPCS,facility,both,,,,141,141,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BACT CULTURE - URINE; QUAN COUNT,30600011,CDM,306,RC,87086,HCPCS,facility,both,,,,170,170,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BACT CULTURE - URINE; QUAN COUNT,30600011,CDM,306,RC,87086,HCPCS,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC URINE BACTERIA CULTURE,30600012,CDM,306,RC,87088,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULT FUNGUS W P ID; SKIN HR NL,30600013,CDM,306,RC,87101,HCPCS,facility,both,,,,205,205,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FUNGUS CULTURE NOT BLOOD,30600014,CDM,306,RC,87102,HCPCS,facility,both,,,,281,281,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FUNGUS CULTURE BLOOD,30600015,CDM,306,RC,87103,HCPCS,facility,both,,,,234,234,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FUNGUS CULTURE DEF I.D YEAST,30600016,CDM,306,RC,87106,HCPCS,facility,both,,,,281,281,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FUNGUS CULTURE DEF ID MOLD,30600017,CDM,306,RC,87107,HCPCS,facility,both,,,,267,267,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE MYCOPLASMA,30600018,CDM,306,RC,87109,HCPCS,facility,both,,,,1248,1248,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLAMYDIA CULTURE,30600019,CDM,306,RC,87110,HCPCS,facility,both,,,,416,416,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE AFB - ISOL & ID,30600020,CDM,306,RC,87116,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULT MYCOBACTERIA DEFIN ID EA,30600021,CDM,306,RC,87118,HCPCS,facility,both,,,,179,179,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE; GLC/HPLC,30600022,CDM,306,RC,87143,HCPCS,facility,both,,,,164,164,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE; IMMUNOLOGIC,30600023,CDM,306,RC,87147,HCPCS,facility,both,,,,281,281,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DNA/RNA DIRECT PROBE,30600024,CDM,306,RC,87149,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC DNA/RNA DIRECT PROBE,30600024,CDM,306,RC,87149,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE; PULSE FLD GEL ID,30600025,CDM,306,RC,87152,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ADENOVIRUS GENOTYPE,30600027,CDM,306,RC,87153,HCPCS,facility,both,,,,645,645,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE; OTHER METHODS,30600028,CDM,306,RC,87158,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PINWORM EXAM,30600029,CDM,306,RC,87172,HCPCS,facility,both,,,,139,139,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC OVA & PARASITES DIR SMR W ID,30600030,CDM,306,RC,87177,HCPCS,facility,both,,,,368,368,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SENSITIVITY - AGAR DILUTION/AGENT,30600031,CDM,306,RC,87181,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SENSITIVITY - DISK PER PLATE,30600032,CDM,306,RC,87184,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SENSTITIVITY - ENZYME DETECT,30600033,CDM,306,RC,87185,HCPCS,facility,both,,,,62,62,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MICROBE SUSCEPTIBILITIES MIC,30600034,CDM,306,RC,87186,HCPCS,facility,both,,,,951,951,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MICROBE SUSCEPTIBILITIES MIC,30600034,CDM,306,RC,87186,HCPCS,facility,both,,,,10,10,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC SENSITIVITY - MACROBROTH EA AGNT,30600035,CDM,306,RC,87188,HCPCS,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SERUM BACTERICIDAL TITER,30600036,CDM,306,RC,87197,HCPCS,facility,both,,,,449,449,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SMEAR - GRAM OR GIEMSA,30600037,CDM,306,RC,87205,HCPCS,facility,both,,,,9,9,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC SMEAR - GRAM OR GIEMSA,30600037,CDM,306,RC,87205,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SMEAR; FLUORESCENT OR AFB STAIN,30600038,CDM,306,RC,87206,HCPCS,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SMEAR SPECIAL STAIN,30600039,CDM,306,RC,87207,HCPCS,facility,both,,,,269,269,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SMEAR - INFECTIOUS WET MOUNT,30600040,CDM,306,RC,87210,HCPCS,facility,both,,,,148,148,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC KOH FOR FUNGI/PARASITES/MITES,30600041,CDM,306,RC,87220,HCPCS,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIRUS ISOLATE; TISSUE CULT INOC,30600042,CDM,306,RC,87252,HCPCS,facility,both,,,,474,474,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIRUS ISOLATE; ADDTL OR ID,30600043,CDM,306,RC,87253,HCPCS,facility,both,,,,511,511,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIRUS ISOL SHELL VIAL TECHN,30600044,CDM,306,RC,87254,HCPCS,facility,both,,,,393,393,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GENET VIRUS ISOLATE HSV,30600045,CDM,306,RC,87255,HCPCS,facility,both,,,,445,445,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ADENOVIRUS AG BY IF,30600046,CDM,306,RC,87260,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADENOVIRUS AG BY IF,30600046,CDM,306,RC,87260,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BORDATELLA P AG BY DFA,30600047,CDM,306,RC,87265,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INFLUENZA B AG BY IF,30600048,CDM,306,RC,87275,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INFLUENZA B AG BY IF,30600048,CDM,306,RC,87275,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFLUENZA A AG BY DFA,30600049,CDM,306,RC,87276,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFLUENZA A AG BY DFA,30600049,CDM,306,RC,87276,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEGIONELLA P AG BY DFA,30600050,CDM,306,RC,87278,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PARAINFLUENZA AG BY DFA,30600051,CDM,306,RC,87279,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PARAINFLUENZA AG BY DFA,30600051,CDM,306,RC,87279,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RSV AG BY IF,30600052,CDM,306,RC,87280,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RSV AG BY IF,30600052,CDM,306,RC,87280,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PNEUMOCYSTIS C AG BY IF,30600053,CDM,306,RC,87281,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VARICELLA ZOSTER AG BY DFA,30600054,CDM,306,RC,87290,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INF AGENT MULTI ORG AG BY IF,30600055,CDM,306,RC,87300,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ADENOVIRUS AG EIA,30600056,CDM,306,RC,87301,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE DEAC 2/8/2017 HC GALACTOMANNAN ASSAY,30600057,CDM,306,RC,87305,HCPCS,facility,both,,,,253,253,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC PLATELIA ASPERGILLUS, BAL",30600058,CDM,306,RC,87305,HCPCS,facility,both,,,,375,375,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ASPERGILLUS AG EIA,30600059,CDM,306,RC,87305,HCPCS,facility,both,,,,372,372,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYPTOCOCCUS NEOFORM AG EIA,30600060,CDM,306,RC,87327,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GIARDIA AG EIA,30600061,CDM,306,RC,87329,HCPCS,facility,both,,,,104,104,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC E COLI 0157 AG EIA,30600062,CDM,306,RC,87335,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HPYLORI STOOL EIA,30600063,CDM,306,RC,87338,HCPCS,facility,both,,,,520,520,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS B SURFACE AG EIA,30600064,CDM,306,RC,87340,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEPATITIS B SURFACE AG EIA,30600064,CDM,306,RC,87340,HCPCS,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION,30600065,CDM,306,RC,87341,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS BE AG EIA,30600066,CDM,306,RC,87350,HCPCS,facility,both,,,,293,293,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HISTOPLASMA CAPSUL AG EIA,30600067,CDM,306,RC,87385,HCPCS,facility,both,,,,445,445,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ROTAVIRUS AG EIA,30600068,CDM,306,RC,87425,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STREP A AG EIA,30600069,CDM,306,RC,87430,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IA BY EIA - MULTI STEP,30600070,CDM,306,RC,87449,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLAMYDIA T AMPLIF NA PROBE,30600071,CDM,306,RC,87491,HCPCS,facility,both,,,,247,247,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC C DIFF AMPLIFIED PROBE,30600072,CDM,306,RC,87493,HCPCS,facility,both,,,,319,319,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTOMEGALOV AMPLIF NA PROBE,30600073,CDM,306,RC,87496,HCPCS,facility,both,,,,1053,1053,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTOMEGALOVIRUS NA QUAN,30600074,CDM,306,RC,87497,HCPCS,facility,both,,,,370,370,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ENTEROVIRUS DNA AMP PROBE,30600075,CDM,306,RC,87498,HCPCS,facility,both,,,,804,804,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEP-B NA QUAN,30600076,CDM,306,RC,87517,HCPCS,facility,both,,,,971,971,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEP-B NA QUAN,30600076,CDM,306,RC,87517,HCPCS,facility,both,,,,155,155,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEP-C AMPLIF NA PROBE,30600077,CDM,306,RC,87521,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HERPES S AMPLIF NA PROBE,30600078,CDM,306,RC,87529,HCPCS,facility,both,,,,590,590,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-1 AMPLIF NA PROBE,30600079,CDM,306,RC,87535,HCPCS,facility,both,,,,576,576,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEGIONELLA AMPLIF NA PROBE,30600080,CDM,306,RC,87541,HCPCS,facility,both,,,,460,460,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MYCOBACTERIA T DIR NA PROBE,30600081,CDM,306,RC,87555,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MYCOBACTERIA T AMPLIF NA PROBE,30600082,CDM,306,RC,87556,HCPCS,facility,both,,,,489,489,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NEISSERIA AMPLIF NA PROBE,30600083,CDM,306,RC,87591,HCPCS,facility,both,,,,247,247,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MR-STAPH DNA AMP PROBE,30600084,CDM,306,RC,87641,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRICHOMONAS VAGIN DIR PROBE,30600085,CDM,306,RC,87660,HCPCS,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIR NA PROBE NOS AGENT,30600086,CDM,306,RC,87797,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AMPLIF NA PROBE NOS AGENT,30600087,CDM,306,RC,87798,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NA QUAN NOS AGENT,30600088,CDM,306,RC,87799,HCPCS,facility,both,,,,879,879,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DNA/RNA; MULTI ORG - AMP PR,30600089,CDM,306,RC,87801,HCPCS,facility,both,,,,918,918,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC AGENT NOS ASSAY W/OPTIC,30600090,CDM,306,RC,87899,HCPCS,facility,both,,,,215,215,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GENOTYPE DNA HIV REVERSE T,30600091,CDM,306,RC,87901,HCPCS,facility,both,,,,1502,1502,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEPATITIS C - DNA OR RNA,30600092,CDM,306,RC,87902,HCPCS,facility,both,,,,301,301,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC HEPATITIS C - DNA OR RNA,30600092,CDM,306,RC,87902,HCPCS,facility,both,,,,1126,1126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHENOTYPE DNA HIV W/CULTURE; 1-10 DRUGS,30600093,CDM,306,RC,87903,HCPCS,facility,both,,,,6354,6354,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IDENT BY DNA SEQUENCE,30600095,CDM,306,RC,87153,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CMV GENOTYPE,30600096,CDM,306,RC,87153,HCPCS,facility,both,,,,571,571,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEGIONELLA AG,30600097,CDM,306,RC,87449,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STREP PNUMO AG,30600098,CDM,306,RC,87449,HCPCS,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYPT AG TITER,30600099,CDM,306,RC,87449,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ARTHROPOD IDENT,30600100,CDM,306,RC,87999,HCPCS,facility,both,,,,267,267,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLAMYDIA CULTURE,30600150,CDM,306,RC,87110,HCPCS,facility,both,,,,416,416,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYPTOSPOR AG BY IFA,30600151,CDM,306,RC,87272,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOSTRIDIUM AG EIA,30600152,CDM,306,RC,87324,HCPCS,facility,both,,,,238,238,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYPTOSPORIDIUM AG EIA,30600153,CDM,306,RC,87328,HCPCS,facility,both,,,,122,122,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-1 AG EIA,30600154,CDM,306,RC,87390,HCPCS,facility,both,,,,577,577,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INFLUENZA A/B AG EIA,30600155,CDM,306,RC,87400,HCPCS,facility,both,,,,126,126,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RESP SYNCYTIAL AG EIA,30600156,CDM,306,RC,87420,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLAMYDIA P AMPLIF NA PROBE,30600157,CDM,306,RC,87486,HCPCS,facility,both,,,,628,628,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHLAMYDIA T DIR NA PROBE,30600158,CDM,306,RC,87490,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MYCOBACTERIA A AMPLIF NA PROBE,30600159,CDM,306,RC,87561,HCPCS,facility,both,,,,942,942,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INFLUENZA IA W DO,30600160,CDM,306,RC,87804,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PHENOTYPE IFECT AGENT DRUG (160),30600161,CDM,306,RC,87900,HCPCS,facility,both,,,,762,762,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CULTURE; IF EA ANTISERUM,30600164,CDM,306,RC,87140,HCPCS,facility,both,,,,73,73,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MACROSCOPIC EXAM PARASITE,30600166,CDM,306,RC,87169,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MACROSCOPIC EXAM PARASITE,30600166,CDM,306,RC,87169,HCPCS,facility,both,,,,29,29,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NOS INFECTIOUS AG BY IF,30600168,CDM,306,RC,87299,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ENTAMOEB HIST GROUP AG EIA,30600170,CDM,306,RC,87337,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BARTONELLA AMPLIF NAP,30600171,CDM,306,RC,87471,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HEP-B AMPLIF NA PROBE,30600172,CDM,306,RC,87516,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HERPES S NA QUAN,30600173,CDM,306,RC,87530,HCPCS,facility,both,,,,372,372,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NEISSERIA DIR NA PROBE,30600174,CDM,306,RC,87590,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DARK FIELD; W SPEC COLLECT,30600175,CDM,306,RC,87164,HCPCS,facility,both,,,,163,163,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MACROSCOPIC EXAM ARTHROPOD,30600176,CDM,306,RC,87168,HCPCS,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SENSITIVITY - MLC EA PLATE,30600177,CDM,306,RC,87187,HCPCS,facility,both,,,,136,136,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SENSITIVITY - MYCOBACT EA AGNT,30600178,CDM,306,RC,87190,HCPCS,facility,both,,,,73,73,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TOXIN ASSAY TISSUE CULTURE,30600179,CDM,306,RC,87230,HCPCS,facility,both,,,,227,227,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC VIRUS ISOLATE; EMBRYO EGG INJ,30600180,CDM,306,RC,87250,HCPCS,facility,both,,,,256,256,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTOMEGALOVIRUS AG EIA,30600181,CDM,306,RC,87332,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-1 AG W/HIV-1 & HIV-2 AB,30600182,CDM,306,RC,87389,HCPCS,facility,both,,,,315,315,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-1 AG W/HIV-1 & HIV-2 AB,30600182,CDM,306,RC,87389,HCPCS,facility,both,,,,30,30,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE HC SHIGA-LIKE TOXIN AG EIA,30600183,CDM,306,RC,87427,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INFLUENZA DNA AMP PROB 1+,30600184,CDM,306,RC,87501,HCPCS,facility,both,,,,667,667,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HERPES 6 NA QUAN,30600185,CDM,306,RC,87533,HCPCS,facility,both,,,,370,370,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HIV-2 PROBE&REVRSE TRNSCRIPJ,30600186,CDM,306,RC,87538,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEGIONELLA DIR NA PROBE,30600187,CDM,306,RC,87540,HCPCS,facility,both,,,,371,371,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MYCOBACTERIA DIR NA PROBE,30600188,CDM,306,RC,87550,HCPCS,facility,both,,,,262,262,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RESP VIRUS 6-11 TARGETS,30600189,CDM,306,RC,87632,HCPCS,facility,both,,,,2789,2789,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STAPH A DNA AMP PROBE,30600190,CDM,306,RC,87640,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STREP B DNA AMP PROBE,30600191,CDM,306,RC,87653,HCPCS,facility,both,,,,458,458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DIR NA PROBE MULTI ORGANISMS,30600192,CDM,306,RC,87800,HCPCS,facility,both,,,,522,522,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STREP B IA W DO,30600193,CDM,306,RC,87802,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CLOSTRIDIUM DIFF IA W DO,30600194,CDM,306,RC,87803,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RSV IA W DIR OBSERV,30600195,CDM,306,RC,87807,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STREP A ASSAY W/OPTIC,30600196,CDM,306,RC,87880,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GENOTYPE CYTOMEGALOVIRUS,30600197,CDM,306,RC,87910,HCPCS,facility,both,,,,645,645,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GENOTYPE DNA HEPATITIS B,30600198,CDM,306,RC,87912,HCPCS,facility,both,,,,3363,3363,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TRICHOMONAS ASSAY W/OPTIC,30600199,CDM,306,RC,87808,HCPCS,facility,both,,,,84,84,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC HOMOGENIZATION, TISSUE, FOR CULTURE",30600200,CDM,306,RC,87176,HCPCS,facility,both,,,,76,76,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RESP VIRUS 3-5 TARGETS,30600202,CDM,306,RC,87631,HCPCS,facility,both,,,,540,540,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC INFECT AGENT DET,GI 3-5 TARGET",30600211,CDM,306,RC,87505,HCPCS,facility,both,,,,775,775,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SMEAR COMPLEX STAIN,30600213,CDM,306,RC,87209,HCPCS,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INFEC AGENT DET,GI 6-11 TARGETS",30600214,CDM,306,RC,87506,HCPCS,facility,both,,,,1550,1550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INFEC AGENT DET,GI 12-25 TARGETS",30600215,CDM,306,RC,87507,HCPCS,facility,both,,,,2327,2327,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ZIKA VIRUS DNA/RNA AMP PROBE,30600217,CDM,306,RC,87662,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STREP A AMPLIF NA PROBE,30600218,CDM,306,RC,87651,HCPCS,facility,both,,,,337,337,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CANDIDA NA AMPLIFIED PROBE,30600219,CDM,306,RC,87481,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENOTYPE INFECT AGENT DRUG (80),30600220,CDM,306,RC,87900,HCPCS,facility,both,,,,482,482,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOTYPE DNA HIV OTHER REGION (75),30600221,CDM,306,RC,87906,HCPCS,facility,both,,,,402,402,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHENOTYPE INFECT AGENT DRUG (1),30600222,CDM,306,RC,87900,HCPCS,facility,both,,,,429,429,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HPV HIGH-RISK TYPES (275),30600223,CDM,306,RC,87624,HCPCS,facility,both,,,,701,701,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DNA/RNA AMPLIFIED PROBE,30600225,CDM,306,RC,87150,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOTYPE DNA HIV OTHER REGION (40),30600226,CDM,306,RC,87906,HCPCS,facility,both,,,,402,402,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RESP VIRUS 12-25 TARGETS,30600227,CDM,306,RC,87633,HCPCS,facility,both,,,,1180,1180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL,30600228,CDM,306,RC,,,facility,both,,,,239,239,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CDC-CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL,30600229,CDM,306,RC,,,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 7/1/25 HC SARS-COV-2 (120),30600230,CDM,306,RC,87635,HCPCS,facility,both,,,,254,254,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RSV DNA/RNA AMP PROBE (2),30600231,CDM,306,RC,87634,HCPCS,facility,both,,,,359,359,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFLUENZA DNA AMP PROBE,30600232,CDM,306,RC,87502,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SARSCOV CORONAVIRUS AG IA,30600233,CDM,306,RC,87426,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 7/1/25 HC SARSCOV2 &INF A&B & RSV,30600234,CDM,306,RC,87637,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NFCT DS BV&VAGINITIS DNA ALG,30600235,CDM,306,RC,81514,HCPCS,facility,both,,,,1872,1872,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 05/12/2023 HC COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT,30600236,CDM,306,RC,,,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC M. GENITALIUM AMP PROBE,30600237,CDM,306,RC,87563,HCPCS,facility,both,,,,942,942,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CUL TYP D BLD PTHGN 6+TRGT,30600238,CDM,306,RC,87154,HCPCS,facility,both,,,,252,252,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID; ORTHOPOXVIRUS, AMPLIFIED PROBE TECHNIQUE, EA",30600239,CDM,306,RC,87593,HCPCS,facility,both,,,,56,56,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SARS-COV-2 (24),30600248,CDM,306,RC,87635,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SARSCOV2 &INF A&B & RSV (39),30600249,CDM,306,RC,87637,HCPCS,facility,both,,,,470,470,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RALTEGRAVIR RESISITANCE, HIV-1",30660018,CDM,306,RC,87906,HCPCS,facility,both,,,,441,441,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INFECT DS (BACTERIAL/VIRAL), TRAIL IP-10 C-REACT PRTN SERUM (41)",30660055,CDM,306,RC,,,facility,both,,,,861,861,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URINE VOL MEASURE EA,30700050,CDM,307,RC,81050,HCPCS,facility,both,,,,44,44,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC N-AUTOM URINE DIP W MICRO,30700051,CDM,307,RC,81000,HCPCS,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LYMPHOCYTOTOX VC; W TITRATE,30900001,CDM,310,RC,86805,HCPCS,facility,both,,,,398,398,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA TYPE; A B C MULTI AG,30900002,CDM,310,RC,86813,HCPCS,facility,both,,,,2783,2783,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA TYPE; DR/DQ MULTI AG,30900003,CDM,310,RC,86817,HCPCS,facility,both,,,,762,762,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA X-MATCH NON-CYTOTOXIC,30900004,CDM,302,RC,86825,HCPCS,facility,both,,,,948,948,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FROZEN BLOOD THAW,30900005,CDM,300,RC,86931,HCPCS,facility,both,,,,804,804,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE CULTURE; LYMPHOCYTE,30900006,CDM,311,RC,88230,HCPCS,facility,both,,,,1007,1007,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; 5 CELLS,30900007,CDM,319,RC,88261,HCPCS,facility,both,,,,2621,2621,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; SITU AF CELLS FROM 6-12 COL,30900008,CDM,319,RC,88269,HCPCS,facility,both,,,,2467,2467,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MCG; DNA PROBE EA,30900009,CDM,311,RC,88271,HCPCS,facility,both,,,,147,147,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COLLECT SWEAT FOR TEST,30900010,CDM,300,RC,89230,HCPCS,facility,both,,,,304,304,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NB SCREEN PANEL -REQ DC,30900011,CDM,309,RC,,,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NB SCREEN PANEL -REQ DC,30900011,CDM,309,RC,,,facility,both,,,,115,115,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MPL W515 & S505 MUTATION,30900012,CDM,310,RC,81402,HCPCS,facility,both,,,,1783,1783,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CELIAC GENE TEST,30900013,CDM,310,RC,81382,HCPCS,facility,both,,,,1576,1576,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PML RARA,30900014,CDM,310,RC,81315,HCPCS,facility,both,,,,1584,1584,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC JAK2 (V617F) MUTATION,30900015,CDM,310,RC,81270,HCPCS,facility,both,,,,1672,1672,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYSTIC FIBROSIS SCREEN,30900016,CDM,310,RC,81220,HCPCS,facility,both,,,,772,772,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROMETHEUS CROHN'S PROGNOSTIC,30900017,CDM,310,RC,81479,HCPCS,facility,both,,,,2122,2122,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDUR LEVEL 5 (435),30900023,CDM,310,RC,81404,HCPCS,facility,both,,,,3074,3074,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTOGEN M ARRAY COPY NO&SNP (640),30900039,CDM,310,RC,81229,HCPCS,facility,both,,,,4526,4526,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EGFR GENE (220),30900040,CDM,310,RC,81235,HCPCS,facility,both,,,,1586,1586,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FMR1 GENE CHARACTERIZ (20),30900045,CDM,310,RC,81244,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLT3 GENE PART OF PANEL),30900047,CDM,310,RC,81246,HCPCS,facility,both,,,,399,399,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDUR LEVEL 1 (65),30900064,CDM,310,RC,81400,HCPCS,facility,both,,,,654,654,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDUR LEVEL 2 (275),30900080,CDM,310,RC,81401,HCPCS,facility,both,,,,1662,1662,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MOPATH PROCEDUR LEVEL 2 (320),30900085,CDM,310,RC,81401,HCPCS,facility,both,,,,2153,2153,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYS (1150),30900219,CDM,310,RC,81450,HCPCS,facility,both,,,,6628,6628,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED MOL PATH (200),30900226,CDM,310,RC,81479,HCPCS,facility,both,,,,1250,1250,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED MOL PATH (350),30900241,CDM,310,RC,81479,HCPCS,facility,both,,,,2786,2786,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED MOL PATH (455),30900246,CDM,310,RC,81479,HCPCS,facility,both,,,,2594,2594,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED MOL PATH (480),30900250,CDM,310,RC,81479,HCPCS,facility,both,,,,3393,3393,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED MOL PATH (1380),30900285,CDM,310,RC,81479,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (1000),30900315,CDM,310,RC,81455,HCPCS,facility,both,,,,5304,5304,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TARGETED GEN SEQ 5-50 (460),30900316,CDM,310,RC,81445,HCPCS,facility,both,,,,3450,3450,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TARGETED GEN SEQ 5-50 (435),30900317,CDM,310,RC,81445,HCPCS,facility,both,,,,3458,3458,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BCR/ABL MJR BP (275),30900320,CDM,310,RC,81206,HCPCS,facility,both,,,,1288,1288,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BRAF GENE (75),30900323,CDM,310,RC,81210,HCPCS,facility,both,,,,1039,1039,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC JAK2 GENE (125),30900327,CDM,310,RC,81270,HCPCS,facility,both,,,,769,769,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CEBPA GENE FULL SEQ (345),30900328,CDM,310,RC,81218,HCPCS,facility,both,,,,2098,2098,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NRAS GENE VAR EXON 2-3 (450),30900329,CDM,310,RC,81311,HCPCS,facility,both,,,,1884,1884,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLE PROC LEVEL 2 (105),30900330,CDM,310,RC,81401,HCPCS,facility,both,,,,699,699,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOLE PROC LEVEL 5 (450),30900331,CDM,310,RC,81404,HCPCS,facility,both,,,,2470,2470,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIT GENE TGT SEQ (415),30900332,CDM,310,RC,81272,HCPCS,facility,both,,,,2098,2098,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KRAS GENE VAR (1),30900333,CDM,310,RC,81276,HCPCS,facility,both,,,,1257,1257,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLT3 GENE (1),30900334,CDM,310,RC,81246,HCPCS,facility,both,,,,531,531,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIT GENE TGTD SEQ (1),30900335,CDM,310,RC,81272,HCPCS,facility,both,,,,2098,2098,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED MOLE PROC (1650),30900336,CDM,310,RC,81479,HCPCS,facility,both,,,,5457,5457,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHIMERISM ANAL NO SEL (145),30900337,CDM,310,RC,81267,HCPCS,facility,both,,,,3689,3689,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NPM1 GENE (345),30900338,CDM,310,RC,81310,HCPCS,facility,both,,,,3223,3223,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PMP22 GENE ANALYSIS,30900339,CDM,310,RC,81325,HCPCS,facility,both,,,,3821,3821,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXOME SEQUENCE ANAL (3670),30900340,CDM,310,RC,81415,HCPCS,facility,both,,,,12133,12133,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPARATOR EXOME (515),30900341,CDM,310,RC,81416,HCPCS,facility,both,,,,16639,16639,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PTN GENE KNOWN (505),30900344,CDM,310,RC,81322,HCPCS,facility,both,,,,225,225,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTGN MARRAY COPY NO & SNP (720),30900345,CDM,310,RC,81229,HCPCS,facility,both,,,,5365,5365,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTGN MARRAY COPY NO & SNP (815),30900346,CDM,310,RC,81229,HCPCS,facility,both,,,,6045,6045,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED MOL PATH (610),30900347,CDM,310,RC,81479,HCPCS,facility,both,,,,4096,4096,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MPATH PROCEDUR LEVEL 5 (2460),30900348,CDM,310,RC,81404,HCPCS,facility,both,,,,17829,17829,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA II TYPING 1 LOC LR (120),30900349,CDM,310,RC,81376,HCPCS,facility,both,,,,1152,1152,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA II TYPING 1 LOC HR (290),30900350,CDM,310,RC,81382,HCPCS,facility,both,,,,2787,2787,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA CLASS I PHENOTYPE QUAL,30900351,CDM,302,RC,86830,HCPCS,facility,both,,,,644,644,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA CLASS II PHENOTYPE QUAL,30900352,CDM,302,RC,86831,HCPCS,facility,both,,,,846,846,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA I TYPING 1 LOCUS LR (55),30900353,CDM,310,RC,81373,HCPCS,facility,both,,,,918,918,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA CLASS I&II ANTIBODY QUAL,30900354,CDM,302,RC,86828,HCPCS,facility,both,,,,217,217,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DMD DUP/DELET ANALYSIS (1340),30900365,CDM,310,RC,81161,HCPCS,facility,both,,,,8120,8120,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MO PATH PROCEDUR LEVEL 1 (320),30900366,CDM,310,RC,81400,HCPCS,facility,both,,,,1939,1939,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MO PATH PROCEDUR LEVEL 6 (320),30900367,CDM,310,RC,81405,HCPCS,facility,both,,,,1939,1939,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BCR/ABL1 GENE MINOR BP (235),30900369,CDM,310,RC,81207,HCPCS,facility,both,,,,558,558,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BCR/ABL1 GENE MINOR BP (235),30900369,CDM,310,RC,81207,HCPCS,facility,both,,,,558,558,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGEN M ARRAY COPY NO&SNP (1115),30900370,CDM,310,RC,81229,HCPCS,facility,both,,,,4502,4502,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BCR/ABL1 GENE MAJOR BP (280),30900371,CDM,310,RC,81206,HCPCS,facility,both,,,,1132,1132,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BCR/ABL1 GENE MAJOR BP (320),30900372,CDM,310,RC,81206,HCPCS,facility,both,,,,1292,1292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRAF GENE (205),30900373,CDM,310,RC,81210,HCPCS,facility,both,,,,828,828,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CEBPA GENE FULL SEQUENCE (400),30900374,CDM,310,RC,81218,HCPCS,facility,both,,,,1616,1616,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGFR GENE COM VARIANTS (390),30900375,CDM,310,RC,81235,HCPCS,facility,both,,,,1576,1576,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLT3 GENE (190),30900376,CDM,310,RC,81245,HCPCS,facility,both,,,,769,769,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGH GENE REARRANGE AMP METH (180),30900377,CDM,310,RC,81261,HCPCS,facility,both,,,,728,728,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STR MARKERS SPECIMEN ANAL (260),30900378,CDM,310,RC,81265,HCPCS,facility,both,,,,1049,1049,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STR MARKERS SPECIMEN ANAL (320),30900379,CDM,310,RC,81265,HCPCS,facility,both,,,,1292,1292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHIMERISM ANAL NO CELL SELEC (170),30900380,CDM,310,RC,81267,HCPCS,facility,both,,,,687,687,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHIMERISM ANAL NO CELL SELEC (300),30900381,CDM,310,RC,81267,HCPCS,facility,both,,,,1212,1212,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHIMERISM ANAL WI/CELL SELECT (245),30900382,CDM,310,RC,81268,HCPCS,facility,both,,,,909,909,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIT GENE TARGETED SEQ ANALYS (440),30900383,CDM,310,RC,81272,HCPCS,facility,both,,,,1778,1778,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MICROSATELLITE INSTABILITY (275),30900384,CDM,310,RC,81301,HCPCS,facility,both,,,,1112,1112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NPM1 GENE (400),30900385,CDM,310,RC,81310,HCPCS,facility,both,,,,1616,1616,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NRAS GENE VARIANTS EXON 2&3 (475),30900386,CDM,310,RC,81311,HCPCS,facility,both,,,,1920,1920,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PML/RARALPHA COM BREAKPOINTS (320),30900387,CDM,310,RC,81315,HCPCS,facility,both,,,,1252,1252,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRG GENE REARRANGEMENT ANAL (230),30900388,CDM,310,RC,81342,HCPCS,facility,both,,,,929,929,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 2 (105),30900389,CDM,310,RC,81401,HCPCS,facility,both,,,,424,424,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 4 (230),30900390,CDM,310,RC,81403,HCPCS,facility,both,,,,929,929,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 7 (350),30900391,CDM,310,RC,81406,HCPCS,facility,both,,,,1413,1413,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYS (480),30900392,CDM,310,RC,81445,HCPCS,facility,both,,,,1939,1939,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYS (530),30900393,CDM,310,RC,81445,HCPCS,facility,both,,,,2141,2141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAR ION CHNNLPATH INC 10 GNS ADDON,30900394,CDM,310,RC,81413,HCPCS,facility,both,,,,3085,3085,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLT3 GENE (100),30900396,CDM,310,RC,81245,HCPCS,facility,both,,,,676,676,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLT3 GENE ANALSYS (455),30900397,CDM,310,RC,81246,HCPCS,facility,both,,,,1838,1838,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HLA CLASS I HIGH DEFIN QUAL,30900399,CDM,302,RC,86832,HCPCS,facility,both,,,,734,734,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA CLAS II HIGH DEFIN QUAL,30900400,CDM,302,RC,86833,HCPCS,facility,both,,,,702,702,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC HLA I & II TYPE VERIFY LR (150),30900404,CDM,310,RC,81371,HCPCS,facility,both,,,,1262,1262,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPARATOR EXOME (375),30900409,CDM,310,RC,81416,HCPCS,facility,both,,,,17828,17828,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED MOLE PROC (900),30900410,CDM,310,RC,81479,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS,30900430,CDM,310,RC,81445,HCPCS,facility,both,,,,2306,2306,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CALR GENE COM VARIANTS (240),30900431,CDM,310,RC,81219,HCPCS,facility,both,,,,1453,1453,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CALR GENE COM VARIANTS (240),30900431,CDM,310,RC,81219,HCPCS,facility,both,,,,1453,1453,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MTHFR GENE (85),30900432,CDM,310,RC,81291,HCPCS,facility,both,,,,508,508,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MTHFR GENE (85),30900432,CDM,310,RC,81291,HCPCS,facility,both,,,,508,508,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (795),30900433,CDM,310,RC,81450,HCPCS,facility,both,,,,3055,3055,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (795),30900433,CDM,310,RC,81450,HCPCS,facility,both,,,,3055,3055,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795),30900434,CDM,310,RC,81455,HCPCS,facility,both,,,,4049,4049,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795),30900434,CDM,310,RC,81455,HCPCS,facility,both,,,,4049,4049,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CFTR GENE COM VARIANTS (70),30900436,CDM,310,RC,81220,HCPCS,facility,both,,,,772,772,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CFTR GENE COM VARIANTS (70),30900436,CDM,310,RC,81220,HCPCS,facility,both,,,,772,772,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ABL1 GENE (200),30900439,CDM,310,RC,81170,HCPCS,facility,both,,,,1276,1276,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GJB2 GENE FULL SEQUENCE (470),30900440,CDM,310,RC,81252,HCPCS,facility,both,,,,2863,2863,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENE TARGETED SEQUENCE ANALYSIS (160),30900441,CDM,310,RC,81272,HCPCS,facility,both,,,,1276,1276,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 2 (555),30900442,CDM,310,RC,81401,HCPCS,facility,both,,,,3389,3389,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IDH1 COMMON VARIANTS (230),30900443,CDM,310,RC,81120,HCPCS,facility,both,,,,929,929,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IDH2 COMMON VARIANTS (230),30900444,CDM,310,RC,81121,HCPCS,facility,both,,,,929,929,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IFNL3 GENE (70),30900445,CDM,310,RC,81283,HCPCS,facility,both,,,,654,654,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TPMT GENE COM VARIANTS,30900446,CDM,310,RC,81335,HCPCS,facility,both,,,,699,699,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDUR LEVEL 2 (260),30900455,CDM,310,RC,81401,HCPCS,facility,both,,,,1561,1561,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC F2 GENE (40),30900457,CDM,310,RC,81240,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC F5 GENE (40),30900458,CDM,310,RC,81241,HCPCS,facility,both,,,,291,291,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 2 (210),30900459,CDM,310,RC,81401,HCPCS,facility,both,,,,1445,1445,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 7 (1490),30900460,CDM,310,RC,81406,HCPCS,facility,both,,,,10431,10431,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MECP2 GENE FULL SEQ (340),30900461,CDM,310,RC,81302,HCPCS,facility,both,,,,2233,2233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASHKENAZI JEWISH ASSOC DIS (730),30900462,CDM,310,RC,81412,HCPCS,facility,both,,,,8960,8960,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BCR/ABL1 GENE MAJOR BP QUAN,30900463,CDM,310,RC,,,facility,both,,,,840,840,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MGMT GENE PMTR MTHYLTN ALYS (355),30900468,CDM,310,RC,81287,HCPCS,facility,both,,,,652,652,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGENOMIC NEO MICRORA ALYS (350),30900469,CDM,310,RC,81277,HCPCS,facility,both,,,,1609,1609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 7 (966),30900470,CDM,310,RC,81406,HCPCS,facility,both,,,,985,985,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (1426),30900471,CDM,310,RC,81455,HCPCS,facility,both,,,,7631,7631,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOGEN M ARRAY COPY NO & SNP (417),30900472,CDM,310,RC,81229,HCPCS,facility,both,,,,2091,2091,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (202),30900473,CDM,310,RC,81455,HCPCS,facility,both,,,,7843,7843,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (328),30900474,CDM,310,RC,81455,HCPCS,facility,both,,,,7843,7843,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (467),30900475,CDM,310,RC,81455,HCPCS,facility,both,,,,7843,7843,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IGK GENE PART OF PANEL (154),30900476,CDM,310,RC,81264,HCPCS,facility,both,,,,558,558,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (170),30900479,CDM,310,RC,81455,HCPCS,facility,both,,,,5304,5304,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROC LEVEL 8 (608),30900480,CDM,310,RC,81407,HCPCS,facility,both,,,,4233,4233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROC LEVEL 9 (778),30900481,CDM,310,RC,81408,HCPCS,facility,both,,,,7851,7851,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (342),30900483,CDM,310,RC,81445,HCPCS,facility,both,,,,2377,2377,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IADNA CNS PTHGN NEXT GEN SEQ(780),30900484,CDM,310,RC,,,facility,both,,,,3083,3083,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 12/31/2023 HC LIVER DISEASE ALYS 3 BMRK SRM ALG (171),30900485,CDM,309,RC,,,facility,both,,,,530,530,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOPATH FL NONGYN SMEARS,31000001,CDM,311,RC,88104,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CP SMR OTHR; SCRN & INT,31000002,CDM,311,RC,88160,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLOW CYTOMETRY EA ADDTL MARKER,31000003,CDM,311,RC,88185,HCPCS,facility,both,,,,81,81,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE CULTURE; BM BLD CELLS,31000004,CDM,310,RC,88237,HCPCS,facility,both,,,,856,856,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE CULTURE; OTHER TISSUE,31000005,CDM,319,RC,88239,HCPCS,facility,both,,,,2188,2188,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; 45 CELLS,31000006,CDM,319,RC,88263,HCPCS,facility,both,,,,2228,2228,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; 45 CELLS,31000006,CDM,319,RC,88263,HCPCS,facility,both,,,,1321,1321,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MCG; SITU HYBRID 3-5 CELLS,31000007,CDM,310,RC,88272,HCPCS,facility,both,,,,397,397,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MCG; SITU HYBRID 10-30 CELLS,31000008,CDM,310,RC,88273,HCPCS,facility,both,,,,477,477,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MCG; IP SITU 25-99 CELLS,31000009,CDM,310,RC,88274,HCPCS,facility,both,,,,517,517,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; ADDTL BANDING,31000010,CDM,319,RC,88283,HCPCS,facility,both,,,,1018,1018,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; ADDTL CELL COUNTS,31000011,CDM,310,RC,88285,HCPCS,facility,both,,,,282,282,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE EXAM BY PATHOLOGIST LVL 4,31000012,CDM,310,RC,88305,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ENZYME HISTOCHEMISTRY,31000013,CDM,310,RC,88319,HCPCS,facility,both,,,,2386,2386,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PATH CONSULT DURING SURGERY,31000014,CDM,310,RC,88329,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INTRAOP CYTO PATH CONSULT 1,31000015,CDM,311,RC,88333,HCPCS,facility,both,,,,1057,1057,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INTRAOP CYTO PATH CONSULT 2,31000016,CDM,311,RC,88334,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INTRAOP CYTO PATH CONSULT 2,31000016,CDM,311,RC,88334,HCPCS,facility,both,,,,133,133,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IHC EACH ANTIBODY,31000017,CDM,310,RC,88342,HCPCS,facility,both,,,,643,643,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IHC EACH ANTIBODY,31000017,CDM,310,RC,88342,HCPCS,facility,both,,,,654,654,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IF STAIN , INITIAL",31000018,CDM,310,RC,88346,HCPCS,facility,both,,,,1312,1312,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IF EA AB; INDIRECT,31000019,CDM,310,RC,88347,HCPCS,facility,both,,,,101,101,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MORPHOMETRICS; NERVE,31000020,CDM,310,RC,88356,HCPCS,facility,both,,,,819,819,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MANUAL TUMOR IM HISTOCHEM EA AB,31000021,CDM,310,RC,88360,HCPCS,facility,both,,,,487,487,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPUTER MORPHOMETRIC ANALYSIS EA AB,31000022,CDM,310,RC,88361,HCPCS,facility,both,,,,444,444,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MICRODISSECTION MANUAL,31000025,CDM,310,RC,88381,HCPCS,facility,both,,,,711,711,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISS EXAM MOLECULAR STUDY,31000038,CDM,310,RC,88387,HCPCS,facility,both,,,,1222,1222,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE DEAC 01/01/2025 HC TISS EX MOLECUL STUDY ADD-ON,31000039,CDM,310,RC,88388,HCPCS,facility,both,,,,1222,1222,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED SURG PATH,31000040,CDM,310,RC,88399,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CELL COUNT NOT BLOOD,31000041,CDM,300,RC,89050,HCPCS,facility,both,,,,71,71,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CELL COUNT NOT BLOOD,31000041,CDM,300,RC,89050,HCPCS,facility,both,,,,12,12,,,,,,,,,,,,,Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE "HC MORPHOMETRIC ANAL,BONE",31000042,CDM,310,RC,88399,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC IMMUNOFLUOR STN, ADD",31000043,CDM,310,RC,88350,HCPCS,facility,both,,,,1375,1375,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 2/8/2017 HC CYTP URNE 3-5 PROBES EA SPEC,31000100,CDM,311,RC,88120,HCPCS,facility,both,,,,436,436,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC REF CONSULT PREP ELSEWHERE,31000101,CDM,310,RC,88321,HCPCS,facility,both,,,,820,820,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC REF CONSULT W SLIDE PREP,31000102,CDM,310,RC,88323,HCPCS,facility,both,,,,631,631,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPREHENSIVE CONSULT,31000103,CDM,310,RC,88325,HCPCS,facility,both,,,,1098,1098,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC XM ARCHIVE TISSUE MOLEC ANAL,31000104,CDM,310,RC,88363,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PROSTATE BIOPSY ANY METHOD,31000106,CDM,310,RC,,,facility,both,,,,2377,2377,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SAT BIOPSY PROSTATE 21-40,31000107,CDM,310,RC,,,facility,both,,,,1658,1658,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MORPHOMETRICS; TUMOR,31000111,CDM,310,RC,88358,HCPCS,facility,both,,,,1866,1866,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NERVE TEASING PREP,31000112,CDM,310,RC,88362,HCPCS,facility,both,,,,2386,2386,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC NERVE TEASING PREP,31000112,CDM,310,RC,88362,HCPCS,facility,both,,,,1415,1415,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PATHOLOGY LAB PROCEDURE,31000113,CDM,310,RC,89240,HCPCS,facility,both,,,,221,221,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC IHC ADD SINGLE AB STN,EACH",31000114,CDM,310,RC,88341,HCPCS,facility,both,,,,643,643,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MULTIPLEX AB STN EACH,31000115,CDM,310,RC,88344,HCPCS,facility,both,,,,643,643,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC CYTOPATH, ISH, URIN C MORPHOM (140)",31000116,CDM,310,RC,88120,HCPCS,facility,both,,,,876,876,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WASH HARVEST STEM CELLS,31000117,CDM,310,RC,38209,HCPCS,facility,both,,,,2195,2195,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50),31000119,CDM,310,RC,88377,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50),31000119,CDM,310,RC,88377,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTP URINE 3-5 PROBES CMPTR (122),31000122,CDM,310,RC,88121,HCPCS,facility,both,,,,990,990,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXOME RE-EVALUATION (1840),31000123,CDM,310,RC,81417,HCPCS,facility,both,,,,1116,1116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYD88 GENE P. LEU265PRO VRNT (300),31000125,CDM,310,RC,81305,HCPCS,facility,both,,,,695,695,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYP2C9, GENE ANALYSIS, COMMON VARIANTS(30)",31000131,CDM,310,RC,81227,HCPCS,facility,both,,,,646,646,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYP2D6, GENE ANALYSIS, COMMON VARIANTS(30)",31000132,CDM,310,RC,81226,HCPCS,facility,both,,,,1519,1519,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYP3A4, GENE ANALYSIS, COMMON VARIANTS(30)",31000133,CDM,310,RC,81230,HCPCS,facility,both,,,,646,646,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYP3A5, GENE ANALYSIS, COMMON VARIANTS(30)",31000134,CDM,310,RC,81231,HCPCS,facility,both,,,,646,646,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DPYD, GENE ANALYSIS, COMMON VARIANTS(30)",31000135,CDM,310,RC,81232,HCPCS,facility,both,,,,646,646,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NUDT15, GENE ANALYSIS, COMMON VARIANTS(30)",31000136,CDM,310,RC,81306,HCPCS,facility,both,,,,1015,1015,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SLCO1BI, GENE ANALYSIS, COMMON VARIANTS(30)",31000137,CDM,310,RC,81328,HCPCS,facility,both,,,,646,646,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 4/1/2023 HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)",31000138,CDM,310,RC,81355,HCPCS,facility,both,,,,283,283,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FETAL CONGENTIAL ABNORML ASSAY TWO PROTEINS (PAPP-A, HCG) (25)",31000140,CDM,310,RC,81508,HCPCS,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC SEQ ANALYSIS (263),31000141,CDM,310,RC,81455,HCPCS,facility,both,,,,4653,4653,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TARGETED GENOMIC ANALYSIS(170),31000142,CDM,310,RC,81456,HCPCS,facility,both,,,,7711,7711,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UGT1A1, GENE ANALYSIS, COMMON VARIANTS(85)",31000144,CDM,310,RC,81350,HCPCS,facility,both,,,,773,773,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)",31000147,CDM,310,RC,81335,HCPCS,facility,both,,,,328,328,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2,31000150,CDM,310,RC,,,facility,both,,,,1180,1180,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLT3 GENE (795),31000152,CDM,310,RC,81245,HCPCS,facility,both,,,,2748,2748,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARDIOMYOPATHY  PANEL (296),31000153,CDM,310,RC,81439,HCPCS,facility,both,,,,661,661,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMBINED CARDIAC  PANEL SEQUENCING AT LEAST 10 GENES (148),31000154,CDM,310,RC,81413,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMBINED CARDIAC  PANEL ANALYSIS AT LEAST 2 GENES (148),31000155,CDM,310,RC,81414,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOMEXPRESS (1109),31000156,CDM,310,RC,81425,HCPCS,facility,both,,,,2477,2477,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GENOMEXPRESS SEQUENCE ANALYSIS, EA COMPARATOR GENOME (554)",31000157,CDM,310,RC,81426,HCPCS,facility,both,,,,1238,1238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHOLE MITO GENOME SEQUENCING & DELETION TESTING (148),31000158,CDM,310,RC,81460,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MITO GENOME SEQUENCING HETEROPLASMY DETECTION, IF PERFRMD (148)",31000159,CDM,310,RC,81465,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NOONAN AND COMPREHENSIVE RASOPATHIES  PANEL (296),31000160,CDM,310,RC,81442,HCPCS,facility,both,,,,661,661,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ONE KNOWN FAMILIAL VARIANT (136),31000161,CDM,310,RC,81455,HCPCS,facility,both,,,,305,305,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRENATAL KNOWN FAMILIAL MUTATION (INCLUDES MCC) (370),31000162,CDM,310,RC,81265,HCPCS,facility,both,,,,826,826,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE (370),31000163,CDM,310,RC,81479,HCPCS,facility,both,,,,826,826,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TWO KNOWN FAMILIAL VARIANTS IN A NUCLEAR GENE (98),31000164,CDM,310,RC,81455,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHROMOSOMAL MICROARRAY (MICROARRAYDX) (296),31000165,CDM,310,RC,81229,HCPCS,facility,both,,,,661,661,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC XOMEDXXPRESS (739),31000166,CDM,310,RC,81415,HCPCS,facility,both,,,,1651,1651,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC XOMEDXXPRESS SEQ ANALYSIS, EA COMPARATOR EXOME (370)",31000167,CDM,310,RC,81416,HCPCS,facility,both,,,,826,826,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOKINE 13 PANEL (13),31000168,CDM,310,RC,83520,HCPCS,facility,both,,,,26,26,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MOLECULAR PATH PROC, LEVEL 4  (71)",31000169,CDM,310,RC,81403,HCPCS,facility,both,,,,611,611,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC-NPM1 GENE (874),31000170,CDM,310,RC,81310,HCPCS,facility,both,,,,1263,1263,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 5 (246),31000172,CDM,310,RC,81404,HCPCS,facility,both,,,,551,551,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 6 (123),31000173,CDM,310,RC,81405,HCPCS,facility,both,,,,276,276,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 7 (83),31000174,CDM,310,RC,81406,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPARATOR EXOME (247),31000175,CDM,310,RC,81416,HCPCS,facility,both,,,,551,551,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMPARATOR EXOME (493),31000176,CDM,310,RC,81416,HCPCS,facility,both,,,,1101,1101,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXOME SEQUENCE ANALYSIS (1232),31000177,CDM,310,RC,81415,HCPCS,facility,both,,,,2752,2752,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXOME RE-EVALUATION (493),31000178,CDM,310,RC,81417,HCPCS,facility,both,,,,1101,1101,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOME SEQUENCE ANALYSIS (1970),31000179,CDM,310,RC,81425,HCPCS,facility,both,,,,4402,4402,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENOME SEQUENCE ANALYSIS (985),31000180,CDM,310,RC,81425,HCPCS,facility,both,,,,2201,2201,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GENOME SEQ ANALYSIS, EA CMPRTR (493)",31000181,CDM,310,RC,81426,HCPCS,facility,both,,,,1101,1101,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GENOME SEQ ANALYSIS, EA CMPRTR (985)",31000182,CDM,310,RC,81426,HCPCS,facility,both,,,,2201,2201,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 6 (99),31000183,CDM,310,RC,81405,HCPCS,facility,both,,,,221,221,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 7 (49),31000184,CDM,310,RC,81406,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 2 (99),31000185,CDM,310,RC,81401,HCPCS,facility,both,,,,221,221,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOPATH PROCEDURE LEVEL 2 (49),31000186,CDM,310,RC,81401,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACTIONABLE PHARMACOGENOMICS PANEL (284),31000187,CDM,310,RC,81418,HCPCS,facility,both,,,,1510,1510,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOG GEN-WIDE ALYS HEM MAL STRUX VRNT&CNV OGM (271),31000188,CDM,310,RC,81195,HCPCS,facility,both,,,,4106,4106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DMPK,MYOTONIC DYSTROPHY,TYPE-1",31060012,CDM,310,RC,81234,HCPCS,facility,both,,,,543,543,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYTOPATH CELL ENHANCE TECH,31100001,CDM,311,RC,88112,HCPCS,facility,both,,,,487,487,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CP CERV/VAG; ATL; MANUAL SCRN,31100002,CDM,311,RC,88142,HCPCS,facility,both,,,,363,363,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CP SMR OTHR; PREP SCRN INT,31100003,CDM,311,RC,88161,HCPCS,facility,both,,,,442,442,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTP DX EVAL FNA 1ST EA SITE,31100004,CDM,311,RC,88172,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC EVAL OF FNA; INT & REP,31100005,CDM,311,RC,88173,HCPCS,facility,both,,,,171,171,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FLOW CYTOMETRY TC 1ST MARKER,31100006,CDM,311,RC,88184,HCPCS,facility,both,,,,449,449,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYOPRESERVATION EA CELL LINE,31100007,CDM,310,RC,88240,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC THAW FROZEN CELLS/ALIQUOT,31100008,CDM,319,RC,88241,HCPCS,facility,both,,,,150,150,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ELECTRON MICRO; DX,31100009,CDM,310,RC,88348,HCPCS,facility,both,,,,3799,3799,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ISH SINGLE PROBE 1ST,31100010,CDM,312,RC,88365,HCPCS,facility,both,,,,488,488,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BETHESDA PAP; MAN SCRN,31100011,CDM,311,RC,88164,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTOPATH C/V INTERPRET,31100050,CDM,311,RC,88141,HCPCS,facility,both,,,,344,344,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CELL MARKER STUDY,31100051,CDM,319,RC,88182,HCPCS,facility,both,,,,839,839,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE DEAC 4/1/2025 HC FLOW CYTOMETRY INTERP 9-15 MARKERS,31100052,CDM,319,RC,88188,HCPCS,facility,both,,,,893,893,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE DEAC 4/1/2025 HC FLOW CYTOMETRY INTERP 16 & > MARKERS,31100053,CDM,319,RC,88189,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTOPATH FL NONGYN FILTER,31100054,CDM,311,RC,88106,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SEX C ID; BARR BODIES,31100055,CDM,311,RC,88130,HCPCS,facility,both,,,,225,225,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DX PAP; MANUAL SCREEN,31100056,CDM,311,RC,88150,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CYTOPATH C/V INDEX ADD-ON,31100057,CDM,311,RC,88155,HCPCS,facility,both,,,,107,107,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CP SMR OTHR; > 5 SLIDES,31100058,CDM,311,RC,88162,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC UNLISTED CYTOPATHOLOGY,31100059,CDM,311,RC,88199,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ISH PROBE ADDITIONAL,31100061,CDM,312,RC,88364,HCPCS,facility,both,,,,488,488,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC ISH MULTIPLEX PROBE,31100062,CDM,310,RC,88366,HCPCS,facility,both,,,,448,448,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CP CONCENTR TECH SMEAR,31200001,CDM,311,RC,88108,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SURG PATH LEVEL-I GROSS ONLY,31200002,CDM,310,RC,88300,HCPCS,facility,both,,,,142,142,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SURG PATH LVL 2,31200003,CDM,310,RC,88302,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE EXAM BY PATHOLOGIST LVL 3,31200004,CDM,310,RC,88304,HCPCS,facility,both,,,,365,365,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE EXAM BY PATHOLOGIST LVL 5,31200005,CDM,310,RC,88307,HCPCS,facility,both,,,,692,692,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE EXAM BY PATHOLOGIST LVL 5,31200005,CDM,310,RC,88307,HCPCS,facility,both,,,,692,692,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TISSUE EXAM BY PATHOLOGIST LVL 6,31200006,CDM,310,RC,88309,HCPCS,facility,both,,,,1032,1032,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DECALCIFICATION,31200007,CDM,310,RC,88311,HCPCS,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPECIAL STAINS GROUP 1,31200008,CDM,310,RC,88312,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SPECIAL STAINS GROUP 2,31200009,CDM,310,RC,88313,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC SP CONSULT; 1ST TB W FS SGL SP,31200011,CDM,310,RC,88331,HCPCS,facility,both,,,,300,300,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PATH CONSULT INTRAOP ADDL,31200012,CDM,310,RC,88332,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE CULTURE; SKIN OR SOLID BX,31900001,CDM,319,RC,88233,HCPCS,facility,both,,,,2077,2077,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC TISSUE CULTURE; AMNIOTIC FLUID,31900002,CDM,319,RC,88235,HCPCS,facility,both,,,,2183,2183,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; 50-100 CELLS,31900003,CDM,319,RC,88248,HCPCS,facility,both,,,,2568,2568,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; 15-20 CELLS,31900004,CDM,310,RC,88262,HCPCS,facility,both,,,,3685,3685,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; 20-25 CELLS,31900005,CDM,310,RC,88264,HCPCS,facility,both,,,,845,845,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; AF/CV 15 CELLS,31900006,CDM,319,RC,88267,HCPCS,facility,both,,,,2667,2667,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC MCG; IP SITU 100-300 CELLS,31900007,CDM,310,RC,88275,HCPCS,facility,both,,,,1714,1714,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; ADDTL KARYOT EA STUDY,31900008,CDM,310,RC,88280,HCPCS,facility,both,,,,375,375,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CHROM ANALY; ADDTL HI RESOLN,31900009,CDM,319,RC,88289,HCPCS,facility,both,,,,1002,1002,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INSITU HYBRIDIZATION AUTO,31900010,CDM,319,RC,88367,HCPCS,facility,both,,,,449,449,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC INSITU HYBRIDIZATION MANUAL,31900011,CDM,319,RC,88368,HCPCS,facility,both,,,,1898,1898,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC CISTERNOGRAPHY, POSITIVE CONTRAST, S & I",32000001,CDM,320,RC,70015,HCPCS,facility,both,,,,857,857,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM OF EYE, DETECTION OF FOREIGN BODY",32000002,CDM,320,RC,70030,HCPCS,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MANDIBLE, LESS THAN 4 VIEWS",32000003,CDM,320,RC,70100,HCPCS,facility,both,,,,467,467,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MANDIBLE, MIN 4 VIEWS",32000004,CDM,320,RC,70110,HCPCS,facility,both,,,,634,634,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FACIAL BONES, LESS THAN 3 VIEWS",32000005,CDM,320,RC,70140,HCPCS,facility,both,,,,676,676,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FACIAL BONES, MIN 3 VIEWS",32000006,CDM,320,RC,70150,HCPCS,facility,both,,,,726,726,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NASAL BONES, MIN 3 VIEWS",32000007,CDM,320,RC,70160,HCPCS,facility,both,,,,500,500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ORBITS, MIN 4 VIEWS",32000008,CDM,320,RC,70200,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SINUSES, PARANASAL, LESS THAN 3 VIEWS",32000009,CDM,320,RC,70210,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SINUSES, PARANASAL, MIN 3 VIEWS",32000010,CDM,320,RC,70220,HCPCS,facility,both,,,,906,906,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SKULL, LESS THAN 4 VIEWS",32000011,CDM,320,RC,70250,HCPCS,facility,both,,,,961,961,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SKULL, MIN 4 VIEWS",32000012,CDM,320,RC,70260,HCPCS,facility,both,,,,945,945,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TEMPOROMANDIBULAR JOINT, BILAT",32000013,CDM,320,RC,70330,HCPCS,facility,both,,,,701,701,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NECK, SOFT TISSUE",32000014,CDM,320,RC,70360,HCPCS,facility,both,,,,399,399,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, SINGLE VIEW, SPECIFY LEVEL",32000015,CDM,320,RC,72020,HCPCS,facility,both,,,,376,376,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, CERVICAL, 2 OR 3 VIEWS",32000016,CDM,320,RC,72040,HCPCS,facility,both,,,,730,730,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, CERVICAL, MIN 4 VIEWS",32000017,CDM,320,RC,72050,HCPCS,facility,both,,,,904,904,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, CERVICAL, COMPLETE",32000018,CDM,320,RC,72052,HCPCS,facility,both,,,,1084,1084,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, THORAX, 2 VIEWS",32000019,CDM,320,RC,72070,HCPCS,facility,both,,,,630,630,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, THORAX, 3 VIEWS",32000020,CDM,320,RC,72072,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, THORAX, MIN 4 VIEWS",32000021,CDM,320,RC,72074,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, THORACOLUMBAR, 2 VIEWS",32000022,CDM,320,RC,72080,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, SCOLIOSIS STUDY",32000023,CDM,320,RC,72090,HCPCS,facility,both,,,,381,381,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, LUMBOSACRAL, 2 OR 3 VIEWS",32000024,CDM,320,RC,72100,HCPCS,facility,both,,,,904,904,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, LUMBOSACRAL, MIN 4 VIEWS",32000025,CDM,320,RC,72110,HCPCS,facility,both,,,,1160,1160,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPINE, LUMBOSACRAL, MIN 6 VIEWS",32000026,CDM,320,RC,72114,HCPCS,facility,both,,,,1231,1231,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM PELVIS, 1 OR 2 VIEWS",32000027,CDM,320,RC,72170,HCPCS,facility,both,,,,539,539,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM PELVIS, MIN 3 VIEWS",32000028,CDM,320,RC,72190,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM SACROILIAC JOINTS, 3 OR MORE VIEWS",32000029,CDM,320,RC,72202,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM SACRUM AND COCCYX, MIN 2 VIEWS",32000030,CDM,320,RC,72220,HCPCS,facility,both,,,,834,834,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MYELOGRAPHY, CERVICAL S & I",32000031,CDM,320,RC,72240,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MYELOGRAPHY, THORACIC S & I",32000032,CDM,320,RC,72255,HCPCS,facility,both,,,,2890,2890,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MYELOGRAPHY, LUMBOSACRAL S & I",32000033,CDM,320,RC,72265,HCPCS,facility,both,,,,1829,1829,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MYELOGRAPHY, 2 OR MORE REGIONS S & I",32000034,CDM,320,RC,72270,HCPCS,facility,both,,,,2670,2670,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DISCOGRAPHY, CERVICAL OR THORACIC S & I",32000035,CDM,320,RC,72285,HCPCS,facility,both,,,,2284,2284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT VERTOPLASTY/SACROPLASTY W/FLUORO,32000036,CDM,320,RC,72291,HCPCS,facility,both,,,,656,656,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DISCOGRAPHY, LUMBAR",32000037,CDM,320,RC,72295,HCPCS,facility,both,,,,3828,3828,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM CLAVICLE, COMPLETE",32000038,CDM,320,RC,73000,HCPCS,facility,both,,,50,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM CLAVICLE, COMPLETE",32000038,CDM,320,RC,73000,HCPCS,facility,both,,,,473,473,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM SCAPULA, COMPLETE",32000039,CDM,320,RC,73010,HCPCS,facility,both,,,,500,500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM SHOULDER, 1 VIEW",32000040,CDM,320,RC,73020,HCPCS,facility,both,,,50,824,824,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM SHOULDER, 1 VIEW",32000040,CDM,320,RC,73020,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM SHOULDER, MIN 2 VIEWS",32000041,CDM,320,RC,73030,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM SHOULDER, MIN 2 VIEWS",32000041,CDM,320,RC,73030,HCPCS,facility,both,,,50,895,895,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM ACROMIOCLAVICULAR JOINTS, BILAT",32000042,CDM,320,RC,73050,HCPCS,facility,both,,,52,571,571,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services "HC RAD EXAM ACROMIOCLAVICULAR JOINTS, BILAT",32000042,CDM,320,RC,73050,HCPCS,facility,both,,,,846,846,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM HUMERUS, MIN 2 VIEWS",32000043,CDM,320,RC,73060,HCPCS,facility,both,,,,549,549,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM HUMERUS, MIN 2 VIEWS",32000043,CDM,320,RC,73060,HCPCS,facility,both,,,50,774,774,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM ELBOW, 2 VIEWS",32000044,CDM,320,RC,73070,HCPCS,facility,both,,,50,874,874,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM ELBOW, 2 VIEWS",32000044,CDM,320,RC,73070,HCPCS,facility,both,,,,535,535,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM ELBOW, MIN 3 VIEWS",32000045,CDM,320,RC,73080,HCPCS,facility,both,,,,645,645,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM ELBOW, MIN 3 VIEWS",32000045,CDM,320,RC,73080,HCPCS,facility,both,,,50,1061,1061,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM FOREARM, 2 VIEWS",32000046,CDM,320,RC,73090,HCPCS,facility,both,,,,499,499,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM FOREARM, 2 VIEWS",32000046,CDM,320,RC,73090,HCPCS,facility,both,,,50,715,715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM UPPER EXT INFANT MIN 2 VIEWS,32000047,CDM,320,RC,73092,HCPCS,facility,both,,,50,1311,1311,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM UPPER EXT INFANT MIN 2 VIEWS,32000047,CDM,320,RC,73092,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM WRIST, 2 VIEWS",32000048,CDM,320,RC,73100,HCPCS,facility,both,,,,438,438,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM WRIST, 2 VIEWS",32000048,CDM,320,RC,73100,HCPCS,facility,both,,,50,676,676,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM WRIST, MIN 3 VIEWS",32000049,CDM,320,RC,73110,HCPCS,facility,both,,,50,1281,1281,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM WRIST, MIN 3 VIEWS",32000049,CDM,320,RC,73110,HCPCS,facility,both,,,,513,513,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM HAND, 2 VIEWS",32000050,CDM,320,RC,73120,HCPCS,facility,both,,,,457,457,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM HAND, 2 VIEWS",32000050,CDM,320,RC,73120,HCPCS,facility,both,,,50,676,676,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM HAND, MIN 3 VIEWS",32000051,CDM,320,RC,73130,HCPCS,facility,both,,,50,764,764,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM HAND, MIN 3 VIEWS",32000051,CDM,320,RC,73130,HCPCS,facility,both,,,,530,530,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM FINGER(S), MIN 2 VIEWS",32000052,CDM,320,RC,73140,HCPCS,facility,both,,,,186,186,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM FINGER(S), MIN 2 VIEWS",32000052,CDM,320,RC,73140,HCPCS,facility,both,,,50,367,367,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM HIP UNILATERAL 1 VIEW,32000053,CDM,320,RC,73500,HCPCS,facility,both,,,,380,380,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM HIP UNILATERAL 1 VIEW,32000053,CDM,320,RC,73500,HCPCS,facility,both,,,50,550,550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM HIP UNILATERAL MIN 2 VIEWS,32000054,CDM,320,RC,73510,HCPCS,facility,both,,,,307,307,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM HIPS BILATERAL MIN 2 VIEWS EACH HIP,32000055,CDM,320,RC,73520,HCPCS,facility,both,,,,381,381,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM DURING OP PROC UP TO 4 STUDIES,32000056,CDM,320,RC,73530,HCPCS,facility,both,,,50,1595,1595,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM DURING OP PROC UP TO 4 STUDIES,32000056,CDM,320,RC,73530,HCPCS,facility,both,,,,964,964,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM PELVIS & HIPS INFANT/CHILD MIN 2 VIEW,32000057,CDM,320,RC,73540,HCPCS,facility,both,,,,307,307,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM FEMUR 2 VIEWS,32000058,CDM,320,RC,73550,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM FEMUR 2 VIEWS,32000058,CDM,320,RC,73550,HCPCS,facility,both,,,50,429,429,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM KNEE 1 OR 2 VIEWS,32000059,CDM,320,RC,73560,HCPCS,facility,both,,,,488,488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM KNEE 1 OR 2 VIEWS,32000059,CDM,320,RC,73560,HCPCS,facility,both,,,50,715,715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM KNEE 3 VIEWS,32000060,CDM,320,RC,73562,HCPCS,facility,both,,,50,748,748,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM KNEE 3 VIEWS,32000060,CDM,320,RC,73562,HCPCS,facility,both,,,,513,513,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM KNEE 4 OR MORE VIEWS,32000061,CDM,320,RC,73564,HCPCS,facility,both,,,,513,513,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM KNEE 4 OR MORE VIEWS,32000061,CDM,320,RC,73564,HCPCS,facility,both,,,50,748,748,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM BOTH KNEES STANDING AP MIN 3 VIEWS,32000062,CDM,320,RC,73565,HCPCS,facility,both,,,,473,473,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM TIBIA AND FIBULA 2 VIEWS,32000063,CDM,320,RC,73590,HCPCS,facility,both,,,,488,488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM TIBIA AND FIBULA 2 VIEWS,32000063,CDM,320,RC,73590,HCPCS,facility,both,,,50,715,715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM LOWER EXT INFANT MIN 2 VIEWS,32000064,CDM,320,RC,73592,HCPCS,facility,both,,,,396,396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM LOWER EXT INFANT MIN 2 VIEWS,32000064,CDM,320,RC,73592,HCPCS,facility,both,,,50,645,645,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM ANKLE 2 VIEWS,32000065,CDM,320,RC,73600,HCPCS,facility,both,,,50,676,676,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM ANKLE 2 VIEWS,32000065,CDM,320,RC,73600,HCPCS,facility,both,,,,457,457,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM ANKLE MIN 3 VIEWS,32000067,CDM,320,RC,73610,HCPCS,facility,both,,,50,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM ANKLE MIN 3 VIEWS,32000067,CDM,320,RC,73610,HCPCS,facility,both,,,,715,715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM FOOT MIN 3 VIEWS,32000068,CDM,320,RC,73630,HCPCS,facility,both,,,,895,895,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM FOOT MIN 3 VIEWS,32000068,CDM,320,RC,73630,HCPCS,facility,both,,,50,1462,1462,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM CALCANEUS MIN 2 VIEWS,32000069,CDM,320,RC,73650,HCPCS,facility,both,,,50,665,665,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM CALCANEUS MIN 2 VIEWS,32000069,CDM,320,RC,73650,HCPCS,facility,both,,,,452,452,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM TOE(S) MIN 2 VIEWS,32000070,CDM,320,RC,73660,HCPCS,facility,both,,,,412,412,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX ABDOMEN SINGLE AP VIEW,32000071,CDM,320,RC,74000,HCPCS,facility,both,,,,336,336,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX ABDOMEN AP + OBLIQ & CONE VIEWS,32000072,CDM,320,RC,74010,HCPCS,facility,both,,,,514,514,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX ABDOMEN DECUBITUS AND/OR ERECT VWS,32000073,CDM,320,RC,74020,HCPCS,facility,both,,,,336,336,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXM; COMPL ACUTE ABD SERIES, INCL 2+ VIEWS ABD, & SNGL VIEW CHEST",32000074,CDM,320,RC,74022,HCPCS,facility,both,,,,1198,1198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXM; ESOPH, INCL SCOUT RAD(S)&DLY IMG(S), SNGL-CONTRAST STDY",32000077,CDM,320,RC,74220,HCPCS,facility,both,,,,1040,1040,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EX, SWALL FUNC W/CIN/VID RAD, INCL SCOUT RAD(S)&IMG(S), CONTR STDY",32000078,CDM,320,RC,74230,HCPCS,facility,both,,,,1068,1068,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX UPPER GASTROINTESTINAL TRACT W/KUB,32000079,CDM,320,RC,74241,HCPCS,facility,both,,,,1141,1141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX UPPER GI W/SMALL INTESTINE SERIES,32000080,CDM,320,RC,74245,HCPCS,facility,both,,,,1652,1652,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX UPPER GI AIR CONTRAST W/KUB,32000081,CDM,320,RC,74247,HCPCS,facility,both,,,,1344,1344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), SNGL-CONTR STDY",32000082,CDM,320,RC,74250,HCPCS,facility,both,,,,1097,1097,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), DBL- CONTR STDY",32000083,CDM,320,RC,74251,HCPCS,facility,both,,,,947,947,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXM, COLON, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY",32000084,CDM,320,RC,74270,HCPCS,facility,both,,,,1499,1499,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXM, COLON,INCL SCOUT ABD RAD(S) & DLY IMG(S), DBL-CONTR STDY",32000085,CDM,320,RC,74280,HCPCS,facility,both,,,,2032,2032,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLANGIOGRAPHY/PANCREATOGRAPHY INTRAOP,32000087,CDM,320,RC,74300,HCPCS,facility,both,,,,999,999,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLANGIOGRAPHY/PANCREATOGRAPHY POSTOP,32000088,CDM,320,RC,74305,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLANGIOGRAM PERCUTANEOUS TRANSHEPATIC,32000089,CDM,320,RC,74320,HCPCS,facility,both,,,,1267,1267,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POSTOP BILIARY DUCT CALCULUS REMOVAL,32000090,CDM,320,RC,74327,HCPCS,facility,both,,,,1453,1453,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDOSCOPIC CATH BILIARY DUCTAL SYSTEM,32000091,CDM,320,RC,74328,HCPCS,facility,both,,,,2209,2209,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRO LONG GI TUBE INC MULTI FLUORO & FILMS,32000092,CDM,320,RC,74340,HCPCS,facility,both,,,,1833,1833,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERC TRANSHEPATIC DILATION BILIARY DUCT,32000093,CDM,320,RC,74363,HCPCS,facility,both,,,,3296,3296,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROGRAPHY IV W OR W/O KUB/TOMOGRAPH,32000094,CDM,320,RC,74400,HCPCS,facility,both,,,,1616,1616,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROGRAPHY RETROGRADE W OR W/O KUB,32000095,CDM,320,RC,74420,HCPCS,facility,both,,,,1285,1285,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UROGRAPHY ANTEGRADE S& I,32000096,CDM,320,RC,74425,HCPCS,facility,both,,,,984,984,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYSTOGRAPHY MIN 3 VIEWS,32000097,CDM,320,RC,74430,HCPCS,facility,both,,,,902,902,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URETHROCYSTOGRAPHY RETROGRADE S & I,32000098,CDM,320,RC,74450,HCPCS,facility,both,,,,1230,1230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC URETHROCYSTOGRAPHY VOIDING S & I,32000099,CDM,320,RC,74455,HCPCS,facility,both,,,,2366,2366,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT INTRACATH OR CATH RENAL PELVIS, PERC",32000100,CDM,320,RC,74475,HCPCS,facility,both,,,,1344,1344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT URETERAL CATH/STENT THRU RENAL PELV,32000101,CDM,320,RC,74480,HCPCS,facility,both,,,,1344,1344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DILATE URETER(S) OR URETHRA,32000102,CDM,320,RC,74485,HCPCS,facility,both,,,,1871,1871,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HYSTEROSALPINGOGRAPHY S & I,32000103,CDM,320,RC,74740,HCPCS,facility,both,,,,1363,1363,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT,32000107,CDM,320,RC,75805,HCPCS,facility,both,,,,2679,2679,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SHUNTOGRAM FOR INDWELL NEUROVASC SHUNT,32000108,CDM,320,RC,75809,HCPCS,facility,both,,,,1358,1358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOGRAPHY EXT UNILATERAL,32000109,CDM,320,RC,75820,HCPCS,facility,both,,,,1629,1629,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOGRAPHY EXT BILATERAL,32000110,CDM,320,RC,75822,HCPCS,facility,both,,,,1772,1772,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOGRAPHY CAVAL INFERIOR W/SERIALOGRAPHY,32000111,CDM,320,RC,75825,HCPCS,facility,both,,,,2824,2824,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOGRAPHY CAVAL SUPERIOR W/SERIALOGRAPH,32000112,CDM,320,RC,75827,HCPCS,facility,both,,,,1771,1771,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOGRAPHY RENAL UNILATERAL SELECTIVE,32000113,CDM,320,RC,75831,HCPCS,facility,both,,,,2631,2631,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOGRAPHY RENAL BILATERAL SELECTIVE,32000114,CDM,320,RC,75833,HCPCS,facility,both,,,,2839,2839,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOGRAPHY VENOUS SINUS/JUGULAR CATHETER,32000115,CDM,320,RC,75860,HCPCS,facility,both,,,,3220,3220,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT TRANSHEPATIC PORTOGRAM W/HDM,32000117,CDM,320,RC,75885,HCPCS,facility,both,,,,3026,3026,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT TRANSHEPATIC PORTOGRAM W/O HDM,32000118,CDM,320,RC,75887,HCPCS,facility,both,,,,3004,3004,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATIC VENOGRAPHY W/ HDM,32000119,CDM,320,RC,75889,HCPCS,facility,both,,,,3053,3053,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATIC VENOGRAPHY W/O HDM,32000120,CDM,320,RC,75891,HCPCS,facility,both,,,,3073,3073,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENOUS SAMPLING THRU CATH W/W/O ANGIO,32000121,CDM,320,RC,75893,HCPCS,facility,both,,,,5509,5509,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCATHETER THERAPY EMBOLIZATION,32000122,CDM,320,RC,75894,HCPCS,facility,both,,,,3664,3664,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCATHETER THERAPY INFUSION,32000123,CDM,320,RC,75896,HCPCS,facility,both,,,,1071,1071,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIO F/U TRANSCATH TX, EMBOLIZ/INFUSION",32000124,CDM,320,RC,75898,HCPCS,facility,both,,,,1614,1614,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCHANGE INTRAVASC CATH DURING THROMB TX,32000125,CDM,320,RC,75900,HCPCS,facility,both,,,,8742,8742,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVE OBSTRUCT FROM CENTRAL VENOUS DEV,32000126,CDM,320,RC,75901,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVE INTRALUMIN OBSTRUCT FROM CVD,32000127,CDM,320,RC,75902,HCPCS,facility,both,,,,212,212,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCATH INTRO IV CATH PERC AND/OR OPEN,32000129,CDM,320,RC,75960,HCPCS,facility,both,,,,821,821,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCATH RETRIEVAL PERC IV FOREIGN BODY,32000130,CDM,320,RC,75961,HCPCS,facility,both,,,,1639,1639,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSLUM BALLOON ANGIOPLAST PERPH ARTERY,32000131,CDM,320,RC,75962,HCPCS,facility,both,,,,1043,1043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANS BALLOON ANGIOPLASTY EA + PER ARTERY,32000132,CDM,320,RC,75964,HCPCS,facility,both,,,,826,826,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANS BALLOON ANGIOPLAST RENAL/VISC ARTERY,32000133,CDM,320,RC,75966,HCPCS,facility,both,,,,1952,1952,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANS BALLOON ANGIOPLASTY EA + VISC ARTERY,32000134,CDM,320,RC,75968,HCPCS,facility,both,,,,826,826,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCATHETER BIOPSY,32000135,CDM,320,RC,75970,HCPCS,facility,both,,,,1494,1494,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS,32000136,CDM,320,RC,75978,HCPCS,facility,both,,,,1678,1678,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERC TRANSHEP BIL DRAINAGE W/CON MONITOR,32000137,CDM,320,RC,75980,HCPCS,facility,both,,,,1485,1485,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERC BIL DRAIN CATH PLACEMENT - INT & EXT DR,32000138,CDM,320,RC,75982,HCPCS,facility,both,,,,1412,1412,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHG PERC TUBE/ DRAIN CATH W/CON MONITOR,32000139,CDM,320,RC,75984,HCPCS,facility,both,,,,2052,2052,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID,32000140,CDM,320,RC,75989,HCPCS,facility,both,,,,2592,2592,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID,32000140,CDM,320,RC,75989,HCPCS,facility,both,,,,3874,3874,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUOROSCOPE EXAMINATION UP TO 1 HOUR,32000141,CDM,320,RC,76000,HCPCS,facility,both,,,,1731,1731,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE HC FLUOROSCOPE EXAMINATION UP TO 1 HOUR,32000141,CDM,320,RC,76000,HCPCS,facility,both,,,,1112,1112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX FISTULA OR SINUS TRACT STUDY S & I,32000143,CDM,320,RC,76080,HCPCS,facility,both,,,,1286,1286,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EX FISTULA OR SINUS TRACT STUDY S & I,32000143,CDM,320,RC,76080,HCPCS,facility,both,,,,902,902,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC RAD EXAM SURGICAL SPECIMEN,32000144,CDM,320,RC,76098,HCPCS,facility,both,,,,555,555,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,32000145,CDM,320,RC,76499,HCPCS,facility,both,,,,111,111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUOROGUIDE CENTRAL VEN ACCESS DEV PLCMNT,32000146,CDM,320,RC,77001,HCPCS,facility,both,,,,1289,1289,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUOROSCOPIC GUIDANCE FOR NEEDLE PLCMNT,32000147,CDM,320,RC,77002,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUOROSCOPIC GUIDANCE FOR NEEDLE PLCMNT,32000147,CDM,320,RC,77002,HCPCS,facility,both,,,,1232,1232,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC FLUOROSCOPIC GUIDANCE FOR SPINE INJECTION,32000148,CDM,320,RC,77003,HCPCS,facility,both,,,,1273,1273,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUOROSCOPIC GUIDANCE FOR SPINE INJECTION,32000148,CDM,320,RC,77003,HCPCS,facility,both,,,,2198,2198,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC STEREOTACTIC GUID BREAST BX/NEEDLE PLCMNT,32000149,CDM,320,RC,77031,HCPCS,facility,both,,,50,2339,2339,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC STEREOTACTIC GUID BREAST BX/NEEDLE PLCMNT,32000149,CDM,320,RC,77031,HCPCS,facility,both,,,,1559,1559,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST,32000150,CDM,320,RC,77032,HCPCS,facility,both,,,50,1418,1418,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST,32000150,CDM,320,RC,77032,HCPCS,facility,both,,,,746,746,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE",32000151,CDM,320,RC,77053,HCPCS,facility,both,,,,1366,1366,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE AGE STUDIES,32000152,CDM,320,RC,77072,HCPCS,facility,both,,,,576,576,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE LENGTH STUDIES,32000153,CDM,320,RC,77073,HCPCS,facility,both,,,,834,834,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM OSSEOUS SURVEY LIMITED,32000154,CDM,320,RC,77074,HCPCS,facility,both,,,,1442,1442,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM OSSEOUS SURVEY COMPLETE,32000155,CDM,320,RC,77075,HCPCS,facility,both,,,,1701,1701,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM OSSEOUS SURVEY INFANT,32000156,CDM,320,RC,77076,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DXA BONE DENSITY STUDY, AXIAL 1+ SITES",32000157,CDM,320,RC,77080,HCPCS,facility,both,,,,808,808,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DXA BONE DENSITY PERIPHERAL, AXIAL 1+ SITES",32000158,CDM,320,RC,77081,HCPCS,facility,both,,,,808,808,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE,32000160,CDM,320,RC,74742,HCPCS,facility,both,,,,1358,1358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SELECTIVE ADRENAL VENOGRAM, BILATERAL",32000161,CDM,320,RC,75842,HCPCS,facility,both,,,,5302,5302,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SELECTIVE ADRENAL VENOGRAM, UNILATERAL",32000162,CDM,320,RC,75840,HCPCS,facility,both,,,,3792,3792,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM OF MASTOIDS 3+ VIEWS,32000200,CDM,320,RC,70130,HCPCS,facility,both,,,,814,814,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TMJ JOINT - UNILATERAL,32000201,CDM,320,RC,70328,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CINE OR VIDEO SPEECH EVAL,32000202,CDM,320,RC,70371,HCPCS,facility,both,,,,1035,1035,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOLOGIC EXAM, SPINE, LUMBOSACRAL; BENDING VIEWS ONLY, 2 OR 3 VIEWS",32000203,CDM,320,RC,72120,HCPCS,facility,both,,,,850,850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM SACROILIAC JOINTS <3 VIEWS,32000204,CDM,320,RC,72200,HCPCS,facility,both,,,,521,521,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 1/1/2022 HC EPIDUROGRAM,32000205,CDM,320,RC,72275,HCPCS,facility,both,,,,702,702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM OF FOOT; 2 VIEWS,32000206,CDM,320,RC,73620,HCPCS,facility,both,,,,726,726,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM OF FOOT; 2 VIEWS,32000206,CDM,320,RC,73620,HCPCS,facility,both,,,50,1090,1090,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY",32000207,CDM,320,RC,74240,HCPCS,facility,both,,,,1404,1404,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; DBL STDY",32000208,CDM,320,RC,74246,HCPCS,facility,both,,,,838,838,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UGI W AIR & BARIUM W SB,32000209,CDM,320,RC,74249,HCPCS,facility,both,,,,1579,1579,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHOLANGIOGRAM ADDTL INTRAOP,32000210,CDM,320,RC,74301,HCPCS,facility,both,,,,846,846,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDO CATH - BIL & PANCR D,32000211,CDM,320,RC,74330,HCPCS,facility,both,,,,2209,2209,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IVP W TOMOGRAPHY,32000212,CDM,320,RC,74415,HCPCS,facility,both,,,,1767,1767,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IR ABD ANEURYSM REPAIR,32000213,CDM,320,RC,75952,HCPCS,facility,both,,,,4517,4517,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ILIAC ANEURYSM ENDOVAS RPR,32000214,CDM,320,RC,75953,HCPCS,facility,both,,,,1956,1956,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NOSE TO RECTUM FOR FB CHILD,32000215,CDM,320,RC,76010,HCPCS,facility,both,,,,1308,1308,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM OF MASTOIDS <3 VIEWS,32000216,CDM,320,RC,70120,HCPCS,facility,both,,,,571,571,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY SELLA TURCICA,32000217,CDM,320,RC,70240,HCPCS,facility,both,,,,467,467,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY SIALOGRAM,32000218,CDM,320,RC,70390,HCPCS,facility,both,,,,1230,1230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY SPINE THORACOLUMBAR STANDING,32000219,CDM,320,RC,72069,HCPCS,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDO CATH PANCREATIC DUCT SYSTEM,32000222,CDM,320,RC,74329,HCPCS,facility,both,,,,1960,1960,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UROGRAPHY, INFUSION IVP, DRIP/BOLUS",32000223,CDM,320,RC,74410,HCPCS,facility,both,,,,1616,1616,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY VASOGRAM VESICULOGRAM,32000224,CDM,320,RC,74440,HCPCS,facility,both,,,,966,966,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY CORPORA CAVERNOSOGRAM,32000225,CDM,320,RC,74445,HCPCS,facility,both,,,,1539,1539,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY RENAL CYST STUDY,32000226,CDM,320,RC,74470,HCPCS,facility,both,,,,1069,1069,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRALUMINAL DILATION OF STRICTURES/OBSTRUCTIONS,32000229,CDM,320,RC,74360,HCPCS,facility,both,,,,2091,2091,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY OF MAMMARY DUCTS,32000235,CDM,320,RC,77054,HCPCS,facility,both,,,,1697,1697,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC XRAY EXAM, ENTIRE SPINE AP & LAT",32000240,CDM,320,RC,72010,HCPCS,facility,both,,,,649,649,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VERTEBRAL FRACTURE ASSESSMENT VIA DXA,32000258,CDM,320,RC,77086,HCPCS,facility,both,,,,706,706,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM ENTIRE SPINE, 1 VW",32000262,CDM,320,RC,72081,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM ENTIRE SPINE, 2/3 VW",32000263,CDM,320,RC,72082,HCPCS,facility,both,,,,1204,1204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM ENTIRE SPINE, 4/5 VW",32000264,CDM,320,RC,72083,HCPCS,facility,both,,,,2289,2289,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM ENTIRE SPINE, 6/> VW",32000265,CDM,320,RC,72084,HCPCS,facility,both,,,,2289,2289,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 1 VW",32000266,CDM,320,RC,73501,HCPCS,facility,both,,,,571,571,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 2-3 VW",32000267,CDM,320,RC,73502,HCPCS,facility,both,,,,704,704,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 4/> VW",32000268,CDM,320,RC,73503,HCPCS,facility,both,,,,1788,1788,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 2 VW",32000269,CDM,320,RC,73521,HCPCS,facility,both,,,,853,853,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 3-4 VW",32000270,CDM,320,RC,73522,HCPCS,facility,both,,,,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 5/> VW",32000271,CDM,320,RC,73523,HCPCS,facility,both,,,,2679,2679,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM OF FEMUR, 1 VIEW",32000272,CDM,320,RC,73551,HCPCS,facility,both,,,,544,544,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC X-RAY EXAM OF FEMUR, 2/> VIEWS",32000273,CDM,320,RC,73552,HCPCS,facility,both,,,,673,673,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM ABDOMEN 1 VIEW,32000278,CDM,320,RC,74018,HCPCS,facility,both,,,,531,531,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM ABDOMEN 2 VIEWS,32000279,CDM,320,RC,74019,HCPCS,facility,both,,,,807,807,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM ABDOMEN 3 OR MORE VIEWS,32000280,CDM,320,RC,74021,HCPCS,facility,both,,,,1198,1198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY,32000281,CDM,320,RC,74248,HCPCS,facility,both,,,,1042,1042,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST EACH ADDITIONAL,32002150,CDM,320,RC,77032,HCPCS,facility,both,,,,597,597,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST EACH ADDITIONAL,32002150,CDM,320,RC,77032,HCPCS,facility,both,,,50,981,981,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM SHOULDER, ARTHROGRAPHY",32200001,CDM,322,RC,73040,HCPCS,facility,both,,,,1537,1537,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD EXAM SHOULDER, ARTHROGRAPHY",32200001,CDM,322,RC,73040,HCPCS,facility,both,,,50,2538,2538,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM ELBOW, ARTHROGRAPHY",32200002,CDM,322,RC,73085,HCPCS,facility,both,,,50,2840,2840,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC RAD EXAM ELBOW, ARTHROGRAPHY",32200002,CDM,322,RC,73085,HCPCS,facility,both,,,,1714,1714,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM WRIST ARTHROGRAPHY,32200003,CDM,322,RC,73115,HCPCS,facility,both,,,,1448,1448,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM WRIST ARTHROGRAPHY,32200003,CDM,322,RC,73115,HCPCS,facility,both,,,50,2399,2399,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM HIP ARTHROGRAPHY,32200004,CDM,322,RC,73525,HCPCS,facility,both,,,,1537,1537,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM HIP ARTHROGRAPHY,32200004,CDM,322,RC,73525,HCPCS,facility,both,,,50,2538,2538,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM KNEE ARTHROGRAPHY,32200005,CDM,322,RC,73580,HCPCS,facility,both,,,,2020,2020,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD EXAM KNEE ARTHROGRAPHY,32200005,CDM,322,RC,73580,HCPCS,facility,both,,,50,3348,3348,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM ANKLE ARTHROGRAPHY,32200006,CDM,322,RC,73615,HCPCS,facility,both,,,50,2892,2892,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RAD EXAM ANKLE ARTHROGRAPHY,32200006,CDM,322,RC,73615,HCPCS,facility,both,,,,1751,1751,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY TMJ JOINT ARTHROGRAPHY,32200007,CDM,322,RC,70332,HCPCS,facility,both,,,,1751,1751,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY TMJ JOINT ARTHROGRAPHY,32200007,CDM,322,RC,70332,HCPCS,facility,both,,,50,2892,2892,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC AORTOGRAPHY THORACIC BY SERIALOGRAPHY,32300001,CDM,323,RC,75605,HCPCS,facility,both,,,,5493,5493,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AORTOGRAPHY ABDOMINAL BY SERIALOGRAPHY,32300002,CDM,323,RC,75625,HCPCS,facility,both,,,,3116,3116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AORTOGRAM ABDOMINAL W/ BILATERAL RUNOFF,32300003,CDM,323,RC,75630,HCPCS,facility,both,,,,4790,4790,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY CERVICOCEREBRAL, CATHETER",32300004,CDM,323,RC,75650,HCPCS,facility,both,,,,1783,1783,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY EXTERNAL CAROTID, UNILAT",32300005,CDM,323,RC,75660,HCPCS,facility,both,,,,1198,1198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY EXTERNAL CAROTID, BILAT",32300006,CDM,323,RC,75662,HCPCS,facility,both,,,,2394,2394,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY, CAROTID, CEREBRAL, UNILAT",32300007,CDM,323,RC,75665,HCPCS,facility,both,,,,1444,1444,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY, CAROTID, CEREBRAL, BILAT",32300008,CDM,323,RC,75671,HCPCS,facility,both,,,,2604,2604,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY, CAROTID, CERVICAL, UNILAT",32300009,CDM,323,RC,75676,HCPCS,facility,both,,,,1344,1344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY, CAROTID, CERVICAL, BILAT",32300010,CDM,323,RC,75680,HCPCS,facility,both,,,,2263,2263,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ANGIOGRAPHY, VERTEBRAL, CERVIC/INTRACRAN",32300011,CDM,323,RC,75685,HCPCS,facility,both,,,,1171,1171,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY SPINAL SELECTIVE,32300012,CDM,323,RC,75705,HCPCS,facility,both,,,,6241,6241,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY EXT UNILATERAL S & I,32300013,CDM,323,RC,75710,HCPCS,facility,both,,,,2814,2814,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY EXT BILATERAL S & I,32300014,CDM,323,RC,75716,HCPCS,facility,both,,,,3055,3055,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY VISCERAL SELECT/SUPRASELECT,32300015,CDM,323,RC,75726,HCPCS,facility,both,,,,5027,5027,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY ADRENAL UNILATERAL SELECTIVE,32300016,CDM,323,RC,75731,HCPCS,facility,both,,,,2471,2471,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY ADRENAL BILATERAL SELECTIVE,32300017,CDM,323,RC,75733,HCPCS,facility,both,,,,3792,3792,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY PELVIC SELECT/SUPRASELECT,32300018,CDM,323,RC,75736,HCPCS,facility,both,,,,4925,4925,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY PULMONARY UNILAT SELECTIVE,32300019,CDM,323,RC,75741,HCPCS,facility,both,,,,2729,2729,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY PULMONARY BILAT SELECTIVE,32300020,CDM,323,RC,75743,HCPCS,facility,both,,,,3368,3368,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY PULMONARY NONSEL CATH/INJECT,32300021,CDM,323,RC,75746,HCPCS,facility,both,,,,2869,2869,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY INTERNAL MAMMARY S & I,32300022,CDM,323,RC,75756,HCPCS,facility,both,,,,3194,3194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANGIOGRAPHY SELECTIVE EA ADDTL VESSEL,32300023,CDM,323,RC,75774,HCPCS,facility,both,,,,824,824,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RETROGRADE BRACHIAL ANGIOGRAM,32300025,CDM,323,RC,75658,HCPCS,facility,both,,,,1220,1220,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AV DIALYSIS SHUNT IMAGING,32300052,CDM,323,RC,75791,HCPCS,facility,both,,,,1530,1530,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEST X-RAY SINGLE VIEW, POSTEROANTERIOR",32400001,CDM,324,RC,71010,HCPCS,facility,both,,,,386,386,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEST X-RAY 2 VIEWS, FRONTAL AND LATERAL",32400002,CDM,324,RC,71020,HCPCS,facility,both,,,,407,407,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEST X-RAY 2 VIEWS W/APICAL LORDOTIC PROJ,32400003,CDM,324,RC,71021,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEST X-RAY 2 VIEWS W/OBLIQUE PROJECTION,32400004,CDM,324,RC,71022,HCPCS,facility,both,,,,519,519,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEST X-RAY COMPLETE MIN 4 VIEWS,32400005,CDM,324,RC,71030,HCPCS,facility,both,,,,482,482,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEST X-RAY SPECIAL VIEW(LATERAL DECUBITUS),32400007,CDM,324,RC,71035,HCPCS,facility,both,,,,309,309,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RIBS X-RAY, UNILAT, MIN 3 VIEWS INCL CHEST",32400009,CDM,320,RC,71101,HCPCS,facility,both,,,,700,700,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RIBS X-RAY, BILAT, MIN 4 VIEWS INCL CHEST",32400010,CDM,320,RC,71111,HCPCS,facility,both,,,,889,889,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STERNUM X-RAY MIN 2 VIEWS,32400011,CDM,320,RC,71120,HCPCS,facility,both,,,,571,571,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS,32400012,CDM,320,RC,71130,HCPCS,facility,both,,,RT,641,641,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS,32400012,CDM,320,RC,71130,HCPCS,facility,both,,,LT,641,641,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS,32400012,CDM,320,RC,71130,HCPCS,facility,both,,,,1051,1051,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM OF RIBS 2 VIEWS UNILAT,32400020,CDM,320,RC,71100,HCPCS,facility,both,,,,584,584,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM OF RIBS 3 VIEWS BILAT,32400022,CDM,320,RC,71110,HCPCS,facility,both,,,,748,748,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEST X-RAY 2 VIEWS FR&LAT W FLUORO,32400024,CDM,324,RC,71023,HCPCS,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM CHEST 1 VIEW,32400025,CDM,324,RC,71045,HCPCS,facility,both,,,,661,661,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM CHEST 2 VIEWS,32400026,CDM,324,RC,71046,HCPCS,facility,both,,,,698,698,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM CHEST 3 VIEWS,32400027,CDM,324,RC,71047,HCPCS,facility,both,,,,773,773,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC X-RAY EXAM CHEST 4 OR MORE VIEWS,32400028,CDM,324,RC,71048,HCPCS,facility,both,,,,827,827,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IM/SQ, NON-HORMONAL",33100001,CDM,331,RC,96401,HCPCS,facility,both,,,,516,516,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL",33100002,CDM,331,RC,96402,HCPCS,facility,both,,,,317,317,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL",33100002,CDM,331,RC,96402,HCPCS,facility,both,,,,317,317,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL",33100003,CDM,331,RC,96409,HCPCS,facility,both,,,,1111,1111,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IVP EA ADDL",33100004,CDM,331,RC,96411,HCPCS,facility,both,,,,662,662,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, CNS W/LP",33100005,CDM,331,RC,96450,HCPCS,facility,both,,,,1209,1209,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMO INTRALESIONAL UP TO 7,33100007,CDM,331,RC,96405,HCPCS,facility,both,,,,381,381,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMO INTRALESIONAL OVER 7,33100008,CDM,331,RC,96406,HCPCS,facility,both,,,,660,660,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADM, INTRA-ARTERIAL; PUSH TECHNIQUE",33100009,CDM,331,RC,96420,HCPCS,facility,both,,,,2161,2161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL",33191101,CDM,331,RC,96409,HCPCS,facility,both,,,,23,23,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL",33191102,CDM,331,RC,96409,HCPCS,facility,both,,,,541,541,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL",33191103,CDM,331,RC,96409,HCPCS,facility,both,,,,449,449,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL",33191104,CDM,331,RC,96402,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL",33191104,CDM,331,RC,96402,HCPCS,facility,both,,,,117,117,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THERA RAD SIMULATE-ADD FIELD SET, SIMPLE",33300001,CDM,333,RC,77280,HCPCS,facility,both,,,,2823,2823,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THERA RAD SIMULATE-ADD FIELD SET, COMPLX",33300002,CDM,333,RC,77290,HCPCS,facility,both,,,,5086,5086,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THERA RAD SIMULATE-ADD FIELD SET, 3D",33300003,CDM,333,RC,77295,HCPCS,facility,both,,,,6897,6897,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BASIC RADIATION DOSIMETRY CALCULATION,33300004,CDM,333,RC,77300,HCPCS,facility,both,,,,1201,1201,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTENSITY MODULATED RADIOTHERAPY PLAN,33300005,CDM,333,RC,77301,HCPCS,facility,both,,,,13830,13830,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TELETHERAPY ISODOSE PLAN SIMPLE 1-2 PORTS,33300006,CDM,333,RC,77305,HCPCS,facility,both,,,,767,767,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TELETHERAPY ISODOSE PLAN INTERMED 3+ PORTS,33300007,CDM,333,RC,77310,HCPCS,facility,both,,,,1045,1045,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TELETHERAPY ISODOSE PLAN COMPLEX,33300008,CDM,333,RC,77315,HCPCS,facility,both,,,,1315,1315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRACHTX ISODOSE PLAN SIMPLE 1-4 SOURCES,33300009,CDM,333,RC,77326,HCPCS,facility,both,,,,628,628,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRACHTX ISODOSE PLAN INTERM 5-10 SOURCES,33300010,CDM,333,RC,77327,HCPCS,facility,both,,,,803,803,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRACHTX ISODOSE PLAN COMPLX 10+ SOURCES,33300011,CDM,333,RC,77328,HCPCS,facility,both,,,,980,980,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIAL DOSIMETRY,33300012,CDM,333,RC,77331,HCPCS,facility,both,,,,999,999,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TREATMENT DEVICES SIMPLE,33300013,CDM,333,RC,77332,HCPCS,facility,both,,,,1190,1190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TREATMENT DEVICES INTERMEDIATE,33300014,CDM,333,RC,77333,HCPCS,facility,both,,,,2313,2313,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TREATMENT DEVICES COMPLEX,33300015,CDM,333,RC,77334,HCPCS,facility,both,,,,2682,2682,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC QUALITY ASSURANCE CHECK FOR RADIATION THERAPY; PER WEEK BY MED TECHNICIAN,33300016,CDM,333,RC,77336,HCPCS,facility,both,,,,1840,1840,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DESIGN MLC DEVICE FOR INTENSITY MOD RAD TX,33300017,CDM,333,RC,77338,HCPCS,facility,both,,,,2570,2570,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIAL MED RADIATION PHYSICS CONSULTATION,33300018,CDM,333,RC,77370,HCPCS,facility,both,,,,2238,2238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD TX DELIVERY SINGLE AREA 6-10 MEV,33300019,CDM,333,RC,77403,HCPCS,facility,both,,,,649,649,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD TX DELIVERY SINGLE AREA 11-19 MEV,33300020,CDM,333,RC,77404,HCPCS,facility,both,,,,671,671,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD TX DELIVERY 3+ AREAS 11-19 MEV,33300022,CDM,333,RC,77414,HCPCS,facility,both,,,,881,881,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD TX DELIVERY 3+ AREAS 20+ MEV,33300023,CDM,333,RC,77416,HCPCS,facility,both,,,,901,901,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC RADIOLOGY PORT FILM(S),33300024,CDM,333,RC,77417,HCPCS,facility,both,,,,648,648,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPECIAL RADIATION TREATMENT,33300026,CDM,333,RC,77470,HCPCS,facility,both,,,,3058,3058,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFUSION/INSTILLATION RADIOELEMENT SOLUTION,33300027,CDM,333,RC,77750,HCPCS,facility,both,,,,1726,1726,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRACAVITARY RAD SOURCE APPLICAT COMPLEX,33300029,CDM,333,RC,77763,HCPCS,facility,both,,,,7228,7228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTERSTITIAL RAD SOURCE APPLICATION COMPLEX,33300030,CDM,333,RC,77778,HCPCS,facility,both,,,,6829,6829,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HDR RADIONUCLIDE BRACHYTX 1 CHANNEL,33300031,CDM,333,RC,77785,HCPCS,facility,both,,,,3747,3747,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HDR RADIONUCLIDE BRACHYTX 2-12 CHANNELS,33300032,CDM,333,RC,77786,HCPCS,facility,both,,,,3747,3747,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HDR RADIONUCLIDE BRACHYTX OVER 12 CHANNEL,33300033,CDM,333,RC,77787,HCPCS,facility,both,,,,4684,4684,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SUPERVISION, HANDLING, LOADING - RAD SOURCE",33300034,CDM,333,RC,77790,HCPCS,facility,both,,,,1198,1198,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STEREOTACTIC RADIOSURGERY, MAX 5 SESSIONS",33300036,CDM,333,RC,,,facility,both,,,,3605,3605,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SIMULATION; INTERMEDIATE,33300050,CDM,333,RC,77285,HCPCS,facility,both,,,,4353,4353,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMIBODY PARTICLES TOTAL BODY,33300052,CDM,333,RC,77321,HCPCS,facility,both,,,,2512,2512,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIATION TX DELIVERY 6-10 MEV,33300053,CDM,333,RC,77408,HCPCS,facility,both,,,,752,752,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIATION TX DELIVERY 11-19 MEV,33300055,CDM,333,RC,77409,HCPCS,facility,both,,,,777,777,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIATION TX DELIVERY 3+ AREAS <= 5 MEV,33300057,CDM,333,RC,77412,HCPCS,facility,both,,,,860,860,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIATION TX DELIVERY 3+ AREAS <= 5 MEV,33300057,CDM,333,RC,77412,HCPCS,facility,both,,,,860,860,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC STEREOSCOPIC X-RAY GUIDANCE,33300058,CDM,333,RC,77421,HCPCS,facility,both,,,,155,155,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ROBOT LNR SRS COMPL/1ST FRACT,33300060,CDM,333,RC,,,facility,both,,,,15870,15870,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ROBOT LIN-RADSURG FRACTX 2-5,33300061,CDM,333,RC,,,facility,both,,,,10741,10741,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SRS LINEAR BASED, 1 SESSION",33300073,CDM,333,RC,77372,HCPCS,facility,both,,,,46308,46308,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SBRT DELIVERY PER FRACTION,33300074,CDM,333,RC,77373,HCPCS,facility,both,,,,18656,18656,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GUIDANCE FOR RADIATION TX,33300076,CDM,333,RC,77387,HCPCS,facility,both,,,,486,486,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GUIDANCE FOR RADIATION TX,33300076,CDM,333,RC,77387,HCPCS,facility,both,,,,486,486,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TELETHERAPY ISODOSE PLAN, COMPLEX",33300077,CDM,333,RC,77307,HCPCS,facility,both,,,,3865,3865,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC TELETHERAPY ISODOSE PLAN, COMPLEX",33300077,CDM,333,RC,77307,HCPCS,facility,both,,,,3865,3865,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRACHYTHERAPY ISODOSE PLAN, SIMPLE",33300078,CDM,333,RC,77316,HCPCS,facility,both,,,,2387,2387,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRACHYTHERAPY ISODOSE PLAN, INTERMEDIATE",33300079,CDM,333,RC,77317,HCPCS,facility,both,,,,2837,2837,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRACHYTHERAPY ISODOSE PLAN, COMPLEX",33300080,CDM,333,RC,77318,HCPCS,facility,both,,,,3361,3361,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), SIMPLE",33300081,CDM,333,RC,77385,HCPCS,facility,both,,,,3722,3722,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), SIMPLE",33300081,CDM,333,RC,77385,HCPCS,facility,both,,,,3722,3722,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), COMPLEX",33300082,CDM,333,RC,77386,HCPCS,facility,both,,,,3729,3729,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), COMPLEX",33300082,CDM,333,RC,77386,HCPCS,facility,both,,,,3729,3729,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC TELETHERAPY ISODOSE PLAN, SIMPLE",33300083,CDM,333,RC,77306,HCPCS,facility,both,,,,2767,2767,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TELETHERAPY ISODOSE PLAN, SIMPLE",33300083,CDM,333,RC,77306,HCPCS,facility,both,,,,2767,2767,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC RADIATION TREATMENT DELIVERY, =>1 MEV; SIMPLE",33300084,CDM,333,RC,77402,HCPCS,facility,both,,,,1257,1257,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE",33300085,CDM,333,RC,77407,HCPCS,facility,both,,,,1817,1817,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIATION TREATMENT DELIVERY,=>1 MEV; COMPLEX",33300086,CDM,333,RC,77412,HCPCS,facility,both,,,,1537,1537,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 1 CHANNEL",33300087,CDM,333,RC,77770,HCPCS,facility,both,,,,7155,7155,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 2-12 CHANNELS",33300088,CDM,333,RC,77771,HCPCS,facility,both,,,,7155,7155,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, OVER 12 CHANNELS",33300089,CDM,333,RC,77772,HCPCS,facility,both,,,,7902,7902,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRNSPERNEAL PLCMNT BDGRDABL MATRL, PERI-PROSTATIC, 1+ INJ, W/IMAG",33300092,CDM,333,RC,55874,HCPCS,facility,both,,,,18323,18323,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTON TX DELIVERY SIMPLE W/O COMPENSATION,33300093,CDM,333,RC,77520,HCPCS,facility,both,,,,4472,4472,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTON TX DELIVERY SIMPLE W/COMPENSATION,33300094,CDM,333,RC,77522,HCPCS,facility,both,,,,7423,7423,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTON TX DELIVERY INTERMEDIATE,33300095,CDM,333,RC,77523,HCPCS,facility,both,,,,7548,7548,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROTON TX DELIVERY COMPLEX,33300096,CDM,333,RC,77525,HCPCS,facility,both,,,,7555,7555,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SURFACE APPLICATION OF LOW DOSE RATE RADIONUCLIDE SOURCE,33300097,CDM,333,RC,77789,HCPCS,facility,both,,,,1076,1076,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RESPIRATORY MOTION MGMT SIMULATION,33300098,CDM,333,RC,77293,HCPCS,facility,both,,,,1046,1046,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD TX, BRACHYTHERAPY, LESION UP TO 2.0 CM/1 CHANNEL",33300099,CDM,333,RC,77767,HCPCS,facility,both,,,,657,657,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RAD TX, BRACHYTHERAPY, LESION > 2.0 CM & 2 + CHANNELS/MULT LESION",33300100,CDM,333,RC,77768,HCPCS,facility,both,,,,983,983,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSPERINEAL PROSTATE PLACEMENT NEEDLES/CATHETERS FOR BRACHYTHERAPY,33300101,CDM,333,RC,55875,HCPCS,facility,both,,,,11000,11000,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLMT ENDORECTAL INTRACAVITARY APPLICATOR,33300102,CDM,333,RC,,,facility,both,,,,1900,1900,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY ANAL, TC",33390001,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY BLADDER, TC",33390002,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THER BONE METS, TC",33390003,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THER BRAIN METS, TC",33390004,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY BREAST, TC",33390005,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY CERVICAL, TC",33390006,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY CNS, TC",33390007,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THER COLORECTAL, TC",33390008,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THER HEAD/NECK, TC",33390009,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY LUNG, TC",33390010,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY LYMPHOMA, TC",33390011,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY PANCREAS, TC",33390012,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY PROSTATE, TC",33390013,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY GI, TC",33390014,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ROM RAD THERAPY UTERUS, TC",33390015,CDM,333,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD TX DELIVERY 3+ AREAS 6-10 MEV,33391101,CDM,333,RC,77413,HCPCS,facility,both,,,,856,856,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD TX DELIVERY 3+ AREAS 6-10 MEV,33391102,CDM,333,RC,77413,HCPCS,facility,both,,,,856,856,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTENSITY MODULATED TX DELIVERY/TX SESSION,33391103,CDM,333,RC,77418,HCPCS,facility,both,,,,2124,2124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTENSITY MODULATED TX DELIVERY/TX SESSION,33391104,CDM,333,RC,77418,HCPCS,facility,both,,,,2124,2124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD DELIVERY SINGLE AREA ; UP TO 5 MEV,33391105,CDM,333,RC,77402,HCPCS,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RAD DELIVERY SINGLE AREA ; UP TO 5 MEV,33391105,CDM,333,RC,77402,HCPCS,facility,both,,,,658,658,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RAD TX DELIVERY SINGLE AREA 20 MEV/>,33391106,CDM,333,RC,77406,HCPCS,facility,both,,,,694,694,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIATION TX DELIVERY <= 5 MEV,33391107,CDM,333,RC,77407,HCPCS,facility,both,,,,769,769,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RADIATION TX DELIVERY <= 5 MEV,33391107,CDM,333,RC,77407,HCPCS,facility,both,,,,769,769,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIATION TX DELIVERY 20+ MEV,33391108,CDM,333,RC,77411,HCPCS,facility,both,,,,800,800,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, 1ST HR",33500001,CDM,335,RC,96413,HCPCS,facility,both,,,,1424,1424,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, EA ADDL HR",33500002,CDM,335,RC,96415,HCPCS,facility,both,,,,521,521,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, EA ADDL SEQ",33500003,CDM,335,RC,96417,HCPCS,facility,both,,,,442,442,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY ADMIN, PERITONEAL VIA INDWELLING PORT OR CATH",33500004,CDM,335,RC,96446,HCPCS,facility,both,,,,1237,1237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMO PROLONG 8+ HRS INFUSE W/PUMP,33500005,CDM,335,RC,96416,HCPCS,facility,both,,,,4460,4460,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 09/24/2022 HC CHEMOTHERAPY ADM, EXTENDED, IV INFUSION W/PORTABLE PUMP",33500006,CDM,335,RC,,,facility,both,,,,856,856,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHER, IA INFUSION TECH >8 HOURS",33500007,CDM,335,RC,96425,HCPCS,facility,both,,,,1318,1318,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, 1ST HR",33591101,CDM,335,RC,96413,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, 1ST 0.5 HR",33591102,CDM,335,RC,96413,HCPCS,facility,both,,,,582,582,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, 1ST HR",33591103,CDM,335,RC,96413,HCPCS,facility,both,,,,678,678,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, EA ADDL HR",33591104,CDM,335,RC,96415,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMOTHERAPY IV INFUSION, EA ADDL HR",33591105,CDM,335,RC,96415,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID UPTAKE MULTIPLE DETERMINATIONS,34100001,CDM,341,RC,78001,HCPCS,facility,both,,,,566,566,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID IMAGING ONLY,34100003,CDM,341,RC,78010,HCPCS,facility,both,,,,957,957,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID CARCINOMA METAST IMAG WHOLE BODY,34100004,CDM,341,RC,78018,HCPCS,facility,both,,,,2940,2940,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARATHYROID IMAGING,34100005,CDM,341,RC,78070,HCPCS,facility,both,,,,800,800,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADRENAL IMAGING CORTEX AND/OR MEDULLA,34100006,CDM,341,RC,78075,HCPCS,facility,both,,,,5330,5330,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LYMPHATICS AND LYMPH NODE IMAGING,34100009,CDM,341,RC,78195,HCPCS,facility,both,,,,1954,1954,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIVER IMAGING W VASCULAR FLOW,34100010,CDM,341,RC,78202,HCPCS,facility,both,,,,2567,2567,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIVER IMAGING (SPECT),34100011,CDM,341,RC,78205,HCPCS,facility,both,,,,2218,2218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIVER IMAGING (SPECT) W/VASCULAR FLOW,34100012,CDM,341,RC,78206,HCPCS,facility,both,,,,2218,2218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATOBILIARY SYSTEM IMAG INC GALLBLADDER,34100013,CDM,341,RC,78226,HCPCS,facility,both,,,,1896,1896,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASTROESOPHAGEAL REFLUX SCAN,34100014,CDM,341,RC,78262,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASTRIC EMPTYING STUDY, SOLID",34100015,CDM,341,RC,78264,HCPCS,facility,both,,,,1274,1274,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UREA BREATH TEST C-14 (ISOTOPIC), ACQUISTION",34100016,CDM,341,RC,78267,HCPCS,facility,both,,,,106,106,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UREA BREATH TEST C-14 (ISOTOPIC), ANALYSIS",34100017,CDM,341,RC,78268,HCPCS,facility,both,,,,467,467,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,34100018,CDM,341,RC,78278,HCPCS,facility,both,,,,1725,1725,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTESTINE IMAGING E.G. MECKEL'S LOCALIZATION,34100019,CDM,341,RC,78290,HCPCS,facility,both,,,,1889,1889,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERITONEAL-VENOUS SHUNT PATENCY TEST,34100020,CDM,341,RC,78291,HCPCS,facility,both,,,,1409,1409,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BONE AND/OR JOINT IMAGING, LIMITED AREA",34100021,CDM,341,RC,78300,HCPCS,facility,both,,,,3213,3213,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BONE AND/OR JOINT IMAGING, WHOLE BODY",34100022,CDM,341,RC,78306,HCPCS,facility,both,,,,2949,2949,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BONE AND/OR JOINT IMAGING , 3 PHASE STUDY",34100023,CDM,341,RC,78315,HCPCS,facility,both,,,,1737,1737,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYOCARD PERF IMAG SPECT MULTI REST/STRESS,34100027,CDM,341,RC,78452,HCPCS,facility,both,,,,5860,5860,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYOCARD PERF IMAG PLANAR SGL REST/STRESS,34100028,CDM,341,RC,78453,HCPCS,facility,both,,,,1394,1394,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARDO BLD POOL IMAG PLANAR SNG REST/STRESS,34100029,CDM,341,RC,78472,HCPCS,facility,both,,,,1831,1831,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PULMONARY VENTILATION IMAG (AEROSOL/GAS),34100030,CDM,341,RC,78579,HCPCS,facility,both,,,,1911,1911,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PULMONARY PERFUSION IMAGING PARTICULATE,34100031,CDM,341,RC,78580,HCPCS,facility,both,,,,1971,1971,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PULMONARY VENTILATION & PERFUSION IMAGING,34100032,CDM,341,RC,78582,HCPCS,facility,both,,,,2251,2251,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRAIN IMAGING TOMOGRAPHIC (SPECT),34100033,CDM,341,RC,78607,HCPCS,facility,both,,,,2464,2464,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CEREBROSPINAL FLUID FLOW IMG CISTERNOGRAM,34100035,CDM,341,RC,78630,HCPCS,facility,both,,,,2579,2579,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CEREBROSPINAL FLUID FLOW IMG SHUNT EVAL,34100036,CDM,341,RC,78645,HCPCS,facility,both,,,,2018,2018,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CEREBROSPINAL FLUID LEAKAGE IMAGING,34100037,CDM,341,RC,78650,HCPCS,facility,both,,,,2841,2841,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIDNEY IMAGING W/VASC FLOW & FUNCTION,34100038,CDM,341,RC,78707,HCPCS,facility,both,,,,1710,1710,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIDNEY IMAGING W/VASC FLOW & FUNC W/DRUG,34100039,CDM,341,RC,78708,HCPCS,facility,both,,,,2636,2636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIDNEY IMAGING TOMOGRAPHIC (SPECT),34100040,CDM,341,RC,78710,HCPCS,facility,both,,,,2567,2567,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED GU PROCEDURE DIAGNOSTIC NM,34100043,CDM,341,RC,78799,HCPCS,facility,both,,,,2636,2636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM LOCAL TUMOR; PLANAR, SINGLE AREA, SINGLE DAY IMG",34100044,CDM,341,RC,78800,HCPCS,facility,both,,,,1645,1645,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM LOCAL TUMOR ; PLANAR, WHOLE BODY, SINGLE DAY IMG",34100045,CDM,341,RC,78802,HCPCS,facility,both,,,,2857,2857,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM LOCAL TUMOR, SPECT; SINGLE AREA , SINGLE DAY IMG",34100046,CDM,341,RC,78803,HCPCS,facility,both,,,,2857,2857,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM LOCALIZE ABSCESS, WHOLE BODY",34100047,CDM,341,RC,78806,HCPCS,facility,both,,,,4750,4750,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID UPTAKE; SINGLE,34100060,CDM,341,RC,78000,HCPCS,facility,both,,,,425,425,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID XR W UPTAKE; MULTIPLE,34100061,CDM,341,RC,78007,HCPCS,facility,both,,,,1270,1270,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIVER & SPLEEN; STATIC ONLY,34100063,CDM,341,RC,78215,HCPCS,facility,both,,,,1652,1652,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIVER & SPLEEN; W VASC FLOW,34100064,CDM,341,RC,78216,HCPCS,facility,both,,,,2567,2567,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEPATOBIL SYST IMAGE W/DRUG,34100065,CDM,341,RC,78227,HCPCS,facility,both,,,,2250,2250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESOPHAGEAL MOTILITY,34100066,CDM,341,RC,78258,HCPCS,facility,both,,,,1268,1268,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED GI PROCEDURE DX NM,34100067,CDM,341,RC,78299,HCPCS,facility,both,,,,1673,1673,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE/JOINT; MULTI AREAS,34100068,CDM,341,RC,78305,HCPCS,facility,both,,,,3213,3213,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE/JOINT; SPECT (3D),34100070,CDM,341,RC,78320,HCPCS,facility,both,,,,2775,2775,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NON-CARDIAC VASC FLOW,34100072,CDM,341,RC,78445,HCPCS,facility,both,,,,1159,1159,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRAIN IMAGE W/FLOW 4 + VIEWS,34100073,CDM,341,RC,78606,HCPCS,facility,both,,,,2251,2251,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TESTICULAR IMAGING W/FLOW,34100074,CDM,341,RC,78761,HCPCS,facility,both,,,,1407,1407,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TUMOR LOCAL; PLANAR, 2 + AREAS, 1+ DAYS IMG/SNGL AREA IMG 2+ DAYS",34100075,CDM,341,RC,78801,HCPCS,facility,both,,,,2337,2337,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Radiopharmaceutical Localization, Tomographic (SPECT)",34100077,CDM,341,RC,78807,HCPCS,facility,both,,,,3112,3112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MYOCARDIAL IMAGE, PLANAR; QUAL/QUAN",34100078,CDM,341,RC,78466,HCPCS,facility,both,,,,1938,1938,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALIVARY GLAND; W SERIAL IMAGES,34100080,CDM,341,RC,78231,HCPCS,facility,both,,,,1725,1725,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LUNG PERFUSION DIFFERENTIAL,34100085,CDM,341,RC,78597,HCPCS,facility,both,,,,2168,2168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE MARROW IMAGING; MULTIPLE AREAS,34100095,CDM,341,RC,78103,HCPCS,facility,both,,,,5330,5330,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LIVER IMAGE; STATIC ONLY,34100105,CDM,341,RC,78201,HCPCS,facility,both,,,,2567,2567,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LUNG PERFUSION & VENTILATION DIFFERENTIAL,34100115,CDM,341,RC,78598,HCPCS,facility,both,,,,2829,2829,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIDNEY IMAGING MORPHOLOGY,34100120,CDM,341,RC,78700,HCPCS,facility,both,,,,1477,1477,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC KIDNEY FLOW/FUNCT IMAGE-MULT W & W/O PHARM INTERV,34100125,CDM,341,RC,78709,HCPCS,facility,both,,,,2636,2636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TUMOR IMAGING WHOLE BODY 2+ DAYS,34100130,CDM,341,RC,78804,HCPCS,facility,both,,,,4995,4995,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LOCALIZATION OF INFLAMMATORY PROCESS; LIMIT AREA,34100135,CDM,341,RC,78805,HCPCS,facility,both,,,,4750,4750,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE MARROW IMAGING; WHOLE BODY,34100136,CDM,341,RC,78104,HCPCS,facility,both,,,,5330,5330,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID UPTAKE MEASUREMENT,34100140,CDM,341,RC,78012,HCPCS,facility,both,,,,759,759,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID IMAGING W/BLOOD FLOW,34100141,CDM,341,RC,78013,HCPCS,facility,both,,,,970,970,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THYROID IMAGING W/BLOOD FLOW & 1+ UPTAKES,34100142,CDM,341,RC,78014,HCPCS,facility,both,,,,1704,1704,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARTHYROID PLANAR IMAGING W/ SPECT,34100144,CDM,341,RC,78071,HCPCS,facility,both,,,,2066,2066,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM LOCALIZE TUMOR, SPECT, W/CT 1 AREA 1 DAY IMAGE",34100157,CDM,341,RC,78830,HCPCS,facility,both,,,,5918,5918,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM LOCAL TUMOR, SPECT, 2 AREA 1 DAY IMG OR 1 AREA IMG 2+ DAYS",34100158,CDM,341,RC,78831,HCPCS,facility,both,,,,5918,5918,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM LOCAL TUMOR, SPECT, MIN 2 AREA 1 DAY IMG /1 AREA OR IMG 2+ DAYS",34100159,CDM,341,RC,78832,HCPCS,facility,both,,,,6715,6715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARMACEUTICAL QUANTIFICATION MEASUREMENT(S), 1 AREA",34100160,CDM,341,RC,78835,HCPCS,facility,both,,,,1714,1714,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRA WO CONTRAST, PELVIS",34100201,CDM,618,RC,,,facility,both,,,,4530,4530,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASTRIC EMPTYING IMAGING STUDY (SOLID, LIQUID OR BOTH)",34100205,CDM,341,RC,78264,HCPCS,facility,both,,,,1709,1709,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASTRIC EMPTYING IMAGING STUDY; W/SMALL BOWEL TRANSIT,34100206,CDM,341,RC,78265,HCPCS,facility,both,,,,1709,1709,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASTRIC EMPTYING IMAG STUDY W/SMALL BOWEL & COLON TRANSIT, MULT DAY",34100207,CDM,341,RC,78266,HCPCS,facility,both,,,,2562,2562,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM THERAPY, BY ORAL ADMINISTRATION",34200001,CDM,342,RC,79005,HCPCS,facility,both,,,,2244,2244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RADIOPHARM THERAPY, BY IV ADMINISTRATION",34200002,CDM,342,RC,79101,HCPCS,facility,both,,,,2870,2870,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEAC 05/05/2021 F18 FDG =< 45 MCI,34341115,CDM,343,RC,,,facility,both,,,,348,348,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT SOFT TISSUE NECK W/O CONTRAST,35000001,CDM,350,RC,70490,HCPCS,facility,both,,,,2324,2324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT SOFT TISSUE NECK W/CONTRAST,35000002,CDM,350,RC,70491,HCPCS,facility,both,,,,2776,2776,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT SOFT TISSUE NECK W/O & W/CONTRAST,35000003,CDM,350,RC,70492,HCPCS,facility,both,,,,3340,3340,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ANGIO NECK W/CONTRAST MATERIAL(S),35000004,CDM,350,RC,70498,HCPCS,facility,both,,,,3340,3340,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT HEART W/O CONTRAST W/CALCIUM QUANT,35000005,CDM,350,RC,75571,HCPCS,facility,both,,,,688,688,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT HEART W/CONTRAST INC W/3 D POSTPROC,35000006,CDM,350,RC,75572,HCPCS,facility,both,,,,1534,1534,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CTA HEART W/CON W/3D IMAGE POSTPROCESS,35000008,CDM,350,RC,75574,HCPCS,facility,both,,,,1534,1534,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 3D RENDERING W/O POSTPROCESS,35000009,CDM,350,RC,76376,HCPCS,facility,both,,,,1597,1597,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 3D RENDERING W POSTPROCESS,35000010,CDM,350,RC,76377,HCPCS,facility,both,,,,1597,1597,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT LIMITED OR LOCALIZED FOLLOW-UP STUDY,35000011,CDM,350,RC,76380,HCPCS,facility,both,,,,1128,1128,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT SCAN FOR NEEDLE BIOPSY,35000013,CDM,350,RC,77012,HCPCS,facility,both,,,,3884,3884,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT GUIDANCE TISSUE ABLATION,35000014,CDM,350,RC,77013,HCPCS,facility,both,,,,3884,3884,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT GUIDANCE TISSUE ABLATION,35000014,CDM,350,RC,77013,HCPCS,facility,both,,,,3884,3884,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC CT GUIDANCE PLCMNT RAD THERAPY FIELDS,35000015,CDM,350,RC,77014,HCPCS,facility,both,,,,542,542,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC (SMH MOSAIQ) CT GUIDANCE PLCMNT RAD THERAPY FIELDS,35091115,CDM,350,RC,77014,HCPCS,facility,both,,,,448,448,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT HEAD OR BRAIN, W/O CONTRAST",35100001,CDM,351,RC,70450,HCPCS,facility,both,,,,2250,2250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT HEAD OR BRAIN, W CONTRAST",35100002,CDM,351,RC,70460,HCPCS,facility,both,,,,2480,2480,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT HEAD OR BRAIN, W & W/O CONTRAST",35100003,CDM,351,RC,70470,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT ORBIT, SELLA, POSTERIOR FOSSA W/O CONTRAST",35100004,CDM,351,RC,70480,HCPCS,facility,both,,,,2541,2541,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT ORBIT, SELLA, POSTERIOR FOSSA W CONTRAST",35100005,CDM,351,RC,70481,HCPCS,facility,both,,,,2696,2696,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT ORBIT, SELLA, P. FOSSA W/O & W CONTRAST",35100006,CDM,351,RC,70482,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT MAXILLOFACIAL W/O CONTRAST,35100007,CDM,351,RC,70486,HCPCS,facility,both,,,,2250,2250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT MAXILLOFACIAL W/O CONTRAST,35100007,CDM,351,RC,70486,HCPCS,facility,both,,,52,791,791,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC CT MAXILLOFACIAL W/CONTRAST,35100008,CDM,351,RC,70487,HCPCS,facility,both,,,,2696,2696,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT MAXILLOFACIAL W/O & W/CONTRAST,35100009,CDM,351,RC,70488,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ANGIO HEAD W/CONTRAST MATERIAL(S),35100010,CDM,351,RC,70496,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DX CT THORAX W/O CONTRAST,35200001,CDM,352,RC,71250,HCPCS,facility,both,,,52,1402,1402,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC DX CT THORAX W/O CONTRAST,35200001,CDM,352,RC,71250,HCPCS,facility,both,,,,2798,2798,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DX CT THORAX W CONTRAST,35200002,CDM,352,RC,71260,HCPCS,facility,both,,,,3359,3359,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DX CT THORAX W & W/O CONTRAST,35200003,CDM,352,RC,71270,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CTA CHEST W CONTRAST,35200004,CDM,352,RC,71275,HCPCS,facility,both,,,,2798,2798,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT CERVICAL SPINE, W/O CONTRAST",35200005,CDM,352,RC,72125,HCPCS,facility,both,,,,2564,2564,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT CERVICAL SPINE, W CONTRAST",35200006,CDM,352,RC,72126,HCPCS,facility,both,,,,2488,2488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT CERVICAL SPINE, W & W/O CONTRAST",35200007,CDM,352,RC,72127,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT THORACIC SPINE, W/O CONTRAST",35200008,CDM,352,RC,72128,HCPCS,facility,both,,,,2798,2798,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT THORACIC SPINE, W CONTRAST",35200009,CDM,352,RC,72129,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT THORACIC SPINE, W & W/O CONTRAST",35200010,CDM,352,RC,72130,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT LUMBAR SPINE, W/O CONTRAST",35200011,CDM,352,RC,72131,HCPCS,facility,both,,,,2891,2891,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT LUMBAR SPINE, W CONTRAST",35200012,CDM,352,RC,72132,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT LUMBAR SPINE, W & W/O CONTRAST",35200013,CDM,352,RC,72133,HCPCS,facility,both,,,,4686,4686,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CTA PELVIS W & W/O CONTRAST,35200014,CDM,352,RC,72191,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT PELVIS W/O CONTRAST,35200015,CDM,352,RC,72192,HCPCS,facility,both,,,,2798,2798,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT PELVIS W CONTRAST,35200016,CDM,352,RC,72193,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT PELVIS W & W/O CONTRAST,35200017,CDM,352,RC,72194,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT VERTOPLASTY/SACROPLASTY W/CT GUID,35200018,CDM,352,RC,72292,HCPCS,facility,both,,,,656,656,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT UPPER EXT W/O CONTRAST,35200019,CDM,352,RC,73200,HCPCS,facility,both,,,50,4350,4350,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CT UPPER EXT W/O CONTRAST,35200019,CDM,352,RC,73200,HCPCS,facility,both,,,,2805,2805,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT UPPER EXT W CONTRAST,35200020,CDM,352,RC,73201,HCPCS,facility,both,,,50,5562,5562,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CT UPPER EXT W CONTRAST,35200020,CDM,352,RC,73201,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CTA UPPER EXT W & W/O CONTRAST,35200021,CDM,352,RC,73206,HCPCS,facility,both,,,50,6979,6979,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CTA UPPER EXT W & W/O CONTRAST,35200021,CDM,352,RC,73206,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT LOWER EXT W/O CONTRAST,35200022,CDM,352,RC,73700,HCPCS,facility,both,,,50,4655,4655,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CT LOWER EXT W/O CONTRAST,35200022,CDM,352,RC,73700,HCPCS,facility,both,,,,2805,2805,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT LOWER EXT W CONTRAST,35200023,CDM,352,RC,73701,HCPCS,facility,both,,,,3357,3357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT LOWER EXT W CONTRAST,35200023,CDM,352,RC,73701,HCPCS,facility,both,,,50,5562,5562,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CT LOWER EXT W & W/O CONTRAST,35200024,CDM,352,RC,73702,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT LOWER EXT W & W/O CONTRAST,35200024,CDM,352,RC,73702,HCPCS,facility,both,,,50,6979,6979,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CTA LOWER EXT W/O & W CONTRAST,35200025,CDM,352,RC,73706,HCPCS,facility,both,,,50,6979,6979,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CTA LOWER EXT W/O & W CONTRAST,35200025,CDM,352,RC,73706,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ABDOMEN W/O CONTRAST,35200026,CDM,352,RC,74150,HCPCS,facility,both,,,,1727,1727,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ABDOMEN W CONTRAST,35200027,CDM,352,RC,74160,HCPCS,facility,both,,,,3256,3256,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ABDOMEN W & W/O CONTRAST,35200028,CDM,352,RC,74170,HCPCS,facility,both,,,,4036,4036,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CTA ABDOMEN W/O AND W CONTRAST,35200029,CDM,352,RC,74175,HCPCS,facility,both,,,,5012,5012,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ABDOMEN AND PELVIS W/O CONTRAST,35200030,CDM,352,RC,74176,HCPCS,facility,both,,,,4523,4523,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ABDOMEN AND PELVIS W CONTRAST,35200031,CDM,352,RC,74177,HCPCS,facility,both,,,,6610,6610,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ABDOMEN AND PELVIS W & W/O CONTRAST,35200032,CDM,352,RC,74178,HCPCS,facility,both,,,,8244,8244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT COLONOGRAPHY, DX W/2D, 3D W/O CON",35200033,CDM,352,RC,74261,HCPCS,facility,both,,,,2798,2798,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT COLONOGRAPHY, DX W/2D, 3D W/CONTRAST",35200034,CDM,352,RC,74262,HCPCS,facility,both,,,,2798,2798,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT COLONOGRAPHY, SCREENING W/2D, 3D",35200035,CDM,352,RC,74263,HCPCS,facility,both,,,,761,761,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT ANGIO ABDOMINAL ARTERIES,35200040,CDM,352,RC,75635,HCPCS,facility,both,,,,3557,3557,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT UPR EXTREMITY W/WO CONTRAST,35200041,CDM,352,RC,73202,HCPCS,facility,both,,,,4210,4210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT UPR EXTREMITY W/WO CONTRAST,35200041,CDM,352,RC,73202,HCPCS,facility,both,,,50,6979,6979,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC CT ANGIO ABD&PELV W/O&W/DYE,35200050,CDM,352,RC,74174,HCPCS,facility,both,,,,8244,8244,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CT THORAX, LOW DOSE LUNG CANCER SCREENING, W/O CONTRAST",35200051,CDM,352,RC,71271,HCPCS,facility,both,,,,1128,1128,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SAME DAY SURGERY FEE,36000002,CDM,360,RC,,,facility,both,,,,534,534,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 1 FIRST 30 MINUTES,36000014,CDM,360,RC,,,facility,both,,,,5083,5083,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 2 FIRST 30 MINUTES,36000015,CDM,360,RC,,,facility,both,,,,5816,5816,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 3 FIRST 30 MINUTES,36000016,CDM,360,RC,,,facility,both,,,,6547,6547,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 4 FIRST 30 MINUTES,36000017,CDM,360,RC,,,facility,both,,,,7273,7273,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 5 FIRST 30 MINUTES,36000018,CDM,360,RC,,,facility,both,,,,6547,6547,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 6 FIRST 30 MINUTES,36000019,CDM,360,RC,,,facility,both,,,,5816,5816,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRE-OP CHARGE,36000024,CDM,360,RC,,,facility,both,,,,946,946,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 1 EA ADDL 30 MIN,36000114,CDM,360,RC,,,facility,both,,,,2567,2567,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 2 EA ADDL 30 MIN,36000115,CDM,360,RC,,,facility,both,,,,3021,3021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 3 EA ADDL 30 MIN,36000116,CDM,360,RC,,,facility,both,,,,3477,3477,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 4 EA ADDL 30 MIN,36000117,CDM,360,RC,,,facility,both,,,,3931,3931,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 5 EA ADDL 30 MIN,36000118,CDM,360,RC,,,facility,both,,,,3477,3477,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE LEVEL 6 PER 30 MINUTE,36000119,CDM,360,RC,,,facility,both,,,,3021,3021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OR FLAT RATE BLOCK ROOM CHARGE,36013001,CDM,360,RC,,,facility,both,,,,2020,2020,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 7/1/2017 HC RADIOLOGY SURGICAL COMPONENT,36100004,CDM,361,RC,,,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY; W/O IMAGE GUIDANCE, 1ST LESION",36100050,CDM,761,RC,10021,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION FOR MAMMARY DUCTOGRAM OR GALACTOGRAM,36100051,CDM,761,RC,19030,HCPCS,facility,both,,,,1399,1399,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Incision and drainage of soft tissue abscess, subfascial",36100052,CDM,761,RC,20005,HCPCS,facility,both,,,,1232,1232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Incision and drainage of soft tissue abscess, subfascial",36100052,CDM,761,RC,20005,HCPCS,facility,both,,,,103,103,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INJECTION OF SINUS TRACT; THERAPEUTIC,36100053,CDM,761,RC,20500,HCPCS,facility,both,,,,2615,2615,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVE FOREIGN BODY, MUSCLE OR TENDON; COMPLICATED",36100054,CDM,761,RC,20525,HCPCS,facility,both,,,,4964,4964,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVE FOREIGN BODY, MUSCLE OR TENDON; COMPLICATED",36100054,CDM,761,RC,20525,HCPCS,facility,both,,,,3573,3573,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INJECTION; SINGLE TENDON SHEATH/LIGAMENT,36100055,CDM,761,RC,20550,HCPCS,facility,both,,,,377,377,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INJECTION; SINGLE TENDON SHEATH/LIGAMENT,36100055,CDM,761,RC,20550,HCPCS,facility,both,,,,659,659,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION; TRIGGER POINTS, 1 OR 2 MUSCLES",36100056,CDM,761,RC,20552,HCPCS,facility,both,,,,856,856,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION; TRIGGER POINTS, 1 OR 2 MUSCLES",36100056,CDM,761,RC,20552,HCPCS,facility,both,,,,377,377,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC ARTHROCENTESIS, SMALL JOINT OR BURSA",36100057,CDM,761,RC,20600,HCPCS,facility,both,,,,754,754,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ARTHROCENTESIS, SMALL JOINT OR BURSA",36100057,CDM,761,RC,20600,HCPCS,facility,both,,,,377,377,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC ARTHROCENTESIS, INTERMEDIATE JOINT OR BURSA",36100058,CDM,761,RC,20605,HCPCS,facility,both,,,,826,826,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ARTHROCENTESIS, INTERMEDIATE JOINT OR BURSA",36100058,CDM,761,RC,20605,HCPCS,facility,both,,,,377,377,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC ARTHROCENTESIS, INTERMEDIATE JOINT OR BURSA",36100058,CDM,761,RC,20605,HCPCS,facility,both,,,,703,703,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC PERCUTANEOUS VERTEBROPLASTY; THORACIC,36100059,CDM,361,RC,22520,HCPCS,facility,both,,,,4662,4662,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS VERTEBROPLASTY; LUMBAR,36100060,CDM,361,RC,22521,HCPCS,facility,both,,,,2670,2670,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS VERTEBROPLASTY; ADDL,36100061,CDM,361,RC,22522,HCPCS,facility,both,,,,2670,2670,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS KYPHOPLASTY; THORACIC,36100062,CDM,361,RC,22523,HCPCS,facility,both,,,,4921,4921,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS KYPHOPLASTY; LUMBAR,36100063,CDM,361,RC,22524,HCPCS,facility,both,,,,4921,4921,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS KYPHOPLASTY ADD-ON,36100064,CDM,361,RC,22525,HCPCS,facility,both,,,,4921,4921,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION FOR SHOULDER X-RAY,36100065,CDM,761,RC,23350,HCPCS,facility,both,,,,759,759,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION FOR SHOULDER X-RAY,36100065,CDM,761,RC,23350,HCPCS,facility,both,,,50,1247,1247,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC INJECTION FOR ELBOW ARTHROGRAPHY,36100066,CDM,761,RC,24220,HCPCS,facility,both,,,50,1627,1627,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC INJECTION FOR ELBOW ARTHROGRAPHY,36100066,CDM,761,RC,24220,HCPCS,facility,both,,,,985,985,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION FOR WRIST ARTHROGRAPHY,36100067,CDM,761,RC,25246,HCPCS,facility,both,,,,1070,1070,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION FOR WRIST ARTHROGRAPHY,36100067,CDM,761,RC,25246,HCPCS,facility,both,,,50,1771,1771,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC INJECTION HIP ARTHROGRAPHY; WO ANESTHESIA,36100068,CDM,761,RC,27093,HCPCS,facility,both,,,,1026,1026,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION HIP ARTHROGRAPHY; WO ANESTHESIA,36100068,CDM,761,RC,27093,HCPCS,facility,both,,,50,1696,1696,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC Injection knee arthrography,36100069,CDM,761,RC,27370,HCPCS,facility,both,,,50,809,809,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC Injection knee arthrography,36100069,CDM,761,RC,27370,HCPCS,facility,both,,,,496,496,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THORACENTESIS W TUBE INSERTION,36100070,CDM,361,RC,32422,HCPCS,facility,both,,,,1138,1138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT PLEURAL CATHETER WITH CUFF,36100071,CDM,761,RC,32550,HCPCS,facility,both,,,,12125,12125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Percutaneous transluminal angioplasty, venous",36100072,CDM,361,RC,35476,HCPCS,facility,both,,,,3517,3517,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXTEMITY VENOGRAPHY INJECTION,36100073,CDM,761,RC,36005,HCPCS,facility,both,,,,361,361,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NONSELECTIVE CATH, SUPERIOR/INFERIOR VENA CAVA",36100074,CDM,761,RC,36010,HCPCS,facility,both,,,,2386,2386,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SELECTIVE CATHETER, FIRST ORDER FAMILY",36100075,CDM,761,RC,36011,HCPCS,facility,both,,,,3600,3600,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SELECTIVE CATHETER, SECOND ORDER FAMILY",36100076,CDM,761,RC,36012,HCPCS,facility,both,,,,4193,4193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC Access AV dialysis graft for eval,36100077,CDM,361,RC,36147,HCPCS,facility,both,,,,1379,1379,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SELECTIVE CATH ARTERY, BRACH-CEPH, FIRST ORDER",36100078,CDM,761,RC,36215,HCPCS,facility,both,,,,4116,4116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT CATHETER ABD/L-EXT ARTERY 1ST,36100079,CDM,761,RC,36245,HCPCS,facility,both,,,,4173,4173,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT CATHETER ABD/L-EXT ART 2ND,36100080,CDM,761,RC,36246,HCPCS,facility,both,,,,4173,4173,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT CATHETER ABD/L-EXT ART 3RD,36100081,CDM,761,RC,36247,HCPCS,facility,both,,,,5415,5415,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION(S) OF SCLEROSANT FOR SPIDER VEINS, LIMB OR TRUNK",36100082,CDM,761,RC,36468,HCPCS,facility,both,,,,1143,1143,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENDOVENOUS ABLATION, RADIOFREQ, 1ST VEIN",36100083,CDM,761,RC,36475,HCPCS,facility,both,,,,15871,15871,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENDOVENOUS ABLATION, RADIOFREQ, VEIN ADD ON",36100084,CDM,761,RC,36476,HCPCS,facility,both,,,,8551,8551,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT NON-TUNNELED CV CATHETER, AGE 5 OR OLDER",36100085,CDM,761,RC,36556,HCPCS,facility,both,,,,3963,3963,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT NON-TUNNELED CV CATHETER, AGE 5 OR OLDER",36100085,CDM,761,RC,36556,HCPCS,facility,both,,,,3963,3963,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INSERT TUNNELED CV CATHETER, AGE 5 OR OLDER",36100086,CDM,761,RC,36558,HCPCS,facility,both,,,,7436,7436,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT TUNNELED CVAD W/PORT, 5YRS OR OLDER",36100087,CDM,761,RC,36561,HCPCS,facility,both,,,,17043,17043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REPLACE TUNNELED CV CATHETER, SAME VENOUS",36100088,CDM,761,RC,36581,HCPCS,facility,both,,,,7334,7334,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPLACE TUNNELED CVAD WITH PORT,36100089,CDM,761,RC,36582,HCPCS,facility,both,,,,14707,14707,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REPLACE PICC CATHETER, INCL IMAGE GUIDE",36100090,CDM,761,RC,36584,HCPCS,facility,both,,,,4006,4006,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVE TUNNELED CV CATHETER, WO PORT",36100091,CDM,761,RC,36589,HCPCS,facility,both,,,,1232,1232,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVE TUNNELED CVAD, WITH PORT OR PUMP",36100092,CDM,761,RC,36590,HCPCS,facility,both,,,,3552,3552,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Thrombectomy, percutaneous, av fistula",36100093,CDM,361,RC,36870,HCPCS,facility,both,,,,3632,3632,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT ENDOVASCULAR VENA CAVA FILTER,36100094,CDM,761,RC,37191,HCPCS,facility,both,,,,8589,8589,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVE ENDOVASCULAR VENA CAVE FILTER,36100095,CDM,761,RC,37193,HCPCS,facility,both,,,,9727,9727,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCATHETER BIOPSY,36100096,CDM,761,RC,37200,HCPCS,facility,both,,,,4695,4695,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRANSCATHETER RETRIEVAL, PERCUT, FOREIGN BODY",36100097,CDM,361,RC,37197,HCPCS,facility,both,,,,2848,2848,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSCATHETER OCCLUSION OR EMBOLIZATION,36100098,CDM,361,RC,37204,HCPCS,facility,both,,,,9238,9238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRANSCATHETER PLACEMENT, IV STENT, INITIAL VESSEL",36100099,CDM,361,RC,37205,HCPCS,facility,both,,,,4570,4570,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UTERINE FIBROID EMBOLIZATION,36100100,CDM,361,RC,37210,HCPCS,facility,both,,,,9238,9238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REVASC, ILIAC ARTERY, UNIL, 1ST VESSEL; W STENT",36100101,CDM,761,RC,37221,HCPCS,facility,both,,,,8873,8873,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REVASC, OPEN/PERCUT, FEMORAL/POPLITEAL W/TLA; UNIL",36100102,CDM,761,RC,37224,HCPCS,facility,both,,,,9266,9266,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STAB PHLEBECTOMY, VEINS, 1 EXT, 10-20",36100103,CDM,761,RC,37765,HCPCS,facility,both,,,,14219,14219,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STAB PHLEBECTOMY, VEINS, 1 EXT, MORE THAN 20",36100104,CDM,761,RC,37766,HCPCS,facility,both,,,,14219,14219,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED VASCULAR SURGERY PROCEDURE,36100105,CDM,761,RC,37799,HCPCS,facility,both,,,,14219,14219,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RADIOACTIVE TRACER ID SENTINEL NODE,36100106,CDM,761,RC,38792,HCPCS,facility,both,,,50,1593,1593,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC RADIOACTIVE TRACER ID SENTINEL NODE,36100106,CDM,761,RC,38792,HCPCS,facility,both,,,,1061,1061,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM",36100107,CDM,761,RC,38999,HCPCS,facility,both,,,,1333,1333,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPOSITION GASTROSTOMY TUBE,36100108,CDM,761,RC,43761,HCPCS,facility,both,,,,290,290,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC REPOSITION GASTROSTOMY TUBE,36100108,CDM,761,RC,43761,HCPCS,facility,both,,,,2004,2004,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEPATOTOMY; PERCUT DRAIN ABSCESS, 1 OR 2 STAGES",36100109,CDM,361,RC,47011,HCPCS,facility,both,,,,3433,3433,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION PERCUT TRANSHEPATIC CHOLANGIOGRAPHY,36100110,CDM,361,RC,47500,HCPCS,facility,both,,,,908,908,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION CHOLANGIOGRAPHY THRU EXISTING CATH,36100111,CDM,361,RC,47505,HCPCS,facility,both,,,,386,386,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT BILIARY DRAINAGE INTERNAL AND EXTERNAL,36100112,CDM,361,RC,47511,HCPCS,facility,both,,,,13353,13353,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHANGE OF PERCUT BILIARY DRAINAGE CATH,36100113,CDM,361,RC,47525,HCPCS,facility,both,,,,3039,3039,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT DILATION BILARY STRICTURE WO STENT,36100114,CDM,761,RC,47555,HCPCS,facility,both,,,,4678,4678,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT DILATION BILARY STRICTURE WITH STENT,36100115,CDM,761,RC,47556,HCPCS,facility,both,,,,5519,5519,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRAIN PERITONEAL ABSCESS OR CYST, PERCUTANEOUS",36100116,CDM,361,RC,49021,HCPCS,facility,both,,,,3344,3344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT TUNNELED IP CATH FOR DIALYSIS, OPEN",36100117,CDM,761,RC,49421,HCPCS,facility,both,,,,3409,3409,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CONTRAST INJECTION, ASSESS CYST VIA EXIST CATH",36100118,CDM,761,RC,49424,HCPCS,facility,both,,,,779,779,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLACE GASTROSTOMY TUBE, PERCUT, UNDER FLUORO GUIDE",36100119,CDM,761,RC,49440,HCPCS,facility,both,,,,5131,5131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN RENAL ABSCESS; PERCUTANEOUS,36100120,CDM,361,RC,50021,HCPCS,facility,both,,,,3745,3745,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE",36100121,CDM,761,RC,50040,HCPCS,facility,both,,,,3552,3552,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHANGE EXT/INT URETER STENT,36100122,CDM,761,RC,50387,HCPCS,facility,both,,,,3449,3449,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHANGE EXT/INT URETER STENT,36100122,CDM,761,RC,50387,HCPCS,facility,both,,,50,5173,5173,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC REMOVE RENAL TUBE W/FLUORO,36100123,CDM,761,RC,50389,HCPCS,facility,both,,,50,1570,1570,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC REMOVE RENAL TUBE W/FLUORO,36100123,CDM,761,RC,50389,HCPCS,facility,both,,,,1050,1050,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT DRAIN OR INJECT RENAL PELVIS,36100124,CDM,361,RC,50392,HCPCS,facility,both,,,,1759,1759,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUT DRAIN OR STENT PLACEMENT URETER,36100125,CDM,361,RC,50393,HCPCS,facility,both,,,,2110,2110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION PROCEDURE FOR PYELOGRAPHY,36100126,CDM,361,RC,50394,HCPCS,facility,both,,,,365,365,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Dilation for nephrostomy tract, percut",36100127,CDM,761,RC,50395,HCPCS,facility,both,,,,1966,1966,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE,36100128,CDM,361,RC,50398,HCPCS,facility,both,,,,899,899,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECT ILEAL CONDUIT/URETEROPYELOGRAM,36100129,CDM,761,RC,50690,HCPCS,facility,both,,,,873,873,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION CYSTOGRAPHY OR VOIDING URETHROCYSTOGRAPHY,36100130,CDM,761,RC,51600,HCPCS,facility,both,,,,662,662,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CYSTOURETHROSCOPY, WITH URETEROSCOPY, DX",36100131,CDM,761,RC,52351,HCPCS,facility,both,,,,3912,3912,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CATHETER FOR HYSTEROGRAPHY,36100132,CDM,761,RC,58340,HCPCS,facility,both,,,,707,707,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MYELOGRAM INJECT, SPINAL NOT C1-C2",36100133,CDM,761,RC,62284,HCPCS,facility,both,,,,1433,1433,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS DISKECTOMY,36100134,CDM,761,RC,62287,HCPCS,facility,both,,,,10085,10085,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION DISCOGRAPHY, EACH LEVEL; LUMBAR",36100135,CDM,761,RC,62290,HCPCS,facility,both,,,,481,481,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Inject spine, cervical or thoracic",36100136,CDM,361,RC,62310,HCPCS,facility,both,,,,755,755,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Inject spine, lumbar or sacral",36100137,CDM,361,RC,62311,HCPCS,facility,both,,,,755,755,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Inject spine, lumbar or sacral",36100137,CDM,361,RC,62311,HCPCS,facility,both,,,,459,459,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC LAMINOTOMY, ONE INTERSPACE, LUMBAR",36100138,CDM,761,RC,63030,HCPCS,facility,both,,,,6812,6812,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LAMINOTOMY, EA ADDL INTERSPACE, CERVICAL OR LUMBAR",36100139,CDM,761,RC,63035,HCPCS,facility,both,,,,3258,3258,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERCUTANEOUS IMPLANT NEURO ELECTRODES, EPIDURAL",36100140,CDM,761,RC,63650,HCPCS,facility,both,,,,18774,18774,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERCUTANEOUS IMPLANT NEURO ELECTRODES, EPIDURAL",36100140,CDM,761,RC,63650,HCPCS,facility,both,,,,5325,5325,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC REMOVE NEURO ELECTRODE PERCUT, W/FLUORO",36100141,CDM,761,RC,63661,HCPCS,facility,both,,,,5772,5772,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REVIS/REMVL IMPL NSTIM GENERATOR/RCVR W/DETACH CONNECT E. ARRAY,36100142,CDM,761,RC,63688,HCPCS,facility,both,,,,8685,8685,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REVIS/REMVL IMPL NSTIM GENERATOR/RCVR W/DETACH CONNECT E. ARRAY,36100142,CDM,761,RC,63688,HCPCS,facility,both,,,,2966,2966,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; TRIGEMINAL NERVE, EA BRCH",36100143,CDM,761,RC,64400,HCPCS,facility,both,,,,377,377,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; TRIGEMINAL NERVE, EA BRCH",36100143,CDM,761,RC,64400,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; GREATER OCCIPITAL NERVE",36100144,CDM,761,RC,64405,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; INTERCOSTAL NERVE, SNGL LEVEL",36100145,CDM,761,RC,64420,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; INTERCOSTAL NERVE EA ADDL LEVEL",36100146,CDM,761,RC,64421,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), ANES AGENT(S)&/OR STERIOD; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES",36100147,CDM,761,RC,64425,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, CERVICAL/THORACIC, 1 LEVEL",36100148,CDM,761,RC,64479,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, CERVICAL/THORACIC, 1 LEVEL",36100148,CDM,761,RC,64479,HCPCS,facility,both,,,,1353,1353,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, CERVICAL/THORACIC, EA ADDL LEVEL",36100149,CDM,761,RC,64480,HCPCS,facility,both,,,,897,897,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, CERVICAL/THORACIC, EA ADDL LEVEL",36100149,CDM,761,RC,64480,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, 1 LEVEL",36100150,CDM,761,RC,64483,HCPCS,facility,both,,,,1181,1181,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, 1 LEVEL",36100150,CDM,761,RC,64483,HCPCS,facility,both,,,50,2284,2284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, 1 LEVEL",36100150,CDM,761,RC,64483,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, EA ADDL LEVEL",36100151,CDM,761,RC,64484,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, EA ADDL LEVEL",36100151,CDM,761,RC,64484,HCPCS,facility,both,,,50,2284,2284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, EA ADDL LEVEL",36100151,CDM,761,RC,64484,HCPCS,facility,both,,,,786,786,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 1 LEVEL",36100152,CDM,761,RC,64490,HCPCS,facility,both,,,50,4483,4483,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 1 LEVEL",36100152,CDM,761,RC,64490,HCPCS,facility,both,,,,2994,2994,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 1 LEVEL",36100152,CDM,761,RC,64490,HCPCS,facility,both,,,,1181,1181,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 2 LEVEL",36100153,CDM,761,RC,64491,HCPCS,facility,both,,,,768,768,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 2 LEVEL",36100153,CDM,761,RC,64491,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 3 LEVEL",36100154,CDM,761,RC,64492,HCPCS,facility,both,,,,1078,1078,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 3 LEVEL",36100154,CDM,761,RC,64492,HCPCS,facility,both,,,,1270,1270,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 1 LEVEL",36100155,CDM,761,RC,64493,HCPCS,facility,both,,,50,3383,3383,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 1 LEVEL",36100155,CDM,761,RC,64493,HCPCS,facility,both,,,50,2881,2881,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 1 LEVEL",36100155,CDM,761,RC,64493,HCPCS,facility,both,,,,2096,2096,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 1 LEVEL",36100155,CDM,761,RC,64493,HCPCS,facility,both,,,,2533,2533,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 2 LEVEL",36100156,CDM,761,RC,64494,HCPCS,facility,both,,,,1215,1215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 2 LEVEL",36100156,CDM,761,RC,64494,HCPCS,facility,both,,,50,1617,1617,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 3 LEVEL",36100157,CDM,761,RC,64495,HCPCS,facility,both,,,50,1816,1816,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 3 LEVEL",36100157,CDM,761,RC,64495,HCPCS,facility,both,,,,1215,1215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NERVE BLOCK INJ, STELLATE GANGLION",36100158,CDM,761,RC,64510,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NERVE BLOCK INJ, SUPERIOR HYPOGASTRIC PLEXUS",36100159,CDM,761,RC,64517,HCPCS,facility,both,,,,2648,2648,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NERVE BLOCK INJ, SUPERIOR HYPOGASTRIC PLEXUS",36100159,CDM,761,RC,64517,HCPCS,facility,both,,,50,3969,3969,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC NERVE BLOCK INJ, LUMBAR OR THORACIC",36100160,CDM,761,RC,64520,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NERVE BLOCK INJ, CELIAC PLEXUS",36100161,CDM,761,RC,64530,HCPCS,facility,both,,,,2994,2994,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DESTROY CERVICAL OR THORACIC, SINGLE FACET JOINT",36100162,CDM,761,RC,64633,HCPCS,facility,both,,,,3327,3327,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DESTROY CERVICAL OR THORACIC, SINGLE FACET JOINT",36100162,CDM,761,RC,64633,HCPCS,facility,both,,,50,4984,4984,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC DESTROY CERVICAL OR THORACIC, EA ADDL FACET JOINT",36100163,CDM,761,RC,64634,HCPCS,facility,both,,,50,2630,2630,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC DESTROY CERVICAL OR THORACIC, EA ADDL FACET JOINT",36100163,CDM,761,RC,64634,HCPCS,facility,both,,,,1756,1756,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DESTROY LUMBAR OR SACRAL, SINGLE FACET JOINT",36100164,CDM,761,RC,64635,HCPCS,facility,both,,,,3327,3327,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DESTROY LUMBAR OR SACRAL, SINGLE FACET JOINT",36100164,CDM,761,RC,64635,HCPCS,facility,both,,,,1877,1877,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC DESTROY LUMBAR OR SACRAL, SINGLE FACET JOINT",36100164,CDM,761,RC,64635,HCPCS,facility,both,,,50,4878,4878,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC DESTROY LUMBAR OR SACRAL, EA ADDL FACET JOINT",36100165,CDM,761,RC,64636,HCPCS,facility,both,,,,1665,1665,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DESTROY LUMBAR OR SACRAL, EA ADDL FACET JOINT",36100165,CDM,761,RC,64636,HCPCS,facility,both,,,50,2495,2495,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC DESTROY NEUROLYTIC, OTHER PERIPHERAL NERVE",36100166,CDM,761,RC,64640,HCPCS,facility,both,,,,2994,2994,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DESTROY NEUROLYTIC, OTHER PERIPHERAL NERVE",36100166,CDM,761,RC,64640,HCPCS,facility,both,,,,1353,1353,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC ARTERIAL BLOOD SAMPLING VIA PERC PUNCTURE,36100167,CDM,761,RC,36620,HCPCS,facility,both,,,,590,590,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ARTERIAL BLOOD SAMPLING VIA PERC PUNCTURE,36100167,CDM,761,RC,36620,HCPCS,facility,both,,,,590,590,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC PLACE NEEDLE INTRAOSSEOUS INFUSION,36100168,CDM,761,RC,36680,HCPCS,facility,both,,,,1309,1309,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE NEEDLE INTRAOSSEOUS INFUSION,36100168,CDM,761,RC,36680,HCPCS,facility,both,,,,521,521,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC PULMONARY EMBOLECTOMY; WO CPB,36100169,CDM,761,RC,33915,HCPCS,facility,both,,,,27451,27451,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THROMBOLYTIC ART THERAPY,36100200,CDM,761,RC,37211,HCPCS,facility,both,,,,3667,3667,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THROMBOLYTIC VENOUS THERAPY,36100201,CDM,761,RC,37212,HCPCS,facility,both,,,,3431,3431,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THROMBLYTIC ART/VEN THERAPY,36100202,CDM,761,RC,37213,HCPCS,facility,both,,,,7654,7654,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CESSJ THERAPY CATH REMOVAL,36100203,CDM,761,RC,37214,HCPCS,facility,both,,,,7654,7654,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRESS/DEBRID P-THICK BURN L,36100250,CDM,761,RC,16030,HCPCS,facility,both,,,,517,517,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CL TX ULNAR SHAFT FX; WO MANIP,36100251,CDM,761,RC,25530,HCPCS,facility,both,,,,339,339,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NONSELECTIVE CATH PLACEMENT IN VEIN,36100252,CDM,761,RC,36000,HCPCS,facility,both,,,,368,368,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANOSCOPY; DX,36100253,CDM,761,RC,46600,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANOSCOPY; DX,36100253,CDM,761,RC,46600,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC REPLACE NON-TUNNELED CV CATH,36100255,CDM,761,RC,,,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ (S), ANESTH AGENT(S) &/OR STERIOD; SCIATIC NERVE, INCL IMG GUIDANCE",36100256,CDM,761,RC,64445,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRONCHOSCOPY RESP COMPONENT,36100257,CDM,460,RC,94799,HCPCS,facility,both,,,,3351,3351,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRONCHOSCOPY ENDO COMPONENT,36100258,CDM,361,RC,,,facility,both,,,,2392,2392,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLEURAL CATH ENDO COMPONENT,36100259,CDM,361,RC,,,facility,both,,,,2064,2064,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLEURAL CATH RESP COMPONENT,36100260,CDM,361,RC,,,facility,both,,,,2055,2055,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPEN/PERQ PLACE STENT SAME INITIAL ARTERY,36100261,CDM,761,RC,37236,HCPCS,facility,both,,,,10883,10883,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPEN/PERQ PLACE STENT EACH ADDTL ARTERY,36100262,CDM,761,RC,37237,HCPCS,facility,both,,,,6302,6302,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPEN/PERQ PLACE STENT SAME INITIAL VEIN,36100263,CDM,761,RC,37238,HCPCS,facility,both,,,,10883,10883,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPEN/PERQ PLACE STENT EA ADD,36100264,CDM,761,RC,37239,HCPCS,facility,both,,,,6302,6302,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VASC EMBOLIZE/OCCLUDE VENOUS,36100265,CDM,761,RC,37241,HCPCS,facility,both,,,,16344,16344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VASC EMBOLIZE/OCCLUDE ARTERY,36100266,CDM,761,RC,37242,HCPCS,facility,both,,,,16344,16344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VASC EMBOLIZE/OCCLUDE ORGAN,36100267,CDM,761,RC,37243,HCPCS,facility,both,,,,16344,16344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VASC EMBOLIZE/OCCLUDE BLEED,36100268,CDM,761,RC,37244,HCPCS,facility,both,,,,16344,16344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMAGE CATH FLUID COLXN VISC,36100269,CDM,761,RC,49405,HCPCS,facility,both,,,,7137,7137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMAGE CATH FLUID PERI/RETRO,36100270,CDM,761,RC,49406,HCPCS,facility,both,,,,7228,7228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERV MUSC NECK DYSTON,36100271,CDM,761,RC,64616,HCPCS,facility,both,,,,1423,1423,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERV 1 EXTREMITY 1-4,36100272,CDM,761,RC,64642,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERV 1 EXTREM 1-4 EA,36100273,CDM,761,RC,64643,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERV 1 EXTREM 5/> MUS,36100274,CDM,761,RC,64644,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERV 1 EXTREM 5/> EA,36100275,CDM,761,RC,64645,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERV TRUNK MUSC 1-5,36100276,CDM,761,RC,64646,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERV TRUNK MUSC 6/>,36100277,CDM,761,RC,64647,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMODENERV, MUSC(S); LARYNX UNI EMG",36100278,CDM,761,RC,64617,HCPCS,facility,both,,,,2488,2488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ABLATE BONE TUMOR PERQ,36100279,CDM,761,RC,20982,HCPCS,facility,both,,,,13757,13757,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMAGE GUIDED CATH ABSCESS TRANSVAGINAL,36100280,CDM,761,RC,49407,HCPCS,facility,both,,,,2373,2373,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLACE NEEDLE/CATH A-V DIALYSIS SHUNT, ADDTL ACCESS FOR THERAPY",36100281,CDM,361,RC,36148,HCPCS,facility,both,,,,690,690,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE,36100282,CDM,761,RC,10030,HCPCS,facility,both,,,,775,775,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJ & PLACEMENT OF CONTRAST CHAINS,36100283,CDM,761,RC,51605,HCPCS,facility,both,,,,662,662,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MODERATE SEDATION 5 YRS & OLDER, 1ST 30 MIN",37000002,CDM,370,RC,99149,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC MODERATE SEDATION UNDER 5 YRS, 1ST 30 MIN",37000003,CDM,370,RC,99143,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ANESTHESIOLOGY FLAT RATE,37000005,CDM,370,RC,,,facility,both,,,,1091,1091,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOD SEDATION SAME PHYS/QHP 5/>YRS; INITL 15 MIN,37000006,CDM,370,RC,99152,HCPCS,facility,both,,,,1131,1131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOD SED SAME PHYS/QHP; EA ADDL 15 MIN,37000007,CDM,370,RC,99153,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOD SED OTHER PHYS/QHP <5 YRS; INITL 15 MIN,37000008,CDM,370,RC,99155,HCPCS,facility,both,,,,1131,1131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOD SED OTHER PHYS/QHP; EA ADDL 15 MIN,37000009,CDM,370,RC,99157,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOD SED OTHER PHYS/QHP 5/>YRS; INITL 15 MIN,37000010,CDM,370,RC,99156,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MOD SED SAME PHYS/QHP <5 YRS; INITL 15 MIN,37000011,CDM,370,RC,99151,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC DEGLYCEROLIZED EACH UNIT,38100001,CDM,390,RC,,,facility,both,,,,1199,1199,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC DEGLYCEROLIZED EACH UNIT,38100002,CDM,390,RC,,,facility,both,,,,1138,1138,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC LR IRRADIATED EACH UNIT,38100003,CDM,390,RC,,,facility,both,,,,839,839,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC WSH LR FROZ DW WB/RBC EA UNIT,38100006,CDM,390,RC,,,facility,both,,,,1526,1526,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC FROZ LEUK REDUC IRRAD EA UNIT,38100007,CDM,390,RC,,,facility,both,,,,1130,1130,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RBC FROZ LEUK REDUC IRRAD EA UNIT,38100007,CDM,390,RC,,,facility,both,,,,1130,1130,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CMV-NEG LR IRRAD RBC EA UNIT,38100008,CDM,390,RC,,,facility,both,,,,1514,1514,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC DEGLYCEROLIZED EA UNIT (AUTOLOGOUS/DIRECTED),38100201,CDM,390,RC,,,facility,both,,,,1456,1456,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC LR IRRADIATED EA UNIT (AUTOLOGOUS/DIRECTED),38100203,CDM,390,RC,,,facility,both,,,,1241,1241,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC RBC, DEGLYCER, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)",38100206,CDM,390,RC,,,facility,both,,,,1791,1791,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC FROZ LEUK REDUC IRRAD EA UNIT (AUTOLOGOUS/DIRECTED),38100207,CDM,390,RC,,,facility,both,,,,1395,1395,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC WASHED RED BLOOD CELLS EA UNIT,38120004,CDM,390,RC,,,facility,both,,,,912,912,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC WASHED RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED),38120005,CDM,390,RC,,,facility,both,,,,3482,3482,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD SPLIT UNIT,38200001,CDM,390,RC,,,facility,both,,,,1223,1223,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC WHOLE BLD FOR TRANSFUSION/UNIT,38200002,CDM,390,RC,,,facility,both,,,,917,917,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC WHOLE BLD FOR TRANSFUSION/UNIT (AUTOLOGOUS/DIRECTED),38200003,CDM,390,RC,,,facility,both,,,,1362,1362,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LR IRRAD WHOLE BLD EA UNIT,38200004,CDM,390,RC,,,facility,both,,,,445,445,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC WHOLE BLOOD, IRRADIATED, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)",38200204,CDM,390,RC,,,facility,both,,,,709,709,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE DEAC 3/14/2017 HC PLASMA 1 DONOR FRZ W/IN 8 HR,38300001,CDM,390,RC,,,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FFP 8-24 HRS OF COLLECT EA UNIT,38300002,CDM,390,RC,,,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC DETERGENT TX FROZEN PLASMA EA UNIT,38300003,CDM,390,RC,,,facility,both,,,,861,861,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FFP DONOR RETSTD EA UNIT,38300004,CDM,390,RC,,,facility,both,,,,223,223,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLATELETS PHERESIS EACH UNIT,38400001,CDM,390,RC,,,facility,both,,,,1352,1352,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLATELETS PHERESIS LR EA UNIT,38400002,CDM,390,RC,,,facility,both,,,,1352,1352,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLATELETS PHERESIS LR IRRAD EA UNIT,38400003,CDM,390,RC,,,facility,both,,,,1587,1587,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC IRRADIATED PLATELETS EA UNIT,38400006,CDM,390,RC,,,facility,both,,,,321,321,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEUKOREDUCED IRRAD PLATELETS EA UNIT,38400007,CDM,390,RC,,,facility,both,,,,372,372,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLTLT HLA-LR EA UNIT,38400008,CDM,390,RC,,,facility,both,,,,2239,2239,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CMV-N LR IR PLTLT EA UNIT,38400009,CDM,390,RC,,,facility,both,,,,1664,1664,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LR CMV-NEG PLATELETS EA UNIT,38400010,CDM,390,RC,,,facility,both,,,,1253,1253,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PR PLASMA EA UNIT,38400011,CDM,390,RC,,,facility,both,,,,619,619,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEUKO REDUCED PLATELETS EA UNIT,38400012,CDM,390,RC,,,facility,both,,,,247,247,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PRT PLATELETS,38460001,CDM,390,RC,,,facility,both,,,,1910,1910,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GRANULOCYTES PHERESIS UNIT,38600001,CDM,390,RC,,,facility,both,,,,8905,8905,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYOPRECIPITATE EA UNIT,38700001,CDM,390,RC,,,facility,both,,,,247,247,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC COMPATIBILITY TEST SPIN,39000001,CDM,300,RC,86920,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FROZEN BLOOD PREP,39000002,CDM,390,RC,86930,HCPCS,facility,both,,,,728,728,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD SPLIT UNIT,39000003,CDM,390,RC,,,facility,both,,,,1278,1278,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CRYOPRECIPITATE EA UNIT,39000004,CDM,390,RC,,,facility,both,,,,247,247,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEUKOCYTE POOR BLOOD EA UNIT,39000005,CDM,390,RC,,,facility,both,,,,723,723,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLASMA 1 DONOR FRZ W/IN 8 HR,39000006,CDM,390,RC,,,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RED BLOOD CELLS EA UNIT,39000007,CDM,390,RC,,,facility,both,,,,723,723,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC CMV-N LR WB/RBC EA UNIT,39000008,CDM,390,RC,,,facility,both,,,,349,349,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC PLASMA, CRYOPRECIPITATE REDUCED, EA UNIT",39000009,CDM,390,RC,,,facility,both,,,,1086,1086,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC PLATELETS, EACH UNIT",39000010,CDM,390,RC,,,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC PLATELET PHERESIS IRRAD EA UNIT,39000011,CDM,390,RC,,,facility,both,,,,1587,1587,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RBC IRRADIATED EACH UNIT,39000012,CDM,390,RC,,,facility,both,,,,839,839,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC BLOOD SPLIT UNIT (AUTOLOGOUS/DIRECTED),39000203,CDM,390,RC,,,facility,both,,,,1223,1223,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC LEUKOCYTE POOR BLOOD EA UNIT (AUTOLOGOUS/DIRECTED),39000205,CDM,390,RC,,,facility,both,,,,1071,1071,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC FFP (FROZ WITH 8 HRS) (AUTOLOGOUS/DIRECTED),39000206,CDM,390,RC,,,facility,both,,,,532,532,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED),39000207,CDM,390,RC,,,facility,both,,,,978,978,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC RBC, IRRADIATED (AUTOLOGOUS/DIRECTED)",39000212,CDM,390,RC,,,facility,both,,,,1362,1362,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE "HC FFP HIGH TITER COVID-19 CONVALESCENT, FROZEN - 8 HR COLLECT, EA UNIT (439)",39000216,CDM,390,RC,,,facility,both,,,,2421,2421,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD OR BLOOD COMPONENTS,39100001,CDM,391,RC,36430,HCPCS,facility,both,,,,352,352,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD OR BLOOD COMPONENTS,39100001,CDM,391,RC,36430,HCPCS,facility,both,,,,772,772,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC TRANSFUSION BLOOD OP ON IP UNIT,39191101,CDM,391,RC,36430,HCPCS,facility,both,,,,527,527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 0.5 HOURS,39191102,CDM,391,RC,36430,HCPCS,facility,both,,,,590,590,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 1.0 HOURS,39191103,CDM,391,RC,36430,HCPCS,facility,both,,,,653,653,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 1.5 HOURS,39191104,CDM,391,RC,36430,HCPCS,facility,both,,,,716,716,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 2.0 HOURS,39191105,CDM,391,RC,36430,HCPCS,facility,both,,,,779,779,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 2.5 HOURS,39191106,CDM,391,RC,36430,HCPCS,facility,both,,,,842,842,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 3.0 HOURS,39191107,CDM,391,RC,36430,HCPCS,facility,both,,,,905,905,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 3.5 HOURS,39191108,CDM,391,RC,36430,HCPCS,facility,both,,,,968,968,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 4.0 HOURS,39191109,CDM,391,RC,36430,HCPCS,facility,both,,,,1032,1032,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 4.5 HOURS,39191110,CDM,391,RC,36430,HCPCS,facility,both,,,,1095,1095,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 5.0 HOURS,39191111,CDM,391,RC,36430,HCPCS,facility,both,,,,1158,1158,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 5.5 HOURS,39191112,CDM,391,RC,36430,HCPCS,facility,both,,,,1221,1221,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 6.0 HOURS,39191113,CDM,391,RC,36430,HCPCS,facility,both,,,,1284,1284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 6.5 HOURS,39191114,CDM,391,RC,36430,HCPCS,facility,both,,,,1347,1347,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 7.0 HOURS,39191115,CDM,391,RC,36430,HCPCS,facility,both,,,,1410,1410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 7.5 HOURS,39191116,CDM,391,RC,36430,HCPCS,facility,both,,,,1473,1473,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 8.0 HOURS,39191117,CDM,391,RC,36430,HCPCS,facility,both,,,,1536,1536,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 9.0 HOURS,39191118,CDM,391,RC,36430,HCPCS,facility,both,,,,1662,1662,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSFUSION BLOOD 10.0 HOURS,39191119,CDM,391,RC,36430,HCPCS,facility,both,,,,1788,1788,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT",40100001,CDM,401,RC,,,facility,both,,,"GG,RT",370,370,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day | Modifier RT: Right side (used to identify procedures performed on the right side of the body)" "HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT",40100001,CDM,401,RC,,,facility,both,,,,548,548,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT",40100001,CDM,401,RC,,,facility,both,,,GG,244,244,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day" "HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT",40100001,CDM,401,RC,,,facility,both,,,"GG,LT",370,370,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day | Modifier LT: Left side (used to identify procedures performed on the left side of the body)" "HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, UNILAT",40100002,CDM,401,RC,,,facility,both,,,,482,482,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, UNILAT",40100002,CDM,401,RC,,,facility,both,,,GG,166,166,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day" "HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL",40100003,CDM,401,RC,,,facility,both,,,"GG,LT",389,389,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day | Modifier LT: Left side (used to identify procedures performed on the left side of the body)" "HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL",40100003,CDM,401,RC,,,facility,both,,,GG,256,256,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day" "HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL",40100003,CDM,401,RC,,,facility,both,,,,576,576,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL",40100003,CDM,401,RC,,,facility,both,,,"GG,RT",389,389,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day | Modifier RT: Right side (used to identify procedures performed on the right side of the body)" "HC DIAG MAMMO, INCL CAD WHEN PERFORMED, UNIL",40100004,CDM,401,RC,,,facility,both,,,,507,507,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DIAG MAMMO, INCL CAD WHEN PERFORMED, UNIL",40100004,CDM,401,RC,,,facility,both,,,GG,174,174,,,,,,,,,,,,,"Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day" HC COMPUTER DX MAMMOGRAM ADD-ON,40100010,CDM,401,RC,77051,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAMMOGRAM ONE BREAST,40100011,CDM,401,RC,77055,HCPCS,facility,both,,,,482,482,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL,40100014,CDM,401,RC,77061,HCPCS,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL,40100015,CDM,401,RC,77062,HCPCS,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DX MAMMO INCL CAD; UNILAT,40100016,CDM,401,RC,77065,HCPCS,facility,both,,,,870,870,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DX MAMMO INCL CAD; BILAT,40100017,CDM,401,RC,77066,HCPCS,facility,both,,,,989,989,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DIAGNOSTIC DIGITAL BREAST TOMOGRAPHY, UNILATERAL OR BILATERAL",40100018,CDM,401,RC,,,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ECHOENCEPHALOGRAPHY OF NEONATAL,40200001,CDM,402,RC,76506,HCPCS,facility,both,,,,1288,1288,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ULTRASOUND, SOFT TISSUES HEAD & NECK",40200002,CDM,402,RC,76536,HCPCS,facility,both,,,,1250,1250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND CHEST INCLS MEDIASTINUM,40200003,CDM,402,RC,76604,HCPCS,facility,both,,,,1215,1215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND BREAST(S) UNILAT OR BILAT,40200004,CDM,402,RC,76645,HCPCS,facility,both,,,,705,705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND ABDOMEN COMPLETE,40200005,CDM,402,RC,76700,HCPCS,facility,both,,,,1756,1756,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ULTRASOUND ABDOMEN LIMITED - 1 ORGAN, QUAD",40200006,CDM,402,RC,76705,HCPCS,facility,both,,,,1221,1221,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND RETROPERITONEAL COMPLETE,40200007,CDM,402,RC,76770,HCPCS,facility,both,,,,1712,1712,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND RETROPERITONEAL LIMITED,40200008,CDM,402,RC,76775,HCPCS,facility,both,,,,1288,1288,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND TRANSPLANTED KIDNEY W/DOPPLER,40200009,CDM,402,RC,76776,HCPCS,facility,both,,,,1288,1288,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND SPINAL CANAL AND CONTENTS,40200010,CDM,402,RC,76800,HCPCS,facility,both,,,,1524,1524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US, SINGLE FETUS < 14 WKS, TRANSABD APPRCH",40200011,CDM,402,RC,76801,HCPCS,facility,both,,,,1524,1524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US, FETUS < 14 WKS, EACH ADDTL FETUS",40200012,CDM,402,RC,76802,HCPCS,facility,both,,,,1524,1524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US, SINGLE FETUS > = 14 WKS, TRANSABD APPRCH",40200013,CDM,402,RC,76805,HCPCS,facility,both,,,,1524,1524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US, FETUS > = 14 WKS, EACH ADDTL FETUS",40200014,CDM,402,RC,76810,HCPCS,facility,both,,,,1524,1524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US, DETAILED FETAL ANATOMIC EXM, SNGL FETUS",40200015,CDM,402,RC,76811,HCPCS,facility,both,,,,1654,1654,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US, DETAILED FETAL ANATOMIC EXM, ADDL FETUS",40200016,CDM,402,RC,76812,HCPCS,facility,both,,,,684,684,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US, NUCHAL TRANSLUCENCY MEASURE, 1 FETUS",40200017,CDM,402,RC,76813,HCPCS,facility,both,,,,684,684,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US NUCHAL TRANSLUCENCY MEASURE,ADDL FETUS",40200018,CDM,402,RC,76814,HCPCS,facility,both,,,,684,684,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US LIMITED 1 OR MORE FETUS(S),40200019,CDM,402,RC,76815,HCPCS,facility,both,,,,1276,1276,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US FOLLOW-UP PER FETUS,40200020,CDM,402,RC,76816,HCPCS,facility,both,,,,970,970,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US OB TRANSVAGINAL,40200021,CDM,402,RC,76817,HCPCS,facility,both,,,,970,970,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FETAL BP PROFILE W/O NON-STRESS TEST,40200022,CDM,402,RC,76819,HCPCS,facility,both,,,,1823,1823,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DOPPLER VELOCIMETRY, FETAL UMB ARTERY",40200023,CDM,402,RC,76820,HCPCS,facility,both,,,,1472,1472,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY",40200024,CDM,402,RC,76821,HCPCS,facility,both,,,,661,661,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ECHOCARDIO FETAL CARDIOVASCULAR W/2-D,40200025,CDM,483,RC,76825,HCPCS,facility,both,,,,2253,2253,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ECHOCARDIO FETAL CARDIOVASCULAR F/U STUDY,40200026,CDM,483,RC,76826,HCPCS,facility,both,,,,2253,2253,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DOPPLER ECHOCARDIOLOGY FETAL COMPLETE,40200027,CDM,483,RC,76827,HCPCS,facility,both,,,,684,684,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DOPPLER ECHOCARDIOLOGY FETAL F/U,40200028,CDM,483,RC,76828,HCPCS,facility,both,,,,684,684,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ULTRASOUND TRANSVAGINAL, NON OB",40200029,CDM,402,RC,76830,HCPCS,facility,both,,,,1606,1606,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND PELVIC EXAM COMPLETE NON OB,40200030,CDM,402,RC,76856,HCPCS,facility,both,,,,1420,1420,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND PELVIC EXAM LIMITED NON OB,40200031,CDM,402,RC,76857,HCPCS,facility,both,,,,1218,1218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND SCROTUM AND CONTRASTENTS,40200032,CDM,402,RC,76870,HCPCS,facility,both,,,,1094,1094,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND TRANSRECTAL,40200033,CDM,402,RC,76872,HCPCS,facility,both,,,,1606,1606,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US TRANSRECTAL-PROSTATE VOL STUDY, BRACHY",40200034,CDM,402,RC,76873,HCPCS,facility,both,,,,1719,1719,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US COMPLETE JOINT,40200035,CDM,402,RC,76881,HCPCS,facility,both,,,50,2064,2064,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC US COMPLETE JOINT,40200035,CDM,402,RC,76881,HCPCS,facility,both,,,,1254,1254,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC US LIMITED, JOINT OR FOCAL EVAL OF OTHER NONVASCULAR EXTREMITY STRUCTURE(S)",40200036,CDM,402,RC,76882,HCPCS,facility,both,,,,1254,1254,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US INFANT HIPS; LIMITED/STATIC,40200037,CDM,402,RC,76886,HCPCS,facility,both,,,,1021,1021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDANCE PERICARDIOCENTESIS,40200038,CDM,402,RC,76930,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDANCE VASCULAR ACCESS,40200039,CDM,402,RC,76937,HCPCS,facility,both,,,,1560,1560,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDED FETAL TRANSFUSION/CORDOCENTESIS,40200041,CDM,402,RC,76941,HCPCS,facility,both,,,,397,397,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDED NEEDLE PLACEMENT,40200042,CDM,402,RC,76942,HCPCS,facility,both,,,,2140,2140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDED CHORIONIC VILLUS SAMPLING,40200043,CDM,402,RC,76945,HCPCS,facility,both,,,,1446,1446,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDED AMNIOCENTESIS,40200044,CDM,402,RC,76946,HCPCS,facility,both,,,,1183,1183,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDED INTERSTITIAL RADIOELEMENT APPLIC,40200046,CDM,402,RC,76965,HCPCS,facility,both,,,,1505,1505,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDANCE INTRAOPERATIVE,40200047,CDM,402,RC,76998,HCPCS,facility,both,,,,1056,1056,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED ULTRASOUND PROCEDURE,40200048,CDM,402,RC,76999,HCPCS,facility,both,,,,586,586,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FETAL BP PROFILE W NON-STRESS TEST,40200049,CDM,402,RC,76818,HCPCS,facility,both,,,,1823,1823,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SALINE INFUSED SONOHYSTEROGRAM,40200050,CDM,402,RC,76831,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US INFANT HIPS; DYNAMIC,40200051,CDM,402,RC,76885,HCPCS,facility,both,,,,1139,1139,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US GUIDED PSA/AVF COMPRESSION REPAIR,40200053,CDM,402,RC,76936,HCPCS,facility,both,,,,1507,1507,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ULTRASOUND BREAST UNILAT, COMPLETE",40200062,CDM,402,RC,76641,HCPCS,facility,both,,,,1187,1187,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ULTRASOUND BREAST UNILAT, LIMITED",40200063,CDM,402,RC,76642,HCPCS,facility,both,,,,1187,1187,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US ABDOMINAL AORTA SCREEN AAA,40200066,CDM,402,RC,76706,HCPCS,facility,both,,,,692,692,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ULTRASOUND, ELASTOGRAPHY; PARENCHYMA (EG, ORGAN)",40200068,CDM,402,RC,76981,HCPCS,facility,both,,,,1265,1265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ULTRASOUND, ELASTOGRAPHY; FIRST TARGET LESION",40200071,CDM,402,RC,76982,HCPCS,facility,both,,,,655,655,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COMP SCREEN MAMMOGRAM ADD-ON,40300005,CDM,403,RC,77052,HCPCS,facility,both,,,,61,61,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SCREENING MAMMOGRAPHY, DIGITAL, BILATERAL",40300006,CDM,403,RC,,,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SCREENING DIGITAL BREAST TOMOSYNTHESIS; BILATERAL,40300007,CDM,403,RC,77063,HCPCS,facility,both,,,,172,172,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SCREEN MAMMO INCL CAD; BILAT,40300008,CDM,403,RC,77067,HCPCS,facility,both,,,,569,569,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SCREENING MAMMO, INCL CAD WHEN PERFORMED, BIL",40300009,CDM,403,RC,,,facility,both,,,,332,332,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRAIN IMAGING, PET, METABOLIC EVALUATION",40400003,CDM,404,RC,78608,HCPCS,facility,both,,,,8878,8878,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PET IMAGING W/CT SKULL BASE TO MID-THIGH,40400005,CDM,404,RC,78815,HCPCS,facility,both,,,,8878,8878,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PET IMAGING W/CT WHOLE BODY,40400006,CDM,404,RC,78816,HCPCS,facility,both,,,,8878,8878,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PET IMAGE W/CT LMTD AREA,40400007,CDM,404,RC,78814,HCPCS,facility,both,,,,8878,8878,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MYOCARDIAL IMG, PET, METABOLIC EVAL, 1 STUDY CONCURRENT CT",40400018,CDM,404,RC,78429,HCPCS,facility,both,,,,6715,6715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENDOTRACHEAL, INTUBATION EMERGENCY",41000001,CDM,410,RC,31500,HCPCS,facility,both,,,,294,294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ENDOTRACHEAL, INTUBATION EMERGENCY",41000001,CDM,410,RC,31500,HCPCS,facility,both,,,,313,313,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CATHETER ASPIRATION: NASOTRACHEAL,41000002,CDM,410,RC,31720,HCPCS,facility,both,,,,312,312,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ARTERIAL PUNCTURE BLOOD FOR DX,41000005,CDM,410,RC,36600,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ARTERIAL PUNCTURE BLOOD FOR DX,41000005,CDM,410,RC,36600,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY < 12 HRS",41000007,CDM,410,RC,94002,HCPCS,facility,both,,,,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY > 12 HRS",41000008,CDM,410,RC,94002,HCPCS,facility,both,,,,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC VENTILATOR MGT, INITIAL DAY NICU < 12 HRS",41000009,CDM,410,RC,94002,HCPCS,facility,both,,,,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC VENTILATOR MGT, INITIAL DAY NICU > 12 HRS",41000010,CDM,410,RC,94002,HCPCS,facility,both,,,,1054,1054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY < 12 HRS",41000011,CDM,410,RC,94003,HCPCS,facility,both,,,,872,872,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY > 12 HRS",41000012,CDM,410,RC,94003,HCPCS,facility,both,,,,872,872,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU < 12 HRS",41000013,CDM,410,RC,94003,HCPCS,facility,both,,,,872,872,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU > 12 HRS",41000014,CDM,410,RC,94003,HCPCS,facility,both,,,,872,872,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC INHALATION TX SPAG, INITIAL",41000015,CDM,410,RC,94640,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC INHALATION TX SPAG, SUBSEQ DAY",41000016,CDM,410,RC,94640,HCPCS,facility,both,,,,91,91,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC INHALATION TX, CONT NEB W/BROCH, INITIAL DAY",41000017,CDM,410,RC,94640,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, INITIAL TREATMENT",41000019,CDM,410,RC,94640,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, SUBSEQ TREATMENT",41000020,CDM,410,RC,94640,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC INHALATION TX, MDI, INITIAL DAY",41000023,CDM,410,RC,94640,HCPCS,facility,both,,,,109,109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC INHALATION TX, MDI, SUBSEQ DAY",41000024,CDM,410,RC,94640,HCPCS,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INHALATION TX, ULTRASONIC NEB, INITIAL DAY",41000025,CDM,410,RC,94640,HCPCS,facility,both,,,,311,311,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AEROSOL PENTAMIDINE FOR P. CARINII,41000026,CDM,410,RC,94642,HCPCS,facility,both,,,,776,776,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY < 12 HRS",41000027,CDM,410,RC,94660,HCPCS,facility,both,,,,839,839,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY < 12 HRS",41000028,CDM,410,RC,94660,HCPCS,facility,both,,,,925,925,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY > 12 HRS",41000029,CDM,410,RC,94660,HCPCS,facility,both,,,,839,839,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY > 12 HRS",41000030,CDM,410,RC,94660,HCPCS,facility,both,,,,840,840,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVALUATE PT USE OF INHALER/PER DAY,41000031,CDM,410,RC,94664,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, INITIAL TX",41000032,CDM,410,RC,94667,HCPCS,facility,both,,,,112,112,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CHEST PT COMPREHENSIVE, 4 POSITIONS, INITIAL TX",41000033,CDM,410,RC,94667,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, SUBSEQ TX",41000034,CDM,410,RC,94668,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CHEST PT COMPREHENSIVE, 4 POSITIONS SUBSEQ TX",41000035,CDM,410,RC,94668,HCPCS,facility,both,,,,230,230,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VENTILATOR MGT, INITIAL DAY - ADULT",41000042,CDM,410,RC,94002,HCPCS,facility,both,,,,1410,1410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VENTILATOR MGT, INITIAL DAY - NICU",41000043,CDM,410,RC,94002,HCPCS,facility,both,,,,1410,1410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VENTILATOR MGT, SUBSEQ DAY - ADULT",41000044,CDM,410,RC,94003,HCPCS,facility,both,,,,1168,1168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VENTILATOR MGT, SUBSEQ DAY - NICU",41000045,CDM,410,RC,94003,HCPCS,facility,both,,,,1168,1168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AIRWAY INHALATION TX - INPATIENT ADMISSION,41000046,CDM,410,RC,94640,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AIRWAY INHALATION TX - OUTPATIENT ENCOUNTER,41000047,CDM,410,RC,94640,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC POS AIRWAY PRESSURE CPAP, PER DAY",41000048,CDM,410,RC,94660,HCPCS,facility,both,,,,1123,1123,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEST PT, INITIAL TX",41000049,CDM,410,RC,94667,HCPCS,facility,both,,,,188,188,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEST PT, SUBSEQ TX",41000050,CDM,410,RC,94668,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRACHEOSTOMY TUBE CHANGE,41000051,CDM,410,RC,31502,HCPCS,facility,both,,,,443,443,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CONTINUOUS INHALATION TX, 1ST HOUR",41000200,CDM,410,RC,94644,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CONTINUOUS INHALATION TX, EA ADD HOUR",41000201,CDM,410,RC,94645,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STRAPPING, UNNA BOOT",42000001,CDM,420,RC,29580,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STRAPPING, UNNA BOOT",42000001,CDM,420,RC,29580,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY SURFACE TENS,42000002,CDM,420,RC,64550,HCPCS,facility,both,,,,87,87,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MECHANICAL TRACTION THERAPY,42000003,CDM,420,RC,97012,HCPCS,facility,both,,,,204,204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTRICAL STIMULATION EA 15 MINS,42000004,CDM,420,RC,97032,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IONTOPHORESIS THERAPY EA 15 MINS,42000005,CDM,420,RC,97033,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ULTRASOUND THERAPY EA 15 MINS,42000006,CDM,420,RC,97035,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC EXERCISES EA 15 MINS,42000007,CDM,420,RC,97110,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEUROMUSCULAR REEDUCATION EA 15 MINS,42000008,CDM,420,RC,97112,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GAIT TRAINING THERAPY EA 15 MINS,42000009,CDM,420,RC,97116,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MASSAGE THERAPY EA 15 MINS,42000010,CDM,420,RC,97124,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MASSAGE THERAPY EA 15 MINS,42000010,CDM,420,RC,97124,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE HC MANUAL THERAPY EA 15 MINS,42000011,CDM,420,RC,97140,HCPCS,facility,both,,,,36,36,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE HC MANUAL THERAPY EA 15 MINS,42000011,CDM,420,RC,97140,HCPCS,facility,both,,,,271,271,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SELECTIVE DEBRIDEMENT 20 SQ CM OR LESS,42000012,CDM,420,RC,97597,HCPCS,facility,both,,,,319,319,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SELECTIVE DEBRIDEMENT EA ADDL SQ CM,42000013,CDM,420,RC,97598,HCPCS,facility,both,,,,319,319,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NEG PRESSURE WOUND TX W/DME, LESS THAN 50 SQ CM",42000014,CDM,420,RC,97605,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NEG PRESSURE WOUND TX W/DME, GREATER THAN 50 SQ CM",42000015,CDM,420,RC,97606,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ORTHOTIC MGMT & TRAINING, INITIAL ENCOUNTER, EA 15 MINS",42000017,CDM,420,RC,97760,HCPCS,facility,both,,,,344,344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PROSTHETIC TRAINING, INITIAL ENCOUNTER, EA 15 MINS",42000018,CDM,420,RC,97761,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC C/O ORTHOTIC/PROSTH USE EA 15 MINS,42000019,CDM,420,RC,97762,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTRICAL STIMULATION UA (NON-WOUND),42000021,CDM,420,RC,,,facility,both,,,,259,259,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOT OR COLD PACKS THERAPY,42000023,CDM,420,RC,97010,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VASOPNEUMATIC DEVICE THERAPY,42000050,CDM,420,RC,97016,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC AQUATIC THERAPY/EXERCISE EA 15 MINS,42000051,CDM,420,RC,97113,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC WOUND CARE NON-SELECTIVE, WO ANES, PER SESSION",42000052,CDM,420,RC,97602,HCPCS,facility,both,,,,319,319,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PHYSICAL PERFORMANCE TEST, EA 15 MINS",42000053,CDM,420,RC,97750,HCPCS,facility,both,,,,371,371,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFRARED THERAPY,42000055,CDM,420,RC,97026,HCPCS,facility,both,,,,13,13,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE HC INFRARED THERAPY,42000055,CDM,420,RC,97026,HCPCS,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEG PRESSURE WND TX NON DME < = 50 SQ CM,42000057,CDM,420,RC,97607,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEG PRESSURE WND TX NON DME > 50 SQ CM,42000058,CDM,420,RC,97608,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APPLY RIGID TOTAL CONTACT LEG CAST,42000059,CDM,420,RC,29445,HCPCS,facility,both,,,,873,873,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ORTH/PROST MGMT, UP/LOW EXT, AND/OR TRUNK, SUBSQ ENC, EA 15 MIN",42000061,CDM,420,RC,97763,HCPCS,facility,both,,,,228,228,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 1/1/2020 HC CANALITH REPOSITIONIONG PROCEDURE,42090018,CDM,420,RC,95992,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHYSICAL THERAPY RE-EVALUATION,42400002,CDM,424,RC,97002,HCPCS,facility,both,,,,463,463,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PT EVAL LOW COMPLEXITY,42400003,CDM,424,RC,97161,HCPCS,facility,both,,,,380,380,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PT EVAL MODERATE COMPLEXITY,42400004,CDM,424,RC,97162,HCPCS,facility,both,,,,553,553,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PT EVAL HIGH COMPLEXITY,42400005,CDM,424,RC,97163,HCPCS,facility,both,,,,729,729,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PT RE-EVAL EST PLAN CARE,42400006,CDM,424,RC,97164,HCPCS,facility,both,,,,737,737,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APPLY LONG ARM SPLINT,43000001,CDM,430,RC,29105,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY LONG ARM SPLINT,43000001,CDM,430,RC,29105,HCPCS,facility,both,,,,723,723,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC APPLY SHORT ARM SPLINT, STATIC",43000002,CDM,430,RC,29125,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC APPLY SHORT ARM SPLINT, STATIC",43000002,CDM,430,RC,29125,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC APPLY SHORT ARM SPLINT, DYNAMIC",43000003,CDM,430,RC,29126,HCPCS,facility,both,,,,723,723,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC APPLY SHORT ARM SPLINT, DYNAMIC",43000003,CDM,430,RC,29126,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC APPLY FINGER SPLINT, STATIC",43000004,CDM,430,RC,29130,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC APPLY FINGER SPLINT, STATIC",43000004,CDM,430,RC,29130,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC APPLY FINGER SPLINT, DYNAMIC",43000005,CDM,430,RC,29131,HCPCS,facility,both,,,,528,528,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC APPLY FINGER SPLINT, DYNAMIC",43000005,CDM,430,RC,29131,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY LONG LEG SPLINT,43000006,CDM,430,RC,29505,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY SHORT LEG SPLINT,43000007,CDM,430,RC,29515,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY SHORT LEG SPLINT,43000007,CDM,430,RC,29515,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED CASTING OR STRAPPING,43000008,CDM,430,RC,29799,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC UNLISTED CASTING OR STRAPPING,43000008,CDM,430,RC,29799,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARAFFIN BATH THERAPY,43000010,CDM,430,RC,97018,HCPCS,facility,both,,,,238,238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHIRLPOOL THERAPY,43000011,CDM,430,RC,97022,HCPCS,facility,both,,,,379,379,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (2,3,4 PTS)",43000012,CDM,430,RC,97150,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC ACTIVITY DIR EA 15 MINS,43000014,CDM,430,RC,97530,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS,43000015,CDM,430,RC,97532,HCPCS,facility,both,,,,174,174,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SENSORY INTEGRATION EA 15 MINS,43000016,CDM,430,RC,97533,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADL/SELF HOME MGMT EA 15 MINS,43000017,CDM,430,RC,97535,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC WHEELCHAIR MGMT TRAINING EA 15 MINS,43000019,CDM,430,RC,97542,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC REHAB GROUP 2 OR MORE,43000020,CDM,430,RC,97150,HCPCS,facility,both,,,,159,159,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS,43000027,CDM,430,RC,,,facility,both,,,,192,192,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN,43000028,CDM,430,RC,97129,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN,43000029,CDM,430,RC,97130,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONTRAST BATH THERAPY EA 15 MINS,43000201,CDM,430,RC,97034,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OCCUPATIONAL THERAPY RE -EVALUATION,43400002,CDM,434,RC,97004,HCPCS,facility,both,,,,463,463,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OT EVAL LOW COMPLEXITY,43400003,CDM,434,RC,97165,HCPCS,facility,both,,,,380,380,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OT EVAL MOD COMPLEXITY,43400004,CDM,434,RC,97166,HCPCS,facility,both,,,,553,553,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OT EVAL HIGH COMPLEXITY,43400005,CDM,434,RC,97167,HCPCS,facility,both,,,,729,729,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OT RE-EVAL EST PLAN CARE,43400006,CDM,434,RC,97168,HCPCS,facility,both,,,,737,737,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SLV THERAPY, INDIVIDUAL",44000001,CDM,440,RC,92507,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LARYNGEAL FUNCTION STUDY,44000002,CDM,440,RC,92520,HCPCS,facility,both,,,,719,719,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TX SWALLOWING DYSFUNCTION,44000003,CDM,440,RC,92526,HCPCS,facility,both,,,,265,265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVAL TO USE/FIT VOICE PROSTHETIC,44000004,CDM,440,RC,92597,HCPCS,facility,both,,,,652,652,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EVAL FOR SPEECH DEVICE RX, 1ST HR",44000006,CDM,440,RC,92607,HCPCS,facility,both,,,,527,527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EVAL FOR SPEECH DEVICE RX, EA ADDL 30 MIN",44000007,CDM,440,RC,92608,HCPCS,facility,both,,,,332,332,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC SP DEVICE SERVICE,44000008,CDM,440,RC,92609,HCPCS,facility,both,,,,435,435,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVALUATE SWALLOWING FUNCTION,44000009,CDM,444,RC,92610,HCPCS,facility,both,,,,809,809,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MOTION FLUORO SWALLOW FCN, CINE/VIDEO",44000010,CDM,440,RC,92611,HCPCS,facility,both,,,,699,699,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FEES W CINE OR VIDEO,44000011,CDM,440,RC,92612,HCPCS,facility,both,,,,699,699,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EVAL AUDITORY FUNCTION, 1ST HR",44000014,CDM,440,RC,92626,HCPCS,facility,both,,,,484,484,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EVAL AUDITORY FUNCTION, EA ADDL 15 MIN",44000015,CDM,440,RC,92627,HCPCS,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APHASIA ASSESMENT EACH HR,44000018,CDM,440,RC,96105,HCPCS,facility,both,,,,924,924,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COGNITIVE ASSESSMENT BY HC PRO PER HR,44000019,CDM,440,RC,96125,HCPCS,facility,both,,,,676,676,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SLV TREATMENT GROUP, 2 OR MORE 2-4",44000050,CDM,440,RC,92508,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SLV EVALUATION,44400001,CDM,444,RC,92506,HCPCS,facility,both,,,,411,411,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVALUATION OF SPEECH FLUENCY,44400002,CDM,444,RC,92521,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVALUATION OF SPEECH SOUND PRODUCTION,44400003,CDM,444,RC,92522,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVALUATION OF SPEECH SOUND PRODUCTION W/LANGUAGE COMPREHENSION,44400004,CDM,444,RC,92523,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BEHAVIORAL & QUALIT ANALYSIS VOICE/RESONANCE,44400005,CDM,444,RC,92524,HCPCS,facility,both,,,,609,609,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAINAGE OF ABSCESS; SINGLE,45000100,CDM,450,RC,10060,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DRAINAGE OF ABSCESS; SINGLE,45000100,CDM,450,RC,10060,HCPCS,facility,both,,,,2255,2255,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAINAGE OF ABSCESS; MULTIPLE,45000101,CDM,450,RC,10061,HCPCS,facility,both,,,,2328,2328,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAINAGE OF ABSCESS; MULTIPLE,45000101,CDM,450,RC,10061,HCPCS,facility,both,,,,517,517,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DRAINAGE OF PILONIDAL CYST; SIMPLE,45000102,CDM,450,RC,10080,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DRAINAGE OF PILONIDAL CYST; COMPLICATED,45000103,CDM,450,RC,10081,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL OF FOREIGN BODY, SUBQ, SIMPLE",45000104,CDM,450,RC,10120,HCPCS,facility,both,,,,269,269,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVAL OF FOREIGN BODY, SUBQ, SIMPLE",45000104,CDM,450,RC,10120,HCPCS,facility,both,,,,517,517,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL OF FOREIGN BODY, SUBQ, COMPLICATED",45000105,CDM,450,RC,10121,HCPCS,facility,both,,,,2074,2074,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DRAINAGE OF HEMATOMA/FLUID,45000106,CDM,450,RC,10140,HCPCS,facility,both,,,,2050,2050,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAINAGE OF HEMATOMA/FLUID,45000106,CDM,450,RC,10140,HCPCS,facility,both,,,,2050,2050,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST",45000107,CDM,450,RC,10160,HCPCS,facility,both,,,,505,505,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST",45000107,CDM,450,RC,10160,HCPCS,facility,both,,,,505,505,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEBRIDE INFECTED SKIN; UP TO 10% OF BODY SURFACE,45000108,CDM,450,RC,11000,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DEBRIDE INFECTED SKIN; UP TO 10% OF BODY SURFACE,45000108,CDM,450,RC,11000,HCPCS,facility,both,,,,1011,1011,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEBRIDE OPEN FRACTURE; SKIN AND SUBQ TISSUES,45000109,CDM,450,RC,11010,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DEBRIDE OPEN FRACTURE; SKIN TO BONE,45000110,CDM,450,RC,11012,HCPCS,facility,both,,,,3498,3498,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DEBRIDE, SUBQ TISSUE; FIRST 20 SQ CM OR LESS",45000111,CDM,450,RC,11042,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DEBRIDE, SUBQ TISSUE; FIRST 20 SQ CM OR LESS",45000111,CDM,450,RC,11042,HCPCS,facility,both,,,,9292,9292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DEBRIDE, MUSCLE AND/OR FASCIA; 1ST 20 SQ CM OR LESS",45000112,CDM,450,RC,11043,HCPCS,facility,both,,,,805,805,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DEBRIDE, MUSCLE AND/OR FASCIA; 1ST 20 SQ CM OR LESS",45000112,CDM,450,RC,11043,HCPCS,facility,both,,,,9292,9292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVAL OF SKIN TAGS, UP TO AND INCLD 15 LESIONS",45000113,CDM,450,RC,11200,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC EXCISION, BENIGN LESION, EXT MARG 0.5 < CM",45000114,CDM,450,RC,11400,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DEBRIDEMENT OF NAIL(S); 1 TO 5,45000115,CDM,450,RC,11720,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC AVULSION OF NAIL PLATE SIMPLE; SINGLE,45000116,CDM,450,RC,11730,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EVACUATION OF SUBUNGUAL HEMATOMA,45000117,CDM,450,RC,11740,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC REPAIR OF NAIL BED,45000118,CDM,450,RC,11760,HCPCS,facility,both,,,,801,801,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC EXCISION OF NAIL FOLD (EG, INGROWN TOENAIL)",45000119,CDM,450,RC,11765,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, S/N/A/G/TR/E; 2.5 CM OR LESS",45000120,CDM,450,RC,12001,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, S/N/A/G/TR/E; 2.6 CM TO 7.5 CM",45000121,CDM,450,RC,12002,HCPCS,facility,both,,,,250,250,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, S/N/A/G/TR/E; 7.6 CM TO 12.5 CM",45000122,CDM,450,RC,12004,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, S/N/A/G/TR/E; 12.6 CM TO 20.0 CM",45000123,CDM,450,RC,12005,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, S/N/A/G/TR/E; 20.1 CM TO 30.0 CM",45000124,CDM,450,RC,12006,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, F/E/N/L/MM; 2.5 CM OR LESS",45000125,CDM,450,RC,12011,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, F/E/N/L/MM; 2.6 CM TO 5.0 CM",45000126,CDM,450,RC,12013,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, F/E/N/L/MM; 5.1 CM TO 7.5 CM",45000127,CDM,450,RC,12014,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIMPLE WOUND, F/E/N/L/MM; 7.6 CM TO 12.5 CM",45000128,CDM,450,RC,12015,HCPCS,facility,both,,,,247,247,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 2.5 CM OR LESS",45000129,CDM,450,RC,12031,HCPCS,facility,both,,,,517,517,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 2.6 CM TO 7.5 CM",45000130,CDM,450,RC,12032,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 7.6 CM TO 12.5 CM",45000131,CDM,450,RC,12034,HCPCS,facility,both,,,,517,517,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 12.6 CM TO 20.0 CM",45000132,CDM,450,RC,12035,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 20.1 CM TO 30.0 CM",45000133,CDM,450,RC,12036,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, N-HF/GENIT; 2.5 CM OR LESS",45000134,CDM,450,RC,12041,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, N-HF/GENIT; 2.6 CM TO 7.5 CM",45000135,CDM,450,RC,12042,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, N-HF/GENIT; 7.6 CM TO 12.5 CM",45000136,CDM,450,RC,12044,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, N-HF/GENIT; 12.6 CM TO 20.0 CM",45000137,CDM,450,RC,12045,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 2.5 CM OR LESS",45000138,CDM,450,RC,12051,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 2.6 CM TO 5.0 CM",45000139,CDM,450,RC,12052,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 5.1 CM TO 7.5 CM",45000140,CDM,450,RC,12053,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INTERMED WOUND, S/A/T/EXT; 7.6 CM TO 12.5 CM",45000141,CDM,450,RC,12054,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM",45000142,CDM,450,RC,13101,HCPCS,facility,both,,,,804,804,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, TRUNK; EA ADDL 5 CM OR LESS",45000143,CDM,450,RC,13102,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, S/A/L; 1.1 CM TO 2.5 CM",45000144,CDM,450,RC,13120,HCPCS,facility,both,,,,804,804,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, S/A/L; 2.6 CM TO 7.5 CM",45000145,CDM,450,RC,13121,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, S/A/L; EA ADDL 5 CM OR LESS",45000146,CDM,450,RC,13122,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, F/G/H/F; 1.1 CM TO 2.5 CM",45000147,CDM,450,RC,13131,HCPCS,facility,both,,,,517,517,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, F/G/H/F; 2.6 CM TO 7.5 CM",45000148,CDM,450,RC,13132,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, F/G/H/F; EA ADDL 5 CM OR LESS",45000149,CDM,450,RC,13133,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, E/N/E/L; 1.0 CM OR LESS",45000150,CDM,450,RC,13150,HCPCS,facility,both,,,,79,79,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, E/N/E/L; 1.1 CM TO 2.5 CM",45000151,CDM,450,RC,13151,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, E/N/E/L; 2.6 CM TO 7.5 CM",45000152,CDM,450,RC,13152,HCPCS,facility,both,,,,806,806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR, COMPLEX, E/N/E/L; EA ADDL 5CM OR LESS",45000153,CDM,450,RC,13153,HCPCS,facility,both,,,,127,127,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INITIAL TREATMENT, FIRST DEGREE BURN",45000154,CDM,450,RC,16000,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRESS AND/OR DEBRIDE, P-THICKNESS BURNS, SMALL",45000155,CDM,450,RC,16020,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRESS AND/OR DEBRIDE, P-THICKNESS BURNS, MEDIUM",45000156,CDM,450,RC,16025,HCPCS,facility,both,,,,306,306,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ESCHAROTOMY; INITIAL INCISION,45000157,CDM,450,RC,16035,HCPCS,facility,both,,,,518,518,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EXPLORE WOUND; EXTREMITY,45000158,CDM,450,RC,20103,HCPCS,facility,both,,,,2068,2068,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPLANTATION, DIGIT, EXCL THUMB, COMPLETE",45000159,CDM,450,RC,20822,HCPCS,facility,both,,,,7725,7725,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE DEAC 1/1/2022 HC CLOSED TX NASAL FRACTURE W/O MANIPULATION,45000160,CDM,450,RC,21310,HCPCS,facility,both,,,,66,66,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX NASAL BONE FX W/MANIPULATION W/O STABILIZATION,45000161,CDM,450,RC,21315,HCPCS,facility,both,,,,1923,1923,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TREATMENT JAW DISLOCATION,45000162,CDM,450,RC,21480,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EA",45000163,CDM,450,RC,21800,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAINAGE, SHOULDER; DEEP ABSCESS OR HEMATOMA",45000164,CDM,450,RC,23030,HCPCS,facility,both,,,,3465,3465,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX CLAVICULAR WO MANIPULATION,45000165,CDM,450,RC,23500,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX SCAPULAR WO MANIPULATION,45000166,CDM,450,RC,23570,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX SCAPULAR WITH MANIPULATION,45000167,CDM,450,RC,23575,HCPCS,facility,both,,,,1984,1984,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX HUMERAL WO MANIPULATION,45000168,CDM,450,RC,23600,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX HUMERAL WITH MANIPULATION,45000169,CDM,450,RC,23605,HCPCS,facility,both,,,,1953,1953,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX SHOULDER DISLOCATION, W/MANIPULATION; WO ANES",45000170,CDM,450,RC,23650,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX SHOULDER DISLOCATION, W/MANIPULATION; ANES",45000171,CDM,450,RC,23665,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAINAGE, ARM; DEEP ABSCESS OR HEMATOMA",45000172,CDM,450,RC,23930,HCPCS,facility,both,,,,3546,3546,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAINAGE, ARM; BURSA",45000173,CDM,450,RC,23931,HCPCS,facility,both,,,,1562,1562,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX HUMERAL WO MANIPULATION,45000174,CDM,450,RC,24500,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX SC/TC HUMERAL WO MANIPULATION,45000175,CDM,450,RC,24530,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX EC HUMERAL WO MANIPULATION,45000176,CDM,450,RC,24560,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC OPEN TX HUMERAL EPICONDYLAR FRACTURE,45000177,CDM,450,RC,24576,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX ELBOW DISLOCATION WO ANESTHESIA,45000178,CDM,450,RC,24600,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX RADIAL HEAD WITH MANIPULATION,45000179,CDM,450,RC,24640,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX RADIAL HEAD OR NECK FX WO MANIPULATION,45000180,CDM,450,RC,24650,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX ULNAR PROXIMAL END FX WO MANIPULATION,45000181,CDM,450,RC,24670,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX RADIAL SHAFT FX WO MANIPULATION,45000182,CDM,450,RC,25500,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX ULNAR SHAFT FX WITH MANIPULATION,45000183,CDM,450,RC,25535,HCPCS,facility,both,,,,233,233,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX RADIUS/ULNAR SHAFT FX WO MANIPULATION,45000184,CDM,450,RC,25560,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX RADIUS/ULNAR SHAFT FX W MANIPULATION,45000185,CDM,450,RC,25565,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX DISTAL RADIAL FX WO MANIPULATION,45000186,CDM,450,RC,25600,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX DISTAL RADIAL FX WITH MANIPULATION,45000187,CDM,450,RC,25605,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSED TX DISTAL RADIAL FX WITH MANIPULATION,45000187,CDM,450,RC,25605,HCPCS,facility,both,,,,1988,1988,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX CARPAL SCAPHOID FX WO MANIPULATION,45000188,CDM,450,RC,25622,HCPCS,facility,both,,,,283,283,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX CARPAL SCAPHOID FX WITH MANIPULATION,45000189,CDM,450,RC,25624,HCPCS,facility,both,,,,1943,1943,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX CARPAL BONE FX WO MANIPULATION, EACH",45000190,CDM,450,RC,25630,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX CARPAL BONE FX WITH MANIP, EACH",45000191,CDM,450,RC,25635,HCPCS,facility,both,,,,1969,1969,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX WRIST DISLOCATION, WITH MANIPULATION",45000192,CDM,450,RC,25660,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DRAINAGE OF FINGER ABSCESS; SIMPLE,45000193,CDM,450,RC,26010,HCPCS,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DRAINAGE OF FINGER ABSCESS; COMPLICATED,45000194,CDM,450,RC,26011,HCPCS,facility,both,,,,2079,2079,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR FLEXOR TENDOR, NOT ZONE 2 WO GRAFT, EACH",45000195,CDM,450,RC,26350,HCPCS,facility,both,,,,3882,3882,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR EXTENSOR TENDON, HAND WO FG, EACH",45000196,CDM,450,RC,26410,HCPCS,facility,both,,,,1957,1957,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR EXTENSOR TENDON, FINGER; WO FG, EACH",45000197,CDM,450,RC,26418,HCPCS,facility,both,,,,1961,1961,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX METACARPAL FX, SINGLE; WO MANIP, EA",45000198,CDM,450,RC,26600,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX METACARPAL FX, SINGLE; W/MANIP, EACH",45000199,CDM,450,RC,26605,HCPCS,facility,both,,,,283,283,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX THUMB FX WITH MANIPULATION,45000200,CDM,450,RC,26641,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX KNUCKLE, W/MANIPULATION; WO ANES",45000201,CDM,450,RC,26700,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX FINGER SHAFT; WO MANIPULATION, EACH",45000202,CDM,450,RC,26720,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX FINGER SHAFT; WITH MANIPULATION, EA",45000203,CDM,450,RC,26725,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX ARTICULAR FRACTURE, WITH MANIPULATION, EACH",45000204,CDM,450,RC,26742,HCPCS,facility,both,,,,1988,1988,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX DISTAL FINGER; WO MANIPULATION, EACH",45000205,CDM,450,RC,26750,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX DISTAL FINGER WITH MANIPULATION, EACH",45000206,CDM,450,RC,26755,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX FINGER DISLOCATION, WITH MANIP WO ANES",45000207,CDM,450,RC,26770,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC Closed fx pelvic ring, dislocation, wo manipulation",45000208,CDM,450,RC,27193,HCPCS,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX COCCYGEAL FRACTURE,45000209,CDM,450,RC,27200,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED FX FEMORAL, NECK WO MANIPULATION",45000210,CDM,450,RC,27230,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX FEMORAL (INTER/PERI/SUB) WO MANIPULATION,45000211,CDM,450,RC,27238,HCPCS,facility,both,,,,1750,1750,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED TX HIP DISLOCATION, TRAUMATIC; WO ANESTHESIA",45000212,CDM,450,RC,27250,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX POST HIP ARTHROPLASTY DISLOCATION; WO ANES,45000213,CDM,450,RC,27265,HCPCS,facility,both,,,,1981,1981,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSED TX POST HIP ARTHROPLASTY DISLOCATION; WO ANES,45000213,CDM,450,RC,27265,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAIN, DEEP ABSCESS, THIGH OR KNEE REGION",45000214,CDM,450,RC,27301,HCPCS,facility,both,,,,3513,3513,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED FX FEMORAL SHAFT, WITHOUT MANIPULATION",45000215,CDM,450,RC,27500,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED FX FEMORAL, DISTAL END WO MANIPULATION",45000216,CDM,450,RC,27508,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX PATELLAR WO MANIPULATION,45000217,CDM,450,RC,27520,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX TIBIAL PLATEAU WO MANIPULATION,45000218,CDM,450,RC,27530,HCPCS,facility,both,,,,284,284,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX KNEE DISLOCATION WO ANESTHESIA,45000219,CDM,450,RC,27550,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX PATELLAR DISLOCATION WO ANESTHESIA,45000220,CDM,450,RC,27560,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAINAGE, LEG OR ANKLE; DEEP ABSCESS",45000221,CDM,450,RC,27603,HCPCS,facility,both,,,,3535,3535,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX TIBIAL SHAFT WO MANIPULATION,45000222,CDM,450,RC,27750,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX MEDIAL MALLEOLUS WO MANIPULATION,45000223,CDM,450,RC,27760,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX PROXIMAL FIBULA OR SHAFT WO MANIPULATION,45000224,CDM,450,RC,27780,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX PROXIMAL FIBULA OR SHAFT WITH MANIPULATION,45000225,CDM,450,RC,27781,HCPCS,facility,both,,,,1878,1878,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX DISTAL FIBULAR WO MANIPULATION,45000226,CDM,450,RC,27786,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX DISTAL FIBULAR WITH MANIPULATION,45000227,CDM,450,RC,27788,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX BIMALLEOLAR ANKLE WO MANIPULATION,45000228,CDM,450,RC,27808,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX BIMALLEOLAR ANKLE WITH MANIPULATION,45000229,CDM,450,RC,27810,HCPCS,facility,both,,,,1986,1986,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX ANKLE DISLOCATION; WO ANESTHESIA,45000230,CDM,450,RC,27840,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS",45000231,CDM,450,RC,28190,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR FOOT TENDON, EXTENSOR, EACH",45000232,CDM,450,RC,28208,HCPCS,facility,both,,,,3427,3427,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX TALUS WO MANIPULATION,45000233,CDM,450,RC,28430,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC TX TARSAL BONE FRACTURE WO MANIPULATION, EACH",45000234,CDM,450,RC,28450,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC TX TARSAL BONE FRACTURE WITH MANIPULATION, EACH",45000235,CDM,450,RC,28455,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED FX METATARSALWO MANIPULATION, EACH",45000236,CDM,450,RC,28470,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED FX METATARSALWITH MANIPULATION, EACH",45000237,CDM,450,RC,28475,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX GREAT TOE WITHOUT MANIPULATION,45000238,CDM,450,RC,28490,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX GREAT TOE WITH MANIPULATION,45000239,CDM,450,RC,28495,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED FX TOE WITHOUT MANIPULATION, EACH",45000240,CDM,450,RC,28510,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CLOSED FX TOE WITH MANIPULATION, EACH",45000241,CDM,450,RC,28515,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX TARSAL DISLOCATION WITHOUT ANESTHESIA,45000242,CDM,450,RC,28540,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX MTP JOINT DISLOCATION WITH ANESTHESIA,45000243,CDM,450,RC,28630,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX IP JOINT DISLOCATION WITHOUT ANESTHESIA,45000244,CDM,450,RC,28660,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "DEAC 7/1/2023 HC APPLY CAST, HAND AND LOWER FOREARM (GAUNTLET)",45000245,CDM,450,RC,29085,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, SHOULDER (EG, VELPEAU)",45000246,CDM,450,RC,29240,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, SHOULDER (EG, VELPEAU)",45000246,CDM,450,RC,29240,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STRAPPING, ELBOW OR WRIST",45000247,CDM,450,RC,29260,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STRAPPING, ELBOW OR WRIST",45000247,CDM,450,RC,29260,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, HAND OR FINGER",45000248,CDM,450,RC,29280,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, HAND OR FINGER",45000248,CDM,450,RC,29280,HCPCS,facility,both,,,,598,598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC APPLY CAST, SHORT LEG",45000249,CDM,450,RC,29405,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, HIP",45000250,CDM,450,RC,29520,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, KNEE",45000251,CDM,450,RC,29530,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, KNEE",45000251,CDM,450,RC,29530,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STRAPPING, ANKEL AND/OR FOOT",45000252,CDM,450,RC,29540,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, ANKEL AND/OR FOOT",45000252,CDM,450,RC,29540,HCPCS,facility,both,,,,485,485,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STRAPPING, TOES",45000253,CDM,450,RC,29550,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC STRAPPING, TOES",45000253,CDM,450,RC,29550,HCPCS,facility,both,,,,368,368,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVAL FOREIGN BODY, INTRANASAL",45000254,CDM,450,RC,30300,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE",45000255,CDM,450,RC,30901,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX",45000256,CDM,450,RC,30903,HCPCS,facility,both,,,,189,189,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CONTROL NASAL HEMORRHAGE, POSTERIOR, INITIAL",45000257,CDM,450,RC,30905,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC LARYNGOSCOPY DIRECT, DIAGNOSTIC, EXCEPT NEWBORN",45000258,CDM,450,RC,31525,HCPCS,facility,both,,,,1667,1667,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INSERT CHEST TUBE (THORACOSTOMY),45000259,CDM,450,RC,32551,HCPCS,facility,both,,,,2012,2012,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INSERT CHEST TUBE (THORACOSTOMY),45000259,CDM,450,RC,32551,HCPCS,facility,both,,,,4124,4124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REPAIR MOUTH LACERATION, 2.5 CM OR LESS",45000260,CDM,450,RC,40830,HCPCS,facility,both,,,,289,289,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR TONGUE LACERATION, ANT 1/3, 2.5 CM OR LESS",45000261,CDM,450,RC,41250,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR TONGUE LACERATION, POST 1/3, 2.5 CM OR LESS",45000262,CDM,450,RC,41251,HCPCS,facility,both,,,,289,289,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR TONGUE LACERATION, OVER 2.6 CM OR COMPLEX",45000263,CDM,450,RC,41252,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAINAGE OF ABSCESS, CYST, GUM STRUCTURES",45000264,CDM,450,RC,41800,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INCISION AND DRAINAGE ABSCESS; PERITONSILLAR,45000265,CDM,450,RC,42700,HCPCS,facility,both,,,,1090,1090,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INCISION AND DRAINAGE ABSCESS; PERITONSILLAR,45000265,CDM,450,RC,42700,HCPCS,facility,both,,,,289,289,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC REMOVAL OF FOREIGN BODY FROM PHARYNX,45000266,CDM,450,RC,42809,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC Change gastro tube, percut, wo image/guide",45000267,CDM,450,RC,43760,HCPCS,facility,both,,,,384,384,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC Change gastro tube, percut, wo image/guide",45000267,CDM,450,RC,43760,HCPCS,facility,both,,,,668,668,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INCISION AND DRAINAGE, RECTAL ABCESS",45000268,CDM,450,RC,46040,HCPCS,facility,both,,,,611,611,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INCISION AND DRAINAGE, RECTAL ABCESS",45000268,CDM,450,RC,46040,HCPCS,facility,both,,,,1499,1499,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL",45000269,CDM,450,RC,46050,HCPCS,facility,both,,,,1152,1152,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INCISION OF THROMBOSED HEMORRHOID, EXTERNAL",45000270,CDM,450,RC,46083,HCPCS,facility,both,,,,299,299,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVE THROMBOSED HEMORRHOID, EXTERNAL",45000271,CDM,450,RC,46320,HCPCS,facility,both,,,,1499,1499,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CHANGE OF CYSTOSTOMY TUBE; SIMPLE,45000272,CDM,450,RC,51705,HCPCS,facility,both,,,,438,438,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM,45000273,CDM,450,RC,54220,HCPCS,facility,both,,,,438,438,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DRAINAGE OF SCROTAL WALL ABSCESS,45000274,CDM,450,RC,55100,HCPCS,facility,both,,,,2072,2072,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS,45000275,CDM,450,RC,56405,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS,45000276,CDM,450,RC,56420,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH",45000277,CDM,450,RC,62273,HCPCS,facility,both,,,,1191,1191,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH",45000277,CDM,450,RC,62273,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH",45000277,CDM,450,RC,62273,HCPCS,facility,both,,,,1275,1275,,,,,,,,,,,,,Gross Charge Type: SMH L&D FEE SCHEDULE "HC INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH",45000277,CDM,450,RC,62273,HCPCS,facility,both,,,,2280,2280,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; OTHER PERIPHER NERVE OR BRCH",45000278,CDM,450,RC,64450,HCPCS,facility,both,,,,887,887,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; OTHER PERIPHER NERVE OR BRCH",45000278,CDM,450,RC,64450,HCPCS,facility,both,,,50,2284,2284,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; OTHER PERIPHER NERVE OR BRCH",45000278,CDM,450,RC,64450,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVAL FOREIGN BODY, CONJUNCTIVAL SUPERFICIAL",45000279,CDM,450,RC,65205,HCPCS,facility,both,,,,373,373,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL FOREIGN BODY, CONJUNCTIVAL EMBEDDED",45000280,CDM,450,RC,65210,HCPCS,facility,both,,,,475,475,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL FOREIGN BODY, WITHOUT SLIT LAMP",45000281,CDM,450,RC,65220,HCPCS,facility,both,,,,473,473,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL FOREIGN BODY, WITH SLIT LAMP",45000282,CDM,450,RC,65222,HCPCS,facility,both,,,,146,146,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID",45000283,CDM,450,RC,67700,HCPCS,facility,both,,,,366,366,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL OF EMBEDDED FOREIGN BODY, EYELID",45000284,CDM,450,RC,67938,HCPCS,facility,both,,,,334,334,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE",45000285,CDM,450,RC,69000,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REMOVAL FOREIGN BODY, AUDITORY CANAL, WO ANES",45000286,CDM,450,RC,69200,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC REMOVAL IMPACTED CERUMEN,45000287,CDM,450,RC,69210,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CARDIOVERSION ELECTRIC EXT,45000288,CDM,450,RC,92960,HCPCS,facility,both,,,,1820,1820,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CARDIOVERSION ELECTRIC EXT,45000288,CDM,450,RC,92960,HCPCS,facility,both,,,,3010,3010,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Moderate sedation by same phys 5 yrs +, 1st 30 mins",45000289,CDM,450,RC,99144,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC Moderate sedation by same phys 5 yrs +, 1st 30 mins",45000289,CDM,450,RC,99144,HCPCS,facility,both,,,,506,506,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE "HC Moderate sedation by same phys 5 yrs +, 1st 30 mins",45000289,CDM,450,RC,99144,HCPCS,facility,both,,,,964,964,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Moderate sedation by same phys, ea addl 15 mins",45000290,CDM,450,RC,99145,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC Moderate sedation diff phys < 5 yrs, 1st 30 min",45000291,CDM,450,RC,99148,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC Moderate sedation diff phys, ea addl 15 mins",45000292,CDM,450,RC,99150,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CRITICAL CARE FIRST HOUR,45000293,CDM,450,RC,99291,HCPCS,facility,both,,,,3558,3558,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CRITICAL CARE ADDL 30 MIN,45000294,CDM,450,RC,99292,HCPCS,facility,both,,,,411,411,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED TX ULNAR FX PROXIMAL END W MNP,45000295,CDM,450,RC,24675,HCPCS,facility,both,,,,1975,1975,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC VENIPUNCTURE < 3 YRS OTHER VEIN (PHYS),45000296,CDM,450,RC,36406,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC VENIPUNCTURE AGE 3 YRS/>,45000297,CDM,450,RC,36410,HCPCS,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC VENIPUNCTURE AGE 3 YRS/>,45000297,CDM,450,RC,36410,HCPCS,facility,both,,,,193,193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VENIPUNCTURE CUTDOWN; AGE 1 OR OVER,45000298,CDM,450,RC,36425,HCPCS,facility,both,,,,523,523,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ASPIRATE PLEURA WO IMAGING,45000299,CDM,761,RC,32554,HCPCS,facility,both,,,,1367,1367,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ASPIRATE PLEURA WO IMAGING,45000299,CDM,761,RC,32554,HCPCS,facility,both,,,,2299,2299,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CYSTOSCOPY W INSERT INDWELLING URETER STENT,45000300,CDM,450,RC,52332,HCPCS,facility,both,,,,3355,3355,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC OPEN TX FINGER SHAFT EA,45000301,CDM,450,RC,26735,HCPCS,facility,both,,,,4750,4750,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC REPAIR MOUTH LACERATION 2.5CM OR COMPLEX,45000302,CDM,450,RC,40831,HCPCS,facility,both,,,,2589,2589,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CONTROL OROPHARYNGEAL HEMORRH: SIMPLE,45000303,CDM,450,RC,42960,HCPCS,facility,both,,,,633,633,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC REPAIR LIP, FULL THICK, VERMILION",45000304,CDM,450,RC,40650,HCPCS,facility,both,,,,2643,2643,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC TREAT RADIUS FRACTURE,45000305,CDM,450,RC,24655,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC TREAT HUMERUS FRACTURE,45000306,CDM,450,RC,24577,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC HC REPAIR OF VAGINA,45000307,CDM,450,RC,57200,HCPCS,facility,both,,,,5869,5869,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX SC/TC HUMERAL W MANIPULATION,45000308,CDM,450,RC,24535,HCPCS,facility,both,,,,286,286,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CLOSED FX SC/TC HUMERAL W MANIPULATION,45000308,CDM,450,RC,24535,HCPCS,facility,both,,,,3007,3007,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRAINAGE OF ABSCESS OF PALATE, UVULA",45000309,CDM,450,RC,42000,HCPCS,facility,both,,,,1919,1919,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NASAL/SINUS ENDOSCOPY W HEMORRHAGE CONTROL,45000310,CDM,450,RC,31238,HCPCS,facility,both,,,,4026,4026,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVAL OR BIVALVING; GAUNTLET, BOOT OR BODY CAST",45000311,CDM,450,RC,29700,HCPCS,facility,both,,,,859,859,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LIP REPAIR, FULL THICKNESS; > ONE-HALF VERTICAL HEIGHT, OR COMPLEX",45000312,CDM,450,RC,40654,HCPCS,facility,both,,,,6062,6062,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSED TX FX WEIGHT BEAR DISTAL TIBIA; W OR W/O ANES; MANIPUL,45000313,CDM,450,RC,27825,HCPCS,facility,both,,,,8599,8599,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GASTRIC INTUBATION & ASPIRATION(S), TX, INCL LAVAGE",45000314,CDM,450,RC,43753,HCPCS,facility,both,,,,905,905,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPEN TX NASAL SEPTAL FRACTURE WITH OR WITHOUT STABILIZATION,45000315,CDM,450,RC,21336,HCPCS,facility,both,,,,6685,6685,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RHINOPLASTY, PRIMARY; LATERAL & ALAR CARTILAGES &/OR ELEVATE TIP",45000316,CDM,450,RC,30400,HCPCS,facility,both,,,,11326,11326,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRAIN ABSCESS/HEMATOMA, NASAL, INTERNAL APPROACH",45000317,CDM,450,RC,30000,HCPCS,facility,both,,,,693,693,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,45000318,CDM,450,RC,17250,HCPCS,facility,both,,,,597,597,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE - UNILAT,45000319,CDM,450,RC,69209,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH",45000320,CDM,450,RC,26530,HCPCS,facility,both,,,,10285,10285,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA,45000321,CDM,450,RC,24605,HCPCS,facility,both,,,,4717,4717,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REPAIR BLOOD VESSEL DIRECT; HAND, FINGER",45000322,CDM,450,RC,35207,HCPCS,facility,both,,,,9161,9161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA",45000323,CDM,450,RC,27252,HCPCS,facility,both,,,,6705,6705,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLOSED TX NASAL BONE FX W/MANIPULATION W/ STABILIZATION,45000324,CDM,450,RC,21320,HCPCS,facility,both,,,,18344,18344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EXCISION; LIP FULL THICKNESS, RECONSTRUCT W/LOCAL FLAP",45000328,CDM,450,RC,40525,HCPCS,facility,both,,,,18344,18344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UNLISTED PROC, DENTOALVEOLAR STRUCTURES",45000329,CDM,450,RC,41899,HCPCS,facility,both,,,,890,890,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UNLISTED PROC, TONGUE OR FLOOR OF MOUTH",45000330,CDM,450,RC,41599,HCPCS,facility,both,,,,7695,7695,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FORESKIN MANIPULATION INCL LYSIS OF ADHESIONS,45000331,CDM,450,RC,54450,HCPCS,facility,both,,,,811,811,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CANTHOTOMY,45000332,CDM,450,RC,67715,HCPCS,facility,both,,,,7775,7775,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMERGENCY DEPT VISIT LVL 1,45100001,CDM,451,RC,99281,HCPCS,facility,both,,,,406,406,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EMERGENCY DEPT VISIT LVL 2,45200002,CDM,452,RC,99282,HCPCS,facility,both,,,,753,753,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EMERGENCY DEPT VISIT LVL 2,45200002,CDM,452,RC,99282,HCPCS,facility,both,,,,661,661,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMERGENCY DEPT VISIT LVL 3,45200003,CDM,452,RC,99283,HCPCS,facility,both,,,,1039,1039,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EMERGENCY DEPT VISIT LVL 4,45200004,CDM,452,RC,99284,HCPCS,facility,both,,,,1317,1317,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EMERGENCY DEPT VISIT LVL 4,45200004,CDM,452,RC,99284,HCPCS,facility,both,,,,1585,1585,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMERGENCY DEPT VISIT LVL 5,45200005,CDM,452,RC,99285,HCPCS,facility,both,,,,1882,1882,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "DEAC 7/1/2018 HC INCENTIVE SPIROMETRY, INITIAL TX",46000001,CDM,460,RC,94010,HCPCS,facility,both,,,,386,386,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPIROMETRY,46000003,CDM,460,RC,94010,HCPCS,facility,both,,,,640,640,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPIROMETRY W/BRONCHODILATOR,46000004,CDM,460,RC,94060,HCPCS,facility,both,,,,1033,1033,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TOTAL VITAL CAPACITY,46000006,CDM,460,RC,94150,HCPCS,facility,both,,,,257,257,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HB RESPIRATORY FLOW VOLUME LOOP - NON-MARYLAND,46000008,CDM,460,RC,94375,HCPCS,facility,both,,,,955,955,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CARDIOPULM EXERCISE TEST, INCL MEASURE MIN VENT, CO2, O2 & ECG",46000009,CDM,460,RC,94621,HCPCS,facility,both,,,,1992,1992,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CO/MEMBRANE DIFFUSE CAPACITY,46000014,CDM,460,RC,94729,HCPCS,facility,both,,,,550,550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PULSE OXIMETRY,46000015,CDM,460,RC,94760,HCPCS,facility,both,,,,509,509,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PULSE OX MULTIPLE, EG EXERCISE",46000016,CDM,460,RC,94761,HCPCS,facility,both,,,,611,611,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, INITIAL DAY",46000017,CDM,460,RC,94770,HCPCS,facility,both,,,,554,554,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, SUBSEQ DAY",46000018,CDM,460,RC,94770,HCPCS,facility,both,,,,443,443,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, INITIAL DAY",46000024,CDM,460,RC,94799,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, SUBSEQ DAY",46000025,CDM,460,RC,94799,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC OXYGEN THERAPY, INITIAL DAY",46000030,CDM,460,RC,94799,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC OXYGEN THERAPY, SUBSEQ DAY",46000031,CDM,460,RC,94799,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BEDSIDE PULMONARY MECHANICS,46000032,CDM,460,RC,94799,HCPCS,facility,both,,,,257,257,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRACHEOSTOMY TUBE CARE, NON-VENT",46000033,CDM,460,RC,94799,HCPCS,facility,both,,,,257,257,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Pulmonary stress test, simple",46000051,CDM,460,RC,94620,HCPCS,facility,both,,,,1345,1345,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PULMONARY FUNCTION TEST BY GAS,46000052,CDM,460,RC,94727,HCPCS,facility,both,,,,524,524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONTINUOUS PULSE OX,46000053,CDM,460,RC,94762,HCPCS,facility,both,,,,920,920,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SURFACTANT ADMIN THRU TUBE,46000054,CDM,460,RC,94610,HCPCS,facility,both,,,,967,967,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY < 12 HRS",46000056,CDM,460,RC,94799,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY > 12 HRS",46000057,CDM,460,RC,94799,HCPCS,facility,both,,,,83,83,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY < 12 HRS",46000058,CDM,460,RC,94799,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY > 12 HRS",46000059,CDM,460,RC,94799,HCPCS,facility,both,,,,28,28,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PULM STRESS TEST(6 MINUTE WALK) INC HR,OXIMET,OXY TITR, WHEN PERF",46000063,CDM,460,RC,94618,HCPCS,facility,both,,,,2585,2585,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EXERCISE TEST BRONCHOSPASM, INCL PRE & POST SPIRO,W/ECG & PULSE OX",46000064,CDM,460,RC,94617,HCPCS,facility,both,,,,2585,2585,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CO2 EXPIRED GAS BY IR / PER DAY,46000065,CDM,460,RC,94799,HCPCS,facility,both,,,,1015,1015,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SMH CONTINUOUS AEROSOL THERAPY, INITIAL DAY",46000080,CDM,460,RC,94799,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SMH CONTINUOUS AEROSOL THERAPY, SUBSEQ DAY",46000081,CDM,460,RC,94799,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SMH OXYGEN THERAPY, INITIAL DAY",46000082,CDM,460,RC,94799,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SMH OXYGEN THERAPY, SUBSEQ DAY",46000083,CDM,460,RC,94799,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SMH HEAT HF NASAL CANNULA, INITIAL DAY",46000084,CDM,460,RC,94799,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SMH HEAT HF NASAL CANNULA, SUBSEQ DAY",46000085,CDM,460,RC,94799,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TYMPANOMETRY & REFLEX THRESH,47000013,CDM,470,RC,92550,HCPCS,facility,both,,,,271,271,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CALORIC VSTBLR TEST W/REC, BILATERAL BITHERMAL",47000014,CDM,470,RC,92537,HCPCS,facility,both,,,,768,768,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CALORIC VSTBLR TEST W/REC, BILATERAL; MONOTHERMAL",47000015,CDM,470,RC,92538,HCPCS,facility,both,,,,768,768,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC AUDITORY EVOKED POTENTIALS; SCRN AUDIT POTENT W/STIMULI, AUTO ANALYS",47000017,CDM,471,RC,92650,HCPCS,facility,both,,,,282,282,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC AUDITORY EVOKED POTENTIALS; HEARING STATUS DETER, BBAND STIMULI, I&R",47000018,CDM,471,RC,92651,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC AUDITORY EVOKED POTENTIALS; THRESHOLD ESTIM AT MULTI FREQ, I & R",47000019,CDM,471,RC,92652,HCPCS,facility,both,,,,337,337,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC AUDITORY EVOKED POTENTIALS; NEURODIAGNOSTIC, W/INTRP & RPT",47000020,CDM,471,RC,92653,HCPCS,facility,both,,,,337,337,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SMH ONLY HEARING AID CONSULT,47080001,CDM,470,RC,,,facility,both,,,,157,157,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FITTING/ORIENTATION/CHECKING OF HA (LOSS/DAMAGE),47080002,CDM,470,RC,,,facility,both,,,,251,251,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA REPAIR/MODIFICATION COMPLETE,47080003,CDM,470,RC,,,facility,both,,,,463,463,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA REPAIR/MODIFICATION MONAURAL,47080004,CDM,470,RC,,,facility,both,,,,38,38,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA REPAIR/MODIFICATION BINAURAL,47080005,CDM,470,RC,,,facility,both,,,,51,51,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA REPAIR/MODIFICATION MONAURAL,47080006,CDM,470,RC,,,facility,both,,,,34,34,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA REPAIR/MODIFICATION BINAURAL,47080007,CDM,470,RC,,,facility,both,,,,45,45,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA REPAIR MONAURAL OUT WA,47080008,CDM,470,RC,,,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA REPAIR BINAURAL OUT WA,47080009,CDM,470,RC,,,facility,both,,,,113,113,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HA DISPENSING FEE UNSPECIFIED,47080010,CDM,470,RC,,,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HA DISPENSING FEE UNSPEC, REPLACEMENT",47080011,CDM,470,RC,,,facility,both,,,,201,201,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SCREENING TEST, PURE TONE AIR ONLY",47100001,CDM,471,RC,92551,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PURE TONE AUDIOMETRY, AIR ONLY",47100002,CDM,471,RC,92552,HCPCS,facility,both,,,,264,264,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PURE TONE AUDIOMETRY, AIR & BONE",47100003,CDM,471,RC,92553,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPEECH AUDIOMETRY THESHOLD W/SR,47100004,CDM,471,RC,92556,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SPEECH AUDIOMETRY W/SR, COMPREHENSIVE",47100005,CDM,471,RC,92557,HCPCS,facility,both,,,,831,831,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TYMPANOMETRY (IMP TESTING),47100006,CDM,471,RC,92567,HCPCS,facility,both,,,,243,243,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACOUSTIC REFLEX TESTING,47100007,CDM,471,RC,92568,HCPCS,facility,both,,,,243,243,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VISUAL REINFORCE AUDIOMETRY,47100008,CDM,471,RC,92579,HCPCS,facility,both,,,,443,443,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONDITIONING PLAY AUDIOMETRY,47100009,CDM,471,RC,92582,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEAC 01/01/2021 AUDITORY EP - COMPREHENSIVE,47100010,CDM,471,RC,92585,HCPCS,facility,both,,,,1078,1078,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEAC 01/01/2021 AUDITORY EP - LIMITED,47100011,CDM,471,RC,92586,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVOKED AUDITORY TEST LIMITED,47100012,CDM,471,RC,92587,HCPCS,facility,both,,,,765,765,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ELECTRO HEARING AID TEST, MONAURAL",47100013,CDM,471,RC,92594,HCPCS,facility,both,,,,144,144,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ELECTRO HEARING AID TEST, BINAURAL",47100014,CDM,471,RC,92595,HCPCS,facility,both,,,,193,193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPEECH AUDIOMETRY THRESHOLD,47100015,CDM,471,RC,92555,HCPCS,facility,both,,,,243,243,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACOUSTIC IMMITTANCE TESTING,47100016,CDM,471,RC,92570,HCPCS,facility,both,,,,343,343,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SELECT PICTURE AUDIOMETRY,47100017,CDM,471,RC,92583,HCPCS,facility,both,,,,544,544,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ELECTROCOCHLEOGRAPHY,47100018,CDM,471,RC,92584,HCPCS,facility,both,,,,1420,1420,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVOKED AUDITORY TEST COMPLETE,47100019,CDM,471,RC,92588,HCPCS,facility,both,,,,859,859,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EVOKED AUDITORY TEST NEWBORN,47100020,CDM,471,RC,92587,HCPCS,facility,both,,,,238,238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NASOPHARYNGOSCOPY,47100150,CDM,471,RC,92511,HCPCS,facility,both,,,,604,604,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEARING AID EXAM ONE EAR,47100151,CDM,471,RC,92590,HCPCS,facility,both,,,,509,509,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEARING AID EXAM BOTH EARS,47100152,CDM,471,RC,92591,HCPCS,facility,both,,,,765,765,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC STENGER TEST, PURE TONE",47100153,CDM,471,RC,92565,HCPCS,facility,both,,,,188,188,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TINNITUS ASSESSMENT,47100154,CDM,471,RC,92625,HCPCS,facility,both,,,,573,573,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EVOKED AUDITORY TEST QUAL, SCREENING",47100163,CDM,471,RC,92558,HCPCS,facility,both,,,,314,314,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYOCRD STRAIN IMG USING SPECKLE TRCK ASSMT OF MYOCRD MECHAN,48000003,CDM,483,RC,93356,HCPCS,facility,both,,,,915,915,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NS CATHETER - RETROGRADE BRACHIAL ARTERY,48100010,CDM,481,RC,36120,HCPCS,facility,both,,,,1584,1584,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT CATHETER RENAL ARTERY 2ND, BILAT",48100011,CDM,481,RC,36254,HCPCS,facility,both,,,,3204,3204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT CATHETER RENAL ARTERY 2ND, UNILAT",48100012,CDM,481,RC,36253,HCPCS,facility,both,,,,4357,4357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PTA RENAL OR VISCERAL ARTERY,48100013,CDM,481,RC,35471,HCPCS,facility,both,,,,5728,5728,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT SWAN GANZ CATH BEDSIDE,48100014,CDM,481,RC,93503,HCPCS,facility,both,,,,2716,2716,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTRO NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY",48100015,CDM,481,RC,36140,HCPCS,facility,both,,,,2084,2084,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVE HEPATIC SHUNT (TIPS),48100016,CDM,481,RC,37183,HCPCS,facility,both,,,,8138,8138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT CATHETER RENAL ARTERY 1ST UNILATERAL,48100017,CDM,481,RC,36251,HCPCS,facility,both,,,,2923,2923,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT CATHETER RENAL ARTERY 1ST BILATERAL,48100018,CDM,481,RC,36252,HCPCS,facility,both,,,,3204,3204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TILT TABLE EVALUATION - STANDARD,48100050,CDM,481,RC,93660,HCPCS,facility,both,,,,3622,3622,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT HEPATIC SHUNT (TIPS),48100051,CDM,481,RC,37182,HCPCS,facility,both,,,,5405,5405,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SEL CATH ARTERIAL; ABD-LWR EXTREMITY; EA ADDL,48100052,CDM,481,RC,36248,HCPCS,facility,both,,,,1497,1497,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SEL CATH ARTERIAL, BRACH-CEPH; EA ADDL",48100053,CDM,481,RC,36218,HCPCS,facility,both,,,,1497,1497,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SEL CATH ARTERIAL, BRACH-CEPH; 3RD ORDER",48100054,CDM,481,RC,36217,HCPCS,facility,both,,,,5446,5446,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SEL CATH ARTERIAL, BRACH-CEPH; 2ND ORDER",48100055,CDM,481,RC,36216,HCPCS,facility,both,,,,4661,4661,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NONSELECTIVE CATHETER - AORTA,48100056,CDM,481,RC,36200,HCPCS,facility,both,,,,2326,2326,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT,48100057,CDM,481,RC,35875,HCPCS,facility,both,,,,12053,12053,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CARDIOVERSION ELECTRICAL CONVERSION, EXTERNAL",48100058,CDM,481,RC,92960,HCPCS,facility,both,,,,3010,3010,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARDIOVERSION WITH TEE,48100059,CDM,481,RC,92960,HCPCS,facility,both,,,,3010,3010,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERICARDIOCENTESIS; INITIAL,48100077,CDM,481,RC,33010,HCPCS,facility,both,,,,1546,1546,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NS CATH, THORACIC AORTA W/ANGIO",48100078,CDM,481,RC,36221,HCPCS,facility,both,,,,4732,4732,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE CATH XTRNL CAROTID,48100110,CDM,481,RC,36227,HCPCS,facility,both,,,50,7090,7090,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PLACE CATH XTRNL CAROTID,48100110,CDM,481,RC,36227,HCPCS,facility,both,,,,4732,4732,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE CATH CAROTID/INOM ART W/ ANGIO EXTRACRANIAL,48100112,CDM,481,RC,36222,HCPCS,facility,both,,,50,7090,7090,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PLACE CATH CAROTID/INOM ART W/ ANGIO EXTRACRANIAL,48100112,CDM,481,RC,36222,HCPCS,facility,both,,,,4732,4732,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE CATH CAROTID/INOM ART W/ ANGIO INTRACRANIAL,48100113,CDM,481,RC,36223,HCPCS,facility,both,,,,5833,5833,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE CATH CAROTID/INOM ART W/ ANGIO INTRACRANIAL,48100113,CDM,481,RC,36223,HCPCS,facility,both,,,50,7094,7094,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PLACE CATH CAROTD ART,48100114,CDM,481,RC,36224,HCPCS,facility,both,,,50,11598,11598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PLACE CATH CAROTD ART,48100114,CDM,481,RC,36224,HCPCS,facility,both,,,,7740,7740,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE CATH SUBCLAVIAN ART,48100115,CDM,481,RC,36225,HCPCS,facility,both,,,50,7090,7090,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PLACE CATH SUBCLAVIAN ART,48100115,CDM,481,RC,36225,HCPCS,facility,both,,,,4732,4732,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE CATH VERTEBRAL ART,48100116,CDM,481,RC,36226,HCPCS,facility,both,,,50,11598,11598,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PLACE CATH VERTEBRAL ART,48100116,CDM,481,RC,36226,HCPCS,facility,both,,,,7740,7740,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERICARDIOCENTESIS; SUBSEQUENT,48100117,CDM,481,RC,33011,HCPCS,facility,both,,,,1335,1335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 12 CVSLR STRESS TEST; TRACING,48200001,CDM,482,RC,93017,HCPCS,facility,both,,,,1526,1526,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PM DEVICE PROGR EVAL, SNGL",48300001,CDM,483,RC,93279,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PM DEVICE PROGR EVAL, DUAL",48300002,CDM,483,RC,93280,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PM DEVICE PROGR EVAL, MULTI",48300003,CDM,483,RC,93281,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ICD DEVICE PROG EVAL, 1 SINGLE",48300004,CDM,483,RC,93282,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ICD DEVICE PROGR EVAL, DUAL",48300005,CDM,483,RC,93283,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ICD DEVICE PROGR EVAL, MULT",48300006,CDM,483,RC,93284,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PM DEVICE EVAL IN PERSON,48300010,CDM,483,RC,93288,HCPCS,facility,both,,,,487,487,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ICD DEVICE INTERROGATE,48300011,CDM,483,RC,93289,HCPCS,facility,both,,,,487,487,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ILR DEVICE INTERROGATE,48300012,CDM,483,RC,93291,HCPCS,facility,both,,,,487,487,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TTE CONG ABN; COMPLETE,48300014,CDM,483,RC,93303,HCPCS,facility,both,,,,4121,4121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TTE CONG ABN; LIMITED/F-UP,48300015,CDM,483,RC,93304,HCPCS,facility,both,,,,4121,4121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TTE W/DOPPLER COMPLETE,48300016,CDM,483,RC,93306,HCPCS,facility,both,,,,4121,4121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TTE W/O DOPPLER COMPLETE,48300017,CDM,483,RC,93307,HCPCS,facility,both,,,,1970,1970,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TTE F-UP OR LMTD,48300018,CDM,483,RC,93308,HCPCS,facility,both,,,,1481,1481,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ECHO TRANSESOPHAGEAL COMPLETE,48300019,CDM,483,RC,93312,HCPCS,facility,both,,,,2988,2988,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DOPPLER ECHO; COMPLETE,48300022,CDM,483,RC,93320,HCPCS,facility,both,,,,1738,1738,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DOPPLER ECHO; LIMITED/ F-UP,48300023,CDM,483,RC,93321,HCPCS,facility,both,,,,1536,1536,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DOPPLER COLOR FLOW,48300024,CDM,483,RC,93325,HCPCS,facility,both,,,,416,416,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STRESS TTE ONLY,48300025,CDM,483,RC,93350,HCPCS,facility,both,,,,4121,4121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 2D TEE W OR W/O FOL W/CON IN,48300029,CDM,483,RC,,,facility,both,,,,2042,2042,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TEE W OR W/O FOLLOWED BY W/CONTRAST, MONITORING",48300034,CDM,483,RC,,,facility,both,,,,2042,2042,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TTE W OR WO FOLLOWED BY W/CONTRAST, DOPPLER",48300035,CDM,483,RC,,,facility,both,,,,2042,2042,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STATISTICAL NO CHARGE VISIT,51000000,CDM,990,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOSPITAL OUTPATIENT CLINIC VISIT,51000001,CDM,510,RC,99211,HCPCS,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH L&D FEE SCHEDULE HC HOSPITAL OUTPATIENT CLINIC VISIT,51000001,CDM,510,RC,99211,HCPCS,facility,both,,,,238,238,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT NEW LVL 2,51000002,CDM,510,RC,99202,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT NEW LVL 3,51000003,CDM,510,RC,99203,HCPCS,facility,both,,,,421,421,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT NEW LVL 4,51000004,CDM,510,RC,99204,HCPCS,facility,both,,,,512,512,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT NEW LVL 5,51000005,CDM,510,RC,99205,HCPCS,facility,both,,,,605,605,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,238,238,,,,,,,,,,,,,Gross Charge Type: SMH ENTEROSTOMAL FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51000006,CDM,510,RC,99211,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,331,331,,,,,,,,,,,,,Gross Charge Type: SMH ENTEROSTOMAL FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51000007,CDM,510,RC,99212,HCPCS,facility,both,,,,266,266,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,422,422,,,,,,,,,,,,,Gross Charge Type: SMH ENTEROSTOMAL FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,347,347,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,348,348,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,348,348,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 3,51000008,CDM,510,RC,99213,HCPCS,facility,both,,,,348,348,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 4,51000009,CDM,510,RC,99214,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 4,51000009,CDM,510,RC,99214,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 4,51000009,CDM,510,RC,99214,HCPCS,facility,both,,,,430,430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 5,51000010,CDM,510,RC,99215,HCPCS,facility,both,,,,510,510,,,,,,,,,,,,,Gross Charge Type: SMH RADIATION FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 5,51000010,CDM,510,RC,99215,HCPCS,facility,both,,,,511,511,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREVENTIVE COUNSELING INDIV 15MIN,51000020,CDM,510,RC,99401,HCPCS,facility,both,,,,140,140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREVENTIVE COUNSELING INDIV 30MIN,51000021,CDM,510,RC,99402,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREVENTIVE COUNSELING INDIV 45MIN,51000022,CDM,510,RC,99403,HCPCS,facility,both,,,,419,419,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PREVENTIVE COUNSELING INDIV 60MIN,51000023,CDM,510,RC,99404,HCPCS,facility,both,,,,558,558,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51091101,CDM,510,RC,99211,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51091102,CDM,510,RC,99211,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 1,51091103,CDM,510,RC,99211,HCPCS,facility,both,,,,116,116,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51091104,CDM,510,RC,99212,HCPCS,facility,both,,,,77,77,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51091105,CDM,510,RC,99212,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OFFICE/OUTPATIENT VISIT EST LVL 2,51091106,CDM,510,RC,99212,HCPCS,facility,both,,,,156,156,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC 1ST OFFICE VISIT,LVL",51091107,CDM,510,RC,99201,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC INIT OFFICE VISIT, LEVEL 2",51091108,CDM,510,RC,99202,HCPCS,facility,both,,,,141,141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC INIT OFFICE VISIT, LEVEL 3",51091109,CDM,510,RC,99203,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC INIT OFFICE VISIT, LEVEL 4",51091110,CDM,510,RC,99204,HCPCS,facility,both,,,,239,239,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC INIT OFFICE VISIT, LEVEL 5",51091111,CDM,510,RC,99205,HCPCS,facility,both,,,,288,288,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC F/U OFFICE VISIT, LEVEL 1",51091112,CDM,510,RC,99211,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC F/U OFFICE VISIT, LEVEL 2",51091113,CDM,510,RC,99212,HCPCS,facility,both,,,,77,77,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC F/U OFFICE VISIT, LEVEL 3",51091114,CDM,510,RC,99213,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC F/U OFFICE VISIT, LEVEL 4",51091115,CDM,510,RC,99214,HCPCS,facility,both,,,,117,117,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC F/U OFFICE VISIT, LEVEL 5",51091116,CDM,510,RC,99215,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT NEW,LEVEL 1",51091117,CDM,510,RC,99201,HCPCS,facility,both,,,,92,92,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT NEW , LEVEL 2",51091118,CDM,510,RC,99202,HCPCS,facility,both,,,,141,141,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT NEW, LEVEL 3",51091119,CDM,510,RC,99203,HCPCS,facility,both,,,,190,190,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT NEW, LEVEL 4",51091120,CDM,510,RC,99204,HCPCS,facility,both,,,,239,239,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT NEW, LEVEL 5",51091121,CDM,510,RC,99205,HCPCS,facility,both,,,,288,288,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT ESTABLISHED, LEVEL 1",51091122,CDM,510,RC,99211,HCPCS,facility,both,,,,57,57,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT ESTABLISHED, LEVEL 2",51091123,CDM,510,RC,99212,HCPCS,facility,both,,,,77,77,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT ESTABLISHED, LEVEL 3",51091124,CDM,510,RC,99213,HCPCS,facility,both,,,,97,97,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT ESTABLISHED, LEVEL 4",51091125,CDM,510,RC,99214,HCPCS,facility,both,,,,117,117,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MED ONC OP CONSULT ESTABLISHED, LEVEL 5",51091126,CDM,510,RC,99215,HCPCS,facility,both,,,,137,137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FOLLOWUP VISIT,51091127,CDM,510,RC,99211,HCPCS,facility,both,,,,53,53,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OSTEOPATHIC MANIPULATION 1-2 BODY REGIONS,53000001,CDM,530,RC,98925,HCPCS,facility,both,,,,246,246,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI OF TEMPOROMANDIBULAR JOINT(S),61000001,CDM,610,RC,70336,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI OF TEMPOROMANDIBULAR JOINT(S),61000001,CDM,610,RC,70336,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ORBIT/FACE/NECK W/O CONTRAST,61000002,CDM,610,RC,70540,HCPCS,facility,both,,,,3850,3850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ORBIT/FACE/NECK W/O CONTRAST,61000002,CDM,610,RC,70540,HCPCS,facility,both,,,52,2633,2633,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ORBIT/FACE/NECK W/CONTRAST,61000003,CDM,610,RC,70542,HCPCS,facility,both,,,,3850,3850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ORBIT/FACE/NECK W/O & W/CONTRAST,61000004,CDM,610,RC,70543,HCPCS,facility,both,,,,4946,4946,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI CHEST W/O CONTRAST,61000005,CDM,610,RC,71550,HCPCS,facility,both,,,52,4453,4453,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI CHEST W/O CONTRAST,61000005,CDM,610,RC,71550,HCPCS,facility,both,,,,4604,4604,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI CHEST W CONTRAST,61000006,CDM,610,RC,71551,HCPCS,facility,both,,,,4604,4604,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI CHEST W & W/O CONTRAST,61000007,CDM,610,RC,71552,HCPCS,facility,both,,,,4604,4604,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI PELVIS W/O CONTRAST,61000008,CDM,610,RC,72195,HCPCS,facility,both,,,52,4161,4161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI PELVIS W/O CONTRAST,61000008,CDM,610,RC,72195,HCPCS,facility,both,,,,4763,4763,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI PELVIS W CONTRAST,61000009,CDM,610,RC,72196,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI PELVIS W CONTRAST,61000009,CDM,610,RC,72196,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI PELVIS W & W/O CONTRAST,61000010,CDM,610,RC,72197,HCPCS,facility,both,,,,4763,4763,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI UPPER EXT NOT JOINT W/O CONTRAST,61000011,CDM,610,RC,73218,HCPCS,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI UPPER EXT NOT JOINT W/O CONTRAST,61000011,CDM,610,RC,73218,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI UPPER EXT NOT JOINT W/ CONTRAST,61000012,CDM,610,RC,73219,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI UPPER EXT NOT JOINT W/ CONTRAST,61000012,CDM,610,RC,73219,HCPCS,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST,61000013,CDM,610,RC,73220,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST,61000013,CDM,610,RC,73220,HCPCS,facility,both,,,50,9021,9021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST,61000013,CDM,610,RC,73220,HCPCS,facility,both,,,,5443,5443,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI UPPER EXT ANY JOINT W/O CONTRAST,61000014,CDM,610,RC,73221,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI UPPER EXT ANY JOINT W/O CONTRAST,61000014,CDM,610,RC,73221,HCPCS,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI UPPER EXT ANY JOINT W/O CONTRAST,61000014,CDM,610,RC,73221,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI UPPER EXT ANY JOINT W CONTRAST,61000015,CDM,610,RC,73222,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI UPPER EXT ANY JOINT W CONTRAST,61000015,CDM,610,RC,73222,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI UPPER EXT ANY JOINT W CONTRAST,61000015,CDM,610,RC,73222,HCPCS,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST,61000016,CDM,610,RC,73223,HCPCS,facility,both,,,,5443,5443,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST,61000016,CDM,610,RC,73223,HCPCS,facility,both,,,52,6140,6140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST,61000016,CDM,610,RC,73223,HCPCS,facility,both,,,50,9021,9021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI LOWER EXT NOT JOINT W/O CONTRAST,61000017,CDM,610,RC,73718,HCPCS,facility,both,,,,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI LOWER EXT NOT JOINT W/O CONTRAST,61000017,CDM,610,RC,73718,HCPCS,facility,both,,,50,6140,6140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI LOWER EXT NOT JOINT W/O CONTRAST,61000017,CDM,610,RC,73718,HCPCS,facility,both,,,52,3102,3102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI LOWER EXT NOT JOINT W CONTRAST,61000018,CDM,610,RC,73719,HCPCS,facility,both,,,50,6140,6140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI LOWER EXT NOT JOINT W CONTRAST,61000018,CDM,610,RC,73719,HCPCS,facility,both,,,,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI LOWER EXT NOT JOINT W CONTRAST,61000018,CDM,610,RC,73719,HCPCS,facility,both,,,52,3102,3102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ANY JOINT LOWER EXT W/O CONTRAST,61000019,CDM,610,RC,73721,HCPCS,facility,both,,,,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ANY JOINT LOWER EXT W/O CONTRAST,61000019,CDM,610,RC,73721,HCPCS,facility,both,,,50,6140,6140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI ANY JOINT LOWER EXT W/O CONTRAST,61000019,CDM,610,RC,73721,HCPCS,facility,both,,,52,3102,3102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ANY JOINT LOWER EXT W/CONTRAST,61000020,CDM,610,RC,73722,HCPCS,facility,both,,,52,3102,3102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ANY JOINT LOWER EXT W/CONTRAST,61000020,CDM,610,RC,73722,HCPCS,facility,both,,,50,6140,6140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI ANY JOINT LOWER EXT W/CONTRAST,61000020,CDM,610,RC,73722,HCPCS,facility,both,,,,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ANY JOINT LOWER EXT W/O & W CON,61000021,CDM,610,RC,73723,HCPCS,facility,both,,,50,9021,9021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI ANY JOINT LOWER EXT W/O & W CON,61000021,CDM,610,RC,73723,HCPCS,facility,both,,,,5443,5443,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ANY JOINT LOWER EXT W/O & W CON,61000021,CDM,610,RC,73723,HCPCS,facility,both,,,52,4135,4135,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ABDOMEN W/O CONTRAST,61000022,CDM,610,RC,74181,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ABDOMEN W/O CONTRAST,61000022,CDM,610,RC,74181,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ABDOMEN W CONTRAST,61000023,CDM,610,RC,74182,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ABDOMEN W CONTRAST,61000023,CDM,610,RC,74182,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI ABDOMEN W & W/O CONTRAST,61000024,CDM,610,RC,74183,HCPCS,facility,both,,,,6398,6398,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI ABDOMEN W & W/O CONTRAST,61000024,CDM,610,RC,74183,HCPCS,facility,both,,,52,5080,5080,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC CARDIAC MRI FOR MORPH & FUNC W/O CONTRAST,61000025,CDM,610,RC,75557,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC CARDIAC MRI FOR MORPH & FUNC W/O CONTRAST,61000025,CDM,610,RC,75557,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED MAGNETIC RESONANCE PROCEDURE,61000028,CDM,610,RC,76498,HCPCS,facility,both,,,,2792,2792,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI NEEDLE GUIDANCE,61000029,CDM,610,RC,77021,HCPCS,facility,both,,,,1045,1045,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI LEXTREM W&WO CONTR,61000040,CDM,610,RC,73720,HCPCS,facility,both,,,52,4135,4135,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI LEXTREM W&WO CONTR,61000040,CDM,610,RC,73720,HCPCS,facility,both,,,50,9021,9021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRI LEXTREM W&WO CONTR,61000040,CDM,610,RC,73720,HCPCS,facility,both,,,,5443,5443,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAD BREAST MRI,61000041,CDM,610,RC,,,facility,both,,,,67,67,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI, BONE MARROW BLOOD SUPPLY",61000047,CDM,610,RC,77084,HCPCS,facility,both,,,,1682,1682,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BREAST UNIL W/O CONTRAST,61000048,CDM,610,RC,77046,HCPCS,facility,both,,,,3054,3054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BREAST BILAT W/O CONTRAST,61000050,CDM,610,RC,77047,HCPCS,facility,both,,,,5317,5317,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAD BREAST MRI,61000052,CDM,610,RC,,,facility,both,,,,78,78,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BRAIN W/O CONTRAST,61100001,CDM,611,RC,70551,HCPCS,facility,both,,,52,3087,3087,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRI BRAIN W/O CONTRAST,61100001,CDM,611,RC,70551,HCPCS,facility,both,,,,3850,3850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BRAIN W CONTRAST,61100002,CDM,611,RC,70552,HCPCS,facility,both,,,,4616,4616,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BRAIN W & W/O CONTRAST,61100003,CDM,611,RC,70553,HCPCS,facility,both,,,,5814,5814,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE CERVICAL, W/O CONTRAST",61200001,CDM,612,RC,72141,HCPCS,facility,both,,,52,3364,3364,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services "HC MRI SPINE CERVICAL, W/O CONTRAST",61200001,CDM,612,RC,72141,HCPCS,facility,both,,,,3850,3850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE CERVICAL, W CONTRAST",61200002,CDM,612,RC,72142,HCPCS,facility,both,,,,4616,4616,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE THORACIC, W/O CONTRAST",61200003,CDM,612,RC,72146,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE THORACIC, W/O CONTRAST",61200003,CDM,612,RC,72146,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services "HC MRI SPINE THORACIC, W CONTRAST",61200004,CDM,612,RC,72147,HCPCS,facility,both,,,,5080,5080,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE LUMBAR, W/O CONTRAST",61200005,CDM,612,RC,72148,HCPCS,facility,both,,,52,3702,3702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services "HC MRI SPINE LUMBAR, W/O CONTRAST",61200005,CDM,612,RC,72148,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE LUMBAR, W CONTRAST",61200006,CDM,612,RC,72149,HCPCS,facility,both,,,,5080,5080,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE CERVICAL, W & W/O CONTRAST",61200007,CDM,612,RC,72156,HCPCS,facility,both,,,,5814,5814,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE THORACIC, W & W/O CONTRAST",61200008,CDM,612,RC,72157,HCPCS,facility,both,,,,6398,6398,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI SPINE LUMBAR, W & W/O CONTRAST",61200009,CDM,612,RC,72158,HCPCS,facility,both,,,,6398,6398,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BREAST UNILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61400001,CDM,614,RC,,,facility,both,,,,3859,3859,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BREAST BILAT W CONTR,61400002,CDM,614,RC,,,facility,both,,,,5317,5317,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BREAST BILAT WO CONTR,61400003,CDM,614,RC,,,facility,both,,,,4416,4416,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRI BREAST BILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61400004,CDM,614,RC,,,facility,both,,,,5975,5975,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI WO CONTRAST, BREAST; UNILATERAL",61400005,CDM,614,RC,,,facility,both,,,,2663,2663,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRI W CONTRAST, BREAST; UNILATERAL",61400006,CDM,614,RC,,,facility,both,,,,3206,3206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA HEAD W/O CONTRAST,61500001,CDM,615,RC,70544,HCPCS,facility,both,,,,4328,4328,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA HEAD W CONTRAST,61500002,CDM,615,RC,70545,HCPCS,facility,both,,,,4328,4328,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA HEAD W & W/O CONTRAST,61500003,CDM,615,RC,70546,HCPCS,facility,both,,,,4946,4946,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA NECK W/O CONTRAST,61500004,CDM,615,RC,70547,HCPCS,facility,both,,,,4328,4328,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA NECK W CONTRAST,61500005,CDM,615,RC,70548,HCPCS,facility,both,,,,4328,4328,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA NECK W & W/O CONTRAST,61500006,CDM,615,RC,70549,HCPCS,facility,both,,,,4946,4946,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA LEXTREM W CONT,61600005,CDM,616,RC,,,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRA LEXTREM W CONT,61600005,CDM,616,RC,,,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA LOWER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61600006,CDM,616,RC,,,facility,both,,,,4890,4890,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA LOWER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61600006,CDM,616,RC,,,facility,both,,,50,7665,7665,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure "HC MRA WO CONTRAST, LOWER EXT",61600007,CDM,616,RC,,,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRA WO CONTRAST, LOWER EXT",61600007,CDM,616,RC,,,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRA SPINE W OR W/O CONTRAST,61800002,CDM,618,RC,72159,HCPCS,facility,both,,,,4699,4699,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA UPPER EXT W OR W/O CONTRAST,61800003,CDM,618,RC,73225,HCPCS,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA UPPER EXT W OR W/O CONTRAST,61800003,CDM,618,RC,73225,HCPCS,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRA UPPER EXT W OR W/O CONTRAST,61800003,CDM,618,RC,73225,HCPCS,facility,both,,,52,2263,2263,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services HC MRA ABD W CONTRAST,61800011,CDM,618,RC,,,facility,both,,,,4763,4763,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA ABDOMEN WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800012,CDM,618,RC,,,facility,both,,,,6398,6398,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA CHEST W CONTRAST,61800013,CDM,618,RC,,,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA PELVIS WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800014,CDM,618,RC,,,facility,both,,,,4763,4763,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MRA W CONTRAST, PELVIS",61800015,CDM,618,RC,,,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA ABD WO CONTRAST,61800016,CDM,618,RC,,,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA CHEST WO CONRAST,61800025,CDM,618,RC,,,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA CHEST WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800026,CDM,618,RC,,,facility,both,,,,4611,4611,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA W/CONTRAST UPPER EXTREMITY,61800027,CDM,618,RC,,,facility,both,,,,6315,6315,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA W/CONTRAST UPPER EXTREMITY,61800027,CDM,618,RC,,,facility,both,,,50,10462,10462,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRA W/O CONTRAST UPPER EXTREMITY,61800028,CDM,618,RC,,,facility,both,,,50,7016,7016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRA W/O CONTRAST UPPER EXTREMITY,61800028,CDM,618,RC,,,facility,both,,,,4237,4237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA UPPER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800029,CDM,618,RC,,,facility,both,,,50,11833,11833,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MRA UPPER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800029,CDM,618,RC,,,facility,both,,,,7146,7146,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA W/CONTRAST SPINAL CANAL,61800030,CDM,618,RC,,,facility,both,,,,7007,7007,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA W/O CONTRAST SPINAL CANAL,61800031,CDM,618,RC,,,facility,both,,,,4699,4699,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MRA SPINAL CANAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,61800032,CDM,618,RC,,,facility,both,,,,7927,7927,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SEED CARRIER,62191101,CDM,621,RC,,,facility,both,,,,210,210,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EYE-PLAQUE TEMPLATE,62191102,CDM,621,RC,,,facility,both,,,,249,249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC I-125 RADIOELEMENT SEED,63691101,CDM,636,RC,,,facility,both,,,,620,620,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC I-125 VARI-STRAND SOURCES,63691102,CDM,636,RC,,,facility,both,,,,257,257,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PD-103 REDI-STRAND SOURCE,63691103,CDM,636,RC,,,facility,both,,,,299,299,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CS-131 REDI-STRAND SOURCE,63691104,CDM,636,RC,,,facility,both,,,,226,226,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APPLY LONG ARM CAST,70000001,CDM,700,RC,29065,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY SHORT ARM CAST,70000002,CDM,700,RC,29075,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY LONG LEG CAST,70000005,CDM,700,RC,29345,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY SHORT LEG CAST WALKER,70000007,CDM,700,RC,29425,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY PATELLAR TENDON BEARING (PTB) CAST,70000008,CDM,700,RC,29435,HCPCS,facility,both,,,,333,333,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC APPLY CLUBFOOT CAST LONG OR SHORT LEG,70000009,CDM,700,RC,29450,HCPCS,facility,both,,,,203,203,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC PACU LEVEL 1 - 1ST 30 MIN,71000010,CDM,710,RC,,,facility,both,,,,1352,1352,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU LEVEL 1 - EA ADDL 30 MINS,71000011,CDM,710,RC,,,facility,both,,,,674,674,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU LEVEL 2 -1ST 30 MIN,71000012,CDM,710,RC,,,facility,both,,,,1509,1509,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU LEVEL 2 - EACH ADDL 30 MINS,71000013,CDM,710,RC,,,facility,both,,,,754,754,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU LEVEL 3 - 1ST 30 MIN,71000014,CDM,710,RC,,,facility,both,,,,1667,1667,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU LEVEL 3 - EACH ADDL 30 MINS,71000015,CDM,710,RC,,,facility,both,,,,829,829,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU LEVEL 4 - 1ST 30 MIN,71000016,CDM,710,RC,,,facility,both,,,,1822,1822,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU LEVEL 4 - EACH ADDL 30 MINS,71000017,CDM,710,RC,,,facility,both,,,,912,912,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ECT RECOVERY,71000020,CDM,710,RC,,,facility,both,,,,345,345,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRE-OP STANDARD OR,71000021,CDM,710,RC,,,facility,both,,,,948,948,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRE-OP MINOR/IR,71000022,CDM,710,RC,,,facility,both,,,,531,531,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRE-OP IV START,71000023,CDM,710,RC,,,facility,both,,,,418,418,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 31-60 MINUTES,71000202,CDM,710,RC,,,facility,both,,,,918,918,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 61-90 MINUTES,71000203,CDM,710,RC,,,facility,both,,,,358,358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 91-120 MINUTES,71000204,CDM,710,RC,,,facility,both,,,,358,358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 121-150 MINUTES,71000205,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 151-180 MINUTES,71000206,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 181-210 MINUTES,71000207,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 211-240 MINUTES,71000208,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 241-270 MINUTES,71000209,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 271-300 MINUTES,71000210,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 301-330 MINUTES,71000211,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 331-360 MINUTES,71000212,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 361-390 MINUTES,71000213,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 391-420 MINUTES,71000214,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 421-450 MINUTES,71000215,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 451-480 MINUTES,71000216,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 481-510 MINUTES,71000217,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 511-540 MINUTES,71000218,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 541-570 MINUTES,71000219,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/ RR 571-600 MINUTES,71000220,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR INITIAL 30 MINUTES,71000221,CDM,710,RC,,,facility,both,,,,1109,1109,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 31-60 MINUTES,71000222,CDM,710,RC,,,facility,both,,,,427,427,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 61-90 MINUTES,71000223,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 91-120 MINUTES,71000224,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 121-150 MINUTES,71000225,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 151-180 MINUTES,71000226,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 181-210 MINUTES,71000227,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 211-240 MINUTES,71000228,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 241-270 MINUTES,71000229,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 271-300 MINUTES,71000230,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 301-330 MINUTES,71000231,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 331-360 MINUTES,71000232,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 361-390 MINUTES,71000233,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 391-420 MINUTES,71000234,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 421-450 MINUTES,71000235,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 451-480 MINUTES,71000236,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 481-510 MINUTES,71000237,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 511-540 MINUTES,71000238,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 541-570 MINUTES,71000239,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II IV SED W/O RR 571-600 MINUTES,71000240,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL INITIAL 30 MINUTES,71000241,CDM,710,RC,,,facility,both,,,,561,561,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 31-60 MINUTES,71000242,CDM,710,RC,,,facility,both,,,,358,358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 61-90 MINUTES,71000243,CDM,710,RC,,,facility,both,,,,358,358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 91-120 MINUTES,71000244,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 121-150 MINUTES,71000245,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 151-180 MINUTES,71000246,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 181-210 MINUTES,71000247,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 211-240 MINUTES,71000248,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 241-270 MINUTES,71000249,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 271-300 MINUTES,71000250,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 301-330 MINUTES,71000251,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 331-360 MINUTES,71000252,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 361-390 MINUTES,71000253,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 391-420 MINUTES,71000254,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 421-450 MINUTES,71000255,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 451-480 MINUTES,71000256,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 481-510 MINUTES,71000257,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 511-540 MINUTES,71000258,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 541-570 MINUTES,71000259,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II REG EPIDRL 571-600 MINUTES,71000260,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES INITIAL 30 MINUTES,71000261,CDM,710,RC,,,facility,both,,,,784,784,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 31-60 MINUTES,71000262,CDM,710,RC,,,facility,both,,,,388,388,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 61-90 MINUTES,71000263,CDM,710,RC,,,facility,both,,,,388,388,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 91-120 MINUTES,71000264,CDM,710,RC,,,facility,both,,,,358,358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 121-150 MINUTES,71000265,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 151-180 MINUTES,71000266,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 181-210 MINUTES,71000267,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 211-240 MINUTES,71000268,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 241-270 MINUTES,71000269,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 271-300 MINUTES,71000270,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 301-330 MINUTES,71000271,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 331-360 MINUTES,71000272,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 361-390 MINUTES,71000273,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 391-420 MINUTES,71000274,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 421-450 MINUTES,71000275,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 451-480 MINUTES,71000276,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 481-510 MINUTES,71000277,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 511-540 MINUTES,71000278,CDM,710,RC,,,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 541-570 MINUTES,71000279,CDM,710,RC,,,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II GENERAL ANES 571-600 MINUTES,71000280,CDM,710,RC,,,facility,both,,,,90,90,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO INITIAL 30 MINUTES,71000281,CDM,710,RC,,,facility,both,,,,687,687,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 31-60 MINUTES,71000282,CDM,710,RC,,,facility,both,,,,427,427,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 61-90 MINUTES,71000283,CDM,710,RC,,,facility,both,,,,427,427,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 91-120 MINUTES,71000284,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 121-150 MINUTES,71000285,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 151-180 MINUTES,71000286,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 181-210 MINUTES,71000287,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 211-240 MINUTES,71000288,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 241-270 MINUTES,71000289,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 271-300 MINUTES,71000290,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 301-330 MINUTES,71000291,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 331-360 MINUTES,71000292,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 361-390 MINUTES,71000293,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 391-420 MINUTES,71000294,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 421-450 MINUTES,71000295,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 451-480 MINUTES,71000296,CDM,710,RC,,,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 481-510 MINUTES,71000297,CDM,710,RC,,,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 511-540 MINUTES,71000298,CDM,710,RC,,,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 541-570 MINUTES,71000299,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II ANGIO 571-600 MINUTES,71000300,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY INITIAL 30 MINUTES,71000301,CDM,710,RC,,,facility,both,,,,687,687,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 31-60 MINUTES,71000302,CDM,710,RC,,,facility,both,,,,427,427,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 61-90 MINUTES,71000303,CDM,710,RC,,,facility,both,,,,427,427,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 91-120 MINUTES,71000304,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 121-150 MINUTES,71000305,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 151-180 MINUTES,71000306,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 181-210 MINUTES,71000307,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 211-240 MINUTES,71000308,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 241-270 MINUTES,71000309,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 271-300 MINUTES,71000310,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 301-330 MINUTES,71000311,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 331-360 MINUTES,71000312,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 361-390 MINUTES,71000313,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 391-420 MINUTES,71000314,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 421-450 MINUTES,71000315,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 451-480 MINUTES,71000316,CDM,710,RC,,,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 481-510 MINUTES,71000317,CDM,710,RC,,,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 511-540 MINUTES,71000318,CDM,710,RC,,,facility,both,,,,98,98,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 541-570 MINUTES,71000319,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II BIOPSY 571-600 MINUTES,71000320,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM INITIAL 30 MINUTES,71000321,CDM,710,RC,,,facility,both,,,,618,618,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 31-60 MINUTES,71000322,CDM,710,RC,,,facility,both,,,,358,358,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 61-90 MINUTES,71000323,CDM,710,RC,,,facility,both,,,,388,388,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 91-120 MINUTES,71000324,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 121-150 MINUTES,71000325,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 151-180 MINUTES,71000326,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 181-210 MINUTES,71000327,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 211-240 MINUTES,71000328,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 241-270 MINUTES,71000329,CDM,710,RC,,,facility,both,,,,182,182,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 271-300 MINUTES,71000330,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 301-330 MINUTES,71000331,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 331-360 MINUTES,71000332,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 361-390 MINUTES,71000333,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 391-420 MINUTES,71000334,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 421-450 MINUTES,71000335,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 451-480 MINUTES,71000336,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 481-510 MINUTES,71000337,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 511-540 MINUTES,71000338,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 541-570 MINUTES,71000339,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II MYELOGRAM 571-600 MINUTES,71000340,CDM,710,RC,,,facility,both,,,,89,89,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES INITIAL 30 MINUTES,71000341,CDM,710,RC,,,facility,both,,,,584,584,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 31-60 MINUTES,71000342,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 61-90 MINUTES,71000343,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 91-120 MINUTES,71000344,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 121-150 MINUTES,71000345,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 151-180 MINUTES,71000346,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 181-210 MINUTES,71000347,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 211-240 MINUTES,71000348,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 241-270 MINUTES,71000349,CDM,710,RC,,,facility,both,,,,208,208,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 271-300 MINUTES,71000350,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 301-330 MINUTES,71000351,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 331-360 MINUTES,71000352,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 361-390 MINUTES,71000353,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 391-420 MINUTES,71000354,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 421-450 MINUTES,71000355,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACU PHASE II LOCAL ANES 451-480 MINUTES,71000356,CDM,710,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDO RECOVERY 1ST HALF HOUR,71025001,CDM,710,RC,,,facility,both,,,,563,563,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDO/PAIN RECOVERY EXTENDED,71025002,CDM,710,RC,,,facility,both,,,,1105,1105,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAIN RECOVERY 1ST HALF HOUR,71025003,CDM,710,RC,,,facility,both,,,,628,628,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAIN/ENDO RECOVERY EXTENDED,71025004,CDM,710,RC,,,facility,both,,,,1105,1105,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PAIN STIM/MILD RECOVERY,71025005,CDM,710,RC,,,facility,both,,,,1638,1638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARDIAC LOOP RECORDER RECOVERY,71025006,CDM,710,RC,,,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACEMAKER RECOVERY 1ST HALF HOUR,71025007,CDM,710,RC,,,facility,both,,,,1328,1328,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACE MAKER RECOVERY EXTENDED,71025008,CDM,710,RC,,,facility,both,,,,2249,2249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BRONCHOSCOPY RECOVERY,71025009,CDM,710,RC,,,facility,both,,,,2249,2249,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STRESS/TILT RECOVERY,71025010,CDM,710,RC,,,facility,both,,,,490,490,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TEE/ EXT TILT RECOVERY,71025011,CDM,710,RC,,,facility,both,,,,1640,1640,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CARDIOVERSION RECOVERY,71025012,CDM,710,RC,,,facility,both,,,,2627,2627,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDO RECOVERY PACU LEVEL INTUBATED PATIENT,71025013,CDM,710,RC,,,facility,both,,,,3115,3115,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDO RECOVERY PACU LEVEL INTUBATED PATIENT EXTENDED,71025014,CDM,710,RC,,,facility,both,,,,3479,3479,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRAUTERINE PRESSURE CATH MONITOR (IUPC),72000021,CDM,720,RC,59050,HCPCS,facility,both,,,,621,621,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEONATAL RESUSCITATION,72000025,CDM,720,RC,,,facility,both,,,,179,179,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC AMNIOCENTESIS, DIAGNOSTIC",72000032,CDM,720,RC,59000,HCPCS,facility,both,,,,2704,2704,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXTERNAL CEPHALIC VERSIONS,72000036,CDM,720,RC,59412,HCPCS,facility,both,,,,2969,2969,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NON-STRESS TEST,72000037,CDM,720,RC,59025,HCPCS,facility,both,,,,1188,1188,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VAGINAL DELIVERY,72000050,CDM,720,RC,,,facility,both,,,,7266,7266,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VAGINAL DELIVERY,72000050,CDM,720,RC,,,facility,both,,,,783,783,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CESAREAN SECTION,72000051,CDM,720,RC,,,facility,both,,,,10745,10745,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEAC 03/01/2021 FETAL MONITORING DURING LABOR,72000052,CDM,720,RC,59050,HCPCS,facility,both,,,,744,744,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TUBAL LIGATION W/VAGINAL DEL,72000056,CDM,720,RC,,,facility,both,,,,6118,6118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TUBAL LIGATION W/C-SECTION,72000057,CDM,720,RC,,,facility,both,,,,4510,4510,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC L&D RECOVERY ROOM,72000058,CDM,720,RC,,,facility,both,,,,3043,3043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHORIONIC VILLUS SAMPLING,72000062,CDM,720,RC,59015,HCPCS,facility,both,,,,3445,3445,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LABOR CHECK (0 TO 2 HOURS),72000067,CDM,720,RC,,,facility,both,,,,903,903,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LABOR CHECK (2 TO 4 HOURS),72000068,CDM,720,RC,,,facility,both,,,,1147,1147,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LABOR CHECK (4 TO 8 HOURS),72000069,CDM,720,RC,,,facility,both,,,,1638,1638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LABOR CHECK (8 TO 12 HOURS),72000070,CDM,720,RC,,,facility,both,,,,2140,2140,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LABOR CHECK (OVER 12 HOURS),72000071,CDM,720,RC,,,facility,both,,,,3185,3185,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CIRCUMCISION (INCL NURSERY),72300001,CDM,723,RC,,,facility,both,,,,385,385,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PRE-OP CARE, L & D SURGERY",72900003,CDM,729,RC,,,facility,both,,,,534,534,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 12 LEAD EKG; TRACING ONLY,73000001,CDM,730,RC,93005,HCPCS,facility,both,,,,391,391,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC 12 LEAD EKG; TRACING ONLY,73000001,CDM,730,RC,93005,HCPCS,facility,both,,,,388,388,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ECG UP TO 48 HRS SCANNING ANALYSIS REPORT,73100001,CDM,731,RC,93226,HCPCS,facility,both,,,,1115,1115,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ECG UP TO 48 HRS RECORDING,73100100,CDM,731,RC,93225,HCPCS,facility,both,,,,533,533,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MSLT- SLEEP LATENCY,74000001,CDM,740,RC,95805,HCPCS,facility,both,,,,3612,3612,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POLYSOMNOGRAPHY W/4> PARAM,74000002,CDM,740,RC,95810,HCPCS,facility,both,,,,6833,6833,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CPAP- SLEEP STAGING, >4 PAR",74000003,CDM,740,RC,95811,HCPCS,facility,both,,,,7670,7670,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXTENDED EEG 41-60 MIN,74000004,CDM,740,RC,95812,HCPCS,facility,both,,,,1372,1372,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG AWAKE & DROWSY,74000006,CDM,740,RC,95816,HCPCS,facility,both,,,,920,920,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG AWAKE & ASLEEP,74000007,CDM,740,RC,95819,HCPCS,facility,both,,,,920,920,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG-SLEEP ONLY,74000008,CDM,740,RC,95822,HCPCS,facility,both,,,,920,920,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG; CEREBRAL SILENCE,74000009,CDM,740,RC,95824,HCPCS,facility,both,,,,1055,1055,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG 16/> CH; EA 24 HRS,74000010,CDM,740,RC,95951,HCPCS,facility,both,,,,4832,4832,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POLYSOM <6 YRS 4> PARAMETERS,74000060,CDM,740,RC,95782,HCPCS,facility,both,,,,3837,3837,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC POLYSOM <6 YRS CPAP/BILVL,74000061,CDM,740,RC,95783,HCPCS,facility,both,,,,3837,3837,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SLEEP STUDY - UNATTD, SIMULT REC & SLEEP TIME",74000062,CDM,740,RC,95800,HCPCS,facility,both,,,,924,924,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SLEEP STUDY - UNATTENDED, SIMULTANEOUS RECORDING",74000063,CDM,740,RC,95801,HCPCS,facility,both,,,,924,924,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SLEEP STUDY UNATTENDED & RESP EFFORT,74000064,CDM,740,RC,95806,HCPCS,facility,both,,,,1290,1290,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS,74000068,CDM,740,RC,95700,HCPCS,facility,both,,,,1569,1569,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED,74000069,CDM,740,RC,95705,HCPCS,facility,both,,,,1569,1569,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR,74000070,CDM,740,RC,95706,HCPCS,facility,both,,,,1759,1759,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS REAL-TIME MNTR,74000071,CDM,740,RC,95707,HCPCS,facility,both,,,,1954,1954,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED,74000072,CDM,740,RC,95708,HCPCS,facility,both,,,,2247,2247,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR,74000073,CDM,740,RC,95709,HCPCS,facility,both,,,,2538,2538,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EEG W/O VID TECH EA INCR 12-26 HR CONT REAL-TIME MNTR,74000074,CDM,740,RC,95710,HCPCS,facility,both,,,,4213,4213,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VEEG BY TECH 2-12 HOURS UNMONITORED,74000075,CDM,740,RC,95711,HCPCS,facility,both,,,,1569,1569,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING,74000076,CDM,740,RC,95712,HCPCS,facility,both,,,,1759,1759,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VEEG BY TECH 2-12 HR CONTINUOUS REAL-TIME MONITORING,74000077,CDM,740,RC,95713,HCPCS,facility,both,,,,2999,2999,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VEEG BY TECH EA INCR 12-26 HR UNMONITORED,74000078,CDM,740,RC,95714,HCPCS,facility,both,,,,2999,2999,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR,74000079,CDM,740,RC,95715,HCPCS,facility,both,,,,3383,3383,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC VEEG BY TECH EA INCR 12-26 HR CONT REAL-TIME MNTR,74000080,CDM,740,RC,95716,HCPCS,facility,both,,,,5613,5613,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE ENDO LEVEL 1 INIT 15 MIN,75000025,CDM,750,RC,,,facility,both,,,,2703,2703,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE ENDO LEVEL 2 INIT 15 MIN,75000026,CDM,750,RC,,,facility,both,,,,3016,3016,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UPPER GI PLACEMENT GASTROSTOMY TUBE,75000100,CDM,750,RC,,,facility,both,,,,1768,1768,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EMG ANAL OR URETHRAL SPHINCTER, OTHER THAN NEEDLE",75000101,CDM,750,RC,,,facility,both,,,,618,618,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESOPHAGUS MOTILITY STUDY,75000102,CDM,750,RC,,,facility,both,,,,1877,1877,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GASTROESOPHAGEAL REFLUX TEST,75000103,CDM,750,RC,,,facility,both,,,,1877,1877,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESOPHAGEAL IMPED FUNCTION TEST,75000104,CDM,750,RC,,,facility,both,,,,1877,1877,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC RECTAL SENSATION, TONE, AND COMPLIANCE TEST",75000105,CDM,750,RC,,,facility,both,,,,1377,1377,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANORECTAL MANOMETRY,75000106,CDM,750,RC,,,facility,both,,,,1377,1377,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE ENDO LEVEL 1 EA ADDL 15 MINUTE,75000125,CDM,750,RC,,,facility,both,,,,733,733,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE ENDO LEVEL 2 EA ADDL 15 MINUTE,75000126,CDM,750,RC,,,facility,both,,,,852,852,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE ENDO LEVEL 3 INIT 15 MIN,75000127,CDM,750,RC,,,facility,both,,,,3330,3330,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PROCEDURE ENDO LEVEL 3 EA ADDL 15 MINUTE,75000128,CDM,750,RC,,,facility,both,,,,978,978,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ESOPHAGOSC DILATE BALLOON 30,75000129,CDM,750,RC,,,facility,both,,,,2778,2778,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGD BALLOON DIL ESOPH 30 MM/>,75000130,CDM,750,RC,,,facility,both,,,,5078,5078,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLLECTION OF BLOOD VIA VAD,76100001,CDM,761,RC,36591,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLLECTION OF BLOOD VIA VAD,76100001,CDM,761,RC,36591,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC COLLECTION OF BLOOD VIA PICC,76100002,CDM,761,RC,36592,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC COLLECTION OF BLOOD VIA PICC,76100002,CDM,761,RC,36592,HCPCS,facility,both,,,,185,185,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE HC COLLECTION OF BLOOD VIA PICC,76100002,CDM,761,RC,36592,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DECLOTTING VAD OR CATHETER,76100003,CDM,761,RC,36593,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC DECLOTTING VAD OR CATHETER,76100003,CDM,761,RC,36593,HCPCS,facility,both,,,,462,462,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FINE NEEDLE ASPIRATION W/IMAGE,76100012,CDM,761,RC,10022,HCPCS,facility,both,,,,194,194,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOSPY OF SKIN, SINGLE LESION",76100013,CDM,761,RC,11100,HCPCS,facility,both,,,,772,772,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOSPY OF SKIN, EACH ADDL LESION",76100014,CDM,761,RC,11101,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL IMPLANT CONTRACEP CAPS,76100015,CDM,761,RC,11976,HCPCS,facility,both,,,,3296,3296,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TX SUPERFICIAL WOUND, SIMPLE CLOSURE",76100017,CDM,761,RC,12020,HCPCS,facility,both,,,,799,799,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC PUNCTURE ASPIRATION BREAST CYST - INITIAL,76100018,CDM,761,RC,19000,HCPCS,facility,both,,,,890,890,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC PUNCTURE ASPIRATION BREAST CYST - INITIAL,76100018,CDM,761,RC,19000,HCPCS,facility,both,,,,1024,1024,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PUNCTURE ASPIRATION BREAST CYST - EA ADDL,76100019,CDM,761,RC,19001,HCPCS,facility,both,,,,667,667,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS CORE BREAST BX W GUIDE,76100020,CDM,761,RC,19102,HCPCS,facility,both,,,,767,767,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS CORE BREAST BX W GUIDE,76100020,CDM,761,RC,19102,HCPCS,facility,both,,,50,1520,1520,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PERCUTANEOUS BREAST BX - AUTO VA/DEVICE,76100021,CDM,761,RC,19103,HCPCS,facility,both,,,50,1520,1520,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PERCUTANEOUS BREAST BX - AUTO VA/DEVICE,76100021,CDM,761,RC,19103,HCPCS,facility,both,,,,767,767,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PREOP NEEDLE LOCALIZATION, BREAST, INITIAL",76100022,CDM,761,RC,19290,HCPCS,facility,both,,,,708,708,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PREOP NEEDLE LOCALIZATION, BREAST, EA ADDL",76100023,CDM,761,RC,19291,HCPCS,facility,both,,,,297,297,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE BREAST CLIP PERCUT,76100024,CDM,761,RC,19295,HCPCS,facility,both,,,,768,768,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE BREAST CLIP PERCUT,76100024,CDM,761,RC,19295,HCPCS,facility,both,,,50,1021,1021,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC MUSCLE BIOPSY PERCUTANEOUS NEEDLE,76100026,CDM,761,RC,20206,HCPCS,facility,both,,,,2073,2073,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE BIOPSY TROCAR/NEEDLE; SUPERFICIAL,76100027,CDM,761,RC,20220,HCPCS,facility,both,,,,2311,2311,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE BIOPSY TROCAR/NEEDLE; DEEP,76100028,CDM,761,RC,20225,HCPCS,facility,both,,,,2802,2802,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRIGGER PTS INJ, SGL/MULTI =/> 3 MUSCLES",76100029,CDM,761,RC,20553,HCPCS,facility,both,,,,1036,1036,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRIGGER PTS INJ, SGL/MULTI =/> 3 MUSCLES",76100029,CDM,761,RC,20553,HCPCS,facility,both,,,,377,377,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ARTHROCENTESIS MAJOR JOINT OR BURSA,76100030,CDM,761,RC,20610,HCPCS,facility,both,,,,909,909,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ARTHROCENTESIS MAJOR JOINT OR BURSA,76100030,CDM,761,RC,20610,HCPCS,facility,both,,,,377,377,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ARTHROCENTESIS MAJOR JOINT OR BURSA,76100030,CDM,761,RC,20610,HCPCS,facility,both,,,,912,912,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC ASPIRATION & INJ TX OF BONE CYST,76100031,CDM,761,RC,20615,HCPCS,facility,both,,,,3100,3100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SOFT TISSUE BIOPSY - NECK/THORAX,76100032,CDM,761,RC,21550,HCPCS,facility,both,,,,2802,2802,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LARYNGOSCOPY FLEX; DIAGNOSTIC,76100033,CDM,761,RC,31575,HCPCS,facility,both,,,,273,273,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC LARYNGOSCOPY FLEX; DIAGNOSTIC,76100033,CDM,761,RC,31575,HCPCS,facility,both,,,,675,675,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLEURA BIOSPY; PERCUTANEOUS NEEDLE,76100035,CDM,761,RC,32400,HCPCS,facility,both,,,,1553,1553,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEAC 01/01/2021 PERCUTANEOUS BIOPSY LUNG/MEDIASTINUM,76100036,CDM,761,RC,32405,HCPCS,facility,both,,,,1391,1391,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THORACENTESIS FOR ASPIRATION,76100037,CDM,761,RC,32421,HCPCS,facility,both,,,,798,798,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APHERESIS WBC,76100038,CDM,761,RC,36511,HCPCS,facility,both,,,,7927,7927,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APHERESIS RBC,76100039,CDM,761,RC,36512,HCPCS,facility,both,,,,7927,7927,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT PICC AGE 5 YRS/>, W/O IMAGE GUIDE",76100041,CDM,761,RC,36569,HCPCS,facility,both,,,,4099,4099,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT PICC AGE 5 YRS/>, W/O IMAGE GUIDE",76100041,CDM,761,RC,36569,HCPCS,facility,both,,,,1713,1713,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INSERT PICC DEVICE W PORT 5 YRS/>,76100042,CDM,761,RC,36571,HCPCS,facility,both,,,,19678,19678,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONTRAST INJ W/FLUORO EVAL CV DEVICE,76100043,CDM,761,RC,36598,HCPCS,facility,both,,,,324,324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HARVEST STEM CELLS AUTOLOGOUS,76100045,CDM,761,RC,38206,HCPCS,facility,both,,,,6046,6046,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CRYOPRESERVE AND STORAGE STEM CELLS,76100046,CDM,761,RC,38207,HCPCS,facility,both,,,,5085,5085,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THAW PRESERVED STEM CELLS,76100047,CDM,761,RC,38208,HCPCS,facility,both,,,,2468,2468,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HARVEST STEM CELL CONCENTRATE,76100050,CDM,761,RC,38215,HCPCS,facility,both,,,,4809,4809,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIAGNOSTIC BONE MARROW; ASPIRATION(S),76100051,CDM,761,RC,38220,HCPCS,facility,both,,,,2059,2059,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIAGNOSTIC BONE MARROW: BIOPSY(IES),76100052,CDM,761,RC,38221,HCPCS,facility,both,,,,2041,2041,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BONE MARROW STEM TRANSPLANT, AUTOLOGOUS",76100055,CDM,761,RC,38241,HCPCS,facility,both,,,,6220,6220,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY LYMPH NODES; SUPERFICIAL,76100057,CDM,761,RC,38505,HCPCS,facility,both,,,,2048,2048,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY SALIVARY GLAND; NEEDLE,76100058,CDM,761,RC,42400,HCPCS,facility,both,,,,1255,1255,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY LIVER; PERCUTANEOUS NEEDLE,76100060,CDM,761,RC,47000,HCPCS,facility,both,,,,2069,2069,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY PANCREAS PERCUTANEOUS NEEDLE,76100061,CDM,761,RC,48102,HCPCS,facility,both,,,,3741,3741,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN RETROPERITONEAL ABSCESS; PERC,76100062,CDM,761,RC,49061,HCPCS,facility,both,,,,3285,3285,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ABD PARACENTESIS W/O IMAGING,76100063,CDM,761,RC,49082,HCPCS,facility,both,,,,855,855,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ABD PARACENTESIS W/O IMAGING,76100063,CDM,761,RC,49082,HCPCS,facility,both,,,,855,855,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ABD PARACENTESIS W/IMAGING,76100064,CDM,761,RC,49083,HCPCS,facility,both,,,,825,825,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC ABD PARACENTESIS W/IMAGING,76100064,CDM,761,RC,49083,HCPCS,facility,both,,,,3886,3886,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERC NDL BIOPSY ABD/RETROPERITONEAL MASS,76100065,CDM,761,RC,49180,HCPCS,facility,both,,,,2072,2072,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC RENAL BIOPSY PERCUTANEOUS,76100066,CDM,761,RC,50200,HCPCS,facility,both,,,,2843,2843,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASP &/OR INJ OF RENAL CYST/PELVIS; PERC,76100067,CDM,761,RC,50390,HCPCS,facility,both,,,,2296,2296,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN BLADDER W/CATH INSERTION,76100068,CDM,761,RC,51102,HCPCS,facility,both,,,,6518,6518,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN BLADDER W/CATH INSERTION,76100068,CDM,761,RC,51102,HCPCS,facility,both,,,,2376,2376,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC SIMPLE BLADDER IRRIGATE LAVAGE/INSTILL,76100069,CDM,761,RC,51700,HCPCS,facility,both,,,,438,438,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INSERT NON-DWELL BLADDER CATH,76100070,CDM,761,RC,51701,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INSERT NON-DWELL BLADDER CATH,76100070,CDM,761,RC,51701,HCPCS,facility,both,,,,991,991,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT TEMP BLADDER CATHETER,76100071,CDM,761,RC,51702,HCPCS,facility,both,,,,323,323,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT TEMP BLADDER CATHETER,76100071,CDM,761,RC,51702,HCPCS,facility,both,,,,161,161,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INSERT BLADDER CATHETER COMPLEX,76100072,CDM,761,RC,51703,HCPCS,facility,both,,,,201,201,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC TREATMENT OF BLADDER LESION,76100073,CDM,761,RC,51720,HCPCS,facility,both,,,,2760,2760,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US POST VOID RESIDUAL URINE,76100076,CDM,761,RC,51798,HCPCS,facility,both,,,,271,271,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC US POST VOID RESIDUAL URINE,76100076,CDM,761,RC,51798,HCPCS,facility,both,,,,290,290,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC PROSTATE NDL/PUNCH BIOPSY;SGL/MULT,76100077,CDM,761,RC,55700,HCPCS,facility,both,,,,2569,2569,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FIT AND INSERT PESSARY,76100082,CDM,761,RC,57160,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FIT AND INSERT PESSARY,76100082,CDM,761,RC,57160,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC REMOVE IUD,76100095,CDM,761,RC,58301,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC AMNIOCENTESIS THERAPEUTIC,76100100,CDM,720,RC,59001,HCPCS,facility,both,,,,5698,5698,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRANSABD AMNIOINFUSION W US,76100101,CDM,761,RC,59070,HCPCS,facility,both,,,,1074,1074,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FETAL FLUID DRAINAGE W US GUIDE,76100102,CDM,720,RC,59074,HCPCS,facility,both,,,,2114,2114,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY THYROID PERC CORE NEEDLE,76100106,CDM,761,RC,60100,HCPCS,facility,both,,,,1294,1294,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERC ASPIRATION SPINAL CORD CYST,76100107,CDM,761,RC,62268,HCPCS,facility,both,,,,1610,1610,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC; W/O IMG,76100108,CDM,761,RC,62270,HCPCS,facility,both,,,,893,893,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC; W/O IMG,76100108,CDM,761,RC,62270,HCPCS,facility,both,,,,1110,1110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN CEREBRO SPINAL FLUID; W/O IMG,76100109,CDM,761,RC,62272,HCPCS,facility,both,,,,1420,1420,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODENERVATION; NECK NERVE MUSCLE(S),76100111,CDM,761,RC,64613,HCPCS,facility,both,,,,704,704,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHEMODEN; EXTREM/TRUNK NERVE MUSCLE(S),76100112,CDM,761,RC,64614,HCPCS,facility,both,,,,589,589,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GI TRACT CAPSULE ENDOSCOPY,76100116,CDM,761,RC,91110,HCPCS,facility,both,,,,5601,5601,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC APHERESIS,76100118,CDM,761,RC,36514,HCPCS,facility,both,,,,7927,7927,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APHERESIS SELECTIVE; W/EXTRACORP IMMUNOADSORP FILTRAT & PLASMA REINF,76100119,CDM,761,RC,36516,HCPCS,facility,both,,,,22992,22992,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APPLY MULTI-LAYER COMPRESSION LOWER LEG,76100150,CDM,761,RC,29581,HCPCS,facility,both,,,,345,345,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC I&D DEEP ABSCESS SOFT TISS NK/THOR,76100151,CDM,761,RC,21501,HCPCS,facility,both,,,,4770,4770,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLEURA CATHETER INSERTION W/IMAGE,76100152,CDM,761,RC,32557,HCPCS,facility,both,,,,2311,2311,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPOSITIONING CENTRAL VENOUS CATHETER W/FLOURO,76100153,CDM,761,RC,36597,HCPCS,facility,both,,,,1736,1736,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPLACE GASTRO/CECO TUBE PERCUTANEOUS,76100154,CDM,761,RC,49450,HCPCS,facility,both,,,,2136,2136,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC FLUORO EXAM GASTRO/COLON TUBE,76100155,CDM,761,RC,49465,HCPCS,facility,both,,,,1137,1137,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ASPIRATE PLEURA W/IMAGING,76100156,CDM,761,RC,32555,HCPCS,facility,both,,,,2299,2299,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVE PREV IMPLANTED EPIDERAL CATH,76100157,CDM,761,RC,62355,HCPCS,facility,both,,,,4225,4225,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT TRANSCERVICAL FALLOPIAN TUBE CATH DX,76100158,CDM,761,RC,58345,HCPCS,facility,both,,,,4524,4524,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACE DEVICE/MARKER NON PRO,76100250,CDM,761,RC,,,facility,both,,,,5416,5416,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SIJ ANESTH/STEROID INJ,76100251,CDM,761,RC,,,facility,both,,,,893,893,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC SIJ ANESTH/STEROID INJ,76100251,CDM,761,RC,,,facility,both,,,,3383,3383,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT HEART PM ATRIAL,76100300,CDM,761,RC,33206,HCPCS,facility,both,,,,7433,7433,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT HEART PM VENTRICULAR,76100301,CDM,761,RC,33207,HCPCS,facility,both,,,,7433,7433,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSRT HEART PM ATRIAL & VENT,76100302,CDM,761,RC,33208,HCPCS,facility,both,,,,9124,9124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT ELECTRD/PM CATH SNGL,76100303,CDM,761,RC,33210,HCPCS,facility,both,,,,9128,9128,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT ELECTRD/PM CATH SNGL,76100303,CDM,761,RC,33210,HCPCS,facility,both,,,,9128,9128,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INSERT CARD ELECTRODES DUAL,76100304,CDM,761,RC,33211,HCPCS,facility,both,,,,8054,8054,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT PULSE GEN SNGL LEAD,76100305,CDM,761,RC,33212,HCPCS,facility,both,,,,6248,6248,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT PULSE GEN DUAL LEADS,76100306,CDM,761,RC,33213,HCPCS,facility,both,,,,6850,6850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UPGRADE IMPL PACEMKR; SC TO DC,76100307,CDM,761,RC,33214,HCPCS,facility,both,,,,9124,9124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPOSITION PACING-DEFIB LEAD,76100308,CDM,761,RC,33215,HCPCS,facility,both,,,,3449,3449,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT 1 ELECTRODE PM-DEFIB,76100309,CDM,761,RC,33216,HCPCS,facility,both,,,,7150,7150,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT 2 ELECTRODE PM-DEFIB,76100310,CDM,761,RC,33217,HCPCS,facility,both,,,,5925,5925,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPAIR LEAD PACE-DEFIB ONE,76100311,CDM,761,RC,33218,HCPCS,facility,both,,,,3324,3324,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPAIR LEAD PACE-DEFIB DUAL,76100312,CDM,761,RC,33220,HCPCS,facility,both,,,,4647,4647,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT PULSE GEN MULT LEADS,76100313,CDM,761,RC,33221,HCPCS,facility,both,,,,10318,10318,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PACER POCKET REVISION,76100314,CDM,761,RC,33222,HCPCS,facility,both,,,,1956,1956,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REVISE POCKET FOR DEFIB,76100315,CDM,761,RC,33223,HCPCS,facility,both,,,,1974,1974,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT PACING LEAD & CONNECT,76100316,CDM,761,RC,33224,HCPCS,facility,both,,,,9124,9124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC L VENTRIC PACING LEAD ADD-ON,76100317,CDM,761,RC,33225,HCPCS,facility,both,,,,9124,9124,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPOSITION L VENTRIC LEAD,76100318,CDM,761,RC,33226,HCPCS,facility,both,,,,2855,2855,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVE&REPLACE PM GEN SINGL,76100319,CDM,761,RC,33227,HCPCS,facility,both,,,,6248,6248,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMV&REPLC PM GEN DUAL LEAD,76100320,CDM,761,RC,33228,HCPCS,facility,both,,,,6850,6850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMV&REPLC PM GEN MULT LEADS,76100321,CDM,761,RC,33229,HCPCS,facility,both,,,,9507,9507,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSRT PULSE GEN W/DUAL LEADS,76100322,CDM,761,RC,33230,HCPCS,facility,both,,,,22636,22636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSRT PULSE GEN W/MULT LEADS,76100323,CDM,761,RC,33231,HCPCS,facility,both,,,,22636,22636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL OF PM GENERATOR,76100324,CDM,761,RC,33233,HCPCS,facility,both,,,,6528,6528,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVE PULSE GENERATOR,76100325,CDM,761,RC,33241,HCPCS,facility,both,,,,3898,3898,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REM SC/DC CARD-DEFIBR ELECTROD OPEN,76100326,CDM,761,RC,33243,HCPCS,facility,both,,,,1497,1497,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REM SC/DC ICD LEAD; TV EXTRACT,76100327,CDM,761,RC,33244,HCPCS,facility,both,,,,3032,3032,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT PACE-DEFIB W/LEAD,76100328,CDM,761,RC,33249,HCPCS,facility,both,,,,28240,28240,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMV&REPLC CVD GEN SING LEAD,76100329,CDM,761,RC,33262,HCPCS,facility,both,,,,22636,22636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMV&REPLC CVD GEN DUAL LEAD,76100330,CDM,761,RC,33263,HCPCS,facility,both,,,,22636,22636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMV&REPLC CVD GEN MULT LEAD,76100331,CDM,761,RC,33264,HCPCS,facility,both,,,,22636,22636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMPL PT-ACTIVATED CARD EVENT RECORDER,76100332,CDM,761,RC,33282,HCPCS,facility,both,,,,2914,2914,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL OF AN IMPL CARD EVENT RECORDER,76100333,CDM,761,RC,33284,HCPCS,facility,both,,,,302,302,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC IMPL OR REVISE EPID CATH FOR PAIN,76100334,CDM,761,RC,62350,HCPCS,facility,both,,,,5539,5539,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSRT/REPL SPINE NSTIM GENERATOR/RCVR REQ POCKET/CONNECT E. ARRAY,76100335,CDM,761,RC,63685,HCPCS,facility,both,,,,18231,18231,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ LAMOT/LAM LUMBAR,76100336,CDM,761,RC,,,facility,both,,,,4265,4265,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TEMPORARY TRANSCUTANEOUS PACING,76100337,CDM,761,RC,92953,HCPCS,facility,both,,,,817,817,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC ESOPHAGUS, REFLUX TEST; WITH MUCOSAL",76100338,CDM,750,RC,,,facility,both,,,,1877,1877,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DESTRUCT W NEUROLYTIC AGENT; CELIAC PLEXUS,76100339,CDM,761,RC,64680,HCPCS,facility,both,,,,3316,3316,,,,,,,,,,,,,Gross Charge Type: SMH INTERVENTIONAL RADIOLOGY FEE SCHEDULE HC DESTRUCT W NEUROLYTIC AGENT; CELIAC PLEXUS,76100339,CDM,761,RC,64680,HCPCS,facility,both,,,,5981,5981,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DESTRUCT W NEUROLYTIC AGENT; CELIAC PLEXUS,76100339,CDM,761,RC,64680,HCPCS,facility,both,,,50,8944,8944,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure HC PLACENTA DELIVERY,76100340,CDM,720,RC,59414,HCPCS,facility,both,,,,991,991,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACENTA DELIVERY,76100340,CDM,720,RC,59414,HCPCS,facility,both,,,,3921,3921,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC CURETTAGE, POSTPARTUM",76100341,CDM,720,RC,59160,HCPCS,facility,both,,,,2965,2965,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DRAIN PELVIC ABSCESS, TRANSVAG/TRANSRECT, PERC",76100342,CDM,761,RC,58823,HCPCS,facility,both,,,,1807,1807,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN PERIVESICAL OR PREVESICAL ABSCESS,76100343,CDM,761,RC,51080,HCPCS,facility,both,,,,5341,5341,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CHANGE URETER TUBE/STENT,76100344,CDM,761,RC,50688,HCPCS,facility,both,,,,4049,4049,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN PERIRENAL OR RENAL ABSCESS; OPEN,76100345,CDM,761,RC,50020,HCPCS,facility,both,,,,17923,17923,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCHANGE PREVIOUS DRAINAGE CATHETER,76100346,CDM,761,RC,49423,HCPCS,facility,both,,,,1573,1573,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT TUNNELED INTRAPERITONEAL CATH; PERC,76100347,CDM,761,RC,49418,HCPCS,facility,both,,,,5711,5711,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN SUBDIAPHRAGMATIC ABSCESS; PERC,76100348,CDM,761,RC,49041,HCPCS,facility,both,,,,3378,3378,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REVISION/REINSERT OF TRANSHEPATIC TUBE,76100349,CDM,761,RC,47530,HCPCS,facility,both,,,,3723,3723,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS BILIARY DRAINAGE EXTERNAL,76100350,CDM,761,RC,47510,HCPCS,facility,both,,,,12079,12079,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERCUTANEOUS CHOLECYSTOSTOMY,76100351,CDM,761,RC,47490,HCPCS,facility,both,,,,7205,7205,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC I&D APPENDICEAL ABSCESS; PERCUTANEOUS,76100352,CDM,761,RC,44901,HCPCS,facility,both,,,,2449,2449,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NG TUBE PLACEMENT W/FLOURO,76100353,CDM,761,RC,43752,HCPCS,facility,both,,,,564,564,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DILATION OF ESOPHAGUS BY BALLOON 30 MM/>,76100354,CDM,761,RC,43458,HCPCS,facility,both,,,,1529,1529,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LIP REPAIR, FT; UP TO HALF VERTICAL HGT",76100355,CDM,761,RC,40652,HCPCS,facility,both,,,,634,634,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INFUSION TRANSCATH TX, NON THROMBOLYTIC",76100356,CDM,761,RC,37202,HCPCS,facility,both,,,,3436,3436,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SA MECH REMOVAL, OBSTRUCTIVE CVAD",76100357,CDM,761,RC,36595,HCPCS,facility,both,,,,10883,10883,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT NON-TUNNEL CV CATH <5 YRS,76100358,CDM,761,RC,36555,HCPCS,facility,both,,,,3981,3981,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC INSTILLATION, AGENT FOR PLEURODESIS",76100359,CDM,761,RC,32560,HCPCS,facility,both,,,,1613,1613,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRIMALLEOLAR ANKLE FX; WITH MANIPULATION CLOSED,76100360,CDM,761,RC,27818,HCPCS,facility,both,,,,1986,1986,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC TIBIAL SHAFT FX WITH MANIPULATION, CLOSED",76100361,CDM,761,RC,27752,HCPCS,facility,both,,,,1984,1984,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC FEMORAL SHAFT FX WITH MANIPULATION, CLOSED",76100362,CDM,761,RC,27502,HCPCS,facility,both,,,,1487,1487,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC FEMORAL FX, PROXIMAL HEAD; WITH MANIPULATION, CLOSED",76100363,CDM,761,RC,27268,HCPCS,facility,both,,,,417,417,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC SPONTANEOUS HIP DISLOC WO MANIPULATION,76100364,CDM,761,RC,27256,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC GTR TROCHANTERIC FX, WO MANIPULATION, CLOSED",76100365,CDM,761,RC,27246,HCPCS,facility,both,,,,287,287,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC RADIAL SHAFT FRACTURE; WITH MANIPULATION, CLOSED",76100366,CDM,761,RC,25505,HCPCS,facility,both,,,,1989,1989,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC HUMERUS FX; WITH MANIPULATION, CLOSED",76100367,CDM,761,RC,24505,HCPCS,facility,both,,,,1979,1979,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC INJECTION SINUS TRACT; DIAGNOSTIC (SINOGRAM),76100368,CDM,761,RC,20501,HCPCS,facility,both,,,,721,721,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION INTO SKIN LESIONS =<7,76100369,CDM,761,RC,11900,HCPCS,facility,both,,,,353,353,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL OF NAIL BED AND FINGER TIP,76100370,CDM,761,RC,11752,HCPCS,facility,both,,,,316,316,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC EXCISION OF NAIL & MATRIX, PARTIAL OR COMPLETE",76100371,CDM,761,RC,11750,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC EXCISION, BENIGN LESION S/N/H/F/G 0.5 CM OR LESS",76100372,CDM,761,RC,11420,HCPCS,facility,both,,,,2079,2079,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC DEBRIDEMENT, BONE 1ST 20 SQ CM OR LESS",76100373,CDM,761,RC,11044,HCPCS,facility,both,,,,9292,9292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DEBRIDEMENT, BONE 1ST 20 SQ CM OR LESS",76100373,CDM,761,RC,11044,HCPCS,facility,both,,,,2067,2067,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC THROMBECTOMY AVF DIALYSIS GRAFT,76100376,CDM,761,RC,36831,HCPCS,facility,both,,,,14163,14163,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BX BREAST 1ST LESION STEREOTACTIC GUIDANCE,76100377,CDM,761,RC,19081,HCPCS,facility,both,,,,4708,4708,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BX BREAST ADD LESION STEREOTACTIC GUIDANCE,76100378,CDM,761,RC,19082,HCPCS,facility,both,,,,4121,4121,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BX BREAST 1ST LESION US IMAG,76100379,CDM,761,RC,19083,HCPCS,facility,both,,,,4298,4298,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BX BREAST ADD LESION US IMAG,76100380,CDM,761,RC,19084,HCPCS,facility,both,,,,3713,3713,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BX BREAST 1ST LESION MR IMAG,76100381,CDM,761,RC,19085,HCPCS,facility,both,,,,3604,3604,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BX BREAST ADD LESION MR IMAG,76100382,CDM,761,RC,19086,HCPCS,facility,both,,,,3019,3019,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEVICE BREAST 1ST IMAG,76100383,CDM,761,RC,19281,HCPCS,facility,both,,,,2072,2072,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEVICE BREAST EA IMAG,76100384,CDM,761,RC,19282,HCPCS,facility,both,,,,1487,1487,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEV BREAST 1ST STEREOTACTIC GUIDANCE,76100385,CDM,761,RC,19283,HCPCS,facility,both,,,,3233,3233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEV BREAST ADD STEREOTACTIC GUIDANCE,76100386,CDM,761,RC,19284,HCPCS,facility,both,,,,2649,2649,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEV BREAST 1ST US IMAG,76100387,CDM,761,RC,19285,HCPCS,facility,both,,,,2821,2821,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEV BREAST ADD US IMAG,76100388,CDM,761,RC,19286,HCPCS,facility,both,,,,2237,2237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEV BREAST 1ST MR GUIDE,76100389,CDM,761,RC,19287,HCPCS,facility,both,,,,2128,2128,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERQ DEV BREAST ADD MR GUIDE,76100390,CDM,761,RC,19288,HCPCS,facility,both,,,,1544,1544,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERC VERTEBROPLASTY INJ, CERVICOTHORACIC",76100401,CDM,761,RC,22510,HCPCS,facility,both,,,,7585,7585,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERC VERTEBROPLASTY INJ, LUMBOSACRAL",76100402,CDM,761,RC,22511,HCPCS,facility,both,,,,4746,4746,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERC VERTEBROPLASTY INJ, EA ADDL",76100403,CDM,761,RC,22512,HCPCS,facility,both,,,,4746,4746,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ VERTEBRAL AUGMENTATION, THORACIC",76100404,CDM,761,RC,22513,HCPCS,facility,both,,,,7955,7955,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ VERTEBRAL AUGMENTATION, LUMBAR",76100405,CDM,761,RC,22514,HCPCS,facility,both,,,,7955,7955,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ VERTEBRAL AUGMENTATION, EA ADDL",76100406,CDM,761,RC,22515,HCPCS,facility,both,,,,7955,7955,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERC SACRAL AUGUMENTATION, UNIL INJ",76100407,CDM,761,RC,,,facility,both,,,,6133,6133,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERC SACRAL AUGUMENTATION, BILAT INJ",76100408,CDM,761,RC,,,facility,both,,,,10687,10687,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN/INJ MAJOR JOINT/BURSA W/US,76100409,CDM,761,RC,20611,HCPCS,facility,both,,,,3477,3477,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYELOGRAPHY LUMBAR INJECTION; CERVICAL,76100410,CDM,761,RC,62302,HCPCS,facility,both,,,,4248,4248,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYELOGRAPHY LUMBAR INJECTION; THORACIC,76100411,CDM,761,RC,62303,HCPCS,facility,both,,,,5371,5371,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYELOGRAPHY LUMBAR INJECTION; LUMBOSACRAL,76100412,CDM,761,RC,62304,HCPCS,facility,both,,,,4050,4050,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYELOGRAPHY LUMBAR INJECTION; 2 OR MORE REGIONS,76100413,CDM,761,RC,62305,HCPCS,facility,both,,,,5097,5097,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TBA, OPEN; BRACHIOCEPHALIC TRUNK/BRANCH",76100414,CDM,761,RC,35458,HCPCS,facility,both,,,,5375,5375,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PTA BRACHIOCEPHALIC ARTERIES,76100415,CDM,761,RC,35475,HCPCS,facility,both,,,,5375,5375,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJ PERC EXTR ANEURYSM,76100416,CDM,761,RC,36002,HCPCS,facility,both,,,,1861,1861,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LUMEN MECH REM OBSTR CVAD,76100417,CDM,761,RC,36596,HCPCS,facility,both,,,,10834,10834,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REM BILIARY STONE VIA T-TUBE,76100418,CDM,761,RC,47630,HCPCS,facility,both,,,,4204,4204,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN/INJ SMALL JOINT/BURSA W/US,76100419,CDM,761,RC,20604,HCPCS,facility,both,,,,745,745,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DRAIN/INJ INTERMEDIATE JOINT/BURSA W/US,76100420,CDM,761,RC,20606,HCPCS,facility,both,,,,1044,1044,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECT FOR SACROILIAC JOINT,76100421,CDM,761,RC,,,facility,both,,,,793,793,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRODUCTION OF LONG GI TUBE,76100422,CDM,761,RC,44500,HCPCS,facility,both,,,,3184,3184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PROC, ANKLE ARTHROGRAPHY",76100423,CDM,761,RC,27648,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PROC, HIP ARTHROGRAPHY, W/ ANESTH",76100424,CDM,761,RC,27095,HCPCS,facility,both,,,,206,206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MASTOTOMY WITH EXPLORATION DEEP,76100425,CDM,761,RC,19020,HCPCS,facility,both,,,,3237,3237,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTRAVASC US NONCORONARY, INITIAL NONCORONARY VESSEL",76100426,CDM,761,RC,37252,HCPCS,facility,both,,,,1717,1717,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS",76100427,CDM,761,RC,47531,HCPCS,facility,both,,,,4396,4396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION FOR CHOLANGIOGRAM, NEW ACCESS",76100428,CDM,761,RC,47532,HCPCS,facility,both,,,,3755,3755,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLACEMENT BILIARY DRAINAGE CATH, EXTERNAL",76100429,CDM,761,RC,47533,HCPCS,facility,both,,,,29815,29815,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLACEMENT BILIARY DRAINAGE CATH, INTERNAL-EXTERNAL",76100430,CDM,761,RC,47534,HCPCS,facility,both,,,,29815,29815,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONVERSION EXTERNAL BILIARY DRAINAGE CATH,76100431,CDM,761,RC,47535,HCPCS,facility,both,,,,21063,21063,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCHANGE BILIARY DRAINAGE CATH,76100432,CDM,761,RC,47536,HCPCS,facility,both,,,,21063,21063,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL BILIARY DRAINAGE CATH,76100433,CDM,761,RC,47537,HCPCS,facility,both,,,,7430,7430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ PLMT BILE DUCT STENT(S), EXISTING ACCESS",76100434,CDM,761,RC,47538,HCPCS,facility,both,,,,29815,29815,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ PLMT BILE DUCT STENT(S), NEW ACCESS, W/O SEPAR CATH",76100435,CDM,761,RC,47539,HCPCS,facility,both,,,,21063,21063,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ PLMT BILE DUCT STENT, NEW ACCESS, W/ SEPAR CATH",76100436,CDM,761,RC,47540,HCPCS,facility,both,,,,21063,21063,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL DUCT GALLBLADDER CALCULI,76100437,CDM,761,RC,47544,HCPCS,facility,both,,,,6835,6835,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PROC NEPHROSTOGRM &/ URETEROGRM, NEW ACCESS",76100438,CDM,761,RC,50430,HCPCS,facility,both,,,,2777,2777,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ PROC NEPHROSTOGRM &/ URETEROGRM, EXIST ACCESS",76100439,CDM,761,RC,50431,HCPCS,facility,both,,,,2777,2777,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PLACEMENT NEPHROSTOMY CATHETER,76100440,CDM,761,RC,50432,HCPCS,facility,both,,,,4425,4425,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLACEMENT NEPHROURETERAL CATHETER, NEW ACCESS",76100441,CDM,761,RC,50433,HCPCS,facility,both,,,,4425,4425,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CONVERT NEPHROSTOMY CATHETER,76100442,CDM,761,RC,50434,HCPCS,facility,both,,,,2436,2436,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCHANGE NEPHROSTOMY CATHETER,76100443,CDM,761,RC,50435,HCPCS,facility,both,,,,3449,3449,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDOLUMINAL BX URETER AND/OR RENAL PELVIS,76100444,CDM,761,RC,50606,HCPCS,facility,both,,,,2436,2436,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLMT URETERAL STENT PRQ, PRE-EXISTING NEPHR TRACT",76100445,CDM,761,RC,50693,HCPCS,facility,both,,,,6974,6974,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLMT URETERAL STENT PRQ, NEW ACCESS, W/O SEPAR CATH",76100446,CDM,761,RC,50694,HCPCS,facility,both,,,,6974,6974,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLMT URETERAL STENT PRQ, NEW ACCESS, W/ SEPAR CATH",76100447,CDM,761,RC,50695,HCPCS,facility,both,,,,6974,6974,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDOVASC PROLONG ADMIN RX AGENT 1ST,76100448,CDM,761,RC,61650,HCPCS,facility,both,,,,6430,6430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDOVASC PROLONG ADMIN RX AGENT ADD,76100449,CDM,761,RC,61651,HCPCS,facility,both,,,,6430,6430,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH,76100450,CDM,761,RC,26765,HCPCS,facility,both,,,,4027,4027,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MULTIFETAL REDUCTION,76100451,CDM,761,RC,59866,HCPCS,facility,both,,,,1056,1056,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; PUDENDAL NERVE",76100452,CDM,761,RC,64430,HCPCS,facility,both,,,,2410,2410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BONE MARROW ASPIRATE & BIOPSY - SAME INCISION & SAME DOS,76100454,CDM,761,RC,,,facility,both,,,,1178,1178,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DEBRIDEMENT INFECTED SKIN EA ADD < = 10% BS,76100455,CDM,761,RC,11001,HCPCS,facility,both,,,,1011,1011,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DEBRIDEMENT, SUBCUTANEOUS TISSUE; ADD-ON < = 20 SQ CM",76100456,CDM,761,RC,11045,HCPCS,facility,both,,,,9292,9292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DEBRIDEMENT, MUSCLE/FASCIA; ADD-ON < = 20 SQ CM",76100457,CDM,761,RC,11046,HCPCS,facility,both,,,,9292,9292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DEBRIDEMENT, BONE; ADD-ON < = 20 SQ CM",76100458,CDM,761,RC,11047,HCPCS,facility,both,,,,9292,9292,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERTION/REPLACEMENT SUBCUTANEOUS DEFIBRILLATOR,76100459,CDM,761,RC,33270,HCPCS,facility,both,,,,28240,28240,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE,76100460,CDM,761,RC,33271,HCPCS,facility,both,,,,5334,5334,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR,76100461,CDM,761,RC,33272,HCPCS,facility,both,,,,4636,4636,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REPOSITIONING PREVIOUS IMPLANTED SUBQ DEFIB ELECTRODE,76100462,CDM,761,RC,33273,HCPCS,facility,both,,,,4258,4258,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LIGATE/DIVIDE/EXCISE VARICOSE VEIN CLUSTER(S), 1 LEG",76100463,CDM,761,RC,37785,HCPCS,facility,both,,,,16498,16498,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC HEMORRHOIDECTOMY, INT & EXT, SNGL COL/GRP; W/FISTULECTOMY",76100464,CDM,761,RC,46258,HCPCS,facility,both,,,,17079,17079,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ILIAC REVASC ARTERY; ANGIOPLASTY INIT VESSEL,76100467,CDM,761,RC,37220,HCPCS,facility,both,,,,18175,18175,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERCUT MECH THROMBECTOMY, VENOUS",76100468,CDM,761,RC,37187,HCPCS,facility,both,,,,11651,11651,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC AVULSION NAIL PLATE, PARTIAL/COMPLETE, SIMPLE; EA ADDTL",76100469,CDM,761,RC,11732,HCPCS,facility,both,,,,82,82,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EXCISION TUMOR, SOFT TISSUE FOOT/TOE <1.5CM",76100470,CDM,761,RC,28045,HCPCS,facility,both,,,,6062,6062,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARTIAL EXCISION BONE; DISTAL PHALANX OF FINGER,76100471,CDM,761,RC,26236,HCPCS,facility,both,,,,1980,1980,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CLSD TX PELVIC RING FX; UNI OR BIL; W/O MANIPUL,76100472,CDM,761,RC,27197,HCPCS,facility,both,,,,413,413,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PARTIAL EXCISION PHALANX TOE BONE,76100473,CDM,761,RC,28124,HCPCS,facility,both,,,,3049,3049,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTERPHALANGEAL TOE JNT EXCISION, EACH",76100474,CDM,761,RC,28160,HCPCS,facility,both,,,,4984,4984,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTR CATH DIALYS CIRCT W/TRLUML BAL ANGIOPLASTY,76100475,CDM,761,RC,36901,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTR CATH DIAL CIRC W/TRCATH PLC INTRVSC STENT(S),76100476,CDM,761,RC,36902,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTR CATH DIAL CIRC W/INTRAPROC PHARM THRMB INJ,76100477,CDM,761,RC,36903,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THRMB/INFUS DIAL CIRC & INTRAPRC PHARM THRMB INJ,76100478,CDM,761,RC,36904,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THRMB/INFUS DIAL CIRC W/TRNSLUM BAL ANGIOPLASTY,76100479,CDM,761,RC,36905,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THRMB/INFUS DIAL CIRC&INTRPRC PHAR INJ W/STENT(S),76100480,CDM,761,RC,36906,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BALLOON ANGIOPLASTY CTR DIALYSIS SEGMENT,76100481,CDM,761,RC,36907,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC STENT PLACEMENT CENTRAL DIALYSIS SEGMENT,76100482,CDM,761,RC,36908,HCPCS,facility,both,,,,3632,3632,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIALYSIS CIRCUIT PERM VASC EMBOL OR OCCLUSION,76100483,CDM,761,RC,36909,HCPCS,facility,both,,,,2784,2784,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRLUML BALLOON ANGIOPLASTY; INITIAL ARTERY,76100484,CDM,761,RC,37246,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRLUML BALLOON ANGIOPLASTY; ADDL ART,76100485,CDM,761,RC,37247,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRLUML BALLOON ANGIOPLASTY; INITIAL VEIN,76100486,CDM,761,RC,37248,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRLUML BALLOON ANGIOPLASTY; ADDL VEIN,76100487,CDM,761,RC,37249,HCPCS,facility,both,,,,17176,17176,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECT INTERLAMINAR CRV/THRC; W/O IMG,76100488,CDM,761,RC,62320,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECT INTERLAMINAR CRV/THRC; W/IMG,76100489,CDM,761,RC,62321,HCPCS,facility,both,,,,5447,5447,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECT INTERLAMINAR LMBR/SAC; W/O IMG,76100490,CDM,761,RC,62322,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECT INTERLAMINAR LMBR/SAC; W/IMG,76100491,CDM,761,RC,62323,HCPCS,facility,both,,,,5447,5447,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ INFUS/BOLUS, INTERLAMINAR CRV/THRC,W/O IMG",76100492,CDM,761,RC,62324,HCPCS,facility,both,,,,2143,2143,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ INFUS/BOLUS, INTERLAMINAR CRV/THRC,W/IMG",76100493,CDM,761,RC,62325,HCPCS,facility,both,,,,6064,6064,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ INFUS/BOLUS, INTERLAMINAR LMBR/SAC,W/O IMG",76100494,CDM,761,RC,62326,HCPCS,facility,both,,,,2143,2143,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ INFUS/BOLUS, INTERLAMINAR LMBR/SAC,W/IMG",76100495,CDM,761,RC,62327,HCPCS,facility,both,,,,6064,6064,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ ABLATION 1 + LIVER TUMOR(S), RADIOFREQ",76100496,CDM,761,RC,47382,HCPCS,facility,both,,,,12110,12110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PERQ INTERDISCAL/PARAVERT TISSUE ASPIRATION, DX",76100497,CDM,761,RC,62267,HCPCS,facility,both,,,,3853,3853,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SCLEROTX FLUID COLLECT, PERC, INCL CONTRAST INJ(S), SCLERO INJ(S)",76100498,CDM,761,RC,49185,HCPCS,facility,both,,,,6917,6917,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC APHERESIS; FOR PLATELETS,76100499,CDM,761,RC,36513,HCPCS,facility,both,,,,2566,2566,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC THERAPEUTIC APHERESIS; W/ EXTRACORP IMMUNOADSORP & PLASMA REINFUSE,76100500,CDM,761,RC,36515,HCPCS,facility,both,,,,12565,12565,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVAL INDWELLING URETERAL STENT, PERQ APPROACH",76100501,CDM,761,RC,50384,HCPCS,facility,both,,,,3449,3449,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; SUPRASCAPULAR NERVE",76100502,CDM,761,RC,64418,HCPCS,facility,both,,,,1967,1967,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF,76100503,CDM,761,RC,32552,HCPCS,facility,both,,,,2656,2656,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ASPIRATION AND/OR INJECTION, THYROID CYST",76100504,CDM,761,RC,60300,HCPCS,facility,both,,,,2095,2095,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIAGNOSTIC BONE MARROW; BIOPSY(IES) AND ASPIRATION(S),76100516,CDM,761,RC,38222,HCPCS,facility,both,,,,3531,3531,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT; 1 VEIN,76100518,CDM,761,RC,36465,HCPCS,facility,both,,,,9962,9962,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT; MULTIPLE VEINS,76100519,CDM,761,RC,36466,HCPCS,facility,both,,,,9962,9962,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDOVENOUS THERAPY CHEMICAL ADHESIVE; 1ST VEIN TREATED,76100520,CDM,761,RC,36482,HCPCS,facility,both,,,,19138,19138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ENDOVENOUS THERAPY CHEMICAL ADHESIVE; SUBSEQUENT VEIN TREATED,76100521,CDM,761,RC,36483,HCPCS,facility,both,,,,9570,9570,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION SCLEROSING SOLUTION; SINGLE VEIN,76100522,CDM,761,RC,36470,HCPCS,facility,both,,,,1981,1981,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION SCLEROSING SOLUTION; MULTIPLE VEIN SAME LEG,76100523,CDM,761,RC,36471,HCPCS,facility,both,,,,1981,1981,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REVSC, ENDOVSC, OPEN/PERQ, TIB/PERON ARTERY, UNI, INITIAL; W/TLA",76100524,CDM,761,RC,37228,HCPCS,facility,both,,,,10012,10012,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATION 1 OR MORE LIVER TUMOR(S), PERCUTANEOUS, CRYOABLATION",76100525,CDM,761,RC,47383,HCPCS,facility,both,,,,12195,12195,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATION 1 OR MORE RENAL TUMORS PERCUTANEOUS, UNIL, RADIOFREQ",76100526,CDM,761,RC,50592,HCPCS,facility,both,,,,13066,13066,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATION RENAL TUMOR(S), UNIL, PERCUTANEOUS, CRYOTHERAPY",76100527,CDM,761,RC,50593,HCPCS,facility,both,,,,17542,17542,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL TUNNELED INTRAPERITONEAL CATHETER,76100528,CDM,761,RC,49422,HCPCS,facility,both,,,,4702,4702,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSTILL (S), VIA CHEST TUBE/CATH, FIBRINOLYSIS AGENT, INIT DAY",76100529,CDM,761,RC,32561,HCPCS,facility,both,,,,757,757,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATE BONE TUMOR, PERQ, W/IMAG PERF, CRYO",76100530,CDM,761,RC,20983,HCPCS,facility,both,,,,13757,13757,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATE PULM TUMOR, PERQ, W/IMAG PERF, UNIL, CRY",76100531,CDM,761,RC,32994,HCPCS,facility,both,,,,7748,7748,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CRYOSURG ABLATE EA FIBROADENOMA, W/ US",76100532,CDM,761,RC,19105,HCPCS,facility,both,,,,4708,4708,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATE, PERQ, INCL IMAGE, UPPER EXTREM/PERPH NERVE",76100533,CDM,761,RC,,,facility,both,,,,11183,11183,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATE, PERQ, INCL IMAGE, LOWER EXTREM/PERPH NERVE",76100534,CDM,761,RC,,,facility,both,,,,11183,11183,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATE, PERQ, INCL IMAGE, PLEXUS/TRUNCAL NERVE",76100535,CDM,761,RC,,,facility,both,,,,11183,11183,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ABLATE, 1 OR MORE PULM TUMOR, PERQ, UNIL; RF",76100536,CDM,761,RC,32998,HCPCS,facility,both,,,,10848,10848,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/O GUIDANCE, EA ADDL LESION",76100537,CDM,761,RC,10004,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/US GUIDANCE, 1ST LESION",76100538,CDM,761,RC,10005,HCPCS,facility,both,,,,2922,2922,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/US GUIDANCE, EA ADDL LESION",76100539,CDM,761,RC,10006,HCPCS,facility,both,,,,2784,2784,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/FLUORO GUIDANCE, 1ST LESION",76100540,CDM,761,RC,10007,HCPCS,facility,both,,,,1796,1796,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/FLUORO GUIDANCE, EA ADDL LESION",76100541,CDM,761,RC,10008,HCPCS,facility,both,,,,1796,1796,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/CT GUIDANCE, 1ST LESION",76100542,CDM,761,RC,10009,HCPCS,facility,both,,,,6525,6525,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/CT GUIDANCE, EA ADDL LESION",76100543,CDM,761,RC,10010,HCPCS,facility,both,,,,6525,6525,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/MR GUIDANCE, 1ST LESION",76100544,CDM,761,RC,10011,HCPCS,facility,both,,,,1850,1850,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FINE NEEDLE ASPIRATION BIOPSY, W/MR GUIDANCE, EA ADDL LESION",76100545,CDM,761,RC,10012,HCPCS,facility,both,,,,1347,1347,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PUNCH BIOSPY OF SKIN, SINGLE LESION",76100547,CDM,761,RC,11104,HCPCS,facility,both,,,,1347,1347,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INCISIONAL BIOSPY OF SKIN, SINGLE LESION",76100548,CDM,761,RC,11106,HCPCS,facility,both,,,,1347,1347,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TANGENTIAL BIOSPY OF SKIN, EA SEPARATE/ADDL LESION",76100549,CDM,761,RC,11103,HCPCS,facility,both,,,,488,488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PUNCH BIOSPY OF SKIN, EA SEPARATE/ADDL LESION",76100550,CDM,761,RC,11105,HCPCS,facility,both,,,,488,488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INCISIONAL BIOSPY OF SKIN, EA SEPARATE/ADDL LESION",76100551,CDM,761,RC,11107,HCPCS,facility,both,,,,488,488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERTION, SUBQ CARDIAC RHYTHM MONITOR, INCL PROGRAM",76100552,CDM,761,RC,33285,HCPCS,facility,both,,,,5334,5334,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REMOVAL, SUBQ CARDIAC RHYTHM MONITOR",76100553,CDM,761,RC,33286,HCPCS,facility,both,,,,885,885,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DILATION EXISTING TRACT, PERC, W/IMG GUIDE, POST TUBE PLACE",76100554,CDM,761,RC,50436,HCPCS,facility,both,,,,2768,2768,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DILAT EXIST TRACT, PERC, W/IMG GUIDE, POSTTUBEPLACE, NEWRENALACCESS",76100555,CDM,761,RC,50437,HCPCS,facility,both,,,,2878,2878,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJ PROC CONTRAST KNEE ARTHROGRAPHY/CONTRAST CT/MRI,76100556,CDM,761,RC,27369,HCPCS,facility,both,,,,864,864,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHANGE G TUBE, PERC, W/O IMG/GUIDE, W/O REVISION OF G TRACT",76100557,CDM,761,RC,43762,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHANGE G TUBE, PERC, W/O IMG/GUIDE, W/REVISION OF G TRACT",76100558,CDM,761,RC,43763,HCPCS,facility,both,,,,638,638,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERT PICC, INCLUDING IMAGING, 5 YR+",76100559,CDM,761,RC,36573,HCPCS,facility,both,,,,3592,3592,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADJ TISS TRANS/REARR FORE/CHKS/CHIN/MOU/NCK/AXIL/GENT/HND/FT 10SQCM,76100560,CDM,761,RC,14040,HCPCS,facility,both,,,,3577,3577,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADJ TISS TRANS/REARR FORE/CHKS/CHIN/MOU/NCK/AXIL/GENT/HND/FT 10SQCM,76100560,CDM,761,RC,14040,HCPCS,facility,both,,,,1806,1806,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC CYSTO W/URETEROSCOPY W/REMOVAL/MANIPULATION STONES,76100561,CDM,761,RC,52352,HCPCS,facility,both,,,,6084,6084,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NEUROPLASTY MAJOR PRPH NRV ARM/LEG OPEN; OTHER/THAN SPECIFIED,76100562,CDM,761,RC,64708,HCPCS,facility,both,,,,5104,5104,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EGD, FLEXIBLE, TRANSORAL; W/ FOREIGN BODY REMOVAL",76100564,CDM,761,RC,43247,HCPCS,facility,both,,,,1582,1582,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH; SIMPLE,76100565,CDM,761,RC,20520,HCPCS,facility,both,,,,4303,4303,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LAPAROSCOPIC TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY,76100566,CDM,761,RC,59151,HCPCS,facility,both,,,,9552,9552,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,76100567,CDM,761,RC,43239,HCPCS,facility,both,,,,2500,2500,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,76100567,CDM,761,RC,43239,HCPCS,facility,both,,,,1582,1582,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC SIGMOIDOSCOPY FLX DX W/COLLECT SPECM(S) BRUSH/WASH, IF PFRMD",76100568,CDM,761,RC,45330,HCPCS,facility,both,,,,1704,1704,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC PRQ SKEL FIX PHLNGL SHFT FX, PROX/MIDDLE PX/FING/THUM, W/MANIP, EA",76100569,CDM,761,RC,26727,HCPCS,facility,both,,,,8210,8210,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE HC EXCHANGE TRANSFUSION BLOOD; NOT NEWBORN,76100570,CDM,761,RC,36455,HCPCS,facility,both,,,,1624,1624,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED,76100571,CDM,761,RC,33016,HCPCS,facility,both,,,,8567,8567,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT,76100577,CDM,761,RC,62328,HCPCS,facility,both,,,,5447,5447,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC THERAPEUTIC SPINAL PUNCTURE, DRAINAGE CSF W/FLUOR/CT",76100578,CDM,761,RC,62329,HCPCS,facility,both,,,,5447,5447,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL,76100579,CDM,761,RC,20999,HCPCS,facility,both,,,,796,796,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REVASC, OPEN/PERCUT, ILIAC ARTERY W/ANGIOPLASTY; EA ADD IPSI VESSEL",76100580,CDM,761,RC,37222,HCPCS,facility,both,,,,4575,4575,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REVASC, OPEN/PERCUT, TIBIAL/PERONEAL, W/ANGIOPLASTY; UNIL, EA ADD VESSEL",76100581,CDM,761,RC,37232,HCPCS,facility,both,,,,1919,1919,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REVASC, OPEN/PERCUT, ILIAC ART W/STENT & ANGIOPLASTY; EA ADD IPSI VESSEL",76100582,CDM,761,RC,37223,HCPCS,facility,both,,,,1919,1919,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PLMT INTERSTITIAL DEVICE RAD THERAPY, PROSTATE, 1/MULTI",76100621,CDM,761,RC,55876,HCPCS,facility,both,,,,5867,5867,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LAPAROSCOPY SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,76100622,CDM,761,RC,47563,HCPCS,facility,both,,,,22775,22775,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJ PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPY,76100623,CDM,761,RC,51610,HCPCS,facility,both,,,,631,631,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INJECTION EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT,76100624,CDM,761,RC,49427,HCPCS,facility,both,,,,1942,1942,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJECT PROC,76100625,CDM,761,RC,61070,HCPCS,facility,both,,,,4170,4170,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REVASC, OPEN/PRQ, FEM/POPL, UNIL, W/STENT/ANGIOPL SAME VESSEL",76100626,CDM,761,RC,37226,HCPCS,facility,both,,,,21378,21378,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE W/FLUORO, IF PERFORMED",76100627,CDM,761,RC,49460,HCPCS,facility,both,,,,1853,1853,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PRIMARY PRQ MECHANICAL THROMBECTOMY N-COR N-ICRA, 1ST VESSEL",76100628,CDM,761,RC,37184,HCPCS,facility,both,,,,16344,16344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PRIMARY PRQ MECHANICAL THROMBECTOMY N-COR N-ICRA, SUBSQ VESSEL",76100629,CDM,761,RC,37185,HCPCS,facility,both,,,,1008,1008,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERTION VAGINAL RADIATION DEVICE,76100630,CDM,761,RC,57156,HCPCS,facility,both,,,,4805,4805,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CORE NEEDLE BX, LUNG/MEDIASTINUM, PERQ, INCL IMG GUIDE",76100631,CDM,761,RC,32408,HCPCS,facility,both,,,,2311,2311,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC PRQ TRANSLUML MECHNL THROMBECTOMY, VEIN(S), REPEAT TX",76100634,CDM,761,RC,37188,HCPCS,facility,both,,,,11655,11655,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SECONDARY PRQ TRANSLUML THROMBECTOMY, N-CORONARY N-INTRACRANIAL",76100635,CDM,761,RC,37186,HCPCS,facility,both,,,,9562,9562,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTRAVASCULAR US, NONCORONARY, INCL RS&I, EA ADDL VESSEL",76100636,CDM,761,RC,37253,HCPCS,facility,both,,,,1715,1715,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRANSCATH PLACE XCRANIAL VERTEBRAL ART STENT(S), OPEN/PERQ, 1ST VESSEL",76100637,CDM,761,RC,,,facility,both,,,,5477,5477,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC TRANSCATH PLACE XCRANIAL VERTEBRAL ART STENT(S), OPEN/PERQ, EA ADDL",76100638,CDM,761,RC,,,facility,both,,,,1369,1369,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 0.5 CM/<,76100639,CDM,761,RC,11600,HCPCS,facility,both,,,,3456,3456,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 0.6-1.0 CM,76100640,CDM,761,RC,11601,HCPCS,facility,both,,,,4184,4184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 1.1-2.0 CM,76100641,CDM,761,RC,11602,HCPCS,facility,both,,,,2041,2041,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 2.1-3.0 CM,76100642,CDM,761,RC,11603,HCPCS,facility,both,,,,5426,5426,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 3.1-4.0 CM,76100643,CDM,761,RC,11604,HCPCS,facility,both,,,,6009,6009,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM,76100644,CDM,761,RC,11606,HCPCS,facility,both,,,,9380,9380,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INSERTION TISSUE EXPANDER(S), NOT BREAST, INCL SBSQ EXPANSION",76100645,CDM,761,RC,11960,HCPCS,facility,both,,,,19763,19763,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REPAIR COMPLEX, TRUNK; 1.1-2.5 CM",76100646,CDM,761,RC,13100,HCPCS,facility,both,,,,2873,2873,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ADJACENT TISSUE TRANSFER/REARRANGEMENT, TRUNK; 10 SQCM/<",76100647,CDM,761,RC,14000,HCPCS,facility,both,,,,10552,10552,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ADJACENT TISSUE TRANSFER/REARRANGEMENT, TRUNK; 10.1-30.0 SQCM",76100648,CDM,761,RC,14001,HCPCS,facility,both,,,,9701,9701,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC APPLY SKIN SUB GRAFT TRUNK/ARMS/LEGS TOTAL AREA/100SQ CM /<1ST 25,76100649,CDM,761,RC,15271,HCPCS,facility,both,,,,1987,1987,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOPSY, INTRANASAL",76100650,CDM,761,RC,30100,HCPCS,facility,both,,,,2222,2222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EXCISION, NASAL POLYP(S), (SIMPLE)",76100651,CDM,761,RC,30110,HCPCS,facility,both,,,,4020,4020,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LAVAGE BY CANNULATION; MAXILLARY SINUS,76100652,CDM,761,RC,31000,HCPCS,facility,both,,,,1278,1278,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NASAL ENDOSCOPY, DIAGNOSTIC, UNIL/BILAT",76100653,CDM,761,RC,31231,HCPCS,facility,both,,,,695,695,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NASAL/SINUS ENDOSCOPY, DIAGNOSTIC, W/MAXILLARY SINUSOSCOPY",76100654,CDM,761,RC,31233,HCPCS,facility,both,,,,1599,1599,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NASAL/SINUS ENDOSCOPY, SURGICAL; W/BX, POLYPECTOMY/DEBRIDE",76100655,CDM,761,RC,31237,HCPCS,facility,both,,,,4026,4026,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NASAL/SINUS ENDOSCOPY, MAX ANTROSTOMY; W/RMVL TISSUE MAX SINUS",76100656,CDM,761,RC,31267,HCPCS,facility,both,,,,24357,24357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NASAL/SINUS ENDOSCOPY; W/SPENOIDOTOMY,76100657,CDM,761,RC,31287,HCPCS,facility,both,,,,18458,18458,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, INDIRECT; DIAGNOSTIC",76100658,CDM,761,RC,31505,HCPCS,facility,both,,,,695,695,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LARYNGOSCOPY W/WO TRACHEOSCOPY; FOR ASPIRATION,76100659,CDM,761,RC,31515,HCPCS,facility,both,,,,1316,1316,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, DIRECT, OPERATIVE; W/BIOPSY",76100660,CDM,761,RC,31535,HCPCS,facility,both,,,,11951,11951,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, W/EXCISION TUMOR &/OR STRIPPING CORDS/EPIGLOTTIS",76100661,CDM,761,RC,31540,HCPCS,facility,both,,,,13010,13010,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPE W/INJ VOCAL CORD(S), THERAPEUTIC",76100662,CDM,761,RC,31570,HCPCS,facility,both,,,,13010,13010,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY W/INJ VOCAL CORD(S), THERAPEUTIC; W/MICRO/TELESCOPE",76100663,CDM,761,RC,31571,HCPCS,facility,both,,,,13010,13010,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, FLEXIBLE, ABLATE/DESTRUCT LESION(S) W/LASER, UNIL",76100664,CDM,761,RC,31572,HCPCS,facility,both,,,,11404,11404,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, FLEXIBLE; W/THERAPEUTIC INJECTION(S)",76100665,CDM,761,RC,31573,HCPCS,facility,both,,,,4026,4026,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, FLEXIBLE; W/INJ(S) FOR AUGMENTATION, UNIL",76100666,CDM,761,RC,31574,HCPCS,facility,both,,,,4026,4026,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, FLEXIBLE; W/BIOPSY(IES)",76100667,CDM,761,RC,31576,HCPCS,facility,both,,,,2988,2988,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY, FLEXIBLE, W/REMVL LESION(S), NON-LASER",76100668,CDM,761,RC,31578,HCPCS,facility,both,,,,9281,9281,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LARYNGOSCOPY FLEX/RIGID, TELESCOPIC W/STROBOSCOPY",76100669,CDM,761,RC,31579,HCPCS,facility,both,,,,1410,1410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TRACHEOBRONCOSCOPY VIA ESTABLISHED TRACH INCISION,76100670,CDM,761,RC,31615,HCPCS,facility,both,,,,873,873,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRONCHOSCOPY, INCL FLUOR GUIDE, DX, W/CELL WASHING",76100671,CDM,761,RC,31622,HCPCS,facility,both,,,,3344,3344,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRONCHOSCOPY, INCL FLUOR GUIDE; W/ BRONCHIAL ALVEOLAR LAVAGE",76100672,CDM,761,RC,31624,HCPCS,facility,both,,,,3396,3396,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BRONCHOSCOPY, INCL FLUOR GUIDE, W/BRONCH/ENDOBRONC BX(S),1+ SITES",76100673,CDM,761,RC,31625,HCPCS,facility,both,,,,3964,3964,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SURGICAL CLOSURE OF TRACHEOSTOMY/FISTULA; W/PLASTIC REPAIR,76100674,CDM,761,RC,31825,HCPCS,facility,both,,,,18357,18357,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REVISION OF TRACHEOSTOMY SCAR,76100675,CDM,761,RC,31830,HCPCS,facility,both,,,,9718,9718,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOPSY/EXCISION LYMPH NODE(S); OPEN, SUPERFICIAL",76100676,CDM,761,RC,38500,HCPCS,facility,both,,,,19917,19917,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY OF LIP,76100677,CDM,761,RC,40490,HCPCS,facility,both,,,,830,830,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOPSY, VESTIBULE MOUTH",76100678,CDM,761,RC,40808,HCPCS,facility,both,,,,1002,1002,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EXCISION LESION MUCOSA & SUBMUCOSA, VESTIBULE; W/SIMPLE REPAIR",76100679,CDM,761,RC,40812,HCPCS,facility,both,,,,5786,5786,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UNLISTED PROCEDURE, LIPS",76100680,CDM,761,RC,40799,HCPCS,facility,both,,,,394,394,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INCISION LABIAL FRENUM (FRENOTOMY),76100681,CDM,761,RC,40806,HCPCS,facility,both,,,,744,744,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EXCISION OF FRENUM, LABIAL OR BUCCAL",76100682,CDM,761,RC,40819,HCPCS,facility,both,,,,6252,6252,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INCISION OF LINGUAL FRENUM (FRENOTOMY),76100683,CDM,761,RC,41010,HCPCS,facility,both,,,,3376,3376,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY OF TONGUE; ANTERIOR 2/3,76100684,CDM,761,RC,41100,HCPCS,facility,both,,,,1233,1233,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY OF TONGUE; POSTERIOR 1/3,76100685,CDM,761,RC,41105,HCPCS,facility,both,,,,4493,4493,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY OF FLOOR OF MOUTH,76100686,CDM,761,RC,41108,HCPCS,facility,both,,,,4595,4595,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION LESION TONGUE W/O CLOSURE,76100687,CDM,761,RC,41110,HCPCS,facility,both,,,,4980,4980,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION OF LINGUAL FRENUM (FRENECTOMY),76100688,CDM,761,RC,41115,HCPCS,facility,both,,,,4517,4517,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOPSY OF PALATE, UVULA",76100689,CDM,761,RC,42100,HCPCS,facility,both,,,,3332,3332,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SIALOLITHOTOMY; SUBMANDIBULAR, SUBLINGUAL/PAROTID, UNCOMP, INTRAORAL",76100690,CDM,761,RC,42330,HCPCS,facility,both,,,,6276,6276,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY SALIVARY GLAND; INCISIONAL,76100691,CDM,761,RC,42405,HCPCS,facility,both,,,,6972,6972,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EXCISION SUBLINGUAL SALIVARY CYST (RANULA),76100692,CDM,761,RC,42408,HCPCS,facility,both,,,,13378,13378,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DILATION SALIVARY DUCT,76100693,CDM,761,RC,42650,HCPCS,facility,both,,,,2222,2222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS",76100694,CDM,761,RC,42699,HCPCS,facility,both,,,,557,557,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOPSY, OROPHARYNX",76100695,CDM,761,RC,42800,HCPCS,facility,both,,,,3522,3522,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE",76100696,CDM,761,RC,42804,HCPCS,facility,both,,,,4509,4509,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGD; W/DIRECTED PLACEMENT PERCUTANEOUS GASTROSTOMY TUBE,76100697,CDM,761,RC,43246,HCPCS,facility,both,,,,6836,6836,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGD; W/INSERT GUIDE WIRE FOLLOWED BY DILATOR PASSAGE ESOPHAGUS,76100698,CDM,761,RC,43248,HCPCS,facility,both,,,,3418,3418,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGD; W/BALLOON DILATION ESOPHAGUS (<30MM DIAMETER),76100699,CDM,761,RC,43249,HCPCS,facility,both,,,,5243,5243,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EGD; W/ENDOSCOPIC STENT PLACEMENT (INCL W/GUIDE WIRE & DILATION),76100700,CDM,761,RC,43266,HCPCS,facility,both,,,,21168,21168,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DILATION ESOPHAGUS, BY UNGUIDED SOUND/BOUGIE, 1/MULTI PASSES",76100701,CDM,761,RC,43450,HCPCS,facility,both,,,,2474,2474,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION(S), ANESTHETIC AGENT(S) &/OR STERIOD; VAGUS NERVE",76100702,CDM,761,RC,64408,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJ (S), ANESTH AGENT(S) &/OR STERIOD; BRACHIAL PLEXUS, INCL IMG GUIDANCE",76100703,CDM,761,RC,64415,HCPCS,facility,both,,,,4483,4483,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION",76100704,CDM,761,RC,64505,HCPCS,facility,both,,,,1527,1527,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMODENERVATION PAROTID & SUBMANDIBULAR SALIVARY GLANDS, BILAT",76100705,CDM,761,RC,64611,HCPCS,facility,both,,,,1757,1757,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMODENERVATION MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE, UNIL",76100706,CDM,761,RC,64612,HCPCS,facility,both,,,,2488,2488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC CHEMODERVATE FACIAL/TRIGEMINAL/CERVICAL MUSCLE, MIGRAINE",76100707,CDM,761,RC,64615,HCPCS,facility,both,,,,2488,2488,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRAINAGE EXTERNAL EAR, ABSCESS/HEMATOMA; COMPLICATED",76100708,CDM,761,RC,69005,HCPCS,facility,both,,,,7981,7981,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS",76100709,CDM,761,RC,69020,HCPCS,facility,both,,,,4058,4058,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY EXTERNAL EAR,76100710,CDM,761,RC,69100,HCPCS,facility,both,,,,557,557,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOPSY EXTERNAL AUDITORY CANAL,76100711,CDM,761,RC,69105,HCPCS,facility,both,,,,2222,2222,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL",76100712,CDM,761,RC,69145,HCPCS,facility,both,,,,4747,4747,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DEBRIDEMENT MASTOIDECTOMY CAVITY, SIMPLE",76100713,CDM,761,RC,69220,HCPCS,facility,both,,,,883,883,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC DEBRIDEMENT MASTOIDECTOMY CAVITY, COMPLEX",76100714,CDM,761,RC,69222,HCPCS,facility,both,,,,1560,1560,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYRINGOTOMY INCL ASPIRATION &/OR EUSTACHIAN TUBE INFLATION,76100715,CDM,761,RC,69420,HCPCS,facility,both,,,,1428,1428,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TYMPANOSTOMY; LOCAL/TOPICAL ANESTHESIA,76100716,CDM,761,RC,69433,HCPCS,facility,both,,,,1503,1503,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MYRINGOPLASTY,76100717,CDM,761,RC,69620,HCPCS,facility,both,,,,18919,18919,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC UNLISTED PROCEDURE, MIDDLE EAR",76100718,CDM,761,RC,69799,HCPCS,facility,both,,,,394,394,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC LABYRINTHOTOMY, W/PERFUSION VESTIBULOACTIVE DRUG(S); TRANSCANAL",76100719,CDM,761,RC,69801,HCPCS,facility,both,,,,2682,2682,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPERATING MICROSCOPE (ADD-ON CODE),76100720,CDM,761,RC,69990,HCPCS,facility,both,,,,900,900,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ORBITOTOMY W/O BONE FLAP; W/REMOVAL LESION,76100721,CDM,761,RC,67412,HCPCS,facility,both,,,,11462,11462,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC REPLACEMENT OF G-J TUBE, PERC, FLUORO GUIDE, INCL CONTRAST INJ(S)",76100724,CDM,761,RC,49452,HCPCS,facility,both,,,,2255,2255,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC INTRODUCTION CATHETER, RT HEART OR MAIN PULM ARTERY",76100725,CDM,761,RC,36013,HCPCS,facility,both,,,,4881,4881,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SELECTIVE CATHETER PLACEMENT, LT OR RT PULM ARTERY",76100726,CDM,761,RC,36014,HCPCS,facility,both,,,,4581,4581,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC SELECTIVE CATHETER PLACEMENT, SEGMENTAL OR SUBSEGMENTAL PULM ARTERY",76100727,CDM,761,RC,36015,HCPCS,facility,both,,,,4581,4581,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INSERT UTERINE TANDEM/OVOIDS,76191101,CDM,761,RC,57155,HCPCS,facility,both,,,,3981,3981,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HOSPITAL OBSERVATION SERVICE PER HR,76200001,CDM,762,RC,,,facility,both,,,,737,737,,,,,,,,,,,,,Gross Charge Type: SMH L&D FEE SCHEDULE HC HOSPITAL OBSERVATION SERVICE PER HR,76200001,CDM,762,RC,,,facility,both,,,,118,118,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OBSERVATION CARE DISCHARGE,76200005,CDM,762,RC,99217,HCPCS,facility,both,,,,847,847,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INITIAL OBSERVATION CARE,76200006,CDM,762,RC,99218,HCPCS,facility,both,,,,1058,1058,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNIZATION ADMIN SQ/IM, SINGLE",77100001,CDM,771,RC,90471,HCPCS,facility,both,,,,169,169,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNIZATION ADMIN SQ/IM, SINGLE",77100001,CDM,771,RC,90471,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC IMMUNIZATION ADMIN SQ/IM, EA ADDL",77100002,CDM,771,RC,90472,HCPCS,facility,both,,,,69,69,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE "HC IMMUNIZATION ADMIN SQ/IM, EA ADDL",77100002,CDM,771,RC,90472,HCPCS,facility,both,,,,86,86,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE",77100003,CDM,771,RC,90473,HCPCS,facility,both,,,,94,94,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VACCINE ADMINISTRATION, FLU",77100004,CDM,771,RC,,,facility,both,,,,74,74,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VACCINE ADMINISTRATION, PNEUMONIA",77100005,CDM,771,RC,,,facility,both,,,,71,71,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VACCINE ADMINISTRATION, HEP B",77100006,CDM,771,RC,,,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMMUNIZATION ADMIN, NASAL/ORAL, EA ADDL",77100007,CDM,771,RC,90474,HCPCS,facility,both,,,,13,13,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 1ST DOSE,77100009,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 2ND DOSE,77100010,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 100MCG/0.5ML 1ST DOSE,77100011,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 2ND DOSE,77100012,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 1ST DOSE",77100013,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 2ND DOSE",77100014,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 11/01/2023 HC ADM SARSCOV2 VAC AD26 /.5ML, SINGLE DOSE",77100015,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 3RD,77100018,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 3RD DOSE,77100019,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 50MCG/0.25ML; BOOSTER DOSE,77100020,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML; BOOSTER DOSE,77100021,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 1ST DOSE,77100022,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 2ND DOSE,77100023,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC SARSCOV2 VAC AD26 .5ML BOOSTER,77100024,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 4/1/2025 HC TIXAGEVIMAB & CILGAVIMAB, INCL INJ & POST ADMIN MONITORING",77100025,CDM,771,RC,,,facility,both,,,,1043,1043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 1ST DOSE,77100026,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 2ND DOSE,77100027,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 3RD DOSE,77100028,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; BOOSTER,77100029,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 4/1/2025 HC IV INFUSION SOTROVIMAB, INCL INFUSION & POST ADMIN MONITORING",77100030,CDM,771,RC,,,facility,both,,,,1043,1043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 4/1/2025 HC BEBTELOVIMAB,INCLU INJECTION & POST ADMIN MONITORING",77100031,CDM,771,RC,,,facility,both,,,,1043,1043,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML BOOSTER DOSE,77100032,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 10 MCG/0.2 ML TRIS-SUCROSE BOOSTER,77100033,CDM,771,RC,,,facility,both,,,,47,47,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-1ST DOSE,77100034,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-2 DOSE,77100035,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-3 DOSE,77100036,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 1ST DOSE,77100037,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 2ND DOSE,77100038,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 1ST DOSE 6-11,77100039,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 2ND DOSE 6-11,77100040,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 3RD DOSE 6-11,77100041,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE,77100049,CDM,771,RC,,,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE,77100050,CDM,771,RC,,,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 3RD DOSE,77100051,CDM,771,RC,,,facility,both,,,,120,120,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCV2 BVL 30MCG/0.3ML 1ST DOSE,77100052,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SRSCV2 BVL 25MCG/0.25ML 1ST DOSE,77100053,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SRSCV2 BVL 25 MCG/0.25ML 2ND DOSE,77100054,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCV2 BVL 10 MCG/0.2ML 1ST DOSE,77100055,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 1ST DOSE,77100056,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 2ND DOSE,77100057,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2ML ADDL DOSE,77100058,CDM,771,RC,,,facility,both,,,,49,49,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC IMM ADMN SARSCOV2 VACCINE, SINGLE DOSE",77100059,CDM,771,RC,90480,HCPCS,facility,both,,,,270,270,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADM RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP,77100060,CDM,771,RC,96380,HCPCS,facility,both,,,,133,133,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ADM RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX,77100061,CDM,771,RC,96381,HCPCS,facility,both,,,,133,133,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INPATIENT HEMODIALYSIS,80100001,CDM,801,RC,,,facility,both,,,,2924,2924,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC HEMODIALYSIS ONE EVALUATION,80100050,CDM,801,RC,90935,HCPCS,facility,both,,,,2550,2550,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OTHER INPATIENT DIALYSIS,80900001,CDM,809,RC,,,facility,both,,,,2924,2924,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMERGENCY DIALYSIS ESRD PT,82900001,CDM,829,RC,,,facility,both,,,,3839,3839,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TCRANIAL MAGN STIM TX PLAN,90000050,CDM,900,RC,90867,HCPCS,facility,both,,,,341,341,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TCRANIAL MAGN STIM TX DELI,90000051,CDM,900,RC,90868,HCPCS,facility,both,,,,894,894,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ECT TREATMENT PRICE PER MIN,90100001,CDM,901,RC,90870,HCPCS,facility,both,,,,1009,1009,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOFEEDBACK TRAINING W/EMG,91700001,CDM,917,RC,90911,HCPCS,facility,both,,,,461,461,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BIOFEEDBACK TRAINING BY ANY MODALITY,91700050,CDM,917,RC,90901,HCPCS,facility,both,,,,184,184,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT,91700051,CDM,917,RC,90912,HCPCS,facility,both,,,,131,131,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT,91700052,CDM,917,RC,90913,HCPCS,facility,both,,,,54,54,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SLS-EPS; PERIPH NRV; UPPER LIMBS,92000020,CDM,920,RC,95925,HCPCS,facility,both,,,,985,985,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SLS-EPS; PERIPH NRV; LOWER LIMBS,92000021,CDM,920,RC,95926,HCPCS,facility,both,,,,985,985,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ANALYZE NEUROSTIM SIMPLE,92000060,CDM,920,RC,95971,HCPCS,facility,both,,,,193,193,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ELECTRORETINOGRAPHY W INT & REP, FULL FIELD",92000094,CDM,920,RC,92273,HCPCS,facility,both,,,,761,761,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ELECTRORETINOGRAPHY W INT & REP, MULTIFOCAL",92000095,CDM,920,RC,92274,HCPCS,facility,both,,,,410,410,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ELECTRORETINOGRAPHY W INT & REP, PATTERN",92000096,CDM,920,RC,,,facility,both,,,,389,389,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOTE INTERROG IMP CARD PHYS MONT SYS UP TO 30 DAYS,92000099,CDM,920,RC,93297,HCPCS,facility,both,,,,487,487,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REMOTE INTERROG SUB CARD RHYM MONT SYS UP TO 30 DAYS,92000100,CDM,920,RC,93298,HCPCS,facility,both,,,,487,487,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAROTID DUPLEX SCAN; BILAT,92100001,CDM,921,RC,93880,HCPCS,facility,both,,,,1215,1215,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAROTID DUPLEX SCAN; UNIL/LIMIT,92100002,CDM,921,RC,93882,HCPCS,facility,both,,,,741,741,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRACRANIAL ARTERY DOPPLER; COMPL,92100003,CDM,921,RC,93886,HCPCS,facility,both,,,,3041,3041,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INTRACRANIAL ARTERY DOPPLER; LIMITED,92100004,CDM,921,RC,93888,HCPCS,facility,both,,,,2031,2031,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UPR/L XTREMITY ART 2 LEVELS,92100005,CDM,921,RC,93922,HCPCS,facility,both,,,,390,390,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC UPR/LXTR ART STDY 3+ LVLS,92100006,CDM,921,RC,93923,HCPCS,facility,both,,,,3241,3241,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC LWR XTR VASC STDY BILAT,92100007,CDM,921,RC,93924,HCPCS,facility,both,,,,1290,1290,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX LE ART/BPG; BILAT,92100008,CDM,921,RC,93925,HCPCS,facility,both,,,,1076,1076,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX LE ART/BPG; UNIL/LIMIT,92100009,CDM,921,RC,93926,HCPCS,facility,both,,,,652,652,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX UE ART/BPG; BILAT,92100010,CDM,921,RC,93930,HCPCS,facility,both,,,,1076,1076,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX UE ART/BPG; UNIL/LIMIT,92100011,CDM,921,RC,93931,HCPCS,facility,both,,,,652,652,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX EXT VEINS; BILAT,92100012,CDM,921,RC,93970,HCPCS,facility,both,,,,1015,1015,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX EXT VEINS; UNIL/LIMIT,92100013,CDM,921,RC,93971,HCPCS,facility,both,,,,846,846,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX ARTERIAL FLOW; COMPL,92100014,CDM,921,RC,93975,HCPCS,facility,both,,,,1999,1999,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX ARTERIAL FLOW; LIMITED,92100015,CDM,921,RC,93976,HCPCS,facility,both,,,,1933,1933,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX A IVC IL/BPG; COMPL,92100016,CDM,921,RC,93978,HCPCS,facility,both,,,,2032,2032,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX A IVC IL/BPG; UNIL/LIM,92100017,CDM,921,RC,93979,HCPCS,facility,both,,,,2032,2032,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX FLOW PENILE V; COMPL,92100018,CDM,921,RC,93980,HCPCS,facility,both,,,,1999,1999,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DUPLEX HEMODIALYSIS ACCESS,92100019,CDM,921,RC,93990,HCPCS,facility,both,,,,1206,1206,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC Extremity Study, Complete Bilateral",92100100,CDM,921,RC,93965,HCPCS,facility,both,,,,899,899,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMG- ONE EXTREMITY,92200001,CDM,922,RC,95860,HCPCS,facility,both,,,,339,339,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMG-TWO EXTREMITIES,92200002,CDM,922,RC,95861,HCPCS,facility,both,,,,440,440,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EMG-THREE EXTREMITIES,92200003,CDM,922,RC,95863,HCPCS,facility,both,,,,560,560,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC NRV CONDUCTION, MOTOR-EA NERVE",92200009,CDM,922,RC,95900,HCPCS,facility,both,,,,138,138,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NCV EA MOTOR NERVE; W F-WAVE,92200010,CDM,922,RC,95903,HCPCS,facility,both,,,,809,809,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NCV EA SENSORY NERVE,92200011,CDM,922,RC,95904,HCPCS,facility,both,,,,809,809,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC VISUAL EVOKED POTENTIAL, CHECKERBD/FLASH TEST, CNS, EXCEPT GLAUCOMA",92200051,CDM,922,RC,95930,HCPCS,facility,both,,,,577,577,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHOTOCHEMOTHERAPY PUVA,94000004,CDM,940,RC,96912,HCPCS,facility,both,,,,319,319,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 7/1/2018 HCCPR PER 15 MIN,94000005,CDM,940,RC,92950,HCPCS,facility,both,,,,267,267,,,,,,,,,,,,,Gross Charge Type: SMH EMERGENCY DEPARTMENT FEE SCHEDULE DEAC 7/1/2018 HCCPR PER 15 MIN,94000005,CDM,940,RC,92950,HCPCS,facility,both,,,,1276,1276,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACUPUNCT W/O STIMUL 15 MIN,94000006,CDM,940,RC,97810,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACUPUNCT W/O STIMUL 15 MIN,94000006,CDM,940,RC,97810,HCPCS,facility,both,,,,218,218,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE "HC ACUPUNCTURE W/O ELECTRIC STIMULATION, ADDL 15 MIN W/INSERT NEEDLE(S)",94000007,CDM,940,RC,97811,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE "HC ACUPUNCTURE W/O ELECTRIC STIMULATION, ADDL 15 MIN W/INSERT NEEDLE(S)",94000007,CDM,940,RC,97811,HCPCS,facility,both,,,,166,166,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ACUPUNCT W/STIMUL 15 MIN,94000008,CDM,940,RC,97813,HCPCS,facility,both,,,,320,320,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC ACUPUNCTURE W/ELECTRIC STIMULATION, ADDL 15 MIN W/INSERT NEEDLE(S)",94000009,CDM,940,RC,97814,HCPCS,facility,both,,,,214,214,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CPR PER SESSION,94000012,CDM,940,RC,92950,HCPCS,facility,both,,,,2336,2336,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHLEBOTOMY THERAPEUTIC,94030001,CDM,940,RC,99195,HCPCS,facility,both,,,,544,544,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PHLEBOTOMY THERAPEUTIC,94030001,CDM,940,RC,99195,HCPCS,facility,both,,,,542,542,,,,,,,,,,,,,Gross Charge Type: SMH SOFT LAB FEE SCHEDULE HC GENETIC COUNSELING ADDITIONAL 30 MIN,94191101,CDM,942,RC,96040,HCPCS,facility,both,,,,272,272,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GENETIC COUNSELING FIRST 30 MIN,94191102,CDM,942,RC,96040,HCPCS,facility,both,,,,428,428,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT",94200001,CDM,942,RC,97802,HCPCS,facility,both,,,,63,63,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MNT, INDIV, EA 15 MIN, RE-ASSESSMENT",94200002,CDM,942,RC,97803,HCPCS,facility,both,,,,63,63,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EDUCATION/TRAINING - NUTRITION 5 VISIT,94200006,CDM,942,RC,,,facility,both,,,,199,199,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC EDUCATION/TRAINING - NUTRITION 6 VISIT,94200007,CDM,942,RC,,,facility,both,,,,255,255,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 01/31/2022 HC DM OP SMT GRP PER 30 MIN,94200025,CDM,942,RC,,,facility,both,,,,64,64,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 01/01/2025 HC GENETIC COUNSELING 30 MIN,94200050,CDM,942,RC,96040,HCPCS,facility,both,,,,786,786,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC MEDICAL NUTRITION THERAPY, GROUP, EA 30 MIN",94200051,CDM,942,RC,97804,HCPCS,facility,both,,,,102,102,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC GENETIC COUNSELING EA 30 MIN, TOTAL TIME, ENCOUNTER DATE",94200060,CDM,942,RC,96041,HCPCS,facility,both,,,,714,714,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/19/2022 HC UNJURY PROTEIN SUPPLEMENT,99000001,CDM,990,RC,,,facility,both,,,,25,25,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPURITY MULTIVITAMIN,99000002,CDM,990,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC OPURITY CALCIUM CITRATE,99000003,CDM,990,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC ATHLETIC TRAINING SESSION,99000021,CDM,990,RC,,,facility,both,,,,75,75,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC NON-BILLABLE (CRITERIA FOR BILLING NOT MET),99041101,CDM,990,RC,,,facility,both,,,,1,1,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAFETERIA/GUEST TRAY,99100000,CDM,991,RC,,,facility,both,,,,7,7,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAFETERIA/GUEST TRAY DISCOUNT,99100001,CDM,991,RC,,,facility,both,,,,18,18,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAFETERIA/GOURMET MEAL,99100002,CDM,991,RC,,,facility,both,,,,4,4,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CAFETERIA/ALA CARTE,99100003,CDM,991,RC,,,facility,both,,,,3,3,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC TV/RADIO,99400000,CDM,994,RC,,,facility,both,,,,5,5,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRIVATE REGULAR ROOM DIFFERENTIAL,99900011,CDM,999,RC,,,facility,both,,,,465,465,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRIVATE DELUXE ROOM DIFFERENTIAL,99900013,CDM,999,RC,,,facility,both,,,,535,535,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC PRIVATE SNF ROOM DIFFERENTIAL,99900015,CDM,999,RC,,,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DELUXE SNF ROOM DIFFERENTIAL,99900016,CDM,999,RC,,,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC DELUXE SNF SUITE DIFFERENTIAL,99900017,CDM,999,RC,,,facility,both,,,,335,335,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARIATRIC MODIFIED PROGRAM FEE,99900050,CDM,999,RC,,,facility,both,,,,350,350,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC BARIATRIC PROGRAM FEE,99900051,CDM,999,RC,,,facility,both,,,,600,600,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/19/2022 HC AQUATICS DROP-IN SESSION,99900100,CDM,999,RC,99900100,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 10/19/2022 HC AQUATIC 10 WEEK, 2X PER",99900101,CDM,999,RC,99900101,HCPCS,facility,both,,,,160,160,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 10/19/2022 HC AQUATIC 10WEEK SESSION,3X",99900102,CDM,999,RC,99900102,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 10/19/2022 HC AQUATIC 10 WEEK, EMPLOYEE",99900103,CDM,999,RC,99900103,HCPCS,facility,both,,,,100,100,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 10/19/2022 HC AQUATICS PT,PRIVATE PAY 3",99900104,CDM,999,RC,99900104,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 10/19/2022 HC AQUATIC EXERCISE PRGM,NON",99900105,CDM,999,RC,99900105,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 10/19/2022 HC EXERCISE, MAINT PROGRAM W",99900106,CDM,999,RC,99900106,HCPCS,facility,both,,,,200,200,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "DEAC 10/19/2022 HC PRIVATE TRAINING, 8 SESSI",99900107,CDM,999,RC,99900107,HCPCS,facility,both,,,,280,280,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/19/2022 HC INDEPENDENT WALKING 3X,99900108,CDM,999,RC,99900108,HCPCS,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/19/2022 HC INDEPENDENT WALKING 2X,99900109,CDM,999,RC,99900109,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/26/2023 HC INDEPENDENT WALKING SAT,99900110,CDM,999,RC,99900110,HCPCS,facility,both,,,,15,15,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/19/2022 HC LO INTENSITY AEROBICS 2X,99900111,CDM,999,RC,99900111,HCPCS,facility,both,,,,70,70,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE DEAC 10/19/2022 HC PRIVATE PAY PT 30 MIN,99900112,CDM,999,RC,99900112,HCPCS,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MANUAL THERAPY LYMPH DRAINAGE BY MASSAGE THERAPIST EA 15 MINS,99900113,CDM,999,RC,,,facility,both,,,,29,29,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MANUAL THERAPY LYMPH DRAINAGE BY MASSAGE THERAPIST EA 15 MINS,99900113,CDM,999,RC,,,facility,both,,,,165,165,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE HC MASSAGE THERAPY BY MASSAGE THERAPIST EA 15 MINS,99900114,CDM,999,RC,,,facility,both,,,,29,29,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MASSAGE THERAPY BY MASSAGE THERAPIST EA 15 MINS,99900114,CDM,999,RC,,,facility,both,,,,125,125,,,,,,,,,,,,,Gross Charge Type: SMH ONCOLOGY INFUSION FEE SCHEDULE "HC NEW CONSULT YOGA THERAPY, 75 MINUTES",99900115,CDM,999,RC,,,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE "HC FOLLOW UP YOGA THERAPY, 45 MINUTES",99900116,CDM,999,RC,,,facility,both,,,,80,80,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNET THERAPY DURING ACUPUNCTURE,99900117,CDM,999,RC,,,facility,both,,,,35,35,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC MAGNET THERAPY,99900118,CDM,999,RC,,,facility,both,,,,145,145,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REIKI 90 MINUTES,99900119,CDM,999,RC,,,facility,both,,,,165,165,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REIKI 60 MINUTES,99900120,CDM,999,RC,,,facility,both,,,,110,110,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC REIKI 30 MINUTES,99900121,CDM,999,RC,,,facility,both,,,,60,60,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC INFRARED THERAPY,99900122,CDM,999,RC,,,facility,both,,,,20,20,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC GROUP ACUPUNCTURE,99900123,CDM,999,RC,,,facility,both,,,,50,50,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC SURGERY HEALING EDUCATION/TRAINING,99900124,CDM,999,RC,,,facility,both,,,,40,40,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE HC CT LUNG SCREENING,99913001,CDM,999,RC,,,facility,both,,,,513,513,,,,,,,,,,,,,Gross Charge Type: SMH DEFAULT FEE SCHEDULE Adm sarscov2 30mcg/0.3ml 1st,0001A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscov2 30mcg/0.3ml 1st,0001A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Rbc dna hea 35 ag 11 bld grp,0001U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2290.39,,,,,,,fee schedule,720,2617.59, Rbc dna hea 35 ag 11 bld grp,0001U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2617.59,,,,,,,fee schedule,720,2617.59, Rbc dna hea 35 ag 11 bld grp,0001U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,748.8,,,,,,,fee schedule,720,2617.59,APC Rbc dna hea 35 ag 11 bld grp,0001U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,756,,,,,,,fee schedule,720,2617.59,APC Rbc dna hea 35 ag 11 bld grp,0001U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,720,,,,,,,fee schedule,720,2617.59,APC Adm sarscov2 30mcg/0.3ml 2nd,0002A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscov2 30mcg/0.3ml 2nd,0002A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Liver dis 10 assays w/ash,0002M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1600.88,,,,,,,fee schedule,503.4,1829.58, Liver dis 10 assays w/ash,0002M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1829.58,,,,,,,fee schedule,503.4,1829.58, Liver dis 10 assays w/ash,0002M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,523.54,,,,,,,fee schedule,503.4,1829.58,APC Liver dis 10 assays w/ash,0002M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,528.57,,,,,,,fee schedule,503.4,1829.58,APC Liver dis 10 assays w/ash,0002M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,503.4,,,,,,,fee schedule,503.4,1829.58,APC Onc clrct 3 ur metab alg plp,0002U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.17,,,,,,,fee schedule,25,90.48, Onc clrct 3 ur metab alg plp,0002U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.48,,,,,,,fee schedule,25,90.48, Onc clrct 3 ur metab alg plp,0002U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26,,,,,,,fee schedule,25,90.48,APC Onc clrct 3 ur metab alg plp,0002U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.25,,,,,,,fee schedule,25,90.48,APC Onc clrct 3 ur metab alg plp,0002U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25,,,,,,,fee schedule,25,90.48,APC Fee covid-19 vac 1 booster,0003A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 1 booster,0003A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Liver dis 10 assays w/nash,0003M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1600.88,,,,,,,fee schedule,503.4,1829.58, Liver dis 10 assays w/nash,0003M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1829.58,,,,,,,fee schedule,503.4,1829.58, Liver dis 10 assays w/nash,0003M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,523.54,,,,,,,fee schedule,503.4,1829.58,APC Liver dis 10 assays w/nash,0003M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,528.57,,,,,,,fee schedule,503.4,1829.58,APC Liver dis 10 assays w/nash,0003M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,503.4,,,,,,,fee schedule,503.4,1829.58,APC Onc ovar 5 prtn ser alg scor,0003U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3021.59,,,,,,,fee schedule,950,3453.24, Onc ovar 5 prtn ser alg scor,0003U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3453.24,,,,,,,fee schedule,950,3453.24, Onc ovar 5 prtn ser alg scor,0003U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,988,,,,,,,fee schedule,950,3453.24,APC Onc ovar 5 prtn ser alg scor,0003U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,997.5,,,,,,,fee schedule,950,3453.24,APC Onc ovar 5 prtn ser alg scor,0003U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,950,,,,,,,fee schedule,950,3453.24,APC Fee covid-19 vac 1 res,0004A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 1 res,0004A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Scoliosis dna alys,0004M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,251.03,,,,,,,fee schedule,79,286.89, Scoliosis dna alys,0004M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,286.89,,,,,,,fee schedule,79,286.89, Scoliosis dna alys,0004M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.16,,,,,,,fee schedule,79,286.89,APC Scoliosis dna alys,0004M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,82.95,,,,,,,fee schedule,79,286.89,APC Scoliosis dna alys,0004M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79,,,,,,,fee schedule,79,286.89,APC Onco prst8 3 gene ur alg,0005U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onco prst8 3 gene ur alg,0005U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onco prst8 3 gene ur alg,0005U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onco prst8 3 gene ur alg,0005U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onco prst8 3 gene ur alg,0005U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Onc hep gene risk classifier,0006M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,477.04,,,,,,,fee schedule,150,545.19, Onc hep gene risk classifier,0006M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,545.19,,,,,,,fee schedule,150,545.19, Onc hep gene risk classifier,0006M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,156,,,,,,,fee schedule,150,545.19,APC Onc hep gene risk classifier,0006M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.5,,,,,,,fee schedule,150,545.19,APC Onc hep gene risk classifier,0006M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,150,,,,,,,fee schedule,150,545.19,APC Onc gastro 51 gene nomogram,0007M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1192.59,,,,,,,fee schedule,375,1362.96, Onc gastro 51 gene nomogram,0007M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1362.96,,,,,,,fee schedule,375,1362.96, Onc gastro 51 gene nomogram,0007M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,390,,,,,,,fee schedule,375,1362.96,APC Onc gastro 51 gene nomogram,0007M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.75,,,,,,,fee schedule,375,1362.96,APC Onc gastro 51 gene nomogram,0007M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,375,,,,,,,fee schedule,375,1362.96,APC Rx test prsmv ur w/def conf,0007U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,363.51,,,,,,,fee schedule,114.43,415.44, Rx test prsmv ur w/def conf,0007U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,415.44,,,,,,,fee schedule,114.43,415.44, Rx test prsmv ur w/def conf,0007U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.01,,,,,,,fee schedule,114.43,415.44,APC Rx test prsmv ur w/def conf,0007U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.15,,,,,,,fee schedule,114.43,415.44,APC Rx test prsmv ur w/def conf,0007U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.43,,,,,,,fee schedule,114.43,415.44,APC Hpylori detcj abx rstnc dna,0008U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1901.89,,,,,,,fee schedule,597.91,2173.59, Hpylori detcj abx rstnc dna,0008U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2173.59,,,,,,,fee schedule,597.91,2173.59, Hpylori detcj abx rstnc dna,0008U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.83,,,,,,,fee schedule,597.91,2173.59,APC Hpylori detcj abx rstnc dna,0008U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.81,,,,,,,fee schedule,597.91,2173.59,APC Hpylori detcj abx rstnc dna,0008U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.91,,,,,,,fee schedule,597.91,2173.59,APC Onc brst ca erbb2 amp/nonamp,0009U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,340.59,,,,,,,fee schedule,107,389.25, Onc brst ca erbb2 amp/nonamp,0009U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,389.25,,,,,,,fee schedule,107,389.25, Onc brst ca erbb2 amp/nonamp,0009U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,111.28,,,,,,,fee schedule,107,389.25,APC Onc brst ca erbb2 amp/nonamp,0009U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,112.35,,,,,,,fee schedule,107,389.25,APC Onc brst ca erbb2 amp/nonamp,0009U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,107,,,,,,,fee schedule,107,389.25,APC Nfct ds strn typ whl gen seq,0010U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1359.25,,,,,,,fee schedule,427.26,1553.43, Nfct ds strn typ whl gen seq,0010U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1553.43,,,,,,,fee schedule,427.26,1553.43, Nfct ds strn typ whl gen seq,0010U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,444.35,,,,,,,fee schedule,427.26,1553.43,APC Nfct ds strn typ whl gen seq,0010U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,448.62,,,,,,,fee schedule,427.26,1553.43,APC Nfct ds strn typ whl gen seq,0010U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,427.26,,,,,,,fee schedule,427.26,1553.43,APC Adm sarscov2 100mcg/0.5ml1st,0011A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscov2 100mcg/0.5ml1st,0011A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Onc prst8 ca mrna 12 gen alg,0011M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc prst8 ca mrna 12 gen alg,0011M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc prst8 ca mrna 12 gen alg,0011M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc prst8 ca mrna 12 gen alg,0011M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc prst8 ca mrna 12 gen alg,0011M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Rx mntr lc-ms/ms oral fluid,0011U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,363.51,,,,,,,fee schedule,114.43,415.44, Rx mntr lc-ms/ms oral fluid,0011U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,415.44,,,,,,,fee schedule,114.43,415.44, Rx mntr lc-ms/ms oral fluid,0011U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.01,,,,,,,fee schedule,114.43,415.44,APC Rx mntr lc-ms/ms oral fluid,0011U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.15,,,,,,,fee schedule,114.43,415.44,APC Rx mntr lc-ms/ms oral fluid,0011U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.43,,,,,,,fee schedule,114.43,415.44,APC Adm sarscov2 100mcg/0.5ml2nd,0012A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscov2 100mcg/0.5ml2nd,0012A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Onc mrna 5 gen rsk urthl ca,0012M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc mrna 5 gen rsk urthl ca,0012M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc mrna 5 gen rsk urthl ca,0012M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc mrna 5 gen rsk urthl ca,0012M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc mrna 5 gen rsk urthl ca,0012M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Fee covid-19 vac 2 booster,0013A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 2 booster,0013A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Onc mrna 5 gen recr urthl ca,0013M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc mrna 5 gen recr urthl ca,0013M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc mrna 5 gen recr urthl ca,0013M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc mrna 5 gen recr urthl ca,0013M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc mrna 5 gen recr urthl ca,0013M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Adrnl cortcl tum bchm asy 25,0015M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4152.72,,,,,,,fee schedule,1305.37,4745.97, Adrnl cortcl tum bchm asy 25,0015M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4745.97,,,,,,,fee schedule,1305.37,4745.97, Adrnl cortcl tum bchm asy 25,0015M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1357.58,,,,,,,fee schedule,1305.37,4745.97,APC Adrnl cortcl tum bchm asy 25,0015M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1370.64,,,,,,,fee schedule,1305.37,4745.97,APC Adrnl cortcl tum bchm asy 25,0015M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1305.37,,,,,,,fee schedule,1305.37,4745.97,APC Onc bladder mrna 209 gen alg,0016M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11099.97,,,,,,,fee schedule,3489.63,12685.68, Onc bladder mrna 209 gen alg,0016M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12685.68,,,,,,,fee schedule,3489.63,12685.68, Onc bladder mrna 209 gen alg,0016M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3629.22,,,,,,,fee schedule,3489.63,12685.68,APC Onc bladder mrna 209 gen alg,0016M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3664.11,,,,,,,fee schedule,3489.63,12685.68,APC Onc bladder mrna 209 gen alg,0016M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3489.63,,,,,,,fee schedule,3489.63,12685.68,APC Onc hmtlmf neo rna bcr/abl1,0016U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,521.82,,,,,,,fee schedule,163.96,596.37, Onc hmtlmf neo rna bcr/abl1,0016U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,596.37,,,,,,,fee schedule,163.96,596.37, Onc hmtlmf neo rna bcr/abl1,0016U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,170.52,,,,,,,fee schedule,163.96,596.37,APC Onc hmtlmf neo rna bcr/abl1,0016U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,172.16,,,,,,,fee schedule,163.96,596.37,APC Onc hmtlmf neo rna bcr/abl1,0016U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,163.96,,,,,,,fee schedule,163.96,596.37,APC Onc dlbcl mrna 20 genes alg,0017M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7984.65,,,,,,,fee schedule,2510.21,9125.31, Onc dlbcl mrna 20 genes alg,0017M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9125.31,,,,,,,fee schedule,2510.21,9125.31, Onc dlbcl mrna 20 genes alg,0017M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2610.62,,,,,,,fee schedule,2510.21,9125.31,APC Onc dlbcl mrna 20 genes alg,0017M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2635.72,,,,,,,fee schedule,2510.21,9125.31,APC Onc dlbcl mrna 20 genes alg,0017M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2510.21,,,,,,,fee schedule,2510.21,9125.31,APC Onc hmtlmf neo jak2 mut dna,0017U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,291.64,,,,,,,fee schedule,91.66,333.3, Onc hmtlmf neo jak2 mut dna,0017U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,333.3,,,,,,,fee schedule,91.66,333.3, Onc hmtlmf neo jak2 mut dna,0017U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.33,,,,,,,fee schedule,91.66,333.3,APC Onc hmtlmf neo jak2 mut dna,0017U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.24,,,,,,,fee schedule,91.66,333.3,APC Onc hmtlmf neo jak2 mut dna,0017U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.66,,,,,,,fee schedule,91.66,333.3,APC Trnsplj rnl meas cd154+cll,0018M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2038.34,,,,,,,fee schedule,640.73,2329.53, Trnsplj rnl meas cd154+cll,0018M,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2329.53,,,,,,,fee schedule,640.73,2329.53, Trnsplj rnl meas cd154+cll,0018M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,666.36,,,,,,,fee schedule,640.73,2329.53,APC Trnsplj rnl meas cd154+cll,0018M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,672.77,,,,,,,fee schedule,640.73,2329.53,APC Trnsplj rnl meas cd154+cll,0018M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,640.73,,,,,,,fee schedule,640.73,2329.53,APC Onc thyr 10 microrna seq alg,0018U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9549.07,,,,,,,fee schedule,3002.09,10913.22, Onc thyr 10 microrna seq alg,0018U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10913.22,,,,,,,fee schedule,3002.09,10913.22, Onc thyr 10 microrna seq alg,0018U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3122.17,,,,,,,fee schedule,3002.09,10913.22,APC Onc thyr 10 microrna seq alg,0018U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3152.19,,,,,,,fee schedule,3002.09,10913.22,APC Onc thyr 10 microrna seq alg,0018U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3002.09,,,,,,,fee schedule,3002.09,10913.22,APC Cv ds plasma alys prtn bmrk,0019M,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,740.9,,,,,,,fee schedule,712.4,748.02,APC Cv ds plasma alys prtn bmrk,0019M,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,748.02,,,,,,,fee schedule,712.4,748.02,APC Cv ds plasma alys prtn bmrk,0019M,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,712.4,,,,,,,fee schedule,712.4,748.02,APC Onc rna tiss predict alg,0019U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11689.49,,,,,,,fee schedule,3675,13359.42, Onc rna tiss predict alg,0019U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13359.42,,,,,,,fee schedule,3675,13359.42, Onc rna tiss predict alg,0019U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3822,,,,,,,fee schedule,3675,13359.42,APC Onc rna tiss predict alg,0019U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3858.75,,,,,,,fee schedule,3675,13359.42,APC Onc rna tiss predict alg,0019U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3675,,,,,,,fee schedule,3675,13359.42,APC Onc prst8 detcj 8 autoantb,0021U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc prst8 detcj 8 autoantb,0021U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc prst8 detcj 8 autoantb,0021U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc prst8 detcj 8 autoantb,0021U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc prst8 detcj 8 autoantb,0021U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Trgt gen seq dna&rna 23 gene,0022U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6202.53,,,,,,,fee schedule,1950,7088.61, Trgt gen seq dna&rna 23 gene,0022U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7088.61,,,,,,,fee schedule,1950,7088.61, Trgt gen seq dna&rna 23 gene,0022U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2028,,,,,,,fee schedule,1950,7088.61,APC Trgt gen seq dna&rna 23 gene,0022U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2047.5,,,,,,,fee schedule,1950,7088.61,APC Trgt gen seq dna&rna 23 gene,0022U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1950,,,,,,,fee schedule,1950,7088.61,APC Onc aml dna detcj/nondetcj,0023U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,790.55,,,,,,,fee schedule,248.51,903.48, Onc aml dna detcj/nondetcj,0023U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,903.48,,,,,,,fee schedule,248.51,903.48, Onc aml dna detcj/nondetcj,0023U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,258.45,,,,,,,fee schedule,248.51,903.48,APC Onc aml dna detcj/nondetcj,0023U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,260.94,,,,,,,fee schedule,248.51,903.48,APC Onc aml dna detcj/nondetcj,0023U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,248.51,,,,,,,fee schedule,248.51,903.48,APC Glyca nuc mr spectrsc quan,0024U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,108.33,,,,,,,fee schedule,34.19,123.81, Glyca nuc mr spectrsc quan,0024U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123.81,,,,,,,fee schedule,34.19,123.81, Glyca nuc mr spectrsc quan,0024U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.56,,,,,,,fee schedule,34.19,123.81,APC Glyca nuc mr spectrsc quan,0024U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.9,,,,,,,fee schedule,34.19,123.81,APC Glyca nuc mr spectrsc quan,0024U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.19,,,,,,,fee schedule,34.19,123.81,APC Tenofovir liq chrom ur quan,0025U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,272.9,,,,,,,fee schedule,114.43,311.88, Tenofovir liq chrom ur quan,0025U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,311.88,,,,,,,fee schedule,114.43,311.88, Tenofovir liq chrom ur quan,0025U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.01,,,,,,,fee schedule,114.43,311.88,APC Tenofovir liq chrom ur quan,0025U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.15,,,,,,,fee schedule,114.43,311.88,APC Tenofovir liq chrom ur quan,0025U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.43,,,,,,,fee schedule,114.43,311.88,APC Onc thyr dna&mrna 112 genes,0026U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11450.99,,,,,,,fee schedule,3600,13086.84, Onc thyr dna&mrna 112 genes,0026U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13086.84,,,,,,,fee schedule,3600,13086.84, Onc thyr dna&mrna 112 genes,0026U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3744,,,,,,,fee schedule,3600,13086.84,APC Onc thyr dna&mrna 112 genes,0026U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3780,,,,,,,fee schedule,3600,13086.84,APC Onc thyr dna&mrna 112 genes,0026U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3600,,,,,,,fee schedule,3600,13086.84,APC Jak2 gene trgt seq alys,0027U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,387.45,,,,,,,fee schedule,121.91,442.8, Jak2 gene trgt seq alys,0027U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,442.8,,,,,,,fee schedule,121.91,442.8, Jak2 gene trgt seq alys,0027U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,126.79,,,,,,,fee schedule,121.91,442.8,APC Jak2 gene trgt seq alys,0027U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.01,,,,,,,fee schedule,121.91,442.8,APC Jak2 gene trgt seq alys,0027U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,121.91,,,,,,,fee schedule,121.91,442.8,APC Rx metab advrs trgt seq alys,0029U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2361.24,,,,,,,fee schedule,742.27,2698.56, Rx metab advrs trgt seq alys,0029U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2698.56,,,,,,,fee schedule,742.27,2698.56, Rx metab advrs trgt seq alys,0029U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,771.96,,,,,,,fee schedule,742.27,2698.56,APC Rx metab advrs trgt seq alys,0029U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,779.38,,,,,,,fee schedule,742.27,2698.56,APC Rx metab advrs trgt seq alys,0029U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,742.27,,,,,,,fee schedule,742.27,2698.56,APC Rx metab warf trgt seq alys,0030U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,427.04,,,,,,,fee schedule,134.13,488.04, Rx metab warf trgt seq alys,0030U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,488.04,,,,,,,fee schedule,134.13,488.04, Rx metab warf trgt seq alys,0030U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,139.5,,,,,,,fee schedule,134.13,488.04,APC Rx metab warf trgt seq alys,0030U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,140.84,,,,,,,fee schedule,134.13,488.04,APC Rx metab warf trgt seq alys,0030U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,134.13,,,,,,,fee schedule,134.13,488.04,APC Fee covid-19 vac 4 dose 1,0031A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 4 dose 1,0031A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Cyp1a2 gene,0031U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Cyp1a2 gene,0031U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Cyp1a2 gene,0031U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Cyp1a2 gene,0031U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Cyp1a2 gene,0031U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Comt gene,0032U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Comt gene,0032U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Comt gene,0032U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Comt gene,0032U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Comt gene,0032U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Htr2a htr2c genes,0033U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1112.4,,,,,,,fee schedule,1112.4,1271.31, Htr2a htr2c genes,0033U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1271.31,,,,,,,fee schedule,1112.4,1271.31, Fee covid-19 vac 4 res,0034A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 4 res,0034A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Tpmt nudt15 genes,0034U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1483.18,,,,,,,fee schedule,466.17,1695.06, Tpmt nudt15 genes,0034U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1695.06,,,,,,,fee schedule,466.17,1695.06, Tpmt nudt15 genes,0034U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,484.82,,,,,,,fee schedule,466.17,1695.06,APC Tpmt nudt15 genes,0034U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,489.48,,,,,,,fee schedule,466.17,1695.06,APC Tpmt nudt15 genes,0034U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,466.17,,,,,,,fee schedule,466.17,1695.06,APC Neuro csf prion prtn qual,0035U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1720.66,,,,,,,fee schedule,540.99,1966.47, Neuro csf prion prtn qual,0035U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1966.47,,,,,,,fee schedule,540.99,1966.47, Neuro csf prion prtn qual,0035U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,562.63,,,,,,,fee schedule,540.99,1966.47,APC Neuro csf prion prtn qual,0035U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,568.04,,,,,,,fee schedule,540.99,1966.47,APC Neuro csf prion prtn qual,0035U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,540.99,,,,,,,fee schedule,540.99,1966.47,APC Xome tum & nml spec seq alys,0036U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15204.79,,,,,,,fee schedule,4780,17376.9, Xome tum & nml spec seq alys,0036U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17376.9,,,,,,,fee schedule,4780,17376.9, Xome tum & nml spec seq alys,0036U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4971.2,,,,,,,fee schedule,4780,17376.9,APC Xome tum & nml spec seq alys,0036U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5019,,,,,,,fee schedule,4780,17376.9,APC Xome tum & nml spec seq alys,0036U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4780,,,,,,,fee schedule,4780,17376.9,APC Trgt gen seq dna 324 genes,0037U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11133.31,,,,,,,fee schedule,3500,12723.78, Trgt gen seq dna 324 genes,0037U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12723.78,,,,,,,fee schedule,3500,12723.78, Trgt gen seq dna 324 genes,0037U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3640,,,,,,,fee schedule,3500,12723.78,APC Trgt gen seq dna 324 genes,0037U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3675,,,,,,,fee schedule,3500,12723.78,APC Trgt gen seq dna 324 genes,0037U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3500,,,,,,,fee schedule,3500,12723.78,APC Vitamin d srm microsamp quan,0038U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,93.74,,,,,,,fee schedule,29.6,107.13, Vitamin d srm microsamp quan,0038U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,107.13,,,,,,,fee schedule,29.6,107.13, Vitamin d srm microsamp quan,0038U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.78,,,,,,,fee schedule,29.6,107.13,APC Vitamin d srm microsamp quan,0038U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.08,,,,,,,fee schedule,29.6,107.13,APC Vitamin d srm microsamp quan,0038U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.6,,,,,,,fee schedule,29.6,107.13,APC Dna antb 2strand hi avidity,0039U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.74,50.01, Dna antb 2strand hi avidity,0039U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.74,50.01, Dna antb 2strand hi avidity,0039U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.29,,,,,,,fee schedule,13.74,50.01,APC Dna antb 2strand hi avidity,0039U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.43,,,,,,,fee schedule,13.74,50.01,APC Dna antb 2strand hi avidity,0039U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.74,,,,,,,fee schedule,13.74,50.01,APC Bcr/abl1 gene major bp quan,0040U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1304.05,,,,,,,fee schedule,409.9,1490.34, Bcr/abl1 gene major bp quan,0040U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1490.34,,,,,,,fee schedule,409.9,1490.34, Bcr/abl1 gene major bp quan,0040U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,426.3,,,,,,,fee schedule,409.9,1490.34,APC Bcr/abl1 gene major bp quan,0040U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,430.4,,,,,,,fee schedule,409.9,1490.34,APC Bcr/abl1 gene major bp quan,0040U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,409.9,,,,,,,fee schedule,409.9,1490.34,APC Fee covid-19 vac 5 dose 1,0041A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 5 dose 1,0041A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, B brgdrferi antb 5 prtn igm,0041U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.21,63.09, B brgdrferi antb 5 prtn igm,0041U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.21,63.09, B brgdrferi antb 5 prtn igm,0041U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.21,63.09,APC B brgdrferi antb 5 prtn igm,0041U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.07,,,,,,,fee schedule,17.21,63.09,APC B brgdrferi antb 5 prtn igm,0041U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.21,,,,,,,fee schedule,17.21,63.09,APC Fee covid-19 vac 5 dose 2,0042A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 5 dose 2,0042A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, B brgdrferi antb 12 prtn igg,0042U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.21,63.09, B brgdrferi antb 12 prtn igg,0042U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.21,63.09, B brgdrferi antb 12 prtn igg,0042U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.21,63.09,APC B brgdrferi antb 12 prtn igg,0042U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.07,,,,,,,fee schedule,17.21,63.09,APC B brgdrferi antb 12 prtn igg,0042U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.21,,,,,,,fee schedule,17.21,63.09,APC Tbrf b grp antb 4 prtn igm,0043U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.86,53.58, Tbrf b grp antb 4 prtn igm,0043U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.86,53.58, Tbrf b grp antb 4 prtn igm,0043U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.45,,,,,,,fee schedule,14.86,53.58,APC Tbrf b grp antb 4 prtn igm,0043U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.6,,,,,,,fee schedule,14.86,53.58,APC Tbrf b grp antb 4 prtn igm,0043U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.86,,,,,,,fee schedule,14.86,53.58,APC Fee covid-19 vac 5 res,0044A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 5 res,0044A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Tbrf b grp antb 4 prtn igg,0044U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.86,53.58, Tbrf b grp antb 4 prtn igg,0044U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.86,53.58, Tbrf b grp antb 4 prtn igg,0044U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.45,,,,,,,fee schedule,14.86,53.58,APC Tbrf b grp antb 4 prtn igg,0044U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.6,,,,,,,fee schedule,14.86,53.58,APC Tbrf b grp antb 4 prtn igg,0044U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.86,,,,,,,fee schedule,14.86,53.58,APC Onc brst dux carc is 12 gene,0045U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc brst dux carc is 12 gene,0045U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc brst dux carc is 12 gene,0045U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc brst dux carc is 12 gene,0045U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc brst dux carc is 12 gene,0045U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Flt3 gene itd variants quan,0046U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1295.7,,,,,,,fee schedule,407.43,1480.8, Flt3 gene itd variants quan,0046U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1480.8,,,,,,,fee schedule,407.43,1480.8, Flt3 gene itd variants quan,0046U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,423.73,,,,,,,fee schedule,407.43,1480.8,APC Flt3 gene itd variants quan,0046U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,427.8,,,,,,,fee schedule,407.43,1480.8,APC Flt3 gene itd variants quan,0046U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,407.43,,,,,,,fee schedule,407.43,1480.8,APC Onc prst8 mrna 17 gene alg,0047U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc prst8 mrna 17 gene alg,0047U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc prst8 mrna 17 gene alg,0047U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc prst8 mrna 17 gene alg,0047U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc prst8 mrna 17 gene alg,0047U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Onc sld org neo dna 468 gene,0048U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,2919.6,10613.25, Onc sld org neo dna 468 gene,0048U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,2919.6,10613.25, Onc sld org neo dna 468 gene,0048U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,10613.25,APC Onc sld org neo dna 468 gene,0048U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,10613.25,APC Onc sld org neo dna 468 gene,0048U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,10613.25,APC Npm1 gene analysis quan,0049U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1295.7,,,,,,,fee schedule,407.43,1480.8, Npm1 gene analysis quan,0049U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1480.8,,,,,,,fee schedule,407.43,1480.8, Npm1 gene analysis quan,0049U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,423.73,,,,,,,fee schedule,407.43,1480.8,APC Npm1 gene analysis quan,0049U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,427.8,,,,,,,fee schedule,407.43,1480.8,APC Npm1 gene analysis quan,0049U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,407.43,,,,,,,fee schedule,407.43,1480.8,APC Trgt gen seq dna 194 genes,0050U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9277.22,,,,,,,fee schedule,2916.6,10602.54, Trgt gen seq dna 194 genes,0050U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10602.54,,,,,,,fee schedule,2916.6,10602.54, Trgt gen seq dna 194 genes,0050U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3033.26,,,,,,,fee schedule,2916.6,10602.54,APC Trgt gen seq dna 194 genes,0050U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3062.43,,,,,,,fee schedule,2916.6,10602.54,APC Trgt gen seq dna 194 genes,0050U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2916.6,,,,,,,fee schedule,2916.6,10602.54,APC Fee covid-19 vac 6 dose 1,0051A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 6 dose 1,0051A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Rx mntr lc-ms/ms ur 31 pnl,0051U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,616.61,,,,,,,fee schedule,246.92,704.7, Rx mntr lc-ms/ms ur 31 pnl,0051U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,704.7,,,,,,,fee schedule,246.92,704.7, Rx mntr lc-ms/ms ur 31 pnl,0051U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,704.7,APC Rx mntr lc-ms/ms ur 31 pnl,0051U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,704.7,APC Rx mntr lc-ms/ms ur 31 pnl,0051U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,704.7,APC Fee covid-19 vac 6 dose 2,0052A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 6 dose 2,0052A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Lpoprtn bld w/5 maj classes,0052U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,107.28,,,,,,,fee schedule,33.86,122.61, Lpoprtn bld w/5 maj classes,0052U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,122.61,,,,,,,fee schedule,33.86,122.61, Lpoprtn bld w/5 maj classes,0052U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.21,,,,,,,fee schedule,33.86,122.61,APC Lpoprtn bld w/5 maj classes,0052U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.55,,,,,,,fee schedule,33.86,122.61,APC Lpoprtn bld w/5 maj classes,0052U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.86,,,,,,,fee schedule,33.86,122.61,APC Fee covid-19 vac 6 booster,0053A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 6 booster,0053A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Fee covid-19 vac 6 res,0054A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 6 res,0054A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Bone srgry cmptr fluor image,0054T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Bone srgry cmptr fluor image,0054T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rx mntr 14+ drugs & sbsts,0054U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,473.92,,,,,,,fee schedule,198.74,541.62, Rx mntr 14+ drugs & sbsts,0054U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,541.62,,,,,,,fee schedule,198.74,541.62, Rx mntr 14+ drugs & sbsts,0054U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,206.69,,,,,,,fee schedule,198.74,541.62,APC Rx mntr 14+ drugs & sbsts,0054U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,208.68,,,,,,,fee schedule,198.74,541.62,APC Rx mntr 14+ drugs & sbsts,0054U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,198.74,,,,,,,fee schedule,198.74,541.62,APC Bone srgry cmptr ct/mri imag,0055T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Bone srgry cmptr ct/mri imag,0055T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Card hrt trnspl 96 dna seq,0055U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10306.3,,,,,,,fee schedule,3240,11778.63, Card hrt trnspl 96 dna seq,0055U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11778.63,,,,,,,fee schedule,3240,11778.63, Card hrt trnspl 96 dna seq,0055U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3369.6,,,,,,,fee schedule,3240,11778.63,APC Card hrt trnspl 96 dna seq,0055U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3402,,,,,,,fee schedule,3240,11778.63,APC Card hrt trnspl 96 dna seq,0055U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3240,,,,,,,fee schedule,3240,11778.63,APC Onc merkel cll carc srm quan,0058U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1026.98,,,,,,,fee schedule,322.96,1173.69, Onc merkel cll carc srm quan,0058U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1173.69,,,,,,,fee schedule,322.96,1173.69, Onc merkel cll carc srm quan,0058U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,335.88,,,,,,,fee schedule,322.96,1173.69,APC Onc merkel cll carc srm quan,0058U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,339.11,,,,,,,fee schedule,322.96,1173.69,APC Onc merkel cll carc srm quan,0058U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,322.96,,,,,,,fee schedule,322.96,1173.69,APC Onc merkel cll carc srm +/-,0059U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1026.98,,,,,,,fee schedule,322.96,1173.69, Onc merkel cll carc srm +/-,0059U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1173.69,,,,,,,fee schedule,322.96,1173.69, Onc merkel cll carc srm +/-,0059U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,335.88,,,,,,,fee schedule,322.96,1173.69,APC Onc merkel cll carc srm +/-,0059U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,339.11,,,,,,,fee schedule,322.96,1173.69,APC Onc merkel cll carc srm +/-,0059U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,322.96,,,,,,,fee schedule,322.96,1173.69,APC Twn zyg gen seq alys chrms2,0060U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2414.34,,,,,,,fee schedule,759.05,2759.25, Twn zyg gen seq alys chrms2,0060U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2759.25,,,,,,,fee schedule,759.05,2759.25, Twn zyg gen seq alys chrms2,0060U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,2759.25,APC Twn zyg gen seq alys chrms2,0060U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,2759.25,APC Twn zyg gen seq alys chrms2,0060U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,2759.25,APC Tc meas 5 bmrk sfdi m-s alys,0061U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.19,,,,,,,fee schedule,25.1,91.65, Tc meas 5 bmrk sfdi m-s alys,0061U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.65,,,,,,,fee schedule,25.1,91.65, Tc meas 5 bmrk sfdi m-s alys,0061U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.1,,,,,,,fee schedule,25.1,91.65,APC Tc meas 5 bmrk sfdi m-s alys,0061U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.36,,,,,,,fee schedule,25.1,91.65,APC Tc meas 5 bmrk sfdi m-s alys,0061U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.1,,,,,,,fee schedule,25.1,91.65,APC Ai sle igg&igm alys 80 bmrk,0062U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1211.33,,,,,,,fee schedule,380.72,1384.38, Ai sle igg&igm alys 80 bmrk,0062U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1384.38,,,,,,,fee schedule,380.72,1384.38, Ai sle igg&igm alys 80 bmrk,0062U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,395.95,,,,,,,fee schedule,380.72,1384.38,APC Ai sle igg&igm alys 80 bmrk,0062U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,399.76,,,,,,,fee schedule,380.72,1384.38,APC Ai sle igg&igm alys 80 bmrk,0062U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,380.72,,,,,,,fee schedule,380.72,1384.38,APC Neuro autism 32 amines alg,0063U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2385.18,,,,,,,fee schedule,750,2725.92, Neuro autism 32 amines alg,0063U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2725.92,,,,,,,fee schedule,750,2725.92, Neuro autism 32 amines alg,0063U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,780,,,,,,,fee schedule,750,2725.92,APC Neuro autism 32 amines alg,0063U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,787.5,,,,,,,fee schedule,750,2725.92,APC Neuro autism 32 amines alg,0063U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,750,,,,,,,fee schedule,750,2725.92,APC Fee covid-19 vac 7 res,0064A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 7 res,0064A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Antb tp total&rpr ia qual,0064U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,99.99,,,,,,,fee schedule,31.33,114.27, Antb tp total&rpr ia qual,0064U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,114.27,,,,,,,fee schedule,31.33,114.27, Antb tp total&rpr ia qual,0064U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.58,,,,,,,fee schedule,31.33,114.27,APC Antb tp total&rpr ia qual,0064U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.9,,,,,,,fee schedule,31.33,114.27,APC Antb tp total&rpr ia qual,0064U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.33,,,,,,,fee schedule,31.33,114.27,APC Syfls tst nontreponemal antb,0065U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.09,65.46, Syfls tst nontreponemal antb,0065U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.09,65.46, Syfls tst nontreponemal antb,0065U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.81,,,,,,,fee schedule,18.09,65.46,APC Syfls tst nontreponemal antb,0065U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.99,,,,,,,fee schedule,18.09,65.46,APC Syfls tst nontreponemal antb,0065U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.09,,,,,,,fee schedule,18.09,65.46,APC Onc brst imhchem prfl 4 bmrk,0067U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6033.8,,,,,,,fee schedule,1897,6895.77, Onc brst imhchem prfl 4 bmrk,0067U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6895.77,,,,,,,fee schedule,1897,6895.77, Onc brst imhchem prfl 4 bmrk,0067U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1972.88,,,,,,,fee schedule,1897,6895.77,APC Onc brst imhchem prfl 4 bmrk,0067U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1991.85,,,,,,,fee schedule,1897,6895.77,APC Onc brst imhchem prfl 4 bmrk,0067U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1897,,,,,,,fee schedule,1897,6895.77,APC Candida species pnl amp prb,0068U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,142.63,519, Candida species pnl amp prb,0068U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,142.63,519, Candida species pnl amp prb,0068U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,519,APC Candida species pnl amp prb,0068U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,519,APC Candida species pnl amp prb,0068U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,519,APC Onc clrct microrna mir-31-3p,0069U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1209.26,,,,,,,fee schedule,380,1382.01, Onc clrct microrna mir-31-3p,0069U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1382.01,,,,,,,fee schedule,380,1382.01, Onc clrct microrna mir-31-3p,0069U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,395.2,,,,,,,fee schedule,380,1382.01,APC Onc clrct microrna mir-31-3p,0069U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,399,,,,,,,fee schedule,380,1382.01,APC Onc clrct microrna mir-31-3p,0069U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,380,,,,,,,fee schedule,380,1382.01,APC Cyp2d6 gen com&slct rar vrnt,0070U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2151.87,,,,,,,fee schedule,676.37,2459.28, Cyp2d6 gen com&slct rar vrnt,0070U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2459.28,,,,,,,fee schedule,676.37,2459.28, Cyp2d6 gen com&slct rar vrnt,0070U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,703.42,,,,,,,fee schedule,676.37,2459.28,APC Cyp2d6 gen com&slct rar vrnt,0070U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,710.19,,,,,,,fee schedule,676.37,2459.28,APC Cyp2d6 gen com&slct rar vrnt,0070U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,676.37,,,,,,,fee schedule,676.37,2459.28,APC Fee covid-19 vac 8 dose 1,0071A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 8 dose 1,0071A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Us leiomyomata ablate <200,0071T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8185.59,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate <200,0071T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9373.82,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate <200,0071T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate <200,0071T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate <200,0071T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3824.16,13320,APC Us leiomyomata ablate <200,0071T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3824.16,13320,APC Us leiomyomata ablate <200,0071T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3824.16,13320,APC Cyp2d6 full gene sequence,0071U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1908.14,,,,,,,fee schedule,600,2180.73, Cyp2d6 full gene sequence,0071U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2180.73,,,,,,,fee schedule,600,2180.73, Cyp2d6 full gene sequence,0071U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,624,,,,,,,fee schedule,600,2180.73,APC Cyp2d6 full gene sequence,0071U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,630,,,,,,,fee schedule,600,2180.73,APC Cyp2d6 full gene sequence,0071U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,600,,,,,,,fee schedule,600,2180.73,APC Fee covid-19 vac 8 dose 2,0072A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 8 dose 2,0072A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Us leiomyomata ablate >200,0072T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8185.59,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate >200,0072T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9373.82,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate >200,0072T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate >200,0072T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3824.16,13320, Us leiomyomata ablate >200,0072T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3824.16,13320,APC Us leiomyomata ablate >200,0072T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3824.16,13320,APC Us leiomyomata ablate >200,0072T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3824.16,13320,APC Cyp2d6 gen cyp2d6-2d7 hybrid,0072U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1434.25,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gen cyp2d6-2d7 hybrid,0072U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1639.14,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gen cyp2d6-2d7 hybrid,0072U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,468.95,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 gen cyp2d6-2d7 hybrid,0072U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,473.46,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 gen cyp2d6-2d7 hybrid,0072U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,450.91,,,,,,,fee schedule,450.91,1639.14,APC Fee covid-19 vac 8 booster,0073A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 8 booster,0073A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Cyp2d6 gen cyp2d7-2d6 hybrid,0073U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1434.25,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gen cyp2d7-2d6 hybrid,0073U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1639.14,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gen cyp2d7-2d6 hybrid,0073U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,468.95,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 gen cyp2d7-2d6 hybrid,0073U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,473.46,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 gen cyp2d7-2d6 hybrid,0073U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,450.91,,,,,,,fee schedule,450.91,1639.14,APC Fee covid-19 vac 8 res,0074A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 8 res,0074A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Cyp2d6 nonduplicated gene,0074U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1434.25,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 nonduplicated gene,0074U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1639.14,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 nonduplicated gene,0074U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,468.95,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 nonduplicated gene,0074U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,473.46,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 nonduplicated gene,0074U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,450.91,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 5' gene dup/mlt,0075U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1434.25,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 5' gene dup/mlt,0075U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1639.14,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 5' gene dup/mlt,0075U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,468.95,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 5' gene dup/mlt,0075U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,473.46,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 5' gene dup/mlt,0075U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,450.91,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 3' gene dup/mlt,0076U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1434.25,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 3' gene dup/mlt,0076U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1639.14,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 3' gene dup/mlt,0076U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,468.95,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 3' gene dup/mlt,0076U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,473.46,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 3' gene dup/mlt,0076U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,450.91,,,,,,,fee schedule,450.91,1639.14,APC Ig paraprotein qual bld/ur,0077U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,138.52,,,,,,,fee schedule,43.43,158.31, Ig paraprotein qual bld/ur,0077U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,158.31,,,,,,,fee schedule,43.43,158.31, Ig paraprotein qual bld/ur,0077U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.17,,,,,,,fee schedule,43.43,158.31,APC Ig paraprotein qual bld/ur,0077U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,45.6,,,,,,,fee schedule,43.43,158.31,APC Ig paraprotein qual bld/ur,0077U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,43.43,,,,,,,fee schedule,43.43,158.31,APC Pain mgt opi use gnotyp pnl,0078U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1434.25,,,,,,,fee schedule,1434.25,1639.14, Pain mgt opi use gnotyp pnl,0078U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1639.14,,,,,,,fee schedule,1434.25,1639.14, Onc lng 5 clin rsk factr alg,0080U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11196.83,,,,,,,fee schedule,3520,12796.38, Onc lng 5 clin rsk factr alg,0080U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12796.38,,,,,,,fee schedule,3520,12796.38, Onc lng 5 clin rsk factr alg,0080U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3660.8,,,,,,,fee schedule,3520,12796.38,APC Onc lng 5 clin rsk factr alg,0080U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3696,,,,,,,fee schedule,3520,12796.38,APC Onc lng 5 clin rsk factr alg,0080U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3520,,,,,,,fee schedule,3520,12796.38,APC Fee covid-19 vac 9 dose 1,0081A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 9 dose 1,0081A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Fee covid-19 vac 9 dose 2,0082A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 9 dose 2,0082A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Rx test def 90+ rx/sbsts ur,0082U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,785.35,,,,,,,fee schedule,246.92,897.54, Rx test def 90+ rx/sbsts ur,0082U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,897.54,,,,,,,fee schedule,246.92,897.54, Rx test def 90+ rx/sbsts ur,0082U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,897.54,APC Rx test def 90+ rx/sbsts ur,0082U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,897.54,APC Rx test def 90+ rx/sbsts ur,0082U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,897.54,APC Fee covid-19 vac 9 booster,0083A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 9 booster,0083A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Onc rspse chemo cntrst tomog,0083U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,532.25,,,,,,,fee schedule,167.35,608.28, Onc rspse chemo cntrst tomog,0083U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,608.28,,,,,,,fee schedule,167.35,608.28, Onc rspse chemo cntrst tomog,0083U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,174.04,,,,,,,fee schedule,167.35,608.28,APC Onc rspse chemo cntrst tomog,0083U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,175.72,,,,,,,fee schedule,167.35,608.28,APC Onc rspse chemo cntrst tomog,0083U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,167.35,,,,,,,fee schedule,167.35,608.28,APC Rbc dna gnotyp 10 bld groups,0084U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2290.39,,,,,,,fee schedule,720,2617.59, Rbc dna gnotyp 10 bld groups,0084U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2617.59,,,,,,,fee schedule,720,2617.59, Rbc dna gnotyp 10 bld groups,0084U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,748.8,,,,,,,fee schedule,720,2617.59,APC Rbc dna gnotyp 10 bld groups,0084U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,756,,,,,,,fee schedule,720,2617.59,APC Rbc dna gnotyp 10 bld groups,0084U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,720,,,,,,,fee schedule,720,2617.59,APC Nfct ds bact&fng org id 6+,0086U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,636.41,,,,,,,fee schedule,200,727.32, Nfct ds bact&fng org id 6+,0086U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,727.32,,,,,,,fee schedule,200,727.32, Nfct ds bact&fng org id 6+,0086U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,208,,,,,,,fee schedule,200,727.32,APC Nfct ds bact&fng org id 6+,0086U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,210,,,,,,,fee schedule,200,727.32,APC Nfct ds bact&fng org id 6+,0086U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,200,,,,,,,fee schedule,200,727.32,APC Crd hrt trnspl mrna 1283 gen,0087U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10050.08,,,,,,,fee schedule,3159.42,11485.8, Crd hrt trnspl mrna 1283 gen,0087U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11485.8,,,,,,,fee schedule,3159.42,11485.8, Crd hrt trnspl mrna 1283 gen,0087U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3285.8,,,,,,,fee schedule,3159.42,11485.8,APC Crd hrt trnspl mrna 1283 gen,0087U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3317.39,,,,,,,fee schedule,3159.42,11485.8,APC Crd hrt trnspl mrna 1283 gen,0087U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3159.42,,,,,,,fee schedule,3159.42,11485.8,APC Trnsplj kdn algrft rej 1494,0088U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10050.08,,,,,,,fee schedule,3159.42,11485.8, Trnsplj kdn algrft rej 1494,0088U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11485.8,,,,,,,fee schedule,3159.42,11485.8, Trnsplj kdn algrft rej 1494,0088U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3285.8,,,,,,,fee schedule,3159.42,11485.8,APC Trnsplj kdn algrft rej 1494,0088U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3317.39,,,,,,,fee schedule,3159.42,11485.8,APC Trnsplj kdn algrft rej 1494,0088U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3159.42,,,,,,,fee schedule,3159.42,11485.8,APC Onc mlnma prame & linc00518,0089U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc mlnma prame & linc00518,0089U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc mlnma prame & linc00518,0089U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc mlnma prame & linc00518,0089U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc mlnma prame & linc00518,0089U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Onc cutan mlnma mrna 23 gene,0090U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6202.53,,,,,,,fee schedule,1950,7088.61, Onc cutan mlnma mrna 23 gene,0090U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7088.61,,,,,,,fee schedule,1950,7088.61, Onc cutan mlnma mrna 23 gene,0090U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2028,,,,,,,fee schedule,1950,7088.61,APC Onc cutan mlnma mrna 23 gene,0090U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2047.5,,,,,,,fee schedule,1950,7088.61,APC Onc cutan mlnma mrna 23 gene,0090U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1950,,,,,,,fee schedule,1950,7088.61,APC Fee covid-19 vac 10 dose 1,0091A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 10 dose 1,0091A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Fee covid-19 vac 10 dose 2,0092A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 10 dose 2,0092A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Onc lng 3 prtn bmrk plsm alg,0092U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7913.82,,,,,,,fee schedule,2488,9044.37, Onc lng 3 prtn bmrk plsm alg,0092U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9044.37,,,,,,,fee schedule,2488,9044.37, Onc lng 3 prtn bmrk plsm alg,0092U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2587.52,,,,,,,fee schedule,2488,9044.37,APC Onc lng 3 prtn bmrk plsm alg,0092U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2612.4,,,,,,,fee schedule,2488,9044.37,APC Onc lng 3 prtn bmrk plsm alg,0092U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2488,,,,,,,fee schedule,2488,9044.37,APC Fee covid-19 vac 10 booster,0093A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 10 booster,0093A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Rx mntr 65 com drugs urine,0093U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,197.9,,,,,,,fee schedule,62.14,226.17, Rx mntr 65 com drugs urine,0093U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,226.17,,,,,,,fee schedule,62.14,226.17, Rx mntr 65 com drugs urine,0093U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.63,,,,,,,fee schedule,62.14,226.17,APC Rx mntr 65 com drugs urine,0093U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.25,,,,,,,fee schedule,62.14,226.17,APC Rx mntr 65 com drugs urine,0093U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.14,,,,,,,fee schedule,62.14,226.17,APC Fee covid-19 vac 10 res,0094A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Fee covid-19 vac 10 res,0094A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Genome rapid sequence alys,0094U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24118.5,,,,,,,fee schedule,7582.2,27564, Genome rapid sequence alys,0094U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27564,,,,,,,fee schedule,7582.2,27564, Genome rapid sequence alys,0094U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7885.49,,,,,,,fee schedule,7582.2,27564,APC Genome rapid sequence alys,0094U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7961.31,,,,,,,fee schedule,7582.2,27564,APC Genome rapid sequence alys,0094U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7582.2,,,,,,,fee schedule,7582.2,27564,APC Rmvl artific disc addl crvcl,0095T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rmvl artific disc addl crvcl,0095T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Inflm ee elisa alys alg,0095U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2456,,,,,,,fee schedule,771.98,2806.86, Inflm ee elisa alys alg,0095U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2806.86,,,,,,,fee schedule,771.98,2806.86, Inflm ee elisa alys alg,0095U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,802.86,,,,,,,fee schedule,771.98,2806.86,APC Inflm ee elisa alys alg,0095U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,810.58,,,,,,,fee schedule,771.98,2806.86,APC Inflm ee elisa alys alg,0095U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,771.98,,,,,,,fee schedule,771.98,2806.86,APC Hpv hi risk types male urine,0096U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,127.38, Hpv hi risk types male urine,0096U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,127.38, Hpv hi risk types male urine,0096U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,127.38,APC Hpv hi risk types male urine,0096U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,127.38,APC Hpv hi risk types male urine,0096U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,127.38,APC Rev Artific Disc Addl,0098T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rev Artific Disc Addl,0098T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Prosth Retina Receive&Gen,0100T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17041, Prosth Retina Receive&Gen,0100T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17041, Prosth Retina Receive&Gen,0100T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,17041, Prosth Retina Receive&Gen,0100T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,17041, Prosth Retina Receive&Gen,0100T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,17041, Prosth Retina Receive&Gen,0100T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,17041, Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,291.4,13320, Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,291.4,13320, Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,291.4,13320, Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,291.4,13320, Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,13320,APC Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,13320,APC Extracorp shockwv tx hi enrg,0101T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,13320,APC Hered colon ca do 15 genes,0101U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5547.39,,,,,,,fee schedule,1743.95,6339.87, Hered colon ca do 15 genes,0101U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6339.87,,,,,,,fee schedule,1743.95,6339.87, Hered colon ca do 15 genes,0101U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1813.71,,,,,,,fee schedule,1743.95,6339.87,APC Hered colon ca do 15 genes,0101U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1831.15,,,,,,,fee schedule,1743.95,6339.87,APC Hered colon ca do 15 genes,0101U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1743.95,,,,,,,fee schedule,1743.95,6339.87,APC Extracorp shockwv tx anesth,0102T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,13320, Extracorp shockwv tx anesth,0102T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,13320, Extracorp shockwv tx anesth,0102T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2138,13320, Extracorp shockwv tx anesth,0102T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2138,13320, Extracorp shockwv tx anesth,0102T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2138,13320,APC Extracorp shockwv tx anesth,0102T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2138,13320,APC Extracorp shockwv tx anesth,0102T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2138,13320,APC Hered brst ca rltd do 17 gen,0102U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4147.53,,,,,,,fee schedule,1303.95,4740.03, Hered brst ca rltd do 17 gen,0102U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4740.03,,,,,,,fee schedule,1303.95,4740.03, Hered brst ca rltd do 17 gen,0102U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1356.11,,,,,,,fee schedule,1303.95,4740.03,APC Hered brst ca rltd do 17 gen,0102U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1369.15,,,,,,,fee schedule,1303.95,4740.03,APC Hered brst ca rltd do 17 gen,0102U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1303.95,,,,,,,fee schedule,1303.95,4740.03,APC Hered ova ca pnl 24 genes,0103U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5547.39,,,,,,,fee schedule,1743.95,6339.87, Hered ova ca pnl 24 genes,0103U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6339.87,,,,,,,fee schedule,1743.95,6339.87, Hered ova ca pnl 24 genes,0103U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1813.71,,,,,,,fee schedule,1743.95,6339.87,APC Hered ova ca pnl 24 genes,0103U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1831.15,,,,,,,fee schedule,1743.95,6339.87,APC Hered ova ca pnl 24 genes,0103U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1743.95,,,,,,,fee schedule,1743.95,6339.87,APC Neph ckd mult eclia tum nec,0105U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3021.59,,,,,,,fee schedule,950,3453.24, Neph ckd mult eclia tum nec,0105U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3453.24,,,,,,,fee schedule,950,3453.24, Neph ckd mult eclia tum nec,0105U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,988,,,,,,,fee schedule,950,3453.24,APC Neph ckd mult eclia tum nec,0105U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,997.5,,,,,,,fee schedule,950,3453.24,APC Neph ckd mult eclia tum nec,0105U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,950,,,,,,,fee schedule,950,3453.24,APC Touch Quant Sensory Test,0106T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.91,,,,,,,fee schedule,16.91,46.33, Touch Quant Sensory Test,0106T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.37,,,,,,,fee schedule,16.91,46.33, Touch Quant Sensory Test,0106T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,16.91,46.33,APC Touch Quant Sensory Test,0106T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,16.91,46.33,APC Touch Quant Sensory Test,0106T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,16.91,46.33,APC Gstr emptg 7 timed brth spec,0106U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2782.03,,,,,,,fee schedule,874.49,3179.46, Gstr emptg 7 timed brth spec,0106U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3179.46,,,,,,,fee schedule,874.49,3179.46, Gstr emptg 7 timed brth spec,0106U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,909.47,,,,,,,fee schedule,874.49,3179.46,APC Gstr emptg 7 timed brth spec,0106U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,918.21,,,,,,,fee schedule,874.49,3179.46,APC Gstr emptg 7 timed brth spec,0106U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,874.49,,,,,,,fee schedule,874.49,3179.46,APC Vibrate Quant Sensory Test,0107T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.91,,,,,,,fee schedule,16.91,46.33, Vibrate Quant Sensory Test,0107T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.37,,,,,,,fee schedule,16.91,46.33, Vibrate Quant Sensory Test,0107T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,16.91,46.33,APC Vibrate Quant Sensory Test,0107T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,16.91,46.33,APC Vibrate Quant Sensory Test,0107T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,16.91,46.33,APC C diff tox ag detcj ia stool,0107U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16,58.32, C diff tox ag detcj ia stool,0107U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16,58.32, C diff tox ag detcj ia stool,0107U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.64,,,,,,,fee schedule,16,58.32,APC C diff tox ag detcj ia stool,0107U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.8,,,,,,,fee schedule,16,58.32,APC C diff tox ag detcj ia stool,0107U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16,,,,,,,fee schedule,16,58.32,APC Cool Quant Sensory Test,0108T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.91,,,,,,,fee schedule,16.91,73.17, Cool Quant Sensory Test,0108T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.37,,,,,,,fee schedule,16.91,73.17, Cool Quant Sensory Test,0108T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,16.91,73.17,APC Cool Quant Sensory Test,0108T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,16.91,73.17,APC Cool Quant Sensory Test,0108T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,16.91,73.17,APC Gi barrett esoph 9 prtn bmrk,0108U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15745.35,,,,,,,fee schedule,4950,17994.69, Gi barrett esoph 9 prtn bmrk,0108U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17994.69,,,,,,,fee schedule,4950,17994.69, Gi barrett esoph 9 prtn bmrk,0108U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5148,,,,,,,fee schedule,4950,17994.69,APC Gi barrett esoph 9 prtn bmrk,0108U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5197.5,,,,,,,fee schedule,4950,17994.69,APC Gi barrett esoph 9 prtn bmrk,0108U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4950,,,,,,,fee schedule,4950,17994.69,APC Heat Quant Sensory Test,0109T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.91,,,,,,,fee schedule,16.91,46.33, Heat Quant Sensory Test,0109T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.37,,,,,,,fee schedule,16.91,46.33, Heat Quant Sensory Test,0109T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,16.91,46.33,APC Heat Quant Sensory Test,0109T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,16.91,46.33,APC Heat Quant Sensory Test,0109T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,16.91,46.33,APC Id aspergillus dna 4 species,0109U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,142.63,519, Id aspergillus dna 4 species,0109U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,142.63,519, Id aspergillus dna 4 species,0109U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,519,APC Id aspergillus dna 4 species,0109U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,519,APC Id aspergillus dna 4 species,0109U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,519,APC Nos Quant Sensory Test,0110T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.91,,,,,,,fee schedule,16.91,165.03, Nos Quant Sensory Test,0110T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.37,,,,,,,fee schedule,16.91,165.03, Nos Quant Sensory Test,0110T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,16.91,165.03,APC Nos Quant Sensory Test,0110T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,16.91,165.03,APC Nos Quant Sensory Test,0110T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,16.91,165.03,APC Rx mntr 1+oral onc rx&sbsts,0110U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.11,98.79, Rx mntr 1+oral onc rx&sbsts,0110U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.11,98.79, Rx mntr 1+oral onc rx&sbsts,0110U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.19,,,,,,,fee schedule,27.11,98.79,APC Rx mntr 1+oral onc rx&sbsts,0110U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,27.11,98.79,APC Rx mntr 1+oral onc rx&sbsts,0110U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,27.11,98.79,APC Adm sarscov2 25mcg/0.25ml1st,0111A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscov2 25mcg/0.25ml1st,0111A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Onc colon ca kras&nras alys,0111U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2170.61,,,,,,,fee schedule,682.29,2480.7, Onc colon ca kras&nras alys,0111U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2480.7,,,,,,,fee schedule,682.29,2480.7, Onc colon ca kras&nras alys,0111U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,709.58,,,,,,,fee schedule,682.29,2480.7,APC Onc colon ca kras&nras alys,0111U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,716.4,,,,,,,fee schedule,682.29,2480.7,APC Onc colon ca kras&nras alys,0111U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,682.29,,,,,,,fee schedule,682.29,2480.7,APC Adm sarscov2 25mcg/0.25ml2nd,0112A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscov2 25mcg/0.25ml2nd,0112A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Iadi 16s&18s rrna genes,0112U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1133.21,,,,,,,fee schedule,356.13,1295.1, Iadi 16s&18s rrna genes,0112U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1295.1,,,,,,,fee schedule,356.13,1295.1, Iadi 16s&18s rrna genes,0112U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,370.38,,,,,,,fee schedule,356.13,1295.1,APC Iadi 16s&18s rrna genes,0112U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,373.94,,,,,,,fee schedule,356.13,1295.1,APC Iadi 16s&18s rrna genes,0112U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,356.13,,,,,,,fee schedule,356.13,1295.1,APC Adm sarscov2 25mcg/0.25ml3rd,0113A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscov2 25mcg/0.25ml3rd,0113A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Onc prst8 pca3&tmprss2-erg,0113U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc prst8 pca3&tmprss2-erg,0113U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc prst8 pca3&tmprss2-erg,0113U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc prst8 pca3&tmprss2-erg,0113U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc prst8 pca3&tmprss2-erg,0113U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Gi barretts esoph vim&ccna1,0114U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6165.02,,,,,,,fee schedule,1938.01,7045.74, Gi barretts esoph vim&ccna1,0114U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7045.74,,,,,,,fee schedule,1938.01,7045.74, Gi barretts esoph vim&ccna1,0114U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2015.53,,,,,,,fee schedule,1938.01,7045.74,APC Gi barretts esoph vim&ccna1,0114U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2034.91,,,,,,,fee schedule,1938.01,7045.74,APC Gi barretts esoph vim&ccna1,0114U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1938.01,,,,,,,fee schedule,1938.01,7045.74,APC Respir iadna 18 viral&2 bact,0115U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,875.96,,,,,,,fee schedule,275.35,1001.1, Respir iadna 18 viral&2 bact,0115U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1001.1,,,,,,,fee schedule,275.35,1001.1, Respir iadna 18 viral&2 bact,0115U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.36,,,,,,,fee schedule,275.35,1001.1,APC Respir iadna 18 viral&2 bact,0115U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.12,,,,,,,fee schedule,275.35,1001.1,APC Respir iadna 18 viral&2 bact,0115U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.35,,,,,,,fee schedule,275.35,1001.1,APC Rx mntr nzm ia 35+oral flu,0116U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,785.35,,,,,,,fee schedule,246.92,897.54, Rx mntr nzm ia 35+oral flu,0116U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,897.54,,,,,,,fee schedule,246.92,897.54, Rx mntr nzm ia 35+oral flu,0116U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,897.54,APC Rx mntr nzm ia 35+oral flu,0116U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,897.54,APC Rx mntr nzm ia 35+oral flu,0116U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,897.54,APC Pain mgmt 11 endogenous anal,0117U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2673.69,,,,,,,fee schedule,840.65,3055.65, Pain mgmt 11 endogenous anal,0117U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3055.65,,,,,,,fee schedule,840.65,3055.65, Pain mgmt 11 endogenous anal,0117U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,874.28,,,,,,,fee schedule,840.65,3055.65,APC Pain mgmt 11 endogenous anal,0117U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,882.68,,,,,,,fee schedule,840.65,3055.65,APC Pain mgmt 11 endogenous anal,0117U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,840.65,,,,,,,fee schedule,840.65,3055.65,APC Trnsplj don-drv cll-fr dna,0118U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8757.5,,,,,,,fee schedule,2753.25,10008.57, Trnsplj don-drv cll-fr dna,0118U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10008.57,,,,,,,fee schedule,2753.25,10008.57, Trnsplj don-drv cll-fr dna,0118U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2863.38,,,,,,,fee schedule,2753.25,10008.57,APC Trnsplj don-drv cll-fr dna,0118U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2890.91,,,,,,,fee schedule,2753.25,10008.57,APC Trnsplj don-drv cll-fr dna,0118U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2753.25,,,,,,,fee schedule,2753.25,10008.57,APC Crd ceramides liq chrom plsm,0119U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,266.65,,,,,,,fee schedule,83.76,304.74, Crd ceramides liq chrom plsm,0119U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,304.74,,,,,,,fee schedule,83.76,304.74, Crd ceramides liq chrom plsm,0119U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,87.11,,,,,,,fee schedule,83.76,304.74,APC Crd ceramides liq chrom plsm,0119U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,87.95,,,,,,,fee schedule,83.76,304.74,APC Crd ceramides liq chrom plsm,0119U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,83.76,,,,,,,fee schedule,83.76,304.74,APC Onc b cll lymphm mrna 58 gen,0120U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7984.65,,,,,,,fee schedule,2510.21,9125.31, Onc b cll lymphm mrna 58 gen,0120U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9125.31,,,,,,,fee schedule,2510.21,9125.31, Onc b cll lymphm mrna 58 gen,0120U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2610.62,,,,,,,fee schedule,2510.21,9125.31,APC Onc b cll lymphm mrna 58 gen,0120U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2635.72,,,,,,,fee schedule,2510.21,9125.31,APC Onc b cll lymphm mrna 58 gen,0120U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2510.21,,,,,,,fee schedule,2510.21,9125.31,APC Sc dis vcam-1 whole blood,0121U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1619.63,,,,,,,fee schedule,509.2,1851, Sc dis vcam-1 whole blood,0121U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1851,,,,,,,fee schedule,509.2,1851, Sc dis vcam-1 whole blood,0121U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,529.57,,,,,,,fee schedule,509.2,1851,APC Sc dis vcam-1 whole blood,0121U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,534.66,,,,,,,fee schedule,509.2,1851,APC Sc dis vcam-1 whole blood,0121U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,509.2,,,,,,,fee schedule,509.2,1851,APC Sc dis p-selectin whl blood,0122U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1673.81,,,,,,,fee schedule,526.23,1912.92, Sc dis p-selectin whl blood,0122U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1912.92,,,,,,,fee schedule,526.23,1912.92, Sc dis p-selectin whl blood,0122U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,547.28,,,,,,,fee schedule,526.23,1912.92,APC Sc dis p-selectin whl blood,0122U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,552.54,,,,,,,fee schedule,526.23,1912.92,APC Sc dis p-selectin whl blood,0122U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,526.23,,,,,,,fee schedule,526.23,1912.92,APC Mchnl fragility rbc prflg,0123U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1137.39,,,,,,,fee schedule,357.63,1299.87, Mchnl fragility rbc prflg,0123U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1299.87,,,,,,,fee schedule,357.63,1299.87, Mchnl fragility rbc prflg,0123U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,371.94,,,,,,,fee schedule,357.63,1299.87,APC Mchnl fragility rbc prflg,0123U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,375.51,,,,,,,fee schedule,357.63,1299.87,APC Mchnl fragility rbc prflg,0123U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,357.63,,,,,,,fee schedule,357.63,1299.87,APC Adm sarscv2 bvl 30mcg/.3ml b,0124A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscv2 bvl 30mcg/.3ml b,0124A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Hered brst ca rltd do panel,0129U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4147.53,,,,,,,fee schedule,1303.95,4740.03, Hered brst ca rltd do panel,0129U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4740.03,,,,,,,fee schedule,1303.95,4740.03, Hered brst ca rltd do panel,0129U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1356.11,,,,,,,fee schedule,1303.95,4740.03,APC Hered brst ca rltd do panel,0129U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1369.15,,,,,,,fee schedule,1303.95,4740.03,APC Hered brst ca rltd do panel,0129U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1303.95,,,,,,,fee schedule,1303.95,4740.03,APC Hered colon ca do mrna pnl,0130U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,584.9,2125.98, Hered colon ca do mrna pnl,0130U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,584.9,2125.98, Hered colon ca do mrna pnl,0130U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,608.3,,,,,,,fee schedule,584.9,2125.98,APC Hered colon ca do mrna pnl,0130U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,614.14,,,,,,,fee schedule,584.9,2125.98,APC Hered colon ca do mrna pnl,0130U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.9,,,,,,,fee schedule,584.9,2125.98,APC Hered brst ca rltd do pnl 13,0131U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2258.1,,,,,,,fee schedule,2258.1,2580.69, Hered brst ca rltd do pnl 13,0131U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2580.69,,,,,,,fee schedule,2258.1,2580.69, Hered ova ca rltd do pnl 17,0132U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2359.14,,,,,,,fee schedule,2359.14,2696.16, Hered ova ca rltd do pnl 17,0132U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2696.16,,,,,,,fee schedule,2359.14,2696.16, Hered prst8 ca rltd do 11,0133U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2195.63,,,,,,,fee schedule,690.29,2509.29, Hered prst8 ca rltd do 11,0133U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2509.29,,,,,,,fee schedule,690.29,2509.29, Hered prst8 ca rltd do 11,0133U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,717.9,,,,,,,fee schedule,690.29,2509.29,APC Hered prst8 ca rltd do 11,0133U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,724.8,,,,,,,fee schedule,690.29,2509.29,APC Hered prst8 ca rltd do 11,0133U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,690.29,,,,,,,fee schedule,690.29,2509.29,APC Adm sarscv2 bvl 50mcg/.5ml b,0134A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscv2 bvl 50mcg/.5ml b,0134A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Hered pan ca mrna pnl 18 gen,0134U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2381.03,,,,,,,fee schedule,748.39,2721.18, Hered pan ca mrna pnl 18 gen,0134U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2721.18,,,,,,,fee schedule,748.39,2721.18, Hered pan ca mrna pnl 18 gen,0134U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,778.33,,,,,,,fee schedule,748.39,2721.18,APC Hered pan ca mrna pnl 18 gen,0134U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,785.81,,,,,,,fee schedule,748.39,2721.18,APC Hered pan ca mrna pnl 18 gen,0134U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,748.39,,,,,,,fee schedule,748.39,2721.18,APC Hered gyn ca mrna pnl 12 gen,0135U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2227.92,,,,,,,fee schedule,2227.92,2546.19, Hered gyn ca mrna pnl 12 gen,0135U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2546.19,,,,,,,fee schedule,2227.92,2546.19, Atm mrna seq alys,0136U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1295.7,,,,,,,fee schedule,407.43,1480.8, Atm mrna seq alys,0136U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1480.8,,,,,,,fee schedule,407.43,1480.8, Atm mrna seq alys,0136U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,423.73,,,,,,,fee schedule,407.43,1480.8,APC Atm mrna seq alys,0136U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,427.8,,,,,,,fee schedule,407.43,1480.8,APC Atm mrna seq alys,0136U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,407.43,,,,,,,fee schedule,407.43,1480.8,APC Palb2 mrna seq alys,0137U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Palb2 mrna seq alys,0137U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Palb2 mrna seq alys,0137U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Palb2 mrna seq alys,0137U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Palb2 mrna seq alys,0137U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Brca1 brca2 mrna seq alys,0138U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1489.45,,,,,,,fee schedule,468.33,1702.23, Brca1 brca2 mrna seq alys,0138U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1702.23,,,,,,,fee schedule,468.33,1702.23, Brca1 brca2 mrna seq alys,0138U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,487.06,,,,,,,fee schedule,468.33,1702.23,APC Brca1 brca2 mrna seq alys,0138U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,491.75,,,,,,,fee schedule,468.33,1702.23,APC Brca1 brca2 mrna seq alys,0138U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,468.33,,,,,,,fee schedule,468.33,1702.23,APC Nfct ds fungi dna 15 trgt,0140U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,498.91,,,,,,,fee schedule,156.75,570.18, Nfct ds fungi dna 15 trgt,0140U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,570.18,,,,,,,fee schedule,156.75,570.18, Nfct ds fungi dna 15 trgt,0140U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.02,,,,,,,fee schedule,156.75,570.18,APC Nfct ds fungi dna 15 trgt,0140U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,164.59,,,,,,,fee schedule,156.75,570.18,APC Nfct ds fungi dna 15 trgt,0140U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.75,,,,,,,fee schedule,156.75,570.18,APC Nfct ds bact&fng gram pos,0141U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,498.91,,,,,,,fee schedule,156.75,570.18, Nfct ds bact&fng gram pos,0141U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,570.18,,,,,,,fee schedule,156.75,570.18, Nfct ds bact&fng gram pos,0141U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.02,,,,,,,fee schedule,156.75,570.18,APC Nfct ds bact&fng gram pos,0141U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,164.59,,,,,,,fee schedule,156.75,570.18,APC Nfct ds bact&fng gram pos,0141U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.75,,,,,,,fee schedule,156.75,570.18,APC Nfct ds bact&fng gram neg,0142U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,498.91,,,,,,,fee schedule,156.75,570.18, Nfct ds bact&fng gram neg,0142U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,570.18,,,,,,,fee schedule,156.75,570.18, Nfct ds bact&fng gram neg,0142U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.02,,,,,,,fee schedule,156.75,570.18,APC Nfct ds bact&fng gram neg,0142U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,164.59,,,,,,,fee schedule,156.75,570.18,APC Nfct ds bact&fng gram neg,0142U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.75,,,,,,,fee schedule,156.75,570.18,APC Adm srscv2 bvl 25mcg/.25ml b,0144A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm srscv2 bvl 25mcg/.25ml b,0144A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Nfct bct fng prst dna >1000,0152U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6762.89,,,,,,,fee schedule,2126.2,7729.02, Nfct bct fng prst dna >1000,0152U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7729.02,,,,,,,fee schedule,2126.2,7729.02, Nfct bct fng prst dna >1000,0152U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2211.25,,,,,,,fee schedule,2126.2,7729.02,APC Nfct bct fng prst dna >1000,0152U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2232.51,,,,,,,fee schedule,2126.2,7729.02,APC Nfct bct fng prst dna >1000,0152U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2126.2,,,,,,,fee schedule,2126.2,7729.02,APC Onc breast mrna 101 genes,0153U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10050.08,,,,,,,fee schedule,3159.42,11485.8, Onc breast mrna 101 genes,0153U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11485.8,,,,,,,fee schedule,3159.42,11485.8, Onc breast mrna 101 genes,0153U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3285.8,,,,,,,fee schedule,3159.42,11485.8,APC Onc breast mrna 101 genes,0153U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3317.39,,,,,,,fee schedule,3159.42,11485.8,APC Onc breast mrna 101 genes,0153U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3159.42,,,,,,,fee schedule,3159.42,11485.8,APC Adm sarscv2 bvl 10mcg/.2ml b,0154A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,62,71, Adm sarscv2 bvl 10mcg/.2ml b,0154A,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,62,71, Fgfr3 gene analysis,0154U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1533.18,,,,,,,fee schedule,482.14,1752.21, Fgfr3 gene analysis,0154U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1752.21,,,,,,,fee schedule,482.14,1752.21, Fgfr3 gene analysis,0154U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,501.43,,,,,,,fee schedule,482.14,1752.21,APC Fgfr3 gene analysis,0154U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,506.25,,,,,,,fee schedule,482.14,1752.21,APC Fgfr3 gene analysis,0154U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,482.14,,,,,,,fee schedule,482.14,1752.21,APC Pik3ca gene analysis,0155U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Pik3ca gene analysis,0155U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Pik3ca gene analysis,0155U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Pik3ca gene analysis,0155U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Pik3ca gene analysis,0155U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Copy number sequence alys,0156U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5534.89,,,,,,,fee schedule,1740,6325.59, Copy number sequence alys,0156U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6325.59,,,,,,,fee schedule,1740,6325.59, Copy number sequence alys,0156U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1809.6,,,,,,,fee schedule,1740,6325.59,APC Copy number sequence alys,0156U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1827,,,,,,,fee schedule,1740,6325.59,APC Copy number sequence alys,0156U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1740,,,,,,,fee schedule,1740,6325.59,APC Apc mrna seq alys,0157U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Apc mrna seq alys,0157U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Apc mrna seq alys,0157U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Apc mrna seq alys,0157U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Apc mrna seq alys,0157U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Mlh1 mrna seq alys,0158U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Mlh1 mrna seq alys,0158U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Mlh1 mrna seq alys,0158U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Mlh1 mrna seq alys,0158U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Mlh1 mrna seq alys,0158U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Msh2 mrna seq alys,0159U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Msh2 mrna seq alys,0159U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Msh2 mrna seq alys,0159U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Msh2 mrna seq alys,0159U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Msh2 mrna seq alys,0159U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Msh6 mrna seq alys,0160U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Msh6 mrna seq alys,0160U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Msh6 mrna seq alys,0160U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Msh6 mrna seq alys,0160U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Msh6 mrna seq alys,0160U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Pms2 mrna seq alys,0161U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Pms2 mrna seq alys,0161U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Pms2 mrna seq alys,0161U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Pms2 mrna seq alys,0161U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Pms2 mrna seq alys,0161U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Hered colon ca trgt mrna pnl,0162U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1547.78,,,,,,,fee schedule,486.54,1768.89, Hered colon ca trgt mrna pnl,0162U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1768.89,,,,,,,fee schedule,486.54,1768.89, Hered colon ca trgt mrna pnl,0162U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,506,,,,,,,fee schedule,486.54,1768.89,APC Hered colon ca trgt mrna pnl,0162U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,510.87,,,,,,,fee schedule,486.54,1768.89,APC Hered colon ca trgt mrna pnl,0162U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,486.54,,,,,,,fee schedule,486.54,1768.89,APC Onc clrct scr 3 prtn alg,0163U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1242.6,,,,,,,fee schedule,1242.6,1420.11, Onc clrct scr 3 prtn alg,0163U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1420.11,,,,,,,fee schedule,1242.6,1420.11, Remove Lumb Artif Disc Addl,0164T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Remove Lumb Artif Disc Addl,0164T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Gi ibs ia anti-cdtb&vinculin,0164U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,356.21,,,,,,,fee schedule,112.02,407.1, Gi ibs ia anti-cdtb&vinculin,0164U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,407.1,,,,,,,fee schedule,112.02,407.1, Gi ibs ia anti-cdtb&vinculin,0164U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.5,,,,,,,fee schedule,112.02,407.1,APC Gi ibs ia anti-cdtb&vinculin,0164U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.62,,,,,,,fee schedule,112.02,407.1,APC Gi ibs ia anti-cdtb&vinculin,0164U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.02,,,,,,,fee schedule,112.02,407.1,APC Revise Lumb Artif Disc Addl,0165T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revise Lumb Artif Disc Addl,0165T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Peanut allg spec asmt 64 epi,0165U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1474.86,,,,,,,fee schedule,463.76,1685.55, Peanut allg spec asmt 64 epi,0165U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1685.55,,,,,,,fee schedule,463.76,1685.55, Peanut allg spec asmt 64 epi,0165U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,482.31,,,,,,,fee schedule,463.76,1685.55,APC Peanut allg spec asmt 64 epi,0165U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,486.95,,,,,,,fee schedule,463.76,1685.55,APC Peanut allg spec asmt 64 epi,0165U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,463.76,,,,,,,fee schedule,463.76,1685.55,APC Liver ds 10 biochem asy srm,0166U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1600.88,,,,,,,fee schedule,503.4,1829.58, Liver ds 10 biochem asy srm,0166U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1829.58,,,,,,,fee schedule,503.4,1829.58, Liver ds 10 biochem asy srm,0166U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,523.54,,,,,,,fee schedule,503.4,1829.58,APC Liver ds 10 biochem asy srm,0166U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,528.57,,,,,,,fee schedule,503.4,1829.58,APC Liver ds 10 biochem asy srm,0166U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,503.4,,,,,,,fee schedule,503.4,1829.58,APC Chornc gonadotropin hcg ia,0167U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.97,,,,,,,fee schedule,23.97,27.39, Chornc gonadotropin hcg ia,0167U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.39,,,,,,,fee schedule,23.97,27.39, Nudt15&tpmt gene com vrnt,0169U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1483.18,,,,,,,fee schedule,466.17,1695.06, Nudt15&tpmt gene com vrnt,0169U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1695.06,,,,,,,fee schedule,466.17,1695.06, Nudt15&tpmt gene com vrnt,0169U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,484.82,,,,,,,fee schedule,466.17,1695.06,APC Nudt15&tpmt gene com vrnt,0169U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,489.48,,,,,,,fee schedule,466.17,1695.06,APC Nudt15&tpmt gene com vrnt,0169U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,466.17,,,,,,,fee schedule,466.17,1695.06,APC Neuro asd rna next gen seq,0170U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6202.53,,,,,,,fee schedule,1950,7088.61, Neuro asd rna next gen seq,0170U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7088.61,,,,,,,fee schedule,1950,7088.61, Neuro asd rna next gen seq,0170U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2028,,,,,,,fee schedule,1950,7088.61,APC Neuro asd rna next gen seq,0170U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2047.5,,,,,,,fee schedule,1950,7088.61,APC Neuro asd rna next gen seq,0170U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1950,,,,,,,fee schedule,1950,7088.61,APC Trgt gen seq alys pnl dna 23,0171U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4831.81,,,,,,,fee schedule,1519.06,5522.07, Trgt gen seq alys pnl dna 23,0171U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5522.07,,,,,,,fee schedule,1519.06,5522.07, Trgt gen seq alys pnl dna 23,0171U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1579.82,,,,,,,fee schedule,1519.06,5522.07,APC Trgt gen seq alys pnl dna 23,0171U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1595.01,,,,,,,fee schedule,1519.06,5522.07,APC Trgt gen seq alys pnl dna 23,0171U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1519.06,,,,,,,fee schedule,1519.06,5522.07,APC Onc sld tum alys brca1 brca2,0172U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9638.66,,,,,,,fee schedule,3030,11015.61, Onc sld tum alys brca1 brca2,0172U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11015.61,,,,,,,fee schedule,3030,11015.61, Onc sld tum alys brca1 brca2,0172U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3151.2,,,,,,,fee schedule,3030,11015.61,APC Onc sld tum alys brca1 brca2,0172U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3181.5,,,,,,,fee schedule,3030,11015.61,APC Onc sld tum alys brca1 brca2,0172U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3030,,,,,,,fee schedule,3030,11015.61,APC Psyc gen alys panel 14 genes,0173U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1483.18,,,,,,,fee schedule,466.17,1695.06, Psyc gen alys panel 14 genes,0173U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1695.06,,,,,,,fee schedule,466.17,1695.06, Psyc gen alys panel 14 genes,0173U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,484.82,,,,,,,fee schedule,466.17,1695.06,APC Psyc gen alys panel 14 genes,0173U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,489.48,,,,,,,fee schedule,466.17,1695.06,APC Psyc gen alys panel 14 genes,0173U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,466.17,,,,,,,fee schedule,466.17,1695.06,APC Onc solid tumor 30 prtn trgt,0174U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4152.72,,,,,,,fee schedule,1305.37,4745.97, Onc solid tumor 30 prtn trgt,0174U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4745.97,,,,,,,fee schedule,1305.37,4745.97, Onc solid tumor 30 prtn trgt,0174U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1357.58,,,,,,,fee schedule,1305.37,4745.97,APC Onc solid tumor 30 prtn trgt,0174U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1370.64,,,,,,,fee schedule,1305.37,4745.97,APC Onc solid tumor 30 prtn trgt,0174U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1305.37,,,,,,,fee schedule,1305.37,4745.97,APC Psyc gen alys panel 15 genes,0175U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4249.59,,,,,,,fee schedule,1336.09,4856.67, Psyc gen alys panel 15 genes,0175U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4856.67,,,,,,,fee schedule,1336.09,4856.67, Psyc gen alys panel 15 genes,0175U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1389.53,,,,,,,fee schedule,1336.09,4856.67,APC Psyc gen alys panel 15 genes,0175U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1402.89,,,,,,,fee schedule,1336.09,4856.67,APC Psyc gen alys panel 15 genes,0175U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1336.09,,,,,,,fee schedule,1336.09,4856.67,APC Cdtb&vinculin igg antb ia,0176U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,204.15,,,,,,,fee schedule,64.19,233.31, Cdtb&vinculin igg antb ia,0176U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,233.31,,,,,,,fee schedule,64.19,233.31, Cdtb&vinculin igg antb ia,0176U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.76,,,,,,,fee schedule,64.19,233.31,APC Cdtb&vinculin igg antb ia,0176U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.4,,,,,,,fee schedule,64.19,233.31,APC Cdtb&vinculin igg antb ia,0176U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.19,,,,,,,fee schedule,64.19,233.31,APC Onc brst ca dna pik3ca 11,0177U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Onc brst ca dna pik3ca 11,0177U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Onc brst ca dna pik3ca 11,0177U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Onc brst ca dna pik3ca 11,0177U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Onc brst ca dna pik3ca 11,0177U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Peanut allg asmt epi clin rx,0178U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1462.36,,,,,,,fee schedule,459.86,1671.27, Peanut allg asmt epi clin rx,0178U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1671.27,,,,,,,fee schedule,459.86,1671.27, Peanut allg asmt epi clin rx,0178U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,478.25,,,,,,,fee schedule,459.86,1671.27,APC Peanut allg asmt epi clin rx,0178U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,482.85,,,,,,,fee schedule,459.86,1671.27,APC Peanut allg asmt epi clin rx,0178U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,459.86,,,,,,,fee schedule,459.86,1671.27,APC Onc nonsm cll lng ca alys 23,0179U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6181.69,,,,,,,fee schedule,1943.21,7064.79, Onc nonsm cll lng ca alys 23,0179U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7064.79,,,,,,,fee schedule,1943.21,7064.79, Onc nonsm cll lng ca alys 23,0179U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2020.94,,,,,,,fee schedule,1943.21,7064.79,APC Onc nonsm cll lng ca alys 23,0179U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2040.37,,,,,,,fee schedule,1943.21,7064.79,APC Onc nonsm cll lng ca alys 23,0179U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1943.21,,,,,,,fee schedule,1943.21,7064.79,APC Abo gnotyp abo 7 exons,0180U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Abo gnotyp abo 7 exons,0180U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Abo gnotyp abo 7 exons,0180U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Abo gnotyp abo 7 exons,0180U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Abo gnotyp abo 7 exons,0180U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Co gnotyp aqp1 exon 1,0181U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Co gnotyp aqp1 exon 1,0181U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Co gnotyp aqp1 exon 1,0181U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Co gnotyp aqp1 exon 1,0181U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Co gnotyp aqp1 exon 1,0181U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Crom gnotyp cd55 exons 1-10,0182U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,958.23,,,,,,,fee schedule,301.35,1095.12, Crom gnotyp cd55 exons 1-10,0182U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1095.12,,,,,,,fee schedule,301.35,1095.12, Crom gnotyp cd55 exons 1-10,0182U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.4,,,,,,,fee schedule,301.35,1095.12,APC Crom gnotyp cd55 exons 1-10,0182U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.42,,,,,,,fee schedule,301.35,1095.12,APC Crom gnotyp cd55 exons 1-10,0182U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.35,,,,,,,fee schedule,301.35,1095.12,APC Di gnotyp slc4a1 exon 19,0183U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Di gnotyp slc4a1 exon 19,0183U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Di gnotyp slc4a1 exon 19,0183U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Di gnotyp slc4a1 exon 19,0183U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Di gnotyp slc4a1 exon 19,0183U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Exc rectal tumor endoscopic,0184T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Exc rectal tumor endoscopic,0184T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Exc rectal tumor endoscopic,0184T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Exc rectal tumor endoscopic,0184T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Exc rectal tumor endoscopic,0184T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3408,11081,APC Exc rectal tumor endoscopic,0184T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3408,11081,APC Exc rectal tumor endoscopic,0184T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3408,11081,APC Do gnotyp art4 exon 2,0184U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Do gnotyp art4 exon 2,0184U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Do gnotyp art4 exon 2,0184U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Do gnotyp art4 exon 2,0184U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Do gnotyp art4 exon 2,0184U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Fut1 gnotyp fut1 exon 4,0185U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Fut1 gnotyp fut1 exon 4,0185U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Fut1 gnotyp fut1 exon 4,0185U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Fut1 gnotyp fut1 exon 4,0185U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Fut1 gnotyp fut1 exon 4,0185U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Fut2 gnotyp fut2 exon 2,0186U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Fut2 gnotyp fut2 exon 2,0186U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Fut2 gnotyp fut2 exon 2,0186U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Fut2 gnotyp fut2 exon 2,0186U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Fut2 gnotyp fut2 exon 2,0186U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Fy gnotyp ackr1 exons 1-2,0187U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Fy gnotyp ackr1 exons 1-2,0187U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Fy gnotyp ackr1 exons 1-2,0187U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Fy gnotyp ackr1 exons 1-2,0187U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Fy gnotyp ackr1 exons 1-2,0187U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Ge gnotyp gypc exons 1-4,0188U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Ge gnotyp gypc exons 1-4,0188U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Ge gnotyp gypc exons 1-4,0188U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Ge gnotyp gypc exons 1-4,0188U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Ge gnotyp gypc exons 1-4,0188U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Gypa gnotyp ntrns 1 5 exon 2,0189U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Gypa gnotyp ntrns 1 5 exon 2,0189U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Gypa gnotyp ntrns 1 5 exon 2,0189U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Gypa gnotyp ntrns 1 5 exon 2,0189U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Gypa gnotyp ntrns 1 5 exon 2,0189U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Gypb gnotyp ntrns 1 5 seux 3,0190U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Gypb gnotyp ntrns 1 5 seux 3,0190U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Gypb gnotyp ntrns 1 5 seux 3,0190U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Gypb gnotyp ntrns 1 5 seux 3,0190U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Gypb gnotyp ntrns 1 5 seux 3,0190U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Insert ant segment drain int,0191T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4457,5123, Insert ant segment drain int,0191T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4457,5123, In gnotyp cd44 exons 2 3 6,0191U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, In gnotyp cd44 exons 2 3 6,0191U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, In gnotyp cd44 exons 2 3 6,0191U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC In gnotyp cd44 exons 2 3 6,0191U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC In gnotyp cd44 exons 2 3 6,0191U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Jk gnotyp slc14a1 exon 9,0192U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Jk gnotyp slc14a1 exon 9,0192U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Jk gnotyp slc14a1 exon 9,0192U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Jk gnotyp slc14a1 exon 9,0192U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Jk gnotyp slc14a1 exon 9,0192U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Jr gnotyp abcg2 exons 2-26,0193U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Jr gnotyp abcg2 exons 2-26,0193U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Jr gnotyp abcg2 exons 2-26,0193U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Jr gnotyp abcg2 exons 2-26,0193U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Jr gnotyp abcg2 exons 2-26,0193U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Kel gnotyp kel exon 8,0194U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Kel gnotyp kel exon 8,0194U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Kel gnotyp kel exon 8,0194U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Kel gnotyp kel exon 8,0194U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Kel gnotyp kel exon 8,0194U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Klf1 targeted sequencing,0195U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1193.64,,,,,,,fee schedule,375.25,1364.16, Klf1 targeted sequencing,0195U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1364.16,,,,,,,fee schedule,375.25,1364.16, Klf1 targeted sequencing,0195U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,390.26,,,,,,,fee schedule,375.25,1364.16,APC Klf1 targeted sequencing,0195U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,394.01,,,,,,,fee schedule,375.25,1364.16,APC Klf1 targeted sequencing,0195U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,375.25,,,,,,,fee schedule,375.25,1364.16,APC Lu gnotyp bcam exon 3,0196U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Lu gnotyp bcam exon 3,0196U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Lu gnotyp bcam exon 3,0196U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Lu gnotyp bcam exon 3,0196U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Lu gnotyp bcam exon 3,0196U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Lw gnotyp icam4 exon 1,0197U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Lw gnotyp icam4 exon 1,0197U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Lw gnotyp icam4 exon 1,0197U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Lw gnotyp icam4 exon 1,0197U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Lw gnotyp icam4 exon 1,0197U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Ocular blood flow measure,0198T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Ocular blood flow measure,0198T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Ocular blood flow measure,0198T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Rhd&rhce gntyp rhd1-10&rhce5,0198U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Rhd&rhce gntyp rhd1-10&rhce5,0198U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Rhd&rhce gntyp rhd1-10&rhce5,0198U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Rhd&rhce gntyp rhd1-10&rhce5,0198U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Rhd&rhce gntyp rhd1-10&rhce5,0198U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Sc gnotyp ermap exons 4 12,0199U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Sc gnotyp ermap exons 4 12,0199U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Sc gnotyp ermap exons 4 12,0199U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Sc gnotyp ermap exons 4 12,0199U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Sc gnotyp ermap exons 4 12,0199U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Perq sacral augmt unilat inj,0200T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,8190,9918, Perq sacral augmt unilat inj,0200T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,8190,9918, Perq sacral augmt unilat inj,0200T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,8190,9918, Perq sacral augmt unilat inj,0200T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,8190,9918, Perq sacral augmt unilat inj,0200T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,8190,9918,APC Perq sacral augmt unilat inj,0200T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,8190,9918,APC Perq sacral augmt unilat inj,0200T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,8190,9918,APC Xk gnotyp xk exons 1-3,0200U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Xk gnotyp xk exons 1-3,0200U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Xk gnotyp xk exons 1-3,0200U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Xk gnotyp xk exons 1-3,0200U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Xk gnotyp xk exons 1-3,0200U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Perq sacral augmt bilat inj,0201T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,8572.09,13320, Perq sacral augmt bilat inj,0201T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,8572.09,13320, Perq sacral augmt bilat inj,0201T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,8572.09,13320, Perq sacral augmt bilat inj,0201T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,8572.09,13320, Perq sacral augmt bilat inj,0201T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,8572.09,13320,APC Perq sacral augmt bilat inj,0201T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,8572.09,13320,APC Perq sacral augmt bilat inj,0201T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,8572.09,13320,APC Yt gnotyp ache exon 2,0201U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Yt gnotyp ache exon 2,0201U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Yt gnotyp ache exon 2,0201U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Yt gnotyp ache exon 2,0201U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Yt gnotyp ache exon 2,0201U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Post vert arthrplst 1 lumbar,0202T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,17939, Post vert arthrplst 1 lumbar,0202T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,17939, Post vert arthrplst 1 lumbar,0202T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,17939, Post vert arthrplst 1 lumbar,0202T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,17939, Post vert arthrplst 1 lumbar,0202T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,17939,APC Post vert arthrplst 1 lumbar,0202T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,17939,APC Post vert arthrplst 1 lumbar,0202T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,17939,APC Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1354.54,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1525.41,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,1525.41,APC Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,1525.41,APC Nfct ds 22 trgt sars-cov-2,0202U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,1525.41,APC Ai ibd mrna xprsn prfl 17,0203U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Ai ibd mrna xprsn prfl 17,0203U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Ai ibd mrna xprsn prfl 17,0203U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Ai ibd mrna xprsn prfl 17,0203U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Ai ibd mrna xprsn prfl 17,0203U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Onc thyr mrna xprsn alys 593,0204U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,9286.59,10613.25, Onc thyr mrna xprsn alys 593,0204U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,9286.59,10613.25, Oph amd alys 3 gene variants,0205U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,149.99,,,,,,,fee schedule,47,171.42, Oph amd alys 3 gene variants,0205U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,171.42,,,,,,,fee schedule,47,171.42, Oph amd alys 3 gene variants,0205U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.88,,,,,,,fee schedule,47,171.42,APC Oph amd alys 3 gene variants,0205U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.35,,,,,,,fee schedule,47,171.42,APC Oph amd alys 3 gene variants,0205U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47,,,,,,,fee schedule,47,171.42,APC Neuro alzheimer cell aggregj,0206U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7047.23,,,,,,,fee schedule,2215.4,8053.98, Neuro alzheimer cell aggregj,0206U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8053.98,,,,,,,fee schedule,2215.4,8053.98, Neuro alzheimer cell aggregj,0206U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2304.02,,,,,,,fee schedule,2215.4,8053.98,APC Neuro alzheimer cell aggregj,0206U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2326.17,,,,,,,fee schedule,2215.4,8053.98,APC Neuro alzheimer cell aggregj,0206U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2215.4,,,,,,,fee schedule,2215.4,8053.98,APC Clear eyelid gland w/heat,0207T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,1866, Clear eyelid gland w/heat,0207T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,1866, Clear eyelid gland w/heat,0207T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,157.18,1866, Clear eyelid gland w/heat,0207T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,157.18,1866, Clear eyelid gland w/heat,0207T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,1866,APC Clear eyelid gland w/heat,0207T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,1866,APC Clear eyelid gland w/heat,0207T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,1866,APC Neuro alzheimer quan imaging,0207U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1625.87,,,,,,,fee schedule,1625.87,1858.14, Neuro alzheimer quan imaging,0207U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1858.14,,,,,,,fee schedule,1625.87,1858.14, Audiometry air only,0208T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Audiometry air only,0208T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Audiometry air only,0208T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Audiometry air & bone,0209T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Audiometry air & bone,0209T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Audiometry air & bone,0209T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Cytog const alys interrog,0209U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2503.94,,,,,,,fee schedule,787.15,2861.64, Cytog const alys interrog,0209U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2861.64,,,,,,,fee schedule,787.15,2861.64, Cytog const alys interrog,0209U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,818.64,,,,,,,fee schedule,787.15,2861.64,APC Cytog const alys interrog,0209U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,826.51,,,,,,,fee schedule,787.15,2861.64,APC Cytog const alys interrog,0209U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,787.15,,,,,,,fee schedule,787.15,2861.64,APC Speech audiometry threshold,0210T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Speech audiometry threshold,0210T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Speech audiometry threshold,0210T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Syphilis tst antb ia quan,0210U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.63,67.86, Syphilis tst antb ia quan,0210U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.63,67.86, Syphilis tst antb ia quan,0210U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.38,,,,,,,fee schedule,18.63,67.86,APC Syphilis tst antb ia quan,0210U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.56,,,,,,,fee schedule,18.63,67.86,APC Syphilis tst antb ia quan,0210U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.63,,,,,,,fee schedule,18.63,67.86,APC Speech audiom thresh & recog,0211T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Speech audiom thresh & recog,0211T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Speech audiom thresh & recog,0211T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Onc pan-tum dna&rna gnrj seq,0211U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26894.28,,,,,,,fee schedule,8455,30736.32, Onc pan-tum dna&rna gnrj seq,0211U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30736.32,,,,,,,fee schedule,8455,30736.32, Onc pan-tum dna&rna gnrj seq,0211U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8793.2,,,,,,,fee schedule,8455,30736.32,APC Onc pan-tum dna&rna gnrj seq,0211U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8877.75,,,,,,,fee schedule,8455,30736.32,APC Onc pan-tum dna&rna gnrj seq,0211U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8455,,,,,,,fee schedule,8455,30736.32,APC Compre audiometry evaluation,0212T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Compre audiometry evaluation,0212T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Compre audiometry evaluation,0212T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Rare ds gen dna alys proband,0212U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17416.04,,,,,,,fee schedule,5475.2,19904.04, Rare ds gen dna alys proband,0212U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19904.04,,,,,,,fee schedule,5475.2,19904.04, Rare ds gen dna alys proband,0212U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5694.21,,,,,,,fee schedule,5475.2,19904.04,APC Rare ds gen dna alys proband,0212U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5748.96,,,,,,,fee schedule,5475.2,19904.04,APC Rare ds gen dna alys proband,0212U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5475.2,,,,,,,fee schedule,5475.2,19904.04,APC Njx paravert w/us cer/thor,0213T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us cer/thor,0213T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us cer/thor,0213T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us cer/thor,0213T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us cer/thor,0213T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Njx paravert w/us cer/thor,0213T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Njx paravert w/us cer/thor,0213T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Rare ds gen dna alys ea comp,0213U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8620,,,,,,,fee schedule,2709.95,9851.43, Rare ds gen dna alys ea comp,0213U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9851.43,,,,,,,fee schedule,2709.95,9851.43, Rare ds gen dna alys ea comp,0213U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2818.35,,,,,,,fee schedule,2709.95,9851.43,APC Rare ds gen dna alys ea comp,0213U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2845.45,,,,,,,fee schedule,2709.95,9851.43,APC Rare ds gen dna alys ea comp,0213U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2709.95,,,,,,,fee schedule,2709.95,9851.43,APC Njx paravert w/us cer/thor,0214T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Njx paravert w/us cer/thor,0214T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Rare ds xom dna alys proband,0214U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16619.22,,,,,,,fee schedule,5224.6,18993.39, Rare ds xom dna alys proband,0214U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18993.39,,,,,,,fee schedule,5224.6,18993.39, Rare ds xom dna alys proband,0214U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5433.58,,,,,,,fee schedule,5224.6,18993.39,APC Rare ds xom dna alys proband,0214U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5485.83,,,,,,,fee schedule,5224.6,18993.39,APC Rare ds xom dna alys proband,0214U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5224.6,,,,,,,fee schedule,5224.6,18993.39,APC Njx paravert w/us cer/thor,0215T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Njx paravert w/us cer/thor,0215T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Rare ds xom dna alys ea comp,0215U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8189.84,,,,,,,fee schedule,2574.65,9359.82, Rare ds xom dna alys ea comp,0215U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9359.82,,,,,,,fee schedule,2574.65,9359.82, Rare ds xom dna alys ea comp,0215U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2677.64,,,,,,,fee schedule,2574.65,9359.82,APC Rare ds xom dna alys ea comp,0215U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2703.38,,,,,,,fee schedule,2574.65,9359.82,APC Rare ds xom dna alys ea comp,0215U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2574.65,,,,,,,fee schedule,2574.65,9359.82,APC Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Njx paravert w/us lumb/sac,0216T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Neuro inh ataxia dna 12 com,0216U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4889.12,,,,,,,fee schedule,1537.02,5587.56, Neuro inh ataxia dna 12 com,0216U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5587.56,,,,,,,fee schedule,1537.02,5587.56, Neuro inh ataxia dna 12 com,0216U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1598.5,,,,,,,fee schedule,1537.02,5587.56,APC Neuro inh ataxia dna 12 com,0216U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1613.87,,,,,,,fee schedule,1537.02,5587.56,APC Neuro inh ataxia dna 12 com,0216U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1537.02,,,,,,,fee schedule,1537.02,5587.56,APC Njx paravert w/us lumb/sac,0217T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Njx paravert w/us lumb/sac,0217T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Njx paravert w/us lumb/sac,0217T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Njx paravert w/us lumb/sac,0217T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Neuro inh ataxia dna 51 gene,0217U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6993.08,,,,,,,fee schedule,2198.35,7992.09, Neuro inh ataxia dna 51 gene,0217U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7992.09,,,,,,,fee schedule,2198.35,7992.09, Neuro inh ataxia dna 51 gene,0217U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2286.28,,,,,,,fee schedule,2198.35,7992.09,APC Neuro inh ataxia dna 51 gene,0217U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2308.27,,,,,,,fee schedule,2198.35,7992.09,APC Neuro inh ataxia dna 51 gene,0217U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2198.35,,,,,,,fee schedule,2198.35,7992.09,APC Njx paravert w/us lumb/sac,0218T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Njx paravert w/us lumb/sac,0218T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Njx paravert w/us lumb/sac,0218T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Njx paravert w/us lumb/sac,0218T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Neuro musc dys dmd seq alys,0218U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7249.31,,,,,,,fee schedule,2279,8284.92, Neuro musc dys dmd seq alys,0218U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8284.92,,,,,,,fee schedule,2279,8284.92, Neuro musc dys dmd seq alys,0218U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2370.16,,,,,,,fee schedule,2279,8284.92,APC Neuro musc dys dmd seq alys,0218U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2392.95,,,,,,,fee schedule,2279,8284.92,APC Neuro musc dys dmd seq alys,0218U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2279,,,,,,,fee schedule,2279,8284.92,APC Plmt post facet implt cerv,0219T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17939, Plmt post facet implt cerv,0219T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17939, Plmt post facet implt cerv,0219T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,17939, Plmt post facet implt cerv,0219T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,17939, Plmt post facet implt cerv,0219T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,17939,APC Plmt post facet implt cerv,0219T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,17939,APC Plmt post facet implt cerv,0219T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,17939,APC Nfct agt hiv gnrj seq alys,0219U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2306.04,,,,,,,fee schedule,725,2635.47, Nfct agt hiv gnrj seq alys,0219U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2635.47,,,,,,,fee schedule,725,2635.47, Nfct agt hiv gnrj seq alys,0219U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,754,,,,,,,fee schedule,725,2635.47,APC Nfct agt hiv gnrj seq alys,0219U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,761.25,,,,,,,fee schedule,725,2635.47,APC Nfct agt hiv gnrj seq alys,0219U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,725,,,,,,,fee schedule,725,2635.47,APC Plmt post facet implt thor,0220T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17939, Plmt post facet implt thor,0220T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17939, Plmt post facet implt thor,0220T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,17939, Plmt post facet implt thor,0220T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,17939, Plmt post facet implt thor,0220T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,17939,APC Plmt post facet implt thor,0220T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,17939,APC Plmt post facet implt thor,0220T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,17939,APC Onc brst ca ai assmt 12 feat,0220U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2246.66,,,,,,,fee schedule,706.25,2567.61, Onc brst ca ai assmt 12 feat,0220U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2567.61,,,,,,,fee schedule,706.25,2567.61, Onc brst ca ai assmt 12 feat,0220U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,734.5,,,,,,,fee schedule,706.25,2567.61,APC Onc brst ca ai assmt 12 feat,0220U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,741.56,,,,,,,fee schedule,706.25,2567.61,APC Onc brst ca ai assmt 12 feat,0220U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,706.25,,,,,,,fee schedule,706.25,2567.61,APC Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13320,APC Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13320,APC Plmt post facet implt lumb,0221T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13320,APC Abo gnotyp next gnrj seq abo,0221U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Abo gnotyp next gnrj seq abo,0221U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Abo gnotyp next gnrj seq abo,0221U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Abo gnotyp next gnrj seq abo,0221U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Abo gnotyp next gnrj seq abo,0221U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Plmt post facet implt addl,0222T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Plmt post facet implt addl,0222T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rhd&rhce gntyp next gnrj seq,0222U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Rhd&rhce gntyp next gnrj seq,0222U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Rhd&rhce gntyp next gnrj seq,0222U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Rhd&rhce gntyp next gnrj seq,0222U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Rhd&rhce gntyp next gnrj seq,0222U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Nfct ds 22 trgt sars-cov-2,0223U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1354.54,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0223U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1525.41,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0223U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0223U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,1525.41, Nfct ds 22 trgt sars-cov-2,0223U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,1525.41,APC Nfct ds 22 trgt sars-cov-2,0223U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,1525.41,APC Nfct ds 22 trgt sars-cov-2,0223U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,1525.41,APC Antibody sars-cov-2 titer(s),0224U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.92,,,,,,,fee schedule,51.43,186.9, Antibody sars-cov-2 titer(s),0224U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,154.2,,,,,,,fee schedule,51.43,186.9, Antibody sars-cov-2 titer(s),0224U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.54,,,,,,,fee schedule,51.43,186.9, Antibody sars-cov-2 titer(s),0224U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,51.43,186.9, Antibody sars-cov-2 titer(s),0224U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.49,,,,,,,fee schedule,51.43,186.9,APC Antibody sars-cov-2 titer(s),0224U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54,,,,,,,fee schedule,51.43,186.9,APC Antibody sars-cov-2 titer(s),0224U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.43,,,,,,,fee schedule,51.43,186.9,APC Nfct ds dna&rna 21 sarscov2,0225U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1354.54,,,,,,,fee schedule,416.78,1525.41, Nfct ds dna&rna 21 sarscov2,0225U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1525.41,,,,,,,fee schedule,416.78,1525.41, Nfct ds dna&rna 21 sarscov2,0225U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,1525.41, Nfct ds dna&rna 21 sarscov2,0225U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,1525.41, Nfct ds dna&rna 21 sarscov2,0225U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,1525.41,APC Nfct ds dna&rna 21 sarscov2,0225U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,1525.41,APC Nfct ds dna&rna 21 sarscov2,0225U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,1525.41,APC Svnt sarscov2 elisa plsm srm,0226U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,137.41,,,,,,,fee schedule,42.28,154.74, Svnt sarscov2 elisa plsm srm,0226U,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,154.74,,,,,,,fee schedule,42.28,154.74, Svnt sarscov2 elisa plsm srm,0226U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,134.37,,,,,,,fee schedule,42.28,154.74, Svnt sarscov2 elisa plsm srm,0226U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,153.57,,,,,,,fee schedule,42.28,154.74, Svnt sarscov2 elisa plsm srm,0226U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.97,,,,,,,fee schedule,42.28,154.74,APC Svnt sarscov2 elisa plsm srm,0226U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.39,,,,,,,fee schedule,42.28,154.74,APC Svnt sarscov2 elisa plsm srm,0226U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.28,,,,,,,fee schedule,42.28,154.74,APC Rx asy prsmv 30+rx/metablt,0227U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,197.9,,,,,,,fee schedule,62.14,226.17, Rx asy prsmv 30+rx/metablt,0227U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,226.17,,,,,,,fee schedule,62.14,226.17, Rx asy prsmv 30+rx/metablt,0227U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.63,,,,,,,fee schedule,62.14,226.17,APC Rx asy prsmv 30+rx/metablt,0227U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.25,,,,,,,fee schedule,62.14,226.17,APC Rx asy prsmv 30+rx/metablt,0227U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.14,,,,,,,fee schedule,62.14,226.17,APC Njx tfrml eprl w/us cer/thor,0228T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4457,5123, Njx tfrml eprl w/us cer/thor,0228T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4457,5123, Onc prst8 ma molec prfl alg,0228U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,549.94,,,,,,,fee schedule,173.03,628.5, Onc prst8 ma molec prfl alg,0228U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,628.5,,,,,,,fee schedule,173.03,628.5, Onc prst8 ma molec prfl alg,0228U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,179.95,,,,,,,fee schedule,173.03,628.5,APC Onc prst8 ma molec prfl alg,0228U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,181.68,,,,,,,fee schedule,173.03,628.5,APC Onc prst8 ma molec prfl alg,0228U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,173.03,,,,,,,fee schedule,173.03,628.5,APC Njx tfrml eprl w/us cer/thor,0229T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Njx tfrml eprl w/us cer/thor,0229T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Bcat1 promoter mthyltn alys,0229U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1221.75,,,,,,,fee schedule,384,1396.29, Bcat1 promoter mthyltn alys,0229U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1396.29,,,,,,,fee schedule,384,1396.29, Bcat1 promoter mthyltn alys,0229U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,399.36,,,,,,,fee schedule,384,1396.29,APC Bcat1 promoter mthyltn alys,0229U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,403.2,,,,,,,fee schedule,384,1396.29,APC Bcat1 promoter mthyltn alys,0229U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,384,,,,,,,fee schedule,384,1396.29,APC Njx tfrml eprl w/us lumb/sac,0230T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,2460, Njx tfrml eprl w/us lumb/sac,0230T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,2460, Ar full sequence analysis,0230U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,958.23,,,,,,,fee schedule,301.35,1095.12, Ar full sequence analysis,0230U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1095.12,,,,,,,fee schedule,301.35,1095.12, Ar full sequence analysis,0230U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.4,,,,,,,fee schedule,301.35,1095.12,APC Ar full sequence analysis,0230U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.42,,,,,,,fee schedule,301.35,1095.12,APC Ar full sequence analysis,0230U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.35,,,,,,,fee schedule,301.35,1095.12,APC Njx tfrml eprl w/us lumb/sac,0231T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Njx tfrml eprl w/us lumb/sac,0231T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Cacna1a full gene analysis,0231U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2691.41,,,,,,,fee schedule,846.27,3075.9, Cacna1a full gene analysis,0231U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3075.9,,,,,,,fee schedule,846.27,3075.9, Cacna1a full gene analysis,0231U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,880.12,,,,,,,fee schedule,846.27,3075.9,APC Cacna1a full gene analysis,0231U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,888.58,,,,,,,fee schedule,846.27,3075.9,APC Cacna1a full gene analysis,0231U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,846.27,,,,,,,fee schedule,846.27,3075.9,APC Njx platelet plasma,0232T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,2460, Njx platelet plasma,0232T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,2460, Njx platelet plasma,0232T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,527.74,2460, Njx platelet plasma,0232T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,527.74,2460, Njx platelet plasma,0232T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,2460,APC Njx platelet plasma,0232T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,2460,APC Njx platelet plasma,0232T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,2460,APC Cstb full gene analysis,0232U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Cstb full gene analysis,0232U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Cstb full gene analysis,0232U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Cstb full gene analysis,0232U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Cstb full gene analysis,0232U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Fxn gene analysis,0233U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Fxn gene analysis,0233U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Fxn gene analysis,0233U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Fxn gene analysis,0233U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Fxn gene analysis,0233U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Trluml perip athrc renal art,0234T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18686, Trluml perip athrc renal art,0234T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18686, Trluml perip athrc renal art,0234T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3408,18686, Trluml perip athrc renal art,0234T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3408,18686, Trluml perip athrc renal art,0234T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,18686,APC Trluml perip athrc renal art,0234T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,18686,APC Trluml perip athrc renal art,0234T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,18686,APC Mecp2 full gene analysis,0234U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1679,,,,,,,fee schedule,527.87,1918.86, Mecp2 full gene analysis,0234U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1918.86,,,,,,,fee schedule,527.87,1918.86, Mecp2 full gene analysis,0234U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.98,,,,,,,fee schedule,527.87,1918.86,APC Mecp2 full gene analysis,0234U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.26,,,,,,,fee schedule,527.87,1918.86,APC Mecp2 full gene analysis,0234U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.87,,,,,,,fee schedule,527.87,1918.86,APC Trluml perip athrc visceral,0235T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Trluml perip athrc visceral,0235T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Pten full gene analysis,0235U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1908.14,,,,,,,fee schedule,600,2180.73, Pten full gene analysis,0235U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2180.73,,,,,,,fee schedule,600,2180.73, Pten full gene analysis,0235U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,624,,,,,,,fee schedule,600,2180.73,APC Pten full gene analysis,0235U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,630,,,,,,,fee schedule,600,2180.73,APC Pten full gene analysis,0235U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,600,,,,,,,fee schedule,600,2180.73,APC Trluml perip athrc abd aorta,0236T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,14319.55, Trluml perip athrc abd aorta,0236T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,14319.55, Trluml perip athrc abd aorta,0236T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,14319.55, Trluml perip athrc abd aorta,0236T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,14319.55, Trluml perip athrc abd aorta,0236T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,14319.55,APC Trluml perip athrc abd aorta,0236T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,14319.55,APC Trluml perip athrc abd aorta,0236T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,14319.55,APC Smn1&smn2 full gene analysis,0236U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1917.51,,,,,,,fee schedule,602.7,2191.44, Smn1&smn2 full gene analysis,0236U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2191.44,,,,,,,fee schedule,602.7,2191.44, Smn1&smn2 full gene analysis,0236U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,626.81,,,,,,,fee schedule,602.7,2191.44,APC Smn1&smn2 full gene analysis,0236U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,632.84,,,,,,,fee schedule,602.7,2191.44,APC Smn1&smn2 full gene analysis,0236U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,602.7,,,,,,,fee schedule,602.7,2191.44,APC Trluml perip athrc brchiocph,0237T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Trluml perip athrc brchiocph,0237T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Trluml perip athrc brchiocph,0237T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Trluml perip athrc brchiocph,0237T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Trluml perip athrc brchiocph,0237T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,17041,APC Trluml perip athrc brchiocph,0237T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,17041,APC Trluml perip athrc brchiocph,0237T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,17041,APC Car ion chnlpthy gen seq pnl,0237U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,584.9,2125.98, Car ion chnlpthy gen seq pnl,0237U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,584.9,2125.98, Car ion chnlpthy gen seq pnl,0237U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,608.3,,,,,,,fee schedule,584.9,2125.98,APC Car ion chnlpthy gen seq pnl,0237U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,614.14,,,,,,,fee schedule,584.9,2125.98,APC Car ion chnlpthy gen seq pnl,0237U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.9,,,,,,,fee schedule,584.9,2125.98,APC Trluml perip athrc iliac art,0238T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,22738.78, Trluml perip athrc iliac art,0238T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,22738.78, Trluml perip athrc iliac art,0238T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,22738.78, Trluml perip athrc iliac art,0238T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,22738.78, Trluml perip athrc iliac art,0238T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4147,22738.78,APC Trluml perip athrc iliac art,0238T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4147,22738.78,APC Trluml perip athrc iliac art,0238T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4147,22738.78,APC Onc lnch syn gen dna seq aly,0238U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,584.9,2125.98, Onc lnch syn gen dna seq aly,0238U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,584.9,2125.98, Onc lnch syn gen dna seq aly,0238U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,608.3,,,,,,,fee schedule,584.9,2125.98,APC Onc lnch syn gen dna seq aly,0238U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,614.14,,,,,,,fee schedule,584.9,2125.98,APC Onc lnch syn gen dna seq aly,0238U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.9,,,,,,,fee schedule,584.9,2125.98,APC Trgt gen seq alys pnl 311+,0239U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11133.31,,,,,,,fee schedule,3500,12723.78, Trgt gen seq alys pnl 311+,0239U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12723.78,,,,,,,fee schedule,3500,12723.78, Trgt gen seq alys pnl 311+,0239U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3640,,,,,,,fee schedule,3500,12723.78,APC Trgt gen seq alys pnl 311+,0239U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3675,,,,,,,fee schedule,3500,12723.78,APC Trgt gen seq alys pnl 311+,0239U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3500,,,,,,,fee schedule,3500,12723.78,APC Nfct ds vir resp rna 3 trgt,0240U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,454.13,519, Nfct ds vir resp rna 3 trgt,0240U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,454.13,519, Nfct ds vir resp rna 4 trgt,0241U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,454.13,519, Nfct ds vir resp rna 4 trgt,0241U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,454.13,519, Trgt gen seq alys pnl 55-74,0242U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15904.72,,,,,,,fee schedule,5000,18176.82, Trgt gen seq alys pnl 55-74,0242U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18176.82,,,,,,,fee schedule,5000,18176.82, Trgt gen seq alys pnl 55-74,0242U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5200,,,,,,,fee schedule,5000,18176.82,APC Trgt gen seq alys pnl 55-74,0242U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5250,,,,,,,fee schedule,5000,18176.82,APC Trgt gen seq alys pnl 55-74,0242U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5000,,,,,,,fee schedule,5000,18176.82,APC Ob pe biochem assay pgf alg,0243U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,205.2,,,,,,,fee schedule,64.41,234.51, Ob pe biochem assay pgf alg,0243U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,234.51,,,,,,,fee schedule,64.41,234.51, Ob pe biochem assay pgf alg,0243U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.99,,,,,,,fee schedule,64.41,234.51,APC Ob pe biochem assay pgf alg,0243U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.63,,,,,,,fee schedule,64.41,234.51,APC Ob pe biochem assay pgf alg,0243U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.41,,,,,,,fee schedule,64.41,234.51,APC Onc solid orgn dna 257 genes,0244U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11133.31,,,,,,,fee schedule,3500,12723.78, Onc solid orgn dna 257 genes,0244U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12723.78,,,,,,,fee schedule,3500,12723.78, Onc solid orgn dna 257 genes,0244U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3640,,,,,,,fee schedule,3500,12723.78,APC Onc solid orgn dna 257 genes,0244U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3675,,,,,,,fee schedule,3500,12723.78,APC Onc solid orgn dna 257 genes,0244U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3500,,,,,,,fee schedule,3500,12723.78,APC Onc thyr mut alys 10 gen&37,0245U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4027.75,,,,,,,fee schedule,1266.07,4603.14, Onc thyr mut alys 10 gen&37,0245U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4603.14,,,,,,,fee schedule,1266.07,4603.14, Onc thyr mut alys 10 gen&37,0245U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1316.71,,,,,,,fee schedule,1266.07,4603.14,APC Onc thyr mut alys 10 gen&37,0245U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1329.37,,,,,,,fee schedule,1266.07,4603.14,APC Onc thyr mut alys 10 gen&37,0245U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1266.07,,,,,,,fee schedule,1266.07,4603.14,APC Rbc dna gnotyp 16 bld groups,0246U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2290.39,,,,,,,fee schedule,720,2617.59, Rbc dna gnotyp 16 bld groups,0246U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2617.59,,,,,,,fee schedule,720,2617.59, Rbc dna gnotyp 16 bld groups,0246U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,748.8,,,,,,,fee schedule,720,2617.59,APC Rbc dna gnotyp 16 bld groups,0246U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,756,,,,,,,fee schedule,720,2617.59,APC Rbc dna gnotyp 16 bld groups,0246U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,720,,,,,,,fee schedule,720,2617.59,APC Ob prtrm brth ibp4 shbg meas,0247U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2385.18,,,,,,,fee schedule,750,2725.92, Ob prtrm brth ibp4 shbg meas,0247U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2725.92,,,,,,,fee schedule,750,2725.92, Ob prtrm brth ibp4 shbg meas,0247U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,780,,,,,,,fee schedule,750,2725.92,APC Ob prtrm brth ibp4 shbg meas,0247U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,787.5,,,,,,,fee schedule,750,2725.92,APC Ob prtrm brth ibp4 shbg meas,0247U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,750,,,,,,,fee schedule,750,2725.92,APC Onc brn sphrd cll 12 rx pnl,0248U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9650.1,,,,,,,fee schedule,3033.86,11028.69, Onc brn sphrd cll 12 rx pnl,0248U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11028.69,,,,,,,fee schedule,3033.86,11028.69, Onc brn sphrd cll 12 rx pnl,0248U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3155.21,,,,,,,fee schedule,3033.86,11028.69,APC Onc brn sphrd cll 12 rx pnl,0248U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3185.55,,,,,,,fee schedule,3033.86,11028.69,APC Onc brn sphrd cll 12 rx pnl,0248U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3033.86,,,,,,,fee schedule,3033.86,11028.69,APC Ligation hemorrhoid w/us,0249T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Ligation hemorrhoid w/us,0249T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Onc brst alys 32 phsprtn alg,0249U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7058.7,,,,,,,fee schedule,2219.13,8067.09, Onc brst alys 32 phsprtn alg,0249U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8067.09,,,,,,,fee schedule,2219.13,8067.09, Onc brst alys 32 phsprtn alg,0249U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2307.9,,,,,,,fee schedule,2219.13,8067.09,APC Onc brst alys 32 phsprtn alg,0249U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2330.09,,,,,,,fee schedule,2219.13,8067.09,APC Onc brst alys 32 phsprtn alg,0249U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2219.13,,,,,,,fee schedule,2219.13,8067.09,APC Onc sld org neo dna 505 gene,0250U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,2919.6,10613.25, Onc sld org neo dna 505 gene,0250U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,2919.6,10613.25, Onc sld org neo dna 505 gene,0250U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,10613.25,APC Onc sld org neo dna 505 gene,0250U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,10613.25,APC Onc sld org neo dna 505 gene,0250U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,10613.25,APC Hepcidin-25 elisa serum/plsm,0251U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.09, Hepcidin-25 elisa serum/plsm,0251U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.09, Hepcidin-25 elisa serum/plsm,0251U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.09,APC Hepcidin-25 elisa serum/plsm,0251U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.09,APC Hepcidin-25 elisa serum/plsm,0251U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.09,APC Ftl aneuploidy str alys dna,0252U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2414.34,,,,,,,fee schedule,759.05,2759.25, Ftl aneuploidy str alys dna,0252U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2759.25,,,,,,,fee schedule,759.05,2759.25, Ftl aneuploidy str alys dna,0252U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,2759.25,APC Ftl aneuploidy str alys dna,0252U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,2759.25,APC Ftl aneuploidy str alys dna,0252U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,2759.25,APC Insert aqueous drain device,0253T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,13320, Insert aqueous drain device,0253T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,13320, Insert aqueous drain device,0253T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3563,13320, Insert aqueous drain device,0253T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3563,13320, Insert aqueous drain device,0253T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3563,13320,APC Insert aqueous drain device,0253T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3563,13320,APC Insert aqueous drain device,0253T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3563,13320,APC Rprdtve med rna gen prfl 238,0253U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10050.08,,,,,,,fee schedule,3159.42,11485.8, Rprdtve med rna gen prfl 238,0253U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11485.8,,,,,,,fee schedule,3159.42,11485.8, Rprdtve med rna gen prfl 238,0253U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3285.8,,,,,,,fee schedule,3159.42,11485.8,APC Rprdtve med rna gen prfl 238,0253U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3317.39,,,,,,,fee schedule,3159.42,11485.8,APC Rprdtve med rna gen prfl 238,0253U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3159.42,,,,,,,fee schedule,3159.42,11485.8,APC Reprdtve med alys 24 chrmsm,0254U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2414.34,,,,,,,fee schedule,759.05,2759.25, Reprdtve med alys 24 chrmsm,0254U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2759.25,,,,,,,fee schedule,759.05,2759.25, Reprdtve med alys 24 chrmsm,0254U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,2759.25,APC Reprdtve med alys 24 chrmsm,0254U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,2759.25,APC Reprdtve med alys 24 chrmsm,0254U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,2759.25,APC Andrology infertility assmt,0255U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,101.04,,,,,,,fee schedule,31.6,115.47, Andrology infertility assmt,0255U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,115.47,,,,,,,fee schedule,31.6,115.47, Andrology infertility assmt,0255U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.86,,,,,,,fee schedule,31.6,115.47,APC Andrology infertility assmt,0255U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.18,,,,,,,fee schedule,31.6,115.47,APC Andrology infertility assmt,0255U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.6,,,,,,,fee schedule,31.6,115.47,APC Tma/tmao prfl ms/ms ur alg,0256U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,508.28,,,,,,,fee schedule,159.95,580.89, Tma/tmao prfl ms/ms ur alg,0256U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,580.89,,,,,,,fee schedule,159.95,580.89, Tma/tmao prfl ms/ms ur alg,0256U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,166.35,,,,,,,fee schedule,159.95,580.89,APC Tma/tmao prfl ms/ms ur alg,0256U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,167.95,,,,,,,fee schedule,159.95,580.89,APC Tma/tmao prfl ms/ms ur alg,0256U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,159.95,,,,,,,fee schedule,159.95,580.89,APC Vlcad leuk nzm actv whl bld,0257U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2266.45,,,,,,,fee schedule,712.47,2590.23, Vlcad leuk nzm actv whl bld,0257U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2590.23,,,,,,,fee schedule,712.47,2590.23, Vlcad leuk nzm actv whl bld,0257U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,740.97,,,,,,,fee schedule,712.47,2590.23,APC Vlcad leuk nzm actv whl bld,0257U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,748.09,,,,,,,fee schedule,712.47,2590.23,APC Vlcad leuk nzm actv whl bld,0257U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,712.47,,,,,,,fee schedule,712.47,2590.23,APC Ai psor mrna 50-100 gen alg,0258U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11689.49,,,,,,,fee schedule,3675,13359.42, Ai psor mrna 50-100 gen alg,0258U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13359.42,,,,,,,fee schedule,3675,13359.42, Ai psor mrna 50-100 gen alg,0258U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3822,,,,,,,fee schedule,3675,13359.42,APC Ai psor mrna 50-100 gen alg,0258U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3858.75,,,,,,,fee schedule,3675,13359.42,APC Ai psor mrna 50-100 gen alg,0258U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3675,,,,,,,fee schedule,3675,13359.42,APC Neph ckd nuc mrs meas gfr,0259U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,167.69,,,,,,,fee schedule,52.71,191.64, Neph ckd nuc mrs meas gfr,0259U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,191.64,,,,,,,fee schedule,52.71,191.64, Neph ckd nuc mrs meas gfr,0259U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54.82,,,,,,,fee schedule,52.71,191.64,APC Neph ckd nuc mrs meas gfr,0259U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,55.35,,,,,,,fee schedule,52.71,191.64,APC Neph ckd nuc mrs meas gfr,0259U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52.71,,,,,,,fee schedule,52.71,191.64,APC Rare ds id opt genome mapg,0260U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4019.4,,,,,,,fee schedule,1263.53,4593.6, Rare ds id opt genome mapg,0260U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4593.6,,,,,,,fee schedule,1263.53,4593.6, Rare ds id opt genome mapg,0260U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1314.07,,,,,,,fee schedule,1263.53,4593.6,APC Rare ds id opt genome mapg,0260U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1326.71,,,,,,,fee schedule,1263.53,4593.6,APC Rare ds id opt genome mapg,0260U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1263.53,,,,,,,fee schedule,1263.53,4593.6,APC Onc clrct ca img alys w/ai,0261U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15745.35,,,,,,,fee schedule,2513.25,17994.69, Onc clrct ca img alys w/ai,0261U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17994.69,,,,,,,fee schedule,2513.25,17994.69, Onc clrct ca img alys w/ai,0261U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2613.78,,,,,,,fee schedule,2513.25,17994.69,APC Onc clrct ca img alys w/ai,0261U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2638.91,,,,,,,fee schedule,2513.25,17994.69,APC Onc clrct ca img alys w/ai,0261U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2513.25,,,,,,,fee schedule,2513.25,17994.69,APC Onc sld tum rt-pcr 7 gen,0262U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10179.23,,,,,,,fee schedule,3200,11633.4, Onc sld tum rt-pcr 7 gen,0262U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11633.4,,,,,,,fee schedule,3200,11633.4, Onc sld tum rt-pcr 7 gen,0262U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3328,,,,,,,fee schedule,3200,11633.4,APC Onc sld tum rt-pcr 7 gen,0262U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3360,,,,,,,fee schedule,3200,11633.4,APC Onc sld tum rt-pcr 7 gen,0262U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3200,,,,,,,fee schedule,3200,11633.4,APC Im b1 mrw cel ther cmpl,0263T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,5402.62, Im b1 mrw cel ther cmpl,0263T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,5402.62, Im b1 mrw cel ther cmpl,0263T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5351.16,,,,,,,fee schedule,2138,5402.62,APC Im b1 mrw cel ther cmpl,0263T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5402.62,,,,,,,fee schedule,2138,5402.62,APC Im b1 mrw cel ther cmpl,0263T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5145.35,,,,,,,fee schedule,2138,5402.62,APC Neuro asd meas 16 c metblt,0263U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2385.18,,,,,,,fee schedule,750,2725.92, Neuro asd meas 16 c metblt,0263U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2725.92,,,,,,,fee schedule,750,2725.92, Neuro asd meas 16 c metblt,0263U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,780,,,,,,,fee schedule,750,2725.92,APC Neuro asd meas 16 c metblt,0263U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,787.5,,,,,,,fee schedule,750,2725.92,APC Neuro asd meas 16 c metblt,0263U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,750,,,,,,,fee schedule,750,2725.92,APC Im b1 mrw cel ther xcl hrvst,0264T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5402.62, Im b1 mrw cel ther xcl hrvst,0264T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5402.62, Im b1 mrw cel ther xcl hrvst,0264T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5351.16,,,,,,,fee schedule,428,5402.62,APC Im b1 mrw cel ther xcl hrvst,0264T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5402.62,,,,,,,fee schedule,428,5402.62,APC Im b1 mrw cel ther xcl hrvst,0264T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5145.35,,,,,,,fee schedule,428,5402.62,APC Rare ds id opt genome mapg,0264U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4019.4,,,,,,,fee schedule,1263.53,4593.6, Rare ds id opt genome mapg,0264U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4593.6,,,,,,,fee schedule,1263.53,4593.6, Rare ds id opt genome mapg,0264U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1314.07,,,,,,,fee schedule,1263.53,4593.6,APC Rare ds id opt genome mapg,0264U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1326.71,,,,,,,fee schedule,1263.53,4593.6,APC Rare ds id opt genome mapg,0264U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1263.53,,,,,,,fee schedule,1263.53,4593.6,APC Im b1 mrw cel ther hrvst onl,0265T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5402.62, Im b1 mrw cel ther hrvst onl,0265T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5402.62, Im b1 mrw cel ther hrvst onl,0265T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5351.16,,,,,,,fee schedule,428,5402.62,APC Im b1 mrw cel ther hrvst onl,0265T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5402.62,,,,,,,fee schedule,428,5402.62,APC Im b1 mrw cel ther hrvst onl,0265T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5145.35,,,,,,,fee schedule,428,5402.62,APC Rar do whl gn&mtcdrl dna als,0265U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17418.11,,,,,,,fee schedule,5475.8,19906.41, Rar do whl gn&mtcdrl dna als,0265U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19906.41,,,,,,,fee schedule,5475.8,19906.41, Rar do whl gn&mtcdrl dna als,0265U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5694.83,,,,,,,fee schedule,5475.8,19906.41,APC Rar do whl gn&mtcdrl dna als,0265U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5749.59,,,,,,,fee schedule,5475.8,19906.41,APC Rar do whl gn&mtcdrl dna als,0265U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5475.8,,,,,,,fee schedule,5475.8,19906.41,APC Implt/rpl crtd sns dev total,0266T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,16249,18686, Implt/rpl crtd sns dev total,0266T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,16249,18686, Unxpl cnst hrtbl do gn xprsn,0266U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10179.23,,,,,,,fee schedule,3200,11633.4, Unxpl cnst hrtbl do gn xprsn,0266U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11633.4,,,,,,,fee schedule,3200,11633.4, Unxpl cnst hrtbl do gn xprsn,0266U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3328,,,,,,,fee schedule,3200,11633.4,APC Unxpl cnst hrtbl do gn xprsn,0266U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3360,,,,,,,fee schedule,3200,11633.4,APC Unxpl cnst hrtbl do gn xprsn,0266U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3200,,,,,,,fee schedule,3200,11633.4,APC Rare do id opt gen mapg&seq,0267U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21437.51,,,,,,,fee schedule,6739.33,24500.01, Rare do id opt gen mapg&seq,0267U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24500.01,,,,,,,fee schedule,6739.33,24500.01, Rare do id opt gen mapg&seq,0267U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7008.9,,,,,,,fee schedule,6739.33,24500.01,APC Rare do id opt gen mapg&seq,0267U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7076.3,,,,,,,fee schedule,6739.33,24500.01,APC Rare do id opt gen mapg&seq,0267U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6739.33,,,,,,,fee schedule,6739.33,24500.01,APC Implt/rpl crtd sns dev gen,0268T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Implt/rpl crtd sns dev gen,0268T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Hem ahus gen seq alys 15 gen,0268U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem ahus gen seq alys 15 gen,0268U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem ahus gen seq alys 15 gen,0268U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem ahus gen seq alys 15 gen,0268U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem ahus gen seq alys 15 gen,0268U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Rev/remvl crtd sns dev total,0269T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4457,5123, Rev/remvl crtd sns dev total,0269T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4457,5123, Hem aut dm cgen trmbctpna 14,0269U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem aut dm cgen trmbctpna 14,0269U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem aut dm cgen trmbctpna 14,0269U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem aut dm cgen trmbctpna 14,0269U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem aut dm cgen trmbctpna 14,0269U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Rev/remvl crtd sns dev lead,0270T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,4097, Rev/remvl crtd sns dev lead,0270T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,4097, Hem cgen coagj do 20 genes,0270U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem cgen coagj do 20 genes,0270U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem cgen coagj do 20 genes,0270U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem cgen coagj do 20 genes,0270U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem cgen coagj do 20 genes,0270U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Rev/remvl crtd sns dev gen,0271T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Rev/remvl crtd sns dev gen,0271T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Hem cgen neutropenia 23 gen,0271U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem cgen neutropenia 23 gen,0271U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem cgen neutropenia 23 gen,0271U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem cgen neutropenia 23 gen,0271U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem cgen neutropenia 23 gen,0271U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Hem genetic bld do 51 genes,0272U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem genetic bld do 51 genes,0272U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem genetic bld do 51 genes,0272U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem genetic bld do 51 genes,0272U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem genetic bld do 51 genes,0272U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Hem gen hyprfibrnlysis 8 gen,0273U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem gen hyprfibrnlysis 8 gen,0273U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem gen hyprfibrnlysis 8 gen,0273U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem gen hyprfibrnlysis 8 gen,0273U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem gen hyprfibrnlysis 8 gen,0273U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,6296,15339, Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,6296,15339, Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,6296,15339, Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,6296,15339, Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,6296,15339,APC Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,6296,15339,APC Perq lamot/lam crv/thrc,0274T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,6296,15339,APC Hem gen pltlt do 43 genes,0274U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem gen pltlt do 43 genes,0274U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem gen pltlt do 43 genes,0274U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem gen pltlt do 43 genes,0274U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem gen pltlt do 43 genes,0274U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Perq lamot/lam lumbar,0275T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,6296,11081, Perq lamot/lam lumbar,0275T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,6296,11081, Perq lamot/lam lumbar,0275T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,6296,11081, Perq lamot/lam lumbar,0275T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,6296,11081, Hem heprn nduc trmbctpna srm,0275U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.37,66.66, Hem heprn nduc trmbctpna srm,0275U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.37,66.66, Hem heprn nduc trmbctpna srm,0275U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.1,,,,,,,fee schedule,18.37,66.66,APC Hem heprn nduc trmbctpna srm,0275U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.29,,,,,,,fee schedule,18.37,66.66,APC Hem heprn nduc trmbctpna srm,0275U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.37,,,,,,,fee schedule,18.37,66.66,APC Hem inh thrombocytopenia 23,0276U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7788.82,,,,,,,fee schedule,2448.56,8901.51, Hem inh thrombocytopenia 23,0276U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8901.51,,,,,,,fee schedule,2448.56,8901.51, Hem inh thrombocytopenia 23,0276U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2546.5,,,,,,,fee schedule,2448.56,8901.51,APC Hem inh thrombocytopenia 23,0276U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2570.99,,,,,,,fee schedule,2448.56,8901.51,APC Hem inh thrombocytopenia 23,0276U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2448.56,,,,,,,fee schedule,2448.56,8901.51,APC Hem gen pltlt funcj do 31,0277U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem gen pltlt funcj do 31,0277U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem gen pltlt funcj do 31,0277U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem gen pltlt funcj do 31,0277U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem gen pltlt funcj do 31,0277U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Tempr,0278T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Tempr,0278T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Tempr,0278T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Hem gen thrombosis 12 genes,0278U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1934.18,,,,,,,fee schedule,608.17,2210.49, Hem gen thrombosis 12 genes,0278U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2210.49,,,,,,,fee schedule,608.17,2210.49, Hem gen thrombosis 12 genes,0278U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,632.5,,,,,,,fee schedule,608.17,2210.49,APC Hem gen thrombosis 12 genes,0278U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,638.58,,,,,,,fee schedule,608.17,2210.49,APC Hem gen thrombosis 12 genes,0278U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.17,,,,,,,fee schedule,608.17,2210.49,APC Hem vw factor&clgn iii bndg,0279U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,41.67, Hem vw factor&clgn iii bndg,0279U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,41.67, Hem vw factor&clgn iii bndg,0279U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,41.67,APC Hem vw factor&clgn iii bndg,0279U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,41.67,APC Hem vw factor&clgn iii bndg,0279U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,41.67,APC Hem vw factor&clgn iv bndg,0280U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.09, Hem vw factor&clgn iv bndg,0280U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.09, Hem vw factor&clgn iv bndg,0280U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.09,APC Hem vw factor&clgn iv bndg,0280U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.09,APC Hem vw factor&clgn iv bndg,0280U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.09,APC Hem vwd propeptide ag lvl,0281U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.09, Hem vwd propeptide ag lvl,0281U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.09, Hem vwd propeptide ag lvl,0281U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.09,APC Hem vwd propeptide ag lvl,0281U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.09,APC Hem vwd propeptide ag lvl,0281U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.09,APC Rbc dna gntyp 12 bld grp gen,0282U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2290.39,,,,,,,fee schedule,720,2617.59, Rbc dna gntyp 12 bld grp gen,0282U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2617.59,,,,,,,fee schedule,720,2617.59, Rbc dna gntyp 12 bld grp gen,0282U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,748.8,,,,,,,fee schedule,720,2617.59,APC Rbc dna gntyp 12 bld grp gen,0282U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,756,,,,,,,fee schedule,720,2617.59,APC Rbc dna gntyp 12 bld grp gen,0282U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,720,,,,,,,fee schedule,720,2617.59,APC Vw factor type 2b eval plsm,0283U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.4,66.66, Vw factor type 2b eval plsm,0283U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.4,66.66, Vw factor type 2b eval plsm,0283U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.14,,,,,,,fee schedule,18.4,66.66,APC Vw factor type 2b eval plsm,0283U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.32,,,,,,,fee schedule,18.4,66.66,APC Vw factor type 2b eval plsm,0283U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.4,,,,,,,fee schedule,18.4,66.66,APC Vw factor type 2n eval plsm,0284U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.09, Vw factor type 2n eval plsm,0284U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.09, Vw factor type 2n eval plsm,0284U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.09,APC Vw factor type 2n eval plsm,0284U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.09,APC Vw factor type 2n eval plsm,0284U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.09,APC Onc rsps radj cll fr dna tox,0285U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1410.28,,,,,,,fee schedule,443.31,1611.75, Onc rsps radj cll fr dna tox,0285U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1611.75,,,,,,,fee schedule,443.31,1611.75, Onc rsps radj cll fr dna tox,0285U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,461.04,,,,,,,fee schedule,443.31,1611.75,APC Onc rsps radj cll fr dna tox,0285U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,465.48,,,,,,,fee schedule,443.31,1611.75,APC Onc rsps radj cll fr dna tox,0285U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,443.31,,,,,,,fee schedule,443.31,1611.75,APC Cep72 nudt15&tpmt gene alys,0286U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,427.04,,,,,,,fee schedule,134.13,488.04, Cep72 nudt15&tpmt gene alys,0286U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,488.04,,,,,,,fee schedule,134.13,488.04, Cep72 nudt15&tpmt gene alys,0286U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,139.5,,,,,,,fee schedule,134.13,488.04,APC Cep72 nudt15&tpmt gene alys,0286U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,140.84,,,,,,,fee schedule,134.13,488.04,APC Cep72 nudt15&tpmt gene alys,0286U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,134.13,,,,,,,fee schedule,134.13,488.04,APC Onc thyr dna&mrna 112 genes,0287U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11450.99,,,,,,,fee schedule,3600,13086.84, Onc thyr dna&mrna 112 genes,0287U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13086.84,,,,,,,fee schedule,3600,13086.84, Onc thyr dna&mrna 112 genes,0287U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3744,,,,,,,fee schedule,3600,13086.84,APC Onc thyr dna&mrna 112 genes,0287U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3780,,,,,,,fee schedule,3600,13086.84,APC Onc thyr dna&mrna 112 genes,0287U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3600,,,,,,,fee schedule,3600,13086.84,APC Onc lung mrna quan pcr 11&3,0288U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc lung mrna quan pcr 11&3,0288U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc lung mrna quan pcr 11&3,0288U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc lung mrna quan pcr 11&3,0288U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc lung mrna quan pcr 11&3,0288U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Neuro alzheimer mrna 24 gen,0289U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Neuro alzheimer mrna 24 gen,0289U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Neuro alzheimer mrna 24 gen,0289U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Neuro alzheimer mrna 24 gen,0289U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Neuro alzheimer mrna 24 gen,0289U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Laser inc for pkp/lkp recip,0290T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Laser inc for pkp/lkp recip,0290T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Pain mgmt mrna gen xprsn 36,0290U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Pain mgmt mrna gen xprsn 36,0290U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Pain mgmt mrna gen xprsn 36,0290U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Pain mgmt mrna gen xprsn 36,0290U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Pain mgmt mrna gen xprsn 36,0290U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Psyc mood do mrna 144 genes,0291U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5582.8,,,,,,,fee schedule,1755,6380.34, Psyc mood do mrna 144 genes,0291U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6380.34,,,,,,,fee schedule,1755,6380.34, Psyc mood do mrna 144 genes,0291U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1825.2,,,,,,,fee schedule,1755,6380.34,APC Psyc mood do mrna 144 genes,0291U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1842.75,,,,,,,fee schedule,1755,6380.34,APC Psyc mood do mrna 144 genes,0291U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1755,,,,,,,fee schedule,1755,6380.34,APC Psyc strs do mrna 72 genes,0292U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5582.8,,,,,,,fee schedule,1755,6380.34, Psyc strs do mrna 72 genes,0292U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6380.34,,,,,,,fee schedule,1755,6380.34, Psyc strs do mrna 72 genes,0292U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1825.2,,,,,,,fee schedule,1755,6380.34,APC Psyc strs do mrna 72 genes,0292U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1842.75,,,,,,,fee schedule,1755,6380.34,APC Psyc strs do mrna 72 genes,0292U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1755,,,,,,,fee schedule,1755,6380.34,APC Psyc suicidal idea mrna 54,0293U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Psyc suicidal idea mrna 54,0293U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Psyc suicidal idea mrna 54,0293U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Psyc suicidal idea mrna 54,0293U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Psyc suicidal idea mrna 54,0293U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Lngvty&mrtlty rsk mrna 18gen,0294U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,2417.47,2762.82, Lngvty&mrtlty rsk mrna 18gen,0294U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,2417.47,2762.82, Onc brst dux carc 7 proteins,0295U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17287.91,,,,,,,fee schedule,5435,19757.61, Onc brst dux carc 7 proteins,0295U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19757.61,,,,,,,fee schedule,5435,19757.61, Onc brst dux carc 7 proteins,0295U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5652.4,,,,,,,fee schedule,5435,19757.61,APC Onc brst dux carc 7 proteins,0295U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5706.75,,,,,,,fee schedule,5435,19757.61,APC Onc brst dux carc 7 proteins,0295U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5435,,,,,,,fee schedule,5435,19757.61,APC Ext ecg recording,0296T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,984, Ext ecg recording,0296T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,984, Onc orl&/orop ca 20 mlc feat,0296U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6202.53,,,,,,,fee schedule,1950,7088.61, Onc orl&/orop ca 20 mlc feat,0296U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7088.61,,,,,,,fee schedule,1950,7088.61, Onc orl&/orop ca 20 mlc feat,0296U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2028,,,,,,,fee schedule,1950,7088.61,APC Onc orl&/orop ca 20 mlc feat,0296U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2047.5,,,,,,,fee schedule,1950,7088.61,APC Onc orl&/orop ca 20 mlc feat,0296U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1950,,,,,,,fee schedule,1950,7088.61,APC Ext ecg scan w/report,0297T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,984, Ext ecg scan w/report,0297T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,984, Onc pan tum whl gen seq dna,0297U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,2919.6,10613.25, Onc pan tum whl gen seq dna,0297U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,2919.6,10613.25, Onc pan tum whl gen seq dna,0297U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,10613.25,APC Onc pan tum whl gen seq dna,0297U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,10613.25,APC Onc pan tum whl gen seq dna,0297U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,10613.25,APC Onc pan tum whl trns seq rna,0298U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,2919.6,10613.25, Onc pan tum whl trns seq rna,0298U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,2919.6,10613.25, Onc pan tum whl trns seq rna,0298U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,10613.25,APC Onc pan tum whl trns seq rna,0298U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,10613.25,APC Onc pan tum whl trns seq rna,0298U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,10613.25,APC Onc pan tum whl gen opt mapg,0299U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5926.52,,,,,,,fee schedule,1863.22,6773.16, Onc pan tum whl gen opt mapg,0299U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6773.16,,,,,,,fee schedule,1863.22,6773.16, Onc pan tum whl gen opt mapg,0299U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1937.75,,,,,,,fee schedule,1863.22,6773.16,APC Onc pan tum whl gen opt mapg,0299U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1956.38,,,,,,,fee schedule,1863.22,6773.16,APC Onc pan tum whl gen opt mapg,0299U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1863.22,,,,,,,fee schedule,1863.22,6773.16,APC Onc pan tum whl gen seq&opt,0300U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13305.99,,,,,,,fee schedule,4183.13,15206.85, Onc pan tum whl gen seq&opt,0300U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15206.85,,,,,,,fee schedule,4183.13,15206.85, Onc pan tum whl gen seq&opt,0300U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4350.46,,,,,,,fee schedule,4183.13,15206.85,APC Onc pan tum whl gen seq&opt,0300U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4392.29,,,,,,,fee schedule,4183.13,15206.85,APC Onc pan tum whl gen seq&opt,0300U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4183.13,,,,,,,fee schedule,4183.13,15206.85,APC Iadna bartonella ddpcr,0301U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,835.33,,,,,,,fee schedule,262.72,954.66, Iadna bartonella ddpcr,0301U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,954.66,,,,,,,fee schedule,262.72,954.66, Iadna bartonella ddpcr,0301U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,273.23,,,,,,,fee schedule,262.72,954.66,APC Iadna bartonella ddpcr,0301U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,275.86,,,,,,,fee schedule,262.72,954.66,APC Iadna bartonella ddpcr,0301U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,262.72,,,,,,,fee schedule,262.72,954.66,APC Iadna brtnla ddpcr flwg liq,0302U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1149.88,,,,,,,fee schedule,361.37,1314.15, Iadna brtnla ddpcr flwg liq,0302U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1314.15,,,,,,,fee schedule,361.37,1314.15, Iadna brtnla ddpcr flwg liq,0302U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,375.82,,,,,,,fee schedule,361.37,1314.15,APC Iadna brtnla ddpcr flwg liq,0302U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,379.44,,,,,,,fee schedule,361.37,1314.15,APC Iadna brtnla ddpcr flwg liq,0302U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,361.37,,,,,,,fee schedule,361.37,1314.15,APC Hem rbc ads whl bld hypoxic,0303U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7003.5,,,,,,,fee schedule,2201.62,8004, Hem rbc ads whl bld hypoxic,0303U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8004,,,,,,,fee schedule,2201.62,8004, Hem rbc ads whl bld hypoxic,0303U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2289.68,,,,,,,fee schedule,2201.62,8004,APC Hem rbc ads whl bld hypoxic,0303U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2311.7,,,,,,,fee schedule,2201.62,8004,APC Hem rbc ads whl bld hypoxic,0303U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2201.62,,,,,,,fee schedule,2201.62,8004,APC Hem rbc ads whl bld normoxic,0304U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6602.48,,,,,,,fee schedule,2075.8,7545.69, Hem rbc ads whl bld normoxic,0304U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7545.69,,,,,,,fee schedule,2075.8,7545.69, Hem rbc ads whl bld normoxic,0304U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2158.83,,,,,,,fee schedule,2075.8,7545.69,APC Hem rbc ads whl bld normoxic,0304U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2179.59,,,,,,,fee schedule,2075.8,7545.69,APC Hem rbc ads whl bld normoxic,0304U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2075.8,,,,,,,fee schedule,2075.8,7545.69,APC Hem rbc fnclty&dfrm shr strs,0305U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2108.14,,,,,,,fee schedule,662.58,2409.3, Hem rbc fnclty&dfrm shr strs,0305U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2409.3,,,,,,,fee schedule,662.58,2409.3, Hem rbc fnclty&dfrm shr strs,0305U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,689.08,,,,,,,fee schedule,662.58,2409.3,APC Hem rbc fnclty&dfrm shr strs,0305U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,695.71,,,,,,,fee schedule,662.58,2409.3,APC Hem rbc fnclty&dfrm shr strs,0305U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,662.58,,,,,,,fee schedule,662.58,2409.3,APC Onc mrd nxt-gnrj alys 1st,0306U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12337.34,,,,,,,fee schedule,3878.45,14099.82, Onc mrd nxt-gnrj alys 1st,0306U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14099.82,,,,,,,fee schedule,3878.45,14099.82, Onc mrd nxt-gnrj alys 1st,0306U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4033.59,,,,,,,fee schedule,3878.45,14099.82,APC Onc mrd nxt-gnrj alys 1st,0306U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4072.37,,,,,,,fee schedule,3878.45,14099.82,APC Onc mrd nxt-gnrj alys 1st,0306U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3878.45,,,,,,,fee schedule,3878.45,14099.82,APC Onc mrd nxt-gnrj alys sbsq,0307U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2526.85,,,,,,,fee schedule,794.49,2887.83, Onc mrd nxt-gnrj alys sbsq,0307U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2887.83,,,,,,,fee schedule,794.49,2887.83, Onc mrd nxt-gnrj alys sbsq,0307U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,826.27,,,,,,,fee schedule,794.49,2887.83,APC Onc mrd nxt-gnrj alys sbsq,0307U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,834.21,,,,,,,fee schedule,794.49,2887.83,APC Onc mrd nxt-gnrj alys sbsq,0307U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,794.49,,,,,,,fee schedule,794.49,2887.83,APC Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,20418.21, Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,20418.21, Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,2816,20418.21, Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,2816,20418.21, Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,20418.21, Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,20418.21, Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20223.75,,,,,,,fee schedule,2816,20418.21,APC Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20418.21,,,,,,,fee schedule,2816,20418.21,APC Insj ocular telescope prosth,0308T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19445.91,,,,,,,fee schedule,2816,20418.21,APC Crd cad alys 3 prtn plsm alg,0308U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1242.6,,,,,,,fee schedule,390.75,1420.11, Crd cad alys 3 prtn plsm alg,0308U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1420.11,,,,,,,fee schedule,390.75,1420.11, Crd cad alys 3 prtn plsm alg,0308U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,406.38,,,,,,,fee schedule,390.75,1420.11,APC Crd cad alys 3 prtn plsm alg,0308U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,410.29,,,,,,,fee schedule,390.75,1420.11,APC Crd cad alys 3 prtn plsm alg,0308U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.75,,,,,,,fee schedule,390.75,1420.11,APC Crd cv ds aly 4 prtn plm alg,0309U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1242.6,,,,,,,fee schedule,390.75,1420.11, Crd cv ds aly 4 prtn plm alg,0309U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1420.11,,,,,,,fee schedule,390.75,1420.11, Crd cv ds aly 4 prtn plm alg,0309U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,406.38,,,,,,,fee schedule,390.75,1420.11,APC Crd cv ds aly 4 prtn plm alg,0309U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,410.29,,,,,,,fee schedule,390.75,1420.11,APC Crd cv ds aly 4 prtn plm alg,0309U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.75,,,,,,,fee schedule,390.75,1420.11,APC Ped vsclts kd alys 3 bmrks,0310U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1242.6,,,,,,,fee schedule,390.75,1420.11, Ped vsclts kd alys 3 bmrks,0310U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1420.11,,,,,,,fee schedule,390.75,1420.11, Ped vsclts kd alys 3 bmrks,0310U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,406.38,,,,,,,fee schedule,390.75,1420.11,APC Ped vsclts kd alys 3 bmrks,0310U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,410.29,,,,,,,fee schedule,390.75,1420.11,APC Ped vsclts kd alys 3 bmrks,0310U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.75,,,,,,,fee schedule,390.75,1420.11,APC Nfct ds bct quan antmcrb sc,0311U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.08,29.76, Nfct ds bct quan antmcrb sc,0311U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.08,29.76, Nfct ds bct quan antmcrb sc,0311U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.4,,,,,,,fee schedule,8.08,29.76,APC Nfct ds bct quan antmcrb sc,0311U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.48,,,,,,,fee schedule,8.08,29.76,APC Nfct ds bct quan antmcrb sc,0311U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.08,,,,,,,fee schedule,8.08,29.76,APC Laps impltj nstim vagus,0312T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Laps impltj nstim vagus,0312T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Ai ds sle alys 8 igg autoant,0312U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2673.69,,,,,,,fee schedule,840.65,3055.65, Ai ds sle alys 8 igg autoant,0312U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3055.65,,,,,,,fee schedule,840.65,3055.65, Ai ds sle alys 8 igg autoant,0312U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,874.28,,,,,,,fee schedule,840.65,3055.65,APC Ai ds sle alys 8 igg autoant,0312U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,882.68,,,,,,,fee schedule,840.65,3055.65,APC Ai ds sle alys 8 igg autoant,0312U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,840.65,,,,,,,fee schedule,840.65,3055.65,APC Laps rmvl nstim array vagus,0313T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Laps rmvl nstim array vagus,0313T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Onc pncrs dna&mrna seq 74,0313U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11450.99,,,,,,,fee schedule,3600,13086.84, Onc pncrs dna&mrna seq 74,0313U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13086.84,,,,,,,fee schedule,3600,13086.84, Onc pncrs dna&mrna seq 74,0313U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3744,,,,,,,fee schedule,3600,13086.84,APC Onc pncrs dna&mrna seq 74,0313U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3780,,,,,,,fee schedule,3600,13086.84,APC Onc pncrs dna&mrna seq 74,0313U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3600,,,,,,,fee schedule,3600,13086.84,APC Laps rmvl vgl arry&pls gen,0314T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Laps rmvl vgl arry&pls gen,0314T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Onc cutan mlnma mrna 35 gene,0314U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6202.53,,,,,,,fee schedule,1950,7088.61, Onc cutan mlnma mrna 35 gene,0314U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7088.61,,,,,,,fee schedule,1950,7088.61, Onc cutan mlnma mrna 35 gene,0314U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2028,,,,,,,fee schedule,1950,7088.61,APC Onc cutan mlnma mrna 35 gene,0314U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2047.5,,,,,,,fee schedule,1950,7088.61,APC Onc cutan mlnma mrna 35 gene,0314U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1950,,,,,,,fee schedule,1950,7088.61,APC Rmvl vagus nerve pls gen,0315T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Rmvl vagus nerve pls gen,0315T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Onc cutan sq cll ca mrna 40,0315U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27038,,,,,,,fee schedule,8500,30900.57, Onc cutan sq cll ca mrna 40,0315U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30900.57,,,,,,,fee schedule,8500,30900.57, Onc cutan sq cll ca mrna 40,0315U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8840,,,,,,,fee schedule,8500,30900.57,APC Onc cutan sq cll ca mrna 40,0315U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8925,,,,,,,fee schedule,8500,30900.57,APC Onc cutan sq cll ca mrna 40,0315U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8500,,,,,,,fee schedule,8500,30900.57,APC Replc vagus nerve pls gen,0316T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Replc vagus nerve pls gen,0316T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, B brgdrferi lyme ds ospa evl,0316U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.66,67.86, B brgdrferi lyme ds ospa evl,0316U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.66,67.86, B brgdrferi lyme ds ospa evl,0316U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.41,,,,,,,fee schedule,18.66,67.86,APC B brgdrferi lyme ds ospa evl,0316U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.59,,,,,,,fee schedule,18.66,67.86,APC B brgdrferi lyme ds ospa evl,0316U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.66,,,,,,,fee schedule,18.66,67.86,APC Onc lung ca 4-prb fish assay,0317U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6457.71,,,,,,,fee schedule,2030,7380.24, Onc lung ca 4-prb fish assay,0317U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7380.24,,,,,,,fee schedule,2030,7380.24, Onc lung ca 4-prb fish assay,0317U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2111.2,,,,,,,fee schedule,2030,7380.24,APC Onc lung ca 4-prb fish assay,0317U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2131.5,,,,,,,fee schedule,2030,7380.24,APC Onc lung ca 4-prb fish assay,0317U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2030,,,,,,,fee schedule,2030,7380.24,APC Ped whl gen mthyltn alys 50+,0318U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5631.75,,,,,,,fee schedule,1770.48,6436.29, Ped whl gen mthyltn alys 50+,0318U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6436.29,,,,,,,fee schedule,1770.48,6436.29, Ped whl gen mthyltn alys 50+,0318U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1841.3,,,,,,,fee schedule,1770.48,6436.29,APC Ped whl gen mthyltn alys 50+,0318U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1859,,,,,,,fee schedule,1770.48,6436.29,APC Ped whl gen mthyltn alys 50+,0318U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1770.48,,,,,,,fee schedule,1770.48,6436.29,APC Neph rna pretrnspl perph bld,0319U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8429.4,,,,,,,fee schedule,2650,9633.6, Neph rna pretrnspl perph bld,0319U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9633.6,,,,,,,fee schedule,2650,9633.6, Neph rna pretrnspl perph bld,0319U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2756,,,,,,,fee schedule,2650,9633.6,APC Neph rna pretrnspl perph bld,0319U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2782.5,,,,,,,fee schedule,2650,9633.6,APC Neph rna pretrnspl perph bld,0319U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2650,,,,,,,fee schedule,2650,9633.6,APC Neph rna psttrnspl perph bld,0320U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8429.4,,,,,,,fee schedule,2650,9633.6, Neph rna psttrnspl perph bld,0320U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9633.6,,,,,,,fee schedule,2650,9633.6, Neph rna psttrnspl perph bld,0320U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2756,,,,,,,fee schedule,2650,9633.6,APC Neph rna psttrnspl perph bld,0320U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2782.5,,,,,,,fee schedule,2650,9633.6,APC Neph rna psttrnspl perph bld,0320U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2650,,,,,,,fee schedule,2650,9633.6,APC Iadna gu pthgn 20bct&fng org,0321U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2019.6,,,,,,,fee schedule,634.84,2308.11, Iadna gu pthgn 20bct&fng org,0321U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2308.11,,,,,,,fee schedule,634.84,2308.11, Iadna gu pthgn 20bct&fng org,0321U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,660.23,,,,,,,fee schedule,634.84,2308.11,APC Iadna gu pthgn 20bct&fng org,0321U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,666.58,,,,,,,fee schedule,634.84,2308.11,APC Iadna gu pthgn 20bct&fng org,0321U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,634.84,,,,,,,fee schedule,634.84,2308.11,APC Neuro asd meas 14 acyl carn,0322U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2385.18,,,,,,,fee schedule,750,2725.92, Neuro asd meas 14 acyl carn,0322U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2725.92,,,,,,,fee schedule,750,2725.92, Neuro asd meas 14 acyl carn,0322U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,780,,,,,,,fee schedule,750,2725.92,APC Neuro asd meas 14 acyl carn,0322U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,787.5,,,,,,,fee schedule,750,2725.92,APC Neuro asd meas 14 acyl carn,0322U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,750,,,,,,,fee schedule,750,2725.92,APC Iadna cns pthgn next gen seq,0323U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6762.89,,,,,,,fee schedule,2126.2,7729.02, Iadna cns pthgn next gen seq,0323U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7729.02,,,,,,,fee schedule,2126.2,7729.02, Iadna cns pthgn next gen seq,0323U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2211.25,,,,,,,fee schedule,2126.2,7729.02,APC Iadna cns pthgn next gen seq,0323U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2232.51,,,,,,,fee schedule,2126.2,7729.02,APC Iadna cns pthgn next gen seq,0323U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2126.2,,,,,,,fee schedule,2126.2,7729.02,APC Trgt gen seq alys pnl 83+,0326U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15904.72,,,,,,,fee schedule,5000,18176.82, Trgt gen seq alys pnl 83+,0326U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18176.82,,,,,,,fee schedule,5000,18176.82, Trgt gen seq alys pnl 83+,0326U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5200,,,,,,,fee schedule,5000,18176.82,APC Trgt gen seq alys pnl 83+,0326U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5250,,,,,,,fee schedule,5000,18176.82,APC Trgt gen seq alys pnl 83+,0326U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5000,,,,,,,fee schedule,5000,18176.82,APC Ftl aneuploidy trsmy dna seq,0327U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2528.93,,,,,,,fee schedule,795,2890.2, Ftl aneuploidy trsmy dna seq,0327U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2890.2,,,,,,,fee schedule,795,2890.2, Ftl aneuploidy trsmy dna seq,0327U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,826.8,,,,,,,fee schedule,795,2890.2,APC Ftl aneuploidy trsmy dna seq,0327U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,834.75,,,,,,,fee schedule,795,2890.2,APC Ftl aneuploidy trsmy dna seq,0327U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,795,,,,,,,fee schedule,795,2890.2,APC Drug assay 120+ rx&metablt,0328U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,363.51,,,,,,,fee schedule,114.43,415.44, Drug assay 120+ rx&metablt,0328U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,415.44,,,,,,,fee schedule,114.43,415.44, Drug assay 120+ rx&metablt,0328U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.01,,,,,,,fee schedule,114.43,415.44,APC Drug assay 120+ rx&metablt,0328U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.15,,,,,,,fee schedule,114.43,415.44,APC Drug assay 120+ rx&metablt,0328U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.43,,,,,,,fee schedule,114.43,415.44,APC Onc neo xome&trns seq alys,0329U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10936.43,,,,,,,fee schedule,3437.98,12498.78, Onc neo xome&trns seq alys,0329U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12498.78,,,,,,,fee schedule,3437.98,12498.78, Onc neo xome&trns seq alys,0329U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3575.5,,,,,,,fee schedule,3437.98,12498.78,APC Onc neo xome&trns seq alys,0329U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3609.88,,,,,,,fee schedule,3437.98,12498.78,APC Onc neo xome&trns seq alys,0329U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3437.98,,,,,,,fee schedule,3437.98,12498.78,APC Tear film img uni/bi w/i&r,0330T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,98.47,,,,,,,fee schedule,44.12,123.85, Tear film img uni/bi w/i&r,0330T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.85,,,,,,,fee schedule,44.12,123.85, Tear film img uni/bi w/i&r,0330T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,123.85,APC Tear film img uni/bi w/i&r,0330T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,123.85,APC Tear film img uni/bi w/i&r,0330T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,123.85,APC Iadna vag pthgn panel 27 org,0330U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,1515.33, Iadna vag pthgn panel 27 org,0330U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,1515.33, Iadna vag pthgn panel 27 org,0330U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,1515.33,APC Iadna vag pthgn panel 27 org,0330U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,1515.33,APC Iadna vag pthgn panel 27 org,0330U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,1515.33,APC Heart symp image plnr,0331T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1529.43,1605.9,APC Heart symp image plnr,0331T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1529.43,1605.9,APC Heart symp image plnr,0331T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1529.43,1605.9,APC Onc hl neo opt gen mapping,0331U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5926.52,,,,,,,fee schedule,1863.22,6773.16, Onc hl neo opt gen mapping,0331U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6773.16,,,,,,,fee schedule,1863.22,6773.16, Onc hl neo opt gen mapping,0331U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1937.75,,,,,,,fee schedule,1863.22,6773.16,APC Onc hl neo opt gen mapping,0331U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1956.38,,,,,,,fee schedule,1863.22,6773.16,APC Onc hl neo opt gen mapping,0331U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1863.22,,,,,,,fee schedule,1863.22,6773.16,APC Heart symp image plnr spect,0332T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1529.43,1605.9,APC Heart symp image plnr spect,0332T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1529.43,1605.9,APC Heart symp image plnr spect,0332T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1529.43,1605.9,APC Onc pan tum gen prflg 8 dna,0332U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3632.97,,,,,,,fee schedule,1142.06,4151.97, Onc pan tum gen prflg 8 dna,0332U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4151.97,,,,,,,fee schedule,1142.06,4151.97, Onc pan tum gen prflg 8 dna,0332U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1187.74,,,,,,,fee schedule,1142.06,4151.97,APC Onc pan tum gen prflg 8 dna,0332U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1199.16,,,,,,,fee schedule,1142.06,4151.97,APC Onc pan tum gen prflg 8 dna,0332U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1142.06,,,,,,,fee schedule,1142.06,4151.97,APC Onc lvr surveilanc hcc cfdna,0333U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2107.09,,,,,,,fee schedule,662.32,2408.1, Onc lvr surveilanc hcc cfdna,0333U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2408.1,,,,,,,fee schedule,662.32,2408.1, Onc lvr surveilanc hcc cfdna,0333U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,688.81,,,,,,,fee schedule,662.32,2408.1,APC Onc lvr surveilanc hcc cfdna,0333U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,695.44,,,,,,,fee schedule,662.32,2408.1,APC Onc lvr surveilanc hcc cfdna,0333U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,662.32,,,,,,,fee schedule,662.32,2408.1,APC Onc sld orgn tgsa dna 84/+,0334U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3640,,,,,,,fee schedule,3500,3675,APC Onc sld orgn tgsa dna 84/+,0334U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3675,,,,,,,fee schedule,3500,3675,APC Onc sld orgn tgsa dna 84/+,0334U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3500,,,,,,,fee schedule,3500,3675,APC Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13320,APC Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13320,APC Extraosseous joint stblztion,0335T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13320,APC Rare ds whl gen seq fetal,0335U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16619.22,,,,,,,fee schedule,5224.6,18993.39, Rare ds whl gen seq fetal,0335U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18993.39,,,,,,,fee schedule,5224.6,18993.39, Rare ds whl gen seq fetal,0335U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5433.58,,,,,,,fee schedule,5224.6,18993.39,APC Rare ds whl gen seq fetal,0335U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5485.83,,,,,,,fee schedule,5224.6,18993.39,APC Rare ds whl gen seq fetal,0335U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5224.6,,,,,,,fee schedule,5224.6,18993.39,APC Rare ds whl gen seq bld/slv,0336U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8189.84,,,,,,,fee schedule,2574.65,9359.82, Rare ds whl gen seq bld/slv,0336U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9359.82,,,,,,,fee schedule,2574.65,9359.82, Rare ds whl gen seq bld/slv,0336U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2677.64,,,,,,,fee schedule,2574.65,9359.82,APC Rare ds whl gen seq bld/slv,0336U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2703.38,,,,,,,fee schedule,2574.65,9359.82,APC Rare ds whl gen seq bld/slv,0336U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2574.65,,,,,,,fee schedule,2574.65,9359.82,APC Onc plsm cell do&myeloma id,0337U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7745.09,,,,,,,fee schedule,2435,8851.53, Onc plsm cell do&myeloma id,0337U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8851.53,,,,,,,fee schedule,2435,8851.53, Onc plsm cell do&myeloma id,0337U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2532.4,,,,,,,fee schedule,2435,8851.53,APC Onc plsm cell do&myeloma id,0337U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2556.75,,,,,,,fee schedule,2435,8851.53,APC Onc plsm cell do&myeloma id,0337U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2435,,,,,,,fee schedule,2435,8851.53,APC Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15339, Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15339, Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,15339, Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,15339, Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,15339, Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,15339, Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4147,15339,APC Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4147,15339,APC Trnscth renal symp denrv unl,0338T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4147,15339,APC Onc sld tum crcg tum cl slct,0338U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7745.09,,,,,,,fee schedule,2435,8851.53, Onc sld tum crcg tum cl slct,0338U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8851.53,,,,,,,fee schedule,2435,8851.53, Onc sld tum crcg tum cl slct,0338U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2532.4,,,,,,,fee schedule,2435,8851.53,APC Onc sld tum crcg tum cl slct,0338U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2556.75,,,,,,,fee schedule,2435,8851.53,APC Onc sld tum crcg tum cl slct,0338U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2435,,,,,,,fee schedule,2435,8851.53,APC Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,13320, Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,13320, Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4147,13320,APC Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4147,13320,APC Trnscth renal symp denrv bil,0339T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4147,13320,APC Onc prst8 mrna hoxc6 & dlx1,0339U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc prst8 mrna hoxc6 & dlx1,0339U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc prst8 mrna hoxc6 & dlx1,0339U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc prst8 mrna hoxc6 & dlx1,0339U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc prst8 mrna hoxc6 & dlx1,0339U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Onc pan ca alys mrd plasma,0340U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11419.72,,,,,,,fee schedule,3590,13051.11, Onc pan ca alys mrd plasma,0340U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13051.11,,,,,,,fee schedule,3590,13051.11, Onc pan ca alys mrd plasma,0340U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3733.6,,,,,,,fee schedule,3590,13051.11,APC Onc pan ca alys mrd plasma,0340U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3769.5,,,,,,,fee schedule,3590,13051.11,APC Onc pan ca alys mrd plasma,0340U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3590,,,,,,,fee schedule,3590,13051.11,APC Quant pupillometry w/ rprt,0341T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Quant pupillometry w/ rprt,0341T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Ftl aneup dna seq cmpr alys,0341U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6044.19,,,,,,,fee schedule,1900.2,6907.65, Ftl aneup dna seq cmpr alys,0341U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6907.65,,,,,,,fee schedule,1900.2,6907.65, Ftl aneup dna seq cmpr alys,0341U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1976.21,,,,,,,fee schedule,1900.2,6907.65,APC Ftl aneup dna seq cmpr alys,0341U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1995.21,,,,,,,fee schedule,1900.2,6907.65,APC Ftl aneup dna seq cmpr alys,0341U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1900.2,,,,,,,fee schedule,1900.2,6907.65,APC Thxp apheresis w/hdl delip,0342T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,5145.35,18686, Thxp apheresis w/hdl delip,0342T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,5145.35,18686, Thxp apheresis w/hdl delip,0342T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5351.16,,,,,,,fee schedule,5145.35,18686,APC Thxp apheresis w/hdl delip,0342T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5402.62,,,,,,,fee schedule,5145.35,18686,APC Thxp apheresis w/hdl delip,0342T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5145.35,,,,,,,fee schedule,5145.35,18686,APC Onc pncrtc ca mult ia eclia,0342U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2852.85,,,,,,,fee schedule,2852.85,3260.4, Onc pncrtc ca mult ia eclia,0342U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3260.4,,,,,,,fee schedule,2852.85,3260.4, Onc prst8 xom aly 442 sncrna,0343U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc prst8 xom aly 442 sncrna,0343U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc prst8 xom aly 442 sncrna,0343U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc prst8 xom aly 442 sncrna,0343U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc prst8 xom aly 442 sncrna,0343U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Hep nafld semiq evl 28 lipid,0344U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2519.55,,,,,,,fee schedule,792.17,2879.49, Hep nafld semiq evl 28 lipid,0344U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2879.49,,,,,,,fee schedule,792.17,2879.49, Hep nafld semiq evl 28 lipid,0344U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,823.86,,,,,,,fee schedule,792.17,2879.49,APC Hep nafld semiq evl 28 lipid,0344U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,831.78,,,,,,,fee schedule,792.17,2879.49,APC Hep nafld semiq evl 28 lipid,0344U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,792.17,,,,,,,fee schedule,792.17,2879.49,APC Psyc genom alys pnl 15 gen,0345U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4249.59,,,,,,,fee schedule,1336.09,4856.67, Psyc genom alys pnl 15 gen,0345U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4856.67,,,,,,,fee schedule,1336.09,4856.67, Psyc genom alys pnl 15 gen,0345U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1389.53,,,,,,,fee schedule,1336.09,4856.67,APC Psyc genom alys pnl 15 gen,0345U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1402.89,,,,,,,fee schedule,1336.09,4856.67,APC Psyc genom alys pnl 15 gen,0345U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1336.09,,,,,,,fee schedule,1336.09,4856.67,APC Beta amyl a?40&a?42 lc-ms/ms,0346U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,296.84,,,,,,,fee schedule,296.84,339.24, Beta amyl a?40&a?42 lc-ms/ms,0346U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,339.24,,,,,,,fee schedule,296.84,339.24, Ins bone device for rsa,0347T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,69.69,4166, Ins bone device for rsa,0347T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,69.69,4166, Ins bone device for rsa,0347T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,4166,APC Ins bone device for rsa,0347T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,4166,APC Ins bone device for rsa,0347T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,4166,APC Rx metab/pcx dna 16 gen alys,0347U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4249.59,,,,,,,fee schedule,1336.09,4856.67, Rx metab/pcx dna 16 gen alys,0347U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4856.67,,,,,,,fee schedule,1336.09,4856.67, Rx metab/pcx dna 16 gen alys,0347U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1389.53,,,,,,,fee schedule,1336.09,4856.67,APC Rx metab/pcx dna 16 gen alys,0347U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1402.89,,,,,,,fee schedule,1336.09,4856.67,APC Rx metab/pcx dna 16 gen alys,0347U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1336.09,,,,,,,fee schedule,1336.09,4856.67,APC RSA spine exam,0348T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,742.09,,,,,,,fee schedule,123.5,890.51, RSA spine exam,0348T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,890.51,,,,,,,fee schedule,123.5,890.51, RSA spine exam,0348T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,890.51,APC RSA spine exam,0348T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,890.51,APC RSA spine exam,0348T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,890.51,APC Rx metab/pcx dna 25 gen alys,0348U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2361.24,,,,,,,fee schedule,742.27,2698.56, Rx metab/pcx dna 25 gen alys,0348U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2698.56,,,,,,,fee schedule,742.27,2698.56, Rx metab/pcx dna 25 gen alys,0348U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,771.96,,,,,,,fee schedule,742.27,2698.56,APC Rx metab/pcx dna 25 gen alys,0348U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,779.38,,,,,,,fee schedule,742.27,2698.56,APC Rx metab/pcx dna 25 gen alys,0348U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,742.27,,,,,,,fee schedule,742.27,2698.56,APC RSA upper extr exam,0349T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,742.09,,,,,,,fee schedule,123.5,890.51, RSA upper extr exam,0349T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,890.51,,,,,,,fee schedule,123.5,890.51, RSA upper extr exam,0349T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,890.51,APC RSA upper extr exam,0349T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,890.51,APC RSA upper extr exam,0349T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,890.51,APC Rx metab/pcx dna 27gen rx ia,0349U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2361.24,,,,,,,fee schedule,742.27,2698.56, Rx metab/pcx dna 27gen rx ia,0349U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2698.56,,,,,,,fee schedule,742.27,2698.56, Rx metab/pcx dna 27gen rx ia,0349U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,771.96,,,,,,,fee schedule,742.27,2698.56,APC Rx metab/pcx dna 27gen rx ia,0349U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,779.38,,,,,,,fee schedule,742.27,2698.56,APC Rx metab/pcx dna 27gen rx ia,0349U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,742.27,,,,,,,fee schedule,742.27,2698.56,APC RSA lower extr exam,0350T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.36,,,,,,,fee schedule,102.81,736.04, RSA lower extr exam,0350T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.04,,,,,,,fee schedule,102.81,736.04, RSA lower extr exam,0350T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,736.04,APC RSA lower extr exam,0350T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,736.04,APC RSA lower extr exam,0350T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,736.04,APC Rx metab/pcx dna 27 gen alys,0350U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4249.59,,,,,,,fee schedule,1336.09,4856.67, Rx metab/pcx dna 27 gen alys,0350U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4856.67,,,,,,,fee schedule,1336.09,4856.67, Rx metab/pcx dna 27 gen alys,0350U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1389.53,,,,,,,fee schedule,1336.09,4856.67,APC Rx metab/pcx dna 27 gen alys,0350U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1402.89,,,,,,,fee schedule,1336.09,4856.67,APC Rx metab/pcx dna 27 gen alys,0350U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1336.09,,,,,,,fee schedule,1336.09,4856.67,APC Nfct ds bct/viral trail ip10,0351U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,829.08,,,,,,,fee schedule,260.5,947.52, Nfct ds bct/viral trail ip10,0351U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,947.52,,,,,,,fee schedule,260.5,947.52, Nfct ds bct/viral trail ip10,0351U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,947.52,APC Nfct ds bct/viral trail ip10,0351U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,947.52,APC Nfct ds bct/viral trail ip10,0351U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,947.52,APC Nfct ds bv&vaginitis amp prb,0352U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,454.13,519, Nfct ds bv&vaginitis amp prb,0352U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,454.13,519, Iadna chlmyd&gonorr amp prb,0353U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,222.89,,,,,,,fee schedule,222.89,254.73, Iadna chlmyd&gonorr amp prb,0353U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,254.73,,,,,,,fee schedule,222.89,254.73, GI tract capsule endoscopy,0355T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,2460, GI tract capsule endoscopy,0355T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,2460, Apol1 risk variants,0355U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Apol1 risk variants,0355U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Apol1 risk variants,0355U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Apol1 risk variants,0355U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Apol1 risk variants,0355U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Onc orop 17 dna ddpcr alg,0356U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1872,,,,,,,fee schedule,1800,1890,APC Onc orop 17 dna ddpcr alg,0356U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1890,,,,,,,fee schedule,1800,1890,APC Onc orop 17 dna ddpcr alg,0356U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1800,,,,,,,fee schedule,1800,1890,APC BIA whole body,0358T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC BIA whole body,0358T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC BIA whole body,0358T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Neuro alys b-amyl 1-42&1-40,0358U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,829.08,,,,,,,fee schedule,260.5,947.52, Neuro alys b-amyl 1-42&1-40,0358U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,947.52,,,,,,,fee schedule,260.5,947.52, Neuro alys b-amyl 1-42&1-40,0358U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,947.52,APC Neuro alys b-amyl 1-42&1-40,0358U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,947.52,APC Neuro alys b-amyl 1-42&1-40,0358U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,947.52,APC Onc prst8 ca alys all psa,0359U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc prst8 ca alys all psa,0359U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc prst8 ca alys all psa,0359U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc prst8 ca alys all psa,0359U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc prst8 ca alys all psa,0359U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Onc lung elisa 7 autoant alg,0360U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2673.69,,,,,,,fee schedule,840.65,3055.65, Onc lung elisa 7 autoant alg,0360U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3055.65,,,,,,,fee schedule,840.65,3055.65, Onc lung elisa 7 autoant alg,0360U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,874.28,,,,,,,fee schedule,840.65,3055.65,APC Onc lung elisa 7 autoant alg,0360U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,882.68,,,,,,,fee schedule,840.65,3055.65,APC Onc lung elisa 7 autoant alg,0360U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,840.65,,,,,,,fee schedule,840.65,3055.65,APC Onc pap thyr ca rna 82&10,0362U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11450.99,,,,,,,fee schedule,3600,13086.84, Onc pap thyr ca rna 82&10,0362U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13086.84,,,,,,,fee schedule,3600,13086.84, Onc pap thyr ca rna 82&10,0362U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3744,,,,,,,fee schedule,3600,13086.84,APC Onc pap thyr ca rna 82&10,0362U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3780,,,,,,,fee schedule,3600,13086.84,APC Onc pap thyr ca rna 82&10,0362U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3600,,,,,,,fee schedule,3600,13086.84,APC Onc urthl mrna 5 gen alg,0363U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc urthl mrna 5 gen alg,0363U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc urthl mrna 5 gen alg,0363U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc urthl mrna 5 gen alg,0363U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc urthl mrna 5 gen alg,0363U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Onc hl neo gen seq alys alg,0364U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2087.54,,,,,,,fee schedule,2007.25,2107.61,APC Onc hl neo gen seq alys alg,0364U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2107.61,,,,,,,fee schedule,2007.25,2107.61,APC Onc hl neo gen seq alys alg,0364U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2007.25,,,,,,,fee schedule,2007.25,2107.61,APC Onc bldr 10 prb bldr ca,0365U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2852.85,,,,,,,fee schedule,897,3260.4, Onc bldr 10 prb bldr ca,0365U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3260.4,,,,,,,fee schedule,897,3260.4, Onc bldr 10 prb bldr ca,0365U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,932.88,,,,,,,fee schedule,897,3260.4,APC Onc bldr 10 prb bldr ca,0365U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,941.85,,,,,,,fee schedule,897,3260.4,APC Onc bldr 10 prb bldr ca,0365U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,897,,,,,,,fee schedule,897,3260.4,APC Onc bldr 10 prb recr bldr ca,0366U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2852.85,,,,,,,fee schedule,897,3260.4, Onc bldr 10 prb recr bldr ca,0366U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3260.4,,,,,,,fee schedule,897,3260.4, Onc bldr 10 prb recr bldr ca,0366U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,932.88,,,,,,,fee schedule,897,3260.4,APC Onc bldr 10 prb recr bldr ca,0366U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,941.85,,,,,,,fee schedule,897,3260.4,APC Onc bldr 10 prb recr bldr ca,0366U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,897,,,,,,,fee schedule,897,3260.4,APC Onc bldr 10 flwg trurl rescj,0367U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2869.52,,,,,,,fee schedule,902.18,3279.45, Onc bldr 10 flwg trurl rescj,0367U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3279.45,,,,,,,fee schedule,902.18,3279.45, Onc bldr 10 flwg trurl rescj,0367U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,938.27,,,,,,,fee schedule,902.18,3279.45,APC Onc bldr 10 flwg trurl rescj,0367U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,947.29,,,,,,,fee schedule,902.18,3279.45,APC Onc bldr 10 flwg trurl rescj,0367U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,902.18,,,,,,,fee schedule,902.18,3279.45,APC Iadna gi pthgn 31 org&21 arg,0369U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,1325.91,1515.33, Iadna gi pthgn 31 org&21 arg,0369U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,1325.91,1515.33, Iadna surg wnd pthgn 34&21,0370U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,1325.91,1515.33, Iadna surg wnd pthgn 34&21,0370U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,1325.91,1515.33, Iadna gu pthgn semiq dna16&1,0371U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,1515.33, Iadna gu pthgn semiq dna16&1,0371U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,1515.33, Iadna gu pthgn semiq dna16&1,0371U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,1515.33,APC Iadna gu pthgn semiq dna16&1,0371U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,1515.33,APC Iadna gu pthgn semiq dna16&1,0371U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,1515.33,APC Nfct ds gu pthgn arg detcj,0372U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,1515.33, Nfct ds gu pthgn arg detcj,0372U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,1515.33, Nfct ds gu pthgn arg detcj,0372U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,1515.33,APC Nfct ds gu pthgn arg detcj,0372U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,1515.33,APC Nfct ds gu pthgn arg detcj,0372U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,1515.33,APC Iadna rsp tr nfct 17 8 13&16,0373U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,1325.91,1515.33, Iadna rsp tr nfct 17 8 13&16,0373U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,1325.91,1515.33, Iadna gu pthgn 21 org&21arg,0374U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,1325.91,1515.33, Iadna gu pthgn 21 org&21arg,0374U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,1325.91,1515.33, Onc ovrn bchm asy 7 prtn alg,0375U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2852.85,,,,,,,fee schedule,897,3260.4, Onc ovrn bchm asy 7 prtn alg,0375U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3260.4,,,,,,,fee schedule,897,3260.4, Onc ovrn bchm asy 7 prtn alg,0375U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,932.88,,,,,,,fee schedule,897,3260.4,APC Onc ovrn bchm asy 7 prtn alg,0375U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,941.85,,,,,,,fee schedule,897,3260.4,APC Onc ovrn bchm asy 7 prtn alg,0375U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,897,,,,,,,fee schedule,897,3260.4,APC Onc prst8 ca img alys 128,0376U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2246.66,,,,,,,fee schedule,706.25,2567.61, Onc prst8 ca img alys 128,0376U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2567.61,,,,,,,fee schedule,706.25,2567.61, Onc prst8 ca img alys 128,0376U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,734.5,,,,,,,fee schedule,706.25,2567.61,APC Onc prst8 ca img alys 128,0376U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,741.56,,,,,,,fee schedule,706.25,2567.61,APC Onc prst8 ca img alys 128,0376U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,706.25,,,,,,,fee schedule,706.25,2567.61,APC Anoscpy inj agent for incont,0377T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Anoscpy inj agent for incont,0377T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Cv ds quan advsrm/plsm lprtn,0377U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,151.02,,,,,,,fee schedule,47.58,172.59, Cv ds quan advsrm/plsm lprtn,0377U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,172.59,,,,,,,fee schedule,47.58,172.59, Cv ds quan advsrm/plsm lprtn,0377U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.48,,,,,,,fee schedule,47.58,172.59,APC Cv ds quan advsrm/plsm lprtn,0377U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.96,,,,,,,fee schedule,47.58,172.59,APC Cv ds quan advsrm/plsm lprtn,0377U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.58,,,,,,,fee schedule,47.58,172.59,APC Rfc1 repeat xpnsj vrnt alys,0378U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Rfc1 repeat xpnsj vrnt alys,0378U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Rfc1 repeat xpnsj vrnt alys,0378U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Rfc1 repeat xpnsj vrnt alys,0378U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Rfc1 repeat xpnsj vrnt alys,0378U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Vis field assmnt tech suppt,0379T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Vis field assmnt tech suppt,0379T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Vis field assmnt tech suppt,0379T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Tgsap sl or neo dna523&rna55,0379U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3420.05,,,,,,,fee schedule,3288.51,3452.94,APC Tgsap sl or neo dna523&rna55,0379U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3452.94,,,,,,,fee schedule,3288.51,3452.94,APC Tgsap sl or neo dna523&rna55,0379U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3288.51,,,,,,,fee schedule,3288.51,3452.94,APC Rx metb advrs trgt sq aly 20,0380U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,1325.91,1515.33, Rx metb advrs trgt sq aly 20,0380U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,1325.91,1515.33, Maple syrup ur ds mntr quan,0381U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.88,,,,,,,fee schedule,44.12,46.33,APC Maple syrup ur ds mntr quan,0381U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Maple syrup ur ds mntr quan,0381U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Hyprphenylalninmia mntr quan,0382U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.71,,,,,,,fee schedule,51.64,54.22,APC Hyprphenylalninmia mntr quan,0382U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.22,,,,,,,fee schedule,51.64,54.22,APC Hyprphenylalninmia mntr quan,0382U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.64,,,,,,,fee schedule,51.64,54.22,APC Tyrosinemia typ i mntr quan,0383U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54.13,,,,,,,fee schedule,52.05,54.65,APC Tyrosinemia typ i mntr quan,0383U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.65,,,,,,,fee schedule,52.05,54.65,APC Tyrosinemia typ i mntr quan,0383U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52.05,,,,,,,fee schedule,52.05,54.65,APC Neph ckd rsk hi stg kdn ds,0384U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2385.18,,,,,,,fee schedule,750,2725.92, Neph ckd rsk hi stg kdn ds,0384U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2725.92,,,,,,,fee schedule,750,2725.92, Neph ckd rsk hi stg kdn ds,0384U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,780,,,,,,,fee schedule,750,2725.92,APC Neph ckd rsk hi stg kdn ds,0384U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,787.5,,,,,,,fee schedule,750,2725.92,APC Neph ckd rsk hi stg kdn ds,0384U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,750,,,,,,,fee schedule,750,2725.92,APC Neph ckd alg rsk dbtc kdn ds,0385U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1242.6,,,,,,,fee schedule,390.75,1420.11, Neph ckd alg rsk dbtc kdn ds,0385U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1420.11,,,,,,,fee schedule,390.75,1420.11, Neph ckd alg rsk dbtc kdn ds,0385U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,406.38,,,,,,,fee schedule,390.75,1420.11,APC Neph ckd alg rsk dbtc kdn ds,0385U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,410.29,,,,,,,fee schedule,390.75,1420.11,APC Neph ckd alg rsk dbtc kdn ds,0385U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.75,,,,,,,fee schedule,390.75,1420.11,APC Onc mlnma ambra1&amlo,0387U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3017.41,,,,,,,fee schedule,948.5,3448.47, Onc mlnma ambra1&amlo,0387U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3448.47,,,,,,,fee schedule,948.5,3448.47, Onc mlnma ambra1&amlo,0387U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,986.44,,,,,,,fee schedule,948.5,3448.47,APC Onc mlnma ambra1&amlo,0387U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,995.92,,,,,,,fee schedule,948.5,3448.47,APC Onc mlnma ambra1&amlo,0387U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,948.5,,,,,,,fee schedule,948.5,3448.47,APC Onc nonsm cll lng ca 37 gen,0388U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3640,,,,,,,fee schedule,3500,3675,APC Onc nonsm cll lng ca 37 gen,0388U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3675,,,,,,,fee schedule,3500,3675,APC Onc nonsm cll lng ca 37 gen,0388U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3500,,,,,,,fee schedule,3500,3675,APC Ped fbrl kd ifi27&mcemp1 rna,0389U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.01,,,,,,,fee schedule,70.2,73.71,APC Ped fbrl kd ifi27&mcemp1 rna,0389U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.71,,,,,,,fee schedule,70.2,73.71,APC Ped fbrl kd ifi27&mcemp1 rna,0389U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.2,,,,,,,fee schedule,70.2,73.71,APC Ob pe kdr eng&rbp4 ia alg,0390U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,205.2,,,,,,,fee schedule,64.41,234.51, Ob pe kdr eng&rbp4 ia alg,0390U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,234.51,,,,,,,fee schedule,64.41,234.51, Ob pe kdr eng&rbp4 ia alg,0390U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.99,,,,,,,fee schedule,64.41,234.51,APC Ob pe kdr eng&rbp4 ia alg,0390U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.63,,,,,,,fee schedule,64.41,234.51,APC Ob pe kdr eng&rbp4 ia alg,0390U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.41,,,,,,,fee schedule,64.41,234.51,APC Onc sld tum dna&rna 437 gen,0391U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11450.99,,,,,,,fee schedule,3600,13086.84, Onc sld tum dna&rna 437 gen,0391U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13086.84,,,,,,,fee schedule,3600,13086.84, Onc sld tum dna&rna 437 gen,0391U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3744,,,,,,,fee schedule,3600,13086.84,APC Onc sld tum dna&rna 437 gen,0391U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3780,,,,,,,fee schedule,3600,13086.84,APC Onc sld tum dna&rna 437 gen,0391U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3600,,,,,,,fee schedule,3600,13086.84,APC Rx metab genrx ia 16 genes,0392U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4249.59,,,,,,,fee schedule,1336.09,4856.67, Rx metab genrx ia 16 genes,0392U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4856.67,,,,,,,fee schedule,1336.09,4856.67, Rx metab genrx ia 16 genes,0392U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1389.53,,,,,,,fee schedule,1336.09,4856.67,APC Rx metab genrx ia 16 genes,0392U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1402.89,,,,,,,fee schedule,1336.09,4856.67,APC Rx metab genrx ia 16 genes,0392U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1336.09,,,,,,,fee schedule,1336.09,4856.67,APC Neu prksn msfl ?-syncln prtn,0393U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1720.66,,,,,,,fee schedule,540.99,1966.47, Neu prksn msfl ?-syncln prtn,0393U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1966.47,,,,,,,fee schedule,540.99,1966.47, Neu prksn msfl ?-syncln prtn,0393U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,562.63,,,,,,,fee schedule,540.99,1966.47,APC Neu prksn msfl ?-syncln prtn,0393U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,568.04,,,,,,,fee schedule,540.99,1966.47,APC Neu prksn msfl ?-syncln prtn,0393U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,540.99,,,,,,,fee schedule,540.99,1966.47,APC Hdr elctrnc skn surf brchytx,0394T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1705.45,,,,,,,fee schedule,1705.45,1953.01, Hdr elctrnc skn surf brchytx,0394T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1953.01,,,,,,,fee schedule,1705.45,1953.01, Pfas 16 pfas compnd lc ms/ms,0394U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,632.23,,,,,,,fee schedule,198.74,722.55, Pfas 16 pfas compnd lc ms/ms,0394U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,722.55,,,,,,,fee schedule,198.74,722.55, Pfas 16 pfas compnd lc ms/ms,0394U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,206.69,,,,,,,fee schedule,198.74,722.55,APC Pfas 16 pfas compnd lc ms/ms,0394U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,208.68,,,,,,,fee schedule,198.74,722.55,APC Pfas 16 pfas compnd lc ms/ms,0394U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,198.74,,,,,,,fee schedule,198.74,722.55,APC Hdr elctr ntrst/ntrcv brchtx,0395T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1705.45,,,,,,,fee schedule,822.78,1953.01, Hdr elctr ntrst/ntrcv brchtx,0395T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1953.01,,,,,,,fee schedule,822.78,1953.01, Hdr elctr ntrst/ntrcv brchtx,0395T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,855.69,,,,,,,fee schedule,822.78,1953.01,APC Hdr elctr ntrst/ntrcv brchtx,0395T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,863.92,,,,,,,fee schedule,822.78,1953.01,APC Hdr elctr ntrst/ntrcv brchtx,0395T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,822.78,,,,,,,fee schedule,822.78,1953.01,APC Onc lng multiomics plsm alg,0395U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,829.35,,,,,,,fee schedule,797.45,837.32,APC Onc lng multiomics plsm alg,0395U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,837.32,,,,,,,fee schedule,797.45,837.32,APC Onc lng multiomics plsm alg,0395U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,797.45,,,,,,,fee schedule,797.45,837.32,APC Ercp w/optical endomicroscpy,0397T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4466, Ercp w/optical endomicroscpy,0397T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4466, Ercp w/optical endomicroscpy,0397T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,4466, Ercp w/optical endomicroscpy,0397T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,4466, Gi baret esph dna mthyln aly,0398U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1825.2,,,,,,,fee schedule,1755,1842.75,APC Gi baret esph dna mthyln aly,0398U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1842.75,,,,,,,fee schedule,1755,1842.75,APC Gi baret esph dna mthyln aly,0398U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1755,,,,,,,fee schedule,1755,1842.75,APC Neuro cere folate defncy srm,0399U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,312,,,,,,,fee schedule,300,315,APC Neuro cere folate defncy srm,0399U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,315,,,,,,,fee schedule,300,315,APC Neuro cere folate defncy srm,0399U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,300,,,,,,,fee schedule,300,315,APC Crd c hrt ds 9 gen 12 vrnts,0401U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,509.27,,,,,,,fee schedule,489.68,514.16,APC Crd c hrt ds 9 gen 12 vrnts,0401U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,514.16,,,,,,,fee schedule,489.68,514.16,APC Crd c hrt ds 9 gen 12 vrnts,0401U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,489.68,,,,,,,fee schedule,489.68,514.16,APC Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5098, Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5098, Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,5098, Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,5098, Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,5098, Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,5098, Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,5098,APC Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,5098,APC Collagen crosslinking cornea,0402T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,5098,APC Nfct agt sti mult amp prb tq,0402U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,142.63,519, Nfct agt sti mult amp prb tq,0402U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,142.63,519, Nfct agt sti mult amp prb tq,0402U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,519,APC Nfct agt sti mult amp prb tq,0402U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,519,APC Nfct agt sti mult amp prb tq,0402U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,519,APC Onc prst8 mrna 18 gen dre ur,0403U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc prst8 mrna 18 gen dre ur,0403U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc prst8 mrna 18 gen dre ur,0403U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc prst8 mrna 18 gen dre ur,0403U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc prst8 mrna 18 gen dre ur,0403U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Onc brst semiq meas thym kn,0404U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1026.98,,,,,,,fee schedule,322.96,1173.69, Onc brst semiq meas thym kn,0404U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1173.69,,,,,,,fee schedule,322.96,1173.69, Onc brst semiq meas thym kn,0404U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,335.88,,,,,,,fee schedule,322.96,1173.69,APC Onc brst semiq meas thym kn,0404U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,339.11,,,,,,,fee schedule,322.96,1173.69,APC Onc brst semiq meas thym kn,0404U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,322.96,,,,,,,fee schedule,322.96,1173.69,APC Onc pncrtc 59 mthltn blk mrk,0405U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5631.75,,,,,,,fee schedule,1770.48,6436.29, Onc pncrtc 59 mthltn blk mrk,0405U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6436.29,,,,,,,fee schedule,1770.48,6436.29, Onc pncrtc 59 mthltn blk mrk,0405U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1841.3,,,,,,,fee schedule,1770.48,6436.29,APC Onc pncrtc 59 mthltn blk mrk,0405U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1859,,,,,,,fee schedule,1770.48,6436.29,APC Onc pncrtc 59 mthltn blk mrk,0405U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1770.48,,,,,,,fee schedule,1770.48,6436.29,APC Onc lung flow cytmtry 5 mrk,0406U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Onc lung flow cytmtry 5 mrk,0406U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Onc lung flow cytmtry 5 mrk,0406U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Onc lung flow cytmtry 5 mrk,0406U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Onc lung flow cytmtry 5 mrk,0406U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Neph dbtc ckd mult eclia alg,0407U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,950,2762.82, Neph dbtc ckd mult eclia alg,0407U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,950,2762.82, Neph dbtc ckd mult eclia alg,0407U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,988,,,,,,,fee schedule,950,2762.82,APC Neph dbtc ckd mult eclia alg,0407U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,997.5,,,,,,,fee schedule,950,2762.82,APC Neph dbtc ckd mult eclia alg,0407U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,950,,,,,,,fee schedule,950,2762.82,APC Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,38935.13, Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,38935.13, Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,4147,38935.13, Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,4147,38935.13, Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38564.32,,,,,,,fee schedule,4147,38935.13,APC Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38935.13,,,,,,,fee schedule,4147,38935.13,APC Insj/rplc cardiac modulj sys,0408T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37081.07,,,,,,,fee schedule,4147,38935.13,APC Iaad blk ac wv bsnsr sarscv2,0408U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.7,,,,,,,fee schedule,14.13,14.84,APC Iaad blk ac wv bsnsr sarscv2,0408U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.84,,,,,,,fee schedule,14.13,14.84,APC Iaad blk ac wv bsnsr sarscv2,0408U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.13,,,,,,,fee schedule,14.13,14.84,APC Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,27591.2, Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,27591.2, Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,4147,27591.2, Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,4147,27591.2, Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,4147,27591.2,APC Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,4147,27591.2,APC Insj/rplc car modulj pls gn,0409T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,4147,27591.2,APC Onc sld tum dna 80 & rna 36,0409U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,2919.6,10613.25, Onc sld tum dna 80 & rna 36,0409U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,2919.6,10613.25, Onc sld tum dna 80 & rna 36,0409U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,10613.25,APC Onc sld tum dna 80 & rna 36,0409U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,10613.25,APC Onc sld tum dna 80 & rna 36,0409U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,10613.25,APC Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,15339,APC Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,15339,APC Insj/rplc car modulj atr elt,0410T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,15339,APC Onc pncrtc dna whl gn seq 5-,0410U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3690.28,,,,,,,fee schedule,1160,4217.46, Onc pncrtc dna whl gn seq 5-,0410U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4217.46,,,,,,,fee schedule,1160,4217.46, Onc pncrtc dna whl gn seq 5-,0410U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1206.4,,,,,,,fee schedule,1160,4217.46,APC Onc pncrtc dna whl gn seq 5-,0410U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1218,,,,,,,fee schedule,1160,4217.46,APC Onc pncrtc dna whl gn seq 5-,0410U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1160,,,,,,,fee schedule,1160,4217.46,APC Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,15339,APC Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,15339,APC Insj/rplc car modulj vnt elt,0411T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,15339,APC Psyc genom alys pnl 15 gen,0411U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4249.59,,,,,,,fee schedule,1336.09,4856.67, Psyc genom alys pnl 15 gen,0411U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4856.67,,,,,,,fee schedule,1336.09,4856.67, Psyc genom alys pnl 15 gen,0411U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1389.53,,,,,,,fee schedule,1336.09,4856.67,APC Psyc genom alys pnl 15 gen,0411U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1402.89,,,,,,,fee schedule,1336.09,4856.67,APC Psyc genom alys pnl 15 gen,0411U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1336.09,,,,,,,fee schedule,1336.09,4856.67,APC Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,13320,APC Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,13320,APC Rmvl cardiac modulj pls gen,0412T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,13320,APC Beta amyloid a?42/40 imprcip,0412U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,780,,,,,,,fee schedule,750,787.5,APC Beta amyloid a?42/40 imprcip,0412U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,787.5,,,,,,,fee schedule,750,787.5,APC Beta amyloid a?42/40 imprcip,0412U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,750,,,,,,,fee schedule,750,787.5,APC Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,13320,APC Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,13320,APC Rmvl car modulj tranvns elt,0413T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,13320,APC Onc hl neo opt gen mapg dna,0413U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4019.4,,,,,,,fee schedule,1263.53,4593.6, Onc hl neo opt gen mapg dna,0413U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4593.6,,,,,,,fee schedule,1263.53,4593.6, Onc hl neo opt gen mapg dna,0413U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1314.07,,,,,,,fee schedule,1263.53,4593.6,APC Onc hl neo opt gen mapg dna,0413U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1326.71,,,,,,,fee schedule,1263.53,4593.6,APC Onc hl neo opt gen mapg dna,0413U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1263.53,,,,,,,fee schedule,1263.53,4593.6,APC Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,27591.2, Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,27591.2, Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,4147,27591.2, Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,4147,27591.2, Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,4147,27591.2,APC Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,4147,27591.2,APC Rmvl & rpl car modulj pls gn,0414T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,4147,27591.2,APC Onc lng aug alg aly whl sld8,0414U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2246.66,,,,,,,fee schedule,706.25,2567.61, Onc lng aug alg aly whl sld8,0414U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2567.61,,,,,,,fee schedule,706.25,2567.61, Onc lng aug alg aly whl sld8,0414U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,734.5,,,,,,,fee schedule,706.25,2567.61,APC Onc lng aug alg aly whl sld8,0414U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,741.56,,,,,,,fee schedule,706.25,2567.61,APC Onc lng aug alg aly whl sld8,0414U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,706.25,,,,,,,fee schedule,706.25,2567.61,APC Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,741.06,6312, Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,741.06,6312, Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,6312, Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,6312, Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,741.06,6312, Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,741.06,6312, Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,6312,APC Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,6312,APC Repos car modulj tranvns elt,0415T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,6312,APC Cv ds acs bld alg 5 yr score,0415U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1242.6,,,,,,,fee schedule,390.75,1420.11, Cv ds acs bld alg 5 yr score,0415U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1420.11,,,,,,,fee schedule,390.75,1420.11, Cv ds acs bld alg 5 yr score,0415U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,406.38,,,,,,,fee schedule,390.75,1420.11,APC Cv ds acs bld alg 5 yr score,0415U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,410.29,,,,,,,fee schedule,390.75,1420.11,APC Cv ds acs bld alg 5 yr score,0415U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.75,,,,,,,fee schedule,390.75,1420.11,APC Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,9918, Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,9918, Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,9918, Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,9918, Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2437.45,9918, Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2437.45,9918, Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,9918,APC Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,9918,APC Reloc skin pocket pls gen,0416T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,9918,APC Rare ds alys 335 nuc genes,0417U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2956.23,,,,,,,fee schedule,2842.53,2984.66,APC Rare ds alys 335 nuc genes,0417U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2984.66,,,,,,,fee schedule,2842.53,2984.66,APC Rare ds alys 335 nuc genes,0417U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2842.53,,,,,,,fee schedule,2842.53,2984.66,APC Onc brst aug alg aly whl sl8,0418U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2246.66,,,,,,,fee schedule,706.25,2567.61, Onc brst aug alg aly whl sl8,0418U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2567.61,,,,,,,fee schedule,706.25,2567.61, Onc brst aug alg aly whl sl8,0418U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,734.5,,,,,,,fee schedule,706.25,2567.61,APC Onc brst aug alg aly whl sl8,0418U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,741.56,,,,,,,fee schedule,706.25,2567.61,APC Onc brst aug alg aly whl sl8,0418U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,706.25,,,,,,,fee schedule,706.25,2567.61,APC Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,428,3314,APC Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,428,3314,APC Dstrj neurofibroma xtnsv,0419T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,428,3314,APC Nrpsyc gen seq vrnt aly 13,0419U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4249.59,,,,,,,fee schedule,1336.09,4856.67, Nrpsyc gen seq vrnt aly 13,0419U,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4856.67,,,,,,,fee schedule,1336.09,4856.67, Nrpsyc gen seq vrnt aly 13,0419U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1389.53,,,,,,,fee schedule,1336.09,4856.67,APC Nrpsyc gen seq vrnt aly 13,0419U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1402.89,,,,,,,fee schedule,1336.09,4856.67,APC Nrpsyc gen seq vrnt aly 13,0419U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1336.09,,,,,,,fee schedule,1336.09,4856.67,APC Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,428,3314,APC Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,428,3314,APC Dstrj neurofibroma xtnsv,0420T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,428,3314,APC Onc urthl mrna xprsn 6 snp,0420U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1381.45,,,,,,,fee schedule,1328.32,1394.74,APC Onc urthl mrna xprsn 6 snp,0420U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1394.74,,,,,,,fee schedule,1328.32,1394.74,APC Onc urthl mrna xprsn 6 snp,0420U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1328.32,,,,,,,fee schedule,1328.32,1394.74,APC Waterjet prostate abltj cmpl,0421T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Waterjet prostate abltj cmpl,0421T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Waterjet prostate abltj cmpl,0421T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,18617, Waterjet prostate abltj cmpl,0421T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,18617, Waterjet prostate abltj cmpl,0421T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Waterjet prostate abltj cmpl,0421T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Tactile breast img uni/bi,0422T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Tactile breast img uni/bi,0422T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Tactile breast img uni/bi,0422T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Onc pan solid tum alys dna,0422U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2020.94,,,,,,,fee schedule,1943.21,2040.37,APC Onc pan solid tum alys dna,0422U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2040.37,,,,,,,fee schedule,1943.21,2040.37,APC Onc pan solid tum alys dna,0422U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1943.21,,,,,,,fee schedule,1943.21,2040.37,APC Psyc genomic alys pnl 26 gen,0423U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Psyc genomic alys pnl 26 gen,0423U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Psyc genomic alys pnl 26 gen,0423U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Insj/rplc nstim apnea compl,0424T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,16249,18686, Insj/rplc nstim apnea compl,0424T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,16249,18686, Onc prst8 xom alys 53 sncrna,0424U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Onc prst8 xom alys 53 sncrna,0424U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Onc prst8 xom alys 53 sncrna,0424U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Insj/rplc nstim apnea sen ld,0425T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,11336,13036, Insj/rplc nstim apnea sen ld,0425T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,11336,13036, Genom rpd seq alys ea cmprtr,0425U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4258.17,,,,,,,fee schedule,4094.39,4299.11,APC Genom rpd seq alys ea cmprtr,0425U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4299.11,,,,,,,fee schedule,4094.39,4299.11,APC Genom rpd seq alys ea cmprtr,0425U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4094.39,,,,,,,fee schedule,4094.39,4299.11,APC Insj/rplc nstim apnea stm ld,0426T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,16249,18686, Insj/rplc nstim apnea stm ld,0426T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,16249,18686, Genome ultra-rapid seq alys,0426U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7885.49,,,,,,,fee schedule,7582.2,7961.31,APC Genome ultra-rapid seq alys,0426U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7961.31,,,,,,,fee schedule,7582.2,7961.31,APC Genome ultra-rapid seq alys,0426U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7582.2,,,,,,,fee schedule,7582.2,7961.31,APC Insj/rplc nstim apnea pls gn,0427T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,16249,18686, Insj/rplc nstim apnea pls gn,0427T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,16249,18686, Monocyte dstrbj wdth whl bld,0427U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.66,,,,,,,fee schedule,4.48,4.7,APC Monocyte dstrbj wdth whl bld,0427U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.7,,,,,,,fee schedule,4.48,4.7,APC Monocyte dstrbj wdth whl bld,0427U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.48,4.7,APC Rmvl nstim apnea pls gen,0428T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Rmvl nstim apnea pls gen,0428T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Rmvl nstim apnea sen ld,0429T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Rmvl nstim apnea sen ld,0429T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Hpv orop swab 14 hi-risk typ,0429U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Hpv orop swab 14 hi-risk typ,0429U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Hpv orop swab 14 hi-risk typ,0429U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Rmvl nstim apnea stimj ld,0430T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Rmvl nstim apnea stimj ld,0430T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Gi malabs aat calpro pncrtc,0430U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64,,,,,,,fee schedule,61.54,64.62,APC Gi malabs aat calpro pncrtc,0430U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.62,,,,,,,fee schedule,61.54,64.62,APC Gi malabs aat calpro pncrtc,0430U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.54,,,,,,,fee schedule,61.54,64.62,APC Rmvl/rplc nstim apnea pls gn,0431T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,16249,18686, Rmvl/rplc nstim apnea pls gn,0431T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,16249,18686, Gly rcptr alpha1 igg srm/csf,0431U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.03,,,,,,,fee schedule,36.57,38.4,APC Gly rcptr alpha1 igg srm/csf,0431U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.4,,,,,,,fee schedule,36.57,38.4,APC Gly rcptr alpha1 igg srm/csf,0431U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.57,,,,,,,fee schedule,36.57,38.4,APC Repos nstim apnea stimj ld,0432T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Repos nstim apnea stimj ld,0432T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Klhl11 antb sr/csf asy qual,0432U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.03,,,,,,,fee schedule,36.57,38.4,APC Klhl11 antb sr/csf asy qual,0432U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.4,,,,,,,fee schedule,36.57,38.4,APC Klhl11 antb sr/csf asy qual,0432U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.57,,,,,,,fee schedule,36.57,38.4,APC Repos nstim apnea sensing ld,0433T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Repos nstim apnea sensing ld,0433T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Onc prst8 5 dna reg mrk pcr,0433U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Onc prst8 5 dna reg mrk pcr,0433U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Onc prst8 5 dna reg mrk pcr,0433U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Rx metab advrs vrnt alys 25,0434U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Rx metab advrs vrnt alys 25,0434U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Rx metab advrs vrnt alys 25,0434U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Onc chemo rx cytox csc 14 rx,0435U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3155.21,,,,,,,fee schedule,3033.86,3185.55,APC Onc chemo rx cytox csc 14 rx,0435U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3185.55,,,,,,,fee schedule,3033.86,3185.55,APC Onc chemo rx cytox csc 14 rx,0435U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3033.86,,,,,,,fee schedule,3033.86,3185.55,APC Onc lng plsm alys 388 prtn,0436U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1564.41,,,,,,,fee schedule,1504.24,1579.45,APC Onc lng plsm alys 388 prtn,0436U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1579.45,,,,,,,fee schedule,1504.24,1579.45,APC Onc lng plsm alys 388 prtn,0436U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1504.24,,,,,,,fee schedule,1504.24,1579.45,APC Impltj synth rnfcmt abdl wal,0437T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Impltj synth rnfcmt abdl wal,0437T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Psyc anxiety do mrna 15 bmrk,0437U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Psyc anxiety do mrna 15 bmrk,0437U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Psyc anxiety do mrna 15 bmrk,0437U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Rx metab advrs vrnt alys 33,0438U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Rx metab advrs vrnt alys 33,0438U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Rx metab advrs vrnt alys 33,0438U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Crd chd dna alys 5 snp 3 dna,0439U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,888.16,,,,,,,fee schedule,854,896.7,APC Crd chd dna alys 5 snp 3 dna,0439U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,896.7,,,,,,,fee schedule,854,896.7,APC Crd chd dna alys 5 snp 3 dna,0439U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,854,,,,,,,fee schedule,854,896.7,APC Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,11081,APC Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,11081,APC Abltj perc uxtr/perph nrv,0440T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,11081,APC Crd chd dna alys 10 snp 6dna,0440U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,888.16,,,,,,,fee schedule,854,896.7,APC Crd chd dna alys 10 snp 6dna,0440U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,896.7,,,,,,,fee schedule,854,896.7,APC Crd chd dna alys 10 snp 6dna,0440U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,854,,,,,,,fee schedule,854,896.7,APC Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,11081,APC Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,11081,APC Abltj perc lxtr/perph nrv,0441T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,11081,APC Nfct ds bct fngl/viral semiq,0441U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,461.84,,,,,,,fee schedule,444.08,466.28,APC Nfct ds bct fngl/viral semiq,0441U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,466.28,,,,,,,fee schedule,444.08,466.28,APC Nfct ds bct fngl/viral semiq,0441U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,444.08,,,,,,,fee schedule,444.08,466.28,APC Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,11081,APC Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,11081,APC Abltj perc plex/trncl nrv,0442T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,11081,APC Nfct ds respir nfctj mxa&crp,0442U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.04,,,,,,,fee schedule,41.38,43.45,APC Nfct ds respir nfctj mxa&crp,0442U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.45,,,,,,,fee schedule,41.38,43.45,APC Nfct ds respir nfctj mxa&crp,0442U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.38,,,,,,,fee schedule,41.38,43.45,APC Neurflmnt lt chn ultrsens ia,0443U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,120.88,,,,,,,fee schedule,116.23,122.04,APC Neurflmnt lt chn ultrsens ia,0443U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,122.04,,,,,,,fee schedule,116.23,122.04,APC Neurflmnt lt chn ultrsens ia,0443U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,116.23,,,,,,,fee schedule,116.23,122.04,APC 1st plmt drug elut oc ins,0444T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, 1st plmt drug elut oc ins,0444T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Onc sld orgn neo tgsap 361,0444U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,3065.58,APC Onc sld orgn neo tgsap 361,0444U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,3065.58,APC Onc sld orgn neo tgsap 361,0444U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,3065.58,APC Sbsqt plmt drug elut oc ins,0445T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Sbsqt plmt drug elut oc ins,0445T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Abeta42 & ptau181 eclia csf,0445U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,273.52,APC Abeta42 & ptau181 eclia csf,0445U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,273.52,APC Abeta42 & ptau181 eclia csf,0445U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,273.52,APC Insj impltbl glucose sensor,0446T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,5160.6, Insj impltbl glucose sensor,0446T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,5160.6, Insj impltbl glucose sensor,0446T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,5160.6, Insj impltbl glucose sensor,0446T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,5160.6, Insj impltbl glucose sensor,0446T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5111.45,,,,,,,fee schedule,2762,5160.6,APC Insj impltbl glucose sensor,0446T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5160.6,,,,,,,fee schedule,2762,5160.6,APC Insj impltbl glucose sensor,0446T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4914.85,,,,,,,fee schedule,2762,5160.6,APC Ai ds sle alys 10 cytokine,0446U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,874.28,,,,,,,fee schedule,840.65,882.68,APC Ai ds sle alys 10 cytokine,0446U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,882.68,,,,,,,fee schedule,840.65,882.68,APC Ai ds sle alys 10 cytokine,0446U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,840.65,,,,,,,fee schedule,840.65,882.68,APC Rmvl impltbl glucose sensor,0447T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,1866, Rmvl impltbl glucose sensor,0447T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,1866, Rmvl impltbl glucose sensor,0447T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,1866,APC Rmvl impltbl glucose sensor,0447T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,1866,APC Rmvl impltbl glucose sensor,0447T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,1866,APC Ai ds sle alys 11 cytokine,0447U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,874.28,,,,,,,fee schedule,840.65,882.68,APC Ai ds sle alys 11 cytokine,0447U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,882.68,,,,,,,fee schedule,840.65,882.68,APC Ai ds sle alys 11 cytokine,0447U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,840.65,,,,,,,fee schedule,840.65,882.68,APC Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,5160.6, Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,5160.6, Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,5160.6, Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,5160.6, Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5111.45,,,,,,,fee schedule,2762,5160.6,APC Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5160.6,,,,,,,fee schedule,2762,5160.6,APC Remvl insj impltbl gluc sens,0448T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4914.85,,,,,,,fee schedule,2762,5160.6,APC Insj aqueous drain dev 1st,0449T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6600.61, Insj aqueous drain dev 1st,0449T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6600.61, Insj aqueous drain dev 1st,0449T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3408,6600.61,APC Insj aqueous drain dev 1st,0449T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3408,6600.61,APC Insj aqueous drain dev 1st,0449T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3408,6600.61,APC Insj aqueous drain dev each,0450T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insj aqueous drain dev each,0450T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Onc bldr mthyl penk lte-qmsp,0452U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.68,,,,,,,fee schedule,192,201.6,APC Onc bldr mthyl penk lte-qmsp,0452U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.6,,,,,,,fee schedule,192,201.6,APC Onc bldr mthyl penk lte-qmsp,0452U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,192,,,,,,,fee schedule,192,201.6,APC Onc clrct ca cfdna qpcr asy,0453U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.68,,,,,,,fee schedule,192,201.6,APC Onc clrct ca cfdna qpcr asy,0453U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.6,,,,,,,fee schedule,192,201.6,APC Onc clrct ca cfdna qpcr asy,0453U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,192,,,,,,,fee schedule,192,201.6,APC U rare ds id opt genome mapg,0454U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1314.07,,,,,,,fee schedule,1263.53,1326.71,APC U rare ds id opt genome mapg,0454U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1326.71,,,,,,,fee schedule,1263.53,1326.71,APC U rare ds id opt genome mapg,0454U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1263.53,,,,,,,fee schedule,1263.53,1326.71,APC Nfct agt sti mult amp prb ur,0455U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,149.76,APC Nfct agt sti mult amp prb ur,0455U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,149.76,APC Nfct agt sti mult amp prb ur,0455U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,149.76,APC Pfas 9 cmpnd lcms/ms pls/sr,0457U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,206.69,,,,,,,fee schedule,198.74,208.68,APC Pfas 9 cmpnd lcms/ms pls/sr,0457U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,208.68,,,,,,,fee schedule,198.74,208.68,APC Pfas 9 cmpnd lcms/ms pls/sr,0457U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,198.74,,,,,,,fee schedule,198.74,208.68,APC Onc brst ca s100 a8&a9 elisa,0458U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,273.52,APC Onc brst ca s100 a8&a9 elisa,0458U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,273.52,APC Onc brst ca s100 a8&a9 elisa,0458U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,273.52,APC Abeta42 & ttau eclia csf,0459U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,273.52,APC Abeta42 & ttau eclia csf,0459U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,273.52,APC Abeta42 & ttau eclia csf,0459U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,273.52,APC Onc whl bld/bucc rtpcr 24gen,0460U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,953.76,,,,,,,fee schedule,917.08,962.93,APC Onc whl bld/bucc rtpcr 24gen,0460U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,962.93,,,,,,,fee schedule,917.08,962.93,APC Onc whl bld/bucc rtpcr 24gen,0460U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,917.08,,,,,,,fee schedule,917.08,962.93,APC Onc rxgenom alys rtpcr 24gen,0461U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,953.76,,,,,,,fee schedule,917.08,962.93,APC Onc rxgenom alys rtpcr 24gen,0461U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,962.93,,,,,,,fee schedule,917.08,962.93,APC Onc rxgenom alys rtpcr 24gen,0461U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,917.08,,,,,,,fee schedule,917.08,962.93,APC Melatonin lvl tst slp std7/9,0462U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,18.13,APC Melatonin lvl tst slp std7/9,0462U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,18.13,APC Melatonin lvl tst slp std7/9,0462U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,18.13,APC Onc crvx mrna genxprsn 14bmk,0463U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Onc crvx mrna genxprsn 14bmk,0463U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Onc crvx mrna genxprsn 14bmk,0463U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Visual ep test for glaucoma,0464T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Visual ep test for glaucoma,0464T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Visual ep test for glaucoma,0464T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Onc clrct scr qrtsa dna mrk,0464U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,615.6,,,,,,,fee schedule,591.92,621.52,APC Onc clrct scr qrtsa dna mrk,0464U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,621.52,,,,,,,fee schedule,591.92,621.52,APC Onc clrct scr qrtsa dna mrk,0464U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,591.92,,,,,,,fee schedule,591.92,621.52,APC Onc urthl carc dna qmsp 2gen,0465U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2015.53,,,,,,,fee schedule,1938.01,2034.91,APC Onc urthl carc dna qmsp 2gen,0465U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2034.91,,,,,,,fee schedule,1938.01,2034.91,APC Onc urthl carc dna qmsp 2gen,0465U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1938.01,,,,,,,fee schedule,1938.01,2034.91,APC Crd cad dna gwas 564856 snp,0466U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,359.25,,,,,,,fee schedule,345.43,362.7,APC Crd cad dna gwas 564856 snp,0466U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,362.7,,,,,,,fee schedule,345.43,362.7,APC Crd cad dna gwas 564856 snp,0466U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,345.43,,,,,,,fee schedule,345.43,362.7,APC Onc bldr dna ngs 60gen&aneup,0467U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1579.82,,,,,,,fee schedule,1519.06,1595.01,APC Onc bldr dna ngs 60gen&aneup,0467U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1595.01,,,,,,,fee schedule,1519.06,1595.01,APC Onc bldr dna ngs 60gen&aneup,0467U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1519.06,,,,,,,fee schedule,1519.06,1595.01,APC Hep nash mir34a5p ?2m ykl40,0468U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.77,,,,,,,fee schedule,251.7,264.29,APC Hep nash mir34a5p ?2m ykl40,0468U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,264.29,,,,,,,fee schedule,251.7,264.29,APC Hep nash mir34a5p ?2m ykl40,0468U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.7,,,,,,,fee schedule,251.7,264.29,APC Rare ds whl gen seq ftl samp,0469U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1245.86,,,,,,,fee schedule,1197.94,1257.84,APC Rare ds whl gen seq ftl samp,0469U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1257.84,,,,,,,fee schedule,1197.94,1257.84,APC Rare ds whl gen seq ftl samp,0469U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1197.94,,,,,,,fee schedule,1197.94,1257.84,APC Onc orop detcj mrd 8 dna hpv,0470U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.83,,,,,,,fee schedule,597.91,627.81,APC Onc orop detcj mrd 8 dna hpv,0470U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.81,,,,,,,fee schedule,597.91,627.81,APC Onc orop detcj mrd 8 dna hpv,0470U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.91,,,,,,,fee schedule,597.91,627.81,APC Onc clrc ca 35 vrn kras&nras,0471U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Onc clrc ca 35 vrn kras&nras,0471U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Onc clrc ca 35 vrn kras&nras,0471U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Ca vi psp&sp1 antb sj?gren,0472U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.02,,,,,,,fee schedule,27.9,29.3,APC Ca vi psp&sp1 antb sj?gren,0472U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.3,,,,,,,fee schedule,27.9,29.3,APC Ca vi psp&sp1 antb sj?gren,0472U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.9,,,,,,,fee schedule,27.9,29.3,APC Onc sld tum bld/slv 648 gene,0473U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4680,,,,,,,fee schedule,4500,4725,APC Onc sld tum bld/slv 648 gene,0473U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4725,,,,,,,fee schedule,4500,4725,APC Onc sld tum bld/slv 648 gene,0473U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4500,,,,,,,fee schedule,4500,4725,APC Insj aqueous drg dev io rsvr,0474T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Insj aqueous drg dev io rsvr,0474T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Insj aqueous drg dev io rsvr,0474T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Insj aqueous drg dev io rsvr,0474T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Hered pan ca gsap 88gene ngs,0474U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1356.11,,,,,,,fee schedule,1303.95,1369.15,APC Hered pan ca gsap 88gene ngs,0474U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1369.15,,,,,,,fee schedule,1303.95,1369.15,APC Hered pan ca gsap 88gene ngs,0474U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1303.95,,,,,,,fee schedule,1303.95,1369.15,APC Hered prst8 ca gsap 23 genes,0475U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1356.11,,,,,,,fee schedule,1303.95,1369.15,APC Hered prst8 ca gsap 23 genes,0475U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1369.15,,,,,,,fee schedule,1303.95,1369.15,APC Hered prst8 ca gsap 23 genes,0475U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1303.95,,,,,,,fee schedule,1303.95,1369.15,APC Rx metab psyc 14gen&cyp2d6,0476U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Rx metab psyc 14gen&cyp2d6,0476U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Rx metab psyc 14gen&cyp2d6,0476U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Rx metab psy 14&cyp2d6 gn-rx,0477U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Rx metab psy 14&cyp2d6 gn-rx,0477U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Rx metab psy 14&cyp2d6 gn-rx,0477U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Onc nsclc dna&rna dpcr 9 gen,0478U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,575.11,,,,,,,fee schedule,552.99,580.64,APC Onc nsclc dna&rna dpcr 9 gen,0478U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,580.64,,,,,,,fee schedule,552.99,580.64,APC Onc nsclc dna&rna dpcr 9 gen,0478U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,552.99,,,,,,,fee schedule,552.99,580.64,APC Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,873.1,3314, Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,873.1,3314, Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,873.1,3314, Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,873.1,3314, Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,3314,APC Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,3314,APC Fxjl abl lsr 1st 100 sq cm,0479T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,3314,APC Tau phosphorylated ptau217,0479U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,18.13,APC Tau phosphorylated ptau217,0479U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,18.13,APC Tau phosphorylated ptau217,0479U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,18.13,APC Fxjl abl lsr ea addl 100sqcm,0480T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Fxjl abl lsr ea addl 100sqcm,0480T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Nfct ds csf metag ngs alys,0480U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2211.25,,,,,,,fee schedule,2126.2,2232.51,APC Nfct ds csf metag ngs alys,0480U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2232.51,,,,,,,fee schedule,2126.2,2232.51,APC Nfct ds csf metag ngs alys,0480U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2126.2,,,,,,,fee schedule,2126.2,2232.51,APC Njx autol wbc concentrate,0481T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,3314, Njx autol wbc concentrate,0481T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,3314, Njx autol wbc concentrate,0481T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,527.74,3314, Njx autol wbc concentrate,0481T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,527.74,3314, Njx autol wbc concentrate,0481T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,3314,APC Njx autol wbc concentrate,0481T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,3314,APC Njx autol wbc concentrate,0481T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,3314,APC Idh1 idh2&tert promoter ngs,0481U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,701.21,,,,,,,fee schedule,674.24,707.95,APC Idh1 idh2&tert promoter ngs,0481U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,707.95,,,,,,,fee schedule,674.24,707.95,APC Idh1 idh2&tert promoter ngs,0481U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,674.24,,,,,,,fee schedule,674.24,707.95,APC Ob pe biochem asy sfit1&pigf,0482U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,133.97,,,,,,,fee schedule,128.82,135.26,APC Ob pe biochem asy sfit1&pigf,0482U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.26,,,,,,,fee schedule,128.82,135.26,APC Ob pe biochem asy sfit1&pigf,0482U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.82,,,,,,,fee schedule,128.82,135.26,APC Tmvi percutaneous approach,0483T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmvi percutaneous approach,0483T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmvi percutaneous approach,0483T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmvi percutaneous approach,0483T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Nfct ds ng gyra s91f pt mut,0483U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Nfct ds ng gyra s91f pt mut,0483U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Nfct ds ng gyra s91f pt mut,0483U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Tmvi transthoracic exposure,0484T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmvi transthoracic exposure,0484T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmvi transthoracic exposure,0484T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmvi transthoracic exposure,0484T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Nfct ds mgen 23s rrna pt mut,0484U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Nfct ds mgen 23s rrna pt mut,0484U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Nfct ds mgen 23s rrna pt mut,0484U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Oct mid ear i&r unilateral,0485T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Oct mid ear i&r unilateral,0485T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Oct mid ear i&r unilateral,0485T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Onc sol tum cfdna&rna ngs gm,0485U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3795.46,,,,,,,fee schedule,3649.48,3831.95,APC Onc sol tum cfdna&rna ngs gm,0485U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3831.95,,,,,,,fee schedule,3649.48,3831.95,APC Onc sol tum cfdna&rna ngs gm,0485U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3649.48,,,,,,,fee schedule,3649.48,3831.95,APC Oct mid ear i&r bilateral,0486T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Oct mid ear i&r bilateral,0486T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Oct mid ear i&r bilateral,0486T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Onc pan sol tum ngs cfctdna,0486U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1710.02,,,,,,,fee schedule,1644.25,1726.46,APC Onc pan sol tum ngs cfctdna,0486U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1726.46,,,,,,,fee schedule,1644.25,1726.46,APC Onc pan sol tum ngs cfctdna,0486U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1644.25,,,,,,,fee schedule,1644.25,1726.46,APC Onc sol tum cfcdna tgsap 84,0487U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,3065.58,APC Onc sol tum cfcdna tgsap 84,0487U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,3065.58,APC Onc sol tum cfcdna tgsap 84,0487U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,3065.58,APC Regn cell tx scldr hands,0489T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Regn cell tx scldr hands,0489T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Regn cell tx scldr hands,0489T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Regn cell tx scldr hands,0489T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Regn cell tx scldr h mlt inj,0490T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Regn cell tx scldr h mlt inj,0490T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Regn cell tx scldr h mlt inj,0490T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Regn cell tx scldr h mlt inj,0490T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Onc cutan/uveal mlnma cd146,0490U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2532.4,,,,,,,fee schedule,2435,2556.75,APC Onc cutan/uveal mlnma cd146,0490U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2556.75,,,,,,,fee schedule,2435,2556.75,APC Onc cutan/uveal mlnma cd146,0490U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2435,,,,,,,fee schedule,2435,2556.75,APC Onc sol tum ctc slct er prtn,0491U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2532.4,,,,,,,fee schedule,2435,2556.75,APC Onc sol tum ctc slct er prtn,0491U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2556.75,,,,,,,fee schedule,2435,2556.75,APC Onc sol tum ctc slct er prtn,0491U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2435,,,,,,,fee schedule,2435,2556.75,APC Onc sol tum ctc slctn pd-l1,0492U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2532.4,,,,,,,fee schedule,2435,2556.75,APC Onc sol tum ctc slctn pd-l1,0492U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2556.75,,,,,,,fee schedule,2435,2556.75,APC Onc sol tum ctc slctn pd-l1,0492U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2435,,,,,,,fee schedule,2435,2556.75,APC Trnspl med quan dd-cfdna ngs,0493U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2863.38,,,,,,,fee schedule,2753.25,2890.91,APC Trnspl med quan dd-cfdna ngs,0493U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2890.91,,,,,,,fee schedule,2753.25,2890.91,APC Trnspl med quan dd-cfdna ngs,0493U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2753.25,,,,,,,fee schedule,2753.25,2890.91,APC Prep & cannulj cdvr don lung,0494T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep & cannulj cdvr don lung,0494T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep & cannulj cdvr don lung,0494T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep & cannulj cdvr don lung,0494T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rbc ag ftl rhd gene alys ngs,0494U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,797,APC Rbc ag ftl rhd gene alys ngs,0494U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,797,APC Rbc ag ftl rhd gene alys ngs,0494U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,797,APC Onc prst8 alys crcg plsm prt,0495U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Onc prst8 alys crcg plsm prt,0495U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Onc prst8 alys crcg plsm prt,0495U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Onc clrct cfdna 8/7 genes,0496U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,505.29,,,,,,,fee schedule,485.86,510.15,APC Onc clrct cfdna 8/7 genes,0496U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,510.15,,,,,,,fee schedule,485.86,510.15,APC Onc clrct cfdna 8/7 genes,0496U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,485.86,,,,,,,fee schedule,485.86,510.15,APC Onc prst8 mrna rt-pcr 6 gene,0497U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,4066.65,APC Onc prst8 mrna rt-pcr 6 gene,0497U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,4066.65,APC Onc prst8 mrna rt-pcr 6 gene,0497U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,4066.65,APC Onc clrct ngs mut detc 43gen,0498U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1399.12,,,,,,,fee schedule,1345.31,1412.58,APC Onc clrct ngs mut detc 43gen,0498U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1412.58,,,,,,,fee schedule,1345.31,1412.58,APC Onc clrct ngs mut detc 43gen,0498U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1345.31,,,,,,,fee schedule,1345.31,1412.58,APC Onc clrct&lng dna ngs 8gene,0499U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.83,,,,,,,fee schedule,597.91,627.81,APC Onc clrct&lng dna ngs 8gene,0499U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.81,,,,,,,fee schedule,597.91,627.81,APC Onc clrct&lng dna ngs 8gene,0499U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.91,,,,,,,fee schedule,597.91,627.81,APC Autoinflam ds vexas synd dna,0500U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.42,,,,,,,fee schedule,175.4,184.17,APC Autoinflam ds vexas synd dna,0500U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.17,,,,,,,fee schedule,175.4,184.17,APC Autoinflam ds vexas synd dna,0500U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.4,,,,,,,fee schedule,175.4,184.17,APC Hpv e6/e7 mrk hi-rsk typ crv,0502U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Hpv e6/e7 mrk hi-rsk typ crv,0502U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Hpv e6/e7 mrk hi-rsk typ crv,0502U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Neuro alz ds ?amyl&tau prtn,0503U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,780,,,,,,,fee schedule,750,787.5,APC Neuro alz ds ?amyl&tau prtn,0503U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,787.5,,,,,,,fee schedule,750,787.5,APC Neuro alz ds ?amyl&tau prtn,0503U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,750,,,,,,,fee schedule,750,787.5,APC Nfct ds uti id 17 path orgs,0504U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Nfct ds uti id 17 path orgs,0504U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Nfct ds uti id 17 path orgs,0504U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Ev fempop artl revsc,0505T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,14319.55, Ev fempop artl revsc,0505T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,14319.55, Ev fempop artl revsc,0505T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,14319.55,APC Ev fempop artl revsc,0505T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,14319.55,APC Ev fempop artl revsc,0505T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,14319.55,APC Nfct ds vag infctj id 32orgs,0505U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,706.96,,,,,,,fee schedule,679.77,713.76,APC Nfct ds vag infctj id 32orgs,0505U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,713.76,,,,,,,fee schedule,679.77,713.76,APC Nfct ds vag infctj id 32orgs,0505U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,679.77,,,,,,,fee schedule,679.77,713.76,APC Mac pgmt opt dns meas hfp,0506T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Mac pgmt opt dns meas hfp,0506T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Mac pgmt opt dns meas hfp,0506T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Gi barretts esophgl cell 89,0506U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2015.53,,,,,,,fee schedule,1938.01,2034.91,APC Gi barretts esophgl cell 89,0506U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2034.91,,,,,,,fee schedule,1938.01,2034.91,APC Gi barretts esophgl cell 89,0506U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1938.01,,,,,,,fee schedule,1938.01,2034.91,APC Near ifr 2img mibmn glnd i&r,0507T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Near ifr 2img mibmn glnd i&r,0507T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Near ifr 2img mibmn glnd i&r,0507T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Onc ovr dna whole gen w/5hmc,0507U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1206.4,,,,,,,fee schedule,1160,1218,APC Onc ovr dna whole gen w/5hmc,0507U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1218,,,,,,,fee schedule,1160,1218,APC Onc ovr dna whole gen w/5hmc,0507U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1160,,,,,,,fee schedule,1160,1218,APC Pattern erg w/i&r,0509T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,324.19,,,,,,,fee schedule,255.08,371.24, Pattern erg w/i&r,0509T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,371.24,,,,,,,fee schedule,255.08,371.24, Pattern erg w/i&r,0509T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,371.24,APC Pattern erg w/i&r,0509T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,371.24,APC Pattern erg w/i&r,0509T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,371.24,APC Rmvl sinus tarsi implant,0510T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Rmvl sinus tarsi implant,0510T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Rmvl sinus tarsi implant,0510T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5044,APC Rmvl sinus tarsi implant,0510T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5044,APC Rmvl sinus tarsi implant,0510T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5044,APC Onc pncrtc ca alg alys 16gen,0510U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,492.87,,,,,,,fee schedule,473.91,497.61,APC Onc pncrtc ca alg alys 16gen,0510U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,497.61,,,,,,,fee schedule,473.91,497.61,APC Onc pncrtc ca alg alys 16gen,0510U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,473.91,,,,,,,fee schedule,473.91,497.61,APC Rmvl&rinsj sinus tarsi implt,0511T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Rmvl&rinsj sinus tarsi implt,0511T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Rmvl&rinsj sinus tarsi implt,0511T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Rmvl&rinsj sinus tarsi implt,0511T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Rmvl&rinsj sinus tarsi implt,0511T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Onc sol tum 3dmicroenvir 36+,0511U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3155.21,,,,,,,fee schedule,3033.86,3185.55,APC Onc sol tum 3dmicroenvir 36+,0511U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3185.55,,,,,,,fee schedule,3033.86,3185.55,APC Onc sol tum 3dmicroenvir 36+,0511U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3033.86,,,,,,,fee schedule,3033.86,3185.55,APC Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,3314, Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,3314, Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,237.02,3314, Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,237.02,3314, Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,3314,APC Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,3314,APC Esw integ wnd hlg 1st wnd,0512T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,3314,APC Onc prst8 alys dgtz img msi,0512U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,734.5,,,,,,,fee schedule,706.25,741.56,APC Onc prst8 alys dgtz img msi,0512U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,741.56,,,,,,,fee schedule,706.25,741.56,APC Onc prst8 alys dgtz img msi,0512U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,706.25,,,,,,,fee schedule,706.25,741.56,APC Onc prst8 alg alys msi&hrd,0513U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,734.5,,,,,,,fee schedule,706.25,741.56,APC Onc prst8 alg alys msi&hrd,0513U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,741.56,,,,,,,fee schedule,706.25,741.56,APC Onc prst8 alg alys msi&hrd,0513U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,706.25,,,,,,,fee schedule,706.25,741.56,APC Gi ibd ia quan deter adl lvl,0514U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,40.5,APC Gi ibd ia quan deter adl lvl,0514U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,40.5,APC Gi ibd ia quan deter adl lvl,0514U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,40.5,APC Insj wcs lv compl sys,0515T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,27591.2, Insj wcs lv compl sys,0515T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,27591.2, Insj wcs lv compl sys,0515T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,4224,27591.2,APC Insj wcs lv compl sys,0515T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,4224,27591.2,APC Insj wcs lv compl sys,0515T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,4224,27591.2,APC Gi ibd ia quan deter ifx lvl,0515U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,40.5,APC Gi ibd ia quan deter ifx lvl,0515U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,40.5,APC Gi ibd ia quan deter ifx lvl,0515U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,40.5,APC Insj wcs lv eltrd only,0516T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,12964.78, Insj wcs lv eltrd only,0516T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,12964.78, Insj wcs lv eltrd only,0516T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4224,12964.78,APC Insj wcs lv eltrd only,0516T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4224,12964.78,APC Insj wcs lv eltrd only,0516T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4224,12964.78,APC Rx metab rxgenomic gnotyp 40,0516U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Rx metab rxgenomic gnotyp 40,0516U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Rx metab rxgenomic gnotyp 40,0516U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Insj wcs lv pg compnt,0517T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,12964.78, Insj wcs lv pg compnt,0517T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,12964.78, Insj wcs lv pg compnt,0517T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4224,12964.78,APC Insj wcs lv pg compnt,0517T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4224,12964.78,APC Insj wcs lv pg compnt,0517T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4224,12964.78,APC Ther rx mntr 80+ psyactiv rx,0517U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr 80+ psyactiv rx,0517U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr 80+ psyactiv rx,0517U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,259.27,APC Rmvl pg compnt wcs,0518T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rmvl pg compnt wcs,0518T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rmvl pg compnt wcs,0518T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rmvl pg compnt wcs,0518T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rmvl pg compnt wcs,0518T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Rmvl pg compnt wcs,0518T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Rmvl pg compnt wcs,0518T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Ther rx mntr 90+ pn&mtl hlth,0518U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr 90+ pn&mtl hlth,0518U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr 90+ pn&mtl hlth,0518U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,259.27,APC Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,18617, Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,18617, Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4224,18617,APC Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4224,18617,APC Rmvl & rplcmt pg compnt wcs,0519T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4224,18617,APC Ther rx mntr meds p/d/a 110+,0519U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr meds p/d/a 110+,0519U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr meds p/d/a 110+,0519U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,259.27,APC Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18686, Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18686, Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,4224,18686, Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,4224,18686, Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4224,18686,APC Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4224,18686,APC Rmvl&rplcmt pg wcs new eltrd,0520T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4224,18686,APC Ther rx mntr 200+ rx/sbsts,0520U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr 200+ rx/sbsts,0520U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,259.27,APC Ther rx mntr 200+ rx/sbsts,0520U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,259.27,APC Interrog dev eval wcs ip,0521T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Interrog dev eval wcs ip,0521T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Interrog dev eval wcs ip,0521T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Rf iga&igm ccp antb sr-a ia,0521U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.87,,,,,,,fee schedule,51.8,54.39,APC Rf iga&igm ccp antb sr-a ia,0521U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.39,,,,,,,fee schedule,51.8,54.39,APC Rf iga&igm ccp antb sr-a ia,0521U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.8,,,,,,,fee schedule,51.8,54.39,APC Ca vi psp&sp1 antb cl semiql,0522U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,273.52,APC Ca vi psp&sp1 antb cl semiql,0522U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,273.52,APC Ca vi psp&sp1 antb cl semiql,0522U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,273.52,APC Onc soltum dna ngs snv 22gen,0523U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1406.17,,,,,,,fee schedule,1352.09,1419.69,APC Onc soltum dna ngs snv 22gen,0523U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1419.69,,,,,,,fee schedule,1352.09,1419.69,APC Onc soltum dna ngs snv 22gen,0523U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1352.09,,,,,,,fee schedule,1352.09,1419.69,APC Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,18617,APC Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,18617,APC Ev cath dir chem abltj w/img,0524T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,18617,APC Ob pe sflt-1/plgf ia srm/pls,0524U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,133.97,,,,,,,fee schedule,128.82,135.26,APC Ob pe sflt-1/plgf ia srm/pls,0524U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.26,,,,,,,fee schedule,128.82,135.26,APC Ob pe sflt-1/plgf ia srm/pls,0524U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.82,,,,,,,fee schedule,128.82,135.26,APC Insj/rplcmt compl iims,0525T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,23892.44, Insj/rplcmt compl iims,0525T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,23892.44, Insj/rplcmt compl iims,0525T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,4081,23892.44,APC Insj/rplcmt compl iims,0525T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,4081,23892.44,APC Insj/rplcmt compl iims,0525T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,4081,23892.44,APC Onc sphrd cell cul 11-rx pnl,0525U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3155.21,,,,,,,fee schedule,3033.86,3185.55,APC Onc sphrd cell cul 11-rx pnl,0525U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3185.55,,,,,,,fee schedule,3033.86,3185.55,APC Onc sphrd cell cul 11-rx pnl,0525U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3033.86,,,,,,,fee schedule,3033.86,3185.55,APC Insj/rplcmt iims eltrd only,0526T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,10264.89, Insj/rplcmt iims eltrd only,0526T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,10264.89, Insj/rplcmt iims eltrd only,0526T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,10264.89,APC Insj/rplcmt iims eltrd only,0526T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,10264.89,APC Insj/rplcmt iims eltrd only,0526T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,10264.89,APC Insj/rplcmt iims implt mntr,0527T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,10264.89, Insj/rplcmt iims implt mntr,0527T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,10264.89, Insj/rplcmt iims implt mntr,0527T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,10264.89,APC Insj/rplcmt iims implt mntr,0527T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,10264.89,APC Insj/rplcmt iims implt mntr,0527T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,10264.89,APC Hsv 1&2 vzv amp prb tq pthgn,0527U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,149.76,APC Hsv 1&2 vzv amp prb tq pthgn,0527U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,149.76,APC Hsv 1&2 vzv amp prb tq pthgn,0527U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,149.76,APC Lrt iad 18bct/8vir&7arg rna,0528U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,660.23,,,,,,,fee schedule,634.84,666.58,APC Lrt iad 18bct/8vir&7arg rna,0528U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,666.58,,,,,,,fee schedule,634.84,666.58,APC Lrt iad 18bct/8vir&7arg rna,0528U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,634.84,,,,,,,fee schedule,634.84,666.58,APC Removal complete iims,0530T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Removal complete iims,0530T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Removal complete iims,0530T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,5044,APC Removal complete iims,0530T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,5044,APC Removal complete iims,0530T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,5044,APC Onc pan-sol tum ctdna 77 gen,0530U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,3065.58,APC Onc pan-sol tum ctdna 77 gen,0530U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,3065.58,APC Onc pan-sol tum ctdna 77 gen,0530U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,3065.58,APC Removal iims electrode only,0531T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Removal iims electrode only,0531T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Removal iims electrode only,0531T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,5044,APC Removal iims electrode only,0531T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,5044,APC Removal iims electrode only,0531T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,5044,APC Removal iims implt mntr only,0532T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Removal iims implt mntr only,0532T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Removal iims implt mntr only,0532T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,5044,APC Removal iims implt mntr only,0532T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,5044,APC Removal iims implt mntr only,0532T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,5044,APC Rare ds whlgen&mitochdrl dna,0532U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5232.45,,,,,,,fee schedule,5031.2,5282.76,APC Rare ds whlgen&mitochdrl dna,0532U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5282.76,,,,,,,fee schedule,5031.2,5282.76,APC Rare ds whlgen&mitochdrl dna,0532U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5031.2,,,,,,,fee schedule,5031.2,5282.76,APC Rx metab advrs gnotyp 16gens,0533U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Rx metab advrs gnotyp 16gens,0533U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Rx metab advrs gnotyp 16gens,0533U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Pfas lc-ms/ms plsm/srm quan,0535U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.63,,,,,,,fee schedule,62.14,65.25,APC Pfas lc-ms/ms plsm/srm quan,0535U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.25,,,,,,,fee schedule,62.14,65.25,APC Pfas lc-ms/ms plsm/srm quan,0535U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.14,,,,,,,fee schedule,62.14,65.25,APC Rbcag ftl rhd pcr alys exon4,0536U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.68,,,,,,,fee schedule,192,201.6,APC Rbcag ftl rhd pcr alys exon4,0536U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.6,,,,,,,fee schedule,192,201.6,APC Rbcag ftl rhd pcr alys exon4,0536U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,192,,,,,,,fee schedule,192,201.6,APC Onc clrct ca cfdna >2500 dmr,0537U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1554.8,,,,,,,fee schedule,1495,1569.75,APC Onc clrct ca cfdna >2500 dmr,0537U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1569.75,,,,,,,fee schedule,1495,1569.75,APC Onc clrct ca cfdna >2500 dmr,0537U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1495,,,,,,,fee schedule,1495,1569.75,APC Onc sol tum ngts ffpe 600gen,0538U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3109.13,,,,,,,fee schedule,2989.55,3139.03,APC Onc sol tum ngts ffpe 600gen,0538U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3139.03,,,,,,,fee schedule,2989.55,3139.03,APC Onc sol tum ngts ffpe 600gen,0538U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2989.55,,,,,,,fee schedule,2989.55,3139.03,APC Onc sol tumor cfctdna 152gen,0539U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3420.05,,,,,,,fee schedule,3288.51,3452.94,APC Onc sol tumor cfctdna 152gen,0539U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3452.94,,,,,,,fee schedule,3288.51,3452.94,APC Onc sol tumor cfctdna 152gen,0539U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3288.51,,,,,,,fee schedule,3288.51,3452.94,APC Trnsplj med quan dd-cfdna,0540U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2863.38,,,,,,,fee schedule,2753.25,2890.91,APC Trnsplj med quan dd-cfdna,0540U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2890.91,,,,,,,fee schedule,2753.25,2890.91,APC Trnsplj med quan dd-cfdna,0540U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2753.25,,,,,,,fee schedule,2753.25,2890.91,APC Myocardial imaging mcg,0541T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,462.87,APC Myocardial imaging mcg,0541T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,462.87,APC Myocardial imaging mcg,0541T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,462.87,APC Onc sol tum ngs dna 517 gens,0543U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3109.13,,,,,,,fee schedule,2989.55,3139.03,APC Onc sol tum ngs dna 517 gens,0543U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3139.03,,,,,,,fee schedule,2989.55,3139.03,APC Onc sol tum ngs dna 517 gens,0543U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2989.55,,,,,,,fee schedule,2989.55,3139.03,APC Achr antb id imfluor livecll,0545U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.24,,,,,,,fee schedule,37.73,39.62,APC Achr antb id imfluor livecll,0545U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.62,,,,,,,fee schedule,37.73,39.62,APC Achr antb id imfluor livecll,0545U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,37.73,39.62,APC Ldns lrp4 antb imflr livecll,0546U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.24,,,,,,,fee schedule,37.73,39.62,APC Ldns lrp4 antb imflr livecll,0546U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.62,,,,,,,fee schedule,37.73,39.62,APC Ldns lrp4 antb imflr livecll,0546U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,37.73,39.62,APC B1 matrl qual tst mcrind tib,0547T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, B1 matrl qual tst mcrind tib,0547T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Neurflmnt lt chn cleia plsm,0547U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,120.88,,,,,,,fee schedule,116.23,122.04,APC Neurflmnt lt chn cleia plsm,0547U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,122.04,,,,,,,fee schedule,116.23,122.04,APC Neurflmnt lt chn cleia plsm,0547U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,116.23,,,,,,,fee schedule,116.23,122.04,APC Tprnl balo cntnc dev bi,0548T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,14820,17041, Tprnl balo cntnc dev bi,0548T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,14820,17041, Gfap cleia plasma,0548U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,120.88,,,,,,,fee schedule,116.23,122.04,APC Gfap cleia plasma,0548U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,122.04,,,,,,,fee schedule,116.23,122.04,APC Gfap cleia plasma,0548U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,116.23,,,,,,,fee schedule,116.23,122.04,APC Onc urthl dna mthyltd rt pcr,0549U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Onc urthl dna mthyltd rt pcr,0549U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Onc urthl dna mthyltd rt pcr,0549U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Low-level laser therapy,0552T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,3314, Low-level laser therapy,0552T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,3314, Perq tcat iliac anast implt,0553T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,4311, Perq tcat iliac anast implt,0553T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,4311, Repr med pga embry te strux,0553U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,797,APC Repr med pga embry te strux,0553U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,797,APC Repr med pga embry te strux,0553U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,797,APC Repr med pga 24chrm te bx qc,0554U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,797,APC Repr med pga 24chrm te bx qc,0554U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,797,APC Repr med pga 24chrm te bx qc,0554U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,797,APC B1 str&fx rsk transmis data,0555T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,200.97,,,,,,,fee schedule,34.17,241.16, B1 str&fx rsk transmis data,0555T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,241.16,,,,,,,fee schedule,34.17,241.16, B1 str&fx rsk transmis data,0555T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,241.16,APC B1 str&fx rsk transmis data,0555T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,241.16,APC B1 str&fx rsk transmis data,0555T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,241.16,APC Repr med pga embryonic te qc,0555U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,797,APC Repr med pga embryonic te qc,0555U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,797,APC Repr med pga embryonic te qc,0555U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,797,APC B1 str & fx rsk assessment,0556T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1654.02,,,,,,,fee schedule,281.87,1984.82, B1 str & fx rsk assessment,0556T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1984.82,,,,,,,fee schedule,281.87,1984.82, B1 str & fx rsk assessment,0556T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1984.82,APC B1 str & fx rsk assessment,0556T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1984.82,APC B1 str & fx rsk assessment,0556T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1984.82,APC Nfct ds p-s dna&rna 12 trgts,0556U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,149.76,APC Nfct ds p-s dna&rna 12 trgts,0556U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,149.76,APC Nfct ds p-s dna&rna 12 trgts,0556U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,149.76,APC Nfct ds bv dna mrk vag fluid,0557U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,273.51,,,,,,,fee schedule,262.99,276.14,APC Nfct ds bv dna mrk vag fluid,0557U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,276.14,,,,,,,fee schedule,262.99,276.14,APC Nfct ds bv dna mrk vag fluid,0557U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,262.99,,,,,,,fee schedule,262.99,276.14,APC Ct scan f/biomchn ct alys,0558T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Ct scan f/biomchn ct alys,0558T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Ct scan f/biomchn ct alys,0558T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Onc clrct elisa bf7 ag serum,0558U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,21.85,APC Onc clrct elisa bf7 ag serum,0558U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,21.85,APC Onc clrct elisa bf7 ag serum,0558U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,21.85,APC Antmc mdl 3d print 1st cmpnt,0559T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Antmc mdl 3d print 1st cmpnt,0559T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Antmc mdl 3d print 1st cmpnt,0559T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Onc brs quan elisa bf9ag srm,0559U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,21.85,APC Onc brs quan elisa bf9ag srm,0559U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,21.85,APC Onc brs quan elisa bf9ag srm,0559U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,21.85,APC Onc mrd gsa cfdna baseline,0560U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4033.59,,,,,,,fee schedule,3878.45,4072.37,APC Onc mrd gsa cfdna baseline,0560U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4072.37,,,,,,,fee schedule,3878.45,4072.37,APC Onc mrd gsa cfdna baseline,0560U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3878.45,,,,,,,fee schedule,3878.45,4072.37,APC Antmc guide 3d print 1st gd,0561T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Antmc guide 3d print 1st gd,0561T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Antmc guide 3d print 1st gd,0561T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Onc mrd gsa cfdna subsequent,0561U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,826.27,,,,,,,fee schedule,794.49,834.21,APC Onc mrd gsa cfdna subsequent,0561U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,834.21,,,,,,,fee schedule,794.49,834.21,APC Onc mrd gsa cfdna subsequent,0561U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,794.49,,,,,,,fee schedule,794.49,834.21,APC Onc sol tum tgsa 33gens snvs,0562U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.83,,,,,,,fee schedule,597.91,627.81,APC Onc sol tum tgsa 33gens snvs,0562U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.81,,,,,,,fee schedule,597.91,627.81,APC Onc sol tum tgsa 33gens snvs,0562U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.91,,,,,,,fee schedule,597.91,627.81,APC Evac meibomian glnd heat bi,0563T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,69.69,1866, Evac meibomian glnd heat bi,0563T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,69.69,1866, Evac meibomian glnd heat bi,0563T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,1866,APC Evac meibomian glnd heat bi,0563T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,1866,APC Evac meibomian glnd heat bi,0563T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,1866,APC Nfct ds pthgn-sna 11vir&4bct,0563U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Nfct ds pthgn-sna 11vir&4bct,0563U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Nfct ds pthgn-sna 11vir&4bct,0563U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Onc chemo rx cytotox csc 14,0564T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.58,,,,,,,fee schedule,1.58,1.8, Onc chemo rx cytotox csc 14,0564T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.8,,,,,,,fee schedule,1.58,1.8, Nfct ds pthgn-sna 10vir&4bct,0564U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Nfct ds pthgn-sna 10vir&4bct,0564U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Nfct ds pthgn-sna 10vir&4bct,0564U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Autol cell implt adps hrvg,0565T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Autol cell implt adps hrvg,0565T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Onc hcc ngs detc 6626epigalt,0565U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1206.4,,,,,,,fee schedule,1160,1218,APC Onc hcc ngs detc 6626epigalt,0565U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1218,,,,,,,fee schedule,1160,1218,APC Onc hcc ngs detc 6626epigalt,0565U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1160,,,,,,,fee schedule,1160,1218,APC Autol cell implt adps njx,0566T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Autol cell implt adps njx,0566T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Autol cell implt adps njx,0566T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Autol cell implt adps njx,0566T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Onc lng qpcr-bsd alys 13dmrs,0566U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,437.62,APC Onc lng qpcr-bsd alys 13dmrs,0566U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,437.62,APC Onc lng qpcr-bsd alys 13dmrs,0566U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,437.62,APC Perm flp tube occls w/implt,0567T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Perm flp tube occls w/implt,0567T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Rare ds whl gen seq srs&lrs,0567U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5232.45,,,,,,,fee schedule,5031.2,5282.76,APC Rare ds whl gen seq srs&lrs,0567U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5282.76,,,,,,,fee schedule,5031.2,5282.76,APC Rare ds whl gen seq srs&lrs,0567U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5031.2,,,,,,,fee schedule,5031.2,5282.76,APC Intro mix saline&air f/ssg,0568T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Intro mix saline&air f/ssg,0568T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Intro mix saline&air f/ssg,0568T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Intro mix saline&air f/ssg,0568T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Neurol dementia ?amyl ptau,0568U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,932.88,,,,,,,fee schedule,897,941.85,APC Neurol dementia ?amyl ptau,0568U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,941.85,,,,,,,fee schedule,897,941.85,APC Neurol dementia ?amyl ptau,0568U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,897,,,,,,,fee schedule,897,941.85,APC Neurol tbi alys gfap&uch-l1,0570U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,273.52,APC Neurol tbi alys gfap&uch-l1,0570U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,273.52,APC Neurol tbi alys gfap&uch-l1,0570U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,273.52,APC Insj/rplcmt icds ss eltrd,0571T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt icds ss eltrd,0571T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt icds ss eltrd,0571T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38564.32,,,,,,,fee schedule,4147,38935.13,APC Insj/rplcmt icds ss eltrd,0571T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38935.13,,,,,,,fee schedule,4147,38935.13,APC Insj/rplcmt icds ss eltrd,0571T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37081.07,,,,,,,fee schedule,4147,38935.13,APC Onc sol tum dna80&rna10g ngs,0571U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,3065.58,APC Onc sol tum dna80&rna10g ngs,0571U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,3065.58,APC Onc sol tum dna80&rna10g ngs,0571U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,3065.58,APC Insertion ss dfb electrode,0572T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,10264.89, Insertion ss dfb electrode,0572T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,10264.89, Insertion ss dfb electrode,0572T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,3408,10264.89,APC Insertion ss dfb electrode,0572T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,3408,10264.89,APC Insertion ss dfb electrode,0572T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,3408,10264.89,APC Removal ss dfb electrode,0573T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Removal ss dfb electrode,0573T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Removal ss dfb electrode,0573T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,5044,APC Removal ss dfb electrode,0573T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,5044,APC Removal ss dfb electrode,0573T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,5044,APC Repos prev ss impl dfb eltrd,0574T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Repos prev ss impl dfb eltrd,0574T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Repos prev ss impl dfb eltrd,0574T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,5044,APC Repos prev ss impl dfb eltrd,0574T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,5044,APC Repos prev ss impl dfb eltrd,0574T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,5044,APC Trnsplj med lar rtpcr 4genes,0575U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,395.2,,,,,,,fee schedule,380,399,APC Trnsplj med lar rtpcr 4genes,0575U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,399,,,,,,,fee schedule,380,399,APC Trnsplj med lar rtpcr 4genes,0575U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,380,,,,,,,fee schedule,380,399,APC Trnsplj med lar quan ddcfdna,0576U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3369.6,,,,,,,fee schedule,3240,3402,APC Trnsplj med lar quan ddcfdna,0576U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3402,,,,,,,fee schedule,3240,3402,APC Trnsplj med lar quan ddcfdna,0576U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3240,,,,,,,fee schedule,3240,3402,APC Onc ovr serum alys 39 gps,0577U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,259.27,APC Onc ovr serum alys 39 gps,0577U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,259.27,APC Onc ovr serum alys 39 gps,0577U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,259.27,APC Onc cutan mln rna qpcr 10gen,0578U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,4066.65,APC Onc cutan mln rna qpcr 10gen,0578U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,4066.65,APC Onc cutan mln rna qpcr 10gen,0578U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,4066.65,APC Nfro dbtc ckd elisa apoa4,0579U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,406.38,,,,,,,fee schedule,390.75,410.29,APC Nfro dbtc ckd elisa apoa4,0579U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,410.29,,,,,,,fee schedule,390.75,410.29,APC Nfro dbtc ckd elisa apoa4,0579U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.75,,,,,,,fee schedule,390.75,410.29,APC Rmvl ss impl dfb pg only,0580T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Rmvl ss impl dfb pg only,0580T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Rmvl ss impl dfb pg only,0580T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,5044,APC Rmvl ss impl dfb pg only,0580T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,5044,APC Rmvl ss impl dfb pg only,0580T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,5044,APC Bbrgdrferi antb detc 24rprtn,0580U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.21,18.07,APC Bbrgdrferi antb detc 24rprtn,0580U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.07,,,,,,,fee schedule,17.21,18.07,APC Bbrgdrferi antb detc 24rprtn,0580U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.21,,,,,,,fee schedule,17.21,18.07,APC Abltj mal brst tum perq crtx,0581T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Abltj mal brst tum perq crtx,0581T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Abltj mal brst tum perq crtx,0581T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,4224,6253,APC Abltj mal brst tum perq crtx,0581T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,4224,6253,APC Abltj mal brst tum perq crtx,0581T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,4224,6253,APC Trnspl med antb nohla 39trgt,0581U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,338.83,,,,,,,fee schedule,325.8,342.09,APC Trnspl med antb nohla 39trgt,0581U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,342.09,,,,,,,fee schedule,325.8,342.09,APC Trnspl med antb nohla 39trgt,0581U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,325.8,,,,,,,fee schedule,325.8,342.09,APC Trurl abltj mal prst8 tiss,0582T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,16365.32, Trurl abltj mal prst8 tiss,0582T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,16365.32, Trurl abltj mal prst8 tiss,0582T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16209.46,,,,,,,fee schedule,2816,16365.32,APC Trurl abltj mal prst8 tiss,0582T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16365.32,,,,,,,fee schedule,2816,16365.32,APC Trurl abltj mal prst8 tiss,0582T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15586.02,,,,,,,fee schedule,2816,16365.32,APC Rare ds rpd whlgen dna vrnts,0582U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7885.49,,,,,,,fee schedule,7582.2,7961.31,APC Rare ds rpd whlgen dna vrnts,0582U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7961.31,,,,,,,fee schedule,7582.2,7961.31,APC Rare ds rpd whlgen dna vrnts,0582U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7582.2,,,,,,,fee schedule,7582.2,7961.31,APC Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1832.96,5044, Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1832.96,5044, Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1832.96,5044, Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1832.96,5044, Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1832.96,5044, Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1832.96,5044, Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,5044,APC Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,5044,APC Tmpst auto tube dlvr sys,0583T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,5044,APC Rare ds rpd whlgen cmptr dna,0583U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3942.74,,,,,,,fee schedule,3791.1,3980.66,APC Rare ds rpd whlgen cmptr dna,0583U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3980.66,,,,,,,fee schedule,3791.1,3980.66,APC Rare ds rpd whlgen cmptr dna,0583U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3791.1,,,,,,,fee schedule,3791.1,3980.66,APC Neuro csf prion prtn qual,0584U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,562.63,,,,,,,fee schedule,540.99,568.04,APC Neuro csf prion prtn qual,0584U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,568.04,,,,,,,fee schedule,540.99,568.04,APC Neuro csf prion prtn qual,0584U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,540.99,,,,,,,fee schedule,540.99,568.04,APC Tgsap so neo cfdna 521 genes,0585U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,3065.58,APC Tgsap so neo cfdna 521 genes,0585U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,3065.58,APC Tgsap so neo cfdna 521 genes,0585U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,3065.58,APC Onc mrna gen xprsn 216 genes,0586U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,3065.58,APC Onc mrna gen xprsn 216 genes,0586U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,3065.58,APC Onc mrna gen xprsn 216 genes,0586U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,3065.58,APC Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7905.14, Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7905.14, Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,7905.14, Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,7905.14, Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7829.85,,,,,,,fee schedule,1544,7905.14,APC Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7905.14,,,,,,,fee schedule,1544,7905.14,APC Perq impltj/rplcmt isdns ptn,0587T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7528.7,,,,,,,fee schedule,1544,7905.14,APC Ther rx mntr 60-150rx&metabl,0587U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.01,,,,,,,fee schedule,114.43,120.15,APC Ther rx mntr 60-150rx&metabl,0587U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.15,,,,,,,fee schedule,114.43,120.15,APC Ther rx mntr 60-150rx&metabl,0587U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.43,,,,,,,fee schedule,114.43,120.15,APC Revision/removal isdns ptn,0588T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4336.61, Revision/removal isdns ptn,0588T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4336.61, Revision/removal isdns ptn,0588T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,4336.61,APC Revision/removal isdns ptn,0588T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,4336.61,APC Revision/removal isdns ptn,0588T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,4336.61,APC Nfct ds bct/vir 32genes mrna,0588U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Nfct ds bct/vir 32genes mrna,0588U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Nfct ds bct/vir 32genes mrna,0588U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Pfas24cmpnd hi-perf lc-ms/ms,0589U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,206.69,,,,,,,fee schedule,198.74,208.68,APC Pfas24cmpnd hi-perf lc-ms/ms,0589U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,208.68,,,,,,,fee schedule,198.74,208.68,APC Pfas24cmpnd hi-perf lc-ms/ms,0589U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,198.74,,,,,,,fee schedule,198.74,208.68,APC Onc prst8 ca 3prtns plsm srm,0591U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,798,APC Onc prst8 ca 3prtns plsm srm,0591U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,798,APC Onc prst8 ca 3prtns plsm srm,0591U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,798,APC Onc hl neo dna tgs 417 genes,0592U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,3065.58,APC Onc hl neo dna tgs 417 genes,0592U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,3065.58,APC Onc hl neo dna tgs 417 genes,0592U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,3065.58,APC Nfct ds gu pthgn dna 46trgt,0593U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,660.23,,,,,,,fee schedule,634.84,666.58,APC Nfct ds gu pthgn dna 46trgt,0593U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,666.58,,,,,,,fee schedule,634.84,666.58,APC Nfct ds gu pthgn dna 46trgt,0593U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,634.84,,,,,,,fee schedule,634.84,666.58,APC Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,18617, Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,18617, Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Osteot hum xtrnl lngth dev,0594T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Nfct ds tfp vctrbrn&zoonotic,0595U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,273.51,,,,,,,fee schedule,262.99,276.14,APC Nfct ds tfp vctrbrn&zoonotic,0595U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,276.14,,,,,,,fee schedule,262.99,276.14,APC Nfct ds tfp vctrbrn&zoonotic,0595U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,262.99,,,,,,,fee schedule,262.99,276.14,APC Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,4466, Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,4466, Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,823.75,4466, Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,823.75,4466, Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,4466,APC Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,4466,APC Temp fml iu vlv-pmp 1st insj,0596T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,4466,APC Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,4466, Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,4466, Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,823.75,4466, Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,823.75,4466, Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,4466,APC Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,4466,APC Temp fml iu valve-pmp rplcmt,0597T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,4466,APC Ncntc r-t fluor wnd img 1st,0598T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Ncntc r-t fluor wnd img 1st,0598T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Ncntc r-t fluor wnd img 1st,0598T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Gi ibs igg antb 18food items,0598U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,312,,,,,,,fee schedule,300,315,APC Gi ibs igg antb 18food items,0598U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,315,,,,,,,fee schedule,300,315,APC Gi ibs igg antb 18food items,0598U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,300,,,,,,,fee schedule,300,315,APC Onc pncrtc ca mult ia serum,0599U,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,932.88,,,,,,,fee schedule,897,941.85,APC Onc pncrtc ca mult ia serum,0599U,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,941.85,,,,,,,fee schedule,897,941.85,APC Onc pncrtc ca mult ia serum,0599U,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,897,,,,,,,fee schedule,897,941.85,APC Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4224,18617,APC Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4224,18617,APC Ire abltj 1+tum organ perq,0600T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4224,18617,APC Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,18617,APC Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,18617,APC Ire abltj 1+tumors open,0601T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,18617,APC Mrs disc pain acquisj data,0609T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Mrs disc pain acquisj data,0609T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Mrs disc pain acquisj data,0609T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Mrs disc pain alg alys data,0611T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Mrs disc pain alg alys data,0611T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Mrs disc pain alg alys data,0611T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,27591.2, Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,27591.2, Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,27591.2, Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,27591.2, Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,27591.2, Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,27591.2, Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,3560,27591.2,APC Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,3560,27591.2,APC Rmvl&rplcmt ss impl dfb pg,0614T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,3560,27591.2,APC Eye mvmt alys w/o calbrj i&r,0615T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Eye mvmt alys w/o calbrj i&r,0615T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Eye mvmt alys w/o calbrj i&r,0615T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Insertion of iris prosthesis,0616T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9701, Insertion of iris prosthesis,0616T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9701, Insertion of iris prosthesis,0616T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3291,9701, Insertion of iris prosthesis,0616T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3291,9701, Insertion of iris prosthesis,0616T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,3291,9701, Insertion of iris prosthesis,0616T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,3291,9701, Insj iris prosth w/rmvl&insj,0617T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9701, Insj iris prosth w/rmvl&insj,0617T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9701, Insj iris prosth w/rmvl&insj,0617T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,9701, Insj iris prosth w/rmvl&insj,0617T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,9701, Insj iris prosth w/rmvl&insj,0617T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,3291,9701, Insj iris prosth w/rmvl&insj,0617T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,3291,9701, Insj iris prosth sec io lens,0618T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9701, Insj iris prosth sec io lens,0618T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9701, Insj iris prosth sec io lens,0618T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,9701, Insj iris prosth sec io lens,0618T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,9701, Insj iris prosth sec io lens,0618T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,3291,9701, Insj iris prosth sec io lens,0618T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,3291,9701, Cysto w/prst8 commissurotomy,0619T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Cysto w/prst8 commissurotomy,0619T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Cysto w/prst8 commissurotomy,0619T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Cysto w/prst8 commissurotomy,0619T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Cysto w/prst8 commissurotomy,0619T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Cysto w/prst8 commissurotomy,0619T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,54635.78, Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,54635.78, Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4224,54635.78, Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4224,54635.78, Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54115.44,,,,,,,fee schedule,4224,54635.78,APC Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54635.78,,,,,,,fee schedule,4224,54635.78,APC Evasc ven artlz tibl/prnl vn,0620T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52034.08,,,,,,,fee schedule,4224,54635.78,APC Trabeculostomy interno laser,0621T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Trabeculostomy interno laser,0621T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Trabeculostomy interno laser,0621T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4224,6253,APC Trabeculostomy interno laser,0621T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4224,6253,APC Trabeculostomy interno laser,0621T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4224,6253,APC Trabeculostomy int lsr w/scp,0622T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Trabeculostomy int lsr w/scp,0622T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Perq njx algc fluor lmbr 1st,0627T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,15925.26, Perq njx algc fluor lmbr 1st,0627T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,15925.26, Perq njx algc fluor lmbr 1st,0627T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,1544,15925.26,APC Perq njx algc fluor lmbr 1st,0627T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,1544,15925.26,APC Perq njx algc fluor lmbr 1st,0627T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,1544,15925.26,APC Perq njx algc fluor lmbr ea,0628T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Perq njx algc fluor lmbr ea,0628T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Perq njx algc ct lmbr 1st,0629T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,15925.26, Perq njx algc ct lmbr 1st,0629T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,15925.26, Perq njx algc ct lmbr 1st,0629T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,1544,15925.26,APC Perq njx algc ct lmbr 1st,0629T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,1544,15925.26,APC Perq njx algc ct lmbr 1st,0629T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,1544,15925.26,APC Perq njx algc ct lmbr ea,0630T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Perq njx algc ct lmbr ea,0630T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Perq tcat us abltj nrv p-art,0632T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,22738.78, Perq tcat us abltj nrv p-art,0632T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,22738.78, Perq tcat us abltj nrv p-art,0632T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4147,22738.78,APC Perq tcat us abltj nrv p-art,0632T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4147,22738.78,APC Perq tcat us abltj nrv p-art,0632T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4147,22738.78,APC Ct breast w/3d uni c-,0633T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Ct breast w/3d uni c-,0633T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Ct breast w/3d uni c-,0633T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Ct breast w/3d uni c+,0634T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,217.57,APC Ct breast w/3d uni c+,0634T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,217.57,APC Ct breast w/3d uni c+,0634T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,217.57,APC Ct breast w/3d uni c-/c+,0635T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,217.57,APC Ct breast w/3d uni c-/c+,0635T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,217.57,APC Ct breast w/3d uni c-/c+,0635T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,217.57,APC Ct breast w/3d bi c-,0636T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Ct breast w/3d bi c-,0636T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Ct breast w/3d bi c-,0636T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Ct breast w/3d bi c+,0637T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,432.75,APC Ct breast w/3d bi c+,0637T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,432.75,APC Ct breast w/3d bi c+,0637T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,432.75,APC Ct breast w/3d bi c-/c+,0638T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,432.75,APC Ct breast w/3d bi c-/c+,0638T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,432.75,APC Ct breast w/3d bi c-/c+,0638T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,432.75,APC Wrls skn snr anisotropy meas,0639T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Wrls skn snr anisotropy meas,0639T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Ncntc nr ifr spctrsc wnd,0640T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Ncntc nr ifr spctrsc wnd,0640T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Ncntc nr ifr spctrsc wnd,0640T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Tcat rmvl/dblk icar mas perq,0644T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,7059.88, Tcat rmvl/dblk icar mas perq,0644T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,7059.88, Tcat rmvl/dblk icar mas perq,0644T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4147,7059.88,APC Tcat rmvl/dblk icar mas perq,0644T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4147,7059.88,APC Tcat rmvl/dblk icar mas perq,0644T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4147,7059.88,APC Tcat impltj c sins rdctj dev,0645T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,22738.78, Tcat impltj c sins rdctj dev,0645T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,22738.78, Tcat impltj c sins rdctj dev,0645T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,22738.78,APC Tcat impltj c sins rdctj dev,0645T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,22738.78,APC Tcat impltj c sins rdctj dev,0645T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,22738.78,APC Insj gtube perq mag gastrpxy,0647T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2266.89,9918, Insj gtube perq mag gastrpxy,0647T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2266.89,9918, Insj gtube perq mag gastrpxy,0647T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2266.89,9918, Insj gtube perq mag gastrpxy,0647T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2266.89,9918, Insj gtube perq mag gastrpxy,0647T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,9918,APC Insj gtube perq mag gastrpxy,0647T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,9918,APC Insj gtube perq mag gastrpxy,0647T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,9918,APC Mag ctrld capsule endoscopy,0651T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1071.46,7422, Mag ctrld capsule endoscopy,0651T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1071.46,7422, Mag ctrld capsule endoscopy,0651T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1071.46,7422, Mag ctrld capsule endoscopy,0651T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1071.46,7422, Mag ctrld capsule endoscopy,0651T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,7422,APC Mag ctrld capsule endoscopy,0651T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,7422,APC Mag ctrld capsule endoscopy,0651T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,7422,APC Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,7422,APC Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,7422,APC Egd flx transnasal dx br/wa,0652T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,7422,APC Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,7422, Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,7422, Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2266.89,7422, Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2266.89,7422, Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,7422,APC Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,7422,APC Egd flx transnasal bx 1/ml,0653T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,7422,APC Egd flx transnasal tube/cath,0654T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Egd flx transnasal tube/cath,0654T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Egd flx transnasal tube/cath,0654T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Egd flx transnasal tube/cath,0654T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Egd flx transnasal tube/cath,0654T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,2816,9918,APC Egd flx transnasal tube/cath,0654T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,2816,9918,APC Egd flx transnasal tube/cath,0654T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,2816,9918,APC Tprnl focal abltj mal prst8,0655T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Tprnl focal abltj mal prst8,0655T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Tprnl focal abltj mal prst8,0655T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Tprnl focal abltj mal prst8,0655T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Tprnl focal abltj mal prst8,0655T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,13320,APC Tprnl focal abltj mal prst8,0655T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,13320,APC Tprnl focal abltj mal prst8,0655T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,13320,APC Vrt bdy tethering ant,0656T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Vrt bdy tethering ant,0656T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Vrt bdy tethering ant,0656T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Vrt bdy tethering ant,0656T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Vrt bdy tethering ant,0656T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Vrt bdy tethering ant 8+ seg,0657T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Vrt bdy tethering ant 8+ seg,0657T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Vrt bdy tethering ant 8+ seg,0657T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Vrt bdy tethering ant 8+ seg,0657T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Vrt bdy tethering ant 8+ seg,0657T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Elec impd spectrsc 1+skn les,0658T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Elec impd spectrsc 1+skn les,0658T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Elec impd spectrsc 1+skn les,0658T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Elec impd spectrsc 1+skn les,0658T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Elec impd spectrsc 1+skn les,0658T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Elec impd spectrsc 1+skn les,0658T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Elec impd spectrsc 1+skn les,0658T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Implt ant sgm io nbio rx sys,0660T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9701, Implt ant sgm io nbio rx sys,0660T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9701, Implt ant sgm io nbio rx sys,0660T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,3408,9701, Implt ant sgm io nbio rx sys,0660T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,3408,9701, Implt ant sgm io nbio rx sys,0660T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3408,9701,APC Implt ant sgm io nbio rx sys,0660T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3408,9701,APC Implt ant sgm io nbio rx sys,0660T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3408,9701,APC Rmvl&Rimpltj ant sgm implt,0661T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9701, Rmvl&Rimpltj ant sgm implt,0661T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9701, Rmvl&Rimpltj ant sgm implt,0661T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,3408,9701, Rmvl&Rimpltj ant sgm implt,0661T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,3408,9701, Rmvl&Rimpltj ant sgm implt,0661T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3408,9701,APC Rmvl&Rimpltj ant sgm implt,0661T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3408,9701,APC Rmvl&Rimpltj ant sgm implt,0661T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3408,9701,APC Scalp cool 1st meas&calbrj,0662T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Scalp cool 1st meas&calbrj,0662T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Scalp cool 1st meas&calbrj,0662T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Scalp cool 1st meas&calbrj,0662T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Don hysterectomy open cdvr,0664T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Don hysterectomy open cdvr,0664T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Don hysterectomy open liv,0665T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Don hysterectomy open liv,0665T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Don hysterectomy laps liv,0666T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,3972, Don hysterectomy laps liv,0666T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,3972, Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,13320, Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,13320, Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3408,13320,APC Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3408,13320,APC Insj ant sgm aq drg dev 1+,0671T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3408,13320,APC Ndovag cryg rf remdl tiss,0672T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Ndovag cryg rf remdl tiss,0672T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Abltj b9 thyr ndul perq lasr,0673T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9918, Abltj b9 thyr ndul perq lasr,0673T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9918, Abltj b9 thyr ndul perq lasr,0673T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,9918, Abltj b9 thyr ndul perq lasr,0673T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,9918, Abltj b9 thyr ndul perq lasr,0673T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,9918,APC Abltj b9 thyr ndul perq lasr,0673T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,9918,APC Abltj b9 thyr ndul perq lasr,0673T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,9918,APC Laps insj nw/rpcmt prm isdss,0674T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38276.26, Laps insj nw/rpcmt prm isdss,0674T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38276.26, Laps insj nw/rpcmt prm isdss,0674T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,3408,38276.26,APC Laps insj nw/rpcmt prm isdss,0674T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,3408,38276.26,APC Laps insj nw/rpcmt prm isdss,0674T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,3408,38276.26,APC Laps insj nw/rpcmt isdss 1ld,0675T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13821.53, Laps insj nw/rpcmt isdss 1ld,0675T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13821.53, Laps insj nw/rpcmt isdss 1ld,0675T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,3408,13821.53,APC Laps insj nw/rpcmt isdss 1ld,0675T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,3408,13821.53,APC Laps insj nw/rpcmt isdss 1ld,0675T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,3408,13821.53,APC Laps insj nw/rpcmt isdss ea,0676T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Laps insj nw/rpcmt isdss ea,0676T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Laps repos lead isdss 1st ld,0677T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13185.37, Laps repos lead isdss 1st ld,0677T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13185.37, Laps repos lead isdss 1st ld,0677T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,2816,13185.37,APC Laps repos lead isdss 1st ld,0677T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,2816,13185.37,APC Laps repos lead isdss 1st ld,0677T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,2816,13185.37,APC Laps repos lead isdss ea add,0678T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Laps repos lead isdss ea add,0678T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Laps rmvl lead isdss,0679T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13185.37, Laps rmvl lead isdss,0679T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13185.37, Laps rmvl lead isdss,0679T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,2816,13185.37,APC Laps rmvl lead isdss,0679T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,2816,13185.37,APC Laps rmvl lead isdss,0679T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,2816,13185.37,APC Insj/rplcmt pg only isdss,0680T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,24064.14, Insj/rplcmt pg only isdss,0680T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,24064.14, Insj/rplcmt pg only isdss,0680T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23834.95,,,,,,,fee schedule,3408,24064.14,APC Insj/rplcmt pg only isdss,0680T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24064.14,,,,,,,fee schedule,3408,24064.14,APC Insj/rplcmt pg only isdss,0680T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22918.22,,,,,,,fee schedule,3408,24064.14,APC Rlcj pulse gen only isdss,0681T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4336.61, Rlcj pulse gen only isdss,0681T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4336.61, Rlcj pulse gen only isdss,0681T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,4336.61,APC Rlcj pulse gen only isdss,0681T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,4336.61,APC Rlcj pulse gen only isdss,0681T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,4336.61,APC Removal pulse gen only isdss,0682T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4336.61, Removal pulse gen only isdss,0682T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4336.61, Removal pulse gen only isdss,0682T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,4336.61,APC Removal pulse gen only isdss,0682T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,4336.61,APC Removal pulse gen only isdss,0682T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,4336.61,APC Histotripsy mal hepatcel tis,0686T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,21247.62, Histotripsy mal hepatcel tis,0686T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,21247.62, Histotripsy mal hepatcel tis,0686T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21045.26,,,,,,,fee schedule,4224,21247.62,APC Histotripsy mal hepatcel tis,0686T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21247.62,,,,,,,fee schedule,4224,21247.62,APC Histotripsy mal hepatcel tis,0686T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20235.83,,,,,,,fee schedule,4224,21247.62,APC Quan us tis charac w/o dx us,0689T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.36,,,,,,,fee schedule,102.81,736.04, Quan us tis charac w/o dx us,0689T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.04,,,,,,,fee schedule,102.81,736.04, Quan us tis charac w/o dx us,0689T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,736.04,APC Quan us tis charac w/o dx us,0689T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,736.04,APC Quan us tis charac w/o dx us,0689T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,736.04,APC Therapeutic ultrafiltration,0692T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,1931.85, Therapeutic ultrafiltration,0692T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,1931.85, Therapeutic ultrafiltration,0692T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,855,1931.85,APC Therapeutic ultrafiltration,0692T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,855,1931.85,APC Therapeutic ultrafiltration,0692T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,855,1931.85,APC Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,13320, Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,13320, Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,13320, Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,13320, Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1406,13320, Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1406,13320, Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1406,13320,APC Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1406,13320,APC Njx pst chmbr eye medication,0699T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1406,13320,APC Njx b1 sub mtrl sbchdrl dfct,0707T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Njx b1 sub mtrl sbchdrl dfct,0707T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Njx b1 sub mtrl sbchdrl dfct,0707T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Njx b1 sub mtrl sbchdrl dfct,0707T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Njx b1 sub mtrl sbchdrl dfct,0707T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,13320,APC Njx b1 sub mtrl sbchdrl dfct,0707T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,13320,APC Njx b1 sub mtrl sbchdrl dfct,0707T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,13320,APC N-nvs artl plaq alys quan,0712T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC N-nvs artl plaq alys quan,0712T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC N-nvs artl plaq alys quan,0712T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Tprnl lsr ablt b9 prst8 hypr,0714T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6650.84, Tprnl lsr ablt b9 prst8 hypr,0714T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6650.84, Tprnl lsr ablt b9 prst8 hypr,0714T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,6650.84,APC Tprnl lsr ablt b9 prst8 hypr,0714T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,6650.84,APC Tprnl lsr ablt b9 prst8 hypr,0714T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,6650.84,APC Car acous wavfrm rec cad rsk,0716T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Car acous wavfrm rec cad rsk,0716T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Car acous wavfrm rec cad rsk,0716T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Adrc ther prtl rc tear,0717T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Adrc ther prtl rc tear,0717T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Adrc ther prtl rc tear,0717T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,5044,APC Adrc ther prtl rc tear,0717T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,5044,APC Adrc ther prtl rc tear,0717T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,5044,APC Adrc ther prtl rc tear njx,0718T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4395.68, Adrc ther prtl rc tear njx,0718T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4395.68, Adrc ther prtl rc tear njx,0718T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,1544,4395.68,APC Adrc ther prtl rc tear njx,0718T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,1544,4395.68,APC Adrc ther prtl rc tear njx,0718T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,1544,4395.68,APC Pst vrt jt rplcmt lmbr 1 sgm,0719T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,4311, Pst vrt jt rplcmt lmbr 1 sgm,0719T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,4311, Vestibular dev impltj uni,0725T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Vestibular dev impltj uni,0725T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Rmvl implt vstibular dev uni,0726T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Rmvl implt vstibular dev uni,0726T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Rmvl&rplcmt implt vstblr dev,0727T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Rmvl&rplcmt implt vstblr dev,0727T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Trabeculotomy lsr w/oct gdn,0730T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Trabeculotomy lsr w/oct gdn,0730T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Augmnt ai-based fcl phnt a/r,0731T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Augmnt ai-based fcl phnt a/r,0731T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Augmnt ai-based fcl phnt a/r,0731T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Prep tum cav iort prim crnot,0735T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Prep tum cav iort prim crnot,0735T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Colonic lavage 35+l water,0736T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,152.01,1866, Colonic lavage 35+l water,0736T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,152.01,1866, Colonic lavage 35+l water,0736T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,1866,APC Colonic lavage 35+l water,0736T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,1866,APC Colonic lavage 35+l water,0736T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,1866,APC Xenograft impltj artclr surf,0737T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15925.26, Xenograft impltj artclr surf,0737T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15925.26, Xenograft impltj artclr surf,0737T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,2816,15925.26,APC Xenograft impltj artclr surf,0737T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,2816,15925.26,APC Xenograft impltj artclr surf,0737T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,2816,15925.26,APC Abltj mal prst8 mag fld ndct,0739T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Abltj mal prst8 mag fld ndct,0739T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Rem auton alg nsln cal setup,0740T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Rem auton alg nsln cal setup,0740T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Rem auton alg nsln cal setup,0740T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC B1 str & fx rsk vrt fx assmt,0743T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC B1 str & fx rsk vrt fx assmt,0743T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC B1 str & fx rsk vrt fx assmt,0743T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Insj bioprostc vlv fem vn,0744T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Insj bioprostc vlv fem vn,0744T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Insj bioprostc vlv fem vn,0744T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Insj bioprostc vlv fem vn,0744T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Insj bioprostc vlv fem vn,0744T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3560,18617,APC Insj bioprostc vlv fem vn,0744T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3560,18617,APC Insj bioprostc vlv fem vn,0744T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3560,18617,APC Njx stm cl prdct anl sft tis,0748T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Njx stm cl prdct anl sft tis,0748T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Asstv alg ecg rsk asmt cncrt,0764T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Asstv alg ecg rsk asmt cncrt,0764T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Asstv alg ecg rsk asmt cncrt,0764T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Asstv alg ecg rsk asmt prev,0765T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Asstv alg ecg rsk asmt prev,0765T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Asstv alg ecg rsk asmt prev,0765T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Tc mag stimj pn 1st tx 1nrv,0766T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Tc mag stimj pn 1st tx 1nrv,0766T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Tc mag stimj pn 1st tx 1nrv,0766T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC R-t prs sensing edrl gdn sys,0777T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, R-t prs sensing edrl gdn sys,0777T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Smmg cncrnt appl imu snr,0778T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Smmg cncrnt appl imu snr,0778T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Smmg cncrnt appl imu snr,0778T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Gi myoelectrical actv study,0779T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,462.87,APC Gi myoelectrical actv study,0779T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,462.87,APC Gi myoelectrical actv study,0779T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,462.87,APC Instlj fecal microbiota ssp,0780T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,1866, Instlj fecal microbiota ssp,0780T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,1866, Instlj fecal microbiota ssp,0780T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,1866,APC Instlj fecal microbiota ssp,0780T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,1866,APC Instlj fecal microbiota ssp,0780T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,1866,APC Brnchsc rf dstrj pulm nrv bi,0781T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Brnchsc rf dstrj pulm nrv bi,0781T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Brnchsc rf dstrj pulm nrv bi,0781T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Brnchsc rf dstrj pulm nrv bi,0781T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Brnchsc rf dstrj plm nrv uni,0782T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Brnchsc rf dstrj plm nrv uni,0782T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Brnchsc rf dstrj plm nrv uni,0782T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Brnchsc rf dstrj plm nrv uni,0782T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Tc auriculr neurostimulation,0783T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Tc auriculr neurostimulation,0783T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Tc auriculr neurostimulation,0783T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Ins/rplmt eltrd ra spi nstim,0784T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Ins/rplmt eltrd ra spi nstim,0784T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Ins/rplmt eltrd ra spi nstim,0784T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Ins/rplmt eltrd ra spi nstim,0784T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Ins/rplmt eltrd ra spi nstim,0784T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,3408,18617,APC Ins/rplmt eltrd ra spi nstim,0784T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,3408,18617,APC Ins/rplmt eltrd ra spi nstim,0784T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,3408,18617,APC Revj/rmvl nea spi w/nstim,0785T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Revj/rmvl nea spi w/nstim,0785T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Revj/rmvl nea spi w/nstim,0785T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Revj/rmvl nea spi w/nstim,0785T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Revj/rmvl nea spi w/nstim,0785T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,13320,APC Revj/rmvl nea spi w/nstim,0785T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,13320,APC Revj/rmvl nea spi w/nstim,0785T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,13320,APC Insj/rplcmt prq ra sac nstim,0786T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Insj/rplcmt prq ra sac nstim,0786T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Insj/rplcmt prq ra sac nstim,0786T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Insj/rplcmt prq ra sac nstim,0786T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Insj/rplcmt prq ra sac nstim,0786T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,3408,18617,APC Insj/rplcmt prq ra sac nstim,0786T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,3408,18617,APC Insj/rplcmt prq ra sac nstim,0786T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,3408,18617,APC Revj/rmvl nea sac w/nstim,0787T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Revj/rmvl nea sac w/nstim,0787T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Revj/rmvl nea sac w/nstim,0787T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Revj/rmvl nea sac w/nstim,0787T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Revj/rmvl nea sac w/nstim,0787T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,13320,APC Revj/rmvl nea sac w/nstim,0787T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,13320,APC Revj/rmvl nea sac w/nstim,0787T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,13320,APC Revj rplcmt/rmvl vrt tethrg,0790T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21749.16, Revj rplcmt/rmvl vrt tethrg,0790T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21749.16, Revj rplcmt/rmvl vrt tethrg,0790T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21749.16, Revj rplcmt/rmvl vrt tethrg,0790T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21749.16, Revj rplcmt/rmvl vrt tethrg,0790T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1406,21749.16,APC Revj rplcmt/rmvl vrt tethrg,0790T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1406,21749.16,APC Revj rplcmt/rmvl vrt tethrg,0790T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1406,21749.16,APC Prq tcat thrm ablt nrv p-art,0793T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,22738.78, Prq tcat thrm ablt nrv p-art,0793T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,22738.78, Prq tcat thrm ablt nrv p-art,0793T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,22738.78, Prq tcat thrm ablt nrv p-art,0793T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,22738.78, Prq tcat thrm ablt nrv p-art,0793T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4147,22738.78,APC Prq tcat thrm ablt nrv p-art,0793T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4147,22738.78,APC Prq tcat thrm ablt nrv p-art,0793T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4147,22738.78,APC Pt spec alg rx-onc tx option,0794T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Pt spec alg rx-onc tx option,0794T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Pt spec alg rx-onc tx option,0794T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Tcat ins 2chmbr ldls pm cmpl,0795T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,23892.44, Tcat ins 2chmbr ldls pm cmpl,0795T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,23892.44, Tcat ins 2chmbr ldls pm cmpl,0795T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,3560,23892.44,APC Tcat ins 2chmbr ldls pm cmpl,0795T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,3560,23892.44,APC Tcat ins 2chmbr ldls pm cmpl,0795T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,3560,23892.44,APC Tcat ins 2chmbr ldls pm ra,0796T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,27591.2, Tcat ins 2chmbr ldls pm ra,0796T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,27591.2, Tcat ins 2chmbr ldls pm ra,0796T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,4224,27591.2,APC Tcat ins 2chmbr ldls pm ra,0796T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,4224,27591.2,APC Tcat ins 2chmbr ldls pm ra,0796T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,4224,27591.2,APC Tcat ins 2chmbr ldls pm rv,0797T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,23892.44, Tcat ins 2chmbr ldls pm rv,0797T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,23892.44, Tcat ins 2chmbr ldls pm rv,0797T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,23892.44, Tcat ins 2chmbr ldls pm rv,0797T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,23892.44, Tcat ins 2chmbr ldls pm rv,0797T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,4224,23892.44,APC Tcat ins 2chmbr ldls pm rv,0797T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,4224,23892.44,APC Tcat ins 2chmbr ldls pm rv,0797T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,4224,23892.44,APC Tcat rmv 2chmbr ldls pm cmpl,0798T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Tcat rmv 2chmbr ldls pm cmpl,0798T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Tcat rmv 2chmbr ldls pm cmpl,0798T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Tcat rmv 2chmbr ldls pm cmpl,0798T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Tcat rmv 2chmbr ldls pm cmpl,0798T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3291,13320,APC Tcat rmv 2chmbr ldls pm cmpl,0798T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3291,13320,APC Tcat rmv 2chmbr ldls pm cmpl,0798T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3291,13320,APC Tcat rmvl 2chmbr ldls pm ra,0799T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm ra,0799T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm ra,0799T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm ra,0799T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm ra,0799T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,13320,APC Tcat rmvl 2chmbr ldls pm ra,0799T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,13320,APC Tcat rmvl 2chmbr ldls pm ra,0799T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,13320,APC Tcat rmvl 2chmbr ldls pm rv,0800T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm rv,0800T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm rv,0800T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm rv,0800T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3730.07,13320, Tcat rmvl 2chmbr ldls pm rv,0800T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,13320,APC Tcat rmvl 2chmbr ldls pm rv,0800T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,13320,APC Tcat rmvl 2chmbr ldls pm rv,0800T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,13320,APC Tcat rmv&rpl 2chmbr ldls pm,0801T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,23892.44, Tcat rmv&rpl 2chmbr ldls pm,0801T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,23892.44, Tcat rmv&rpl 2chmbr ldls pm,0801T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,4147,23892.44,APC Tcat rmv&rpl 2chmbr ldls pm,0801T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,4147,23892.44,APC Tcat rmv&rpl 2chmbr ldls pm,0801T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,4147,23892.44,APC Tcat rmv&rpl2chmb ldls pm ra,0802T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,23892.44, Tcat rmv&rpl2chmb ldls pm ra,0802T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,23892.44, Tcat rmv&rpl2chmb ldls pm ra,0802T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,3291,23892.44,APC Tcat rmv&rpl2chmb ldls pm ra,0802T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,3291,23892.44,APC Tcat rmv&rpl2chmb ldls pm ra,0802T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,3291,23892.44,APC Tcat rmv&rpl2chmb ldls pm rv,0803T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,23892.44, Tcat rmv&rpl2chmb ldls pm rv,0803T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,23892.44, Tcat rmv&rpl2chmb ldls pm rv,0803T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,23892.44, Tcat rmv&rpl2chmb ldls pm rv,0803T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,23892.44, Tcat rmv&rpl2chmb ldls pm rv,0803T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,3291,23892.44,APC Tcat rmv&rpl2chmb ldls pm rv,0803T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,3291,23892.44,APC Tcat rmv&rpl2chmb ldls pm rv,0803T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,3291,23892.44,APC Tcat s&ivc prstc vl impl prq,0805T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,4311, Tcat s&ivc prstc vl impl prq,0805T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,4311, Tcat s&ivc prstc vl impl opn,0806T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,4311, Tcat s&ivc prstc vl impl opn,0806T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,4311, Pulm tiss vntj alys prev ct,0807T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Pulm tiss vntj alys prev ct,0807T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Pulm tiss vntj alys prev ct,0807T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Pulm tiss vntj alys w/ct,0808T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Pulm tiss vntj alys w/ct,0808T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Pulm tiss vntj alys w/ct,0808T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Subrta njx rx agt w/vtrc,0810T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Subrta njx rx agt w/vtrc,0810T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Subrta njx rx agt w/vtrc,0810T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Subrta njx rx agt w/vtrc,0810T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Subrta njx rx agt w/vtrc,0810T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5111.45,,,,,,,fee schedule,3291,13320,APC Subrta njx rx agt w/vtrc,0810T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5160.6,,,,,,,fee schedule,3291,13320,APC Subrta njx rx agt w/vtrc,0810T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4914.85,,,,,,,fee schedule,3291,13320,APC Rem mlt day uroflow setup,0811T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Rem mlt day uroflow setup,0811T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Rem mlt day uroflow setup,0811T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Rem mlt day uroflow dev sply,0812T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Rem mlt day uroflow dev sply,0812T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Rem mlt day uroflow dev sply,0812T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Egd vol adjmt bariatric balo,0813T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,7422, Egd vol adjmt bariatric balo,0813T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,7422, Egd vol adjmt bariatric balo,0813T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1071.46,7422, Egd vol adjmt bariatric balo,0813T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1071.46,7422, Egd vol adjmt bariatric balo,0813T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,7422,APC Egd vol adjmt bariatric balo,0813T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,7422,APC Egd vol adjmt bariatric balo,0813T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,7422,APC Prq njx biod osteo matrl fem,0814T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Prq njx biod osteo matrl fem,0814T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Prq njx biod osteo matrl fem,0814T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Prq njx biod osteo matrl fem,0814T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Opn insj/rplcmt ins ptn subq,0816T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subq,0816T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subq,0816T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subq,0816T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subq,0816T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23834.95,,,,,,,fee schedule,2816,24064.14,APC Opn insj/rplcmt ins ptn subq,0816T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24064.14,,,,,,,fee schedule,2816,24064.14,APC Opn insj/rplcmt ins ptn subq,0816T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22918.22,,,,,,,fee schedule,2816,24064.14,APC Opn insj/rplcmt ins ptn subf,0817T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subf,0817T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subf,0817T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subf,0817T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,24064.14, Opn insj/rplcmt ins ptn subf,0817T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23834.95,,,,,,,fee schedule,2816,24064.14,APC Opn insj/rplcmt ins ptn subf,0817T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24064.14,,,,,,,fee schedule,2816,24064.14,APC Opn insj/rplcmt ins ptn subf,0817T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22918.22,,,,,,,fee schedule,2816,24064.14,APC Revj/rmvl ins ptn subq,0818T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subq,0818T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subq,0818T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subq,0818T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subq,0818T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,13320,APC Revj/rmvl ins ptn subq,0818T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,13320,APC Revj/rmvl ins ptn subq,0818T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,13320,APC Revj/rmvl ins ptn subf,0819T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subf,0819T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subf,0819T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subf,0819T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Revj/rmvl ins ptn subf,0819T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,13320,APC Revj/rmvl ins ptn subf,0819T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,13320,APC Revj/rmvl ins ptn subf,0819T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,13320,APC Tcat ins 1chmbr ldls pm ra,0823T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,27591.2, Tcat ins 1chmbr ldls pm ra,0823T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,27591.2, Tcat ins 1chmbr ldls pm ra,0823T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,27591.2, Tcat ins 1chmbr ldls pm ra,0823T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,27591.2, Tcat ins 1chmbr ldls pm ra,0823T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,3560,27591.2,APC Tcat ins 1chmbr ldls pm ra,0823T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,3560,27591.2,APC Tcat ins 1chmbr ldls pm ra,0823T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,3560,27591.2,APC Tcat rmv 1chmbr ldls pm ra,0824T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,13320, Tcat rmv 1chmbr ldls pm ra,0824T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,13320, Tcat rmv 1chmbr ldls pm ra,0824T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3730.07,13320, Tcat rmv 1chmbr ldls pm ra,0824T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3730.07,13320, Tcat rmv 1chmbr ldls pm ra,0824T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,13320,APC Tcat rmv 1chmbr ldls pm ra,0824T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,13320,APC Tcat rmv 1chmbr ldls pm ra,0824T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,13320,APC Tcat rmv&rpl1chmb ldls pm ra,0825T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,23892.44, Tcat rmv&rpl1chmb ldls pm ra,0825T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,23892.44, Tcat rmv&rpl1chmb ldls pm ra,0825T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,23892.44, Tcat rmv&rpl1chmb ldls pm ra,0825T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,23892.44, Tcat rmv&rpl1chmb ldls pm ra,0825T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,3560,23892.44,APC Tcat rmv&rpl1chmb ldls pm ra,0825T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,3560,23892.44,APC Tcat rmv&rpl1chmb ldls pm ra,0825T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,3560,23892.44,APC Opto-acoustic img breast uni,0857T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,742.09,,,,,,,fee schedule,123.5,890.51, Opto-acoustic img breast uni,0857T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,890.51,,,,,,,fee schedule,123.5,890.51, Opto-acoustic img breast uni,0857T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,890.51,APC Opto-acoustic img breast uni,0857T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,890.51,APC Opto-acoustic img breast uni,0857T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,890.51,APC Rmvl pg wcs lv both compnt,0861T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rmvl pg wcs lv both compnt,0861T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rmvl pg wcs lv both compnt,0861T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rmvl pg wcs lv both compnt,0861T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Rmvl pg wcs lv both compnt,0861T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,13320,APC Rmvl pg wcs lv both compnt,0861T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,13320,APC Rmvl pg wcs lv both compnt,0861T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,13320,APC Rlcj pg wcs lv battery only,0862T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv battery only,0862T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv battery only,0862T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv battery only,0862T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv battery only,0862T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,13320,APC Rlcj pg wcs lv battery only,0862T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,13320,APC Rlcj pg wcs lv battery only,0862T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,13320,APC Rlcj pg wcs lv trnsmtr only,0863T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv trnsmtr only,0863T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv trnsmtr only,0863T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv trnsmtr only,0863T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2437.45,13320, Rlcj pg wcs lv trnsmtr only,0863T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,13320,APC Rlcj pg wcs lv trnsmtr only,0863T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,13320,APC Rlcj pg wcs lv trnsmtr only,0863T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,13320,APC Low ntsty eswt corpus cvrnsm,0864T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,18617, Low ntsty eswt corpus cvrnsm,0864T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,18617, Low ntsty eswt corpus cvrnsm,0864T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Low ntsty eswt corpus cvrnsm,0864T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Low ntsty eswt corpus cvrnsm,0864T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Low ntsty eswt corpus cvrnsm,0864T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Low ntsty eswt corpus cvrnsm,0864T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Quan mri alys brn w/o dx mri,0865T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Quan mri alys brn w/o dx mri,0865T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Quan mri alys brn w/o dx mri,0865T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Quan mri alys brn w/dx mri,0866T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Quan mri alys brn w/dx mri,0866T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Quan mri alys brn w/dx mri,0866T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Tpla b9 prst8 hyprplsa>=50ml,0867T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6650.84, Tpla b9 prst8 hyprplsa>=50ml,0867T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6650.84, Tpla b9 prst8 hyprplsa>=50ml,0867T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,6650.84,APC Tpla b9 prst8 hyprplsa>=50ml,0867T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,6650.84,APC Tpla b9 prst8 hyprplsa>=50ml,0867T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,6650.84,APC Hi-res gastric ep mapping,0868T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,462.87,APC Hi-res gastric ep mapping,0868T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,462.87,APC Hi-res gastric ep mapping,0868T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,462.87,APC Njx b1 sub mtrl hw fixj aug,0869T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Njx b1 sub mtrl hw fixj aug,0869T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Njx b1 sub mtrl hw fixj aug,0869T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4166,APC Njx b1 sub mtrl hw fixj aug,0869T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4166,APC Njx b1 sub mtrl hw fixj aug,0869T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4166,APC Imp subq prtl ascts pmp sys,0870T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,42494.63, Imp subq prtl ascts pmp sys,0870T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,42494.63, Imp subq prtl ascts pmp sys,0870T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42089.92,,,,,,,fee schedule,2816,42494.63,APC Imp subq prtl ascts pmp sys,0870T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42494.63,,,,,,,fee schedule,2816,42494.63,APC Imp subq prtl ascts pmp sys,0870T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40471.08,,,,,,,fee schedule,2816,42494.63,APC Rplcmt subq prtl ascites pmp,0871T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,33388.77, Rplcmt subq prtl ascites pmp,0871T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,33388.77, Rplcmt subq prtl ascites pmp,0871T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33070.78,,,,,,,fee schedule,2816,33388.77,APC Rplcmt subq prtl ascites pmp,0871T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33388.77,,,,,,,fee schedule,2816,33388.77,APC Rplcmt subq prtl ascites pmp,0871T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31798.83,,,,,,,fee schedule,2816,33388.77,APC Rplcmt ndwllg bldr&prtl cath,0872T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4441.17, Rplcmt ndwllg bldr&prtl cath,0872T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4441.17, Rplcmt ndwllg bldr&prtl cath,0872T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,2816,4441.17,APC Rplcmt ndwllg bldr&prtl cath,0872T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,2816,4441.17,APC Rplcmt ndwllg bldr&prtl cath,0872T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,2816,4441.17,APC Revj subq prtl asct pmp sys,0873T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4441.17, Revj subq prtl asct pmp sys,0873T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4441.17, Revj subq prtl asct pmp sys,0873T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,2816,4441.17,APC Revj subq prtl asct pmp sys,0873T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,2816,4441.17,APC Revj subq prtl asct pmp sys,0873T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,2816,4441.17,APC Rmvl pertl ascites pmp sys,0874T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4441.17, Rmvl pertl ascites pmp sys,0874T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4441.17, Rmvl pertl ascites pmp sys,0874T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,1544,4441.17,APC Rmvl pertl ascites pmp sys,0874T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,1544,4441.17,APC Rmvl pertl ascites pmp sys,0874T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,1544,4441.17,APC Intraop ther estim pn ue 1st,0882T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Intraop ther estim pn ue 1st,0882T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Intraop ther estim pn ue ea,0883T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Intraop ther estim pn ue ea,0883T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Esphgsc flx 1st tndsc dilat,0884T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,7530.41, Esphgsc flx 1st tndsc dilat,0884T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,7530.41, Esphgsc flx 1st tndsc dilat,0884T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3408,7530.41,APC Esphgsc flx 1st tndsc dilat,0884T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3408,7530.41,APC Esphgsc flx 1st tndsc dilat,0884T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3408,7530.41,APC Colsc flx 1st tndsc dilat,0885T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,7530.41, Colsc flx 1st tndsc dilat,0885T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,7530.41, Colsc flx 1st tndsc dilat,0885T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3408,7530.41,APC Colsc flx 1st tndsc dilat,0885T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3408,7530.41,APC Colsc flx 1st tndsc dilat,0885T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3408,7530.41,APC Sgmdsc flx 1st tndsc dilat,0886T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,7530.41, Sgmdsc flx 1st tndsc dilat,0886T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,7530.41, Sgmdsc flx 1st tndsc dilat,0886T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,2816,7530.41,APC Sgmdsc flx 1st tndsc dilat,0886T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,2816,7530.41,APC Sgmdsc flx 1st tndsc dilat,0886T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,2816,7530.41,APC Histotripsy mal renal tissue,0888T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,21247.62, Histotripsy mal renal tissue,0888T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,21247.62, Histotripsy mal renal tissue,0888T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21045.26,,,,,,,fee schedule,4224,21247.62,APC Histotripsy mal renal tissue,0888T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21247.62,,,,,,,fee schedule,4224,21247.62,APC Histotripsy mal renal tissue,0888T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20235.83,,,,,,,fee schedule,4224,21247.62,APC N-invas assmt bld oxygnation,0893T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC N-invas assmt bld oxygnation,0893T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC N-invas assmt bld oxygnation,0893T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC N-invas augmnt arrhyt alys,0897T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1065.19,APC N-invas augmnt arrhyt alys,0897T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1065.19,APC N-invas augmnt arrhyt alys,0897T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1065.19,APC N-invas prst8 cancer est map,0898T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1065.19,APC N-invas prst8 cancer est map,0898T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1065.19,APC N-invas prst8 cancer est map,0898T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1065.19,APC Plmt bone marrow smplg port,0901T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Plmt bone marrow smplg port,0901T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Plmt bone marrow smplg port,0901T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Plmt bone marrow smplg port,0901T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Qtc ntrvl augmnt alg aly ecg,0902T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Qtc ntrvl augmnt alg aly ecg,0902T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Qtc ntrvl augmnt alg aly ecg,0902T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Ecg alg 12 ld rdcd trcg only,0904T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Ecg alg 12 ld rdcd trcg only,0904T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Ecg alg 12 ld rdcd trcg only,0904T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Coms ther 1st appl<=50 sq cm,0906T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,248.87,APC Coms ther 1st appl<=50 sq cm,0906T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,248.87,APC Coms ther 1st appl<=50 sq cm,0906T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,248.87,APC Opn imp int nstm sys vgs nrv,0908T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,38276.26, Opn imp int nstm sys vgs nrv,0908T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,38276.26, Opn imp int nstm sys vgs nrv,0908T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,38276.26, Opn imp int nstm sys vgs nrv,0908T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,38276.26, Opn imp int nstm sys vgs nrv,0908T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,2816,38276.26,APC Opn imp int nstm sys vgs nrv,0908T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,2816,38276.26,APC Opn imp int nstm sys vgs nrv,0908T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,2816,38276.26,APC Rplcmt int nstim sys vgs nrv,0909T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,38276.26, Rplcmt int nstim sys vgs nrv,0909T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,38276.26, Rplcmt int nstim sys vgs nrv,0909T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,38276.26, Rplcmt int nstim sys vgs nrv,0909T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,38276.26, Rplcmt int nstim sys vgs nrv,0909T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,2816,38276.26,APC Rplcmt int nstim sys vgs nrv,0909T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,2816,38276.26,APC Rplcmt int nstim sys vgs nrv,0909T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,2816,38276.26,APC Rmvl int nstim sys vagus nrv,0910T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Rmvl int nstim sys vagus nrv,0910T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Rmvl int nstim sys vagus nrv,0910T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Rmvl int nstim sys vagus nrv,0910T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Rmvl int nstim sys vagus nrv,0910T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,18617,APC Rmvl int nstim sys vagus nrv,0910T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,18617,APC Rmvl int nstim sys vagus nrv,0910T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,18617,APC Elec aly nstm sys vgs nrv wo,0911T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Elec aly nstm sys vgs nrv wo,0911T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Elec aly nstm sys vgs nrv wo,0911T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Prq tcat ther rx ntrac balo1,0913T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Prq tcat ther rx ntrac balo1,0913T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Prq tcat ther rx ntrac balo1,0913T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Prq tcat ther rx ntrac balo1,0913T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Prq tcat ther rx ntrac balo1,0913T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,18617,APC Prq tcat ther rx ntrac balo1,0913T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,18617,APC Prq tcat ther rx ntrac balo1,0913T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,18617,APC Prq tcat thr rx ntrc bal sep,0914T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Prq tcat thr rx ntrc bal sep,0914T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insj perm ccm-d sys pg&eltrd,0915T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,38935.13, Insj perm ccm-d sys pg&eltrd,0915T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,38935.13, Insj perm ccm-d sys pg&eltrd,0915T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,38935.13, Insj perm ccm-d sys pg&eltrd,0915T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,38935.13, Insj perm ccm-d sys pg&eltrd,0915T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38564.32,,,,,,,fee schedule,4147,38935.13,APC Insj perm ccm-d sys pg&eltrd,0915T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38935.13,,,,,,,fee schedule,4147,38935.13,APC Insj perm ccm-d sys pg&eltrd,0915T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37081.07,,,,,,,fee schedule,4147,38935.13,APC Insj perm ccm-d sys pg only,0916T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,27591.2, Insj perm ccm-d sys pg only,0916T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,27591.2, Insj perm ccm-d sys pg only,0916T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,27591.2, Insj perm ccm-d sys pg only,0916T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,27591.2, Insj perm ccm-d sys pg only,0916T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,3408,27591.2,APC Insj perm ccm-d sys pg only,0916T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,3408,27591.2,APC Insj perm ccm-d sys pg only,0916T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,3408,27591.2,APC Insj perm ccm-d sys 1 lead,0917T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys 1 lead,0917T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys 1 lead,0917T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys 1 lead,0917T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys 1 lead,0917T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,18617,APC Insj perm ccm-d sys 1 lead,0917T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,18617,APC Insj perm ccm-d sys 1 lead,0917T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,18617,APC Insj perm ccm-d sys dual ld,0918T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys dual ld,0918T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys dual ld,0918T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys dual ld,0918T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Insj perm ccm-d sys dual ld,0918T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,18617,APC Insj perm ccm-d sys dual ld,0918T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,18617,APC Insj perm ccm-d sys dual ld,0918T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys pg only,0919T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys pg only,0919T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys pg only,0919T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys pg only,0919T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys pg only,0919T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys pg only,0919T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys pg only,0919T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys 1 pac ld,0920T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 pac ld,0920T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 pac ld,0920T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 pac ld,0920T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 pac ld,0920T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys 1 pac ld,0920T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys 1 pac ld,0920T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys 1 dfb ld,0921T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 dfb ld,0921T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 dfb ld,0921T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 dfb ld,0921T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys 1 dfb ld,0921T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys 1 dfb ld,0921T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys 1 dfb ld,0921T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys dual ld,0922T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys dual ld,0922T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys dual ld,0922T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys dual ld,0922T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rmvl perm ccm-d sys dual ld,0922T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys dual ld,0922T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Rmvl perm ccm-d sys dual ld,0922T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Rmvl&rplcmt perm ccm-d pg,0923T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,27591.2, Rmvl&rplcmt perm ccm-d pg,0923T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,27591.2, Rmvl&rplcmt perm ccm-d pg,0923T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,27591.2, Rmvl&rplcmt perm ccm-d pg,0923T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,27591.2, Rmvl&rplcmt perm ccm-d pg,0923T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,3408,27591.2,APC Rmvl&rplcmt perm ccm-d pg,0923T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,3408,27591.2,APC Rmvl&rplcmt perm ccm-d pg,0923T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,3408,27591.2,APC Rpos prv ccm-d trnsvns eltrd,0924T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,741.06,18617, Rpos prv ccm-d trnsvns eltrd,0924T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,741.06,18617, Rpos prv ccm-d trnsvns eltrd,0924T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,741.06,18617, Rpos prv ccm-d trnsvns eltrd,0924T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,741.06,18617, Rpos prv ccm-d trnsvns eltrd,0924T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,18617,APC Rpos prv ccm-d trnsvns eltrd,0924T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,18617,APC Rpos prv ccm-d trnsvns eltrd,0924T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,18617,APC Rlcj skin pocket ccm-d pg,0925T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,18617, Rlcj skin pocket ccm-d pg,0925T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,18617, Rlcj skin pocket ccm-d pg,0925T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2437.45,18617, Rlcj skin pocket ccm-d pg,0925T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2437.45,18617, Rlcj skin pocket ccm-d pg,0925T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,18617,APC Rlcj skin pocket ccm-d pg,0925T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,18617,APC Rlcj skin pocket ccm-d pg,0925T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,18617,APC Ephys eval ccm-d ld 1st impl,0930T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1438.33,1866, Ephys eval ccm-d ld 1st impl,0930T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1438.33,1866, Ephys eval ccm-d ld 1st impl,0930T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1495.87,,,,,,,fee schedule,1438.33,1866,APC Ephys eval ccm-d ld 1st impl,0930T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1510.25,,,,,,,fee schedule,1438.33,1866,APC Ephys eval ccm-d ld 1st impl,0930T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1438.33,,,,,,,fee schedule,1438.33,1866,APC Ephys eval ccm-d ld separate,0931T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1438.33,4166, Ephys eval ccm-d ld separate,0931T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1438.33,4166, Ephys eval ccm-d ld separate,0931T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1495.87,,,,,,,fee schedule,1438.33,4166,APC Ephys eval ccm-d ld separate,0931T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1510.25,,,,,,,fee schedule,1438.33,4166,APC Ephys eval ccm-d ld separate,0931T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1438.33,,,,,,,fee schedule,1438.33,4166,APC Tcat impl wrls l atr prs snr,0933T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, Tcat impl wrls l atr prs snr,0933T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, Tcat impl wrls l atr prs snr,0933T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, Tcat impl wrls l atr prs snr,0933T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, Tcat impl wrls l atr prs snr,0933T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC Tcat impl wrls l atr prs snr,0933T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC Tcat impl wrls l atr prs snr,0933T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC Cysto w/rnl pel symp dnrvtj,0935T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Cysto w/rnl pel symp dnrvtj,0935T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Cysto w/rnl pel symp dnrvtj,0935T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Cysto w/rnl pel symp dnrvtj,0935T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Cysto flx ins&xpns urtl scaf,0941T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Cysto flx ins&xpns urtl scaf,0941T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Cysto flx ins&xpns urtl scaf,0941T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Cysto flx ins&xpns urtl scaf,0941T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Cysto flx ins&xpns urtl scaf,0941T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3408,18617,APC Cysto flx ins&xpns urtl scaf,0941T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3408,18617,APC Cysto flx ins&xpns urtl scaf,0941T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3408,18617,APC Cysto flx rmv&rplc urtl scaf,0942T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Cysto flx rmv&rplc urtl scaf,0942T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Cysto flx rmv&rplc urtl scaf,0942T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Cysto flx rmv&rplc urtl scaf,0942T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Cysto flx rmv&rplc urtl scaf,0942T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3408,18617,APC Cysto flx rmv&rplc urtl scaf,0942T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3408,18617,APC Cysto flx rmv&rplc urtl scaf,0942T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3408,18617,APC Cysto flx rmvl urtl scaffold,0943T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,18617, Cysto flx rmvl urtl scaffold,0943T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,18617, Cysto flx rmvl urtl scaffold,0943T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2469.46,18617, Cysto flx rmvl urtl scaffold,0943T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2469.46,18617, Cysto flx rmvl urtl scaffold,0943T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,18617,APC Cysto flx rmvl urtl scaffold,0943T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,18617,APC Cysto flx rmvl urtl scaffold,0943T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,18617,APC 3d cntr simula trgt lvr les,0944T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC 3d cntr simula trgt lvr les,0944T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC 3d cntr simula trgt lvr les,0944T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Intraop assmt abnl tum tiss,0945T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Intraop assmt abnl tum tiss,0945T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Ortho impl mvmt alys pair ct,0946T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Ortho impl mvmt alys pair ct,0946T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Ortho impl mvmt alys pair ct,0946T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Mrgfus strtctc bl-br disrpj,0947T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Mrgfus strtctc bl-br disrpj,0947T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Abltj b9 prst8 tissue hifu,0950T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Abltj b9 prst8 tissue hifu,0950T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Abltj b9 prst8 tissue hifu,0950T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Abltj b9 prst8 tissue hifu,0950T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Abltj b9 prst8 tissue hifu,0950T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,2816,18617,APC Abltj b9 prst8 tissue hifu,0950T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,2816,18617,APC Abltj b9 prst8 tissue hifu,0950T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,2816,18617,APC Tot impl amei 1st plmt,0951T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Tot impl amei 1st plmt,0951T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Tot impl amei rev/rplc mstdc,0952T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Tot impl amei rev/rplc mstdc,0952T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Tot impl amei rev/rplc w/o,0953T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Tot impl amei rev/rplc w/o,0953T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Tot impl amei rplc snd proc,0954T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Tot impl amei rplc snd proc,0954T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Tot impl amei removal,0955T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Tot impl amei removal,0955T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Prt crn ch cr&tun elt s-sclp,0956T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,33657.37, Prt crn ch cr&tun elt s-sclp,0956T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,33657.37, Prt crn ch cr&tun elt s-sclp,0956T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,33657.37, Prt crn ch cr&tun elt s-sclp,0956T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,33657.37, Prt crn ch cr&tun elt s-sclp,0956T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,3408,33657.37,APC Prt crn ch cr&tun elt s-sclp,0956T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,3408,33657.37,APC Prt crn ch cr&tun elt s-sclp,0956T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,3408,33657.37,APC Rev s-sclp eltr ra rcvr&tlmt,0957T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,18617, Rev s-sclp eltr ra rcvr&tlmt,0957T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,18617, Rev s-sclp eltr ra rcvr&tlmt,0957T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Rev s-sclp eltr ra rcvr&tlmt,0957T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Rev s-sclp eltr ra rcvr&tlmt,0957T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Rev s-sclp eltr ra rcvr&tlmt,0957T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Rev s-sclp eltr ra rcvr&tlmt,0957T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Rmv s-sclp eltr ra rcvr&tlmt,0958T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rmv s-sclp eltr ra rcvr&tlmt,0958T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rmv s-sclp eltr ra rcvr&tlmt,0958T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rmv s-sclp eltr ra rcvr&tlmt,0958T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rmv s-sclp eltr ra rcvr&tlmt,0958T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,18617,APC Rmv s-sclp eltr ra rcvr&tlmt,0958T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,18617,APC Rmv s-sclp eltr ra rcvr&tlmt,0958T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,18617,APC Rmv/rplc magnet coil assem,0959T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,18617, Rmv/rplc magnet coil assem,0959T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,18617, Rmv/rplc magnet coil assem,0959T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1951.11,18617, Rmv/rplc magnet coil assem,0959T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1951.11,18617, Rmv/rplc magnet coil assem,0959T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,18617,APC Rmv/rplc magnet coil assem,0959T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,18617,APC Rmv/rplc magnet coil assem,0959T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,18617,APC Rpl s-sclp eltr ra rcvr&tlmt,0960T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,33657.37, Rpl s-sclp eltr ra rcvr&tlmt,0960T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,33657.37, Rpl s-sclp eltr ra rcvr&tlmt,0960T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,33657.37, Rpl s-sclp eltr ra rcvr&tlmt,0960T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,33657.37, Rpl s-sclp eltr ra rcvr&tlmt,0960T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,2816,33657.37,APC Rpl s-sclp eltr ra rcvr&tlmt,0960T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,2816,33657.37,APC Rpl s-sclp eltr ra rcvr&tlmt,0960T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,2816,33657.37,APC Asstv alg alys acous&ecg rec,0962T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Asstv alg alys acous&ecg rec,0962T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Asstv alg alys acous&ecg rec,0962T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Anosc sbmcsl njx bulking agt,0963T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,18617, Anosc sbmcsl njx bulking agt,0963T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,18617, Anosc sbmcsl njx bulking agt,0963T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1413.65,18617, Anosc sbmcsl njx bulking agt,0963T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1413.65,18617, Anosc sbmcsl njx bulking agt,0963T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,18617,APC Anosc sbmcsl njx bulking agt,0963T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,18617,APC Anosc sbmcsl njx bulking agt,0963T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,18617,APC I&cust prep jaw xpnsj 1arch,0964T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, I&cust prep jaw xpnsj 1arch,0964T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, I&cust prep jaw xpnsj 1arch,0964T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, I&cust prep jaw xpnsj 1arch,0964T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, I&cust prep jaw xpnsj 1arch,0964T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC I&cust prep jaw xpnsj 1arch,0964T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC I&cust prep jaw xpnsj 1arch,0964T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC I&cst prp jw xpn dl arch non,0965T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch non,0965T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch non,0965T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch non,0965T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch non,0965T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC I&cst prp jw xpn dl arch non,0965T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC I&cst prp jw xpn dl arch non,0965T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC I&cst prp jw xpn dl arch fxd,0966T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch fxd,0966T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch fxd,0966T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch fxd,0966T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, I&cst prp jw xpn dl arch fxd,0966T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC I&cst prp jw xpn dl arch fxd,0966T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC I&cst prp jw xpn dl arch fxd,0966T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Tranal ins tmp clrc anst dev,0967T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,18617, Tranal ins tmp clrc anst dev,0967T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,18617, Tranal ins tmp clrc anst dev,0967T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1413.65,18617, Tranal ins tmp clrc anst dev,0967T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1413.65,18617, Tranal ins tmp clrc anst dev,0967T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,18617,APC Tranal ins tmp clrc anst dev,0967T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,18617,APC Tranal ins tmp clrc anst dev,0967T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,18617,APC Insj/rplcmt epcrnl nstim sys,0968T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Insj/rplcmt epcrnl nstim sys,0968T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Removal epicranial nstim sys,0969T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Removal epicranial nstim sys,0969T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Ablt b9 brst tum perq lsr ea,0970T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ablt b9 brst tum perq lsr ea,0970T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ablt b9 brst tum perq lsr ea,0970T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ablt b9 brst tum perq lsr ea,0970T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ablt b9 brst tum perq lsr ea,0970T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,18617,APC Ablt b9 brst tum perq lsr ea,0970T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,18617,APC Ablt b9 brst tum perq lsr ea,0970T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,18617,APC Ablt mal brst tum pq lsr uni,0971T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ablt mal brst tum pq lsr uni,0971T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ablt mal brst tum pq lsr uni,0971T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ablt mal brst tum pq lsr uni,0971T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ablt mal brst tum pq lsr uni,0971T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,18617,APC Ablt mal brst tum pq lsr uni,0971T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,18617,APC Ablt mal brst tum pq lsr uni,0971T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,18617,APC Slctv nzmtc dbrdmt t/a/l 1st,0973T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt t/a/l 1st,0973T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt t/a/l 1st,0973T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt t/a/l 1st,0973T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt t/a/l 1st,0973T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Slctv nzmtc dbrdmt t/a/l 1st,0973T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Slctv nzmtc dbrdmt t/a/l 1st,0973T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Slctv nzmtc dbrdmt t/a/l ea,0974T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Slctv nzmtc dbrdmt t/a/l ea,0974T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Slctv nzmtc dbrdmt s/n/hf 1,0975T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt s/n/hf 1,0975T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt s/n/hf 1,0975T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt s/n/hf 1,0975T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Slctv nzmtc dbrdmt s/n/hf 1,0975T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Slctv nzmtc dbrdmt s/n/hf 1,0975T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Slctv nzmtc dbrdmt s/n/hf 1,0975T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Slctv nzmtc dbrdmt s/n/hf ea,0976T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Slctv nzmtc dbrdmt s/n/hf ea,0976T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Upr gi bld detcj snr capsule,0977T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,1125.04,APC Upr gi bld detcj snr capsule,0977T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,1125.04,APC Upr gi bld detcj snr capsule,0977T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,1125.04,APC Submucosal cryolysis therapy,0978T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Submucosal cryolysis therapy,0978T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Sbmcsl crylys ther sft palt,0979T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Sbmcsl crylys ther sft palt,0979T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Sbmcsl crylys ther tng&tnsl,0980T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Sbmcsl crylys ther tng&tnsl,0980T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Tcat impl wrls ivc snr,0981T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,22738.78, Tcat impl wrls ivc snr,0981T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,22738.78, Tcat impl wrls ivc snr,0981T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,22738.78, Tcat impl wrls ivc snr,0981T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,22738.78, Tcat impl wrls ivc snr,0981T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,3560,22738.78,APC Tcat impl wrls ivc snr,0981T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,3560,22738.78,APC Tcat impl wrls ivc snr,0981T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,3560,22738.78,APC Rem mntr impl ivc snr set-up,0982T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Rem mntr impl ivc snr set-up,0982T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Rem mntr impl ivc snr set-up,0982T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Iv img xtrc cere vsl oct 1st,0984T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Iv img xtrc cere vsl oct 1st,0984T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Iv img xtrc cere vsl oct ea,0985T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Iv img xtrc cere vsl oct ea,0985T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Iv img icr cere vsl oct 1st,0986T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Iv img icr cere vsl oct 1st,0986T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Iv img icr cere vsl oct ea,0987T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Iv img icr cere vsl oct ea,0987T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Opn ins/rplc ins ptn sbq&sbf,0988T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Opn ins/rplc ins ptn sbq&sbf,0988T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Opn ins/rplc ins ptn sbq&sbf,0988T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Opn ins/rplc ins ptn sbq&sbf,0988T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Revj/rmvl ins ptn subq&subf,0989T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Revj/rmvl ins ptn subq&subf,0989T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Revj/rmvl ins ptn subq&subf,0989T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Revj/rmvl ins ptn subq&subf,0989T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Revj/rmvl ins ptn subq&subf,0989T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,18617,APC Revj/rmvl ins ptn subq&subf,0989T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,18617,APC Revj/rmvl ins ptn subq&subf,0989T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,18617,APC Trncrv inst biod hydrgl mtrl,0990T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Trncrv inst biod hydrgl mtrl,0990T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Trncrv inst biod hydrgl mtrl,0990T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Trncrv inst biod hydrgl mtrl,0990T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Cysto lo-nrg lithtrp&mcrsphr,0991T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Cysto lo-nrg lithtrp&mcrsphr,0991T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Cysto lo-nrg lithtrp&mcrsphr,0991T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Cysto lo-nrg lithtrp&mcrsphr,0991T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Cysto lo-nrg lithtrp&mcrsphr,0991T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,4224,18617,APC Cysto lo-nrg lithtrp&mcrsphr,0991T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,4224,18617,APC Cysto lo-nrg lithtrp&mcrsphr,0991T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,4224,18617,APC N-invas assmt car rsk w/o ct,0992T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC N-invas assmt car rsk w/o ct,0992T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC N-invas assmt car rsk w/o ct,0992T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC N-invas assmt car rsk w/ct,0993T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC N-invas assmt car rsk w/ct,0993T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC N-invas assmt car rsk w/ct,0993T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Evasc dlvr a-wal stbl rx prq,0994T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Evasc dlvr a-wal stbl rx prq,0994T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Evasc dlvr a-wal stbl rx prq,0994T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Evasc dlvr a-wal stbl rx prq,0994T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Evasc dlvr a-wal stbl rx opn,0995T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Evasc dlvr a-wal stbl rx opn,0995T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Evasc dlvr a-wal stbl rx opn,0995T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Evasc dlvr a-wal stbl rx opn,0995T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Ins&sclr fix caps bag prosth,0996T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2726.34,18617, Ins&sclr fix caps bag prosth,0996T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2726.34,18617, Ins&sclr fix caps bag prosth,0996T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2726.34,18617, Ins&sclr fix caps bag prosth,0996T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2726.34,18617, Ins&sclr fix caps bag prosth,0996T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,18617,APC Ins&sclr fix caps bag prosth,0996T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,18617,APC Ins&sclr fix caps bag prosth,0996T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,18617,APC Autol musc cell therapy hrvg,0999T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Autol musc cell therapy hrvg,0999T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Fna bx w/o img gdn ea addl,10004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Fna bx w/o img gdn ea addl,10004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Fna bx w/o img gdn ea addl,10004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Fna bx w/o img gdn ea addl,10004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Fna bx w/us gdn 1st les,10005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Fna bx w/us gdn ea addl,10006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Fna bx w/us gdn ea addl,10006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Fna bx w/us gdn ea addl,10006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Fna bx w/us gdn ea addl,10006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Fna bx w/fluor gdn 1st les,10007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Fna bx w/fluor gdn ea addl,10008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Fna bx w/fluor gdn ea addl,10008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Fna bx w/fluor gdn ea addl,10008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Fna bx w/fluor gdn ea addl,10008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Fna bx w/ct gdn 1st les,10009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Autol musc cell therapy admn,1000T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Autol musc cell therapy admn,1000T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Fna bx w/ct gdn ea addl,10010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Fna bx w/ct gdn ea addl,10010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Fna bx w/ct gdn ea addl,10010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Fna bx w/ct gdn ea addl,10010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Fna bx w/mr gdn 1st les,10011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Fna bx w/mr gdn ea addl,10012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Fna bx w/mr gdn ea addl,10012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Fna bx w/mr gdn ea addl,10012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Fna bx w/mr gdn ea addl,10012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Autol musc cell therapy njx,1001T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Autol musc cell therapy njx,1001T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Fna w/o image,10021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Air displacmnt plethysmograp,1002T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Air displacmnt plethysmograp,1002T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Air displacmnt plethysmograp,1002T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,18617, Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,18617, Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,18617, Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,18617, Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Guide cathet fluid drainage,10030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,428,4466,APC Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,428,4466,APC Perq dev soft tiss 1st imag,10035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,428,4466,APC Perq dev soft tiss add imag,10036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq dev soft tiss add imag,10036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq dev soft tiss add imag,10036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq dev soft tiss add imag,10036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Arthrp 1st crp/mtcrpl prostc,1003T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Arthrp 1st crp/mtcrpl prostc,1003T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Arthrp 1st crp/mtcrpl prostc,1003T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Arthrp 1st crp/mtcrpl prostc,1003T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Arthrp 1st crp/mtcrpl prostc,1003T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Arthrp 1st crp/mtcrpl prostc,1003T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Arthrp 1st crp/mtcrpl prostc,1003T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Acne surgery,10040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Elec alys s-scl eeg wo prgrm,1004T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Elec alys s-scl eeg wo prgrm,1004T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Elec alys s-scl eeg wo prgrm,1004T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Drainage of skin abscess,10060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Drainage of skin abscess,10061,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Drainage of pilonidal cyst,10080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Drainage of pilonidal cyst,10081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Rem mntr s-scl eeg sys setup,1008T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Rem mntr s-scl eeg sys setup,1008T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Rem mntr s-scl eeg sys setup,1008T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Cptr oph alys monoc eye mvmt,1010T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Cptr oph alys monoc eye mvmt,1010T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Cptr oph alys monoc eye mvmt,1010T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Remove foreign body,10120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Remove foreign body,10121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Mtrz ab ntrno trph scl/tr mw,1012T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Mtrz ab ntrno trph scl/tr mw,1012T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Mtrz ab ntrno trph scl/tr mw,1012T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Mtrz ab ntrno trph scl/tr mw,1012T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Mtrz ab ntrno trph scl/tr mw,1012T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4224,18617,APC Mtrz ab ntrno trph scl/tr mw,1012T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4224,18617,APC Mtrz ab ntrno trph scl/tr mw,1012T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4224,18617,APC Lap srg imp/rpl eso nea&pg/r,1013T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Lap srg imp/rpl eso nea&pg/r,1013T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Lap srg imp/rpl eso nea&pg/r,1013T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Lap srg imp/rpl eso nea&pg/r,1013T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,18617,APC Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,18617,APC Drainage of hematoma/fluid,10140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,18617,APC Lap rv/rmv eso sph nstm eltr,1014T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lap rv/rmv eso sph nstm eltr,1014T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lap rv/rmv eso sph nstm eltr,1014T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lap rv/rmv eso sph nstm eltr,1014T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rev/rmv lw esoph sphnc npg/r,1015T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rev/rmv lw esoph sphnc npg/r,1015T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rev/rmv lw esoph sphnc npg/r,1015T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rev/rmv lw esoph sphnc npg/r,1015T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Puncture drainage of lesion,10160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Complex drainage wound,10180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Lymphovenous bypass per xtr,1019T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lymphovenous bypass per xtr,1019T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lymphovenous bypass per xtr,1019T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lymphovenous bypass per xtr,1019T,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lymphovenous bypass per xtr,1019T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,3408,18617,APC Lymphovenous bypass per xtr,1019T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,3408,18617,APC Lymphovenous bypass per xtr,1019T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,3408,18617,APC Raman spectroscopy 1+skn les,1020T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Raman spectroscopy 1+skn les,1020T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Raman spectroscopy 1+skn les,1020T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Active thrc irrigation spx,1021T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,741.06,4166, Active thrc irrigation spx,1021T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,741.06,4166, Active thrc irrigation spx,1021T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,4166,APC Active thrc irrigation spx,1021T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,4166,APC Active thrc irrigation spx,1021T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,4166,APC Prq tis dsplmt ntra-abdl/pel,1022T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Prq tis dsplmt ntra-abdl/pel,1022T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Prq tis dsplmt intrathoracic,1023T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Prq tis dsplmt intrathoracic,1023T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Perq tiss dsplmt soft tissue,1024T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Perq tiss dsplmt soft tissue,1024T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Alt elec fld dos&dlv sim mdl,1025T,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,166.72,APC Alt elec fld dos&dlv sim mdl,1025T,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,166.72,APC Alt elec fld dos&dlv sim mdl,1025T,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,166.72,APC Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,18617, Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,18617, Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Debride infected skin,11000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Debride infected skin add-on,11001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Debride infected skin add-on,11001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Debride infected skin add-on,11001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Debride infected skin add-on,11001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Debride genitalia & perineum,11004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Debride genitalia & perineum,11004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Debride genitalia & perineum,11004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Debride genitalia & perineum,11004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Debride abdom wall,11005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Debride abdom wall,11005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Debride abdom wall,11005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1406,18617, Debride abdom wall,11005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1406,18617, Debride abdom wall,11005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Debride abdom wall,11005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Debride genit/per/abdom wall,11006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Debride genit/per/abdom wall,11006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Debride genit/per/abdom wall,11006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Debride genit/per/abdom wall,11006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove mesh from abd wall,11008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove mesh from abd wall,11008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove mesh from abd wall,11008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1406,18617, Remove mesh from abd wall,11008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1406,18617, Remove mesh from abd wall,11008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove mesh from abd wall,11008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4466, Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4466, Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4466, Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4466, Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,836.55,4466, Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,836.55,4466, Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4466,APC Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4466,APC Debride skin at fx site,11010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4466,APC Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4466, Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4466, Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4466, Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4466, Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,836.55,4466, Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,836.55,4466, Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4466,APC Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4466,APC Debride skin musc at fx site,11011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4466,APC Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Deb skin bone at fx site,11012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Deb subq tissue 20 sq cm/<,11042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,4466, Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,4466, Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,4466, Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,4466, Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,855,4466, Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,855,4466, Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,4466,APC Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,4466,APC Deb musc/fascia 20 sq cm/<,11043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,4466,APC Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Deb bone 20 sq cm/<,11044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Deb subq tissue add-on,11045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Deb subq tissue add-on,11045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Deb subq tissue add-on,11045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Deb subq tissue add-on,11045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Deb musc/fascia add-on,11046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Deb musc/fascia add-on,11046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Deb musc/fascia add-on,11046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Deb musc/fascia add-on,11046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Deb bone add-on,11047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Deb bone add-on,11047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Deb bone add-on,11047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Deb bone add-on,11047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Description Not Available,11050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,11051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,11052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Trim skin lesion,11055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Trim skin lesions 2 to 4,11056,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Trim skin lesions over 4,11057,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Tangntl bx skin single les,11102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Tangntl bx skin ea sep/addl,11103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Tangntl bx skin ea sep/addl,11103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Tangntl bx skin ea sep/addl,11103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Tangntl bx skin ea sep/addl,11103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Punch bx skin single lesion,11104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Punch bx skin ea sep/addl,11105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Punch bx skin ea sep/addl,11105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Punch bx skin ea sep/addl,11105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Punch bx skin ea sep/addl,11105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,3314,APC Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,3314,APC Incal bx skn single les,11106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,3314,APC Incal bx skn ea sep/addl,11107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Incal bx skn ea sep/addl,11107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Incal bx skn ea sep/addl,11107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Incal bx skn ea sep/addl,11107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Removal of skin tags 2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion >2.0 cm,11303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.5 cm/<,11305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.6-1.0 cm,11306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 1.1-2.0 cm,11307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion >2.0 cm,11308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.5 cm/<,11310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 0.6-1.0 cm,11311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,18617, Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,18617, Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion 1.1-2.0 cm,11312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Shave skin lesion >2.0 cm,11313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 0.5 cm<,11400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,3314, Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,3314, Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Exc tr-ext b9+marg 0.6-1 cm,11401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 1.1-2 cm,11402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 2.1-3cm/<,11403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Exc tr-ext b9+marg 3.1-4 cm,11404,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc tr-ext b9+marg >4.0 cm,11406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4166, Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4166, Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4166, Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4166, Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1951.11,4166, Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1951.11,4166, Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4166,APC Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4166,APC Exc h-f-nk-sp b9+marg 0.5/<,11420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4166,APC Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Exc h-f-nk-sp b9+marg 0.6-1,11421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp b9+marg 1.1-2,11422,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp b9+marg 2.1-3,11423,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc h-f-nk-sp b9+marg 3.1-4,11424,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Exc h-f-nk-sp b9+marg >4 cm,11426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Exc face-mm b9+marg 0.5 cm/<,11440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Exc face-mm b9+marg 0.6-1 cm,11441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc face-mm b9+marg 1.1-2 cm,11442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Exc face-mm b9+marg 2.1-3 cm,11443,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Exc face-mm b9+marg 3.1-4 cm,11444,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,4466,APC Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,4466,APC Exc face-mm b9+marg >4 cm,11446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,4466,APC Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Removal sweat gland lesion,11450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Removal sweat gland lesion,11462,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11463,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,6404,APC Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,8006,APC Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,8006,APC Removal sweat gland lesion,11471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,8006,APC Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 0.5 cm/<,11600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 0.6-1 cm,11601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,3314, Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,3314, Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Exc tr-ext mal+marg 1.1-2 cm,11602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 2.1-3 cm,11603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4466, Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4466, Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4466, Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4466, Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,836.55,4466, Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,836.55,4466, Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4466,APC Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4466,APC Exc tr-ext mal+marg 3.1-4 cm,11604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4466,APC Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,5123, Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,5123, Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1951.11,5123, Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1951.11,5123, Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,5123, Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,5123, Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,5123,APC Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,5123,APC Exc tr-ext mal+marg >4 cm,11606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,5123,APC Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Exc h-f-nk-sp mal+marg 0.5/<,11620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc s/n/h/f/g mal+mrg 0.6-1,11621,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Exc s/n/h/f/g mal+mrg 1.1-2,11622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,18617,APC Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,18617,APC Exc s/n/h/f/g mal+mrg 2.1-3,11623,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,18617,APC Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc s/n/h/f/g mal+mrg 3.1-4,11624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,6404,APC Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,6404,APC Exc s/n/h/f/g mal+mrg >4 cm,11626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,6404,APC Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 0.5cm<,11640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 0.6-1,11641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 1.1-2,11642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4166, Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4166, Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4166, Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4166, Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1951.11,4166, Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1951.11,4166, Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4166,APC Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4166,APC Exc f/e/e/n/l mal+mrg 2.1-3,11643,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4166,APC Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc f/e/e/n/l mal+mrg 3.1-4,11644,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Exc f/e/e/n/l mal+mrg >4 cm,11646,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Description Not Available,11700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,11701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,11710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,11711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Trim nail(s) any number,11719,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,69.69,18617, Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,69.69,18617, Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Debride nail 1-5,11720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,69.69,18617, Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,69.69,18617, Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Debride nail 6 or more,11721,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Removal of nail plate,11730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Description Not Available,11731,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,11731,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,11731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,11731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove nail plate add-on,11732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Remove nail plate add-on,11732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Remove nail plate add-on,11732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Remove nail plate add-on,11732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,18617, Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,18617, Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Drain blood from under nail,11740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Removal of nail bed,11750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Biopsy nail unit,11755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,873.1,18617, Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,873.1,18617, Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,18617, Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,18617, Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,873.1,18617, Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,873.1,18617, Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,18617,APC Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,18617,APC Repair of nail bed,11760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,18617,APC Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,18617, Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,18617, Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,18617, Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,18617, Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2437.45,18617, Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2437.45,18617, Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,18617,APC Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,18617,APC Reconstruction of nail bed,11762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,18617,APC Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Excision of nail fold toe,11765,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Remove pilonidal cyst simple,11770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Remove pilonidal cyst exten,11771,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Remove pilonidal cyst compl,11772,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Inject skin lesions <=w 7,11900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Inject skin lesions >7,11901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,873.1,18617, Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,873.1,18617, Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,18617, Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,18617, Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,873.1,18617, Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,873.1,18617, Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,18617,APC Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,18617,APC Correct skin color 6.0 cm/<,11920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,18617,APC Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,873.1,18617, Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,873.1,18617, Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,18617, Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,18617, Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,873.1,18617, Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,873.1,18617, Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,18617,APC Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,18617,APC Correct skn color 6.1-20.0cm,11921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,18617,APC Correct skin color ea 20.0cm,11922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Correct skin color ea 20.0cm,11922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Correct skin color ea 20.0cm,11922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Correct skin color ea 20.0cm,11922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Tx contour defects 1 cc/<,11950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,873.1,18617, Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,873.1,18617, Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,18617, Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,18617, Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,873.1,18617, Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,873.1,18617, Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,18617,APC Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,18617,APC Tx contour defects 1.1-5.0cc,11951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,18617,APC Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,855,18617, Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,855,18617, Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,18617,APC Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,18617,APC Tx contour defects 5.1-10cc,11952,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,18617,APC Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,855,18617, Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,855,18617, Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,18617,APC Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,18617,APC Tx contour defects >10.0 cc,11954,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,18617,APC Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,2816,11081,APC Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,2816,11081,APC Insert tissue expander(s),11960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,2816,11081,APC Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Replace tissue expander,11970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,6404,APC Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,6404,APC Remove tissue expander(s),11971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,6404,APC Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,3314, Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,3314, Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Remove contraceptive capsule,11976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,18617, Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,18617, Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,527.74,18617, Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,527.74,18617, Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Implant hormone pellet(s),11980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,18617, Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,18617, Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Insert drug implant device,11981,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,18617, Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,18617, Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Remove drug implant device,11982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,18617, Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,18617, Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Remove/insert drug implant,11983,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trnk 2.5cm/<,12001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trnk2.6-7.5cm,12002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/ax/gen/trk7.6-12.5cm,12004,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Rpr s/n/a/gen/trk12.6-20.0cm,12005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Rpr s/n/a/gen/trk20.1-30.0cm,12006,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,237.02,4466, Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,237.02,4466, Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,4466, Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,4466, Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,237.02,4466, Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,237.02,4466, Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,4466,APC Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,4466,APC Rpr s/n/ax/gen/trnk >30.0 cm,12007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,4466,APC Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 2.5 cm/<,12011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 2.6-5.0 cm,12013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 5.1-7.5 cm,12014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Rpr f/e/e/n/l/m 7.6-12.5 cm,12015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Rpr fe/e/en/l/m 12.6-20.0 cm,12016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Rpr fe/e/en/l/m 20.1-30.0 cm,12017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,237.02,4466, Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,237.02,4466, Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,237.02,4466, Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,237.02,4466, Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,237.02,4466, Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,237.02,4466, Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,4466,APC Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,4466,APC Rpr f/e/e/n/l/m >30.0 cm,12018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,4466,APC Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,873.1,3314, Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,873.1,3314, Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,3314, Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,3314, Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,873.1,3314, Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,873.1,3314, Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,3314,APC Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,3314,APC Closure of split wound,12020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,3314,APC Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Closure of split wound,12021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Intmd rpr s/a/t/ext 2.5 cm/<,12031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Intmd rpr s/a/t/ext 2.6-7.5,12032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Intmd rpr s/tr/ext 7.6-12.5,12034,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Intmd rpr s/a/t/ext 12.6-20,12035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4466, Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4466, Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,4466, Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,4466, Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,873.1,4466, Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,873.1,4466, Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4466,APC Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4466,APC Intmd rpr s/a/t/ext 20.1-30,12036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4466,APC Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,6404, Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,6404, Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,6404, Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,6404, Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Intmd rpr s/tr/ext >30.0 cm,12037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Intmd rpr n-hf/genit 2.5cm/<,12041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Intmd rpr n-hf/genit2.6-7.5,12042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,4466,APC Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,4466,APC Intmd rpr n-hf/genit7.6-12.5,12044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,4466,APC Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,855,4466, Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,4466,APC Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,4466,APC Intmd rpr n-hf/genit12.6-20,12045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,4466,APC Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,428,4466,APC Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,428,4466,APC Intmd rpr n-hf/genit20.1-30,12046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,428,4466,APC Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,8006, Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,8006, Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2437.45,8006, Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2437.45,8006, Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,8006, Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,8006, Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,8006,APC Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,8006,APC Intmd rpr n-hf/genit >30.0cm,12047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,8006,APC Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 2.5 cm/<,12051,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 2.6-5.0 cm,12052,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 5.1-7.5 cm,12053,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm 7.6-12.5cm,12054,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm 12.6-20 cm,12055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,5123, Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,5123, Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,480.23,5123, Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,480.23,5123, Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,5123, Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,5123, Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,5123,APC Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,5123,APC Intmd rpr face/mm 20.1-30.0,12056,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,5123,APC Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Intmd rpr face/mm >30.0 cm,12057,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4466, Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4466, Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,4466, Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,4466, Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,873.1,4466, Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,873.1,4466, Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4466,APC Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4466,APC Cmplx rpr trunk 1.1-2.5 cm,13100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4466,APC Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,873.1,5098, Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,873.1,5098, Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,5098, Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,5098, Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,873.1,5098, Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,873.1,5098, Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr trunk 2.6-7.5 cm,13101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr trunk addl 5cm/<,13102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cmplx rpr trunk addl 5cm/<,13102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cmplx rpr trunk addl 5cm/<,13102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cmplx rpr trunk addl 5cm/<,13102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Cmplx rpr s/a/l 1.1-2.5 cm,13120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,480.23,5098, Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,480.23,5098, Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,5098, Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,5098, Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,480.23,5098, Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,480.23,5098, Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,5098,APC Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,5098,APC Cmplx rpr s/a/l 2.6-7.5 cm,13121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,5098,APC Cmplx rpr s/a/l addl 5 cm/>,13122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cmplx rpr s/a/l addl 5 cm/>,13122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cmplx rpr s/a/l addl 5 cm/>,13122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cmplx rpr s/a/l addl 5 cm/>,13122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Cmplx rpr f/c/c/m/n/ax/g/h/f,13131,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,480.23,5098, Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,480.23,5098, Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,5098, Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,5098, Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,480.23,5098, Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,480.23,5098, Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,5098,APC Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,5098,APC Cmplx rpr f/c/c/m/n/ax/g/h/f,13132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,5098,APC Cmplx rpr f/c/c/m/n/ax/g/h/f,13133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cmplx rpr f/c/c/m/n/ax/g/h/f,13133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cmplx rpr f/c/c/m/n/ax/g/h/f,13133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cmplx rpr f/c/c/m/n/ax/g/h/f,13133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr e/n/e/l 1.1-2.5 cm,13151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,873.1,5098, Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr e/n/e/l 2.6-7.5 cm,13152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,5098,APC Cmplx rpr e/n/e/l addl 5cm/<,13153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Cmplx rpr e/n/e/l addl 5cm/<,13153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Cmplx rpr e/n/e/l addl 5cm/<,13153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Cmplx rpr e/n/e/l addl 5cm/<,13153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,2816,5123,APC Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,2816,5123,APC Late closure of wound,13160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,2816,5123,APC Description Not Available,13300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,13300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,13300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,13300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,4466, Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,4466, Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,4466, Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,4466, Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,4466, Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,4466, Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,4466,APC Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,4466,APC Tis trnfr trunk 10 sq cm/<,14000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,4466,APC Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr trunk 10.1-30sqcm,14001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr s/a/l 10 sq cm/<,14020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr s/a/l 10.1-30 sqcm,14021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,4466, Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,4466, Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,4466, Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,4466, Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,4466, Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,4466, Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,4466,APC Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,4466,APC Tis trnfr f/c/c/m/n/a/g/h/f,14040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,4466,APC Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr f/c/c/m/n/a/g/h/f,14041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr e/n/e/l 10 sq cm/<,14060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr e/n/e/l10.1-30sqcm,14061,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,13320,APC Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,13320,APC Tis trnfr any 30.1-60 sq cm,14301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,13320,APC Tis trnfr addl 30 sq cm/<,14302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Tis trnfr addl 30 sq cm/<,14302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Tis trnfr addl 30 sq cm/<,14302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Tis trnfr addl 30 sq cm/<,14302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5123, Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5123, Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5123, Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5123, Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Filleted finger/toe flap,14350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4466, Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4466, Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,4466, Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,4466, Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,873.1,4466, Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,873.1,4466, Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4466,APC Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4466,APC Wound prep trk/arm/leg,15002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4466,APC Wound prep addl 100 cm,15003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Wound prep addl 100 cm,15003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Wound prep addl 100 cm,15003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Wound prep addl 100 cm,15003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,4466, Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,4466, Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Wound prep f/n/hf/g,15004,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Wnd prep f/n/hf/g addl cm,15005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Wnd prep f/n/hf/g addl cm,15005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Wnd prep f/n/hf/g addl cm,15005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Wnd prep f/n/hf/g addl cm,15005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Hrv skn cll ssp agrft 1st 25,15011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,18617, Hrv skn cll ssp agrft 1st 25,15011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,18617, Hrv skn cll ssp agrft 1st 25,15011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2437.45,18617, Hrv skn cll ssp agrft 1st 25,15011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2437.45,18617, Hrv skn cll ssp agrft 1st 25,15011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,18617,APC Hrv skn cll ssp agrft 1st 25,15011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,18617,APC Hrv skn cll ssp agrft 1st 25,15011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,18617,APC Hrv skn cll ssp agrft ea add,15012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Hrv skn cll ssp agrft ea add,15012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Prepj skn cll ssp agrft 1st,15013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepj skn cll ssp agrft 1st,15013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepj skn cll ssp agrft 1st,15013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepj skn cll ssp agrft 1st,15013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepj skn cll ssp agrft 1st,15013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8719.1,,,,,,,fee schedule,1406,18617,APC Prepj skn cll ssp agrft 1st,15013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8802.94,,,,,,,fee schedule,1406,18617,APC Prepj skn cll ssp agrft 1st,15013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8383.75,,,,,,,fee schedule,1406,18617,APC App skn cl ssp agrft t/a/l 1,15015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,18617, App skn cl ssp agrft t/a/l 1,15015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,18617, App skn cl ssp agrft t/a/l 1,15015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2437.45,18617, App skn cl ssp agrft t/a/l 1,15015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2437.45,18617, App skn cl ssp agrft t/a/l 1,15015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,18617,APC App skn cl ssp agrft t/a/l 1,15015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,18617,APC App skn cl ssp agrft t/a/l 1,15015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,18617,APC App skn cl ssp agrf t/a/l ea,15016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, App skn cl ssp agrf t/a/l ea,15016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, App skn cll ssp f/n/g/hf 1st,15017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,18617, App skn cll ssp f/n/g/hf 1st,15017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,18617, App skn cll ssp f/n/g/hf 1st,15017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2437.45,18617, App skn cll ssp f/n/g/hf 1st,15017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2437.45,18617, App skn cll ssp f/n/g/hf 1st,15017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,18617,APC App skn cll ssp f/n/g/hf 1st,15017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,18617,APC App skn cll ssp f/n/g/hf 1st,15017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,18617,APC App skn cll ssp f/n/g/hf ea,15018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, App skn cll ssp f/n/g/hf ea,15018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2138,4466,APC Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2138,4466,APC Harvest cultured skin graft,15040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2138,4466,APC Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4466, Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4466, Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,4466, Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,4466, Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,873.1,4466, Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,873.1,4466, Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4466,APC Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4466,APC Skin pinch graft,15050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4466,APC Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,5123, Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,5123, Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,5123, Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,5123, Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Skin splt grft trnk/arm/leg,15100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Skin splt grft t/a/l add-on,15101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Skin splt grft t/a/l add-on,15101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Skin splt grft t/a/l add-on,15101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Skin splt grft t/a/l add-on,15101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,4466, Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,4466, Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,4466, Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,4466, Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,4466, Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,4466, Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,4466,APC Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,4466,APC Epidrm autogrft trnk/arm/leg,15110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,4466,APC Epidrm autogrft t/a/l add-on,15111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Epidrm autogrft t/a/l add-on,15111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Epidrm autogrft t/a/l add-on,15111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Epidrm autogrft t/a/l add-on,15111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2138,4466,APC Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2138,4466,APC Epidrm a-grft face/nck/hf/g,15115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2138,4466,APC Epidrm a-grft f/n/hf/g addl,15116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Epidrm a-grft f/n/hf/g addl,15116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Epidrm a-grft f/n/hf/g addl,15116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Epidrm a-grft f/n/hf/g addl,15116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,2816,6404,APC Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,2816,6404,APC Skn splt a-grft fac/nck/hf/g,15120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,2816,6404,APC Skn splt a-grft f/n/hf/g add,15121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Skn splt a-grft f/n/hf/g add,15121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Skn splt a-grft f/n/hf/g add,15121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Skn splt a-grft f/n/hf/g add,15121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,6404, Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,6404, Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,6404, Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,6404, Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Derm autograft trnk/arm/leg,15130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Derm autograft t/a/l add-on,15131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Derm autograft t/a/l add-on,15131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Derm autograft t/a/l add-on,15131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Derm autograft t/a/l add-on,15131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,2816,8006,APC Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,2816,8006,APC Derm autograft face/nck/hf/g,15135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,2816,8006,APC Derm autograft f/n/hf/g add,15136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Derm autograft f/n/hf/g add,15136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Derm autograft f/n/hf/g add,15136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Derm autograft f/n/hf/g add,15136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,17041, Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,17041, Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,2437.45,17041, Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,2437.45,17041, Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,17041, Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,17041, Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,17041,APC Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,17041,APC Cult skin grft t/arm/leg,15150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,17041,APC Cult skin grft t/a/l addl,15151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cult skin grft t/a/l addl,15151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cult skin grft t/a/l addl,15151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cult skin grft t/a/l addl,15151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cult skin graft t/a/l +%,15152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cult skin graft t/a/l +%,15152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cult skin graft t/a/l +%,15152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cult skin graft t/a/l +%,15152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,2816,13036,APC Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,2816,13036,APC Cult skin graft f/n/hf/g,15155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,2816,13036,APC Cult skin grft f/n/hfg add,15156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cult skin grft f/n/hfg add,15156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cult skin grft f/n/hfg add,15156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cult skin grft f/n/hfg add,15156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cult epiderm grft f/n/hfg +%,15157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cult epiderm grft f/n/hfg +%,15157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cult epiderm grft f/n/hfg +%,15157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cult epiderm grft f/n/hfg +%,15157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,6404, Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,6404, Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,6404, Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,6404, Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Skin full graft trunk,15200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Skin full graft trunk add-on,15201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Skin full graft trunk add-on,15201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Skin full graft trunk add-on,15201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Skin full graft trunk add-on,15201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,5123, Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,5123, Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,5123, Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,5123, Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Skin full graft sclp/arm/leg,15220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Skin full graft add-on,15221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Skin full graft add-on,15221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Skin full graft add-on,15221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Skin full graft add-on,15221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5123, Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5123, Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5123, Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5123, Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Skin full grft face/genit/hf,15240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Skin full graft add-on,15241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Skin full graft add-on,15241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Skin full graft add-on,15241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Skin full graft add-on,15241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,4466, Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,4466, Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,4466, Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,4466, Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,4466, Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,4466, Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,4466,APC Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,4466,APC Skin full graft een & lips,15260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,4466,APC Skin full graft add-on,15261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Skin full graft add-on,15261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Skin full graft add-on,15261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Skin full graft add-on,15261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4166, Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4166, Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,873.1,4166, Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,873.1,4166, Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,873.1,4166, Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,873.1,4166, Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4166,APC Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4166,APC Skin sub graft trnk/arm/leg,15271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4166,APC Skin sub graft t/a/l add-on,15272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Skin sub graft t/a/l add-on,15272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Skin sub graft t/a/l add-on,15272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Skin sub graft t/a/l add-on,15272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,6404, Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,6404, Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2437.45,6404, Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2437.45,6404, Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Skin sub grft t/arm/lg child,15273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Skn sub grft t/a/l child add,15274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Skn sub grft t/a/l child add,15274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Skn sub grft t/a/l child add,15274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Skn sub grft t/a/l child add,15274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4166, Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4166, Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,873.1,4166, Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,873.1,4166, Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,873.1,4166, Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,873.1,4166, Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4166,APC Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4166,APC Skin sub graft face/nk/hf/g,15275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4166,APC Skin sub graft f/n/hf/g addl,15276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Skin sub graft f/n/hf/g addl,15276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Skin sub graft f/n/hf/g addl,15276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Skin sub graft f/n/hf/g addl,15276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,4166, Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,4166, Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,4166, Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,4166, Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2437.45,4166, Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2437.45,4166, Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,4166,APC Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,4166,APC Skn sub grft f/n/hf/g child,15277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,4166,APC Skn sub grft f/n/hf/g ch add,15278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Skn sub grft f/n/hf/g ch add,15278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Skn sub grft f/n/hf/g ch add,15278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Skn sub grft f/n/hf/g ch add,15278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,6404, Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,6404, Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,6404, Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,6404, Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Skin pedicle flap trunk,15570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,6404,APC Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,6404,APC Skin pedicle flap arms/legs,15572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,6404,APC Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5123, Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5123, Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5123, Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5123, Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Pedcle fh/ch/ch/m/n/ax/g/h/f,15574,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Pedicle e/n/e/l/ntroral,15576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Description Not Available,15580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,15580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,15580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,15580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,6404,APC Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,6404,APC Delay flap trunk,15600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,6404,APC Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,6404, Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,6404, Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,6404, Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,6404, Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Delay flap arms/legs,15610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2437.45,6312, Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2437.45,6312, Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,6312, Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,6312, Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2437.45,6312, Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2437.45,6312, Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6312,APC Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6312,APC Delay flap f/c/c/n/ax/g/h/f,15620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6312,APC Description Not Available,15625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,15625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,15625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,15625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Delay flap eye/nos/ear/lip,15630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2437.45,7422, Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2437.45,7422, Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,7422, Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,7422, Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2437.45,7422, Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2437.45,7422, Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,7422,APC Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,7422,APC Transfer skin pedicle flap,15650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,7422,APC Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,13320,APC Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,13320,APC Mdfc flap w/prsrv vasc pedcl,15730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,13320,APC Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,6404,APC Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,6404,APC Forehead Flap w/Vasc Pedicle,15731,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,6404,APC Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,13320,APC Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,13320,APC Musc myoq/fscq flp h&n pedcl,15733,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,13320,APC Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,8006,APC Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,8006,APC Muscle-skin graft trunk,15734,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,8006,APC Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5123, Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5123, Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5123, Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5123, Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Muscle-skin graft arm,15736,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,6404,APC Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,6404,APC Muscle-skin graft leg,15738,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,6404,APC Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2138,4466,APC Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2138,4466,APC Island pedicle flap graft,15740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2138,4466,APC Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,2816,8006,APC Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,2816,8006,APC Neurovascular pedicle flap,15750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,2816,8006,APC Description Not Available,15755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,15755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,15755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,15755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Free myo/skin flap microvasc,15756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Free myo/skin flap microvasc,15756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Free myo/skin flap microvasc,15756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Free myo/skin flap microvasc,15756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Free myo/skin flap microvasc,15756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Free myo/skin flap microvasc,15756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Free skin flap microvasc,15757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Free skin flap microvasc,15757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Free skin flap microvasc,15757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Free skin flap microvasc,15757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Free skin flap microvasc,15757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Free skin flap microvasc,15757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Free fascial flap microvasc,15758,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Free fascial flap microvasc,15758,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Free fascial flap microvasc,15758,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Free fascial flap microvasc,15758,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Free fascial flap microvasc,15758,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Free fascial flap microvasc,15758,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,5123, Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,5123, Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,5123, Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,5123, Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Composite skin graft,15760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,13320, Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,13320, Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4186.36,13320, Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4186.36,13320, Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4186.36,13320, Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4186.36,13320, Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,13320,APC Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,13320,APC Grfg autol soft tiss dir exc,15769,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,13320,APC Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,9420,APC Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,9420,APC Derma-fat-fascia graft,15770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,9420,APC Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,13320, Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,13320, Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4186.36,13320, Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4186.36,13320, Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4186.36,13320, Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4186.36,13320, Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,13320,APC Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,13320,APC Grfg autol fat lipo 50 cc/<,15771,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,13320,APC Grfg autol fat lipo ea addl,15772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Grfg autol fat lipo ea addl,15772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Grfg autol fat lipo ea addl,15772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Grfg autol fat lipo ea addl,15772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,13320, Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,13320, Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,13320, Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,13320, Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2437.45,13320, Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2437.45,13320, Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,13320,APC Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,13320,APC Grfg autol fat lipo 25 cc/<,15773,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,13320,APC Gfrg autol fat lipo ea addl,15774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Gfrg autol fat lipo ea addl,15774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Gfrg autol fat lipo ea addl,15774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Gfrg autol fat lipo ea addl,15774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,428,5098,APC Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,428,5098,APC Hair trnspl 1-15 punch grfts,15775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,428,5098,APC Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,428,5098,APC Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,428,5098,APC Hair trnspl >15 punch grafts,15776,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,428,5098,APC Acellular derm matrix implt,15777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Acellular derm matrix implt,15777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Acellular derm matrix implt,15777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Acellular derm matrix implt,15777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Impl absrb msh/prsth dly cls,15778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Impl absrb msh/prsth dly cls,15778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Impl absrb msh/prsth dly cls,15778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Impl absrb msh/prsth dly cls,15778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1406,18617,APC Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1406,18617,APC Dermabrasion total face,15780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1406,18617,APC Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,3314, Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,3314, Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Dermabrasion segmental face,15781,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18686, Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18686, Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,18686, Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,18686, Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1406,18686, Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1406,18686, Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1406,18686,APC Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1406,18686,APC Dermabrasion other than face,15782,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1406,18686,APC Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,3314, Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,3314, Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Dermabrasion suprfl any site,15783,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Abrasion lesion single,15786,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Abrasion lesions add-on,15787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Abrasion lesions add-on,15787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,18617, Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,18617, Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Chemical peel face epiderm,15788,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,873.1,18617, Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,873.1,18617, Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,873.1,18617, Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,873.1,18617, Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,873.1,18617, Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,873.1,18617, Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,18617,APC Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,18617,APC Chemical peel face dermal,15789,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,18617,APC Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,855,18617, Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,855,18617, Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,18617,APC Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,18617,APC Chemical peel nonfacial,15792,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,18617,APC Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,18617, Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,18617, Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,480.23,18617, Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,480.23,18617, Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Chemical peel nonfacial,15793,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Plastic surgery neck,15819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Plastic surgery neck,15819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Plastic surgery neck,15819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Plastic surgery neck,15819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Plastic surgery neck,15819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,4166, Plastic surgery neck,15819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,4166, Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Revision of lower eyelid,15820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,6404, Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,6404, Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,6404, Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,6404, Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Revision of lower eyelid,15821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Revision of upper eyelid,15822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2437.45,7422, Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2437.45,7422, Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,7422, Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,7422, Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2437.45,7422, Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2437.45,7422, Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,7422,APC Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,7422,APC Revision of upper eyelid,15823,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,7422,APC Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Removal of forehead wrinkles,15824,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,8006,APC Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,8006,APC Removal of neck wrinkles,15825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,8006,APC Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,9420,APC Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,9420,APC Removal of brow wrinkles,15826,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,9420,APC Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,15339,APC Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,15339,APC Removal of face wrinkles,15828,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,15339,APC Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3291,11081,APC Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3291,11081,APC Removal of skin wrinkles,15829,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3291,11081,APC Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,3408,11081,APC Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,3408,11081,APC Exc Skin Abd,15830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,3408,11081,APC Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13036,APC Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13036,APC Excise excessive skin thigh,15832,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13036,APC Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,9420,APC Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,9420,APC Excise excessive skin leg,15833,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,9420,APC Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,15339,APC Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,15339,APC Excise excessive skin hip,15834,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,15339,APC Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Excise excessive skin buttck,15835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,9420,APC Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,9420,APC Excise excessive skin arm,15836,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,9420,APC Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,18617, Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,18617, Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,18617,APC Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,18617,APC Excise excess skin arm/hand,15837,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,18617,APC Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,18617, Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,18617, Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,18617,APC Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,18617,APC Excise excess skin fat pad,15838,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,18617,APC Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Excise excess skin & tissue,15839,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,9420, Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,9420, Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4186.36,9420, Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4186.36,9420, Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4186.36,9420, Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4186.36,9420, Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,9420,APC Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,9420,APC Nerve palsy fascial graft,15840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,9420,APC Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,9420, Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,9420, Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4186.36,9420, Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4186.36,9420, Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4186.36,9420, Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4186.36,9420, Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,9420,APC Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,9420,APC Nerve palsy muscle graft,15841,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,9420,APC Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,428,6312,APC Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,428,6312,APC Nerve palsy microsurg graft,15842,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,428,6312,APC Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,11081, Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,11081, Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4186.36,11081, Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4186.36,11081, Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4186.36,11081, Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4186.36,11081, Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,11081,APC Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,11081,APC Skin and muscle repair face,15845,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,11081,APC Exc Skin Abd Add-on,15847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Exc Skin Abd Add-on,15847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Exc Skin Abd Add-on,15847,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Exc Skin Abd Add-on,15847,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Remove sutures same surgeon,15850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,2460, Remove sutures same surgeon,15850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,2460, Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1544,4097,APC Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1544,4097,APC Remove sutures diff surgeon,15851,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1544,4097,APC Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,873.1,18617, Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,873.1,18617, Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,873.1,18617, Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,873.1,18617, Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,873.1,18617, Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,873.1,18617, Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,18617,APC Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,18617,APC Dressing change not for burn,15852,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,18617,APC Removal sutr/stapl xreq anes,15853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Removal sutr/stapl xreq anes,15853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Removal sutr/stapl xreq anes,15853,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Removal sutr/stapl xreq anes,15853,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Removal sutr&stapl xreq anes,15854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Removal sutr&stapl xreq anes,15854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Removal sutr&stapl xreq anes,15854,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Removal sutr&stapl xreq anes,15854,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Test for blood flow in graft,15860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,6404, Test for blood flow in graft,15860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,6404, Test for blood flow in graft,15860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,527.74,6404, Test for blood flow in graft,15860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,527.74,6404, Test for blood flow in graft,15860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,6404,APC Test for blood flow in graft,15860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,6404,APC Test for blood flow in graft,15860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,6404,APC Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,6404,APC Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,6404,APC Suction lipectomy head&neck,15876,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,6404,APC Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,6404,APC Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,6404,APC Suction lipectomy trunk,15877,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,6404,APC Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Suction lipectomy upr extrem,15878,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,5123,APC Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,5123,APC Suction lipectomy lwr extrem,15879,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,5123,APC Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Removal of tail bone ulcer,15920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,6404, Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,6404, Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4186.36,6404, Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4186.36,6404, Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4186.36,6404, Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4186.36,6404, Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,6404,APC Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,6404,APC Removal of tail bone ulcer,15922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,6404,APC Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Remove sacrum pressure sore,15931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Remove sacrum pressure sore,15933,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,5123,APC Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,5123,APC Remove sacrum pressure sore,15934,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,5123,APC Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,6404, Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,6404, Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4186.36,6404, Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4186.36,6404, Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4186.36,6404, Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4186.36,6404, Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,6404,APC Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,6404,APC Remove sacrum pressure sore,15935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,6404,APC Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6312,APC Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6312,APC Remove sacrum pressure sore,15936,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6312,APC Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2437.45,6312, Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6312,APC Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6312,APC Remove sacrum pressure sore,15937,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6312,APC Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5098,APC Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5098,APC Remove hip pressure sore,15940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5098,APC Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,8006,APC Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,8006,APC Remove hip pressure sore,15941,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,8006,APC Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,8006,APC Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,8006,APC Remove hip pressure sore,15944,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,8006,APC Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Remove hip pressure sore,15945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2437.45,6404, Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,6404,APC Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,6404,APC Remove hip pressure sore,15946,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,6404,APC Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,5123, Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,5123, Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1951.11,5123, Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1951.11,5123, Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1951.11,5123, Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1951.11,5123, Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,5123,APC Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,5123,APC Remove thigh pressure sore,15950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,5123,APC Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3431.47,11081, Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3431.47,11081, Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3431.47,11081, Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3431.47,11081, Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3431.47,11081, Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3431.47,11081, Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3431.47,11081,APC Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3431.47,11081,APC Remove thigh pressure sore,15951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3431.47,11081,APC Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,8006, Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,8006, Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2437.45,8006, Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2437.45,8006, Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,8006, Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,8006, Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,8006,APC Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,8006,APC Remove thigh pressure sore,15952,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,8006,APC Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,6312, Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,6312, Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4186.36,6312, Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4186.36,6312, Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4186.36,6312, Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4186.36,6312, Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,6312,APC Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,6312,APC Remove thigh pressure sore,15953,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,6312,APC Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5098, Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5098, Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,5098, Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,5098, Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5098, Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5098, Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5098,APC Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5098,APC Remove thigh pressure sore,15956,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5098,APC Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,13036, Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,13036, Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4186.36,13036, Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4186.36,13036, Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4186.36,13036, Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4186.36,13036, Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,13036,APC Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,13036,APC Remove thigh pressure sore,15958,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,13036,APC Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,836.55,18617, Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,836.55,18617, Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Removal of pressure sore,15999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Initial treatment of burn(s),16000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,3314, Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,3314, Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,3314, Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,3314, Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,237.02,3314, Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,237.02,3314, Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,3314,APC Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,3314,APC Dress/debrid p-thick burn s,16020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,3314,APC Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,237.02,4466, Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,237.02,4466, Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,4466, Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,4466, Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,237.02,4466, Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,237.02,4466, Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,4466,APC Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,4466,APC Dress/debrid p-thick burn m,16025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,4466,APC Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4466, Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4466, Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4466, Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4466, Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,480.23,4466, Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,480.23,4466, Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4466,APC Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4466,APC Dress/debrid p-thick burn l,16030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4466,APC Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,18617, Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,18617, Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Incision of burn scab initi,16035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Escharotomy addl incision,16036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Escharotomy addl incision,16036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Escharotomy addl incision,16036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Escharotomy addl incision,16036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,16040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,16040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,16040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,16040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,16041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,16041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,16041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,16041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,16042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,16042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,16042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,16042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruct premalg lesion,17000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Description Not Available,17001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,17002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Destruct premalg les 2-14,17003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Destruct premalg les 2-14,17003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Destruct premalg les 2-14,17003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Destruct premalg les 2-14,17003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Destroy premal lesions 15/>,17004,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Description Not Available,17100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,17101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,17102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,17104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,17105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Destruction of skin lesions,17106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,873.1,3314, Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,873.1,3314, Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,3314, Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,3314, Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,873.1,3314, Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,873.1,3314, Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,3314,APC Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,3314,APC Destruction of skin lesions,17107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,3314,APC Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1544,3314,APC Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1544,3314,APC Destruction of skin lesions,17108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1544,3314,APC Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruct b9 lesion 1-14,17110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruct lesion 15 or more,17111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Description Not Available,17200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,17201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,17201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,17201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,17201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Chemical cautery tissue,17250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4166,APC Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4166,APC Destruction of skin lesions,17266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4166,APC Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Destruction of skin lesions,17274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,4166, Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,4166,APC Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,4166,APC Destruction of skin lesions,17276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,4166,APC Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,3314,APC Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,3314,APC Destruction of skin lesions,17284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,3314,APC Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,18617, Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,18617, Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,855,18617,APC Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,855,18617,APC Destruction of skin lesions,17286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,855,18617,APC Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4166, Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4166, Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,4166, Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,4166, Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,873.1,4166, Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,873.1,4166, Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4166,APC Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4166,APC Mohs 1 stage h/n/hf/g,17311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4166,APC Mohs Addl Stage,17312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Mohs Addl Stage,17312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Mohs Addl Stage,17312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Mohs Addl Stage,17312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,873.1,4166, Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,873.1,4166, Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,4166, Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,4166, Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,873.1,4166, Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,873.1,4166, Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,4166,APC Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,4166,APC Mohs 1 stage t/a/l,17313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,4166,APC Mohs addl stage t/a/l,17314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Mohs addl stage t/a/l,17314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Mohs addl stage t/a/l,17314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Mohs addl stage t/a/l,17314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Mohs surg addl block,17315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Mohs surg addl block,17315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Mohs surg addl block,17315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Mohs surg addl block,17315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Cryotherapy of skin,17340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,237.02,18617, Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,237.02,18617, Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Skin peel therapy,17360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,873.1,18617, Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,873.1,18617, Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,873.1,18617, Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,873.1,18617, Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,873.1,18617, Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,873.1,18617, Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,873.1,18617,APC Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,873.1,18617,APC Hair removal by electrolysis,17380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,873.1,18617,APC Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,18617, Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,18617, Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,237.02,18617, Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,237.02,18617, Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Skin tissue procedure,17999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Drainage of breast lesion,19000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Drain breast lesion add-on,19001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Drain breast lesion add-on,19001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Drain breast lesion add-on,19001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Drain breast lesion add-on,19001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Incision of breast lesion,19020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Injection for breast x-ray,19030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for breast x-ray,19030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for breast x-ray,19030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for breast x-ray,19030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,5098,APC Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,5098,APC Bx breast 1st lesion strtctc,19081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,5098,APC Bx breast add lesion strtctc,19082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Bx breast add lesion strtctc,19082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Bx breast add lesion strtctc,19082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Bx breast add lesion strtctc,19082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,5098,APC Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,5098,APC Bx breast 1st lesion us imag,19083,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,5098,APC Bx breast add lesion us imag,19084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Bx breast add lesion us imag,19084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Bx breast add lesion us imag,19084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Bx breast add lesion us imag,19084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1951.11,5098, Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,5098,APC Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,5098,APC Bx breast 1st lesion mr imag,19085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,5098,APC Bx breast add lesion mr imag,19086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Bx breast add lesion mr imag,19086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Bx breast add lesion mr imag,19086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Bx breast add lesion mr imag,19086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Bx breast percut w/o image,19100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,5123,APC Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,5123,APC Biopsy of breast open,19101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,5123,APC Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,13320, Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,13320, Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,13320, Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,13320, Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3563,13320, Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3563,13320, Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,3563,13320,APC Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,3563,13320,APC Cryosurg ablate fa each,19105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,3563,13320,APC Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,5123,APC Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,5123,APC Nipple exploration,19110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,5123,APC Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,3408,5123,APC Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,3408,5123,APC Excise breast duct fistula,19112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,3408,5123,APC Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,3408,5123,APC Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,3408,5123,APC Removal of breast lesion,19120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,3408,5123,APC Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,3408,6404,APC Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,3408,6404,APC Excision breast lesion,19125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,3408,6404,APC Excision addl breast lesion,19126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Excision addl breast lesion,19126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Excision addl breast lesion,19126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Excision addl breast lesion,19126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of chest wall lesion,19260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4457,5123, Removal of chest wall lesion,19260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4457,5123, Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4166, Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4166, Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1951.11,4166, Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1951.11,4166, Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1951.11,4166, Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1951.11,4166, Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4166,APC Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4166,APC Perq device breast 1st imag,19281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4166,APC Perq device breast ea imag,19282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq device breast ea imag,19282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq device breast ea imag,19282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq device breast ea imag,19282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Perq dev breast 1st strtctc,19283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Perq dev breast add strtctc,19284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq dev breast add strtctc,19284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq dev breast add strtctc,19284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq dev breast add strtctc,19284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Perq dev breast 1st us imag,19285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Perq dev breast add us imag,19286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq dev breast add us imag,19286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq dev breast add us imag,19286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq dev breast add us imag,19286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,836.55,5044, Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,836.55,5044, Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,5044, Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,5044, Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,5044, Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,5044, Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,5044,APC Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,5044,APC Perq dev breast 1st mr guide,19287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,5044,APC Perq dev breast add mr guide,19288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq dev breast add mr guide,19288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq dev breast add mr guide,19288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq dev breast add mr guide,19288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Prep tum cav iort prtl mast,19294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Prep tum cav iort prtl mast,19294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Prep tum cav iort prtl mast,19294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Prep tum cav iort prtl mast,19294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,13320, Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,13320, Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4062,13320, Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4062,13320, Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,13320, Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,13320, Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10041.81,,,,,,,fee schedule,4062,13320,APC Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10138.37,,,,,,,fee schedule,4062,13320,APC Place po breast cath for rad,19296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9655.59,,,,,,,fee schedule,4062,13320,APC Place breast cath for rad,19297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,428,4920, Place breast cath for rad,19297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,428,4920, Place breast cath for rad,19297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4920, Place breast cath for rad,19297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4920, Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,17094.06, Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,17094.06, Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,17094.06, Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,17094.06, Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,17094.06, Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,17094.06, Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16931.26,,,,,,,fee schedule,3560,17094.06,APC Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17094.06,,,,,,,fee schedule,3560,17094.06,APC Place breast rad tube/caths,19298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16280.06,,,,,,,fee schedule,3560,17094.06,APC Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,4224,6404,APC Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,4224,6404,APC Removal of Breast Tissue,19300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,4224,6404,APC Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,3408,6404,APC Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,3408,6404,APC Partial Mastectomy,19301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,3408,6404,APC P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,4147,11081,APC P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,4147,11081,APC P-Mastectomy w/LN Removal,19302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,4147,11081,APC Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,4224,11081,APC Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,4224,11081,APC Mast simple complete,19303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,4224,11081,APC Mast subq,19304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Mast subq,19304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Mast radical,19305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Mast radical,19305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Mast radical,19305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Mast radical,19305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mast rad urban type,19306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Mast rad urban type,19306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Mast rad urban type,19306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Mast rad urban type,19306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,3291,13320,APC Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,3291,13320,APC Mast mod rad,19307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,3291,13320,APC Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,4224,9420,APC Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,4224,9420,APC Suspension of breast,19316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,4224,9420,APC Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,4224,11081,APC Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,4224,11081,APC Reduction of large breast,19318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,4224,11081,APC Enlarge breast,19324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,13338,15339, Enlarge breast,19324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,13338,15339, Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,13320, Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,13320, Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4062,13320, Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4062,13320, Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,13320, Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,13320, Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10041.81,,,,,,,fee schedule,4062,13320,APC Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10138.37,,,,,,,fee schedule,4062,13320,APC Enlarge breast with implant,19325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9655.59,,,,,,,fee schedule,4062,13320,APC Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,1544,6404,APC Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,1544,6404,APC Removal of breast implant,19328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,1544,6404,APC Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,1544,6404,APC Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,1544,6404,APC Removal of implant material,19330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,1544,6404,APC Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10041.81,,,,,,,fee schedule,2816,13036,APC Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10138.37,,,,,,,fee schedule,2816,13036,APC Immediate breast prosthesis,19340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9655.59,,,,,,,fee schedule,2816,13036,APC Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10041.81,,,,,,,fee schedule,3408,13036,APC Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10138.37,,,,,,,fee schedule,3408,13036,APC Delayed breast prosthesis,19342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9655.59,,,,,,,fee schedule,3408,13036,APC Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,4224,6404,APC Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,4224,6404,APC Breast reconstruction,19350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,4224,6404,APC Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6312, Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6312, Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,6312, Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,6312, Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6312, Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6312, Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,4224,6312,APC Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,4224,6312,APC Correct inverted nipple(s),19355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,4224,6312,APC Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17939, Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17939, Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,17939, Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,17939, Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17939, Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17939, Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16931.26,,,,,,,fee schedule,3291,17939,APC Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17094.06,,,,,,,fee schedule,3291,17939,APC Breast reconstruction,19357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16280.06,,,,,,,fee schedule,3291,17939,APC Breast reconstr w/lat flap,19361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Breast reconstr w/lat flap,19361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Breast reconstr w/lat flap,19361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Breast reconstr w/lat flap,19361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Breast reconstruction,19364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Breast reconstruction,19364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Breast reconstruction,19364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Breast reconstruction,19364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Breast reconstruction,19364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Breast reconstruction,19364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Breast reconstruction,19366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,8190,9420, Breast reconstruction,19366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,8190,9420, Breast reconstruction,19367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Breast reconstruction,19367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Breast reconstruction,19367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Breast reconstruction,19367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Breast reconstruction,19368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Breast reconstruction,19368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Breast reconstruction,19368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Breast reconstruction,19368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Breast reconstruction,19369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Breast reconstruction,19369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Breast reconstruction,19369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Breast reconstruction,19369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,4224,8006,APC Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,4224,8006,APC Surgery of breast capsule,19370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,4224,8006,APC Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,4224,8006,APC Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,4224,8006,APC Removal of breast capsule,19371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,4224,8006,APC Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,3291,9420,APC Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,3291,9420,APC Revise breast reconstruction,19380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,3291,9420,APC Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,428,18617,APC Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,428,18617,APC Design custom breast implant,19396,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,428,18617,APC Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,18617, Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,18617, Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,1544,18617,APC Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,1544,18617,APC Breast surgery procedure,19499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,1544,18617,APC Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,637.13,4097, Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,637.13,4097, Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,637.13,4097, Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,637.13,4097, Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,4097, Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,4097, Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4097,APC Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4097,APC Explore wound neck,20100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4097,APC Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1406,18617,APC Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1406,18617,APC Explore wound chest,20101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1406,18617,APC Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1406,18617,APC Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1406,18617,APC Explore wound abdomen,20102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1406,18617,APC Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Explore wound extremity,20103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Excise epiphyseal bar,20150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Muscle biopsy,20200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Deep muscle biopsy,20205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Needle biopsy muscle,20206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Bone biopsy trocar/needle,20220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Bone biopsy trocar/needle,20225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,6404,APC Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,6404,APC Bone biopsy open superficial,20240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,6404,APC Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Bone biopsy open deep,20245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Open bone biopsy,20250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Open bone biopsy,20251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,18617, Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,18617, Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Injection of sinus tract,20500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Inject sinus tract for x-ray,20501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inject sinus tract for x-ray,20501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inject sinus tract for x-ray,20501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inject sinus tract for x-ray,20501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4166, Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4166, Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1951.11,4166, Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1951.11,4166, Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1951.11,4166, Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1951.11,4166, Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4166,APC Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4166,APC Removal of foreign body,20520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4166,APC Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5098,APC Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5098,APC Removal of foreign body,20525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5098,APC Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Ther injection carp tunnel,20526,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC Inj dupuytren cord w/enzyme,20527,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Inj tendon sheath/ligament,20550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Inj tendon origin/insertion,20551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Inj trigger point 1/2 muscl,20552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Inject trigger points 3/>,20553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,13320, Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,13320, Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,13320,APC Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,13320,APC Place ndl musc/tis for rt,20555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,13320,APC Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,18617,APC Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,18617,APC Ndl insj w/o njx 1 or 2 musc,20560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,18617,APC Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,34.17,18617, Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,18617,APC Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,18617,APC Ndl insj w/o njx 3+ musc,20561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,18617,APC Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/o us,20600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC Drain/inj joint/bursa w/us,20604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/o us,20605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,18617, Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,18617, Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,18617, Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,18617, Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,833.89,18617, Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,833.89,18617, Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,18617,APC Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,18617,APC Drain/inj joint/bursa w/us,20606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,18617,APC Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/o us,20610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC Drain/inj joint/bursa w/us,20611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Aspirate/inj ganglion cyst,20612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,18617, Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,18617, Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,18617, Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,18617, Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Treatment of bone cyst,20615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Insert and remove bone pin,20650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,18617, Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,18617, Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,18617, Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,18617, Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Apply rem fixation device,20660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,428,18617,APC Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,428,18617,APC Application of head brace,20661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,428,18617,APC Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,428,5098,APC Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,428,5098,APC Application of pelvis brace,20662,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,428,5098,APC Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Application of thigh brace,20663,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,18617, Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,18617, Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1899.59,18617, Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1899.59,18617, Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Application of halo,20664,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Removal of fixation device,20665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,1866, Removal of fixation device,20665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,1866, Removal of fixation device,20665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,1866, Removal of fixation device,20665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,1866, Removal of fixation device,20665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,1866,APC Removal of fixation device,20665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,1866,APC Removal of fixation device,20665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,1866,APC Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Removal of support implant,20670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Removal of support implant,20680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,13036,APC Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,13036,APC Apply bone fixation device,20690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,13036,APC Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15925.26, Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15925.26, Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,15925.26, Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,15925.26, Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15925.26, Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15925.26, Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,15925.26,APC Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,15925.26,APC Apply bone fixation device,20692,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,15925.26,APC Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Adjust bone fixation device,20693,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Remove bone fixation device,20694,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,33657.37, Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,33657.37, Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3408,33657.37, Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3408,33657.37, Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,33657.37, Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,33657.37, Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,3408,33657.37,APC Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,3408,33657.37,APC Comp multiplane ext fixation,20696,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,3408,33657.37,APC Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,9918, Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,9918, Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,9918, Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,9918, Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1899.59,9918, Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1899.59,9918, Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,9918,APC Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,9918,APC Comp ext fixate strut change,20697,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,9918,APC Mnl prep&insj dp rx dlvr dev,20700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Mnl prep&insj dp rx dlvr dev,20700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rmvl deep rx delivery device,20701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rmvl deep rx delivery device,20701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Mnl prep&insj imed rx dev,20702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Mnl prep&insj imed rx dev,20702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rmvl imed rx delivery device,20703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rmvl imed rx delivery device,20703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Mnl prep&insj i-artic rx dev,20704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Mnl prep&insj i-artic rx dev,20704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rmvl i-artic rx delivery dev,20705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rmvl i-artic rx delivery dev,20705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21749.16, Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21749.16, Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,21749.16, Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,21749.16, Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21749.16, Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21749.16, Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1406,21749.16,APC Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1406,21749.16,APC Replantation arm complete,20802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1406,21749.16,APC Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21749.16, Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21749.16, Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,21749.16, Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,21749.16, Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21749.16, Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21749.16, Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1406,21749.16,APC Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1406,21749.16,APC Replant forearm complete,20805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1406,21749.16,APC Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21749.16, Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21749.16, Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,21749.16, Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,21749.16, Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21749.16, Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21749.16, Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1406,21749.16,APC Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1406,21749.16,APC Replantation hand complete,20808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1406,21749.16,APC Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1406,18617,APC Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1406,18617,APC Replantation digit complete,20816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1406,18617,APC Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,5098, Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,5098, Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,5098, Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,5098, Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1406,5098, Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1406,5098, Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1406,5098,APC Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1406,5098,APC Replantation digit complete,20822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1406,5098,APC Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1406,18617,APC Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1406,18617,APC Replantation thumb complete,20824,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1406,18617,APC Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1406,18617,APC Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1406,18617,APC Replantation thumb complete,20827,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1406,18617,APC Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21749.16, Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21749.16, Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,21749.16, Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,21749.16, Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21749.16, Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21749.16, Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1406,21749.16,APC Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1406,21749.16,APC Replantation foot complete,20838,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1406,21749.16,APC Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Removal of bone for graft,20900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9000.7, Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9000.7, Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,9000.7, Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,9000.7, Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9000.7, Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9000.7, Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9000.7,APC Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9000.7,APC Removal of bone for graft,20902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9000.7,APC Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.02,,,,,,,fee schedule,428,5098,APC Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,916.75,,,,,,,fee schedule,428,5098,APC Remove cartilage for graft,20910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.1,,,,,,,fee schedule,428,5098,APC Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,8006,APC Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,8006,APC Remove cartilage for graft,20912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,8006,APC Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,428,6312,APC Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,428,6312,APC Removal of fascia for graft,20920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,428,6312,APC Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,13036, Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,13036, Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2437.45,13036, Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2437.45,13036, Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,13036, Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,13036, Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,13036,APC Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,13036,APC Removal of fascia for graft,20922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,13036,APC Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Removal of tendon for graft,20924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Removal of tissue for graft,20926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Removal of tissue for graft,20926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Sp bone algrft morsel add-on,20930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Sp bone algrft morsel add-on,20930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Sp bone algrft morsel add-on,20930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Sp bone algrft morsel add-on,20930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Sp bone algrft struct add-on,20931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Sp bone algrft struct add-on,20931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Sp bone algrft struct add-on,20931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Sp bone algrft struct add-on,20931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Osteoart algrft w/surf & b1,20932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Osteoart algrft w/surf & b1,20932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Osteoart algrft w/surf & b1,20932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Osteoart algrft w/surf & b1,20932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Hemicrt intrclry algrft prtl,20933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Hemicrt intrclry algrft prtl,20933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Hemicrt intrclry algrft prtl,20933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Hemicrt intrclry algrft prtl,20933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Intercalary algrft compl,20934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Intercalary algrft compl,20934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Intercalary algrft compl,20934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Intercalary algrft compl,20934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Sp bone agrft local add-on,20936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Sp bone agrft local add-on,20936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Sp bone agrft local add-on,20936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Sp bone agrft local add-on,20936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Sp bone agrft morsel add-on,20937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Sp bone agrft morsel add-on,20937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Sp bone agrft struct add-on,20938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Sp bone agrft struct add-on,20938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Bone marrow aspir bone grfg,20939,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Bone marrow aspir bone grfg,20939,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Bone marrow aspir bone grfg,20939,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Bone marrow aspir bone grfg,20939,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,3314, Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,3314, Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Fluid pressure muscle,20950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Fibula bone graft microvasc,20955,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Iliac bone graft microvasc,20956,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Mt bone graft microvasc,20957,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Description Not Available,20960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,20960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,20960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,20960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Other bone graft microvasc,20962,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Bone/skin graft microvasc,20969,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Bone/skin graft iliac crest,20970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Description Not Available,20971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,20971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,20971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,20971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,17041,APC Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,17041,APC Bone/skin graft metatarsal,20972,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,17041,APC Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,9000.7, Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,9000.7, Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9000.7, Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9000.7, Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,9000.7, Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,9000.7, Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,9000.7,APC Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,9000.7,APC Bone/skin graft great toe,20973,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,9000.7,APC Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,56.97,18617, Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,56.97,18617, Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,56.97,18617, Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,56.97,18617, Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,56.97,18617, Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,56.97,18617, Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,59.25,,,,,,,fee schedule,56.97,18617,APC Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.82,,,,,,,fee schedule,56.97,18617,APC Electrical bone stimulation,20974,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.97,,,,,,,fee schedule,56.97,18617,APC Electrical bone stimulation,20975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Electrical bone stimulation,20975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Electrical bone stimulation,20975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Electrical bone stimulation,20975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,34.17,18617, Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,34.17,18617, Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,34.17,18617, Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,34.17,18617, Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,34.17,18617, Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,34.17,18617, Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,18617,APC Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,18617,APC Us bone stimulation,20979,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,18617,APC Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,21749.16, Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,21749.16, Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,1544,21749.16, Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,1544,21749.16, Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,21749.16, Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,21749.16, Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1544,21749.16,APC Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1544,21749.16,APC Ablate bone tumor(s) perq,20982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1544,21749.16,APC Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,18617, Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,18617, Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,18617,APC Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,18617,APC Ablate bone tumor(s) perq,20983,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,18617,APC Cptr-asst dir ms px,20985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Cptr-asst dir ms px,20985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Cptr-asst dir ms px,20985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Cptr-asst dir ms px,20985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Musculoskeletal surgery,20999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,5123, Musculoskeletal surgery,20999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,5123, Musculoskeletal surgery,20999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,291.4,5123, Musculoskeletal surgery,20999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,291.4,5123, Musculoskeletal surgery,20999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,5123,APC Musculoskeletal surgery,20999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,5123,APC Musculoskeletal surgery,20999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,5123,APC Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Incision of jaw joint,21010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,18617,APC Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,18617,APC Exc face les sc <2 cm,21011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,18617,APC Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,5123, Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,5123, Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,5123,APC Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,5123,APC Exc face les sbq 2 cm/>,21012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,5123,APC Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4466, Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4466, Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4466, Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4466, Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,4466, Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,4466, Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4466,APC Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4466,APC Exc face tum deep < 2 cm,21013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4466,APC Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,5123, Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,5123, Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,5123,APC Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,5123,APC Exc face tum deep 2 cm/>,21014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,5123,APC Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Resect face/scalp tum < 2 cm,21015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,13320, Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,13320, Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,13320,APC Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,13320,APC Resect face/scalp tum 2 cm/>,21016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,13320,APC Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Excision of bone lower jaw,21025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Excision of facial bone(s),21026,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Contour of face bone lesion,21029,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,18617, Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,18617, Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,18617,APC Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,18617,APC Excise max/zygoma b9 tumor,21030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,18617,APC Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,18617, Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,18617, Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Remove exostosis mandible,21031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,18617, Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,18617, Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Remove exostosis maxilla,21032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Excise max/zygoma mal tumor,21034,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Excise mandible lesion,21040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3721,9420, Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3721,9420, Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3721,9420, Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3721,9420, Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,3721,9420, Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,3721,9420, Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3721,9420,APC Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3721,9420,APC Removal of jaw bone lesion,21044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3721,9420,APC Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Extensive jaw surgery,21045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Remove mandible cyst complex,21046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,11081,APC Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,11081,APC Excise lwr jaw cyst w/repair,21047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,11081,APC Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,9420, Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,9420, Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Remove maxilla cyst complex,21048,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,9420, Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,9420, Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Excis uppr jaw cyst w/repair,21049,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,9420,APC Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,9420,APC Removal of jaw joint,21050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,9420,APC Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,13036,APC Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,13036,APC Remove jaw joint cartilage,21060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,13036,APC Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,11081,APC Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,11081,APC Remove coronoid process,21070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,11081,APC Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Mnpj of tmj w/anesth,21073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21079,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21082,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21083,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21084,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Prepare face/oral prosthesis,21085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21086,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21087,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21088,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Prepare face/oral prosthesis,21089,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,7343.03, Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,7343.03, Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7343.03, Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7343.03, Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,7343.03, Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,7343.03, Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,7343.03,APC Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,7343.03,APC Maxillofacial fixation,21100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,7343.03,APC Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,8006,APC Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,8006,APC Interdental fixation,21110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,8006,APC Injection jaw joint x-ray,21116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection jaw joint x-ray,21116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection jaw joint x-ray,21116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection jaw joint x-ray,21116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15339, Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15339, Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,15339, Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,15339, Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,15339, Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,15339, Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,15339,APC Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,15339,APC Reconstruction of chin,21120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,15339,APC Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3916.7,9918, Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3916.7,9918, Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,9918, Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,9918, Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3916.7,9918, Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3916.7,9918, Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,9918,APC Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,9918,APC Reconstruction of chin,21121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,9918,APC Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Reconstruction of chin,21122,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3916.7,17041, Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3916.7,17041, Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3916.7,17041, Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3916.7,17041, Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3916.7,17041, Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3916.7,17041, Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,17041,APC Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,17041,APC Reconstruction of chin,21123,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,17041,APC Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Augmentation lower jaw bone,21125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,15339, Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,15339, Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3560,15339, Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3560,15339, Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,15339, Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,15339, Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3560,15339,APC Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3560,15339,APC Augmentation lower jaw bone,21127,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3560,15339,APC Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,18617, Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,18617, Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,18617,APC Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,18617,APC Reduction of forehead,21137,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,18617,APC Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,18617, Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,18617, Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,18617,APC Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,18617,APC Reduction of forehead,21138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,18617,APC Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,18617,APC Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,18617,APC Reduction of forehead,21139,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,18617,APC Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,18617, Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,18617, Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,18617, Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,18617, Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3563,18617, Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3563,18617, Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3563,18617,APC Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3563,18617,APC Lefort i-1 piece w/o graft,21141,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3563,18617,APC Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort i-2 piece w/o graft,21142,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort i-3/> piece w/o graft,21143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort i-1 piece w/ graft,21145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort i-2 piece w/ graft,21146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort i-3/> piece w/ graft,21147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort ii anterior intrusion,21150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort ii w/bone grafts,21151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort iii w/o lefort i,21154,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort iii w/ lefort i,21155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort iii w/fhdw/o lefort i,21159,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Lefort iii w/fhd w/ lefort i,21160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Reconstruct orbit/forehead,21172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Reconstruct orbit/forehead,21175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2138,18617, Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2138,18617, Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,18617, Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,18617, Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2138,18617, Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2138,18617, Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2138,18617,APC Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2138,18617,APC Reconstruct entire forehead,21179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2138,18617,APC Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Reconstruct entire forehead,21180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Contour cranial bone lesion,21181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Reconstruct cranial bone,21184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Reconstruction of midface,21188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Reconst lwr jaw w/o graft,21193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Reconst lwr jaw w/graft,21194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Reconst lwr jaw w/o fixation,21195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Reconst lwr jaw w/fixation,21196,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,18617,APC Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,18617,APC Reconstr lwr jaw segment,21198,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,18617,APC Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Reconstr Lwr Jaw W/Advance,21199,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13036,APC Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13036,APC Reconstruct upper jaw bone,21206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13036,APC Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Augmentation of facial bones,21208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Reduction of facial bones,21209,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Face bone graft,21210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Lower jaw bone graft,21215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Rib cartilage graft,21230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Ear cartilage graft,21235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,8006,APC Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,8006,APC Reconstruction of jaw joint,21240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,8006,APC Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13036,APC Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13036,APC Reconstruction of jaw joint,21242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13036,APC Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,33657.37, Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,33657.37, Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,33657.37, Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,33657.37, Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,33657.37, Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,33657.37, Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,3291,33657.37,APC Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,3291,33657.37,APC Reconstruction of jaw joint,21243,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,3291,33657.37,APC Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18686, Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18686, Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,4147,18686, Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,4147,18686, Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,18686, Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,18686, Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,18686,APC Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,18686,APC Reconstruction of lower jaw,21244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,18686,APC Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Reconstruction of jaw,21245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17041, Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17041, Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,17041, Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,17041, Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,17041, Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,17041, Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,17041,APC Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,17041,APC Reconstruction of jaw,21246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,17041,APC Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,18617,APC Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,18617,APC Reconstruct lower jaw bone,21247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,18617,APC Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Reconstruction of jaw,21248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Reconstruction of jaw,21249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Reconstruct lower jaw bone,21255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,1406,18617, Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,1406,18617, Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Reconstruction of orbit,21256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,18617,APC Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,18617,APC Revise eye sockets,21260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,18617,APC Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,18617,APC Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,18617,APC Revise eye sockets,21261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,18617,APC Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,855,18617, Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,855,18617, Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,855,18617,APC Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,855,18617,APC Revise eye sockets,21263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,855,18617,APC Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,9918, Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,9918, Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9918, Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9918, Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,428,9918, Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,428,9918, Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,9918,APC Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,9918,APC Revise eye sockets,21267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,9918,APC Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Revise eye sockets,21268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Augmentation cheek bone,21270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3563,9918, Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3563,9918, Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,9918, Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,9918, Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3563,9918, Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3563,9918, Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3563,9918,APC Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3563,9918,APC Revision orbitofacial bones,21275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3563,9918,APC Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3291,7422,APC Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3291,7422,APC Revision of eyelid,21280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3291,7422,APC Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3291,7422,APC Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3291,7422,APC Revision of eyelid,21282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3291,7422,APC Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,428,3314,APC Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,428,3314,APC Revision of jaw muscle/bone,21295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,428,3314,APC Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,4112.54, Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,4112.54, Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4112.54, Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4112.54, Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,4112.54, Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,4112.54, Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,428,4112.54,APC Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,428,4112.54,APC Revision of jaw muscle/bone,21296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,428,4112.54,APC Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,279.8,18617, Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,279.8,18617, Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Cranio/maxillofacial surgery,21299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Closed tx nose fx w/o manj,21310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,984, Closed tx nose fx w/o manj,21310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,984, Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,4466, Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,4466, Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,4466, Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,4466, Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1832.96,4466, Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1832.96,4466, Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,4466,APC Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,4466,APC Closed tx nose fx w/o stablj,21315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,4466,APC Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,4466,APC Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,4466,APC Closed tx nose fx w/ stablj,21320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,4466,APC Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6312, Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6312, Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3916.7,6312, Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3916.7,6312, Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6312, Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6312, Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6312,APC Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6312,APC Open tx nose fx uncomplicatd,21325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6312,APC Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,8006,APC Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,8006,APC Open tx nose fx w/skele fixj,21330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,8006,APC Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3916.7,9918, Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3916.7,9918, Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,9918, Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,9918, Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3916.7,9918, Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3916.7,9918, Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,9918,APC Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,9918,APC Open tx nose & septal fx,21335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,9918,APC Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Open tx septal fx w/wo stabj,21336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,4466,APC Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,4466,APC Closed tx septal&nose fx,21337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,4466,APC Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,8006,APC Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,8006,APC Open nasoethmoid fx w/o fixj,21338,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,8006,APC Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13036,APC Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13036,APC Open nasoethmoid fx w/ fixj,21339,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13036,APC Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6404, Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6404, Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,6404, Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,6404, Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6404, Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6404, Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6404,APC Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6404,APC Perq tx nasoethmoid fx,21340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6404,APC Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Open tx dprsd front sinus fx,21343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Open tx compl front sinus fx,21344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1832.96,9918, Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1832.96,9918, Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1832.96,9918, Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1832.96,9918, Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1832.96,9918, Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1832.96,9918, Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,9918,APC Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,9918,APC Closed tx nose/jaw fx,21345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,9918,APC Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Opn tx nasomax fx w/fixj,21346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Opn tx nasomax fx multple,21347,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Opn tx nasomax fx w/graft,21348,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Perq tx malar fracture,21355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,7343.03, Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,7343.03, Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,7343.03, Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,7343.03, Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,7343.03, Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,7343.03, Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,7343.03,APC Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,7343.03,APC Opn tx dprsd zygomatic arch,21356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,7343.03,APC Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4224,11081, Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4224,11081, Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,11081,APC Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,11081,APC Opn tx dprsd malar fracture,21360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,11081,APC Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3291,13036, Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3291,13036, Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13036,APC Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13036,APC Opn tx complx malar fx,21365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13036,APC Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3291,18617, Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3291,18617, Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Opn tx complx malar w/grft,21366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13320,APC Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13320,APC Opn tx orbit fx transantral,21385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13320,APC Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Opn tx orbit fx periorbital,21386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Opn tx orbit fx combined,21387,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Opn tx orbit periorbtl implt,21390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,18617, Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,18617, Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,18617,APC Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,18617,APC Opn tx orbit periorbt w/grft,21395,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,18617,APC Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,637.13,4466, Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,637.13,4466, Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,4466, Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,4466, Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,637.13,4466, Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,637.13,4466, Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4466,APC Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4466,APC Closed tx orbit w/o manipulj,21400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4466,APC Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1832.96,6404, Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1832.96,6404, Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1832.96,6404, Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1832.96,6404, Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1832.96,6404, Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1832.96,6404, Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,6404,APC Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,6404,APC Closed tx orbit w/manipulj,21401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,6404,APC Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,15339,APC Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,15339,APC Opn tx orbit fx w/o implant,21406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,15339,APC Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13036,APC Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13036,APC Opn tx orbit fx w/implant,21407,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13036,APC Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,7422, Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,7422, Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7422, Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7422, Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7422, Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7422, Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,7422,APC Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,7422,APC Opn tx orbit fx w/bone grft,21408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,7422,APC Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,8006, Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,8006, Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3916.7,8006, Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3916.7,8006, Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,8006, Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,8006, Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,8006,APC Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,8006,APC Treat mouth roof fracture,21421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,8006,APC Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Treat mouth roof fracture,21422,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,18617, Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,18617, Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Treat mouth roof fracture,21423,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21433,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Treat craniofacial fracture,21436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,8006,APC Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,8006,APC Treat dental ridge fracture,21440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,8006,APC Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,11081,APC Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,11081,APC Treat dental ridge fracture,21445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,11081,APC Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,637.13,5098, Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,637.13,5098, Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,637.13,5098, Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,637.13,5098, Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,637.13,5098, Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,637.13,5098, Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,5098,APC Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,5098,APC Treat lower jaw fracture,21450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,5098,APC Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1832.96,6312, Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1832.96,6312, Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1832.96,6312, Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1832.96,6312, Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1832.96,6312, Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1832.96,6312, Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,6312,APC Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,6312,APC Treat lower jaw fracture,21451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,6312,APC Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,17041, Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,17041, Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,2816,17041, Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,2816,17041, Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,17041, Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,17041, Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,17041,APC Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,17041,APC Treat lower jaw fracture,21452,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,17041,APC Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,9420,APC Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,9420,APC Treat lower jaw fracture,21453,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,9420,APC Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,15339,APC Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,15339,APC Treat lower jaw fracture,21461,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,15339,APC Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21462,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,15339,APC Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,15339,APC Treat lower jaw fracture,21465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,15339,APC Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,17041,APC Treat lower jaw fracture,21470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,17041,APC Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Reset dislocated jaw,21480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,4466, Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,4466, Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,4466, Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,4466, Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1832.96,4466, Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1832.96,4466, Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,4466,APC Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,4466,APC Reset dislocated jaw,21485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,4466,APC Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,8006,APC Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,8006,APC Repair dislocated jaw,21490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,8006,APC Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,6404, Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,6404, Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1832.96,6404, Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1832.96,6404, Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1832.96,6404, Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1832.96,6404, Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,6404,APC Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,6404,APC Interdental wiring,21497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,6404,APC Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,279.8,18617, Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,279.8,18617, Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Head surgery procedure,21499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Drain neck/chest lesion,21501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Drain chest lesion,21502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,18617,APC Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,18617,APC Drainage of bone lesion,21510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,18617,APC Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy of neck/chest,21550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc neck les sc 3 cm/>,21552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc neck tum deep 5 cm/>,21554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc neck les sc < 3 cm,21555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Exc neck tum deep < 5 cm,21556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,18617, Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,18617, Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,18617,APC Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,18617,APC Resect neck thorax tumor<5cm,21557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,18617,APC Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect neck tumor 5 cm/>,21558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9420,APC Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9420,APC Partial removal of rib,21600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9420,APC Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,18617, Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,18617, Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3291,18617,APC Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3291,18617,APC Exc chest wall tumor w/ribs,21601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3291,18617,APC Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Exc ch wal tum w/o lymphadec,21602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Exc ch wal tum w/lymphadec,21603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,11081,APC Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,11081,APC Partial removal of rib,21610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,11081,APC Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Removal of rib,21615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Removal of rib and nerves,21616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,18617,APC Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,18617,APC Partial removal of sternum,21620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,18617,APC Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,18617,APC Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,18617,APC Sternal debridement,21627,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,18617,APC Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Extensive sternum surgery,21630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Extensive sternum surgery,21632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Extensive sternum surgery,21632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,13036, Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,13036, Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2762,13036, Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2762,13036, Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,13036, Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,13036, Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2762,13036,APC Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2762,13036,APC Hyoid myotomy & suspension,21685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2762,13036,APC Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9000.7, Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9000.7, Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,9000.7, Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,9000.7, Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9000.7, Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9000.7, Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9000.7,APC Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9000.7,APC Revision of neck muscle,21700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9000.7,APC Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Revision of neck muscle/rib,21705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revision of neck muscle,21720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,428,5098,APC Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,428,5098,APC Revision of neck muscle,21725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,428,5098,APC Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Reconstruction of sternum,21740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,5098, Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,5098, Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Repair stern/nuss w/o scope,21742,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,5098, Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,5098, Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Repair sternum/nuss w/scope,21743,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Repair of sternum separation,21750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13320, Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13320, Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13320,APC Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13320,APC Optx of rib fx w/fixj scope,21811,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13320,APC Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,13320, Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,13320, Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13320,APC Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13320,APC Treatment of rib fracture,21812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13320,APC Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,13320, Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,13320, Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,13320, Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,13320, Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1899.59,13320, Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1899.59,13320, Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,13320,APC Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,13320,APC Treatment of rib fracture,21813,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,13320,APC Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat sternum fracture,21820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Treat sternum fracture,21825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,279.8,18617, Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,279.8,18617, Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Neck/chest surgery procedure,21899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Biopsy soft tissue of back,21920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Biopsy soft tissue of back,21925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc back les sc < 3 cm,21930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,13320, Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,13320, Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,13320, Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,13320, Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1951.11,13320, Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1951.11,13320, Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,13320,APC Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,13320,APC Exc back les sc 3 cm/>,21931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,13320,APC Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,9918, Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,9918, Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,9918,APC Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,9918,APC Exc back tum deep < 5 cm,21932,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,9918,APC Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc back tum deep 5 cm/>,21933,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Resect back tum < 5 cm,21935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect back tum 5 cm/>,21936,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC I&d p-spine c/t/cerv-thor,22010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC I&d abscess p-spine l/s/ls,22015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3408,9420, Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3408,9420, Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Remove part of neck vertebra,22100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,9000.7, Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,9000.7, Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3408,9000.7, Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3408,9000.7, Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Remove part thorax vertebra,22101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3408,9420, Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3408,9420, Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Remove part lumbar vertebra,22102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Remove extra spine segment,22103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,7555, Remove extra spine segment,22103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,7555, Remove extra spine segment,22103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7555, Remove extra spine segment,22103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7555, Remove extra spine segment,22103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,428,7555, Remove extra spine segment,22103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,428,7555, Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Remove part of neck vertebra,22110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Remove part thorax vertebra,22112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Remove part lumbar vertebra,22114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Remove extra spine segment,22116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Remove extra spine segment,22116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incis spine 3 column thorac,22206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incis spine 3 column lumbar,22207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incis spine 3 column adl seg,22208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Incis spine 3 column adl seg,22208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg cerv,22210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg thorac,22212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incis 1 vertebral seg lumbar,22214,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incis addl spine segment,22216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Incis addl spine segment,22216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incis w/discectomy cervical,22220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Incis w/discectomy thoracic,22222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incis w/discectomy lumbar,22224,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Revise extra spine segment,22226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revise extra spine segment,22226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Closed tx vert fx w/o manj,22310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Closed tx vert fx w/manj,22315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Treat odontoid fx w/o graft,22318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Treat odontoid fx w/graft,22319,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,18617, Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,18617, Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,428,18617,APC Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,428,18617,APC Treat spine fracture,22325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,428,18617,APC Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,18617, Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,18617, Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,428,18617,APC Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,428,18617,APC Treat neck spine fracture,22326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,428,18617,APC Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,18617, Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,18617, Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,428,18617,APC Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,428,18617,APC Treat thorax spine fracture,22327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,428,18617,APC Treat each add spine fx,22328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Treat each add spine fx,22328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Treat each add spine fx,22328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Treat each add spine fx,22328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Manipulation of spine,22505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,13320, Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,13320, Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,13320, Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,13320, Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3865.36,13320, Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3865.36,13320, Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,13320,APC Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,13320,APC Perq cervicothoracic inject,22510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,13320,APC Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,13320, Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,13320, Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,13320, Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,13320, Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3865.36,13320, Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3865.36,13320, Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,13320,APC Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,13320,APC Perq lumbosacral injection,22511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,13320,APC Vertebroplasty addl inject,22512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,13320, Vertebroplasty addl inject,22512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,13320, Vertebroplasty addl inject,22512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Vertebroplasty addl inject,22512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Vertebroplasty addl inject,22512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Vertebroplasty addl inject,22512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Perq vertebral augmentation,22513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Perq vertebral augmentation,22514,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Perq vertebral augmentation,22515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq vertebral augmentation,22515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq vertebral augmentation,22515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq vertebral augmentation,22515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Idet single level,22526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Idet single level,22526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Idet single level,22526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Idet single level,22526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Idet single level,22526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Idet single level,22526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Idet 1 or more levels,22527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Idet 1 or more levels,22527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Idet 1 or more levels,22527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Idet 1 or more levels,22527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Idet 1 or more levels,22527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Idet 1 or more levels,22527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18686, Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18686, Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,18686, Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,18686, Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18686, Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18686, Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18686,APC Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18686,APC Lat thorax spine fusion,22532,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18686,APC Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,21749.16, Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,21749.16, Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Lat lumbar spine fusion,22533,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Lat thor/lumb addl seg,22534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Lat thor/lumb addl seg,22534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,18617, Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,18617, Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Neck spine fusion,22548,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Neck spine fuse&remov bel c2,22551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Addl neck spine fusion,22552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Addl neck spine fusion,22552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Addl neck spine fusion,22552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Addl neck spine fusion,22552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Neck spine fusion,22554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Thorax spine fusion,22556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,3560,33657.37,APC Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,3560,33657.37,APC Lumbar spine fusion,22558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,3560,33657.37,APC Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Prescrl fuse w/ instr l5-s1,22586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Spine & skull spinal fusion,22590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Neck spinal fusion,22595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3560,21749.16, Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3560,21749.16, Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Neck spine fusion,22600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Thorax spine fusion,22610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,21749.16, Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,21749.16, Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Lumbar spine fusion,22612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Spine fusion extra segment,22614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Spine fusion extra segment,22614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Spine fusion extra segment,22614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Spine fusion extra segment,22614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,3560,33657.37,APC Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,3560,33657.37,APC Lumbar spine fusion,22630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,3560,33657.37,APC Spine fusion extra segment,22632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Spine fusion extra segment,22632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,33657.37, Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,3560,33657.37,APC Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,3560,33657.37,APC Lumbar spine fusion combined,22633,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,3560,33657.37,APC Spine fusion extra segment,22634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Spine fusion extra segment,22634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,21749.16, Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,21749.16, Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Post fusion <=6 vert seg,22800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Post fusion 7-12 vert seg,22802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Post fusion 13/> vert seg,22804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,21749.16, Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,21749.16, Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 2-3 vert seg,22808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 4-7 vert seg,22810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Ant fusion 8/> vert seg,22812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Kyphectomy 1-2 segments,22818,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Kyphectomy 3 or more,22819,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,18617, Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,18617, Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Exploration of spinal fusion,22830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Ant thrc vrt body tethrg <7,22836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg <7,22836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg <7,22836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg <7,22836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg <7,22836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Ant thrc vrt body tethrg <7,22836,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Ant thrc vrt body tethrg <7,22836,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Ant thrc vrt body tethrg 8+,22837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg 8+,22837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg 8+,22837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg 8+,22837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Ant thrc vrt body tethrg 8+,22837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Ant thrc vrt body tethrg 8+,22837,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Ant thrc vrt body tethrg 8+,22837,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Rev rplc/rmv thrc vrt tethrg,22838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Rev rplc/rmv thrc vrt tethrg,22838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Rev rplc/rmv thrc vrt tethrg,22838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Rev rplc/rmv thrc vrt tethrg,22838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Rev rplc/rmv thrc vrt tethrg,22838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Rev rplc/rmv thrc vrt tethrg,22838,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Rev rplc/rmv thrc vrt tethrg,22838,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Insert spine fixation device,22840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insert spine fixation device,22845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insert spine fixation device,22845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insert spine fixation device,22845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Insert spine fixation device,22846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert spine fixation device,22847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert pelv fixation device,22848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insert pelv fixation device,22848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,18617, Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,18617, Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18617,APC Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18617,APC Reinsert spinal fixation,22849,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18617,APC Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,18617,APC Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,18617,APC Remove spine fixation device,22850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,18617,APC Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,18617,APC Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,18617,APC Remove spine fixation device,22852,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,18617,APC Insj biomechanical device,22853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insj biomechanical device,22853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insj biomechanical device,22853,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insj biomechanical device,22853,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Insj biomechanical device,22854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insj biomechanical device,22854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insj biomechanical device,22854,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insj biomechanical device,22854,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,18617, Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,18617, Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Remove spine fixation device,22855,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,21749.16, Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,21749.16, Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Cerv artific diskectomy,22856,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Lumbar Artif Diskectomy,22857,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Second level cer diskectomy,22858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Second level cer diskectomy,22858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insj biomechanical device,22859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insj biomechanical device,22859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insj biomechanical device,22859,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insj biomechanical device,22859,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Tot disc arthrp 2ntrspc lmbr,22860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Tot disc arthrp 2ntrspc lmbr,22860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,21749.16, Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,21749.16, Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Revise cerv artific disc,22861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,21749.16, Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,21749.16, Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Revise Lumbar Artif Disc,22862,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,18617,APC Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,18617,APC Remove cerv artif disc,22864,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,18617,APC Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,18617, Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,18617, Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,18617,APC Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,18617,APC Remove Lumb Artif Disc,22865,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,18617,APC Insj stablj dev w/dcmprn,22867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,21749.16, Insj stablj dev w/dcmprn,22867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,21749.16, Insj stablj dev w/dcmprn,22867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3291,21749.16, Insj stablj dev w/dcmprn,22867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3291,21749.16, Insj stablj dev w/dcmprn,22867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3291,21749.16,APC Insj stablj dev w/dcmprn,22867,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3291,21749.16,APC Insj stablj dev w/dcmprn,22867,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3291,21749.16,APC Insj stablj dev w/dcmprn,22868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insj stablj dev w/dcmprn,22868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insj stablj dev w/o dcmprn,22869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18686, Insj stablj dev w/o dcmprn,22869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18686, Insj stablj dev w/o dcmprn,22869,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,2816,18686, Insj stablj dev w/o dcmprn,22869,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,2816,18686, Insj stablj dev w/o dcmprn,22869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,2816,18686,APC Insj stablj dev w/o dcmprn,22869,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,2816,18686,APC Insj stablj dev w/o dcmprn,22869,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,2816,18686,APC Insj stablj dev w/o dcmprn,22870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insj stablj dev w/o dcmprn,22870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,291.4,18617, Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,291.4,18617, Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Spine surgery procedure,22899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3431.47,6312, Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3431.47,6312, Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3431.47,6312, Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3431.47,6312, Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3431.47,6312, Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3431.47,6312, Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3431.47,6312,APC Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3431.47,6312,APC Exc abdl tum deep < 5 cm,22900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3431.47,6312,APC Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc abdl tum deep 5 cm/>,22901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,9918, Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,9918, Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,9918, Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,9918, Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1951.11,9918, Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1951.11,9918, Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,9918,APC Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,9918,APC Exc abd les sc < 3 cm,22902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,9918,APC Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc abd les sc 3 cm/>,22903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,9918, Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,9918, Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,9918,APC Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,9918,APC Radical resect abd tumor<5cm,22904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,9918,APC Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,13320, Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,13320, Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Rad resect abd tumor 5 cm/>,22905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,291.4,18617, Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,291.4,18617, Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Abdomen surgery procedure,22999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,9420,APC Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,9420,APC Removal of calcium deposits,23000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,9420,APC Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,9420,APC Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,9420,APC Release shoulder joint,23020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,9420,APC Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,6404,APC Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,6404,APC Drain shoulder lesion,23030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,6404,APC Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Drain shoulder bursa,23031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Drain shoulder bone lesion,23035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Exploratory shoulder surgery,23040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Exploratory shoulder surgery,23044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy shoulder tissues,23065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Biopsy shoulder tissues,23066,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,13320, Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,13320, Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,13320, Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,13320, Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1951.11,13320, Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1951.11,13320, Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,13320,APC Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,13320,APC Exc shoulder les sc 3 cm/>,23071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,13320,APC Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc shoulder tum deep 5 cm/>,23073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc shoulder les sc < 3 cm,23075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Exc shoulder tum deep < 5 cm,23076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,8006,APC Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,8006,APC Resect shoulder tumor < 5 cm,23077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,8006,APC Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect shoulder tumor 5 cm/>,23078,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Biopsy of shoulder joint,23100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3865.36,9918, Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3865.36,9918, Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,9918, Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,9918, Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3865.36,9918, Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3865.36,9918, Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9918,APC Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9918,APC Shoulder joint surgery,23101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9918,APC Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Remove shoulder joint lining,23105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Incision of collarbone joint,23106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Explore treat shoulder joint,23107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Partial removal collar bone,23120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Removal of collar bone,23125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Remove shoulder bone part,23130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Removal of bone lesion,23140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7422, Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7422, Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7422, Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7422, Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7422, Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7422, Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,7422,APC Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,7422,APC Removal of bone lesion,23145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,7422,APC Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Removal of bone lesion,23146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Removal of humerus lesion,23150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Removal of humerus lesion,23155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9420,APC Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9420,APC Removal of humerus lesion,23156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9420,APC Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2138,4466,APC Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2138,4466,APC Remove collar bone lesion,23170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2138,4466,APC Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Remove shoulder blade lesion,23172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,9000.7, Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,9000.7, Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9000.7, Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9000.7, Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,9000.7, Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,9000.7, Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,9000.7,APC Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,9000.7,APC Remove humerus lesion,23174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,9000.7,APC Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9000.7, Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9000.7, Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,9000.7, Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,9000.7, Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9000.7, Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9000.7, Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9000.7,APC Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9000.7,APC Remove collar bone lesion,23180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9000.7,APC Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Remove shoulder blade lesion,23182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Remove humerus lesion,23184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Partial removal of scapula,23190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9420,APC Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9420,APC Removal of head of humerus,23195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9420,APC Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Resect clavicle tumor,23200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Resect scapula tumor,23210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Resect prox humerus tumor,23220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Remove shoulder foreign body,23330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,5123, Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,5123, Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Remove shoulder fb deep,23333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,13320, Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,13320, Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13320,APC Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13320,APC Shoulder prosthesis removal,23334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13320,APC Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Shoulder prosthesis removal,23335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Injection for shoulder x-ray,23350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for shoulder x-ray,23350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for shoulder x-ray,23350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for shoulder x-ray,23350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Muscle transfer shoulder/arm,23395,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,9918,APC Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,9918,APC Muscle transfers,23397,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,9918,APC Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,13036,APC Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,13036,APC Fixation of shoulder blade,23400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,13036,APC Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9420,APC Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9420,APC Incision of tendon & muscle,23405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9420,APC Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,9000.7, Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,9000.7, Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,9000.7, Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,9000.7, Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,9000.7, Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,9000.7, Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2138,9000.7,APC Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2138,9000.7,APC Incise tendon(s) & muscle(s),23406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2138,9000.7,APC Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Repair rotator cuff acute,23410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,11081,APC Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,11081,APC Repair rotator cuff chronic,23412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,11081,APC Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9420,APC Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9420,APC Release of shoulder ligament,23415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9420,APC Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,11081,APC Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,11081,APC Repair of shoulder,23420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,11081,APC Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Repair biceps tendon,23430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9000.7, Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9000.7, Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,9000.7, Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,9000.7, Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9000.7, Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9000.7, Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9000.7,APC Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9000.7,APC Remove/transplant tendon,23440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9000.7,APC Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Repair shoulder capsule,23450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,13036,APC Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,13036,APC Repair shoulder capsule,23455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,13036,APC Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,17041,APC Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,17041,APC Repair shoulder capsule,23460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,17041,APC Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15339, Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15339, Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,15339, Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,15339, Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,15339, Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,15339, Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,15339,APC Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,15339,APC Repair shoulder capsule,23462,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,15339,APC Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Repair shoulder capsule,23465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,13036,APC Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,13036,APC Repair shoulder capsule,23466,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,13036,APC Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Reconstruct shoulder joint,23470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,21749.16, Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,21749.16, Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,21749.16, Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,21749.16, Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,21749.16, Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,21749.16, Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,428,21749.16,APC Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,428,21749.16,APC Reconstruct shoulder joint,23472,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,428,21749.16,APC Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Revis reconst shoulder joint,23473,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Revis reconst shoulder joint,23474,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Revision of collar bone,23480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15925.26, Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15925.26, Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,15925.26, Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,15925.26, Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,15925.26, Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,15925.26, Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4147,15925.26,APC Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4147,15925.26,APC Revision of collar bone,23485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4147,15925.26,APC Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,9000.7, Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,9000.7, Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Reinforce clavicle,23490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17041,APC Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17041,APC Reinforce shoulder bones,23491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17041,APC Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat clavicle fracture,23500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat clavicle fracture,23505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Treat clavicle fracture,23515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,428,3314,APC Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,428,3314,APC Treat clavicle dislocation,23520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,428,3314,APC Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,4097,APC Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,4097,APC Treat clavicle dislocation,23525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,4097,APC Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat clavicle dislocation,23530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,13036, Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,13036, Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13036,APC Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13036,APC Treat clavicle dislocation,23532,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13036,APC Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat clavicle dislocation,23540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,4097, Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,4097,APC Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,4097,APC Treat clavicle dislocation,23545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,4097,APC Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat clavicle dislocation,23550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,15339,APC Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,15339,APC Treat clavicle dislocation,23552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,15339,APC Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat shoulder blade fx,23570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat shoulder blade fx,23575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Treat scapula fracture,23585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,23600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,23605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Treat humerus fracture,23615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,21749.16, Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,21749.16, Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,21749.16, Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,21749.16, Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,21749.16, Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,21749.16, Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,4224,21749.16,APC Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,4224,21749.16,APC Treat humerus fracture,23616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,4224,21749.16,APC Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,23620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,23625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,15339,APC Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,15339,APC Treat humerus fracture,23630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,15339,APC Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat shoulder dislocation,23650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat shoulder dislocation,23655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treat shoulder dislocation,23660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat dislocation/fracture,23665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat dislocation/fracture,23670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat dislocation/fracture,23675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17041,APC Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17041,APC Treat dislocation/fracture,23680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17041,APC Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Fixation of shoulder,23700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,15339,APC Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,15339,APC Fusion of shoulder joint,23800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,15339,APC Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17041, Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17041, Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,17041, Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,17041, Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,17041, Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,17041, Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4147,17041,APC Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4147,17041,APC Fusion of shoulder joint,23802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4147,17041,APC Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,1406,18617,APC Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,1406,18617,APC Amputation of arm & girdle,23900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,1406,18617,APC Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,1406,18617,APC Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,1406,18617,APC Amputation at shoulder joint,23920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,428,5098,APC Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,428,5098,APC Amputation follow-up surgery,23921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,428,5098,APC Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,291.4,18617, Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,291.4,18617, Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Shoulder surgery procedure,23929,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,4097,APC Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,4097,APC Drainage of arm lesion,23930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,4097,APC Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1951.11,4466, Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1951.11,4466, Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Drainage of arm bursa,23931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Drain arm/elbow bone lesion,23935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Exploratory elbow surgery,24000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Release elbow joint,24006,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy arm/elbow soft tissue,24065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Biopsy arm/elbow soft tissue,24066,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc arm/elbow les sc 3 cm/>,24071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Ex arm/elbow tum deep 5 cm/>,24073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc arm/elbow les sc < 3 cm,24075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,4466,APC Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,4466,APC Ex arm/elbow tum deep < 5 cm,24076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,4466,APC Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Resect arm/elbow tum < 5 cm,24077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect arm/elbow tum 5 cm/>,24079,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,8006,APC Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,8006,APC Biopsy elbow joint lining,24100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,8006,APC Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Explore/treat elbow joint,24101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Remove elbow joint lining,24102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Removal of elbow bursa,24105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Remove humerus lesion,24110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Remove/graft bone lesion,24115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Remove/graft bone lesion,24116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Remove elbow lesion,24120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Remove/graft bone lesion,24125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Remove/graft bone lesion,24126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Removal of head of radius,24130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Removal of arm bone lesion,24134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Remove radius bone lesion,24136,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,13036,APC Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,13036,APC Remove elbow bone lesion,24138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,13036,APC Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Partial removal of arm bone,24140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Partial removal of radius,24145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Partial removal of elbow,24147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Radical resection of elbow,24149,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Resect distal humerus tumor,24150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Resect radius tumor,24152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Removal of elbow joint,24155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Remove elbow joint implant,24160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Remove radius head implant,24164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,4097, Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,4097, Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,4097, Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,4097, Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1406,4097, Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1406,4097, Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1406,4097,APC Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1406,4097,APC Removal of arm foreign body,24200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1406,4097,APC Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,6404,APC Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,6404,APC Removal of arm foreign body,24201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,6404,APC Injection for elbow x-ray,24220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for elbow x-ray,24220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for elbow x-ray,24220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for elbow x-ray,24220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6312, Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6312, Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,6312, Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,6312, Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1544,6312, Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1544,6312, Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,6312,APC Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,6312,APC Manipulate elbow w/anesth,24300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,6312,APC Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Muscle/tendon transfer,24301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Arm tendon lengthening,24305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revision of arm tendon,24310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Repair of arm tendon,24320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,9000.7, Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,9000.7, Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Revision of arm muscles,24330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Revision of arm muscles,24331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,9420, Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,9420, Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,9420,APC Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,9420,APC Tenolysis triceps,24332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,9420,APC Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Repair of biceps tendon,24340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair arm tendon/muscle,24341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair of ruptured tendon,24342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3865.36,8006, Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3865.36,8006, Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Repr elbow lat ligmnt w/tiss,24343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,13036, Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,13036, Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4081,13036, Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4081,13036, Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,4081,13036, Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,4081,13036, Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4081,13036,APC Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4081,13036,APC Reconstruct elbow lat ligmnt,24344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4081,13036,APC Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Repr elbw med ligmnt w/tissu,24345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17939, Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17939, Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4224,17939, Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4224,17939, Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,4224,17939, Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,4224,17939, Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17939,APC Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17939,APC Reconstruct elbow med ligmnt,24346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17939,APC Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,13320, Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,13320, Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,13320,APC Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,13320,APC Repair elbow perc,24357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,13320,APC Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,13320,APC Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,13320,APC Repair elbow w/deb open,24358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,13320,APC Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,13320,APC Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,13320,APC Repair elbow deb/attch open,24359,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,13320,APC Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,15339,APC Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,15339,APC Reconstruct elbow joint,24360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,15339,APC Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,21749.16, Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,21749.16, Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,21749.16, Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,21749.16, Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,21749.16, Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,21749.16, Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3291,21749.16,APC Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3291,21749.16,APC Reconstruct elbow joint,24361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3291,21749.16,APC Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,15925.26, Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,15925.26, Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Reconstruct elbow joint,24362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,21749.16, Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,21749.16, Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,21749.16, Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,21749.16, Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,21749.16, Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,21749.16, Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,4147,21749.16,APC Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,4147,21749.16,APC Replace elbow joint,24363,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,4147,21749.16,APC Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,15925.26, Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,15925.26, Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Reconstruct head of radius,24365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Reconstruct head of radius,24366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Revise reconst elbow joint,24370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,21749.16, Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,21749.16, Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,21749.16, Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,21749.16, Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,21749.16, Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,21749.16, Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,4147,21749.16,APC Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,4147,21749.16,APC Revise reconst elbow joint,24371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,4147,21749.16,APC Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Revision of humerus,24400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15925.26, Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15925.26, Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Revision of humerus,24410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Revision of humerus,24420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15925.26, Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15925.26, Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,15925.26, Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,15925.26, Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15925.26, Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15925.26, Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,15925.26,APC Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,15925.26,APC Repair of humerus,24430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,15925.26,APC Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15925.26, Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15925.26, Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Repair humerus with graft,24435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Revision of elbow joint,24470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,13036,APC Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,13036,APC Decompression of forearm,24495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,13036,APC Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17041,APC Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17041,APC Reinforce humerus,24498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17041,APC Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Treat humerus fracture,24515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Treat humerus fracture,24516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9000.7,APC Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9000.7,APC Treat humerus fracture,24538,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9000.7,APC Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Treat humerus fracture,24545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15925.26, Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15925.26, Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Treat humerus fracture,24546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,24565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,8006, Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,8006, Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1899.59,8006, Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1899.59,8006, Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,8006, Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,8006, Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,8006,APC Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,8006,APC Treat humerus fracture,24566,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,8006,APC Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17041,APC Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17041,APC Treat humerus fracture,24575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17041,APC Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24577,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17041,APC Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17041,APC Treat humerus fracture,24579,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17041,APC Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9000.7, Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9000.7,APC Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9000.7,APC Treat humerus fracture,24582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9000.7,APC Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Treat elbow fracture,24586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,15925.26, Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,15925.26, Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Treat elbow fracture,24587,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat elbow dislocation,24600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat elbow dislocation,24605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treat elbow dislocation,24615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat elbow fracture,24620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Treat elbow fracture,24635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat elbow dislocation,24640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat radius fracture,24650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat radius fracture,24655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Treat radius fracture,24665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,15925.26, Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,15925.26, Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Treat radius fracture,24666,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat ulnar fracture,24670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat ulnar fracture,24675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat ulnar fracture,24685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,15339,APC Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,15339,APC Fusion of elbow joint,24800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,15339,APC Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,17041,APC Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,17041,APC Fusion/graft of elbow joint,24802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,17041,APC Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,1406,18617,APC Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,1406,18617,APC Amputation of upper arm,24900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,1406,18617,APC Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,1406,18617,APC Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,1406,18617,APC Amputation of upper arm,24920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Amputation follow-up surgery,24925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,24930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,18617,APC Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,1406,18617,APC Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,1406,18617,APC Amputate upper arm & implant,24931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,1406,18617,APC Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Revision of amputation,24935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4224,18617, Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4224,18617, Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,18617,APC Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,18617,APC Revision of upper arm,24940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,18617,APC Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,291.4,18617, Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,291.4,18617, Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Upper arm/elbow surgery,24999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Incision of tendon sheath,25000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5098, Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5098, Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,5098, Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,5098, Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,5098, Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,5098, Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5098,APC Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5098,APC Incise flexor carpi radialis,25001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5098,APC Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Decompress forearm 1 space,25020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Decompress forearm 1 space,25023,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,9420,APC Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,9420,APC Decompress forearm 2 spaces,25024,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,9420,APC Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,8006, Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,8006, Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1899.59,8006, Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1899.59,8006, Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,8006, Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,8006, Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,8006,APC Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,8006,APC Decompress forearm 2 spaces,25025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,8006,APC Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Drainage of forearm lesion,25028,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Drainage of forearm bursa,25031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9420,APC Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9420,APC Treat forearm bone lesion,25035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9420,APC Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,7422,APC Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,7422,APC Explore/treat wrist joint,25040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,7422,APC Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy forearm soft tissues,25065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Biopsy forearm soft tissues,25066,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,13320, Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,13320, Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,13320, Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,13320, Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1951.11,13320, Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1951.11,13320, Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,13320,APC Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,13320,APC Exc forearm les sc 3 cm/>,25071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,13320,APC Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc forearm tum deep 3 cm/>,25073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc forearm les sc < 3 cm,25075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,5098, Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,5098, Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,5098, Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,5098, Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1951.11,5098, Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1951.11,5098, Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,5098,APC Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,5098,APC Exc forearm tum deep < 3 cm,25076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,5098,APC Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5098,APC Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5098,APC Resect forearm/wrist tum<3cm,25077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5098,APC Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect forarm/wrist tum 3cm>,25078,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Incision of wrist capsule,25085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Biopsy of wrist joint,25100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Explore/treat wrist joint,25101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Remove wrist joint lining,25105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Remove wrist joint cartilage,25107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,6253, Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,6253, Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,6253, Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,6253, Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3563,6253, Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3563,6253, Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3563,6253,APC Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3563,6253,APC Excise tendon forearm/wrist,25109,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3563,6253,APC Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Remove wrist tendon lesion,25110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Remove wrist tendon lesion,25111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,6312, Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,6312, Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Reremove wrist tendon lesion,25112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,6312, Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,6312, Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Remove wrist/forearm lesion,25115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Remove wrist/forearm lesion,25116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,5123, Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,5123, Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,5123, Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,5123, Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,5123, Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,5123, Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5123,APC Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5123,APC Excise wrist tendon sheath,25118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5123,APC Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Partial removal of ulna,25119,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Removal of forearm lesion,25120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,6404, Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,6404, Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1899.59,6404, Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1899.59,6404, Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,6404, Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,6404, Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6404,APC Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6404,APC Remove/graft forearm lesion,25125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6404,APC Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Remove/graft forearm lesion,25126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Removal of wrist lesion,25130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Remove & graft wrist lesion,25135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Remove & graft wrist lesion,25136,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,9420,APC Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,9420,APC Remove forearm bone lesion,25145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,9420,APC Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Partial removal of ulna,25150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Partial removal of radius,25151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Resect radius/ulnar tumor,25170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Removal of wrist bone,25210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Removal of wrist bones,25215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Partial removal of radius,25230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Partial removal of ulna,25240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Injection for wrist x-ray,25246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for wrist x-ray,25246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for wrist x-ray,25246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for wrist x-ray,25246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Remove forearm foreign body,25248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,8006,APC Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,8006,APC Removal of wrist prosthesis,25250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,8006,APC Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13036, Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13036, Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,13036, Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,13036, Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,13036, Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,13036, Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,13036,APC Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,13036,APC Removal of wrist prosthesis,25251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,13036,APC Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5098, Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5098, Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,5098, Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,5098, Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,5098, Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,5098, Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,5098,APC Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,5098,APC Manipulate wrist w/anesthes,25259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,5098,APC Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Repair forearm tendon/muscle,25260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9000.7, Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9000.7, Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,9000.7, Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,9000.7, Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9000.7, Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9000.7, Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9000.7,APC Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9000.7,APC Repair forearm tendon/muscle,25263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9000.7,APC Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Repair forearm tendon/muscle,25265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Repair forearm tendon/muscle,25270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Repair forearm tendon/muscle,25272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,9420, Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,9420, Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3865.36,9420, Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3865.36,9420, Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,9420, Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,9420, Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9420,APC Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9420,APC Repair forearm tendon/muscle,25274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9420,APC Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Repair forearm tendon sheath,25275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Revise wrist/forearm tendon,25280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Incise wrist/forearm tendon,25290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Release wrist/forearm tendon,25295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Fusion of tendons at wrist,25300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Fusion of tendons at wrist,25301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Transplant forearm tendon,25310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Transplant forearm tendon,25312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Revise palsy hand tendon(s),25315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Revise palsy hand tendon(s),25316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair/revise wrist joint,25320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Description Not Available,25330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,25330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,25330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,25330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,25331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,25331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,25331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,25331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Revise wrist joint,25332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Realignment of hand,25335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9420,APC Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9420,APC Reconstruct ulna/radioulnar,25337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9420,APC Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Revision of radius,25350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Revision of radius,25355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Revision of ulna,25360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17939, Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17939, Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3408,17939, Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3408,17939, Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17939, Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17939, Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17939,APC Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17939,APC Revise radius & ulna,25365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17939,APC Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Revise radius or ulna,25370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,6312,APC Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,6312,APC Revise radius & ulna,25375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,6312,APC Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Shorten radius or ulna,25390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,15925.26, Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,15925.26, Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Lengthen radius or ulna,25391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Shorten radius & ulna,25392,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,9000.7, Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,9000.7, Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9000.7, Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9000.7, Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,9000.7, Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,9000.7, Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,9000.7,APC Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,9000.7,APC Lengthen radius & ulna,25393,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,9000.7,APC Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3291,8006, Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3291,8006, Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Repair carpal bone shorten,25394,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Repair radius or ulna,25400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,17041,APC Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,17041,APC Repair/graft radius or ulna,25405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,17041,APC Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair radius & ulna,25415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Repair/graft radius & ulna,25420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair/graft radius or ulna,25425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,6312, Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,6312, Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,6312, Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,6312, Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3563,6312, Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3563,6312, Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3563,6312,APC Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3563,6312,APC Repair/graft radius & ulna,25426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3563,6312,APC Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Vasc graft into carpal bone,25430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Repair nonunion carpal bone,25431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Repair/graft wrist bone,25440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Reconstruct wrist joint,25441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,21749.16, Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,21749.16, Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,21749.16, Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,21749.16, Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,21749.16, Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,21749.16, Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3291,21749.16,APC Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3291,21749.16,APC Reconstruct wrist joint,25442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3291,21749.16,APC Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9000.7,APC Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9000.7,APC Reconstruct wrist joint,25443,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9000.7,APC Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,15925.26, Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,15925.26, Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Reconstruct wrist joint,25444,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9000.7, Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9000.7,APC Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9000.7,APC Reconstruct wrist joint,25445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9000.7,APC Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,21749.16, Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,21749.16, Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,21749.16, Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,21749.16, Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,21749.16, Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,21749.16, Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,4147,21749.16,APC Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,4147,21749.16,APC Wrist replacement,25446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,4147,21749.16,APC Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Repair wrist joints,25447,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Arthrp ntrcrpl/crp/mtcrp ssp,25448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Arthrp ntrcrpl/crp/mtcrp ssp,25448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Arthrp ntrcrpl/crp/mtcrp ssp,25448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Arthrp ntrcrpl/crp/mtcrp ssp,25448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Arthrp ntrcrpl/crp/mtcrp ssp,25448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Arthrp ntrcrpl/crp/mtcrp ssp,25448,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Arthrp ntrcrpl/crp/mtcrp ssp,25448,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Remove wrist joint implant,25449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Revision of wrist joint,25450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Revision of wrist joint,25455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Reinforce radius,25490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17939, Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17939, Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3408,17939, Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3408,17939, Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17939, Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17939, Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17939,APC Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17939,APC Reinforce ulna,25491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17939,APC Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,5098,APC Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,5098,APC Reinforce radius and ulna,25492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,5098,APC Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat fracture of radius,25500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat fracture of radius,25505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat fracture of radius,25515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat fracture of radius,25520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,13036, Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,13036, Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13036,APC Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13036,APC Treat fracture of radius,25525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13036,APC Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Treat fracture of radius,25526,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat fracture of ulna,25530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat fracture of ulna,25535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treat fracture of ulna,25545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat fracture radius & ulna,25560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat fracture radius & ulna,25565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat fracture radius & ulna,25574,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Treat fracture radius/ulna,25575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat fracture radius/ulna,25600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,5098, Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,5098, Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Treat fracture radius/ulna,25605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Treat Fx Distal Radial,25606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Rad Extra-Articul,25607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9000.7, Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Rad Intra-Articul,25608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9000.7, Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9000.7, Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,9000.7, Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,9000.7, Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9000.7, Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9000.7, Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9000.7,APC Treat Fx Radial 3+ Frag,25609,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9000.7,APC Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat wrist bone fracture,25624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Treat wrist bone fracture,25628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat wrist bone fracture,25635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Treat wrist bone fracture,25645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat wrist bone fracture,25650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5098, Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5098, Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,5098, Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,5098, Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,5098, Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,5098, Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5098,APC Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5098,APC Pin ulnar styloid fracture,25651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5098,APC Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treat fracture ulnar styloid,25652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat wrist dislocation,25660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treat wrist dislocation,25670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Pin radioulnar dislocation,25671,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat wrist dislocation,25675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9000.7, Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9000.7, Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,9000.7, Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,9000.7, Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9000.7, Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9000.7, Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9000.7,APC Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9000.7,APC Treat wrist dislocation,25676,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9000.7,APC Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,291.4,4466, Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,291.4,4466, Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,4466, Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,4466, Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,291.4,4466, Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,291.4,4466, Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,4466,APC Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,4466,APC Treat wrist fracture,25680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,4466,APC Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Treat wrist fracture,25685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Treat wrist dislocation,25690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Treat wrist dislocation,25695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Fusion of wrist joint,25800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,15339,APC Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,15339,APC Fusion/graft of wrist joint,25805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,15339,APC Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,17041,APC Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,17041,APC Fusion/graft of wrist joint,25810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,17041,APC Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,13036, Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,13036, Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13036,APC Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13036,APC Fusion of hand bones,25820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13036,APC Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,15339,APC Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,15339,APC Fuse hand bones with graft,25825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,15339,APC Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Fusion radioulnar jnt/ulna,25830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,18617,APC Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,18617,APC Amputation of forearm,25900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,18617,APC Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,18617,APC Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,18617,APC Amputation of forearm,25905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Amputation follow-up surgery,25907,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,18617, Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,18617, Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,18617,APC Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,18617,APC Amputation follow-up surgery,25909,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,18617,APC Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,18617,APC Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,18617,APC Amputation of forearm,25915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,18617,APC Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputate hand at wrist,25920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,428,5098,APC Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,428,5098,APC Amputate hand at wrist,25922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,428,5098,APC Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,25924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,18617, Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,18617, Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,18617, Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,18617, Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3865.36,18617, Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3865.36,18617, Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,18617,APC Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,18617,APC Amputation of hand,25927,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,18617,APC Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,428,5098,APC Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,428,5098,APC Amputation follow-up surgery,25929,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,428,5098,APC Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,25931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,291.4,18617, Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,291.4,18617, Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Forearm or wrist surgery,25999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Drainage of finger abscess,26010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Drainage of finger abscess,26011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Drain hand tendon sheath,26020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Drainage of palm bursa,26025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,9420,APC Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,9420,APC Drainage of palm bursas,26030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,9420,APC Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat hand bone lesion,26034,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Decompress fingers/hand,26035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Decompress fingers/hand,26037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,6312, Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,6312, Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Release palm contracture,26040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Release palm contracture,26045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Incise finger tendon sheath,26055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Incision of finger tendon,26060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,5123, Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,5123, Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,5123, Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,5123, Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,5123, Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,5123, Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5123,APC Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5123,APC Explore/treat hand joint,26070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5123,APC Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Explore/treat finger joint,26075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,6312, Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,6312, Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Explore/treat finger joint,26080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Biopsy hand joint lining,26100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Biopsy finger joint lining,26105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Biopsy finger joint lining,26110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,13320, Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,13320, Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,13320, Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,13320, Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1951.11,13320, Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1951.11,13320, Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,13320,APC Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,13320,APC Exc hand les sc 1.5 cm/>,26111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,13320,APC Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,13320, Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,13320, Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,13320, Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,13320, Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1951.11,13320, Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1951.11,13320, Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,13320,APC Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,13320,APC Exc hand tum deep 1.5 cm/>,26113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,13320,APC Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc hand les sc < 1.5 cm,26115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc hand tum deep < 1.5 cm,26116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Rad resect hand tumor < 3 cm,26117,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Rad resect hand tumor 3 cm/>,26118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,6312, Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,6312, Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,6312, Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,6312, Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3563,6312, Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3563,6312, Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3563,6312,APC Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3563,6312,APC Release palm contracture,26121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3563,6312,APC Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Release palm contracture,26123,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Release palm contracture,26125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6253, Release palm contracture,26125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6253, Release palm contracture,26125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6253, Release palm contracture,26125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6253, Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Remove wrist joint lining,26130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Revise finger joint each,26135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Revise finger joint each,26140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Tendon excision palm/finger,26145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Remove tendon sheath lesion,26160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Removal of palm tendon each,26170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Removal of finger tendon,26180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,6312, Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,6312, Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Remove finger bone,26185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Remove hand bone lesion,26200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Remove/graft bone lesion,26205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Removal of finger lesion,26210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Remove/graft finger lesion,26215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3865.36,9918, Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3865.36,9918, Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,9918, Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,9918, Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3865.36,9918, Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3865.36,9918, Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9918,APC Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9918,APC Partial removal of hand bone,26230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9918,APC Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Partial removal finger bone,26235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Partial removal finger bone,26236,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Extensive hand surgery,26250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Resect prox finger tumor,26260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,5123, Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,5123, Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,5123, Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,5123, Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,5123, Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,5123, Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5123,APC Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5123,APC Resect distal finger tumor,26262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5123,APC Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Removal of implant from hand,26320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Manipulate finger w/anesth,26340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Manipulat palm cord post inj,26341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Repair finger/hand tendon,26350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9000.7,APC Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9000.7,APC Repair/graft hand tendon,26352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9000.7,APC Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Repair finger/hand tendon,26356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Repair finger/hand tendon,26357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9000.7, Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9000.7,APC Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9000.7,APC Repair/graft hand tendon,26358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9000.7,APC Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Repair finger/hand tendon,26370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Repair/graft hand tendon,26372,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Repair finger/hand tendon,26373,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Revise hand/finger tendon,26390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Repair/graft hand tendon,26392,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5123, Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5123, Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,5123, Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,5123, Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5123, Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5123, Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5123,APC Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5123,APC Repair hand tendon,26410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5123,APC Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Repair/graft hand tendon,26412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,855,6312, Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,855,6312, Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,6312, Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,6312, Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,855,6312, Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,855,6312, Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,855,6312,APC Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,855,6312,APC Excision hand/finger tendon,26415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,855,6312,APC Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Graft hand or finger tendon,26416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,6312, Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,6312, Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Repair finger tendon,26418,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Repair/graft finger tendon,26420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Repair finger/hand tendon,26426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Repair/graft finger tendon,26428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Repair finger tendon,26432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Repair finger tendon,26433,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Repair/graft finger tendon,26434,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Realignment of tendons,26437,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Release palm/finger tendon,26440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Release palm & finger tendon,26442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Release hand/finger tendon,26445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Release forearm/hand tendon,26449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Incision of palm tendon,26450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Incision of finger tendon,26455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Incise hand/finger tendon,26460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Fusion of finger tendons,26471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,6404, Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,6404, Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1899.59,6404, Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1899.59,6404, Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,6404, Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,6404, Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6404,APC Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6404,APC Fusion of finger tendons,26474,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6404,APC Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,8006,APC Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,8006,APC Tendon lengthening,26476,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,8006,APC Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Tendon shortening,26477,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Lengthening of hand tendon,26478,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,4058.63, Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,4058.63, Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4058.63, Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4058.63, Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,4058.63, Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,4058.63, Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4058.63,APC Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4058.63,APC Shortening of hand tendon,26479,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4058.63,APC Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Transplant hand tendon,26480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Transplant/graft hand tendon,26483,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Transplant palm tendon,26485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Transplant/graft palm tendon,26489,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revise thumb tendon,26490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Tendon transfer with graft,26492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Hand tendon/muscle transfer,26494,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revise thumb tendon,26496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Finger tendon transfer,26497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Finger tendon transfer,26498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revision of finger,26499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Hand tendon reconstruction,26500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Hand tendon reconstruction,26502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Release thumb contracture,26508,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Thumb tendon transfer,26510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Fusion of knuckle joint,26516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Fusion of knuckle joints,26517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Fusion of knuckle joints,26518,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Release knuckle contracture,26520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5123, Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5123, Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,5123, Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,5123, Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5123, Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5123, Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5123,APC Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5123,APC Release finger contracture,26525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5123,APC Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Revise knuckle joint,26530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,9918, Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,9918, Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,9918,APC Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,9918,APC Revise knuckle with implant,26531,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,9918,APC Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Revise finger joint,26535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Revise/implant finger joint,26536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Repair hand joint,26540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3865.36,9918, Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3865.36,9918, Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3865.36,9918, Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3865.36,9918, Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3865.36,9918, Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3865.36,9918, Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9918,APC Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9918,APC Repair hand joint with graft,26541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9918,APC Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Repair hand joint with graft,26542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Reconstruct finger joint,26545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Repair nonunion hand,26546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Reconstruct finger joint,26548,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Construct thumb replacement,26550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Great toe-hand transfer,26551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Description Not Available,26552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,26552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,26552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,26552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Single transfer toe-hand,26553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Double transfer toe-hand,26554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Positional change of finger,26555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Toe joint transfer,26556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Description Not Available,26557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,26557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,26557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,26557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,26558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,26558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,26558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,26558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,26559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,26559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,26559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,26559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,8006, Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,8006, Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1899.59,8006, Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1899.59,8006, Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,8006, Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,8006, Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,8006,APC Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,8006,APC Repair of web finger,26560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,8006,APC Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Repair of web finger,26561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Repair of web finger,26562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Correct metacarpal flaw,26565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,7422,APC Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,7422,APC Correct finger deformity,26567,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,7422,APC Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Lengthen metacarpal/finger,26568,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,11081,APC Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,11081,APC Repair hand deformity,26580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,11081,APC Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,7422,APC Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,7422,APC Reconstruct extra finger,26587,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,7422,APC Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7422, Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7422, Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7422, Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7422, Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7422, Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7422, Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,428,7422,APC Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,428,7422,APC Repair finger deformity,26590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,428,7422,APC Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,5098, Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,5098, Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,5098, Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,5098, Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2138,5098, Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2138,5098, Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2138,5098,APC Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2138,5098,APC Repair muscles of hand,26591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2138,5098,APC Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Release muscles of hand,26593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Excision constricting tissue,26596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat metacarpal fracture,26600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,291.4,4466, Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,291.4,4466, Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,4466, Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,4466, Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,291.4,4466, Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,291.4,4466, Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,4466,APC Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,4466,APC Treat metacarpal fracture,26605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,4466,APC Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Treat metacarpal fracture,26607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Treat metacarpal fracture,26608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Treat metacarpal fracture,26615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,18617, Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,18617, Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat thumb dislocation,26641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat thumb fracture,26645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Treat thumb fracture,26650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Treat thumb fracture,26665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,18617, Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,18617, Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat hand dislocation,26670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat hand dislocation,26675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Pin hand dislocation,26676,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Treat hand dislocation,26685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Treat hand dislocation,26686,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat knuckle dislocation,26700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat knuckle dislocation,26705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Pin knuckle dislocation,26706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Treat knuckle dislocation,26715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3865.36,9918, Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3865.36,9918, Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,9918, Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,9918, Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3865.36,9918, Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3865.36,9918, Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9918,APC Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9918,APC Treat finger fracture each,26727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9918,APC Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Treat finger fracture each,26735,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat finger fracture each,26742,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,7422,APC Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,7422,APC Treat finger fracture each,26746,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,7422,APC Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat finger fracture each,26755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Pin finger fracture each,26756,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Treat finger fracture each,26765,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat finger dislocation,26770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,330.41,18617, Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,330.41,18617, Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Treat finger dislocation,26775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Pin finger dislocation,26776,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Treat finger dislocation,26785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9420,APC Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9420,APC Thumb fusion with graft,26820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9420,APC Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Fusion of thumb,26841,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Thumb fusion with graft,26842,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Fusion of hand joint,26843,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Fusion/graft of hand joint,26844,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Fusion of knuckle,26850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Fusion of knuckle with graft,26852,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Fusion of finger joint,26860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Fusion of finger jnt add-on,26861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Fusion of finger jnt add-on,26861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Fusion of finger jnt add-on,26861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Fusion of finger jnt add-on,26861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Fusion/graft of finger joint,26862,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Fuse/graft added joint,26863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Fuse/graft added joint,26863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Fuse/graft added joint,26863,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Fuse/graft added joint,26863,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Amputate metacarpal bone,26910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Amputation of finger/thumb,26951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Amputation of finger/thumb,26952,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,291.4,18617, Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,291.4,18617, Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Hand/finger surgery,26989,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Drainage of pelvis lesion,26990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,5123,APC Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,5123,APC Drainage of pelvis bursa,26991,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,5123,APC Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,18617,APC Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,18617,APC Drainage of bone lesion,26992,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,18617,APC Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,8006, Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,8006, Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1899.59,8006, Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1899.59,8006, Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,8006, Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,8006, Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,8006,APC Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,8006,APC Incision of hip tendon,27000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,8006,APC Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Incision of hip tendon,27001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Incision of hip tendon,27003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,18617, Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,18617, Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,18617,APC Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,18617,APC Incision of hip tendon,27005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,18617,APC Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,18617, Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,18617, Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,18617, Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,18617, Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3865.36,18617, Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3865.36,18617, Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,18617,APC Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,18617,APC Incision of hip tendons,27006,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,18617,APC Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,18617, Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,18617, Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,18617,APC Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,18617,APC Incision of hip/thigh fascia,27025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,18617,APC Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,13320, Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,13320, Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,13320,APC Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,13320,APC Buttock fasciotomy,27027,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,13320,APC Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Drainage of hip joint,27030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Exploration of hip joint,27033,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Denervation of hip joint,27035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Excision of hip joint/muscle,27036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Biopsy of soft tissues,27040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Biopsy of soft tissues,27041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc hip pelvis les sc 3 cm/>,27043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc hip/pelv tum deep 5 cm/>,27045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Exc hip/pelvis les sc < 3 cm,27047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Exc hip/pelv tum deep < 5 cm,27048,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,6404,APC Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,6404,APC Resect hip/pelv tum < 5 cm,27049,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,6404,APC Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Biopsy of sacroiliac joint,27050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Biopsy of hip joint,27052,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,18617,APC Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,18617,APC Removal of hip joint lining,27054,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,18617,APC Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,13320, Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,13320, Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,13320, Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,13320, Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1899.59,13320, Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1899.59,13320, Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,13320,APC Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,13320,APC Buttock fasciotomy w/dbrdmt,27057,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,13320,APC Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect hip/pelv tum 5 cm/>,27059,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9000.7, Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9000.7, Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,9000.7, Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,9000.7, Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9000.7, Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9000.7, Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9000.7,APC Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9000.7,APC Removal of ischial bursa,27060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9000.7,APC Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Remove femur lesion/bursa,27062,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9000.7, Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9000.7, Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3291,9000.7, Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3291,9000.7, Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9000.7, Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9000.7, Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9000.7,APC Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9000.7,APC Remove hip bone les super,27065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9000.7,APC Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Remove hip bone les deep,27066,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Remove/graft hip bone lesion,27067,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Part remove hip bone super,27070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Part removal hip bone deep,27071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Resect hip tumor,27075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Resect hip tum incl acetabul,27076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Resect hip tum w/innom bone,27077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Rsect hip tum incl femur,27078,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Removal of tail bone,27080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,4097,APC Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,4097,APC Remove hip foreign body,27086,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,4097,APC Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Remove hip foreign body,27087,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,18617,APC Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,18617,APC Removal of hip prosthesis,27090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,18617,APC Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,18617,APC Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,18617,APC Removal of hip prosthesis,27091,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,18617,APC Injection for hip x-ray,27093,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for hip x-ray,27093,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for hip x-ray,27093,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for hip x-ray,27093,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Injection for hip x-ray,27095,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for hip x-ray,27095,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for hip x-ray,27095,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for hip x-ray,27095,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Inject sacroiliac joint,27096,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inject sacroiliac joint,27096,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inject sacroiliac joint,27096,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inject sacroiliac joint,27096,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revision of hip tendon,27097,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,17041,APC Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,17041,APC Transfer tendon to pelvis,27098,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,17041,APC Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Transfer of abdominal muscle,27100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,6312,APC Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,6312,APC Transfer of spinal muscle,27105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,6312,APC Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,17041,APC Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,17041,APC Transfer of iliopsoas muscle,27110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,17041,APC Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,6312,APC Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,6312,APC Transfer of iliopsoas muscle,27111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,6312,APC Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Reconstruction of hip socket,27120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Reconstruction of hip socket,27122,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,29527, Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,29527, Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,29527, Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,29527, Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24606,,,,,,,fee schedule,3560,29527, Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29527,,,,,,,fee schedule,3560,29527, Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,29527,APC Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,29527,APC Partial hip replacement,27125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,29527,APC Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24606,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29527,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,29527,APC Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,29527,APC Total hip arthroplasty,27130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,29527,APC Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24606,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29527,,,,,,,fee schedule,3560,29527, Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,29527,APC Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,29527,APC Total hip arthroplasty,27132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24606,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29527,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24606,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29527,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27137,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24606,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29527,,,,,,,fee schedule,3560,29527, Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,29527,APC Revise hip joint replacement,27138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,29527,APC Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Transplant femur ridge,27140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incision of hip bone,27146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Revision of hip bone,27147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incision of hip bones,27151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Revision of hip bones,27156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Revision of pelvis,27158,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incision of neck of femur,27161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incision/fixation of femur,27165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Repair/graft femur head/neck,27170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27176,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27178,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,18617,APC Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,18617,APC Revise head/neck of femur,27179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,18617,APC Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat slipped epiphysis,27181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Revision of femur epiphysis,27185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,18617, Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,18617, Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Reinforce hip bones,27187,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Clsd tx pelvic ring fx,27197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Clsd tx pelvic ring fx,27198,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat tail bone fracture,27200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Treat tail bone fracture,27202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Treat pelvic fracture(s),27215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Treat pelvic fracture(s),27215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Treat pelvic fracture(s),27215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat pelvic fracture(s),27215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat pelvic fracture(s),27215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat pelvic fracture(s),27215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat pelvic ring fracture,27218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treat pelvic ring fracture,27218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treat pelvic ring fracture,27218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treat pelvic ring fracture,27218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat hip socket fracture,27220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat hip socket fracture,27222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat hip wall fracture,27226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat hip fracture(s),27227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat hip fracture(s),27228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat thigh fracture,27230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,18617, Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,18617, Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,18617,APC Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,18617,APC Treat thigh fracture,27232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,18617,APC Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Treat thigh fracture,27235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27236,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Treat thigh fracture,27238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,428,18617,APC Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,428,18617,APC Treat thigh fracture,27240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,428,18617,APC Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat thigh fracture,27246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat thigh fracture,27248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat hip dislocation,27250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat hip dislocation,27252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,18617, Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,18617, Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Treat hip dislocation,27254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,291.4,18617, Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,291.4,18617, Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat hip dislocation,27256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,5098, Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,5098, Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Treat hip dislocation,27257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3865.36,18617, Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,18617,APC Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat hip dislocation,27265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat hip dislocation,27266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Cltx thigh fx,27267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,18617, Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,18617, Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,18617,APC Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,18617,APC Cltx thigh fx w/mnpj,27268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,18617,APC Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,18617, Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,18617, Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,18617, Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,18617, Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2138,18617, Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2138,18617, Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2138,18617,APC Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2138,18617,APC Optx thigh fx,27269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2138,18617,APC Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Manipulation of hip joint,27275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Arthrd si jt prq wo tfxj dev,27278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,21749.16, Arthrd si jt prq wo tfxj dev,27278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,21749.16, Arthrd si jt prq wo tfxj dev,27278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,21749.16, Arthrd si jt prq wo tfxj dev,27278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,21749.16, Arthrd si jt prq wo tfxj dev,27278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3291,21749.16,APC Arthrd si jt prq wo tfxj dev,27278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3291,21749.16,APC Arthrd si jt prq wo tfxj dev,27278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3291,21749.16,APC Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,21749.16, Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,21749.16, Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,21749.16, Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,21749.16, Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,21749.16, Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,21749.16, Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3291,21749.16,APC Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3291,21749.16,APC Arthrodesis sacroiliac joint,27279,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3291,21749.16,APC Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,21749.16, Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,21749.16, Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,21749.16, Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,21749.16, Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,21749.16, Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,21749.16, Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,21749.16,APC Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,21749.16,APC Fusion of sacroiliac joint,27280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,21749.16,APC Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Fusion of pubic bones,27282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18686,APC Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18686,APC Fusion of hip joint,27284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18686,APC Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18686, Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,18686,APC Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,18686,APC Fusion of hip joint,27286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,18686,APC Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1406,21749.16,APC Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1406,21749.16,APC Amputation of leg at hip,27290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1406,21749.16,APC Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21749.16, Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,1406,21749.16,APC Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,1406,21749.16,APC Amputation of leg at hip,27295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,1406,21749.16,APC Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,291.4,18617, Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,291.4,18617, Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Pelvis/hip joint surgery,27299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Drain thigh/knee lesion,27301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,18617,APC Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,18617,APC Drainage of bone lesion,27303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,18617,APC Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Incise thigh tendon & fascia,27305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Incision of thigh tendon,27306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Incision of thigh tendons,27307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Exploration of knee joint,27310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy thigh soft tissues,27323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,5123,APC Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,5123,APC Biopsy thigh soft tissues,27324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,5123,APC Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,8006, Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,8006, Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2306.84,8006, Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2306.84,8006, Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,8006, Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,8006, Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,8006,APC Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,8006,APC Neurectomy hamstring,27325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,8006,APC Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,4466, Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,4466, Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2306.84,4466, Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2306.84,4466, Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,4466, Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,4466, Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,4466,APC Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,4466,APC Neurectomy popliteal,27326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,4466,APC Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc thigh/knee les sc < 3 cm,27327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Exc thigh/knee tum deep <5cm,27328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3431.47,6404, Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3431.47,6404, Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3431.47,6404, Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3431.47,6404, Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3431.47,6404, Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3431.47,6404, Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3431.47,6404,APC Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3431.47,6404,APC Resect thigh/knee tum < 5 cm,27329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3431.47,6404,APC Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,6312, Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,6312, Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,6312, Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,6312, Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3563,6312, Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3563,6312, Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3563,6312,APC Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3563,6312,APC Biopsy knee joint lining,27330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3563,6312,APC Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Explore/treat knee joint,27331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Removal of knee cartilage,27332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Removal of knee cartilage,27333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Remove knee joint lining,27334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Remove knee joint lining,27335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc thigh/knee les sc 3 cm/>,27337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc thigh/knee tum dep 5cm/>,27339,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Removal of kneecap bursa,27340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Removal of knee cyst,27345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Remove knee cyst,27347,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Removal of kneecap,27350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Remove femur lesion,27355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,15925.26, Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,15925.26, Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Remove femur lesion/graft,27356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18686, Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18686, Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3291,18686, Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3291,18686, Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,18686, Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,18686, Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18686,APC Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18686,APC Remove femur lesion/graft,27357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18686,APC Remove femur lesion/fixation,27358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,3972, Remove femur lesion/fixation,27358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,3972, Remove femur lesion/fixation,27358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3972, Remove femur lesion/fixation,27358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3972, Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Partial removal leg bone(s),27360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,13320, Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,13320, Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect thigh/knee tum 5 cm/>,27364,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,18617,APC Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,18617,APC Resect femur/knee tumor,27365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,18617,APC Njx cntrst kne arthg/ct/mri,27369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Njx cntrst kne arthg/ct/mri,27369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Njx cntrst kne arthg/ct/mri,27369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Njx cntrst kne arthg/ct/mri,27369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3431.47,9918, Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3431.47,9918, Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3431.47,9918, Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3431.47,9918, Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3431.47,9918, Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3431.47,9918, Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3431.47,9918,APC Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3431.47,9918,APC Removal of foreign body,27372,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3431.47,9918,APC Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,9420, Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,9420, Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1544,9420,APC Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1544,9420,APC Repair of kneecap tendon,27380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1544,9420,APC Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Repair/graft kneecap tendon,27381,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair of thigh muscle,27385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Repair/graft of thigh muscle,27386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,8006,APC Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,8006,APC Incision of thigh tendon,27390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,8006,APC Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Incision of thigh tendons,27391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Incision of thigh tendons,27392,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9000.7, Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9000.7, Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,9000.7, Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,9000.7, Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9000.7, Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9000.7, Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9000.7,APC Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9000.7,APC Lengthening of thigh tendon,27393,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9000.7,APC Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Lengthening of thigh tendons,27394,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Lengthening of thigh tendons,27395,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Transplant of thigh tendon,27396,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,9000.7, Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,9000.7, Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Transplants of thigh tendons,27397,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Revise thigh muscles/tendons,27400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9000.7, Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9000.7, Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,9000.7, Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,9000.7, Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9000.7, Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9000.7, Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9000.7,APC Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9000.7,APC Repair of knee cartilage,27403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9000.7,APC Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Repair of knee ligament,27405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Repair of knee ligament,27407,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Repair of knee ligaments,27409,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,18617, Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,18617, Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,18617,APC Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,18617,APC Autochondrocyte implant knee,27412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,18617,APC Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,18617,APC Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,18617,APC Osteochondral knee allograft,27415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,18617,APC Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,13320, Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,13320, Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13320,APC Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13320,APC Osteochondral knee autograft,27416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13320,APC Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Repair degenerated kneecap,27418,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Revision of unstable kneecap,27420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4147,11081,APC Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4147,11081,APC Revision of unstable kneecap,27422,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4147,11081,APC Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Revision/removal of kneecap,27424,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3865.36,9918, Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3865.36,9918, Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,9918, Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,9918, Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3865.36,9918, Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3865.36,9918, Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9918,APC Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9918,APC Lat retinacular release open,27425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9918,APC Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Reconstruction knee,27427,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Reconstruction knee,27428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Reconstruction knee,27429,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Revision of thigh muscles,27430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Incision of knee joint,27435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,15339,APC Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,15339,APC Revise kneecap,27437,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,15339,APC Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,23447, Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,23447, Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,23447, Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,23447, Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19538,,,,,,,fee schedule,3291,23447, Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23447,,,,,,,fee schedule,3291,23447, Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,23447,APC Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,23447,APC Revise kneecap with implant,27438,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,23447,APC Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18686, Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18686, Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3291,18686, Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3291,18686, Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,18686, Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,18686, Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18686,APC Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18686,APC Revision of knee joint,27443,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18686,APC Revision of knee joint,27445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,23447, Revision of knee joint,27445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,23447, Revision of knee joint,27445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,23447, Revision of knee joint,27445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,23447, Revision of knee joint,27445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19538,,,,,,,fee schedule,3560,23447, Revision of knee joint,27445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23447,,,,,,,fee schedule,3560,23447, Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,23447, Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,23447, Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,23447, Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,23447, Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19538,,,,,,,fee schedule,3291,23447, Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23447,,,,,,,fee schedule,3291,23447, Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,23447,APC Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,23447,APC Revision of knee joint,27446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,23447,APC Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,23447, Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,23447, Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,23447, Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,23447, Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19538,,,,,,,fee schedule,3560,23447, Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23447,,,,,,,fee schedule,3560,23447, Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,23447,APC Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,23447,APC Total knee arthroplasty,27447,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,23447,APC Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incision of thigh,27448,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Incision of thigh,27450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Realignment of thigh bone,27454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Realignment of knee,27455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Realignment of knee,27457,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Osteot femur imed lngth dev,27458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Osteot femur imed lngth dev,27458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Osteot femur imed lngth dev,27458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Osteot femur imed lngth dev,27458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Osteot femur imed lngth dev,27458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Osteot femur imed lngth dev,27458,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Osteot femur imed lngth dev,27458,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Shortening of thigh bone,27465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Lengthening of thigh bone,27466,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Shorten/lengthen thighs,27468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Shorten/lengthen thighs,27468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Shorten/lengthen thighs,27468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Shorten/lengthen thighs,27468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Shorten/lengthen thighs,27468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Shorten/lengthen thighs,27468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Repair of thigh,27470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Repair/graft of thigh,27472,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Surgery to stop leg growth,27475,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Surgery to stop leg growth,27477,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Surgery to stop leg growth,27479,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Surgery to stop leg growth,27485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19538,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23447,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3560,23447,APC Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3560,23447,APC Revise/replace knee joint,27486,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3560,23447,APC Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19538,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23447,,,,,,,fee schedule,3560,23447, Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,3560,23447,APC Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,3560,23447,APC Revise/replace knee joint,27487,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,3560,23447,APC Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Removal of knee prosthesis,27488,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Reinforce thigh,27495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,7422,APC Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,7422,APC Decompression of thigh/knee,27496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,7422,APC Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Decompression of thigh/knee,27497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Decompression of thigh/knee,27498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,9000.7, Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,9000.7, Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9000.7, Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9000.7, Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,9000.7, Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,9000.7, Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,9000.7,APC Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,9000.7,APC Decompression of thigh/knee,27499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,9000.7,APC Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of thigh fracture,27500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,291.4,4466, Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,291.4,4466, Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,4466, Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,4466, Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,291.4,4466, Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,291.4,4466, Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,4466,APC Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,4466,APC Treatment of thigh fracture,27501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,4466,APC Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treatment of thigh fracture,27502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,5098, Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,5098, Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Treatment of thigh fracture,27503,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treatment of thigh fracture,27506,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of thigh fracture,27508,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Treatment of thigh fracture,27509,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Treatment of thigh fracture,27510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,428,18617,APC Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Treatment of thigh fracture,27514,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat thigh fx growth plate,27516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Treat thigh fx growth plate,27517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat thigh fx growth plate,27519,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat kneecap fracture,27520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treat kneecap fracture,27524,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat knee fracture,27530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,8006,APC Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,8006,APC Treat knee fracture,27532,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,8006,APC Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,18617, Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,18617, Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,18617,APC Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,18617,APC Treat knee fracture,27535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,18617,APC Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat knee fracture,27536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat knee fracture(s),27538,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat knee fracture,27540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat knee dislocation,27550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Treat knee dislocation,27552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Treat knee dislocation,27558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat kneecap dislocation,27560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat kneecap dislocation,27562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9420,APC Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9420,APC Treat kneecap dislocation,27566,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9420,APC Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Fixation of knee joint,27570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Fusion of knee,27580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18686, Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18686,APC Amputate leg at thigh,27592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18686,APC Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Amputation follow-up surgery,27594,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,27596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputate lower leg at knee,27598,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,291.4,18617, Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,291.4,18617, Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Leg surgery procedure,27599,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Decompression of lower leg,27600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Decompression of lower leg,27601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Decompression of lower leg,27602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Drain lower leg lesion,27603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Drain lower leg bursa,27604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Incision of achilles tendon,27605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Incision of achilles tendon,27606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Treat lower leg bone lesion,27607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Explore/treat ankle joint,27610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Exploration of ankle joint,27612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy lower leg soft tissue,27613,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,5123,APC Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,5123,APC Biopsy lower leg soft tissue,27614,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,5123,APC Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Resect leg/ankle tum < 5 cm,27615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect leg/ankle tum 5 cm/>,27616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc leg/ankle tum < 3 cm,27618,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Exc leg/ankle tum deep <5 cm,27619,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Explore/treat ankle joint,27620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Remove ankle joint lining,27625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Remove ankle joint lining,27626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Removal of tendon lesion,27630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc leg/ankle les sc 3 cm/>,27632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Exc leg/ankle tum dep 5 cm/>,27634,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Remove lower leg bone lesion,27635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Remove/graft leg bone lesion,27637,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Remove/graft leg bone lesion,27638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Partial removal of tibia,27640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Partial removal of fibula,27641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Resect tibia tumor,27645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Resect fibula tumor,27646,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Resect talus/calcaneus tum,27647,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Injection for ankle x-ray,27648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for ankle x-ray,27648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for ankle x-ray,27648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for ankle x-ray,27648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair achilles tendon,27650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Repair/graft achilles tendon,27652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Repair of achilles tendon,27654,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Repair leg fascia defect,27656,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,8006,APC Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,8006,APC Repair of leg tendon each,27658,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,8006,APC Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9420,APC Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9420,APC Repair of leg tendon each,27659,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9420,APC Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9420,APC Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9420,APC Repair of leg tendon each,27664,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9420,APC Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,13036,APC Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,13036,APC Repair of leg tendon each,27665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,13036,APC Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Repair lower leg tendons,27675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Repair lower leg tendons,27676,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Release of lower leg tendon,27680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Release of lower leg tendons,27681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revision of lower leg tendon,27685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Revise lower leg tendons,27686,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Revision of calf tendon,27687,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Revise lower leg tendon,27690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Revise lower leg tendon,27691,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Revise additional leg tendon,27692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Revise additional leg tendon,27692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Revise additional leg tendon,27692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Revise additional leg tendon,27692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligament,27695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligaments,27696,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Repair of ankle ligament,27698,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9420,APC Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9420,APC Revision of ankle joint,27700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9420,APC Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,33657.37, Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,33657.37, Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3560,33657.37, Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3560,33657.37, Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,33657.37, Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,33657.37, Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33336.82,,,,,,,fee schedule,3560,33657.37,APC Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33657.37,,,,,,,fee schedule,3560,33657.37,APC Reconstruct ankle joint,27702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32054.64,,,,,,,fee schedule,3560,33657.37,APC Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,21749.16, Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,21749.16, Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,21749.16, Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,21749.16, Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,21749.16, Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,21749.16, Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,428,21749.16,APC Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,428,21749.16,APC Reconstruction ankle joint,27703,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,428,21749.16,APC Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Removal of ankle implant,27704,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,15339, Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,15339, Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,15339,APC Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,15339,APC Incision of tibia,27705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,15339,APC Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Incision of fibula,27707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15925.26, Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15925.26, Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,15925.26, Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,15925.26, Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,15925.26, Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,15925.26, Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,2816,15925.26,APC Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,2816,15925.26,APC Incision of tibia & fibula,27709,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,2816,15925.26,APC Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,18617, Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,18617, Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Realignment of lower leg,27712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Osteot tibia imed lngth dev,27713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Osteot tibia imed lngth dev,27713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Osteot tibia imed lngth dev,27713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Osteot tibia imed lngth dev,27713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Osteot tibia imed lngth dev,27713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Osteot tibia imed lngth dev,27713,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Osteot tibia imed lngth dev,27713,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,18617,APC Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,18617,APC Revision of lower leg,27715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,18617,APC Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,15339, Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,15339, Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,15339,APC Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,15339,APC Repair of tibia,27720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,15339,APC Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13320,APC Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13320,APC Repair/graft of tibia,27722,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13320,APC Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Repair/graft of tibia,27724,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Repair of lower leg,27725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,15339, Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,15339, Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Repair fibula nonunion,27726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,18617,APC Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,18617,APC Repair of lower leg,27727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,18617,APC Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Repair of tibia epiphysis,27730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Repair of fibula epiphysis,27732,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Repair lower leg epiphyses,27734,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Repair of leg epiphyses,27740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,428,4466,APC Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,428,4466,APC Repair of leg epiphyses,27742,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,428,4466,APC Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Reinforce tibia,27745,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of tibia fracture,27750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Treatment of tibia fracture,27752,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Treatment of tibia fracture,27756,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Treatment of tibia fracture,27758,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Treatment of tibia fracture,27759,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Cltx medial ankle fx,27760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Cltx med ankle fx w/mnpj,27762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Optx medial ankle fx,27766,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Cltx post ankle fx,27767,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Cltx post ankle fx w/mnpj,27768,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,13320, Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,13320, Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13320,APC Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13320,APC Optx post ankle fx,27769,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13320,APC Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of fibula fracture,27780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treatment of fibula fracture,27781,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treatment of fibula fracture,27784,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27786,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27788,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treatment of ankle fracture,27792,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treatment of ankle fracture,27810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treatment of ankle fracture,27814,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treatment of ankle fracture,27818,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Treatment of ankle fracture,27822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Treatment of ankle fracture,27823,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat lower leg fracture,27824,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat lower leg fracture,27825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Treat lower leg fracture,27826,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17041,APC Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17041,APC Treat lower leg fracture,27827,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17041,APC Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Treat lower leg fracture,27828,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Treat lower leg joint,27829,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,291.4,3314, Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,291.4,3314, Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat lower leg dislocation,27830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,9420, Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,9420, Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,9420,APC Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,9420,APC Treat lower leg dislocation,27831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,9420,APC Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,13036,APC Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,13036,APC Treat lower leg dislocation,27832,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,13036,APC Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,3314, Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,3314, Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat ankle dislocation,27840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,4097,APC Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,4097,APC Treat ankle dislocation,27842,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,4097,APC Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat ankle dislocation,27846,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat ankle dislocation,27848,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Fixation of ankle joint,27860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,15925.26, Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,15925.26, Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Fusion of ankle joint open,27870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,15925.26, Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,15925.26, Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Fusion of tibiofibular joint,27871,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18686, Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18686, Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,18686, Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,18686, Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18686, Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18686, Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,18686,APC Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,18686,APC Amputation of lower leg,27880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,18686,APC Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputation of lower leg,27881,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputation of lower leg,27882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Amputation follow-up surgery,27884,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputation follow-up surgery,27886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Amputation of foot at ankle,27888,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Amputation of foot at ankle,27889,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Decompression of leg,27892,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Decompression of leg,27893,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Decompression of leg,27894,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,291.4,18617, Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,291.4,18617, Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Leg/ankle surgery procedure,27899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,18617, Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,18617, Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1951.11,18617, Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1951.11,18617, Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1951.11,18617, Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1951.11,18617, Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,18617,APC Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,18617,APC Drainage of bursa of foot,28001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,18617,APC Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5123, Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5123, Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,5123, Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,5123, Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5123, Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5123, Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5123,APC Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5123,APC Treatment of foot infection,28002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5123,APC Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Treatment of foot infection,28003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Treat foot bone lesion,28005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Incision of foot fascia,28008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Incision of toe tendon,28010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,5098, Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,5098, Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Incision of toe tendons,28011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Exploration of foot joint,28020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Exploration of foot joint,28022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,5123, Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,5123, Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,5123, Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,5123, Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,5123, Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,5123, Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5123,APC Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5123,APC Exploration of toe joint,28024,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5123,APC Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2306.84,6312, Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2306.84,6312, Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,6312, Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,6312, Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2306.84,6312, Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2306.84,6312, Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6312,APC Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6312,APC Decompression of tibia nerve,28035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6312,APC Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,5123, Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,5123, Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,5123,APC Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,5123,APC Exc foot/toe tum sc 1.5 cm/>,28039,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,5123,APC Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,3408,5123, Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,3408,5123, Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Exc foot/toe tum dep 1.5cm/>,28041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Exc foot/toe tum sc < 1.5 cm,28043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5098,APC Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5098,APC Exc foot/toe tum deep <1.5cm,28045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5098,APC Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,5123,APC Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,5123,APC Resect foot/toe tumor < 3 cm,28046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,5123,APC Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,3408,13320,APC Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,3408,13320,APC Resect foot/toe tumor 3 cm/>,28047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,3408,13320,APC Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Biopsy of foot joint lining,28050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Biopsy of foot joint lining,28052,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Biopsy of toe joint lining,28054,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2306.84,6312, Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2306.84,6312, Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2306.84,6312, Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2306.84,6312, Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2306.84,6312, Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2306.84,6312, Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6312,APC Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6312,APC Neurectomy foot,28055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6312,APC Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Partial removal foot fascia,28060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Removal of foot fascia,28062,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,9000.7, Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,9000.7, Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Removal of foot joint lining,28070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Removal of foot joint lining,28072,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Removal of foot lesion,28080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Excise foot tendon sheath,28086,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Excise foot tendon sheath,28088,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Removal of foot lesion,28090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Removal of toe lesions,28092,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Removal of ankle/heel lesion,28100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Remove/graft foot lesion,28103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Removal of foot lesion,28104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Remove/graft foot lesion,28107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Removal of toe lesions,28108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Part removal of metatarsal,28113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Removal of metatarsal heads,28114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revision of foot,28116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,9420, Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,9420, Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3865.36,9420, Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3865.36,9420, Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,9420, Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,9420, Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9420,APC Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9420,APC Removal of heel bone,28118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9420,APC Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Removal of heel spur,28119,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3865.36,9918, Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3865.36,9918, Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,9918, Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,9918, Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3865.36,9918, Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3865.36,9918, Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9918,APC Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9918,APC Part removal of ankle/heel,28120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9918,APC Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Partial removal of foot bone,28122,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5098, Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5098, Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,5098, Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,5098, Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,5098, Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,5098, Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5098,APC Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5098,APC Partial removal of toe,28124,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5098,APC Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Partial removal of toe,28126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,9000.7, Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,9000.7, Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Removal of ankle bone,28130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Removal of metatarsal,28140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Removal of toe,28150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Partial removal of toe,28153,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Partial removal of toe,28160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Resect tarsal tumor,28171,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Resect metatarsal tumor,28173,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Resect phalanx of toe tumor,28175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,836.55,4166, Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,836.55,4166, Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4166, Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4166, Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,4166, Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,4166, Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4166,APC Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4166,APC Removal of foot foreign body,28190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4166,APC Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Removal of foot foreign body,28192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1951.11,6312, Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1951.11,6312, Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,6312, Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,6312, Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1951.11,6312, Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1951.11,6312, Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,6312,APC Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,6312,APC Removal of foot foreign body,28193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,6312,APC Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Repair of foot tendon,28200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Repair/graft of foot tendon,28202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Repair of foot tendon,28208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Repair/graft of foot tendon,28210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,18617, Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,18617, Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1899.59,18617, Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1899.59,18617, Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Release of foot tendon,28220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Release of foot tendons,28222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Release of foot tendon,28225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,4097,APC Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,4097,APC Release of foot tendons,28226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,4097,APC Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,18617, Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,18617, Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,18617, Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,18617, Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Incision of foot tendon(s),28230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Incision of toe tendon,28232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Incision of foot tendon,28234,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Revision of foot tendon,28238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Release of big toe,28240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Revision of foot fascia,28250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,5098, Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,5098, Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,5098, Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,5098, Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2138,5098, Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2138,5098, Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2138,5098,APC Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2138,5098,APC Release of midfoot joint,28260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2138,5098,APC Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,6404, Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,6404, Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1899.59,6404, Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1899.59,6404, Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,6404, Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,6404, Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6404,APC Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6404,APC Revision of foot tendon,28261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6404,APC Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,17041,APC Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,17041,APC Revision of foot and ankle,28262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,17041,APC Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Release of midfoot joint,28264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Release of foot contracture,28270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,18617, Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,18617, Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,18617, Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,18617, Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Release of toe joint each,28272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Fusion of toes,28280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Repair of hammertoe,28285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Repair of hammertoe,28286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Partial removal of foot bone,28288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Corrj halux rigdus w/o implt,28289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,18617, Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,18617, Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,18617,APC Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,18617,APC Corrj halux rigdus w/implt,28291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,18617,APC Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Correction hallux valgus,28292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,6404, Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,6404,APC Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,6404,APC Correction hallux valgus,28295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,6404,APC Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Correction hallux valgus,28296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15925.26, Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15925.26, Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15925.26, Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15925.26, Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15925.26, Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15925.26, Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,15925.26,APC Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,15925.26,APC Correction hallux valgus,28297,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,15925.26,APC Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Correction hallux valgus,28298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,9420,APC Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,9420,APC Correction hallux valgus,28299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,9420,APC Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,15339, Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,15339, Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,15339,APC Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,15339,APC Incision of heel bone,28300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,15339,APC Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Incision of ankle bone,28302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Incision of midfoot bones,28304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Incise/graft midfoot bones,28305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Incision of metatarsal,28306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9000.7, Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9000.7, Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,9000.7, Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,9000.7, Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9000.7, Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9000.7, Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9000.7,APC Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9000.7,APC Incision of metatarsal,28307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9000.7,APC Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Incision of metatarsal,28308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Incision of metatarsals,28309,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Revision of big toe,28310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Revision of toe,28312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Repair deformity of toe,28313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Removal of sesamoid bone,28315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Repair of foot bones,28320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,13036, Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,13036, Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13036,APC Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13036,APC Repair of metatarsals,28322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13036,APC Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,9420, Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,9420, Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3865.36,9420, Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3865.36,9420, Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,9420, Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,9420, Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,9420,APC Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,9420,APC Resect enlarged toe tissue,28340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,9420,APC Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Resect enlarged toe,28341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6312, Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6312, Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3865.36,6312, Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3865.36,6312, Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6312, Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6312, Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6312,APC Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6312,APC Repair extra toe(s),28344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6312,APC Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1899.59,6312, Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1899.59,6312, Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Repair webbed toe(s),28345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,18617,APC Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,18617,APC Reconstruct cleft foot,28360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,18617,APC Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,3314, Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,3314, Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treatment of heel fracture,28400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,291.4,4466, Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,291.4,4466, Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,4466, Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,4466, Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,291.4,4466, Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,291.4,4466, Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,4466,APC Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,4466,APC Treatment of heel fracture,28405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,4466,APC Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Treatment of heel fracture,28406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Treat heel fracture,28415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,15925.26, Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,15925.26, Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Treat/graft heel fracture,28420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treatment of ankle fracture,28430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,4466, Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,4466, Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treatment of ankle fracture,28435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9000.7, Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9000.7, Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,9000.7, Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,9000.7, Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9000.7, Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9000.7, Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,9000.7,APC Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,9000.7,APC Treatment of ankle fracture,28436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,9000.7,APC Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Treat ankle fracture,28445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,13320, Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,13320, Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13320,APC Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13320,APC Osteochondral talus autogrft,28446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13320,APC Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat midfoot fracture each,28450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,18617,APC Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,18617,APC Treat midfoot fracture each,28455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,18617,APC Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,11081,APC Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,11081,APC Treat midfoot fracture,28456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,11081,APC Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat midfoot fracture each,28465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat metatarsal fracture,28470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat metatarsal fracture,28475,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,8006,APC Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,8006,APC Treat metatarsal fracture,28476,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,8006,APC Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Treat metatarsal fracture,28485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat big toe fracture,28490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat big toe fracture,28495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Treat big toe fracture,28496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Treat big toe fracture,28505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treatment of toe fracture,28510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treatment of toe fracture,28515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Treat toe fracture,28525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat sesamoid bone fracture,28530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Treat sesamoid bone fracture,28531,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,5123,APC Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,5123,APC Treat foot dislocation,28545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,5123,APC Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1899.59,4466, Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1899.59,4466, Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,4466, Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,4466, Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1899.59,4466, Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1899.59,4466, Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,4466,APC Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,4466,APC Treat foot dislocation,28546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,4466,APC Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,15339, Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,15339, Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,15339,APC Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,15339,APC Repair foot dislocation,28555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,15339,APC Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1544,6404,APC Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1544,6404,APC Treat foot dislocation,28575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1544,6404,APC Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,9000.7, Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,9000.7, Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9000.7, Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9000.7, Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,9000.7, Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,9000.7, Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,428,9000.7,APC Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,428,9000.7,APC Treat foot dislocation,28576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,428,9000.7,APC Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,9000.7, Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,9000.7, Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Repair foot dislocation,28585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,3314, Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,3314, Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,291.4,3314, Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,291.4,3314, Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,291.4,3314, Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,291.4,3314, Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,3314,APC Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,3314,APC Treat foot dislocation,28605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,3314,APC Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,11081,APC Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,11081,APC Treat foot dislocation,28606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,11081,APC Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Repair foot dislocation,28615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat toe dislocation,28630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1544,3314,APC Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1544,3314,APC Treat toe dislocation,28635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1544,3314,APC Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Treat toe dislocation,28636,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Repair toe dislocation,28645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Treat toe dislocation,28660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,330.41,4097, Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,330.41,4097, Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,330.41,4097, Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,330.41,4097, Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,330.41,4097, Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,330.41,4097, Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,4097,APC Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,4097,APC Treat toe dislocation,28665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,4097,APC Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5098,APC Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5098,APC Treat toe dislocation,28666,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5098,APC Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Repair of toe dislocation,28675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,21749.16, Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,21749.16, Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,21749.16, Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,21749.16, Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,21749.16, Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,21749.16, Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,4224,21749.16,APC Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,4224,21749.16,APC Fusion of foot bones,28705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,4224,21749.16,APC Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,17041,APC Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,17041,APC Fusion of foot bones,28725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,17041,APC Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Fusion of foot bones,28735,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15925.26, Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15925.26, Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,15925.26, Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,15925.26, Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15925.26, Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15925.26, Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,15925.26,APC Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,15925.26,APC Revision of foot bones,28737,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,15925.26,APC Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Fusion of foot bones,28740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Fusion of big toe joint,28750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Fusion of big toe joint,28755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Fusion of big toe joint,28760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,18617, Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,18617, Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,18617, Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,18617, Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3865.36,18617, Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3865.36,18617, Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,18617,APC Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,18617,APC Amputation of midfoot,28800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,18617,APC Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,18617, Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,18617, Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,18617,APC Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,18617,APC Amputation thru metatarsal,28805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,18617,APC Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,5123,APC Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,5123,APC Amputation toe & metatarsal,28810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,5123,APC Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Amputation of toe,28820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Partial amputation of toe,28825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,18617, Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,18617, Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,18617, Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,18617, Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1899.59,18617, Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1899.59,18617, Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,18617,APC Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,18617,APC Hi enrgy eswt plantar fascia,28890,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,18617,APC Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,291.4,18617, Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,291.4,18617, Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Foot/toes surgery procedure,28899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,3314, Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,3314, Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,3314, Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,3314, Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,330.41,3314, Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,330.41,3314, Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,3314,APC Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,3314,APC Application of body cast,29000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,3314,APC Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,330.41,18617, Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,330.41,18617, Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,330.41,18617, Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,330.41,18617, Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Application of body cast,29044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,330.41,18617, Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,330.41,18617, Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of body cast,29046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of figure eight,29049,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of shoulder cast,29055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of shoulder cast,29058,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of long arm cast,29065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of forearm cast,29075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Apply hand/wrist cast,29085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Apply finger cast,29086,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Apply long arm splint,29105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Apply forearm splint,29125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Apply forearm splint,29126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Application of finger splint,29130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Application of finger splint,29131,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Strapping of chest,29200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Strapping of shoulder,29240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Strapping of elbow or wrist,29260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Strapping of hand or finger,29280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,330.41,18617, Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,330.41,18617, Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of hip cast,29305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,330.41,18617, Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,330.41,18617, Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,330.41,18617, Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,330.41,18617, Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of hip casts,29325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Apply long leg cast brace,29358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Application of long leg cast,29365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Apply short leg cast,29435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Addition of walker to cast,29440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Apply rigid leg cast,29445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Application of leg cast,29450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Application long leg splint,29505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Application lower leg splint,29515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Strapping of hip,29520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Strapping of knee,29530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Strapping of ankle and/or ft,29540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Strapping of toes,29550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Application of paste boot,29580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Apply multlay comprs lwr leg,29581,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Appl multlay comprs arm/hand,29584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Removal/revision of cast,29710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Repair of body cast,29720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,191.97,18617, Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,191.97,18617, Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,18617, Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,18617, Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,191.97,18617, Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,191.97,18617, Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,18617,APC Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,18617,APC Windowing of cast,29730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,18617,APC Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,330.41,18617, Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,330.41,18617, Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Wedging of cast,29740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,330.41,18617, Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,330.41,18617, Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,330.41,18617, Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,330.41,18617, Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,330.41,18617, Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,330.41,18617, Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.63,,,,,,,fee schedule,330.41,18617,APC Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.93,,,,,,,fee schedule,330.41,18617,APC Wedging of clubfoot cast,29750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.41,,,,,,,fee schedule,330.41,18617,APC Casting/strapping procedure,29799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,191.97,984, Casting/strapping procedure,29799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,191.97,984, Casting/strapping procedure,29799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.65,,,,,,,fee schedule,191.97,984,APC Casting/strapping procedure,29799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,191.97,984,APC Casting/strapping procedure,29799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.97,,,,,,,fee schedule,191.97,984,APC Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,9420,APC Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,9420,APC Jaw arthroscopy/surgery,29800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,9420,APC Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Jaw arthroscopy/surgery,29804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Shoulder arthroscopy dx,29805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Shoulder arthroscopy/surgery,29806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13036,APC Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13036,APC Shoulder arthroscopy/surgery,29807,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13036,APC Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29819,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Shoulder arthroscopy/surgery,29820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29823,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3291,8006,APC Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3291,8006,APC Shoulder arthroscopy/surgery,29824,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3291,8006,APC Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Shoulder arthroscopy/surgery,29826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Shoulder arthroscopy/surgery,29826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Shoulder arthroscopy/surgery,29826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Shoulder arthroscopy/surgery,29826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Shoulder arthroscopy/surgery,29826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Shoulder arthroscopy/surgery,29826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Arthroscop rotator cuff repr,29827,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,13320, Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,13320, Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13320,APC Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13320,APC Arthroscopy biceps tenodesis,29828,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13320,APC Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Elbow arthroscopy,29830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29834,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Elbow arthroscopy/surgery,29836,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29837,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,9420,APC Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,9420,APC Elbow arthroscopy/surgery,29838,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,9420,APC Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Wrist arthroscopy,29840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Wrist arthroscopy/surgery,29843,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29844,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29845,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29846,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Wrist arthroscopy/surgery,29847,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,13320, Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,13320, Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,13320, Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,13320, Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1899.59,13320, Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1899.59,13320, Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,13320,APC Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,13320,APC Wrist endoscopy/surgery,29848,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,13320,APC Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Knee arthroscopy/surgery,29850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1899.59,6312, Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,6312,APC Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,6312,APC Knee arthroscopy/surgery,29851,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,6312,APC Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,9420,APC Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,9420,APC Tibial arthroscopy/surgery,29855,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,9420,APC Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15925.26, Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15925.26, Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,15925.26, Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,15925.26, Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15925.26, Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15925.26, Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4224,15925.26,APC Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4224,15925.26,APC Tibial arthroscopy/surgery,29856,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4224,15925.26,APC Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Hip arthroscopy dx,29860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,11081,APC Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,11081,APC Hip arthro w/fb removal,29861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,11081,APC Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,13320, Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,13320, Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13320,APC Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13320,APC Hip arthr0 w/debridement,29862,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13320,APC Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,8006, Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,8006, Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3865.36,8006, Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3865.36,8006, Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,8006, Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,8006, Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,8006,APC Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,8006,APC Hip arthr0 w/synovectomy,29863,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,8006,APC Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,18617,APC Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,18617,APC Autgrft implnt knee w/scope,29866,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,18617,APC Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,18617,APC Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,18617,APC Allgrft implnt knee w/scope,29867,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,18617,APC Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,18617, Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,18617, Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,18617,APC Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,18617,APC Meniscal trnspl knee w/scpe,29868,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,18617,APC Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy dx,29870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Knee arthroscopy/drainage,29871,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29873,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29874,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29875,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29876,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29877,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29879,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29881,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Knee arthroscopy/surgery,29882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy/surgery,29883,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29884,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Knee arthroscopy/surgery,29885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy/surgery,29886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,5123,APC Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9000.7, Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9000.7, Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,9000.7, Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,9000.7, Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9000.7, Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9000.7, Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9000.7,APC Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9000.7,APC Knee arthroscopy/surgery,29887,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9000.7,APC Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,17041,APC Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,17041,APC Knee arthroscopy/surgery,29888,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,17041,APC Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17939, Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17939, Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3408,17939, Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3408,17939, Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17939, Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17939, Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17939,APC Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17939,APC Knee arthroscopy/surgery,29889,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17939,APC Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,9420,APC Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,9420,APC Ankle arthroscopy/surgery,29891,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,9420,APC Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,9420,APC Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,9420,APC Ankle arthroscopy/surgery,29892,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,9420,APC Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,13320,APC Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,13320,APC Scope plantar fasciotomy,29893,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,13320,APC Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29894,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29895,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29897,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29898,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,15339,APC Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,15339,APC Ankle arthroscopy/surgery,29899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,15339,APC Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,6404,APC Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,6404,APC Mcp joint arthroscopy dx,29900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,6404,APC Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,8006,APC Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,8006,APC Mcp joint arthroscopy surg,29901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,8006,APC Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1899.59,5098, Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1899.59,5098, Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1899.59,5098, Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1899.59,5098, Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1899.59,5098, Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1899.59,5098, Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1975.58,,,,,,,fee schedule,1899.59,5098,APC Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1994.57,,,,,,,fee schedule,1899.59,5098,APC Mcp joint arthroscopy surg,29902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1899.59,,,,,,,fee schedule,1899.59,5098,APC Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/fb rmvl,29904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/exc,29905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/deb,29906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3408,13320,APC Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,17041, Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,17041, Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3408,17041,APC Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3408,17041,APC Subtalar arthro w/fusion,29907,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3408,17041,APC Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,13320, Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,13320, Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13320,APC Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13320,APC Hip arthro w/femoroplasty,29914,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13320,APC Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,15339, Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,15339, Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,15339,APC Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,15339,APC Hip arthro acetabuloplasty,29915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,15339,APC Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,15339, Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,15339, Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,15339,APC Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,15339,APC Hip arthro w/labral repair,29916,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,15339,APC Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,291.4,18617, Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,291.4,18617, Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,291.4,18617, Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,291.4,18617, Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,291.4,18617, Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,291.4,18617, Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.06,,,,,,,fee schedule,291.4,18617,APC Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.97,,,,,,,fee schedule,291.4,18617,APC Arthroscopy of joint,29999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.4,,,,,,,fee schedule,291.4,18617,APC Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,279.8,18617, Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,279.8,18617, Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Drainage of nose lesion,30000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,18617, Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,18617, Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,637.13,18617, Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,637.13,18617, Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,637.13,18617, Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,637.13,18617, Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,18617,APC Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,18617,APC Drainage of nose lesion,30020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,18617,APC Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Intranasal biopsy,30100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Removal of nose polyp(s),30110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Removal of nose polyp(s),30115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,5123,APC Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,5123,APC Removal of intranasal lesion,30117,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,5123,APC Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,5123,APC Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,5123,APC Removal of intranasal lesion,30118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,5123,APC Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,5123,APC Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,5123,APC Revision of nose,30120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,5123,APC Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Removal of nose lesion,30124,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Removal of nose lesion,30125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,5123,APC Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,5123,APC Excise inferior turbinate,30130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,5123,APC Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Resect inferior turbinate,30140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,11081,APC Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,11081,APC Partial removal of nose,30150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,11081,APC Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,13036, Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,13036, Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,13036,APC Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,13036,APC Removal of nose,30160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,13036,APC Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,637.13,3314, Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,637.13,3314, Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,3314, Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,3314, Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,3314, Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,3314, Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,3314,APC Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,3314,APC Injection treatment of nose,30200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,3314,APC Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,3314, Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,3314, Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,428,3314,APC Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,428,3314,APC Nasal sinus therapy,30210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,428,3314,APC Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1832.96,5098, Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1832.96,5098, Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,5098, Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,5098, Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1832.96,5098, Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1832.96,5098, Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,5098,APC Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,5098,APC Insert nasal septal button,30220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,5098,APC Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Remove nasal foreign body,30300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4112.54, Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4112.54, Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4112.54, Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4112.54, Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4112.54, Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4112.54, Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,4112.54,APC Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,4112.54,APC Remove nasal foreign body,30310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,4112.54,APC Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,4466, Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,4466, Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,4466, Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,4466, Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1832.96,4466, Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1832.96,4466, Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,4466,APC Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,4466,APC Remove nasal foreign body,30320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,4466,APC Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,8006,APC Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,8006,APC Reconstruction of nose,30400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,8006,APC Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Reconstruction of nose,30410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Reconstruction of nose,30420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Revision of nose,30430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Revision of nose,30435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Revision of nose,30450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,9918, Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,9918, Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Revision of nose,30460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,13320, Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,13320, Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13320,APC Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13320,APC Revision of nose,30462,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13320,APC Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,13320, Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,13320, Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13320,APC Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13320,APC Repair Nasal Stenosis,30465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13320,APC Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13320,APC Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13320,APC Rpr nsl vlv collapse w/implt,30468,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13320,APC Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13320,APC Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13320,APC Rpr nsl vlv collapse w/rmdlg,30469,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13320,APC Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6404, Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6404, Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,6404, Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,6404, Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6404, Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6404, Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6404,APC Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6404,APC Repair of nasal septum,30520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6404,APC Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Repair nasal defect,30540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7422, Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7422, Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7422, Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7422, Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7422, Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7422, Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,7422,APC Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,7422,APC Repair nasal defect,30545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,7422,APC Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,637.13,4466, Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,637.13,4466, Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,637.13,4466, Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,637.13,4466, Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,637.13,4466, Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,637.13,4466, Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4466,APC Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4466,APC Release of nasal adhesions,30560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4466,APC Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,8006,APC Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,8006,APC Repair upper jaw fistula,30580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,8006,APC Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,9420,APC Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,9420,APC Repair mouth/nose fistula,30600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,9420,APC Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,9918, Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,9918, Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Intranasal reconstruction,30620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3916.7,9918, Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3916.7,9918, Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,9918, Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,9918, Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3916.7,9918, Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3916.7,9918, Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,9918,APC Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,9918,APC Repair nasal septum defect,30630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,9918,APC Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Ablate inf turbinate superf,30801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Ablate inf turbinate submuc,30802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,18617, Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,18617, Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Control of nosebleed,30901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,3314,APC Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,3314,APC Control of nosebleed,30903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,3314,APC Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,157.18,3314, Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,3314,APC Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,3314,APC Control of nosebleed,30905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,3314,APC Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,3314, Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,3314, Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,3314, Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,3314, Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,3314, Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,3314, Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,3314,APC Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,3314,APC Repeat control of nosebleed,30906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,3314,APC Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,6404,APC Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,6404,APC Ligation nasal sinus artery,30915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,6404,APC Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Ligation upper jaw artery,30920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6312, Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6312, Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3916.7,6312, Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3916.7,6312, Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6312, Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6312, Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6312,APC Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6312,APC Ther fx nasal inf turbinate,30930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6312,APC Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,18617, Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,18617, Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Nasal surgery procedure,30999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,18617, Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,18617, Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Irrigation maxillary sinus,31000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,428,3314,APC Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,428,3314,APC Irrigation sphenoid sinus,31002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,428,3314,APC Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Exploration maxillary sinus,31020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,9420,APC Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,9420,APC Exploration maxillary sinus,31030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,9420,APC Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,8006,APC Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,8006,APC Explore sinus remove polyps,31032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,8006,APC Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Exploration behind upper jaw,31040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,11081,APC Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,11081,APC Exploration sphenoid sinus,31050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,11081,APC Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,11081,APC Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,11081,APC Sphenoid sinus surgery,31051,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,11081,APC Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,11081,APC Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,11081,APC Exploration of frontal sinus,31070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,11081,APC Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,13036, Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,13036, Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,13036,APC Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,13036,APC Exploration of frontal sinus,31075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,13036,APC Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,13036, Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,13036, Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,13036,APC Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,13036,APC Removal of frontal sinus,31080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,13036,APC Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,15339,APC Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,15339,APC Removal of frontal sinus,31081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,15339,APC Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,17041,APC Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,17041,APC Removal of frontal sinus,31084,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,17041,APC Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17041, Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,17041,APC Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,17041,APC Removal of frontal sinus,31085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,17041,APC Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,15339, Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,15339,APC Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,15339,APC Removal of frontal sinus,31086,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,15339,APC Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,17939, Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,17939, Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4224,17939, Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4224,17939, Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,17939, Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,17939, Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,17939,APC Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,17939,APC Removal of frontal sinus,31087,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,17939,APC Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Exploration of sinuses,31090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Removal of ethmoid sinus,31200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,1832.96,7422, Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,1832.96,7422, Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1832.96,7422, Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1832.96,7422, Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1832.96,7422, Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1832.96,7422, Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,7422,APC Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,7422,APC Removal of ethmoid sinus,31201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,7422,APC Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,8006,APC Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,8006,APC Removal of ethmoid sinus,31205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,8006,APC Removal of upper jaw,31225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of upper jaw,31225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of upper jaw,31225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of upper jaw,31225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of upper jaw,31230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of upper jaw,31230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of upper jaw,31230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of upper jaw,31230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,235.8,18617, Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,235.8,18617, Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,235.8,18617, Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,235.8,18617, Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,235.8,18617, Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,235.8,18617, Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.24,,,,,,,fee schedule,235.8,18617,APC Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,247.59,,,,,,,fee schedule,235.8,18617,APC Nasal endoscopy dx,31231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,235.8,,,,,,,fee schedule,235.8,18617,APC Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,462.05,4466, Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,462.05,4466, Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,462.05,4466, Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,462.05,4466, Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,462.05,4466, Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,462.05,4466, Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,462.05,4466,APC Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,462.05,4466,APC Nasal/sinus endoscopy dx,31233,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,462.05,4466,APC Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4166,APC Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4166,APC Nasal/sinus endoscopy dx,31235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4166,APC Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Nasal/sinus endoscopy surg,31237,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2102.67,4166, Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4166,APC Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4166,APC Nasal/sinus endoscopy surg,31238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4166,APC Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,4224,8006,APC Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,4224,8006,APC Nasal/sinus endoscopy surg,31239,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,4224,8006,APC Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,8006, Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,8006, Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2102.67,8006, Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2102.67,8006, Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,8006, Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,8006, Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,8006,APC Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,8006,APC Nasal/sinus endoscopy surg,31240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,8006,APC Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2102.67,18617, Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2102.67,18617, Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,18617, Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,18617, Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2102.67,18617, Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2102.67,18617, Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,18617,APC Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,18617,APC Nsl/sins ndsc w/artery lig,31241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,18617,APC Nsl/sinus ndsc rf abltj pnn,31242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc rf abltj pnn,31242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc rf abltj pnn,31242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc rf abltj pnn,31242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc rf abltj pnn,31242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,18617,APC Nsl/sinus ndsc rf abltj pnn,31242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,18617,APC Nsl/sinus ndsc rf abltj pnn,31242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,18617,APC Nsl/sinus ndsc cryoabltj pnn,31243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc cryoabltj pnn,31243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc cryoabltj pnn,31243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc cryoabltj pnn,31243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Nsl/sinus ndsc cryoabltj pnn,31243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,18617,APC Nsl/sinus ndsc cryoabltj pnn,31243,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,18617,APC Nsl/sinus ndsc cryoabltj pnn,31243,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,18617,APC Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3291,13320,APC Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3291,13320,APC Nsl/sins ndsc total,31253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3291,13320,APC Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8754.16, Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8754.16, Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8754.16, Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8754.16, Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,4224,8754.16, Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,4224,8754.16, Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,4224,8754.16,APC Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,4224,8754.16,APC Revision of ethmoid sinus,31254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,4224,8754.16,APC Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3291,9420,APC Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3291,9420,APC Removal of ethmoid sinus,31255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3291,9420,APC Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,3408,8006,APC Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,3408,8006,APC Exploration maxillary sinus,31256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,3408,8006,APC Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3291,13320,APC Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3291,13320,APC Nsl/sins ndsc tot w/sphendt,31257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3291,13320,APC Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3291,13320,APC Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3291,13320,APC Nsl/sins ndsc sphn tiss rmvl,31259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3291,13320,APC Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8754.16, Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8754.16, Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8754.16, Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8754.16, Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8754.16, Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8754.16, Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,8754.16,APC Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,8754.16,APC Endoscopy maxillary sinus,31267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,8754.16,APC Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,13036,APC Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,13036,APC Sinus endoscopy surgical,31276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,13036,APC Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,11081,APC Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,11081,APC Nasal/sinus endoscopy surg,31287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,11081,APC Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,11081,APC Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,11081,APC Nasal/sinus endoscopy surg,31288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,11081,APC Nasal/sinus endoscopy surg,31290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,18617,APC Nasal/sinus endoscopy surg,31294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,18617,APC Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,13320,APC Sinus endo w/balloon dil,31297,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,13320,APC Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,13320, Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,13320, Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,4224,13320,APC Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,4224,13320,APC Nsl/sins ndsc w/sins dilat,31298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,4224,13320,APC Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,279.8,18617, Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,279.8,18617, Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Sinus surgery procedure,31299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3291,7422,APC Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3291,7422,APC Removal of larynx lesion,31300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3291,7422,APC Removal of larynx,31360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of larynx,31360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of larynx,31360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of larynx,31360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of larynx,31365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of larynx,31365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of larynx,31365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of larynx,31365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of larynx,31382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of larynx & pharynx,31390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of larynx & pharynx,31390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of larynx & pharynx,31390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of larynx & pharynx,31390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct larynx & pharynx,31395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct larynx & pharynx,31395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct larynx & pharynx,31395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct larynx & pharynx,31395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,15339, Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,15339, Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,15339,APC Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,15339,APC Revision of larynx,31400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,15339,APC Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,11081,APC Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,11081,APC Removal of epiglottis,31420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,11081,APC Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,3314, Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,3314, Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,3314, Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,3314, Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,3314, Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,3314, Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,3314,APC Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,3314,APC Insert emergency airway,31500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,3314,APC Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,3314, Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,3314, Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,3314, Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,3314, Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,3314, Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,3314, Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,3314,APC Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,3314,APC Change of windpipe airway,31502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,3314,APC Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.24,,,,,,,fee schedule,235.8,18617,APC Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,247.59,,,,,,,fee schedule,235.8,18617,APC Diagnostic laryngoscopy,31505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,235.8,,,,,,,fee schedule,235.8,18617,APC Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,5123,APC Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,5123,APC Laryngoscopy with biopsy,31510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,5123,APC Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,235.8,4466, Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,235.8,4466, Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,235.8,4466, Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,235.8,4466, Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,235.8,4466, Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,235.8,4466, Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.24,,,,,,,fee schedule,235.8,4466,APC Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,247.59,,,,,,,fee schedule,235.8,4466,APC Remove foreign body larynx,31511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,235.8,,,,,,,fee schedule,235.8,4466,APC Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,6404,APC Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,6404,APC Removal of larynx lesion,31512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,6404,APC Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,462.05,4466, Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,462.05,4466, Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,462.05,4466, Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,462.05,4466, Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,462.05,4466, Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,462.05,4466, Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,462.05,4466,APC Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,462.05,4466,APC Injection into vocal cord,31513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,462.05,4466,APC Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,462.05,3314, Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,462.05,3314, Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,462.05,3314, Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,462.05,3314, Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,462.05,3314, Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,462.05,3314, Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,462.05,3314,APC Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,462.05,3314,APC Laryngoscopy for aspiration,31515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,462.05,3314,APC Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,462.05,18617, Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,462.05,18617, Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,462.05,18617, Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,462.05,18617, Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,462.05,18617, Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,462.05,18617, Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,462.05,18617,APC Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,462.05,18617,APC Dx laryngoscopy newborn,31520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,462.05,18617,APC Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4166, Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4166, Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4166, Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4166, Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2102.67,4166, Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2102.67,4166, Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4166,APC Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4166,APC Dx laryngoscopy excl nb,31525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4166,APC Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Dx laryngoscopy w/oper scope,31526,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4624.69, Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4624.69, Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4624.69, Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4624.69, Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,4624.69, Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,4624.69, Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,428,4624.69,APC Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,428,4624.69,APC Laryngoscopy for treatment,31527,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,428,4624.69,APC Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,8006,APC Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,8006,APC Laryngoscopy and dilation,31528,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,8006,APC Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,8006,APC Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,8006,APC Laryngoscopy and dilation,31529,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,8006,APC Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Laryngoscopy w/fb removal,31530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,3408,6404,APC Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,3408,6404,APC Laryngoscopy w/fb & op scope,31531,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,3408,6404,APC Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,5123,APC Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,5123,APC Laryngoscopy w/biopsy,31535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,5123,APC Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,3408,5123,APC Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,3408,5123,APC Laryngoscopy w/bx & op scope,31536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,3408,5123,APC Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,3408,5123,APC Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,3408,5123,APC Laryngoscopy w/exc of tumor,31540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,3408,5123,APC Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,4224,6404,APC Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,4224,6404,APC Larynscop w/tumr exc + scope,31541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,4224,6404,APC Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,4224,6404,APC Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,4224,6404,APC Remove vc lesion w/scope,31545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,4224,6404,APC Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,4224,9420,APC Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,4224,9420,APC Remove vc lesion scope/graft,31546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,4224,9420,APC Laryngoplasty laryngeal sten,31551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Laryngoplasty laryngeal sten,31554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Laryngoplasty laryngeal sten,31554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3291,9420,APC Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3291,9420,APC Laryngoscop w/arytenoidectom,31560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3291,9420,APC Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3291,9420,APC Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3291,9420,APC Larynscop remve cart + scop,31561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3291,9420,APC Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,5123,APC Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,5123,APC Laryngoscope w/vc inj,31570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,5123,APC Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,6404,APC Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,6404,APC Laryngoscop w/vc inj + scope,31571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,6404,APC Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,9918, Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,9918, Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,9918,APC Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,9918,APC Largsc w/laser dstrj les,31572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,9918,APC Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,9918, Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,9918, Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,9918, Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,9918, Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2102.67,9918, Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2102.67,9918, Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,9918,APC Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,9918,APC Largsc w/ther injection,31573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,9918,APC Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,9918, Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,9918, Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,9918, Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,9918, Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2102.67,9918, Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2102.67,9918, Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,9918,APC Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,9918,APC Largsc w/njx augmentation,31574,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,9918,APC Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,235.8,18617, Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.24,,,,,,,fee schedule,235.8,18617,APC Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,247.59,,,,,,,fee schedule,235.8,18617,APC Diagnostic laryngoscopy,31575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,235.8,,,,,,,fee schedule,235.8,18617,APC Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Laryngoscopy with biopsy,31576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,462.05,4466, Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,462.05,4466, Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,462.05,4466, Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,462.05,4466, Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,462.05,4466, Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,462.05,4466, Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,462.05,4466,APC Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,462.05,4466,APC Largsc w/rmvl foreign bdy(s),31577,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,462.05,4466,APC Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,5123,APC Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,5123,APC Largsc w/removal lesion,31578,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,5123,APC Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,462.05,4166, Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,462.05,4166, Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,462.05,4166, Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,462.05,4166, Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,462.05,4166, Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,462.05,4166, Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,462.05,4166,APC Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,462.05,4166,APC Laryngoscopy telescopic,31579,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,462.05,4166,APC Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Laryngoplasty laryngeal web,31580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,18617,APC Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,18617,APC Laryngoplasty fx rdctj fixj,31584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,18617,APC Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,18617,APC Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,18617,APC Laryngoplasty cricoid split,31587,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,18617,APC Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,15339,APC Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,15339,APC Reinnervate larynx,31590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,15339,APC Laryngoplasty medialization,31591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Laryngoplasty medialization,31591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Laryngoplasty medialization,31591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Laryngoplasty medialization,31591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Laryngoplasty medialization,31591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,11081,APC Laryngoplasty medialization,31591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,11081,APC Laryngoplasty medialization,31591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,11081,APC Cricotracheal resection,31592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Cricotracheal resection,31592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Cricotracheal resection,31592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Cricotracheal resection,31592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Cricotracheal resection,31592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,11081,APC Cricotracheal resection,31592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,11081,APC Cricotracheal resection,31592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,11081,APC Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,279.8,18617, Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,279.8,18617, Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Larynx surgery procedure,31599,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Incision of windpipe,31600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,18617, Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,18617, Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Incision of windpipe,31601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,3314,APC Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,3314,APC Incision of windpipe,31603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,3314,APC Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,3314, Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,3314, Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,3314, Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,3314, Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,3314, Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,3314, Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,3314,APC Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,3314,APC Incision of windpipe,31605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,3314,APC Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Incision of windpipe,31610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Surgery/speech prosthesis,31611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,6404,APC Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,6404,APC Puncture/clear windpipe,31612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,6404,APC Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Repair windpipe opening,31613,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Repair windpipe opening,31614,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,3314, Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,3314, Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,3314, Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,3314, Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,3314, Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,3314, Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,3314,APC Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,3314,APC Visualization of windpipe,31615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,3314,APC Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4166, Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4166, Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2102.67,4166, Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2102.67,4166, Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2102.67,4166, Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2102.67,4166, Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4166,APC Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4166,APC Dx bronchoscope/wash,31622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4166,APC Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Dx bronchoscope/brush,31623,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Dx bronchoscope/lavage,31624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy w/biopsy(s),31625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,11081,APC Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,11081,APC Bronchoscopy w/markers,31626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,11081,APC Navigational bronchoscopy,31627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Navigational bronchoscopy,31627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Navigational bronchoscopy,31627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Navigational bronchoscopy,31627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,5123,APC Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,5123,APC Bronchoscopy/lung bx each,31628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,5123,APC Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,8006,APC Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,8006,APC Bronchoscopy/needle bx each,31629,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,8006,APC Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,6404,APC Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,6404,APC Bronchoscopy dilate/fx repr,31630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,6404,APC Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,2816,9420,APC Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,2816,9420,APC Bronchoscopy dilate w/stent,31631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,2816,9420,APC Bronchoscopy/lung bx addl,31632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Bronchoscopy/lung bx addl,31632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Bronchoscopy/lung bx addl,31632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Bronchoscopy/lung bx addl,31632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Bronchoscopy/lung bx addl,31632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Bronchoscopy/lung bx addl,31632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Bronchoscopy/needle bx addl,31633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Bronchoscopy/needle bx addl,31633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Bronchoscopy/needle bx addl,31633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Bronchoscopy/needle bx addl,31633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Bronchoscopy/needle bx addl,31633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Bronchoscopy/needle bx addl,31633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,9420,APC Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,9420,APC Bronch w/balloon occlusion,31634,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,9420,APC Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy w/fb removal,31635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8754.16, Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8754.16, Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8754.16, Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8754.16, Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8754.16, Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8754.16, Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,2816,8754.16,APC Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,2816,8754.16,APC Bronchoscopy bronch stents,31636,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,2816,8754.16,APC Bronchoscopy stent add-on,31637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Bronchoscopy stent add-on,31637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Bronchoscopy stent add-on,31637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Bronchoscopy stent add-on,31637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Bronchoscopy stent add-on,31637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Bronchoscopy stent add-on,31637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,2816,9420,APC Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,2816,9420,APC Bronchoscopy revise stent,31638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,2816,9420,APC Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,6404,APC Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,6404,APC Bronchoscopy w/tumor excise,31640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,6404,APC Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,8006,APC Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,8006,APC Bronchoscopy treat blockage,31641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,8006,APC Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4466, Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4466, Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2102.67,4466, Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2102.67,4466, Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2102.67,4466, Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2102.67,4466, Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4466,APC Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4466,APC Diag bronchoscope/catheter,31643,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4466,APC Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4166, Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4166, Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2102.67,4166, Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2102.67,4166, Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2102.67,4166, Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2102.67,4166, Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4166,APC Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4166,APC Bronchoscopy clear airways,31645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4166,APC Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,462.05,3314, Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,462.05,3314, Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,462.05,3314, Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,462.05,3314, Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,462.05,3314, Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,462.05,3314, Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,462.05,3314,APC Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,462.05,3314,APC Bronchoscopy reclear airway,31646,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,462.05,3314,APC Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,15339, Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,15339, Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,2816,15339,APC Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,2816,15339,APC Bronchial valve init insert,31647,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,2816,15339,APC Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,9918, Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,9918, Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,2816,9918,APC Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,2816,9918,APC Bronchial valve remov init,31648,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,2816,9918,APC Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,5098, Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,5098, Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,428,5098,APC Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,428,5098,APC Bronchial valve remov addl,31649,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,428,5098,APC Bronchial valve addl insert,31651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,9918, Bronchial valve addl insert,31651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,9918, Bronchial valve addl insert,31651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9918, Bronchial valve addl insert,31651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9918, Bronchial valve addl insert,31651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,428,9918, Bronchial valve addl insert,31651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,428,9918, Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,428,13320,APC Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,428,13320,APC Bronch ebus samplng 1/2 node,31652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,428,13320,APC Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4580.64,,,,,,,fee schedule,428,13320,APC Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4624.69,,,,,,,fee schedule,428,13320,APC Bronch ebus samplng 3/> node,31653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4404.46,,,,,,,fee schedule,428,13320,APC Bronch ebus ivntj perph les,31654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,4466, Bronch ebus ivntj perph les,31654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,4466, Bronch ebus ivntj perph les,31654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Bronch ebus ivntj perph les,31654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Bronch ebus ivntj perph les,31654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Bronch ebus ivntj perph les,31654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,13320,APC Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,13320,APC Bronch thermoplsty 1 lobe,31660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,13320,APC Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8670.78,,,,,,,fee schedule,3408,13320,APC Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8754.16,,,,,,,fee schedule,3408,13320,APC Bronch thermoplsty 2/> lobes,31661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8337.29,,,,,,,fee schedule,3408,13320,APC Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,480.53,,,,,,,fee schedule,428,3314,APC Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.15,,,,,,,fee schedule,428,3314,APC Bronchial brush biopsy,31717,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.05,,,,,,,fee schedule,428,3314,APC Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,258.69,3314, Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,258.69,3314, Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,258.69,3314, Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,258.69,3314, Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,258.69,3314, Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,258.69,3314, Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.03,,,,,,,fee schedule,258.69,3314,APC Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.62,,,,,,,fee schedule,258.69,3314,APC Clearance of airways,31720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.69,,,,,,,fee schedule,258.69,3314,APC Clearance of airways,31725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Clearance of airways,31725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Clearance of airways,31725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Clearance of airways,31725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2102.67,4166, Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2102.67,4166, Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2102.67,4166, Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2102.67,4166, Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2102.67,4166, Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2102.67,4166, Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,2102.67,4166,APC Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,2102.67,4166,APC Intro windpipe wire/tube,31730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,2102.67,4166,APC Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,7422,APC Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,7422,APC Repair of windpipe,31750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,7422,APC Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Repair of windpipe,31755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Repair of windpipe,31760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of windpipe,31760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of windpipe,31760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of windpipe,31760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruction of windpipe,31766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruction of windpipe,31766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruction of windpipe,31766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruction of windpipe,31766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair/graft of bronchus,31770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair/graft of bronchus,31770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair/graft of bronchus,31770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair/graft of bronchus,31770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct bronchus,31775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct bronchus,31775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct bronchus,31775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct bronchus,31775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct windpipe,31781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,9420,APC Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,9420,APC Remove windpipe lesion,31785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,9420,APC Remove windpipe lesion,31786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove windpipe lesion,31786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove windpipe lesion,31786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove windpipe lesion,31786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of windpipe injury,31800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Repair of windpipe injury,31800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Repair of windpipe injury,31800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Repair of windpipe injury,31800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Repair of windpipe injury,31800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Repair of windpipe injury,31800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Repair of windpipe injury,31805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of windpipe injury,31805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of windpipe injury,31805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of windpipe injury,31805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,6404,APC Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,6404,APC Closure of windpipe lesion,31820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,6404,APC Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Repair of windpipe defect,31825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Revise windpipe scar,31830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,235.8,18617, Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,235.8,18617, Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,235.8,18617, Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,235.8,18617, Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,235.8,18617, Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,235.8,18617, Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.24,,,,,,,fee schedule,235.8,18617,APC Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,247.59,,,,,,,fee schedule,235.8,18617,APC Airways surgical procedure,31899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,235.8,,,,,,,fee schedule,235.8,18617,APC Description Not Available,32001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,32001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,32001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,32001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracostomy w/rib resection,32035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracostomy w/rib resection,32035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracostomy w/rib resection,32035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracostomy w/rib resection,32035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracostomy w/flap drainage,32036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracostomy w/flap drainage,32036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracostomy w/flap drainage,32036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracostomy w/flap drainage,32036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open wedge/bx lung infiltr,32096,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open wedge/bx lung infiltr,32096,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open wedge/bx lung infiltr,32096,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open wedge/bx lung infiltr,32096,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open wedge/bx lung nodule,32097,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open wedge/bx lung nodule,32097,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open wedge/bx lung nodule,32097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open wedge/bx lung nodule,32097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open biopsy of lung pleura,32098,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open biopsy of lung pleura,32098,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open biopsy of lung pleura,32098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open biopsy of lung pleura,32098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploration of chest,32100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Exploration of chest,32100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Exploration of chest,32100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exploration of chest,32100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exploration of chest,32100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exploration of chest,32100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Explore/repair chest,32110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore/repair chest,32110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore/repair chest,32110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore/repair chest,32110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Re-exploration of chest,32120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Re-exploration of chest,32120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Re-exploration of chest,32120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Re-exploration of chest,32120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore chest free adhesions,32124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore chest free adhesions,32124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore chest free adhesions,32124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore chest free adhesions,32124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove/treat lung lesions,32141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove/treat lung lesions,32141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove/treat lung lesions,32141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove/treat lung lesions,32141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of lung lesion(s),32150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove lung foreign body,32151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove lung foreign body,32151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove lung foreign body,32151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove lung foreign body,32151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open chest heart massage,32160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open chest heart massage,32160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open chest heart massage,32160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open chest heart massage,32160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drain open lung lesion,32200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Drain open lung lesion,32200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Drain open lung lesion,32200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Drain open lung lesion,32200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Drain open lung lesion,32200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Drain open lung lesion,32200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Treat chest lining,32215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treat chest lining,32215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treat chest lining,32215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treat chest lining,32215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release of lung,32220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release of lung,32220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release of lung,32220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release of lung,32220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial release of lung,32225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial release of lung,32225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial release of lung,32225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial release of lung,32225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of chest lining,32310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of chest lining,32310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of chest lining,32310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of chest lining,32310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Free/remove chest lining,32320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Free/remove chest lining,32320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Free/remove chest lining,32320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Free/remove chest lining,32320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Needle biopsy chest lining,32400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Percut bx lung/mediastinum,32405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,2460, Percut bx lung/mediastinum,32405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,2460, Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9918, Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9918, Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,9918, Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,9918, Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,9918, Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,9918, Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,9918,APC Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,9918,APC Core ndl bx lng/med perq,32408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,9918,APC Remove lung pneumonectomy,32440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove lung pneumonectomy,32440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove lung pneumonectomy,32440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove lung pneumonectomy,32440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sleeve pneumonectomy,32442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sleeve pneumonectomy,32442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sleeve pneumonectomy,32442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sleeve pneumonectomy,32442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of lung extrapleural,32445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of lung extrapleural,32445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of lung extrapleural,32445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of lung extrapleural,32445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of lung,32480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of lung,32480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of lung,32480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of lung,32480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bilobectomy,32482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bilobectomy,32482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bilobectomy,32482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bilobectomy,32482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Segmentectomy,32484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Segmentectomy,32484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Segmentectomy,32484,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Segmentectomy,32484,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sleeve lobectomy,32486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sleeve lobectomy,32486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sleeve lobectomy,32486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sleeve lobectomy,32486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Completion pneumonectomy,32488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Completion pneumonectomy,32488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Completion pneumonectomy,32488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Completion pneumonectomy,32488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lung volume reduction,32491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lung volume reduction,32491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lung volume reduction,32491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lung volume reduction,32491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bronchus add-on,32501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bronchus add-on,32501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bronchus add-on,32501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bronchus add-on,32501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect apical lung tumor,32503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect apical lung tumor,32503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect apical lung tumor,32503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect apical lung tumor,32503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect apical lung tum/chest,32504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect apical lung tum/chest,32504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect apical lung tum/chest,32504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect apical lung tum/chest,32504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Wedge resect of lung initial,32505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Wedge resect of lung initial,32505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Wedge resect of lung initial,32505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Wedge resect of lung initial,32505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Wedge resect of lung add-on,32506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Wedge resect of lung add-on,32506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Wedge resect of lung add-on,32506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Wedge resect of lung add-on,32506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Wedge resect of lung diag,32507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Wedge resect of lung diag,32507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Wedge resect of lung diag,32507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Wedge resect of lung diag,32507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of lung lesion,32540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of lung lesion,32540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of lung lesion,32540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of lung lesion,32540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,13320, Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,13320, Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,2816,13320,APC Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,2816,13320,APC Insert pleural cath,32550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,2816,13320,APC Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1859.62,4166, Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1859.62,4166, Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1859.62,4166, Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1859.62,4166, Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1859.62,4166, Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1859.62,4166, Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1859.62,4166,APC Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1859.62,4166,APC Insertion of chest tube,32551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1859.62,4166,APC Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,18617, Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,18617, Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,18617, Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,18617, Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,741.06,18617, Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,741.06,18617, Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,18617,APC Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,18617,APC Remove lung catheter,32552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,18617,APC Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,7422, Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,7422, Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1700.54,,,,,,,fee schedule,1544,7422,APC Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1716.89,,,,,,,fee schedule,1544,7422,APC Ins mark thor for rt perq,32553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1635.14,,,,,,,fee schedule,1544,7422,APC Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,3314,APC Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,3314,APC Aspirate pleura w/o imaging,32554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,3314,APC Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,3314, Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,3314,APC Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,3314,APC Aspirate pleura w/ imaging,32555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,3314,APC Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,5123, Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,5123, Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2266.89,5123, Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2266.89,5123, Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2266.89,5123, Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2266.89,5123, Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,5123,APC Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,5123,APC Insert cath pleura w/o image,32556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,5123,APC Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1859.62,4166, Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1859.62,4166, Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1859.62,4166, Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1859.62,4166, Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1859.62,4166, Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1859.62,4166, Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1859.62,4166,APC Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1859.62,4166,APC Insert cath pleura w/ image,32557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1859.62,4166,APC Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,741.06,4166, Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,741.06,4166, Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,4166, Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,4166, Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,4166, Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,4166, Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,4166,APC Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,4166,APC Treat pleurodesis w/agent,32560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,4166,APC Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,3314,APC Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,3314,APC Lyse chest fibrin init day,32561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,3314,APC Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,3314, Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,3314,APC Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,3314,APC Lyse chest fibrin subq day,32562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,3314,APC Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Thoracoscopy diagnostic,32601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,18617,APC Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,18617,APC Thoracoscopy wbx sac,32604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,18617,APC Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Thoracoscopy w/bx med space,32606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,15339,APC Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,15339,APC Thoracoscopy w/bx infiltrate,32607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,15339,APC Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,15339, Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,15339,APC Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,15339,APC Thoracoscopy w/bx nodule,32608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,15339,APC Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,13320, Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,13320, Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,13320,APC Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,13320,APC Thoracoscopy w/bx pleura,32609,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,13320,APC Thoracoscopy w/pleurodesis,32650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pleurodesis,32650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pleurodesis,32650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pleurodesis,32650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy remove cortex,32651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy remove cortex,32651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy remove cortex,32651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy remove cortex,32651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy rem totl cortex,32652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy rem totl cortex,32652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy rem totl cortex,32652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy rem totl cortex,32652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy remov fb/fibrin,32653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy remov fb/fibrin,32653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy remov fb/fibrin,32653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy remov fb/fibrin,32653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy contrl bleeding,32654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy contrl bleeding,32654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy contrl bleeding,32654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy contrl bleeding,32654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy resect bullae,32655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy resect bullae,32655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy resect bullae,32655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy resect bullae,32655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pleurectomy,32656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pleurectomy,32656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pleurectomy,32656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pleurectomy,32656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac fb remove,32658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac fb remove,32658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac fb remove,32658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac fb remove,32658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac drainage,32659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac drainage,32659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac drainage,32659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/sac drainage,32659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pericard exc,32661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pericard exc,32661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pericard exc,32661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pericard exc,32661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pericard exc,32661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/pericard exc,32661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/mediast exc,32662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/mediast exc,32662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/mediast exc,32662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/mediast exc,32662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/lobectomy,32663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/lobectomy,32663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/lobectomy,32663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/lobectomy,32663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/ th nrv exc,32664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Thoracoscopy w/ th nrv exc,32664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Thoracoscopy w/ th nrv exc,32664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Thoracoscopy w/ th nrv exc,32664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Thoracoscop w/esoph musc exc,32665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Thoracoscop w/esoph musc exc,32665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Thoracoscop w/esoph musc exc,32665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Thoracoscop w/esoph musc exc,32665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Thoracoscop w/esoph musc exc,32665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Thoracoscop w/esoph musc exc,32665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Thoracoscopy w/wedge resect,32666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/wedge resect,32666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/wedge resect,32666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/wedge resect,32666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect addl,32667,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect addl,32667,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect addl,32667,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect addl,32667,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect diag,32668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect diag,32668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect diag,32668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/w resect diag,32668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy remove segment,32669,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy remove segment,32669,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy remove segment,32669,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy remove segment,32669,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy bilobectomy,32670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy bilobectomy,32670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy bilobectomy,32670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy bilobectomy,32670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy pneumonectomy,32671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy pneumonectomy,32671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy pneumonectomy,32671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy pneumonectomy,32671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy for lvrs,32672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy for lvrs,32672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy for lvrs,32672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy for lvrs,32672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy w/thymus resect,32673,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy w/thymus resect,32673,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy w/thymus resect,32673,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy w/thymus resect,32673,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoscopy lymph node exc,32674,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoscopy lymph node exc,32674,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoscopy lymph node exc,32674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoscopy lymph node exc,32674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thorax stereo rad targetw/tx,32701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thorax stereo rad targetw/tx,32701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thorax stereo rad targetw/tx,32701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thorax stereo rad targetw/tx,32701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair lung hernia,32800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair lung hernia,32800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair lung hernia,32800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair lung hernia,32800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Close chest after drainage,32810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Close chest after drainage,32810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Close chest after drainage,32810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Close chest after drainage,32810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Close bronchial fistula,32815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Close bronchial fistula,32815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Close bronchial fistula,32815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Close bronchial fistula,32815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct injured chest,32820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct injured chest,32820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct injured chest,32820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct injured chest,32820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Donor pneumonectomy,32850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Donor pneumonectomy,32850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Donor pneumonectomy,32850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Donor pneumonectomy,32850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lung transplant single,32851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lung transplant single,32851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lung transplant single,32851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lung transplant single,32851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lung transplant double,32853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lung transplant double,32853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lung transplant double,32853,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lung transplant double,32853,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32854,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lung transplant with bypass,32854,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare donor lung single,32855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare donor lung single,32855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare donor lung single,32855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare donor lung single,32855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare donor lung double,32856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare donor lung double,32856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare donor lung double,32856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare donor lung double,32856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of rib(s),32900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of rib(s),32900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of rib(s),32900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of rib(s),32900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise & repair chest wall,32905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Revise & repair chest wall,32905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Revise & repair chest wall,32905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revise & repair chest wall,32905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revise & repair chest wall,32905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revise & repair chest wall,32905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revise & repair chest wall,32906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise & repair chest wall,32906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise & repair chest wall,32906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise & repair chest wall,32906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of lung,32940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of lung,32940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of lung,32940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of lung,32940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,741.06,3314, Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,741.06,3314, Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,741.06,3314, Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,741.06,3314, Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,3314, Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,3314, Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,3314,APC Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,3314,APC Therapeutic pneumothorax,32960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,3314,APC Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4224,18617,APC Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4224,18617,APC Ablate pulm tumor perq crybl,32994,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4224,18617,APC Total lung lavage,32997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Total lung lavage,32997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Total lung lavage,32997,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Total lung lavage,32997,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Total lung lavage,32997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Total lung lavage,32997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,13320, Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,13320, Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,13320,APC Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,13320,APC Perq rf ablate tx pul tumor,32998,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,13320,APC Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,741.06,18617, Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,741.06,18617, Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,18617, Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,18617, Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,741.06,18617, Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,741.06,18617, Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,18617,APC Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,18617,APC Chest surgery procedure,32999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,18617,APC Drainage of heart sac,33010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,2460, Drainage of heart sac,33010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,2460, Repeat drainage of heart sac,33011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4457,5123, Repeat drainage of heart sac,33011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4457,5123, Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1859.62,9918, Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1859.62,9918, Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1859.62,9918, Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1859.62,9918, Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1859.62,9918, Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1859.62,9918, Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1859.62,9918,APC Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1859.62,9918,APC Pericardiocentesis w/imaging,33016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1859.62,9918,APC Prcrd drg 6yr+ w/o cgen car,33017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Prcrd drg 6yr+ w/o cgen car,33017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Prcrd drg 6yr+ w/o cgen car,33017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Prcrd drg 6yr+ w/o cgen car,33017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Prcrd drg 6yr+ w/o cgen car,33017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Prcrd drg 6yr+ w/o cgen car,33017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Prcrd drg 0-5yr or w/anomly,33018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Prcrd drg 0-5yr or w/anomly,33018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Prcrd drg 0-5yr or w/anomly,33018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Prcrd drg 0-5yr or w/anomly,33018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Prcrd drg 0-5yr or w/anomly,33018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Prcrd drg 0-5yr or w/anomly,33018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Perq prcrd drg insj cath ct,33019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Perq prcrd drg insj cath ct,33019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Perq prcrd drg insj cath ct,33019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Perq prcrd drg insj cath ct,33019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Perq prcrd drg insj cath ct,33019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Perq prcrd drg insj cath ct,33019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Incision of heart sac,33020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of heart sac,33020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of heart sac,33020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of heart sac,33020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of heart sac,33025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of heart sac,33025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of heart sac,33025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of heart sac,33025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of heart sac,33031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect heart sac lesion,33050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect heart sac lesion,33050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect heart sac lesion,33050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect heart sac lesion,33050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Heart revascularize (tmr),33140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Heart revascularize (tmr),33140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Heart revascularize (tmr),33140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Heart revascularize (tmr),33140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Heart Tmr W/Other Procedure,33141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Heart Tmr W/Other Procedure,33141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Heart Tmr W/Other Procedure,33141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Heart Tmr W/Other Procedure,33141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert epicard eltrd open,33202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert epicard eltrd open,33202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert epicard eltrd open,33202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert epicard eltrd open,33202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert epicard eltrd endo,33203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert epicard eltrd endo,33203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert epicard eltrd endo,33203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert epicard eltrd endo,33203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,18617, Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,18617, Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4147,18617,APC Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4147,18617,APC Insert heart pm atrial,33206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4147,18617,APC Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,18617, Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,18617, Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4147,18617,APC Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4147,18617,APC Insert heart pm ventricular,33207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4147,18617,APC Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,18617, Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,18617, Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4147,18617,APC Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4147,18617,APC Insrt heart pm atrial & vent,33208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4147,18617,APC Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,18617,APC Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,18617,APC Insert electrd/pm cath sngl,33210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,18617,APC Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,18617,APC Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,18617,APC Insert card electrodes dual,33211,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,18617,APC Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,10264.89, Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,10264.89, Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,10264.89, Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,10264.89, Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,10264.89, Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,10264.89, Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,3408,10264.89,APC Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,3408,10264.89,APC Insert pulse gen sngl lead,33212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,3408,10264.89,APC Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,12964.78, Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,12964.78, Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,12964.78, Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,12964.78, Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,12964.78, Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,12964.78, Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,3408,12964.78,APC Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,3408,12964.78,APC Insert pulse gen dual leads,33213,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,3408,12964.78,APC Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,18617, Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,18617, Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,4147,18617,APC Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,4147,18617,APC Upgrade of pacemaker system,33214,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,4147,18617,APC Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,18617, Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,18617, Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,18617,APC Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,18617,APC Reposition pacing-defib lead,33215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,18617,APC Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,18617,APC Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,18617,APC Insert 1 electrode pm-defib,33216,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,18617,APC Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,18617, Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,18617, Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,4224,18617,APC Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,4224,18617,APC Insert 2 electrode pm-defib,33217,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,4224,18617,APC Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,18617, Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,18617, Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Repair lead pace-defib one,33218,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,18617, Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,18617, Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Repair lead pace-defib dual,33220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,23892.44, Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,23892.44, Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,23892.44, Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,23892.44, Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,23892.44, Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,23892.44, Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,3408,23892.44,APC Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,3408,23892.44,APC Insert pulse gen mult leads,33221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,3408,23892.44,APC Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,4466, Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,4466, Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,4466, Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,4466, Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,4466, Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,4466, Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,4466,APC Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,4466,APC Relocation pocket pacemaker,33222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,4466,APC Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,4466, Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,4466, Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,4466, Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,4466, Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2437.45,4466, Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2437.45,4466, Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,4466,APC Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,4466,APC Relocate pocket for defib,33223,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,4466,APC Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,3408,18617,APC Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,3408,18617,APC Insert pacing lead & connect,33224,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,3408,18617,APC L ventric pacing lead add-on,33225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6253, L ventric pacing lead add-on,33225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6253, L ventric pacing lead add-on,33225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6253, L ventric pacing lead add-on,33225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6253, Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,18617,APC Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,18617,APC Reposition l ventric lead,33226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,18617,APC Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,3408,18617,APC Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,3408,18617,APC Remove&replace pm gen singl,33227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,3408,18617,APC Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,18617, Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,18617, Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12841.31,,,,,,,fee schedule,3408,18617,APC Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12964.78,,,,,,,fee schedule,3408,18617,APC Remv&replc pm gen dual lead,33228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12347.41,,,,,,,fee schedule,3408,18617,APC Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,23892.44, Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,23892.44, Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,23892.44, Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,23892.44, Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,23892.44, Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,23892.44, Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,3408,23892.44,APC Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,3408,23892.44,APC Remv&replc pm gen mult leads,33229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,3408,23892.44,APC Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,27591.2, Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,27591.2, Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,27591.2, Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,27591.2, Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,27591.2, Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,27591.2, Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,3408,27591.2,APC Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,3408,27591.2,APC Insrt pulse gen w/dual leads,33230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,3408,27591.2,APC Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38935.13, Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38935.13, Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,38935.13, Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,38935.13, Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,38935.13, Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,38935.13, Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38564.32,,,,,,,fee schedule,3408,38935.13,APC Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38935.13,,,,,,,fee schedule,3408,38935.13,APC Insrt pulse gen w/mult leads,33231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37081.07,,,,,,,fee schedule,3408,38935.13,APC Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,10264.89, Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,10264.89, Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,10264.89, Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,10264.89, Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,10264.89, Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,10264.89, Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,2816,10264.89,APC Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,2816,10264.89,APC Removal of pm generator,33233,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,2816,10264.89,APC Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,18617, Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,18617, Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Removal of pacemaker system,33234,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Removal pacemaker electrode,33235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Remove electrode/thoracotomy,33236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove electrode/thoracotomy,33238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,27591.2, Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,27591.2, Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,27591.2, Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,27591.2, Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,27591.2, Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,27591.2, Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,4147,27591.2,APC Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,4147,27591.2,APC Insrt pulse gen w/singl lead,33240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,4147,27591.2,APC Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,18617, Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,18617, Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Remove pulse generator,33241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Description Not Available,33242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,33242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,33242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,33242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove eltrd/thoracotomy,33243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove eltrd/thoracotomy,33243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove eltrd/thoracotomy,33243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove eltrd/thoracotomy,33243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,4224,18617,APC Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,4224,18617,APC Remove elctrd transvenously,33244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,4224,18617,APC Description Not Available,33247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,33247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,33247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,33247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,38935.13, Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38564.32,,,,,,,fee schedule,4147,38935.13,APC Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38935.13,,,,,,,fee schedule,4147,38935.13,APC Insj/rplcmt defib w/lead(s),33249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37081.07,,,,,,,fee schedule,4147,38935.13,APC Ablate heart dysrhythm focus,33250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate atria lmtd,33254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria lmtd,33254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria lmtd,33254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria lmtd,33254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate atria w/o bypass ext,33255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria w/o bypass ext,33255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria w/o bypass ext,33255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria w/o bypass ext,33255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass exten,33256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass exten,33256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass exten,33256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass exten,33256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate atria lmtd add-on,33257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria lmtd add-on,33257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria lmtd add-on,33257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria lmtd add-on,33257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate atria x10sv add-on,33258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria x10sv add-on,33258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria x10sv add-on,33258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria x10sv add-on,33258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass add-on,33259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass add-on,33259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass add-on,33259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria w/bypass add-on,33259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate heart dysrhythm focus,33261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,27591.2, Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,27591.2, Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,27591.2, Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,27591.2, Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,27591.2, Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,27591.2, Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,3408,27591.2,APC Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,3408,27591.2,APC Rmvl& replc pulse gen 1 lead,33262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,3408,27591.2,APC Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,27591.2, Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,27591.2, Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,27591.2, Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,27591.2, Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,27591.2, Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,27591.2, Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27328.43,,,,,,,fee schedule,3408,27591.2,APC Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27591.2,,,,,,,fee schedule,3408,27591.2,APC Rmvl & rplcmt dfb gen 2 lead,33263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26277.33,,,,,,,fee schedule,3408,27591.2,APC Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38935.13, Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38935.13, Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,38935.13, Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,38935.13, Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,38935.13, Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,38935.13, Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38564.32,,,,,,,fee schedule,3408,38935.13,APC Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38935.13,,,,,,,fee schedule,3408,38935.13,APC Rmvl & rplcmt dfb gen mlt ld,33264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37081.07,,,,,,,fee schedule,3408,38935.13,APC Ablate atria lmtd endo,33265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria lmtd endo,33265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria lmtd endo,33265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria lmtd endo,33265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ablate atria x10sv endo,33266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ablate atria x10sv endo,33266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ablate atria x10sv endo,33266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ablate atria x10sv endo,33266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excl laa open any method,33267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Excl laa open any method,33267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Excl laa open any method,33267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Excl laa open any method,33267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Excl laa open any method,33267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Excl laa open any method,33267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Excl laa opn oth px any meth,33268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Excl laa opn oth px any meth,33268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Excl laa opn oth px any meth,33268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Excl laa opn oth px any meth,33268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Excl laa opn oth px any meth,33268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Excl laa opn oth px any meth,33268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Excl laa thrscp any method,33269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Excl laa thrscp any method,33269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Excl laa thrscp any method,33269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Excl laa thrscp any method,33269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Excl laa thrscp any method,33269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Excl laa thrscp any method,33269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38935.13, Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38935.13, Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,38935.13, Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,38935.13, Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,38935.13, Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,38935.13, Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38564.32,,,,,,,fee schedule,3408,38935.13,APC Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38935.13,,,,,,,fee schedule,3408,38935.13,APC Ins/rep subq defibrillator,33270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37081.07,,,,,,,fee schedule,3408,38935.13,APC Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,3408,18617,APC Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,3408,18617,APC Insj subq impltbl dfb elctrd,33271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,3408,18617,APC Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,18617, Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,18617, Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,18617,APC Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,18617,APC Rmvl of subq defibrillator,33272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,18617,APC Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,3408,13320,APC Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,3408,13320,APC Repos prev impltbl subq dfb,33273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,3408,13320,APC Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,23892.44, Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,23892.44, Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,23892.44, Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,23892.44, Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,23892.44, Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,23892.44, Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23664.89,,,,,,,fee schedule,4224,23892.44,APC Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23892.44,,,,,,,fee schedule,4224,23892.44,APC Tcat insj/rpl perm ldls pm,33274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22754.7,,,,,,,fee schedule,4224,23892.44,APC Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,13320, Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,13320, Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3730.07,13320, Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3730.07,13320, Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3730.07,13320, Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3730.07,13320, Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,13320,APC Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,13320,APC Tcat rmvl perm ldls pm,33275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,13320,APC Insj phrnc nrv stim sys,33276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,54635.78, Insj phrnc nrv stim sys,33276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,54635.78, Insj phrnc nrv stim sys,33276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,54635.78, Insj phrnc nrv stim sys,33276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,54635.78, Insj phrnc nrv stim sys,33276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54115.44,,,,,,,fee schedule,3408,54635.78,APC Insj phrnc nrv stim sys,33276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54635.78,,,,,,,fee schedule,3408,54635.78,APC Insj phrnc nrv stim sys,33276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52034.08,,,,,,,fee schedule,3408,54635.78,APC Insj phrnc nrv stim transvns,33277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Insj phrnc nrv stim transvns,33277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rmvl phrnc nrv stim sys,33278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim sys,33278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim sys,33278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim sys,33278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim sys,33278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim sys,33278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim sys,33278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim transvns,33279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim transvns,33279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim transvns,33279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim transvns,33279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim transvns,33279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim transvns,33279,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim transvns,33279,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim pg only,33280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim pg only,33280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim pg only,33280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim pg only,33280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Rmvl phrnc nrv stim pg only,33280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim pg only,33280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,13320,APC Rmvl phrnc nrv stim pg only,33280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,13320,APC Reposg phrnc nrv stim trnsvn,33281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Reposg phrnc nrv stim trnsvn,33281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Reposg phrnc nrv stim trnsvn,33281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Reposg phrnc nrv stim trnsvn,33281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Reposg phrnc nrv stim trnsvn,33281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,13320,APC Reposg phrnc nrv stim trnsvn,33281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,13320,APC Reposg phrnc nrv stim trnsvn,33281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,13320,APC Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10167.13,,,,,,,fee schedule,1544,18617,APC Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10264.89,,,,,,,fee schedule,1544,18617,APC Insj subq car rhythm mntr,33285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9776.09,,,,,,,fee schedule,1544,18617,APC Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,4466, Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,4466, Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,4466, Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,4466, Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,836.55,4466, Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,836.55,4466, Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,4466,APC Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,4466,APC Rmvl subq car rhythm mntr,33286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,4466,APC Rmv&rplcmt phrnc nrv stim pg,33287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38276.26, Rmv&rplcmt phrnc nrv stim pg,33287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38276.26, Rmv&rplcmt phrnc nrv stim pg,33287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,38276.26, Rmv&rplcmt phrnc nrv stim pg,33287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,38276.26, Rmv&rplcmt phrnc nrv stim pg,33287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,3408,38276.26,APC Rmv&rplcmt phrnc nrv stim pg,33287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,3408,38276.26,APC Rmv&rplcmt phrnc nrv stim pg,33287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,3408,38276.26,APC Rmv&rplcmt phrnc nrv stim ld,33288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rmv&rplcmt phrnc nrv stim ld,33288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rmv&rplcmt phrnc nrv stim ld,33288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rmv&rplcmt phrnc nrv stim ld,33288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rmv&rplcmt phrnc nrv stim ld,33288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,2816,18617,APC Rmv&rplcmt phrnc nrv stim ld,33288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,2816,18617,APC Rmv&rplcmt phrnc nrv stim ld,33288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,2816,18617,APC Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,35579.18, Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,35579.18, Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,35579.18, Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,35579.18, Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,35579.18, Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,35579.18, Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35240.33,,,,,,,fee schedule,4147,35579.18,APC Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35579.18,,,,,,,fee schedule,4147,35579.18,APC Tcat impl wrls p-art prs snr,33289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33884.93,,,,,,,fee schedule,4147,35579.18,APC Repair of heart wound,33300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart wound,33300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart wound,33300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart wound,33300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart wound,33305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart wound,33305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart wound,33305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart wound,33305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploratory heart surgery,33315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair major vessel,33321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair major vessel,33321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair major vessel,33321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair major vessel,33321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair major blood vessel(s),33322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert major vessel graft,33335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve perq,33361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve perq,33361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve perq,33361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve perq,33361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve open,33365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Trcath replace aortic valve,33366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Trcath replace aortic valve,33366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Trcath replace aortic valve,33366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Trcath replace aortic valve,33366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace aortic valve w/byp,33369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tcat plmt&rmvl cepd perq,33370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Tcat plmt&rmvl cepd perq,33370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Tcat plmt&rmvl cepd perq,33370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Tcat plmt&rmvl cepd perq,33370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Prepare heart-aorta conduit,33404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare heart-aorta conduit,33404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare heart-aorta conduit,33404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare heart-aorta conduit,33404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement aortic valve opn,33410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement of aortic valve,33413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision subvalvular tissue,33415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision subvalvular tissue,33415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision subvalvular tissue,33415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision subvalvular tissue,33415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise ventricle muscle,33416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise ventricle muscle,33416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise ventricle muscle,33416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise ventricle muscle,33416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of aortic valve,33417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair tcat mitral valve,33418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair tcat mitral valve,33418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair tcat mitral valve,33418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair tcat mitral valve,33418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair tcat mitral valve,33419,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Repair tcat mitral valve,33419,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Revision of mitral valve,33420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of mitral valve,33420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of mitral valve,33420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of mitral valve,33420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of mitral valve,33422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of mitral valve,33422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of mitral valve,33422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of mitral valve,33422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of mitral valve,33427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement of mitral valve,33430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement of mitral valve,33430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement of mitral valve,33430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement of mitral valve,33430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rplcmt a-valve tlcj autol pv,33440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rplcmt a-valve tlcj autol pv,33440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rplcmt a-valve tlcj autol pv,33440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rplcmt a-valve tlcj autol pv,33440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33463,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33463,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33464,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33464,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33464,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Valvuloplasty tricuspid,33464,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace tricuspid valve,33465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace tricuspid valve,33465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace tricuspid valve,33465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace tricuspid valve,33465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of tricuspid valve,33468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Valvotomy pulmonary valve,33471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Valvotomy pulmonary valve,33471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Valvotomy pulmonary valve,33471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Valvotomy pulmonary valve,33471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of pulmonary valve,33474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of pulmonary valve,33474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of pulmonary valve,33474,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of pulmonary valve,33474,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replacement pulmonary valve,33475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replacement pulmonary valve,33475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replacement pulmonary valve,33475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replacement pulmonary valve,33475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant tcat pulm vlv perq,33477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant tcat pulm vlv perq,33477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant tcat pulm vlv perq,33477,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant tcat pulm vlv perq,33477,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair prosth valve clot,33496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair prosth valve clot,33496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair prosth valve clot,33496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair prosth valve clot,33496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart vessel fistula,33501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Coronary artery correction,33502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Coronary artery correction,33502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Coronary artery correction,33502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Coronary artery correction,33502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Coronary artery graft,33503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Coronary artery graft,33503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Coronary artery graft,33503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Coronary artery graft,33503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Coronary artery graft,33504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Coronary artery graft,33504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Coronary artery graft,33504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Coronary artery graft,33504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery w/tunnel,33505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery w/tunnel,33505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery w/tunnel,33505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery w/tunnel,33505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery translocation,33506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery translocation,33506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery translocation,33506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery translocation,33506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair art intramural,33507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair art intramural,33507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair art intramural,33507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair art intramural,33507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endoscopic vein harvest,33508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Endoscopic vein harvest,33508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Ndsc hrv uxtr art 1 sgm cab,33509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Ndsc hrv uxtr art 1 sgm cab,33509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Ndsc hrv uxtr art 1 sgm cab,33509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Ndsc hrv uxtr art 1 sgm cab,33509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Ndsc hrv uxtr art 1 sgm cab,33509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Ndsc hrv uxtr art 1 sgm cab,33509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Cabg vein single,33510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg vein single,33510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg vein single,33510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg vein single,33510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg vein two,33511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg vein two,33511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg vein two,33511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg vein two,33511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg vein three,33512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg vein three,33512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg vein three,33512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg vein three,33512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg vein four,33513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg vein four,33513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg vein four,33513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg vein four,33513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg vein five,33514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg vein five,33514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg vein five,33514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg vein five,33514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg vein six or more,33516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg vein six or more,33516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg vein six or more,33516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg vein six or more,33516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg artery-vein single,33517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg artery-vein single,33517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg artery-vein single,33517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg artery-vein single,33517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg artery-vein two,33518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg artery-vein two,33518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg artery-vein two,33518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg artery-vein two,33518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg artery-vein three,33519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg artery-vein three,33519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg artery-vein three,33519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg artery-vein three,33519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg artery-vein four,33521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg artery-vein four,33521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg artery-vein four,33521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg artery-vein four,33521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg artery-vein five,33522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg artery-vein five,33522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg artery-vein five,33522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg artery-vein five,33522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg art-vein six or more,33523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg art-vein six or more,33523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg art-vein six or more,33523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg art-vein six or more,33523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Coronary artery bypass/reop,33530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Coronary artery bypass/reop,33530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Coronary artery bypass/reop,33530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Coronary artery bypass/reop,33530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg arterial single,33533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg arterial single,33533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg arterial single,33533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg arterial single,33533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg arterial two,33534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg arterial two,33534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg arterial two,33534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg arterial two,33534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg arterial three,33535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg arterial three,33535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg arterial three,33535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg arterial three,33535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cabg arterial four or more,33536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cabg arterial four or more,33536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cabg arterial four or more,33536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cabg arterial four or more,33536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of heart lesion,33542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart damage,33545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart damage,33545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart damage,33545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart damage,33545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Restore/remodel ventricle,33548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Restore/remodel ventricle,33548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Restore/remodel ventricle,33548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Restore/remodel ventricle,33548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open coronary endarterectomy,33572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open coronary endarterectomy,33572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open coronary endarterectomy,33572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open coronary endarterectomy,33572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Closure of valve,33600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Closure of valve,33600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Closure of valve,33600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Closure of valve,33600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Closure of valve,33602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Closure of valve,33602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Closure of valve,33602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Closure of valve,33602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Anastomosis/artery-aorta,33606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Anastomosis/artery-aorta,33606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Anastomosis/artery-aorta,33606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Anastomosis/artery-aorta,33606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair anomaly w/conduit,33608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair anomaly w/conduit,33608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair anomaly w/conduit,33608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair anomaly w/conduit,33608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair by enlargement,33610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair by enlargement,33610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair by enlargement,33610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair by enlargement,33610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair double ventricle,33611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair double ventricle,33611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair double ventricle,33611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair double ventricle,33611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair double ventricle,33612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair double ventricle,33612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair double ventricle,33612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair double ventricle,33612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair modified fontan,33615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair modified fontan,33615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair modified fontan,33615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair modified fontan,33615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair single ventricle,33617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair single ventricle,33617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair single ventricle,33617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair single ventricle,33617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair single ventricle,33619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair single ventricle,33619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair single ventricle,33619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair single ventricle,33619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Apply r&l pulm art bands,33620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Apply r&l pulm art bands,33620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Apply r&l pulm art bands,33620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Apply r&l pulm art bands,33620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transthor cath for stent,33621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transthor cath for stent,33621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transthor cath for stent,33621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transthor cath for stent,33621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Redo compl cardiac anomaly,33622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Redo compl cardiac anomaly,33622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Redo compl cardiac anomaly,33622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Redo compl cardiac anomaly,33622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of heart veins,33645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of heart veins,33645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of heart veins,33645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of heart veins,33645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart septum defects,33647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart septum defects,33647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart septum defects,33647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart septum defects,33647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defects,33660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defects,33660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defects,33660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defects,33660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defects,33665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defects,33665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defects,33665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defects,33665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart chambers,33670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart chambers,33670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart chambers,33670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart chambers,33670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Close Mult Vsd,33675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Close Mult Vsd,33675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Close Mult Vsd,33675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Close Mult Vsd,33675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Close mult vsd w/resection,33676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Close mult vsd w/resection,33676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Close mult vsd w/resection,33676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Close mult vsd w/resection,33676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cl mult vsd w/rem pul band,33677,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cl mult vsd w/rem pul band,33677,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cl mult vsd w/rem pul band,33677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cl mult vsd w/rem pul band,33677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart septum defect,33688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reinforce pulmonary artery,33690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reinforce pulmonary artery,33690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reinforce pulmonary artery,33690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reinforce pulmonary artery,33690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defects,33692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defects,33692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defects,33692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defects,33692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defects,33694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defects,33694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defects,33694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defects,33694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defects,33697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defects,33697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defects,33697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defects,33697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defects,33702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defects,33702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defects,33702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defects,33702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defects,33710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defects,33710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defects,33710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defects,33710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of heart defect,33720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of heart defect,33720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of heart defect,33720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of heart defect,33720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair Venous Anomaly,33724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair Venous Anomaly,33724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair Venous Anomaly,33724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair Venous Anomaly,33724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair Pul Venous Stenosis,33726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair Pul Venous Stenosis,33726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair Pul Venous Stenosis,33726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair Pul Venous Stenosis,33726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart-vein defect(s),33730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart-vein defect(s),33730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart-vein defect(s),33730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart-vein defect(s),33730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair heart-vein defect,33732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair heart-vein defect,33732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair heart-vein defect,33732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair heart-vein defect,33732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33737,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33737,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of heart chamber,33737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Major vessel shunt,33750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Major vessel shunt,33750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Major vessel shunt,33750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Major vessel shunt,33750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Major vessel shunt,33755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Major vessel shunt,33755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Major vessel shunt,33755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Major vessel shunt,33755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Major vessel shunt,33762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Major vessel shunt,33762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Major vessel shunt,33762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Major vessel shunt,33762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Major vessel shunt & graft,33764,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Major vessel shunt & graft,33764,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Major vessel shunt & graft,33764,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Major vessel shunt & graft,33764,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Major vessel shunt,33766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Major vessel shunt,33766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Major vessel shunt,33766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Major vessel shunt,33766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Major vessel shunt,33767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Major vessel shunt,33767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Major vessel shunt,33767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Major vessel shunt,33767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cavopulmonary shunting,33768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cavopulmonary shunting,33768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cavopulmonary shunting,33768,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cavopulmonary shunting,33768,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair great vessels defect,33781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Nikaidoh proc,33782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Nikaidoh proc,33782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Nikaidoh proc,33782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Nikaidoh proc,33782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Nikaidoh proc w/ostia implt,33783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Nikaidoh proc w/ostia implt,33783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Nikaidoh proc w/ostia implt,33783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Nikaidoh proc w/ostia implt,33783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair arterial trunk,33786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair arterial trunk,33786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair arterial trunk,33786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair arterial trunk,33786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of pulmonary artery,33788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of pulmonary artery,33788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of pulmonary artery,33788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of pulmonary artery,33788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Aortic suspension,33800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Aortic suspension,33800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Aortic suspension,33800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Aortic suspension,33800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair vessel defect,33802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair vessel defect,33802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair vessel defect,33802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair vessel defect,33802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair vessel defect,33803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair vessel defect,33803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair vessel defect,33803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair vessel defect,33803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair septal defect,33813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair septal defect,33813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair septal defect,33813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair septal defect,33813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair septal defect,33814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair septal defect,33814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair septal defect,33814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair septal defect,33814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise major vessel,33820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise major vessel,33820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise major vessel,33820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise major vessel,33820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise major vessel,33822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise major vessel,33822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise major vessel,33822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise major vessel,33822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise major vessel,33824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise major vessel,33824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise major vessel,33824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise major vessel,33824,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove aorta constriction,33851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair septal defect,33852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair septal defect,33852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair septal defect,33852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair septal defect,33852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair septal defect,33853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair septal defect,33853,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair septal defect,33853,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair septal defect,33853,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, As-aort grf f/aortic dsj,33858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, As-aort grf f/aortic dsj,33858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, As-aort grf f/aortic dsj,33858,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, As-aort grf f/aortic dsj,33858,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, As-aort grf f/ds oth/thn dsj,33859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, As-aort grf f/ds oth/thn dsj,33859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, As-aort grf f/ds oth/thn dsj,33859,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, As-aort grf f/ds oth/thn dsj,33859,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33863,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33863,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ascending aortic graft,33864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Aortic hemiarch graft,33866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Aortic hemiarch graft,33866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Transvrs a-arch grf hypthrm,33871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transvrs a-arch grf hypthrm,33871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transvrs a-arch grf hypthrm,33871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transvrs a-arch grf hypthrm,33871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracic aortic graft,33875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracic aortic graft,33875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracic aortic graft,33875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracic aortic graft,33875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracoabdominal graft,33877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracoabdominal graft,33877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracoabdominal graft,33877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracoabdominal graft,33877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc taa repr incl subcl,33880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc taa repr incl subcl,33880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc taa repr incl subcl,33880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc taa repr incl subcl,33880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc taa repr w/o subcl,33881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc taa repr w/o subcl,33881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc taa repr w/o subcl,33881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc taa repr w/o subcl,33881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Evasc rpr ta dplmt mltpc sys,33882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Evasc rpr ta dplmt mltpc sys,33882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Evasc rpr ta dplmt mltpc sys,33882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Evasc rpr ta dplmt mltpc sys,33882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert endovasc prosth taa,33883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert endovasc prosth taa,33883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert endovasc prosth taa,33883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert endovasc prosth taa,33883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc prosth taa add-on,33884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc prosth taa add-on,33884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc prosth taa add-on,33884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc prosth taa add-on,33884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc prosth delayed,33886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc prosth delayed,33886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc prosth delayed,33886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc prosth delayed,33886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Artery transpose/endovas taa,33889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Artery transpose/endovas taa,33889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Artery transpose/endovas taa,33889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Artery transpose/endovas taa,33889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Car-car bp grft/endovas taa,33891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Car-car bp grft/endovas taa,33891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Car-car bp grft/endovas taa,33891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Car-car bp grft/endovas taa,33891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Evasc st rpr thrc/aa acrs br,33894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa acrs br,33894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa acrs br,33894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa acrs br,33894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa acrs br,33894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa acrs br,33894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa x crsg,33895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa x crsg,33895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa x crsg,33895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa x crsg,33895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa x crsg,33895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Evasc st rpr thrc/aa x crsg,33895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Perq trluml angp nt/recr coa,33897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Perq trluml angp nt/recr coa,33897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Perq trluml angp nt/recr coa,33897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Perq trluml angp nt/recr coa,33897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Perq trluml angp nt/recr coa,33897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Perq trluml angp nt/recr coa,33897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,18617,APC Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,18617,APC Perq p-art revsc 1 nm nt uni,33900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,18617,APC Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,18617,APC Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,18617,APC Perq p-art revsc 1 nm nt bi,33901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,18617,APC Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,22738.78, Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,22738.78, Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4081,22738.78, Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4081,22738.78, Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,22738.78, Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,22738.78, Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,22738.78,APC Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,22738.78,APC Perq p-art revsc 1 abnor uni,33902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,22738.78,APC Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4081,18617, Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4081,18617, Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4081,18617,APC Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4081,18617,APC Perq p-art revsc 1 abnor bi,33903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4081,18617,APC Perq p-art revsc each addl,33904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq p-art revsc each addl,33904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq p-art revsc each addl,33904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq p-art revsc each addl,33904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Remove lung artery emboli,33910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove lung artery emboli,33910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove lung artery emboli,33910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove lung artery emboli,33910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove lung artery emboli,33915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove lung artery emboli,33915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove lung artery emboli,33915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove lung artery emboli,33915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgery of great vessel,33916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgery of great vessel,33916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgery of great vessel,33916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgery of great vessel,33916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair pulmonary artery,33917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair pulmonary artery,33917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair pulmonary artery,33917,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair pulmonary artery,33917,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair pulmonary atresia,33920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair pulmonary atresia,33920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair pulmonary atresia,33920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair pulmonary atresia,33920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transect pulmonary artery,33922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transect pulmonary artery,33922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transect pulmonary artery,33922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transect pulmonary artery,33922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove pulmonary shunt,33924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove pulmonary shunt,33924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove pulmonary shunt,33924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove pulmonary shunt,33924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rpr pul art unifocal w/o cpb,33925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rpr pul art unifocal w/o cpb,33925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rpr pul art unifocal w/o cpb,33925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rpr pul art unifocal w/o cpb,33925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repr pul art unifocal w/cpb,33926,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repr pul art unifocal w/cpb,33926,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repr pul art unifocal w/cpb,33926,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repr pul art unifocal w/cpb,33926,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Impltj tot rplcmt hrt sys,33927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Impltj tot rplcmt hrt sys,33927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Impltj tot rplcmt hrt sys,33927,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Impltj tot rplcmt hrt sys,33927,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rmvl & rplcmt tot hrt sys,33928,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rmvl & rplcmt tot hrt sys,33928,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rmvl & rplcmt tot hrt sys,33928,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rmvl & rplcmt tot hrt sys,33928,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rmvl rplcmt hrt sys f/trnspl,33929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rmvl rplcmt hrt sys f/trnspl,33929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rmvl rplcmt hrt sys f/trnspl,33929,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rmvl rplcmt hrt sys f/trnspl,33929,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of donor heart/lung,33930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of donor heart/lung,33930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of donor heart/lung,33930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of donor heart/lung,33930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare donor heart/lung,33933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare donor heart/lung,33933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare donor heart/lung,33933,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare donor heart/lung,33933,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplantation heart/lung,33935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplantation heart/lung,33935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplantation heart/lung,33935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplantation heart/lung,33935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of donor heart,33940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of donor heart,33940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of donor heart,33940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of donor heart,33940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prepare donor heart,33944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare donor heart,33944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare donor heart,33944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare donor heart,33944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplantation of heart,33945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplantation of heart,33945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplantation of heart,33945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplantation of heart,33945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation venous,33946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation venous,33946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation venous,33946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation venous,33946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation artery,33947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation artery,33947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation artery,33947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls initiation artery,33947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt-venous,33948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt-venous,33948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt-venous,33948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt-venous,33948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt artery,33949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt artery,33949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt artery,33949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls daily mgmt artery,33949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj prph cannula,33954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls insj ctr cannula,33956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33959,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33959,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33959,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33959,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33963,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33963,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33964,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33964,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33964,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls repos perph cnula,33964,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl perph cannula,33965,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl perph cannula,33965,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl perph cannula,33965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl perph cannula,33965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33966,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33966,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33966,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33966,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert i-aort percut device,33967,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert i-aort percut device,33967,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert i-aort percut device,33967,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert i-aort percut device,33967,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove aortic assist device,33968,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Remove aortic assist device,33968,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Remove aortic assist device,33968,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Remove aortic assist device,33968,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Ecmo/ecls rmvl perph cannula,33969,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl perph cannula,33969,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl perph cannula,33969,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl perph cannula,33969,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Aortic circulation assist,33971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert balloon device,33973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert balloon device,33973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert balloon device,33973,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert balloon device,33973,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove intra-aortic balloon,33974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove intra-aortic balloon,33974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove intra-aortic balloon,33974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove intra-aortic balloon,33974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant ventricular device,33975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant ventricular device,33975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant ventricular device,33975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant ventricular device,33975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant ventricular device,33976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant ventricular device,33976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant ventricular device,33976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant ventricular device,33976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove ventricular device,33977,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove ventricular device,33977,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove ventricular device,33977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove ventricular device,33977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove ventricular device,33978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove ventricular device,33978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove ventricular device,33978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove ventricular device,33978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert intracorporeal device,33979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert intracorporeal device,33979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert intracorporeal device,33979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert intracorporeal device,33979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove intracorporeal device,33980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove intracorporeal device,33980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove intracorporeal device,33980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove intracorporeal device,33980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace vad pump ext,33981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace vad pump ext,33981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace vad pump ext,33981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace vad pump ext,33981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace vad intra w/o bp,33982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace vad intra w/o bp,33982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace vad intra w/o bp,33982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace vad intra w/o bp,33982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace vad intra w/bp,33983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace vad intra w/bp,33983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace vad intra w/bp,33983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace vad intra w/bp,33983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33984,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl prph cannula,33984,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ecmo/ecls rmvl ctr cannula,33986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Artery expos/graft artery,33987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Artery expos/graft artery,33987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Artery expos/graft artery,33987,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Artery expos/graft artery,33987,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insertion of left heart vent,33988,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insertion of left heart vent,33988,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insertion of left heart vent,33988,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insertion of left heart vent,33988,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of left heart vent,33989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of left heart vent,33989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of left heart vent,33989,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of left heart vent,33989,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert vad artery access,33990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert vad artery access,33990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert vad artery access,33990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert vad artery access,33990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert vad art&vein access,33991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert vad art&vein access,33991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert vad art&vein access,33991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert vad art&vein access,33991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vad different session,33992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vad different session,33992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vad different session,33992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vad different session,33992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reposition vad diff session,33993,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reposition vad diff session,33993,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reposition vad diff session,33993,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reposition vad diff session,33993,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,741.06,18617, Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,741.06,18617, Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,741.06,18617, Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,741.06,18617, Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,741.06,18617, Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,741.06,18617, Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,18617,APC Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,18617,APC Cardiac surgery procedure,33999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,18617,APC Removal of artery clot,34001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of artery clot,34001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of artery clot,34001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of artery clot,34001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of artery clot,34051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of artery clot,34051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of artery clot,34051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of artery clot,34051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,8006,APC Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,8006,APC Removal of artery clot,34101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,8006,APC Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Removal of arm artery clot,34111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Removal of artery clot,34151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of artery clot,34151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of artery clot,34151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of artery clot,34151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Removal of artery clot,34201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Removal of leg artery clot,34203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Removal of vein clot,34401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of vein clot,34401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of vein clot,34401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of vein clot,34401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Removal of vein clot,34421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Removal of vein clot,34451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of vein clot,34451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of vein clot,34451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of vein clot,34451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,741.06,18617, Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,741.06,18617, Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,741.06,18617, Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,741.06,18617, Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,741.06,18617, Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,741.06,18617, Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,18617,APC Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,18617,APC Removal of vein clot,34471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,18617,APC Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Removal of vein clot,34490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,428,18617,APC Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,428,18617,APC Repair valve femoral vein,34501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,428,18617,APC Reconstruct vena cava,34502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct vena cava,34502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct vena cava,34502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct vena cava,34502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Transposition of vein valve,34510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,1406,18617, Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,1406,18617, Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Cross-over vein graft,34520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,428,18617,APC Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,428,18617,APC Leg vein fusion,34530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,428,18617,APC Evasc rpr a-ao ndgft,34701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Evasc rpr a-ao ndgft,34701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Evasc rpr a-ao ndgft,34701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Evasc rpr a-ao ndgft,34701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Evasc rpr a-ao ndgft rpt,34702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Evasc rpr a-ao ndgft rpt,34702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Evasc rpr a-ao ndgft rpt,34702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Evasc rpr a-ao ndgft rpt,34702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft,34703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft,34703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft,34703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft,34703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft rpt,34704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft rpt,34704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft rpt,34704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Evasc rpr a-unilac ndgft rpt,34704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Evac rpr a-biiliac ndgft,34705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Evac rpr a-biiliac ndgft,34705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Evac rpr a-biiliac ndgft,34705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Evac rpr a-biiliac ndgft,34705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Evasc rpr a-biiliac rpt,34706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Evasc rpr a-biiliac rpt,34706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Evasc rpr a-biiliac rpt,34706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Evasc rpr a-biiliac rpt,34706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Evasc rpr ilio-iliac ndgft,34707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Evasc rpr ilio-iliac ndgft,34707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Evasc rpr ilio-iliac ndgft,34707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Evasc rpr ilio-iliac ndgft,34707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Evasc rpr ilio-iliac rpt,34708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Evasc rpr ilio-iliac rpt,34708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Evasc rpr ilio-iliac rpt,34708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Evasc rpr ilio-iliac rpt,34708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Plmt xtn prosth evasc rpr,34709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Plmt xtn prosth evasc rpr,34709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Plmt xtn prosth evasc rpr,34709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Plmt xtn prosth evasc rpr,34709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Dlyd plmt xtn prosth 1st vsl,34710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Dlyd plmt xtn prosth 1st vsl,34710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Dlyd plmt xtn prosth 1st vsl,34710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Dlyd plmt xtn prosth 1st vsl,34710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Dlyd plmt xtn prosth ea addl,34711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Dlyd plmt xtn prosth ea addl,34711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Dlyd plmt xtn prosth ea addl,34711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Dlyd plmt xtn prosth ea addl,34711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Tcat dlvr enhncd fixj dev,34712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Tcat dlvr enhncd fixj dev,34712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Tcat dlvr enhncd fixj dev,34712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Tcat dlvr enhncd fixj dev,34712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Perq access & clsr fem art,34713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Perq access & clsr fem art,34713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Perq access & clsr fem art,34713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Perq access & clsr fem art,34713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Opn fem art expos cndt crtj,34714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Opn fem art expos cndt crtj,34714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Opn fem art expos cndt crtj,34714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Opn fem art expos cndt crtj,34714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos,34715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos,34715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos,34715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos,34715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos cndt,34716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos cndt,34716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos cndt,34716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Opn ax/subcla art expos cndt,34716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Evasc rpr a-iliac ndgft,34717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Evasc rpr a-iliac ndgft,34717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Evasc rpr a-iliac ndgft,34717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Evasc rpr a-iliac ndgft,34717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Evasc rpr n/a a-iliac ndgft,34718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Evasc rpr n/a a-iliac ndgft,34718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Evasc rpr n/a a-iliac ndgft,34718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Evasc rpr n/a a-iliac ndgft,34718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovas iliac a device addon,34808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovas iliac a device addon,34808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovas iliac a device addon,34808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovas iliac a device addon,34808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Xpose for endoprosth femorl,34812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Xpose for endoprosth femorl,34812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Xpose for endoprosth femorl,34812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Xpose for endoprosth femorl,34812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Femoral endovas graft add-on,34813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Femoral endovas graft add-on,34813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Femoral endovas graft add-on,34813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Femoral endovas graft add-on,34813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Xpose for endoprosth iliac,34820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Xpose for endoprosth iliac,34820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Xpose for endoprosth iliac,34820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Xpose for endoprosth iliac,34820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open Aortic Tube Prosth Repr,34830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open Aortic Tube Prosth Repr,34830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open Aortic Tube Prosth Repr,34830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open Aortic Tube Prosth Repr,34830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open Aortoiliac Prosth Repr,34831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open Aortoiliac Prosth Repr,34831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open Aortoiliac Prosth Repr,34831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open Aortoiliac Prosth Repr,34831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open Aortofemor Prosth Repr,34832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open Aortofemor Prosth Repr,34832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open Aortofemor Prosth Repr,34832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open Aortofemor Prosth Repr,34832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Xpose for endoprosth iliac,34833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Xpose for endoprosth iliac,34833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Xpose for endoprosth iliac,34833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Xpose for endoprosth iliac,34833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Xpose endoprosth brachial,34834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Xpose endoprosth brachial,34834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Xpose endoprosth brachial,34834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Xpose endoprosth brachial,34834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Plnning pt spec fenest graft,34839,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Plnning pt spec fenest graft,34839,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Plnning pt spec fenest graft,34839,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Plnning pt spec fenest graft,34839,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 1 graft,34841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 1 graft,34841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 1 graft,34841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 1 graft,34841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 2 graft,34842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 2 graft,34842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 2 graft,34842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 2 graft,34842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 3 graft,34843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 3 graft,34843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 3 graft,34843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 3 graft,34843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 4 graft,34844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 4 graft,34844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 4 graft,34844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endovasc visc aorta 4 graft,34844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Visc & infraren abd 1 prosth,34845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Visc & infraren abd 1 prosth,34845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Visc & infraren abd 1 prosth,34845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Visc & infraren abd 1 prosth,34845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Visc & infraren abd 2 prosth,34846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Visc & infraren abd 2 prosth,34846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Visc & infraren abd 2 prosth,34846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Visc & infraren abd 2 prosth,34846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Visc & infraren abd 3 prosth,34847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Visc & infraren abd 3 prosth,34847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Visc & infraren abd 3 prosth,34847,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Visc & infraren abd 3 prosth,34847,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Visc & infraren abd 4+ prost,34848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Visc & infraren abd 4+ prost,34848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Visc & infraren abd 4+ prost,34848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Visc & infraren abd 4+ prost,34848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture neck,35002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture neck,35002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture neck,35002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture neck,35002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Repair defect of artery,35011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Repair artery rupture arm,35013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture arm,35013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture arm,35013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture arm,35013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture chest,35022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture chest,35022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture chest,35022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture chest,35022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Repair defect of arm artery,35045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Repair defect of artery,35081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35092,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35092,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture aorta,35103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture spleen,35112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture spleen,35112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture spleen,35112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture spleen,35112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture belly,35122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture belly,35122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture belly,35122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture belly,35122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture groin,35132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture groin,35132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture groin,35132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture groin,35132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair artery rupture thigh,35142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair artery rupture thigh,35142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair artery rupture thigh,35142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair artery rupture thigh,35142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair defect of artery,35151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair defect of artery,35151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair defect of artery,35151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair defect of artery,35151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair ruptd popliteal art,35152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair ruptd popliteal art,35152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair ruptd popliteal art,35152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair ruptd popliteal art,35152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,8006,APC Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,8006,APC Repair blood vessel lesion,35188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,8006,APC Repair blood vessel lesion,35189,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35189,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3291,18617,APC Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3291,18617,APC Repair blood vessel lesion,35201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3291,18617,APC Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,18617, Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,18617, Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3730.07,18617, Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3730.07,18617, Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3730.07,18617, Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3730.07,18617, Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,18617,APC Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,18617,APC Repair blood vessel lesion,35206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,18617,APC Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,8006, Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,8006, Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3730.07,8006, Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3730.07,8006, Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3730.07,8006, Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3730.07,8006, Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,8006,APC Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,8006,APC Repair blood vessel lesion,35207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,8006,APC Repair blood vessel lesion,35211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,836.55,18617, Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,836.55,18617, Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,18617, Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,18617, Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Repair blood vessel lesion,35226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35236,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,18617, Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,18617, Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,428,18617,APC Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,428,18617,APC Repair blood vessel lesion,35261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,428,18617,APC Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3560,18617,APC Repair blood vessel lesion,35286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3560,18617,APC Rechanneling of artery,35301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of Artery,35306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3291,18617,APC Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3291,18617,APC Rechanneling of artery,35321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3291,18617,APC Rechanneling of artery,35331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3291,18617,APC Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3291,18617,APC Rechanneling of artery,35372,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3291,18617,APC Reoperation carotid add-on,35390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reoperation carotid add-on,35390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reoperation carotid add-on,35390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reoperation carotid add-on,35390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Angioscopy,35400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Angioscopy,35400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Angioscopy,35400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Angioscopy,35400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Harvest vein for bypass,35500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Harvest vein for bypass,35500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Art byp grft ipsilat carotid,35501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft ipsilat carotid,35501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft ipsilat carotid,35501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft ipsilat carotid,35501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft subclav-carotid,35506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft subclav-carotid,35506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft subclav-carotid,35506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft subclav-carotid,35506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft carotid-vertbrl,35508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft carotid-vertbrl,35508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft carotid-vertbrl,35508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft carotid-vertbrl,35508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft contral carotid,35509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft contral carotid,35509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft contral carotid,35509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft contral carotid,35509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft carotid-brchial,35510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft carotid-brchial,35510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft carotid-brchial,35510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft carotid-brchial,35510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft subclav-subclav,35511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft subclav-subclav,35511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft subclav-subclav,35511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft subclav-subclav,35511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft subclav-brchial,35512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft subclav-brchial,35512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft subclav-brchial,35512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft subclav-brchial,35512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft subclav-vertbrl,35515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft subclav-vertbrl,35515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft subclav-vertbrl,35515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft subclav-vertbrl,35515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft subclav-axilary,35516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft subclav-axilary,35516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft subclav-axilary,35516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft subclav-axilary,35516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft axillary-axilry,35518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft axillary-axilry,35518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft axillary-axilry,35518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft axillary-axilry,35518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft axill-femoral,35521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft axill-femoral,35521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft axill-femoral,35521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft axill-femoral,35521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft axill-brachial,35522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft axill-brachial,35522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft axill-brachial,35522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft axill-brachial,35522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft brchl-ulnr-rdl,35523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft brchl-ulnr-rdl,35523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft brchl-ulnr-rdl,35523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft brchl-ulnr-rdl,35523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft brachial-brchl,35525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft brachial-brchl,35525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft brachial-brchl,35525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft brachial-brchl,35525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft aor/carot/innom,35526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft aor/carot/innom,35526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft aor/carot/innom,35526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft aor/carot/innom,35526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft aorcel/aormesen,35531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft aorcel/aormesen,35531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft aorcel/aormesen,35531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft aorcel/aormesen,35531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft axill/fem/fem,35533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft axill/fem/fem,35533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft axill/fem/fem,35533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft axill/fem/fem,35533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft hepatorenal,35535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft hepatorenal,35535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft hepatorenal,35535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft hepatorenal,35535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft splenorenal,35536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft splenorenal,35536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft splenorenal,35536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft splenorenal,35536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft aortoiliac,35537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft aortoiliac,35537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft aortoiliac,35537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft aortoiliac,35537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft aortobi-iliac,35538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft aortobi-iliac,35538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft aortobi-iliac,35538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft aortobi-iliac,35538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft aortofemoral,35539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft aortofemoral,35539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft aortofemoral,35539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft aortofemoral,35539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft aortbifemoral,35540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft aortbifemoral,35540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft aortbifemoral,35540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft aortbifemoral,35540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft fem-popliteal,35556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft fem-popliteal,35556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft fem-popliteal,35556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft fem-popliteal,35556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft fem-femoral,35558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft fem-femoral,35558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft fem-femoral,35558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft fem-femoral,35558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft aortorenal,35560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft aortorenal,35560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft aortorenal,35560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft aortorenal,35560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft ilioiliac,35563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft ilioiliac,35563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft ilioiliac,35563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft ilioiliac,35563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp grft iliofemoral,35565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp grft iliofemoral,35565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp grft iliofemoral,35565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp grft iliofemoral,35565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp tibial-tib/peroneal,35570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp tibial-tib/peroneal,35570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp tibial-tib/peroneal,35570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp tibial-tib/peroneal,35570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Harvest femoropopliteal vein,35572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Harvest femoropopliteal vein,35572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Vein byp grft fem-popliteal,35583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vein byp grft fem-popliteal,35583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vein byp grft fem-popliteal,35583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vein byp grft fem-popliteal,35583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vein byp fem-tibial peroneal,35585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vein byp fem-tibial peroneal,35585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vein byp fem-tibial peroneal,35585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vein byp fem-tibial peroneal,35585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vein byp pop-tibl peroneal,35587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vein byp pop-tibl peroneal,35587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vein byp pop-tibl peroneal,35587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vein byp pop-tibl peroneal,35587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Harvest art for cabg add-on,35600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Harvest art for cabg add-on,35600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Harvest art for cabg add-on,35600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Harvest art for cabg add-on,35600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp common ipsi carotid,35601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp common ipsi carotid,35601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp common ipsi carotid,35601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp common ipsi carotid,35601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bpg crtd-clat crtd,35602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bpg crtd-clat crtd,35602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bpg crtd-clat crtd,35602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bpg crtd-clat crtd,35602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp carotid-subclavian,35606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp carotid-subclavian,35606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp carotid-subclavian,35606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp carotid-subclavian,35606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp subclav-subclavian,35612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp subclav-subclavian,35612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp subclav-subclavian,35612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp subclav-subclavian,35612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp subclav-axillary,35616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp subclav-axillary,35616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp subclav-axillary,35616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp subclav-axillary,35616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp axillary-femoral,35621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp axillary-femoral,35621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp axillary-femoral,35621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp axillary-femoral,35621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp axillary-pop-tibial,35623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp axillary-pop-tibial,35623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp axillary-pop-tibial,35623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp axillary-pop-tibial,35623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp aorsubcl/carot/innom,35626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp aorsubcl/carot/innom,35626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp aorsubcl/carot/innom,35626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp aorsubcl/carot/innom,35626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp aor-celiac-msn-renal,35631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp aor-celiac-msn-renal,35631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp aor-celiac-msn-renal,35631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp aor-celiac-msn-renal,35631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp ilio-celiac,35632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp ilio-celiac,35632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp ilio-celiac,35632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp ilio-celiac,35632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp ilio-mesenteric,35633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp ilio-mesenteric,35633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp ilio-mesenteric,35633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp ilio-mesenteric,35633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp iliorenal,35634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp iliorenal,35634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp iliorenal,35634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp iliorenal,35634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp spenorenal,35636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp spenorenal,35636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp spenorenal,35636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp spenorenal,35636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp aortoiliac,35637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp aortoiliac,35637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp aortoiliac,35637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp aortoiliac,35637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp aortobi-iliac,35638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp aortobi-iliac,35638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp aortobi-iliac,35638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp aortobi-iliac,35638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp carotid-vertebral,35642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp carotid-vertebral,35642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp carotid-vertebral,35642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp carotid-vertebral,35642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp subclav-vertebrl,35645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp subclav-vertebrl,35645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp subclav-vertebrl,35645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp subclav-vertebrl,35645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp aortobifemoral,35646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp aortobifemoral,35646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp aortobifemoral,35646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp aortobifemoral,35646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp aortofemoral,35647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp aortofemoral,35647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp aortofemoral,35647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp aortofemoral,35647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp axillary-axillary,35650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp axillary-axillary,35650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp axillary-axillary,35650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp axillary-axillary,35650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp axill-fem-femoral,35654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp axill-fem-femoral,35654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp axill-fem-femoral,35654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp axill-fem-femoral,35654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp femoral-popliteal,35656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp femoral-popliteal,35656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp femoral-popliteal,35656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp femoral-popliteal,35656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp femoral-femoral,35661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp femoral-femoral,35661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp femoral-femoral,35661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp femoral-femoral,35661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp ilioiliac,35663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp ilioiliac,35663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp ilioiliac,35663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp ilioiliac,35663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp iliofemoral,35665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp iliofemoral,35665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp iliofemoral,35665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp iliofemoral,35665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp fem-ant-post tib/prl,35666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art byp pop-tibl-prl-other,35671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Composite byp grft pros&vein,35681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Composite byp grft pros&vein,35681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Composite byp grft pros&vein,35681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Composite byp grft pros&vein,35681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Composite byp grft 2 veins,35682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Composite byp grft 2 veins,35682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Composite byp grft 2 veins,35682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Composite byp grft 2 veins,35682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Composite byp grft 3/> segmt,35683,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Composite byp grft 3/> segmt,35683,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Composite byp grft 3/> segmt,35683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Composite byp grft 3/> segmt,35683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bypass graft patency/patch,35685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Bypass graft patency/patch,35685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Bypass graft/av fist patency,35686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Bypass graft/av fist patency,35686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Art trnsposj vertbrl carotid,35691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art trnsposj vertbrl carotid,35691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art trnsposj vertbrl carotid,35691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art trnsposj vertbrl carotid,35691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art trnsposj subclavian,35693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art trnsposj subclavian,35693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art trnsposj subclavian,35693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art trnsposj subclavian,35693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art trnsposj subclav carotid,35694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art trnsposj subclav carotid,35694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art trnsposj subclav carotid,35694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art trnsposj subclav carotid,35694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Art trnsposj carotid subclav,35695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Art trnsposj carotid subclav,35695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Art trnsposj carotid subclav,35695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Art trnsposj carotid subclav,35695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reimplant artery each,35697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reimplant artery each,35697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reimplant artery each,35697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reimplant artery each,35697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reoperation bypass graft,35700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reoperation bypass graft,35700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reoperation bypass graft,35700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reoperation bypass graft,35700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploration carotid artery,35701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration carotid artery,35701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration carotid artery,35701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration carotid artery,35701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Expl n/flwd surg uxtr art,35702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Expl n/flwd surg uxtr art,35702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Expl n/flwd surg uxtr art,35702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Expl n/flwd surg uxtr art,35702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Expl n/flwd surg lxtr art,35703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Expl n/flwd surg lxtr art,35703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Expl n/flwd surg lxtr art,35703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Expl n/flwd surg lxtr art,35703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Exploration of artery/vein,35761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Exploration of artery/vein,35761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3291,18617,APC Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3291,18617,APC Explore neck vessels,35800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3291,18617,APC Explore chest vessels,35820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore chest vessels,35820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore chest vessels,35820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore chest vessels,35820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore abdominal vessels,35840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore abdominal vessels,35840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore abdominal vessels,35840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore abdominal vessels,35840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,18617, Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,18617, Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3730.07,18617, Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3730.07,18617, Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3730.07,18617, Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3730.07,18617, Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,18617,APC Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,18617,APC Explore limb vessels,35860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,18617,APC Repair vessel graft defect,35870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair vessel graft defect,35870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair vessel graft defect,35870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair vessel graft defect,35870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4147,13320,APC Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4147,13320,APC Removal of clot in graft,35875,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4147,13320,APC Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4147,13320,APC Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4147,13320,APC Removal of clot in graft,35876,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4147,13320,APC Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Revise graft w/vein,35879,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Revise graft w/vein,35881,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13320, Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13320, Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,13320,APC Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,13320,APC Revise Graft w/Nonauto Graft,35883,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,13320,APC Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,13320, Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,13320, Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,13320,APC Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,13320,APC Revise graft w/vein,35884,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,13320,APC Excision graft neck,35901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision graft neck,35901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision graft neck,35901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision graft neck,35901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Excision graft extremity,35903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Excision graft thorax,35905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision graft thorax,35905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision graft thorax,35905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision graft thorax,35905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision graft abdomen,35907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision graft abdomen,35907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision graft abdomen,35907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision graft abdomen,35907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Place needle in vein,36000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Place needle in vein,36000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,3314, Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,3314, Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,3314, Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,3314, Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,3314, Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,3314, Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,3314,APC Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,3314,APC Pseudoaneurysm injection trt,36002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,3314,APC Injection ext venography,36005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection ext venography,36005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection ext venography,36005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection ext venography,36005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Place catheter in vein,36010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Place catheter in vein,36010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Place catheter in vein,36010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Place catheter in vein,36010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Place catheter in vein,36011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Place catheter in vein,36011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Place catheter in vein,36011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Place catheter in vein,36011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Place catheter in vein,36012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Place catheter in vein,36012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Place catheter in vein,36012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Place catheter in vein,36012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Place catheter in artery,36013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Place catheter in artery,36013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Place catheter in artery,36013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Place catheter in artery,36013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Place catheter in artery,36014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Place catheter in artery,36014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Place catheter in artery,36014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Place catheter in artery,36014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Place catheter in artery,36015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Place catheter in artery,36015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Place catheter in artery,36015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Place catheter in artery,36015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Establish access to artery,36100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Establish access to artery,36100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Establish access to artery,36100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Establish access to artery,36100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Establish access to artery,36140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Establish access to artery,36140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Establish access to artery,36140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Establish access to artery,36140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Establish access to aorta,36160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Establish access to aorta,36160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Establish access to aorta,36160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Establish access to aorta,36160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Place catheter in aorta,36200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Place catheter in aorta,36200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Place catheter in aorta,36200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Place catheter in aorta,36200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Place catheter in artery,36215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Place catheter in artery,36215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Place catheter in artery,36215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Place catheter in artery,36215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Place catheter in artery,36216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Place catheter in artery,36216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Place catheter in artery,36216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Place catheter in artery,36216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Place catheter in artery,36217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Place catheter in artery,36217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Place catheter in artery,36217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Place catheter in artery,36217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Place catheter in artery,36218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Place catheter in artery,36218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Place catheter in artery,36218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Place catheter in artery,36218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,997.23,18617, Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,997.23,18617, Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,997.23,,,,,,,fee schedule,997.23,18617, Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1254.25,,,,,,,fee schedule,997.23,18617, Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,997.23,18617, Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,997.23,18617, Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,997.23,18617,APC Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,997.23,18617,APC Place cath thoracic aorta,36221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,997.23,18617,APC Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,997.23,18617, Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,997.23,18617, Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,997.23,,,,,,,fee schedule,997.23,18617, Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1254.25,,,,,,,fee schedule,997.23,18617, Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,997.23,18617, Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,997.23,18617, Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,997.23,18617,APC Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,997.23,18617,APC Place cath carotid/inom art,36222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,997.23,18617,APC Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1166.74,18617, Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1166.74,18617, Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1166.74,,,,,,,fee schedule,1166.74,18617, Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1467.44,,,,,,,fee schedule,1166.74,18617, Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1166.74,18617, Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1166.74,18617, Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1166.74,18617,APC Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1166.74,18617,APC Place cath carotid/inom art,36223,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1166.74,18617,APC Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1166.74,18617, Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1166.74,18617, Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1166.74,,,,,,,fee schedule,1166.74,18617, Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1467.44,,,,,,,fee schedule,1166.74,18617, Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1166.74,18617, Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1166.74,18617, Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1166.74,18617,APC Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1166.74,18617,APC Place cath carotd art,36224,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1166.74,18617,APC Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1009.6,18617, Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1009.6,18617, Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1009.6,,,,,,,fee schedule,1009.6,18617, Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1269.8,,,,,,,fee schedule,1009.6,18617, Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1009.6,18617, Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1009.6,18617, Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1009.6,18617,APC Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1009.6,18617,APC Place cath subclavian art,36225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1009.6,18617,APC Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1009.6,18617, Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1009.6,18617, Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1009.6,,,,,,,fee schedule,1009.6,18617, Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1269.8,,,,,,,fee schedule,1009.6,18617, Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1009.6,18617, Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1009.6,18617, Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1009.6,18617,APC Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1009.6,18617,APC Place cath vertebral art,36226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1009.6,18617,APC Place cath xtrnl carotid,36227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1151.6,1866, Place cath xtrnl carotid,36227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1151.6,1866, Place cath xtrnl carotid,36227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1151.6,,,,,,,fee schedule,1151.6,1866, Place cath xtrnl carotid,36227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1448.41,,,,,,,fee schedule,1151.6,1866, Place cath intracranial art,36228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Place cath intracranial art,36228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Ins cath abd/l-ext art 1st,36245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 1st,36245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 1st,36245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 1st,36245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 2nd,36246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 2nd,36246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 2nd,36246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 2nd,36246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 3rd,36247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 3rd,36247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 3rd,36247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art 3rd,36247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art addl,36248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art addl,36248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art addl,36248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Ins cath abd/l-ext art addl,36248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 1st unilat,36251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 1st bilat,36252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 2nd+ unilat,36253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,18617,APC Ins cath ren art 2nd+ bilat,36254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,18617,APC Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,8006,APC Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,8006,APC Insertion of infusion pump,36260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,8006,APC Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,2816,9420,APC Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,2816,9420,APC Revision of infusion pump,36261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,2816,9420,APC Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4635.37, Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4635.37, Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,4635.37, Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,4635.37, Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4635.37, Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4635.37, Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4591.22,,,,,,,fee schedule,1544,4635.37,APC Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4635.37,,,,,,,fee schedule,1544,4635.37,APC Removal of infusion pump,36262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4414.64,,,,,,,fee schedule,1544,4635.37,APC Bl draw < 3 yrs fem/jugular,36400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Bl draw < 3 yrs fem/jugular,36400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Bl draw <3 yrs scalp vein,36405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Bl draw <3 yrs scalp vein,36405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Bl draw <3 yrs other vein,36406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Bl draw <3 yrs other vein,36406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Non-routine bl draw 3/> yrs,36410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,15.09,490, Non-routine bl draw 3/> yrs,36410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,15.09,490, Non-routine bl draw 3/> yrs,36410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.09,,,,,,,fee schedule,15.09,490, Non-routine bl draw 3/> yrs,36410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.25,,,,,,,fee schedule,15.09,490, Routine venipuncture,36415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.75,,,,,,,fee schedule,9.34,17.22, Routine venipuncture,36415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.98,,,,,,,fee schedule,9.34,17.22, Routine venipuncture,36415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.07,,,,,,,fee schedule,9.34,17.22, Routine venipuncture,36415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.22,,,,,,,fee schedule,9.34,17.22, Routine venipuncture,36415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.71,,,,,,,fee schedule,9.34,17.22,APC Routine venipuncture,36415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.81,,,,,,,fee schedule,9.34,17.22,APC Routine venipuncture,36415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.34,,,,,,,fee schedule,9.34,17.22,APC Capillary blood draw,36416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.47,,,,,,,fee schedule,0.47,0.54, Capillary blood draw,36416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.54,,,,,,,fee schedule,0.47,0.54, Vein access cutdown < 1 yr,36420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,1866, Vein access cutdown < 1 yr,36420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,1866, Vein access cutdown < 1 yr,36420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,1866,APC Vein access cutdown < 1 yr,36420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,1866,APC Vein access cutdown < 1 yr,36420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,1866,APC Vein access cutdown > 1 yr,36425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,8006, Vein access cutdown > 1 yr,36425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,8006, Vein access cutdown > 1 yr,36425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,527.74,8006, Vein access cutdown > 1 yr,36425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,527.74,8006, Vein access cutdown > 1 yr,36425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,8006,APC Vein access cutdown > 1 yr,36425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,8006,APC Vein access cutdown > 1 yr,36425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,8006,APC Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,521.18,3314, Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,521.18,3314, Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,521.18,3314, Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,521.18,3314, Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Blood transfusion service,36430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,521.18,3314, Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,521.18,3314, Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,521.18,3314, Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,521.18,3314, Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Bl push transfuse 2 yr/<,36440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Bl exchange/transfuse nb,36450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Bl exchange/transfuse non-nb,36455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,521.18,3314, Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,521.18,3314, Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,521.18,3314, Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,521.18,3314, Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Prtl exchange transfuse nb,36456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,521.18,3314, Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,521.18,3314, Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,521.18,3314, Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,521.18,3314, Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Transfusion service fetal,36460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,13320,APC Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,13320,APC Njx noncmpnd sclrsnt 1 vein,36465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,13320,APC Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2437.45,13320, Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,13320,APC Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,13320,APC Njx noncmpnd sclrsnt mlt vn,36466,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,13320,APC Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Injection(s) spider veins,36468,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Injection therapy of vein,36470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,18617, Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,18617, Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Injection therapy of veins,36471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Endovenous mchnchem 1st vein,36473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,855,5044, Endovenous mchnchem 1st vein,36473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,855,5044, Endovenous mchnchem 1st vein,36473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,5044, Endovenous mchnchem 1st vein,36473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,5044, Endovenous mchnchem 1st vein,36473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,855,5044,APC Endovenous mchnchem 1st vein,36473,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,855,5044,APC Endovenous mchnchem 1st vein,36473,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,855,5044,APC Endovenous mchnchem add-on,36474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Endovenous mchnchem add-on,36474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,13320,APC Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,13320,APC Endovenous rf 1st vein,36475,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,13320,APC Endovenous rf vein add-on,36476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Endovenous rf vein add-on,36476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Endovenous rf vein add-on,36476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Endovenous rf vein add-on,36476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,13320,APC Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,13320,APC Endovenous laser 1st vein,36478,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,13320,APC Endovenous laser vein addon,36479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Endovenous laser vein addon,36479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Endovenous laser vein addon,36479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Endovenous laser vein addon,36479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,18617,APC Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,18617,APC Endoven ther chem adhes 1st,36482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,18617,APC Endoven ther chem adhes sbsq,36483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Endoven ther chem adhes sbsq,36483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Endoven ther chem adhes sbsq,36483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Endoven ther chem adhes sbsq,36483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Insertion of catheter vein,36510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Insertion of catheter vein,36510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1839.86,18617, Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1839.86,18617, Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1839.86,18617, Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1839.86,18617, Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1839.86,18617, Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1839.86,18617, Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1839.86,18617,APC Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1839.86,18617,APC Apheresis wbc,36511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1839.86,18617,APC Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1839.86,18617, Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1839.86,18617, Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1839.86,18617, Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1839.86,18617, Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1839.86,18617, Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1839.86,18617, Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1839.86,18617,APC Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1839.86,18617,APC Apheresis rbc,36512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1839.86,18617,APC Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,521.18,18617, Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,521.18,18617, Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,521.18,18617, Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,521.18,18617, Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,521.18,18617, Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,521.18,18617, Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,18617,APC Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,18617,APC Apheresis platelets,36513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,18617,APC Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1839.86,18617, Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1839.86,18617, Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1839.86,18617, Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1839.86,18617, Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1839.86,18617, Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1839.86,18617, Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1839.86,18617,APC Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1839.86,18617,APC Apheresis plasma,36514,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1839.86,18617,APC Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4147,18617, Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4147,18617, Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5351.16,,,,,,,fee schedule,4147,18617,APC Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5402.62,,,,,,,fee schedule,4147,18617,APC Apheresis selective,36516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5145.35,,,,,,,fee schedule,4147,18617,APC Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,18617, Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,18617, Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5351.16,,,,,,,fee schedule,2816,18617,APC Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5402.62,,,,,,,fee schedule,2816,18617,APC Photopheresis,36522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5145.35,,,,,,,fee schedule,2816,18617,APC Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3916.58, Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3916.58, Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3916.58, Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3916.58, Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3916.58, Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3916.58, Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,855,3916.58,APC Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,855,3916.58,APC Insert non-tunnel cv cath,36555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,855,3916.58,APC Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1544,4097,APC Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1544,4097,APC Insert non-tunnel cv cath,36556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1544,4097,APC Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,2816,8006,APC Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,2816,8006,APC Insert tunneled cv cath,36557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,2816,8006,APC Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,5123,APC Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,5123,APC Insert tunneled cv cath,36558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,5123,APC Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,6902.26, Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,6902.26, Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,6902.26, Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,6902.26, Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2138,6902.26, Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2138,6902.26, Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,2138,6902.26,APC Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,2138,6902.26,APC Insert tunneled cv cath,36563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,2138,6902.26,APC Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9918, Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9918, Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,9918, Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,9918, Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3408,9918, Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3408,9918, Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,9918,APC Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,9918,APC Insert tunneled cv cath,36566,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,9918,APC Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,3314,APC Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,3314,APC Insert picc cath,36568,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,3314,APC Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,3314,APC Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,3314,APC Insert picc cath,36569,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,3314,APC Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5123,APC Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5123,APC Insert picvad cath,36570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5123,APC Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5123,APC Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5123,APC Insert picvad cath,36571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5123,APC Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,5098, Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,5098, Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,5098, Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,5098, Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,741.06,5098, Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,741.06,5098, Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,5098,APC Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,5098,APC Insj picc rs&i <5 yr,36572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,5098,APC Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8190, Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8190, Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,8190, Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,8190, Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6825,,,,,,,fee schedule,1544,8190, Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8190,,,,,,,fee schedule,1544,8190, Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,8190,APC Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,8190,APC Insj picc rs&i 5 yr+,36573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,8190,APC Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,741.06,4466, Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,741.06,4466, Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,4466, Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,4466, Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,741.06,4466, Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,741.06,4466, Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,4466,APC Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,4466,APC Repair tunneled cv cath,36575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,4466,APC Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1859.62,4466, Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1859.62,4466, Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1859.62,4466, Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1859.62,4466, Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1859.62,4466, Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1859.62,4466, Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1859.62,4466,APC Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1859.62,4466,APC Repair tunneled cv cath,36576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1859.62,4466,APC Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,5123,APC Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,5123,APC Replace tunneled cv cath,36578,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,5123,APC Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,4097,APC Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,4097,APC Replace cvad cath,36580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,4097,APC Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,4466,APC Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,4466,APC Replace tunneled cv cath,36581,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,4466,APC Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Replace tunneled cv cath,36582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6902.26, Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6902.26, Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,6902.26, Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,6902.26, Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6902.26, Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6902.26, Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,6902.26,APC Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,6902.26,APC Replace tunneled cv cath,36583,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,6902.26,APC Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,3314,APC Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,3314,APC Replace picc cath,36584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,3314,APC Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Replace picvad cath,36585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,741.06,3314, Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,741.06,3314, Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,741.06,3314, Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,741.06,3314, Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,741.06,3314, Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,741.06,3314, Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,3314,APC Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,3314,APC Removal tunneled cv cath,36589,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,3314,APC Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,3314,APC Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,3314,APC Removal tunneled cv cath,36590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,3314,APC Draw blood off venous device,36591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,984, Draw blood off venous device,36591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,984, Draw blood off venous device,36591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,984,APC Draw blood off venous device,36591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,984,APC Draw blood off venous device,36591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,984,APC Collect blood from picc,36592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,984, Collect blood from picc,36592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,984, Collect blood from picc,36592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,984,APC Collect blood from picc,36592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,984,APC Collect blood from picc,36592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,984,APC Declot vascular device,36593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,390.2,1866, Declot vascular device,36593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,390.2,1866, Declot vascular device,36593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,390.2,1866, Declot vascular device,36593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,390.2,1866, Declot vascular device,36593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,1866,APC Declot vascular device,36593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,1866,APC Declot vascular device,36593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,1866,APC Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2762,6253, Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2762,6253, Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2762,6253, Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2762,6253, Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,6253, Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,6253, Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2762,6253,APC Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2762,6253,APC Mech remov tunneled cv cath,36595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2762,6253,APC Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,3314,APC Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,3314,APC Mech remov tunneled cv cath,36596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,3314,APC Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,3314,APC Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,3314,APC Reposition venous catheter,36597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,3314,APC Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,251.28,4166, Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,251.28,4166, Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,251.28,4166, Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,251.28,4166, Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,251.28,4166, Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,251.28,4166, Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,4166,APC Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,4166,APC Inj w/fluor eval cv device,36598,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,4166,APC Withdrawal of arterial blood,36600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,984, Withdrawal of arterial blood,36600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,984, Withdrawal of arterial blood,36600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,984,APC Withdrawal of arterial blood,36600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,984,APC Withdrawal of arterial blood,36600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,984,APC Insertion catheter artery,36620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insertion catheter artery,36620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insertion catheter artery,36620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insertion catheter artery,36620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Insertion catheter artery,36625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Insertion catheter artery,36625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18686, Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18686, Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1544,18686, Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1544,18686, Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,18686, Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,18686, Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1544,18686,APC Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1544,18686,APC Insertion catheter artery,36640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1544,18686,APC Insertion catheter artery,36660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insertion catheter artery,36660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insertion catheter artery,36660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insertion catheter artery,36660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,18617, Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,18617, Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Insert needle bone cavity,36680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,9420,APC Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,9420,APC Insertion of cannula,36800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,9420,APC Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,8006,APC Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,8006,APC Insertion of cannula,36810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,8006,APC Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,9420,APC Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,9420,APC Insertion of cannula,36815,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,9420,APC Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,8006,APC Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,8006,APC Av fuse uppr arm cephalic,36818,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,8006,APC Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,9420,APC Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,9420,APC Av fuse uppr arm basilic,36819,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,9420,APC Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,8006,APC Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,8006,APC Av fusion/forearm vein,36820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,8006,APC Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,8006,APC Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,8006,APC Av fusion direct any site,36821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,8006,APC Insertion of cannula(s),36823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insertion of cannula(s),36823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insertion of cannula(s),36823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insertion of cannula(s),36823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,9420,APC Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,9420,APC Artery-vein autograft,36825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,9420,APC Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,11081,APC Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,11081,APC Artery-vein nonautograft,36830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,11081,APC Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,13320, Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,13320, Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4147,13320,APC Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4147,13320,APC Open thrombect av fistula,36831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4147,13320,APC Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,9420,APC Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,9420,APC Av fistula revision open,36832,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,9420,APC Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,9420,APC Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,9420,APC Av fistula revision,36833,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,9420,APC Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3730.07,8006, Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3730.07,8006, Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3730.07,8006, Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3730.07,8006, Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3730.07,8006, Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3730.07,8006, Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3730.07,8006,APC Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3730.07,8006,APC Artery to vein shunt,36835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3730.07,8006,APC Prq av fstl crtj uxtr 1 acs,36836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,22738.78, Prq av fstl crtj uxtr 1 acs,36836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,22738.78, Prq av fstl crtj uxtr 1 acs,36836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,22738.78, Prq av fstl crtj uxtr 1 acs,36836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,22738.78, Prq av fstl crtj uxtr 1 acs,36836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4147,22738.78,APC Prq av fstl crtj uxtr 1 acs,36836,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4147,22738.78,APC Prq av fstl crtj uxtr 1 acs,36836,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4147,22738.78,APC Prq av fstl crt uxtr sep acs,36837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,22738.78, Prq av fstl crt uxtr sep acs,36837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,22738.78, Prq av fstl crt uxtr sep acs,36837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,22738.78, Prq av fstl crt uxtr sep acs,36837,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,22738.78, Prq av fstl crt uxtr sep acs,36837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4147,22738.78,APC Prq av fstl crt uxtr sep acs,36837,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4147,22738.78,APC Prq av fstl crt uxtr sep acs,36837,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4147,22738.78,APC Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,18617, Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,18617, Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,4224,18617,APC Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,4224,18617,APC Dist revas ligation hemo,36838,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,4224,18617,APC External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,4466, External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,4466, External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,4466, External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,4466, External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,855,4466, External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,855,4466, External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,855,4466,APC External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,855,4466,APC External cannula declotting,36860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,855,4466,APC Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,9420,APC Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,9420,APC Cannula declotting,36861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,9420,APC Intro cath dialysis circuit,36901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,2460, Intro cath dialysis circuit,36901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,2460, Intro cath dialysis circuit,36901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,2460, Intro cath dialysis circuit,36901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,2460, Intro cath dialysis circuit,36901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,1544,2460,APC Intro cath dialysis circuit,36901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,1544,2460,APC Intro cath dialysis circuit,36901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,1544,2460,APC Intro cath dialysis circuit,36902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Intro cath dialysis circuit,36902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Intro cath dialysis circuit,36902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Intro cath dialysis circuit,36902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Intro cath dialysis circuit,36902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4147,11081,APC Intro cath dialysis circuit,36902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4147,11081,APC Intro cath dialysis circuit,36902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4147,11081,APC Intro cath dialysis circuit,36903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17939, Intro cath dialysis circuit,36903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17939, Intro cath dialysis circuit,36903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4147,17939, Intro cath dialysis circuit,36903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4147,17939, Intro cath dialysis circuit,36903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,17939,APC Intro cath dialysis circuit,36903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,17939,APC Intro cath dialysis circuit,36903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,17939,APC Thrmbc/nfs dialysis circuit,36904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Thrmbc/nfs dialysis circuit,36904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Thrmbc/nfs dialysis circuit,36904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Thrmbc/nfs dialysis circuit,36904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Thrmbc/nfs dialysis circuit,36904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,3291,11081,APC Thrmbc/nfs dialysis circuit,36904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,3291,11081,APC Thrmbc/nfs dialysis circuit,36904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,3291,11081,APC Thrmbc/nfs dialysis circuit,36905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17939, Thrmbc/nfs dialysis circuit,36905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17939, Thrmbc/nfs dialysis circuit,36905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4147,17939, Thrmbc/nfs dialysis circuit,36905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4147,17939, Thrmbc/nfs dialysis circuit,36905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,17939,APC Thrmbc/nfs dialysis circuit,36905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,17939,APC Thrmbc/nfs dialysis circuit,36905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,17939,APC Thrmbc/nfs dialysis circuit,36906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,22738.78, Thrmbc/nfs dialysis circuit,36906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,22738.78, Thrmbc/nfs dialysis circuit,36906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,4147,22738.78, Thrmbc/nfs dialysis circuit,36906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,4147,22738.78, Thrmbc/nfs dialysis circuit,36906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4147,22738.78,APC Thrmbc/nfs dialysis circuit,36906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4147,22738.78,APC Thrmbc/nfs dialysis circuit,36906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4147,22738.78,APC Balo angiop ctr dialysis seg,36907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Balo angiop ctr dialysis seg,36907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Balo angiop ctr dialysis seg,36907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Balo angiop ctr dialysis seg,36907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Stent plmt ctr dialysis seg,36908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Stent plmt ctr dialysis seg,36908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Dialysis circuit embolj,36909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Dialysis circuit embolj,36909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revision of circulation,37140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of circulation,37140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of circulation,37140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of circulation,37140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of circulation,37145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of circulation,37145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of circulation,37145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of circulation,37145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of circulation,37160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of circulation,37160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of circulation,37160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of circulation,37160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of circulation,37180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of circulation,37180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of circulation,37180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of circulation,37180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Splice spleen/kidney veins,37181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Splice spleen/kidney veins,37181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Splice spleen/kidney veins,37181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Splice spleen/kidney veins,37181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,22738.78, Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,22738.78, Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4062,22738.78, Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4062,22738.78, Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,22738.78, Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,22738.78, Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4062,22738.78,APC Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4062,22738.78,APC Insert hepatic shunt (tips),37182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4062,22738.78,APC Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4062,18617, Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4062,18617, Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4062,18617,APC Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4062,18617,APC Remove hepatic shunt (tips),37183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4062,18617,APC Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,22738.78, Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,22738.78, Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4062,22738.78, Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4062,22738.78, Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,22738.78, Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,22738.78, Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4062,22738.78,APC Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4062,22738.78,APC Prim art m-thrmbc 1st vsl,37184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4062,22738.78,APC Prim art m-thrmbc sbsq vsl,37185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Prim art m-thrmbc sbsq vsl,37185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Prim art m-thrmbc sbsq vsl,37185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Prim art m-thrmbc sbsq vsl,37185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Sec art thrombectomy add-on,37186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Sec art thrombectomy add-on,37186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Sec art thrombectomy add-on,37186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Sec art thrombectomy add-on,37186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,14319.55, Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,14319.55, Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4062,14319.55, Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4062,14319.55, Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,14319.55, Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,14319.55, Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4062,14319.55,APC Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4062,14319.55,APC Venous mech thrombectomy,37187,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4062,14319.55,APC Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,3563,13320, Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,3563,13320, Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,13320, Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,13320, Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3563,13320, Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3563,13320, Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3563,13320,APC Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3563,13320,APC Venous m-thrombectomy add-on,37188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3563,13320,APC Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,18617, Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,18617, Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,18617,APC Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,18617,APC Ins endovas vena cava filtr,37191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,18617,APC Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,18617,APC Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,18617,APC Redo endovas vena cava filtr,37192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,18617,APC Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,18617,APC Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,18617,APC Rem endovas vena cava filter,37193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,18617,APC Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,390.2,3314, Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,390.2,3314, Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,390.2,3314, Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,390.2,3314, Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,390.2,3314, Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,390.2,3314, Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,3314,APC Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,3314,APC Thrombolytic therapy stroke,37195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,3314,APC Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1384.87,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1741.79,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1384.87,13320, Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1384.87,13320,APC Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1384.87,13320,APC Remove intrvas foreign body,37197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1384.87,13320,APC Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2762,9420, Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2762,9420, Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2762,9420, Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2762,9420, Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,9420, Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,9420, Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,2762,9420,APC Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,2762,9420,APC Transcatheter biopsy,37200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,2762,9420,APC Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2988.05,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3758.16,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1544,11081, Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1544,11081,APC Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1544,11081,APC Thrombolytic art therapy,37211,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1544,11081,APC Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2988.05,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3758.16,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1544,6404, Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1544,6404,APC Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1544,6404,APC Thrombolytic venous therapy,37212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1544,6404,APC Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2988.05,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3758.16,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2988.05,13320, Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2988.05,13320,APC Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2988.05,13320,APC Thromblytic art/ven therapy,37213,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2988.05,13320,APC Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2988.05,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3758.16,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2988.05,13320, Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2988.05,13320,APC Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2988.05,13320,APC Cessj therapy cath removal,37214,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2988.05,13320,APC Transcath stent cca w/eps,37215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Transcath stent cca w/eps,37215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Transcath stent cca w/eps,37215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Transcath stent cca w/eps,37215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Transcath stent cca w/o eps,37216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Transcath stent cca w/o eps,37216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Transcath stent cca w/o eps,37216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Transcath stent cca w/o eps,37216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Transcath stent cca w/o eps,37216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Transcath stent cca w/o eps,37216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Stent placemt retro carotid,37217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Stent placemt retro carotid,37217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Stent placemt retro carotid,37217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Stent placemt retro carotid,37217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Stent placemt ante carotid,37218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Stent placemt ante carotid,37218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Stent placemt ante carotid,37218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Stent placemt ante carotid,37218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Iliac revasc,37220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Iliac revasc,37220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Iliac revasc,37220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Iliac revasc,37220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Iliac revasc,37220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Iliac revasc,37220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Iliac revasc w/stent,37221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Iliac revasc w/stent,37221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Iliac revasc w/stent,37221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Iliac revasc w/stent,37221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Iliac revasc w/stent,37221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Iliac revasc w/stent,37221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Iliac revasc add-on,37222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13036, Iliac revasc add-on,37222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13036, Iliac revasc add-on,37222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,13036, Iliac revasc add-on,37222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,13036, Iliac revasc w/stent add-on,37223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13036, Iliac revasc w/stent add-on,37223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13036, Iliac revasc w/stent add-on,37223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,13036, Iliac revasc w/stent add-on,37223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,13036, Fem/popl revas w/tla,37224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Fem/popl revas w/tla,37224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Fem/popl revas w/tla,37224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,18617, Fem/popl revas w/tla,37224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,18617, Fem/popl revas w/tla,37224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Fem/popl revas w/tla,37224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Fem/popl revas w/ather,37225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Fem/popl revas w/ather,37225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Fem/popl revas w/ather,37225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Fem/popl revas w/ather,37225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Fem/popl revas w/ather,37225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Fem/popl revas w/ather,37225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Fem/popl revasc w/stent,37226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Fem/popl revasc w/stent,37226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Fem/popl revasc w/stent,37226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Fem/popl revasc w/stent,37226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Fem/popl revasc w/stent,37226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Fem/popl revasc w/stent,37226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Fem/popl revasc stnt & ather,37227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Fem/popl revasc stnt & ather,37227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Fem/popl revasc stnt & ather,37227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,18617, Fem/popl revasc stnt & ather,37227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,18617, Fem/popl revasc stnt & ather,37227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Fem/popl revasc stnt & ather,37227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Tib/per revasc w/tla,37228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Tib/per revasc w/tla,37228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Tib/per revasc w/tla,37228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,18617, Tib/per revasc w/tla,37228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,18617, Tib/per revasc w/tla,37228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Tib/per revasc w/tla,37228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Tib/per revasc w/ather,37229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Tib/per revasc w/ather,37229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Tib/per revasc w/ather,37229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,18617, Tib/per revasc w/ather,37229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,18617, Tib/per revasc w/ather,37229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Tib/per revasc w/ather,37229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Tib/per revasc w/stent,37230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Tib/per revasc w/stent,37230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Tib/per revasc w/stent,37230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,18617, Tib/per revasc w/stent,37230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,18617, Tib/per revasc w/stent,37230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Tib/per revasc w/stent,37230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Tib/per revasc stent & ather,37231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Tib/per revasc stent & ather,37231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Tib/per revasc stent & ather,37231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,18617, Tib/per revasc stent & ather,37231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,18617, Tib/per revasc stent & ather,37231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Tib/per revasc stent & ather,37231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Tib/per revasc add-on,37232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Tib/per revasc add-on,37232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Tib/per revasc add-on,37232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Tib/per revasc add-on,37232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Tibper revasc w/ather add-on,37233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Tibper revasc w/ather add-on,37233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Tibper revasc w/ather add-on,37233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Tibper revasc w/ather add-on,37233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Revsc opn/prq tib/pero stent,37234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Revsc opn/prq tib/pero stent,37234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Revsc opn/prq tib/pero stent,37234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Revsc opn/prq tib/pero stent,37234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Tib/per revasc stnt & ather,37235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Tib/per revasc stnt & ather,37235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Tib/per revasc stnt & ather,37235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Tib/per revasc stnt & ather,37235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,18617, Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,18617, Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,18617,APC Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,18617,APC Open/perq place stent 1st,37236,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,18617,APC Open/perq place stent ea add,37237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Open/perq place stent ea add,37237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Open/perq place stent ea add,37237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Open/perq place stent ea add,37237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,18617,APC Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,18617,APC Open/perq place stent same,37238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,18617,APC Open/perq place stent ea add,37239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Open/perq place stent ea add,37239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Open/perq place stent ea add,37239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Open/perq place stent ea add,37239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude venous,37241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,22738.78, Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,22738.78, Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3408,22738.78, Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3408,22738.78, Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,22738.78, Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,22738.78, Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,3408,22738.78,APC Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,3408,22738.78,APC Vasc embolize/occlude artery,37242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,3408,22738.78,APC Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude organ,37243,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3408,18617,APC Vasc embolize/occlude bleed,37244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3408,18617,APC Trluml balo angiop 1st art,37246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st art,37246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st art,37246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st art,37246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st art,37246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4147,11081,APC Trluml balo angiop 1st art,37246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4147,11081,APC Trluml balo angiop 1st art,37246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4147,11081,APC Trluml balo angiop addl art,37247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Trluml balo angiop addl art,37247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Trluml balo angiop addl art,37247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Trluml balo angiop addl art,37247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Trluml balo angiop 1st vein,37248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st vein,37248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st vein,37248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st vein,37248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Trluml balo angiop 1st vein,37248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4147,11081,APC Trluml balo angiop 1st vein,37248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4147,11081,APC Trluml balo angiop 1st vein,37248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4147,11081,APC Trluml balo angiop addl vein,37249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Trluml balo angiop addl vein,37249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Trluml balo angiop addl vein,37249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Trluml balo angiop addl vein,37249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary 1st,37252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary 1st,37252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary 1st,37252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary 1st,37252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary addl,37253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary addl,37253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary addl,37253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Intrvasc us noncoronary addl,37253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Revsc evasc ivt angio sf 1st,37254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio sf 1st,37254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio sf 1st,37254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio sf 1st,37254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio sf 1st,37254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt angio sf 1st,37254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt angio sf 1st,37254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt angio sf ea,37255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc ivt angio sf ea,37255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc ivt angio cplx 1,37256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio cplx 1,37256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio cplx 1,37256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio cplx 1,37256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evasc ivt angio cplx 1,37256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt angio cplx 1,37256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt angio cplx 1,37256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4224,18617,APC Revsc evsc ivt angio cplx ea,37257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evsc ivt angio cplx ea,37257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc ivt stent sf 1st,37258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evasc ivt stent sf 1st,37258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evasc ivt stent sf 1st,37258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evasc ivt stent sf 1st,37258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evasc ivt stent sf 1st,37258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt stent sf 1st,37258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt stent sf 1st,37258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt stent sf ea,37259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc ivt stent sf ea,37259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc ivt st cplx 1st,37260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evasc ivt st cplx 1st,37260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evasc ivt st cplx 1st,37260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evasc ivt st cplx 1st,37260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evasc ivt st cplx 1st,37260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt st cplx 1st,37260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt st cplx 1st,37260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revsc evasc ivt st cplx ea,37261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc ivt st cplx ea,37261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Iv lithotrp ivt w/in sm art,37262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Iv lithotrp ivt w/in sm art,37262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc fpvt angio sf 1,37263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt angio sf 1,37263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt angio sf 1,37263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt angio sf 1,37263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt angio sf 1,37263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4224,18617,APC Revsc evasc fpvt angio sf 1,37263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4224,18617,APC Revsc evasc fpvt angio sf 1,37263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4224,18617,APC Revsc evasc fpvt angio sf ea,37264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc fpvt angio sf ea,37264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc fpvt angio cplx 1,37265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt angio cplx 1,37265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt angio cplx 1,37265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt angio cplx 1,37265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt angio cplx 1,37265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4224,18617,APC Revsc evsc fpvt angio cplx 1,37265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4224,18617,APC Revsc evsc fpvt angio cplx 1,37265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4224,18617,APC Rvsc evsc fpvt angio cplx ea,37266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rvsc evsc fpvt angio cplx ea,37266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc fpvt stent sf 1st,37267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt stent sf 1st,37267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt stent sf 1st,37267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt stent sf 1st,37267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evsc fpvt stent sf 1st,37267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revsc evsc fpvt stent sf 1st,37267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revsc evsc fpvt stent sf 1st,37267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revsc evasc fpvt stent sf ea,37268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc fpvt stent sf ea,37268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc fpvt st cplx 1st,37269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt st cplx 1st,37269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt st cplx 1st,37269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt st cplx 1st,37269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evasc fpvt st cplx 1st,37269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revsc evasc fpvt st cplx 1st,37269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revsc evasc fpvt st cplx 1st,37269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revsc evasc fpvt st cplx ea,37270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc fpvt st cplx ea,37270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc fpvt athrc sf 1st,37271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc sf 1st,37271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc sf 1st,37271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc sf 1st,37271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc sf 1st,37271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc fpvt athrc sf 1st,37271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc fpvt athrc sf 1st,37271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc fpvt athrc sf ea,37272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evsc fpvt athrc sf ea,37272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc fpvt athrc cplx 1,37273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc cplx 1,37273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc cplx 1,37273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc cplx 1,37273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Revsc evsc fpvt athrc cplx 1,37273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc fpvt athrc cplx 1,37273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc fpvt athrc cplx 1,37273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc fpvt athrc cplx ea,37274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rvsc evsc fpvt athrc cplx ea,37274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rvsc evsc fpvt st athrc sf 1,37275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athrc sf 1,37275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athrc sf 1,37275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athrc sf 1,37275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athrc sf 1,37275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc fpvt st athrc sf 1,37275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc fpvt st athrc sf 1,37275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc fpvt st athr sf ea,37276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rvsc evsc fpvt st athr sf ea,37276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rvsc evsc fpvt st athr cpx 1,37277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athr cpx 1,37277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athr cpx 1,37277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athr cpx 1,37277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Rvsc evsc fpvt st athr cpx 1,37277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc fpvt st athr cpx 1,37277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc fpvt st athr cpx 1,37277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc fpvt st ath cpx ea,37278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rvsc evsc fpvt st ath cpx ea,37278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Iv lithotrp fpvt w/in sm art,37279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Iv lithotrp fpvt w/in sm art,37279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc tpvt angio sf 1st,37280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evsc tpvt angio sf 1st,37280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evsc tpvt angio sf 1st,37280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evsc tpvt angio sf 1st,37280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evsc tpvt angio sf 1st,37280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revsc evsc tpvt angio sf 1st,37280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revsc evsc tpvt angio sf 1st,37280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revsc evsc tpvt angio sf ea,37281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evsc tpvt angio sf ea,37281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rvsc evsc tpvt angio cplx 1,37282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rvsc evsc tpvt angio cplx 1,37282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rvsc evsc tpvt angio cplx 1,37282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rvsc evsc tpvt angio cplx 1,37282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rvsc evsc tpvt angio cplx 1,37282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Rvsc evsc tpvt angio cplx 1,37282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Rvsc evsc tpvt angio cplx 1,37282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Rvsc evsc tpvt angio cplx ea,37283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rvsc evsc tpvt angio cplx ea,37283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc tpvt st sf 1st,37284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st sf 1st,37284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st sf 1st,37284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st sf 1st,37284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st sf 1st,37284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revsc evasc tpvt st sf 1st,37284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revsc evasc tpvt st sf 1st,37284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revsc evasc tpvt st sf ea,37285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc tpvt st sf ea,37285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc tpvt st cplx 1st,37286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st cplx 1st,37286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st cplx 1st,37286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st cplx 1st,37286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Revsc evasc tpvt st cplx 1st,37286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revsc evasc tpvt st cplx 1st,37286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revsc evasc tpvt st cplx 1st,37286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revsc evasc tpvt st cplx ea,37287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc tpvt st cplx ea,37287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc tpvt athrc sf 1st,37288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc sf 1st,37288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc sf 1st,37288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc sf 1st,37288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc sf 1st,37288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc tpvt athrc sf 1st,37288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc tpvt athrc sf 1st,37288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc tpvt athrc sf ea,37289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evsc tpvt athrc sf ea,37289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc tpvt athrc cplx 1,37290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc cplx 1,37290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc cplx 1,37290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc cplx 1,37290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Revsc evsc tpvt athrc cplx 1,37290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc tpvt athrc cplx 1,37290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc tpvt athrc cplx 1,37290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revsc evsc tpvt athr cplx ea,37291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evsc tpvt athr cplx ea,37291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rvsc evsc tpvt st athrc sf 1,37292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athrc sf 1,37292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athrc sf 1,37292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athrc sf 1,37292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athrc sf 1,37292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc tpvt st athrc sf 1,37292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc tpvt st athrc sf 1,37292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc tpvt st athr sf ea,37293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rvsc evsc tpvt st athr sf ea,37293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Rvsc evsc tpvt st athr cpx 1,37294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athr cpx 1,37294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athr cpx 1,37294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athr cpx 1,37294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Rvsc evsc tpvt st athr cpx 1,37294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc tpvt st athr cpx 1,37294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc tpvt st athr cpx 1,37294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Rvsc evsc tpvt st ath cpx ea,37295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Rvsc evsc tpvt st ath cpx ea,37295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evasc imvt angio sf 1,37296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evasc imvt angio sf 1,37296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evasc imvt angio sf 1,37296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evasc imvt angio sf 1,37296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evasc imvt angio sf 1,37296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revsc evasc imvt angio sf 1,37296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revsc evasc imvt angio sf 1,37296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revsc evasc imvt angio sf ea,37297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evasc imvt angio sf ea,37297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revsc evsc imvt angio cplx 1,37298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revsc evsc imvt angio cplx 1,37298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revsc evsc imvt angio cplx 1,37298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revsc evsc imvt angio cplx 1,37298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revsc evsc imvt angio cplx 1,37298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revsc evsc imvt angio cplx 1,37298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revsc evsc imvt angio cplx 1,37298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revsc evsc imvt angio cpx ea,37299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Revsc evsc imvt angio cpx ea,37299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Endoscopy ligate perf veins,37500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Endoscopy ligate perf veins,37500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Endoscopy ligate perf veins,37500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Endoscopy ligate perf veins,37500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Endoscopy ligate perf veins,37500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Endoscopy ligate perf veins,37500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,741.06,18617, Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,741.06,18617, Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,741.06,18617, Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,741.06,18617, Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,741.06,18617, Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,741.06,18617, Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,18617,APC Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,18617,APC Vascular endoscopy procedure,37501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,18617,APC Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Ligation of neck vein,37565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Ligation of a-v fistula,37607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,4466, Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,4466, Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,4466, Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,4466, Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1951.11,4466, Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1951.11,4466, Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,4466,APC Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,4466,APC Temporal artery procedure,37609,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,4466,APC Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1406,18617,APC Ligation of neck artery,37615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1406,18617,APC Ligation of chest artery,37616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of chest artery,37616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of chest artery,37616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of chest artery,37616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,1406,18617,APC Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,1406,18617,APC Ligation of abdomen artery,37617,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,1406,18617,APC Ligation of extremity artery,37618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of extremity artery,37618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of extremity artery,37618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of extremity artery,37618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,18617, Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,18617, Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,3408,18617,APC Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,3408,18617,APC Ligation of inf vena cava,37619,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,3408,18617,APC Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,6404,APC Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,6404,APC Revision of major vein,37650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,6404,APC Revision of major vein,37660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of major vein,37660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of major vein,37660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of major vein,37660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,6404,APC Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,6404,APC Revise leg vein,37700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,6404,APC Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Ligate/strip short leg vein,37718,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,8006,APC Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,8006,APC Ligate/strip long leg vein,37722,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,8006,APC Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,6404,APC Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,6404,APC Removal of leg veins/lesion,37735,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,6404,APC Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5123,APC Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5123,APC Ligate leg veins radical,37760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5123,APC Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5044, Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5044, Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,3408,5044, Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,3408,5044, Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5044,APC Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5044,APC Ligate leg veins open,37761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5044,APC Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5098,APC Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5098,APC Stab phleb veins xtr 10-20,37765,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5098,APC Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5098,APC Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5098,APC Phleb veins - extrem 20+,37766,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5098,APC Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5098,APC Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5098,APC Revision of leg vein,37780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5098,APC Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,3408,5123,APC Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,3408,5123,APC Ligate/divide/excise vein,37785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,3408,5123,APC Revascularization penis,37788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Revascularization penis,37788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Revascularization penis,37788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revascularization penis,37788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revascularization penis,37788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revascularization penis,37788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,8006,APC Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,8006,APC Penile venous occlusion,37790,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,8006,APC Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,741.06,18617, Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,741.06,18617, Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,741.06,18617, Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,741.06,18617, Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,741.06,18617, Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,741.06,18617, Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,18617,APC Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,18617,APC Vascular surgery procedure,37799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,18617,APC Removal of spleen total,38100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of spleen total,38100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of spleen total,38100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of spleen total,38100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of spleen partial,38101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of spleen partial,38101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of spleen partial,38101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of spleen partial,38101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of spleen total,38102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of spleen total,38102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of spleen total,38102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of spleen total,38102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of ruptured spleen,38115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of ruptured spleen,38115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of ruptured spleen,38115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of ruptured spleen,38115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,17041,APC Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,17041,APC Laparoscopy splenectomy,38120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,17041,APC Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,18617, Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,18617, Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc spleen,38129,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Injection for spleen x-ray,38200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for spleen x-ray,38200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for spleen x-ray,38200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for spleen x-ray,38200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Bl donor search management,38204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Bl donor search management,38204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Harvest allogeneic stem cell,38205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Harvest allogeneic stem cell,38205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Harvest allogeneic stem cell,38205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Harvest allogeneic stem cell,38205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Harvest allogeneic stem cell,38205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Harvest allogeneic stem cell,38205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1406,18617,APC Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1406,18617,APC Harvest auto stem cells,38206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1406,18617,APC Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,3314, Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,3314, Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,521.18,3314, Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,521.18,3314, Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Cryopreserve stem cells,38207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,3314, Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,3314, Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,521.18,3314, Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,521.18,3314, Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Thaw preserved stem cells,38208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,3314, Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,3314, Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,521.18,3314, Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,521.18,3314, Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Wash harvest stem cells,38209,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,3314, T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,3314, T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,521.18,3314, T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,521.18,3314, T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC T-cell depletion of harvest,38210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,4097, Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,4097, Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,521.18,4097, Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,521.18,4097, Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,4097, Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,4097, Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,4097,APC Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,4097,APC Tumor cell deplete of harvst,38211,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,4097,APC Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,3314, Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,3314, Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,521.18,3314, Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,521.18,3314, Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Rbc depletion of harvest,38212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,4097, Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,4097, Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,521.18,4097, Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,521.18,4097, Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,4097, Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,4097, Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,4097,APC Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,4097,APC Platelet deplete of harvest,38213,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,4097,APC Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,3314, Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,3314, Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,521.18,3314, Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,521.18,3314, Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Volume deplete of harvest,38214,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,521.18,3314, Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,521.18,3314, Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,521.18,3314, Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,521.18,3314, Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,521.18,3314, Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,521.18,3314, Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,3314,APC Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,3314,APC Harvest stem cell concentrte,38215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,3314,APC Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Bone marrow aspiration,38220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Bone marrow biopsy,38221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,4097,APC Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,4097,APC Dx bone marrow bx & aspir,38222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,4097,APC Car-t admn autologous,38228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,409.72,APC Car-t admn autologous,38228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,409.72,APC Car-t admn autologous,38228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,409.72,APC Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,1839.86,18617, Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,1839.86,18617, Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1839.86,18617, Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1839.86,18617, Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1839.86,18617, Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1839.86,18617, Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1839.86,18617,APC Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1839.86,18617,APC Bone marrow harvest allogen,38230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1839.86,18617,APC Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,13320, Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,13320, Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5351.16,,,,,,,fee schedule,3408,13320,APC Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5402.62,,,,,,,fee schedule,3408,13320,APC Bone marrow harvest autolog,38232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5145.35,,,,,,,fee schedule,3408,13320,APC Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,78023.3, Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,78023.3, Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3291,78023.3, Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3291,78023.3, Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,78023.3, Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,78023.3, Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77280.22,,,,,,,fee schedule,3291,78023.3,APC Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78023.3,,,,,,,fee schedule,3291,78023.3,APC Transplt allo hct/donor,38240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74307.91,,,,,,,fee schedule,3291,78023.3,APC Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,1839.86,18617, Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,1839.86,18617, Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1839.86,18617, Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1839.86,18617, Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1839.86,18617, Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1839.86,18617, Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1839.86,18617,APC Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1839.86,18617,APC Transplt autol hct/donor,38241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1839.86,18617,APC Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1406,18617,APC Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1406,18617,APC Transplt allo lymphocytes,38242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1406,18617,APC Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1913.45,,,,,,,fee schedule,1544,18617,APC Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1931.85,,,,,,,fee schedule,1544,18617,APC Transplj hematopoietic boost,38243,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1839.86,,,,,,,fee schedule,1544,18617,APC Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,4097,APC Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,4097,APC Drainage lymph node lesion,38300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,4097,APC Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,4466,APC Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,4466,APC Drainage lymph node lesion,38305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,4466,APC Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,6404,APC Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,6404,APC Incision of lymph channels,38308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,6404,APC Thoracic duct procedure,38380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thoracic duct procedure,38382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,8006,APC Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Needle biopsy lymph nodes,38505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,8006,APC Biopsy/removal lymph nodes,38530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,8006,APC Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,18617, Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,18617, Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,2816,18617,APC Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,2816,18617,APC Open bx/exc inguinofem nodes,38531,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,2816,18617,APC Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,2816,11081,APC Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,2816,11081,APC Explore deep node(s) neck,38542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,2816,11081,APC Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4810.5,,,,,,,fee schedule,3408,6404,APC Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4856.75,,,,,,,fee schedule,3408,6404,APC Removal neck/armpit lesion,38550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4625.48,,,,,,,fee schedule,3408,6404,APC Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8236.54, Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8236.54, Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8236.54, Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8236.54, Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8236.54, Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8236.54, Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,4224,8236.54,APC Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,4224,8236.54,APC Removal neck/armpit lesion,38555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,4224,8236.54,APC Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10041.81,,,,,,,fee schedule,428,18617,APC Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10138.37,,,,,,,fee schedule,428,18617,APC Removal pelvic lymph nodes,38562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9655.59,,,,,,,fee schedule,428,18617,APC Removal abdomen lymph nodes,38564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal abdomen lymph nodes,38564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal abdomen lymph nodes,38564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal abdomen lymph nodes,38564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,13320, Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,13320, Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3560,13320,APC Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3560,13320,APC Laparoscopy lymph node biop,38570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3560,13320,APC Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4062,17041,APC Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4062,17041,APC Laparoscopy lymphadenectomy,38571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4062,17041,APC Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,17041, Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4062,17041,APC Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4062,17041,APC Laparoscopy lymphadenectomy,38572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4062,17041,APC Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,18617, Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,18617, Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3560,18617,APC Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3560,18617,APC Laps pelvic lymphadec,38573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3560,18617,APC Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,18617, Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,18617, Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc lymphatic,38589,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,2816,11081,APC Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,2816,11081,APC Removal of lymph nodes neck,38700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,2816,11081,APC Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,4224,18617,APC Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,4224,18617,APC Removal of lymph nodes neck,38720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,4224,18617,APC Removal of lymph nodes neck,38724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal of lymph nodes neck,38724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,2816,9420,APC Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,2816,9420,APC Remove armpit lymph nodes,38740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,2816,9420,APC Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,9420,APC Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,9420,APC Remove armpit lymph nodes,38745,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,9420,APC Remove thoracic lymph nodes,38746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove thoracic lymph nodes,38746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove thoracic lymph nodes,38746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove thoracic lymph nodes,38746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove abdominal lymph nodes,38747,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove abdominal lymph nodes,38747,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove abdominal lymph nodes,38747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove abdominal lymph nodes,38747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.1,,,,,,,fee schedule,2816,9420,APC Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8236.54,,,,,,,fee schedule,2816,9420,APC Remove groin lymph nodes,38760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.33,,,,,,,fee schedule,2816,9420,APC Remove groin lymph nodes,38765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove groin lymph nodes,38765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove groin lymph nodes,38765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove groin lymph nodes,38765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove pelvis lymph nodes,38770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove pelvis lymph nodes,38770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove pelvis lymph nodes,38770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove pelvis lymph nodes,38770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove abdomen lymph nodes,38780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove abdomen lymph nodes,38780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove abdomen lymph nodes,38780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove abdomen lymph nodes,38780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Inject for lymphatic x-ray,38790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inject for lymphatic x-ray,38790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inject for lymphatic x-ray,38790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inject for lymphatic x-ray,38790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,472.27,3314, Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,472.27,3314, Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,472.27,3314, Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,472.27,3314, Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,472.27,3314, Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,472.27,3314, Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,3314,APC Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,3314,APC Ra tracer id of sentinl node,38792,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,3314,APC Access thoracic lymph duct,38794,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Access thoracic lymph duct,38794,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Io map of sent lymph node,38900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Io map of sent lymph node,38900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Io map of sent lymph node,38900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Io map of sent lymph node,38900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,521.18,18617, Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,521.18,18617, Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,521.18,18617, Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,521.18,18617, Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,521.18,18617, Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,521.18,18617, Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,542.03,,,,,,,fee schedule,521.18,18617,APC Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,547.24,,,,,,,fee schedule,521.18,18617,APC Blood/lymph system procedure,38999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,521.18,,,,,,,fee schedule,521.18,18617,APC Exploration of chest,39000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Exploration of chest,39000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Exploration of chest,39000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exploration of chest,39000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exploration of chest,39000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exploration of chest,39000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Exploration of chest,39010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration of chest,39010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration of chest,39010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration of chest,39010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect mediastinal cyst,39200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect mediastinal cyst,39200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect mediastinal cyst,39200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect mediastinal cyst,39200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect mediastinal tumor,39220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect mediastinal tumor,39220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect mediastinal tumor,39220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect mediastinal tumor,39220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,18617,APC Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,18617,APC Mediastinoscpy w/medstnl bx,39401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,18617,APC Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,18617,APC Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,18617,APC Mediastinoscpy w/lmph nod bx,39402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,18617,APC Chest procedure,39499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Chest procedure,39499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Chest procedure,39499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Chest procedure,39499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair diaphragm laceration,39501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair diaphragm laceration,39501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair diaphragm laceration,39501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair diaphragm laceration,39501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of diaphragm hernia,39541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of diaphragm,39545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of diaphragm,39545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of diaphragm,39545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of diaphragm,39545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect diaphragm simple,39560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect diaphragm simple,39560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect diaphragm simple,39560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect diaphragm simple,39560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect diaphragm complex,39561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect diaphragm complex,39561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect diaphragm complex,39561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect diaphragm complex,39561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Diaphragm surgery procedure,39599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Diaphragm surgery procedure,39599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Diaphragm surgery procedure,39599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Diaphragm surgery procedure,39599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,18617, Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,18617, Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Biopsy of lip,40490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Partial excision of lip,40520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Reconstruct lip with flap,40525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Reconstruct lip with flap,40527,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Partial removal of lip,40530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,637.13,5098, Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,637.13,5098, Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,637.13,5098, Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,637.13,5098, Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,637.13,5098, Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,637.13,5098, Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,5098,APC Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,5098,APC Repair lip,40650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,5098,APC Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,637.13,5098, Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,637.13,5098, Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,637.13,5098, Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,637.13,5098, Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,637.13,5098, Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,637.13,5098, Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,5098,APC Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,5098,APC Repair lip,40652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,5098,APC Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1832.96,5098, Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1832.96,5098, Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1832.96,5098, Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1832.96,5098, Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1832.96,5098, Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1832.96,5098, Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,5098,APC Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,5098,APC Repair lip,40654,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,5098,APC Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Repair cleft lip/nasal,40700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Repair cleft lip/nasal,40701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,18617, Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,18617, Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,18617,APC Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,18617,APC Repair cleft lip/nasal,40702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,18617,APC Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3563,9918, Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3563,9918, Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,9918, Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,9918, Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3563,9918, Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3563,9918, Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3563,9918,APC Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3563,9918,APC Repair cleft lip/nasal,40720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3563,9918,APC Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Repair cleft lip/nasal,40761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,279.8,18617, Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,279.8,18617, Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Lip surgery procedure,40799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,18617, Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,18617, Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Drainage of mouth lesion,40800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,637.13,4466, Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,637.13,4466, Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,637.13,4466, Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,637.13,4466, Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,637.13,4466, Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,637.13,4466, Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4466,APC Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4466,APC Drainage of mouth lesion,40801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4466,APC Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1071.46,18617, Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1071.46,18617, Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1071.46,18617, Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1071.46,18617, Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1071.46,18617, Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1071.46,18617, Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,18617,APC Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,18617,APC Removal foreign body mouth,40804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,18617,APC Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,637.13,4466, Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,637.13,4466, Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,4466, Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,4466, Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,637.13,4466, Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,637.13,4466, Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4466,APC Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4466,APC Removal foreign body mouth,40805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4466,APC Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,428,18617,APC Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,428,18617,APC Incision of lip fold,40806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,428,18617,APC Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,18617, Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,18617, Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,637.13,18617, Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,637.13,18617, Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,637.13,18617, Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,637.13,18617, Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,18617,APC Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,18617,APC Biopsy of mouth lesion,40808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,18617,APC Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Excision of mouth lesion,40810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Excise/repair mouth lesion,40812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,8006,APC Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,8006,APC Excise/repair mouth lesion,40814,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,8006,APC Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,8006,APC Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,8006,APC Excision of mouth lesion,40816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,8006,APC Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,6404, Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,6404, Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,637.13,6404, Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,637.13,6404, Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,6404, Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,6404, Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,6404,APC Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,6404,APC Excise oral mucosa for graft,40818,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,6404,APC Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,5123,APC Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,5123,APC Excise lip or cheek fold,40819,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,5123,APC Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,6404,APC Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,6404,APC Treatment of mouth lesion,40820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,6404,APC Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,18617, Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,18617, Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Repair mouth laceration,40830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,3314, Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,3314, Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,637.13,3314, Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,637.13,3314, Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,3314, Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,3314, Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,3314,APC Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,3314,APC Repair mouth laceration,40831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,3314,APC Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Reconstruction of mouth,40840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Reconstruction of mouth,40842,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,13036,APC Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,13036,APC Reconstruction of mouth,40843,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,13036,APC Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,8006,APC Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,8006,APC Reconstruction of mouth,40844,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,8006,APC Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,8006,APC Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,8006,APC Reconstruction of mouth,40845,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,8006,APC Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,279.8,18617, Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,279.8,18617, Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,279.8,18617, Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,279.8,18617, Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Mouth surgery procedure,40899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,3314, Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,3314, Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,637.13,3314, Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,637.13,3314, Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,3314, Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,3314, Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,3314,APC Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,3314,APC Drainage of mouth lesion,41000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,3314,APC Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,3314, Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,3314, Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,279.8,3314, Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,279.8,3314, Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,3314, Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,3314, Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,3314,APC Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,3314,APC Drainage of mouth lesion,41005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,3314,APC Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,855,3314,APC Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,855,3314,APC Drainage of mouth lesion,41006,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,855,3314,APC Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,5123,APC Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,5123,APC Drainage of mouth lesion,41007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,5123,APC Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,6404,APC Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,6404,APC Drainage of mouth lesion,41008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,6404,APC Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,4097, Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,4097, Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,637.13,4097, Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,637.13,4097, Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,4097, Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,4097, Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4097,APC Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4097,APC Drainage of mouth lesion,41009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4097,APC Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,5123,APC Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,5123,APC Incision of tongue fold,41010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,5123,APC Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,17041, Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,17041, Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,637.13,17041, Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,637.13,17041, Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,17041, Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,17041, Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,17041,APC Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,17041,APC Drainage of mouth lesion,41015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,17041,APC Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1544,8006,APC Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1544,8006,APC Drainage of mouth lesion,41016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1544,8006,APC Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,6404,APC Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,6404,APC Drainage of mouth lesion,41017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,6404,APC Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,3314,APC Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,3314,APC Drainage of mouth lesion,41018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,3314,APC Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9918, Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9918, Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9918, Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9918, Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,9918, Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,9918, Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1544,9918,APC Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1544,9918,APC Place needles h&n for rt,41019,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1544,9918,APC Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,3314, Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,3314, Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,3314, Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,3314, Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,3314, Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,3314, Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,3314,APC Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,3314,APC Biopsy of tongue,41100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,3314,APC Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,4466,APC Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,4466,APC Biopsy of tongue,41105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,4466,APC Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Biopsy of floor of mouth,41108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,5123,APC Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,5123,APC Excision of tongue lesion,41110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,5123,APC Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Excision of tongue lesion,41112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Excision of tongue lesion,41113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Excision of tongue lesion,41114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Excision of tongue fold,41115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,6404,APC Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,6404,APC Excision of mouth lesion,41116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,6404,APC Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,8006,APC Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,8006,APC Partial removal of tongue,41120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,8006,APC Partial removal of tongue,41130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of tongue,41130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of tongue,41130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of tongue,41130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tongue and neck surgery,41135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tongue and neck surgery,41135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tongue and neck surgery,41135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tongue and neck surgery,41135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of tongue,41140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of tongue,41140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of tongue,41140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of tongue,41140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tongue removal neck surgery,41145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tongue removal neck surgery,41145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tongue removal neck surgery,41145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tongue removal neck surgery,41145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tongue mouth jaw surgery,41150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tongue mouth jaw surgery,41150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tongue mouth jaw surgery,41150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tongue mouth jaw surgery,41150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tongue mouth neck surgery,41153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tongue mouth neck surgery,41153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tongue mouth neck surgery,41153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tongue mouth neck surgery,41153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tongue jaw & neck surgery,41155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tongue jaw & neck surgery,41155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tongue jaw & neck surgery,41155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tongue jaw & neck surgery,41155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,527.74,4466, Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,527.74,4466, Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,4466, Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,4466, Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,527.74,4466, Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,527.74,4466, Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,4466,APC Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,4466,APC Repair tongue laceration,41250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,4466,APC Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,4466,APC Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,4466,APC Repair tongue laceration,41251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,4466,APC Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,279.8,4466, Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,4466,APC Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,4466,APC Repair tongue laceration,41252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,4466,APC Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4112.54, Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4112.54, Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4112.54, Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4112.54, Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4112.54, Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4112.54, Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,4112.54,APC Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,4112.54,APC Tongue to lip surgery,41510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,4112.54,APC Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,15339, Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,15339, Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,15339,APC Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,15339,APC Tongue suspension,41512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,15339,APC Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Reconstruction tongue fold,41520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9918, Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9918, Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,9918, Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,9918, Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,9918, Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,9918, Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,9918,APC Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,9918,APC Tongue base vol reduction,41530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,9918,APC Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,279.8,18617, Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,279.8,18617, Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Tongue and mouth surgery,41599,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,3314, Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,3314, Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,3314, Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,3314, Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,157.18,3314, Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,157.18,3314, Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,3314,APC Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,3314,APC Drainage of gum lesion,41800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,3314,APC Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,8006,APC Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,8006,APC Removal foreign body gum,41805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,8006,APC Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,6404,APC Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,6404,APC Removal foreign body jawbone,41806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,6404,APC Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4112.54, Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4112.54, Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4112.54, Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4112.54, Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4112.54, Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4112.54, Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,4112.54,APC Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,4112.54,APC Excision gum each quadrant,41820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,4112.54,APC Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,428,3314,APC Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,428,3314,APC Excision of gum flap,41821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,428,3314,APC Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,18617, Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,18617, Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,18617,APC Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,18617,APC Excision of gum lesion,41823,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,18617,APC Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41826,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Excision of gum lesion,41827,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Excision of gum lesion,41828,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,18617, Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,18617, Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Removal of gum tissue,41830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,18617, Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,18617, Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Treatment of gum lesion,41850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,18617, Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,18617, Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,18617, Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,18617, Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1832.96,18617, Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1832.96,18617, Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,18617,APC Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,18617,APC Gum graft,41870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,18617,APC Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Repair gum,41872,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,18617, Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,18617, Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Repair tooth socket,41874,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,279.8,18617, Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,279.8,18617, Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Dental surgery procedure,41899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,279.8,4466, Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,279.8,4466, Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,4466, Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,4466, Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,279.8,4466, Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,279.8,4466, Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,4466,APC Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,4466,APC Drainage mouth roof lesion,42000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,4466,APC Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,3314,APC Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,3314,APC Biopsy roof of mouth,42100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,3314,APC Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Excision lesion mouth roof,42104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Excision lesion mouth roof,42106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Excision lesion mouth roof,42107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,8006,APC Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,8006,APC Remove palate/lesion,42120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,8006,APC Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Excision of uvula,42140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,8006,APC Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,8006,APC Repair palate pharynx/uvula,42145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,8006,APC Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,5123,APC Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,5123,APC Treatment mouth roof lesion,42160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,5123,APC Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,4097, Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,4097, Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,637.13,4097, Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,637.13,4097, Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,4097, Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,4097, Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4097,APC Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4097,APC Repair palate,42180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4097,APC Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Repair palate,42182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Reconstruct cleft palate,42200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3291,7422,APC Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3291,7422,APC Reconstruct cleft palate,42205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3291,7422,APC Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,15339,APC Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,15339,APC Reconstruct cleft palate,42210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,15339,APC Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Reconstruct cleft palate,42215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Reconstruct cleft palate,42220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13036,APC Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13036,APC Reconstruct cleft palate,42225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13036,APC Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Lengthening of palate,42226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,18617,APC Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,18617,APC Lengthening of palate,42227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,18617,APC Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,13036,APC Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,13036,APC Repair palate,42235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,13036,APC Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,8006,APC Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,8006,APC Repair nose to lip fistula,42260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,8006,APC Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,428,18617,APC Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,428,18617,APC Preparation palate mold,42280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,428,18617,APC Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,11081,APC Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,11081,APC Insertion palate prosthesis,42281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,11081,APC Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,279.8,18617, Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,279.8,18617, Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Palate/uvula surgery,42299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Drainage of salivary gland,42300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,4466,APC Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,4466,APC Drainage of salivary gland,42305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,4466,APC Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,3314,APC Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,3314,APC Drainage of salivary gland,42310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,3314,APC Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,3314, Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,3314,APC Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,3314,APC Drainage of salivary gland,42320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,3314,APC Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,18617,APC Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,18617,APC Removal of salivary stone,42330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,18617,APC Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Removal of salivary stone,42335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Removal of salivary stone,42340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Biopsy of salivary gland,42400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,5123, Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,5123, Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1832.96,5123, Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1832.96,5123, Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1832.96,5123, Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1832.96,5123, Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,5123,APC Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,5123,APC Biopsy of salivary gland,42405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,5123,APC Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Excision of salivary cyst,42408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Drainage of salivary cyst,42409,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,11081,APC Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,11081,APC Excise parotid gland/lesion,42410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,11081,APC Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Excise parotid gland/lesion,42415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Excise parotid gland/lesion,42420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Excise parotid gland/lesion,42425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Excise parotid gland/lesion,42426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excise parotid gland/lesion,42426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excise parotid gland/lesion,42426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excise parotid gland/lesion,42426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Excise submaxillary gland,42440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Excise sublingual gland,42450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Repair salivary duct,42500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,9420,APC Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,9420,APC Repair salivary duct,42505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,9420,APC Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,9420,APC Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,9420,APC Parotid duct diversion,42507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,9420,APC Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,7343.03, Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,7343.03, Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7343.03, Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7343.03, Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,7343.03, Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,7343.03, Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,7343.03,APC Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,7343.03,APC Parotid duct diversion,42509,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,7343.03,APC Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,8006, Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,8006, Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3916.7,8006, Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3916.7,8006, Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,8006, Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,8006, Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,8006,APC Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,8006,APC Parotid duct diversion,42510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,8006,APC Injection for salivary x-ray,42550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for salivary x-ray,42550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for salivary x-ray,42550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for salivary x-ray,42550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,6404,APC Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,6404,APC Closure of salivary fistula,42600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,6404,APC Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Dilation of salivary duct,42650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,18617, Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,18617, Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,637.13,18617, Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,637.13,18617, Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,637.13,18617, Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,637.13,18617, Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,18617,APC Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,18617,APC Dilation of salivary duct,42660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,18617,APC Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3916.7,9918, Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3916.7,9918, Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,9918, Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,9918, Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3916.7,9918, Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3916.7,9918, Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,9918,APC Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,9918,APC Ligation of salivary duct,42665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,9918,APC Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,279.8,18617, Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,279.8,18617, Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Salivary surgery procedure,42699,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,3314, Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,3314, Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,3314, Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,3314, Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,3314, Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,3314, Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,3314,APC Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,3314,APC Drainage of tonsil abscess,42700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,3314,APC Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,8006,APC Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,8006,APC Drainage of throat abscess,42720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,8006,APC Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,15339, Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,15339, Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,15339,APC Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,15339,APC Drainage of throat abscess,42725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,15339,APC Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,18617,APC Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,18617,APC Biopsy of throat,42800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,18617,APC Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,5123,APC Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,5123,APC Biopsy of upper nose/throat,42804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,5123,APC Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,8006,APC Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,8006,APC Biopsy of upper nose/throat,42806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,8006,APC Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,6404,APC Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,6404,APC Excise pharynx lesion,42808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,6404,APC Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,4097, Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,4097, Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,527.74,4097, Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,527.74,4097, Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,527.74,4097, Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,527.74,4097, Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,4097,APC Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,4097,APC Remove pharynx foreign body,42809,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,4097,APC Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Excision of neck cyst,42810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,8006,APC Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,8006,APC Excision of neck cyst,42815,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,8006,APC Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,11081,APC Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,11081,APC Remove tonsils and adenoids,42820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,11081,APC Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3291,7422,APC Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3291,7422,APC Remove tonsils and adenoids,42821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3291,7422,APC Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,7343.03, Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,7343.03, Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,7343.03, Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,7343.03, Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,7343.03, Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,7343.03, Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,7343.03,APC Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,7343.03,APC Removal of tonsils,42825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,7343.03,APC Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6312, Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6312, Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3916.7,6312, Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3916.7,6312, Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6312, Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6312, Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6312,APC Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6312,APC Removal of tonsils,42826,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6312,APC Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6312,APC Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6312,APC Removal of adenoids,42830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6312,APC Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6404, Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6404, Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,6404, Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,6404, Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6404, Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6404, Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6404,APC Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6404,APC Removal of adenoids,42831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6404,APC Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,6312, Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,6312, Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,6312, Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,6312, Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3563,6312, Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3563,6312, Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3563,6312,APC Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3563,6312,APC Removal of adenoids,42835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3563,6312,APC Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6312, Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6312,APC Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6312,APC Removal of adenoids,42836,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6312,APC Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Extensive surgery of throat,42842,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Extensive surgery of throat,42844,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Extensive surgery of throat,42845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive surgery of throat,42845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,5123,APC Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,5123,APC Excision of tonsil tags,42860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,5123,APC Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Excision of lingual tonsil,42870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Description Not Available,42880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,42880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,42880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,42880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Partial removal of pharynx,42890,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Revision of pharyngeal walls,42892,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Revision of pharyngeal walls,42894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of pharyngeal walls,42894,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of pharyngeal walls,42894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of pharyngeal walls,42894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,4097,APC Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,4097,APC Repair throat wound,42900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,4097,APC Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,9420,APC Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,9420,APC Reconstruction of throat,42950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,9420,APC Repair throat esophagus,42953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair throat esophagus,42953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair throat esophagus,42953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair throat esophagus,42953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,4466, Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,4466, Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1832.96,4466, Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1832.96,4466, Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1832.96,4466, Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1832.96,4466, Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,4466,APC Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,4466,APC Surgical opening of throat,42955,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,4466,APC Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,637.13,4097, Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,637.13,4097, Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,637.13,4097, Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,637.13,4097, Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,4097, Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,4097, Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,4097,APC Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,4097,APC Control throat bleeding,42960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,4097,APC Control throat bleeding,42961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Control throat bleeding,42961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Control throat bleeding,42961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Control throat bleeding,42961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Control throat bleeding,42962,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,279.8,18617, Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,279.8,18617, Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Control nose/throat bleeding,42970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Control nose/throat bleeding,42971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Control nose/throat bleeding,42971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Control nose/throat bleeding,42971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Control nose/throat bleeding,42971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Control nose/throat bleeding,42972,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,18617, Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,18617, Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2186.78,,,,,,,fee schedule,855,18617,APC Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2207.81,,,,,,,fee schedule,855,18617,APC Dise eval slp do brth flx dx,42975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2102.67,,,,,,,fee schedule,855,18617,APC Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,279.8,18617, Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,279.8,18617, Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Throat surgery procedure,42999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,3314, Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,3314, Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,428,3314,APC Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,428,3314,APC Incision of esophagus,43020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,428,3314,APC Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Throat muscle surgery,43030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Incision of esophagus,43045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of esophagus,43045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of esophagus,43045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of esophagus,43045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of esophagus lesion,43101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of esophagus,43107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of esophagus,43107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of esophagus,43107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of esophagus,43107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of esophagus,43108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of esophagus,43108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of esophagus,43108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of esophagus,43108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of esophagus,43112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of esophagus,43112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of esophagus,43112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of esophagus,43112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of esophagus,43113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of esophagus,43113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of esophagus,43113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of esophagus,43113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of esophagus,43123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of esophagus,43124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of esophagus,43124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of esophagus,43124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of esophagus,43124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Removal of esophagus pouch,43130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Removal of esophagus pouch,43135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of esophagus pouch,43135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of esophagus pouch,43135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of esophagus pouch,43135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,13320, Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,13320, Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,13320,APC Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,13320,APC Esophagoscopy rigid trnso,43180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,13320,APC Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,5123, Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,5123, Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,5123,APC Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,5123,APC Esophagoscopy rigid trnso dx,43191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,5123,APC Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso inject,43192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso biopsy,43193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,7422,APC Esophagoscp rig trnso rem fb,43194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,7422,APC Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,7422, Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,7422, Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,7422, Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,7422, Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2816,7422, Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2816,7422, Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,2816,7422,APC Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,2816,7422,APC Esophagoscopy rigid balloon,43195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,2816,7422,APC Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,7422, Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,7422, Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2266.89,7422, Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2266.89,7422, Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2266.89,7422, Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2266.89,7422, Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,7422,APC Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,7422,APC Esophagoscp guide wire dilat,43196,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,7422,APC Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,5098, Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,5098, Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,5098, Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,5098, Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,855,5098, Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,855,5098, Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,855,5098,APC Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,855,5098,APC Esophagoscopy flex dx brush,43197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,855,5098,APC Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,5098, Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,5098, Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,5098, Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,5098, Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1071.46,5098, Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1071.46,5098, Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,5098,APC Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,5098,APC Esophagosc flex trnsn biopsy,43198,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,5098,APC Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Esophagoscopy flexible brush,43200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,4097,APC Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,4097,APC Esoph scope w/submucous inj,43201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,4097,APC Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,3314,APC Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,3314,APC Esophagoscopy flex biopsy,43202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,3314,APC Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,3314,APC Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,3314,APC Esoph scope w/sclerosis inj,43204,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,3314,APC Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,3314,APC Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,3314,APC Esophagus endoscopy/ligation,43205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,3314,APC Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,7422, Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,7422, Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,7422,APC Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,7422,APC Esoph optical endomicroscopy,43206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,7422,APC Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,428,13320,APC Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,428,13320,APC Egd esophagogastrc fndoplsty,43210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,428,13320,APC Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,5098, Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,5098, Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,5098, Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,5098, Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2266.89,5098, Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2266.89,5098, Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,5098,APC Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,5098,APC Esophagoscop mucosal resect,43211,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,5098,APC Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,13320, Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,13320, Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,2816,13320,APC Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,2816,13320,APC Esophagoscop stent placement,43212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,2816,13320,APC Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,7422, Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,7422, Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,7422, Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,7422, Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2138,7422, Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2138,7422, Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2138,7422,APC Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2138,7422,APC Esophagoscopy retro balloon,43213,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2138,7422,APC Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,7422, Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,7422, Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,7422, Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,7422, Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2266.89,7422, Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2266.89,7422, Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,7422,APC Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,7422,APC Esophagosc dilate balloon 30,43214,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,7422,APC Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,4097,APC Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,4097,APC Esophagoscopy flex remove fb,43215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,4097,APC Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,5123,APC Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,5123,APC Esophagoscopy lesion removal,43216,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,5123,APC Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,4097,APC Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,4097,APC Esophagoscopy snare les remv,43217,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,4097,APC Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4166, Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4166, Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4166, Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4166, Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2266.89,4166, Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2266.89,4166, Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4166,APC Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4166,APC Esophagoscopy balloon <30mm,43220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4166,APC Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,4097,APC Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,4097,APC Esoph endoscopy dilation,43226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,4097,APC Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Esophagoscopy control bleed,43227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,13320, Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,13320, Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,2816,13320,APC Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,2816,13320,APC Esophagoscopy lesion ablate,43229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,2816,13320,APC Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2138,4466,APC Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2138,4466,APC Esophagoscop ultrasound exam,43231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2138,4466,APC Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Esophagoscopy w/us needle bx,43232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,7422, Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,7422, Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,7422, Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,7422, Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2266.89,7422, Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2266.89,7422, Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,7422,APC Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,7422,APC Egd balloon dil esoph30 mm/>,43233,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,7422,APC Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Egd diagnostic brush wash,43235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,4466, Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,4466, Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,4466, Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,4466, Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1071.46,4466, Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1071.46,4466, Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,4466,APC Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,4466,APC Uppr gi scope w/submuc inj,43236,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,4466,APC Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2138,4466,APC Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2138,4466,APC Endoscopic us exam esoph,43237,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2138,4466,APC Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd us fine needle bx/aspir,43238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,4466, Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,4466, Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,4466, Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,4466, Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1071.46,4466, Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1071.46,4466, Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,4466,APC Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,4466,APC Egd biopsy single/multiple,43239,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,4466,APC Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,7530.41, Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,7530.41, Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,7530.41, Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,7530.41, Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,7530.41, Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,7530.41, Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,2816,7530.41,APC Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,2816,7530.41,APC Egd w/transmural drain cyst,43240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,2816,7530.41,APC Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd tube/cath insertion,43241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd us fine needle bx/aspir,43242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd injection varices,43243,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2138,4466,APC Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2138,4466,APC Egd varices ligation,43244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2138,4466,APC Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd dilate stricture,43245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd place gastrostomy tube,43246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,4466, Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,4466, Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,4466, Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,4466, Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1071.46,4466, Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1071.46,4466, Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,4466,APC Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,4466,APC Egd remove foreign body,43247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,4466,APC Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,4466, Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,4466, Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,4466, Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,4466, Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1071.46,4466, Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1071.46,4466, Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,4466,APC Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,4466,APC Egd guide wire insertion,43248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,4466,APC Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Esoph egd dilation <30 mm,43249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd cautery tumor polyp,43250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd remove lesion snare,43251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,7422, Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,7422, Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2266.89,7422, Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2266.89,7422, Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2266.89,7422, Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2266.89,7422, Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,7422,APC Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,7422,APC Egd optical endomicroscopy,43252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,7422,APC Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2266.89,7422, Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2266.89,7422, Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,7422, Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,7422, Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2266.89,7422, Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2266.89,7422, Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,7422,APC Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,7422,APC Egd us transmural injxn/mark,43253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,7422,APC Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2266.89,5098, Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2266.89,5098, Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,5098, Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,5098, Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2266.89,5098, Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2266.89,5098, Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,5098,APC Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,5098,APC Egd endo mucosal resection,43254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,5098,APC Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Egd control bleeding any,43255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,3408,6404,APC Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,3408,6404,APC Egd w/thrml txmnt gerd,43257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,3408,6404,APC Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,5098, Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,5098, Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,5098, Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,5098, Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2138,5098, Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2138,5098, Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2138,5098,APC Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2138,5098,APC Egd us exam duodenum/jejunum,43259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2138,5098,APC Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,2816,5123,APC Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,2816,5123,APC Ercp w/specimen collection,43260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,2816,5123,APC Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,2816,6404,APC Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,2816,6404,APC Endo cholangiopancreatograph,43261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,2816,6404,APC Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,2816,6404,APC Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,2816,6404,APC Endo cholangiopancreatograph,43262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,2816,6404,APC Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,5123, Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,5123, Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2266.89,5123, Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2266.89,5123, Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,5123, Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,5123, Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,5123,APC Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,5123,APC Ercp sphincter pressure meas,43263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,5123,APC Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,2816,6404,APC Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,2816,6404,APC Ercp remove duct calculi,43264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,2816,6404,APC Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,2816,9420,APC Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,2816,9420,APC Ercp lithotripsy calculi,43265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,2816,9420,APC Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3408,13320,APC Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3408,13320,APC Egd endoscopic stent place,43266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3408,13320,APC Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2266.89,7422, Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2266.89,7422, Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,7422, Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,7422, Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2266.89,7422, Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2266.89,7422, Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,7422,APC Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,7422,APC Egd lesion ablation,43270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,7422,APC Endoscopic pancreatoscopy,43273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Endoscopic pancreatoscopy,43273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Endoscopic pancreatoscopy,43273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,13320, Endoscopic pancreatoscopy,43273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,13320, Endoscopic pancreatoscopy,43273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Endoscopic pancreatoscopy,43273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,13320, Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,13320, Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3408,13320,APC Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3408,13320,APC Ercp duct stent placement,43274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3408,13320,APC Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2266.89,13320, Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2266.89,13320, Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2266.89,13320, Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2266.89,13320, Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2266.89,13320, Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2266.89,13320, Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,13320,APC Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,13320,APC Ercp remove forgn body duct,43275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,13320,APC Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,13320, Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,13320, Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3408,13320,APC Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3408,13320,APC Ercp stent exchange w/dilate,43276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3408,13320,APC Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,3408,13320,APC Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,3408,13320,APC Ercp ea duct/ampulla dilate,43277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,3408,13320,APC Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,13320, Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,13320, Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,3408,13320,APC Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,3408,13320,APC Ercp lesion ablate w/dilate,43278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,3408,13320,APC Lap myotomy heller,43279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Lap myotomy heller,43279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Lap myotomy heller,43279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Lap myotomy heller,43279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Lap myotomy heller,43279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Lap myotomy heller,43279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,15339,APC Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,15339,APC Laparoscopy fundoplasty,43280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,15339,APC Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,18617,APC Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,18617,APC Lap paraesophag hern repair,43281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,18617,APC Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,18617,APC Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,18617,APC Lap paraesoph her rpr w/mesh,43282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,18617,APC Lap esoph lengthening,43283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Lap esoph lengthening,43283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Lap esoph lengthening,43283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Lap esoph lengthening,43283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Lap esoph lengthening,43283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Lap esoph lengthening,43283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laps esophgl sphnctr agmntj,43284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Laps esophgl sphnctr agmntj,43284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Laps esophgl sphnctr agmntj,43284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Laps esophgl sphnctr agmntj,43284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Laps esophgl sphnctr agmntj,43284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,17041,APC Laps esophgl sphnctr agmntj,43284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,17041,APC Laps esophgl sphnctr agmntj,43284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,17041,APC Rmvl esophgl sphnctr dev,43285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Rmvl esophgl sphnctr dev,43285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Rmvl esophgl sphnctr dev,43285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Rmvl esophgl sphnctr dev,43285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Rmvl esophgl sphnctr dev,43285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,11081,APC Rmvl esophgl sphnctr dev,43285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,11081,APC Rmvl esophgl sphnctr dev,43285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,11081,APC Esphg tot w/laps moblj,43286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esphg tot w/laps moblj,43286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esphg tot w/laps moblj,43286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esphg tot w/laps moblj,43286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esphg dstl 2/3 w/laps moblj,43287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esphg dstl 2/3 w/laps moblj,43287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esphg dstl 2/3 w/laps moblj,43287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esphg dstl 2/3 w/laps moblj,43287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esphg thrsc moblj,43288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esphg thrsc moblj,43288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esphg thrsc moblj,43288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esphg thrsc moblj,43288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,18617, Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,18617, Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc esoph,43289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Egd flx trnsorl dplmnt balo,43290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2266.89,9918, Egd flx trnsorl dplmnt balo,43290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2266.89,9918, Egd flx trnsorl dplmnt balo,43290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2266.89,9918, Egd flx trnsorl dplmnt balo,43290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2266.89,9918, Egd flx trnsorl dplmnt balo,43290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,9918,APC Egd flx trnsorl dplmnt balo,43290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,9918,APC Egd flx trnsorl dplmnt balo,43290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,9918,APC Egd flx trnsorl rmvl balo,43291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,7422, Egd flx trnsorl rmvl balo,43291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,7422, Egd flx trnsorl rmvl balo,43291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1071.46,7422, Egd flx trnsorl rmvl balo,43291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1071.46,7422, Egd flx trnsorl rmvl balo,43291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,7422,APC Egd flx trnsorl rmvl balo,43291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,7422,APC Egd flx trnsorl rmvl balo,43291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,7422,APC Repair of esophagus,43300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of esophagus,43300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of esophagus,43300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of esophagus,43300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of esophagus,43310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of esophagus,43310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of esophagus,43310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of esophagus,43310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair esophagus and fistula,43312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esophagoplasty congenital,43313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esophagoplasty congenital,43313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esophagoplasty congenital,43313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esophagoplasty congenital,43313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tracheo-esophagoplasty cong,43314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tracheo-esophagoplasty cong,43314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tracheo-esophagoplasty cong,43314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tracheo-esophagoplasty cong,43314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse esophagus & stomach,43320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse esophagus & stomach,43320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse esophagus & stomach,43320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse esophagus & stomach,43320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise esophagus & stomach,43325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise esophagus & stomach,43325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise esophagus & stomach,43325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise esophagus & stomach,43325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esoph fundoplasty lap,43327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esoph fundoplasty lap,43327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esoph fundoplasty lap,43327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esoph fundoplasty lap,43327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esoph fundoplasty thor,43328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esoph fundoplasty thor,43328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esoph fundoplasty thor,43328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esoph fundoplasty thor,43328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esophagomyotomy abdominal,43330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esophagomyotomy abdominal,43330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esophagomyotomy abdominal,43330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esophagomyotomy abdominal,43330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esophagomyotomy thoracic,43331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esophagomyotomy thoracic,43331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esophagomyotomy thoracic,43331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esophagomyotomy thoracic,43331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transab esoph hiat hern rpr,43333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transthor diaphrag hern rpr,43335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Thorabd diaphr hern repair,43337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Esoph lengthening,43338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Esoph lengthening,43338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Esoph lengthening,43338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Esoph lengthening,43338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse esophagus & intestine,43341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgical opening esophagus,43352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gastrointestinal repair,43361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligate esophagus veins,43400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligate esophagus veins,43400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligate esophagus veins,43400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligate esophagus veins,43400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ligate/staple esophagus,43405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligate/staple esophagus,43405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligate/staple esophagus,43405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligate/staple esophagus,43405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair esophagus wound,43415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,18617, Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,18617, Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,18617,APC Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,18617,APC Repair esophagus opening,43420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,18617,APC Repair esophagus opening,43425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair esophagus opening,43425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair esophagus opening,43425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair esophagus opening,43425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Dilate esophagus 1/mult pass,43450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,4097,APC Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,4097,APC Dilate esophagus,43453,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,4097,APC Pressure treatment esophagus,43460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pressure treatment esophagus,43460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pressure treatment esophagus,43460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pressure treatment esophagus,43460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Free jejunum flap microvasc,43496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Free jejunum flap microvasc,43496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Free jejunum flap microvasc,43496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Free jejunum flap microvasc,43496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,13320, Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,13320, Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,2816,13320,APC Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,2816,13320,APC Transorl lwr esophgl myotomy,43497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,2816,13320,APC Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,18617, Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,18617, Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1071.46,18617, Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1071.46,18617, Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1071.46,18617, Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1071.46,18617, Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,18617,APC Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,18617,APC Esophagus surgery procedure,43499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,18617,APC Surgical opening of stomach,43500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgical opening of stomach,43500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgical opening of stomach,43500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgical opening of stomach,43500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgical repair of stomach,43502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,855,18617, Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,855,18617, Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,855,18617,APC Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,855,18617,APC Surgical opening of stomach,43510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,855,18617,APC Incision of pyloric muscle,43520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of pyloric muscle,43520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of pyloric muscle,43520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of pyloric muscle,43520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy of stomach,43605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Biopsy of stomach,43605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Biopsy of stomach,43605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Biopsy of stomach,43605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of stomach lesion,43611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach,43620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach,43620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach,43620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach,43620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach,43621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach,43621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach,43621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach,43621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach,43622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach,43622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach,43622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach,43622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of stomach partial,43635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vagotomy & pylorus repair,43641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap gastric bypass/roux-en-y,43644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lap gastric bypass/roux-en-y,43644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lap gastric bypass/roux-en-y,43644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lap gastric bypass/roux-en-y,43644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap gastr bypass incl smll i,43645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lap gastr bypass incl smll i,43645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lap gastr bypass incl smll i,43645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lap gastr bypass incl smll i,43645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13821.53, Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13821.53, Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13821.53, Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13821.53, Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13821.53, Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13821.53, Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,3408,13821.53,APC Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,3408,13821.53,APC Lap impl electrode antrum,43647,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,3408,13821.53,APC Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,13320, Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,13320, Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,13320,APC Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,13320,APC Lap revise/remv eltrd antrum,43648,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,13320,APC Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7498.94, Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7498.94, Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7498.94, Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7498.94, Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7498.94, Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7498.94, Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,7498.94,APC Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,7498.94,APC Laparoscopy vagus nerve,43651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,7498.94,APC Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,9420,APC Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,9420,APC Laparoscopy vagus nerve,43652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,9420,APC Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,13320, Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,13320, Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3560,13320,APC Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3560,13320,APC Laparoscopy gastrostomy,43653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3560,13320,APC Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,18617, Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,18617, Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc stom,43659,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,527.74,18617, Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,527.74,18617, Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Nasal/orogastric w/tube plmt,43752,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,255.08,3314, Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,255.08,3314, Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,255.08,3314, Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,255.08,3314, Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,255.08,3314, Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,255.08,3314, Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,3314,APC Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,3314,APC Tx gastro intub w/asp,43753,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,3314,APC Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,432.56,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,495.35,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,255.08,4097, Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,4097,APC Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,4097,APC Dx gastr intub w/asp spec,43754,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,4097,APC Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,432.56,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,495.35,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,152.01,3314, Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,3314,APC Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,3314,APC Dx gastr intub w/asp specs,43755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,3314,APC Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.53,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.14,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,36.53,3314, Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,36.53,3314,APC Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,36.53,3314,APC Dx duod intub w/asp spec,43756,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,36.53,3314,APC Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,855,3314,APC Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,855,3314,APC Dx duod intub w/asp specs,43757,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,855,3314,APC Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Reposition gastrostomy tube,43761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Rplc gtube no revj trc,43762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Rplc gtube revj gstrst trc,43763,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,18617,APC Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,18617,APC Lap place gastr adj device,43770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,18617,APC Lap revise gastr adj device,43771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap revise gastr adj device,43771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap revise gastr adj device,43771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Lap revise gastr adj device,43771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Lap revise gastr adj device,43771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap revise gastr adj device,43771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,3408,18617,APC Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,3408,18617,APC Lap rmvl gastr adj device,43772,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,3408,18617,APC Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Lap replace gastr adj device,43773,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,3408,18617,APC Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,3408,18617,APC Lap rmvl gastr adj all parts,43774,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,3408,18617,APC Lap sleeve gastrectomy,43775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lap sleeve gastrectomy,43775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lap sleeve gastrectomy,43775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lap sleeve gastrectomy,43775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruction of pylorus,43800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruction of pylorus,43800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruction of pylorus,43800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruction of pylorus,43800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of stomach and bowel,43825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1406,18617,APC Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1406,18617,APC Place gastrostomy tube,43830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1406,18617,APC Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,428,18617,APC Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,428,18617,APC Place gastrostomy tube,43831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,428,18617,APC Place gastrostomy tube,43832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Place gastrostomy tube,43832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,1406,18617,APC Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,1406,18617,APC Repair of stomach lesion,43840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,1406,18617,APC V-band gastroplasty,43842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, V-band gastroplasty,43842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, V-band gastroplasty,43842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, V-band gastroplasty,43842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gastroplasty w/o v-band,43843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Gastroplasty w/o v-band,43843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Gastroplasty w/o v-band,43843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Gastroplasty w/o v-band,43843,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Gastroplasty w/o v-band,43843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Gastroplasty w/o v-band,43843,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Gastroplasty duodenal switch,43845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gastroplasty duodenal switch,43845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gastroplasty duodenal switch,43845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gastroplasty duodenal switch,43845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gastric bypass for obesity,43846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gastric bypass for obesity,43846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gastric bypass for obesity,43846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gastric bypass for obesity,43846,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gastric bypass incl small i,43847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gastric bypass incl small i,43847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gastric bypass incl small i,43847,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gastric bypass incl small i,43847,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision gastroplasty,43848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision gastroplasty,43848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision gastroplasty,43848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision gastroplasty,43848,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise stomach-bowel fusion,43865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,1544,6404,APC Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,1544,6404,APC Repair stomach opening,43870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,1544,6404,APC Repair stomach-bowel fistula,43880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair stomach-bowel fistula,43880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair stomach-bowel fistula,43880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair stomach-bowel fistula,43880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Impl/redo electrd antrum,43881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Impl/redo electrd antrum,43881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Impl/redo electrd antrum,43881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Impl/redo electrd antrum,43881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise/remove electrd antrum,43882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise/remove electrd antrum,43882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise/remove electrd antrum,43882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise/remove electrd antrum,43882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,1544,6404,APC Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,1544,6404,APC Revise gastric port open,43886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,1544,6404,APC Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1544,5123,APC Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1544,5123,APC Remove gastric port open,43887,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1544,5123,APC Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,2816,8006,APC Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,2816,8006,APC Change gastric port open,43888,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,2816,8006,APC Gstr rstcv px trnsorl esg,43889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Gstr rstcv px trnsorl esg,43889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Gstr rstcv px trnsorl esg,43889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Gstr rstcv px trnsorl esg,43889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Gstr rstcv px trnsorl esg,43889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,18617,APC Gstr rstcv px trnsorl esg,43889,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,18617,APC Gstr rstcv px trnsorl esg,43889,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,18617,APC Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,18617, Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,18617, Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,855,18617,APC Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,855,18617,APC Stomach surgery procedure,43999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,855,18617,APC Freeing of bowel adhesion,44005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Freeing of bowel adhesion,44005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Freeing of bowel adhesion,44005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Freeing of bowel adhesion,44005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Incision of small bowel,44010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Incision of small bowel,44010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Incision of small bowel,44010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Incision of small bowel,44010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Insert needle cath bowel,44015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Insert needle cath bowel,44015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Insert needle cath bowel,44015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Insert needle cath bowel,44015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore small intestine,44020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Explore small intestine,44020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Explore small intestine,44020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Explore small intestine,44020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Decompress small bowel,44021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Decompress small bowel,44021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Decompress small bowel,44021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Decompress small bowel,44021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of large bowel,44025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Incision of large bowel,44025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Incision of large bowel,44025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Incision of large bowel,44025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Reduce bowel obstruction,44050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Reduce bowel obstruction,44050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Reduce bowel obstruction,44050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Reduce bowel obstruction,44050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Correct malrotation of bowel,44055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Correct malrotation of bowel,44055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Correct malrotation of bowel,44055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Correct malrotation of bowel,44055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Biopsy of bowel,44100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Excise intestine lesion(s),44110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excise intestine lesion(s),44110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excise intestine lesion(s),44110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excise intestine lesion(s),44110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of bowel lesion(s),44111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of bowel lesion(s),44111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of bowel lesion(s),44111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of bowel lesion(s),44111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of small intestine,44120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of small intestine,44120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of small intestine,44120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of small intestine,44120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of small intestine,44121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of small intestine,44121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of small intestine,44121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of small intestine,44121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of small intestine,44125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of small intestine,44125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of small intestine,44125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of small intestine,44125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Enterectomy w/o taper cong,44126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Enterectomy w/o taper cong,44126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Enterectomy w/o taper cong,44126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Enterectomy w/o taper cong,44126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Enterectomy w/taper cong,44127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Enterectomy w/taper cong,44127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Enterectomy w/taper cong,44127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Enterectomy w/taper cong,44127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Enterectomy cong add-on,44128,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Enterectomy cong add-on,44128,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Enterectomy cong add-on,44128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Enterectomy cong add-on,44128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bowel to bowel fusion,44130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bowel to bowel fusion,44130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bowel to bowel fusion,44130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bowel to bowel fusion,44130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Enterectomy cadaver donor,44132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Enterectomy cadaver donor,44132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Enterectomy cadaver donor,44132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Enterectomy cadaver donor,44132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Enterectomy live donor,44133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Enterectomy live donor,44133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Enterectomy live donor,44133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Enterectomy live donor,44133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intestine transplnt cadaver,44135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intestine transplnt cadaver,44135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intestine transplnt cadaver,44135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intestine transplnt cadaver,44135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intestine transplant live,44136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intestine transplant live,44136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intestine transplant live,44136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intestine transplant live,44136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove intestinal allograft,44137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove intestinal allograft,44137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove intestinal allograft,44137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove intestinal allograft,44137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mobilization of colon,44139,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Mobilization of colon,44139,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Mobilization of colon,44139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Mobilization of colon,44139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of colon,44140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of colon,44140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of colon,44140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of colon,44140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of colon,44141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of colon,44141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of colon,44141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of colon,44141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of colon,44143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of colon,44143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of colon,44143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of colon,44143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of colon,44144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of colon,44144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of colon,44144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of colon,44144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of colon,44145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of colon,44145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of colon,44145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of colon,44145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of colon,44146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of colon,44146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of colon,44146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of colon,44146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of colon,44147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of colon,44147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of colon,44147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of colon,44147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of colon,44150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of colon,44150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of colon,44150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of colon,44150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of colon/ileostomy,44156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Colectomy w/Ileoanal Anast,44157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Colectomy w/Ileoanal Anast,44157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Colectomy w/Ileoanal Anast,44157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Colectomy w/Ileoanal Anast,44157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Colectomy w/Neo-Rectum Pouch,44158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Colectomy w/Neo-Rectum Pouch,44158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Colectomy w/Neo-Rectum Pouch,44158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Colectomy w/Neo-Rectum Pouch,44158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of colon,44160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of colon,44160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of colon,44160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of colon,44160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3408,9420, Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3408,9420, Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,9420,APC Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,9420,APC Lap enterolysis,44180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,9420,APC Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,11081,APC Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,11081,APC Lap jejunostomy,44186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,11081,APC Lap ileo/jejuno-stomy,44187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Lap ileo/jejuno-stomy,44187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Lap ileo/jejuno-stomy,44187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Lap ileo/jejuno-stomy,44187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Lap ileo/jejuno-stomy,44187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Lap ileo/jejuno-stomy,44187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Lap colostomy,44188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap colostomy,44188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap colostomy,44188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap colostomy,44188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap enterectomy,44202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Lap enterectomy,44202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Lap enterectomy,44202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Lap enterectomy,44202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Lap resect s/intestine addl,44203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lap resect s/intestine addl,44203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lap resect s/intestine addl,44203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lap resect s/intestine addl,44203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo partial colectomy,44204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laparo partial colectomy,44204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laparo partial colectomy,44204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laparo partial colectomy,44204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap colectomy part w/ileum,44205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lap colectomy part w/ileum,44205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lap colectomy part w/ileum,44205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lap colectomy part w/ileum,44205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap part colectomy w/stoma,44206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Lap part colectomy w/stoma,44206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Lap part colectomy w/stoma,44206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Lap part colectomy w/stoma,44206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Lap part colectomy w/stoma,44206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Lap part colectomy w/stoma,44206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, L colectomy/coloproctostomy,44208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laparo total proctocolectomy,44210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laparo total proctocolectomy,44210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laparo total proctocolectomy,44210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laparo total proctocolectomy,44210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap colectomy w/proctectomy,44211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lap colectomy w/proctectomy,44211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lap colectomy w/proctectomy,44211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lap colectomy w/proctectomy,44211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo total proctocolectomy,44212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laparo total proctocolectomy,44212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laparo total proctocolectomy,44212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laparo total proctocolectomy,44212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lap mobil splenic fl add-on,44213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Lap mobil splenic fl add-on,44213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Lap mobil splenic fl add-on,44213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Lap mobil splenic fl add-on,44213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Lap mobil splenic fl add-on,44213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Lap mobil splenic fl add-on,44213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Lap close enterostomy,44227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap close enterostomy,44227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap close enterostomy,44227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap close enterostomy,44227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,1406,18617,APC Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,1406,18617,APC Laparoscope proc intestine,44238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,1406,18617,APC Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,18617, Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,18617, Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,18617, Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,18617, Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2266.89,18617, Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2266.89,18617, Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,18617,APC Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,18617,APC Open bowel to skin,44300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,18617,APC Ileostomy/jejunostomy,44310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ileostomy/jejunostomy,44310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ileostomy/jejunostomy,44310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ileostomy/jejunostomy,44310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,1544,6404,APC Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,1544,6404,APC Revision of ileostomy,44312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,1544,6404,APC Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4186.36,18617, Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4186.36,18617, Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4186.36,18617, Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4186.36,18617, Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4186.36,18617, Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4186.36,18617, Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,4186.36,18617,APC Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,4186.36,18617,APC Revision of ileostomy,44314,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,4186.36,18617,APC Devise bowel pouch,44316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Devise bowel pouch,44316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Devise bowel pouch,44316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Devise bowel pouch,44316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Colostomy,44320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Colostomy,44320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Colostomy,44320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Colostomy,44320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Colostomy with biopsies,44322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Colostomy with biopsies,44322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Colostomy with biopsies,44322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Colostomy with biopsies,44322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,3408,6404,APC Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,3408,6404,APC Revision of colostomy,44340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,3408,6404,APC Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,428,18617,APC Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,428,18617,APC Revision of colostomy,44345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,428,18617,APC Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4353.82,,,,,,,fee schedule,428,18617,APC Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4395.68,,,,,,,fee schedule,428,18617,APC Revision of colostomy,44346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4186.36,,,,,,,fee schedule,428,18617,APC Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy/biopsy,44361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44363,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44364,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44369,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,13320, Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,13320, Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3291,13320,APC Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3291,13320,APC Small Bowel Endoscopy/Stent,44370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3291,13320,APC Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44372,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44373,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2138,4466,APC Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2138,4466,APC Small bowel endoscopy,44376,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2138,4466,APC Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy/biopsy,44377,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2266.89,4466, Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4466,APC Small bowel endoscopy,44378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4466,APC S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3291,13320, S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3291,13320, S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,3291,13320,APC S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,3291,13320,APC S Bowel Endoscope W/Stent,44379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,3291,13320,APC Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Small bowel endoscopy br/wa,44380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6312, Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6312, Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,6312, Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,6312, Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1544,6312, Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1544,6312, Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,6312,APC Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,6312,APC Small bowel endoscopy br/wa,44381,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,6312,APC Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Small bowel endoscopy,44382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,6312, Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,6312, Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2266.89,6312, Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2266.89,6312, Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2266.89,6312, Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2266.89,6312, Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,6312,APC Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,6312,APC Small bowel endoscopy,44384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,6312,APC Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Endoscopy of bowel pouch,44385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Endoscopy bowel pouch/biop,44386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Colonoscopy thru stoma spx,44388,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy with biopsy,44389,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,4097, Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,4097, Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1098.6,4097, Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1098.6,4097, Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,4097, Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,4097, Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,4097,APC Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,4097,APC Colonoscopy for foreign body,44390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,4097,APC Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy for bleeding,44391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy & polypectomy,44392,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy w/snare,44394,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy with ablation,44401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7530.41, Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7530.41, Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,7530.41, Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,7530.41, Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1544,7530.41, Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1544,7530.41, Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,1544,7530.41,APC Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,1544,7530.41,APC Colonoscopy w/stent plcmt,44402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,1544,7530.41,APC Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/resection,44403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/injection,44404,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/dilation,44405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/ultrasound,44406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,6312, Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,6312, Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,428,6312,APC Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,428,6312,APC Colonoscopy w/ndl aspir/bx,44407,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,428,6312,APC Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,6312, Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,6312, Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,6312, Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,6312, Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,855,6312, Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,855,6312, Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,855,6312,APC Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,855,6312,APC Colonoscopy w/decompression,44408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,855,6312,APC Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1071.46,3314, Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1071.46,3314, Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Intro gastrointestinal tube,44500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,1406,18617,APC Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,1406,18617,APC Suture small intestine,44602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,1406,18617,APC Suture small intestine,44603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Suture small intestine,44603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Suture small intestine,44603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Suture small intestine,44603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Suture large intestine,44604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Suture large intestine,44604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Suture large intestine,44604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Suture large intestine,44604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of bowel lesion,44605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of bowel lesion,44605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of bowel lesion,44605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of bowel lesion,44605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intestinal stricturoplasty,44615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intestinal stricturoplasty,44615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intestinal stricturoplasty,44615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intestinal stricturoplasty,44615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bowel opening,44620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bowel opening,44620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bowel opening,44620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bowel opening,44620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bowel opening,44625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bowel opening,44625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bowel opening,44625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bowel opening,44625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bowel opening,44626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bowel opening,44626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bowel opening,44626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bowel opening,44626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bowel-skin fistula,44640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bowel-skin fistula,44640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bowel-skin fistula,44640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bowel-skin fistula,44640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bowel fistula,44650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bowel fistula,44650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bowel fistula,44650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bowel fistula,44650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bowel-bladder fistula,44661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical revision intestine,44680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgical revision intestine,44680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgical revision intestine,44680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgical revision intestine,44680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Suspend bowel w/prosthesis,44700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Suspend bowel w/prosthesis,44700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Suspend bowel w/prosthesis,44700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Suspend bowel w/prosthesis,44700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intraop colon lavage add-on,44701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Intraop colon lavage add-on,44701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Prepare fecal microbiota,44705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Prepare fecal microbiota,44705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Prepare fecal microbiota,44705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Prepare fecal microbiota,44705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Prepare donor intestine,44715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prepare donor intestine,44715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prepare donor intestine,44715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prepare donor intestine,44715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor intestine/venous,44720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor intestine/venous,44720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor intestine/venous,44720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor intestine/venous,44720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor intestine/artery,44721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor intestine/artery,44721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor intestine/artery,44721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor intestine/artery,44721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,18617, Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,18617, Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1071.46,18617, Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1071.46,18617, Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1071.46,18617, Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1071.46,18617, Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,18617,APC Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,18617,APC Unlisted px small intestine,44799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,18617,APC Excision of bowel pouch,44800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of bowel pouch,44800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of bowel pouch,44800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of bowel pouch,44800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of mesentery lesion,44820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of mesentery lesion,44820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of mesentery lesion,44820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of mesentery lesion,44820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of mesentery,44850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of mesentery,44850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of mesentery,44850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of mesentery,44850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bowel surgery procedure,44899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bowel surgery procedure,44899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bowel surgery procedure,44899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bowel surgery procedure,44899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drain appendix abscess open,44900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drain appendix abscess open,44900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drain appendix abscess open,44900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drain appendix abscess open,44900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,18617,APC Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,18617,APC Appendectomy,44950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,18617,APC Appendectomy add-on,44955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Appendectomy add-on,44955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Appendectomy,44960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Appendectomy,44960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Appendectomy,44960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Appendectomy,44960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3408,11081, Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3408,11081, Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,11081,APC Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,11081,APC Laparoscopy appendectomy,44970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,11081,APC Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc app,44979,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Drainage of pelvic abscess,45000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4466, Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4466, Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Drainage of rectal abscess,45005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,5123,APC Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,5123,APC Drainage of rectal abscess,45020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,5123,APC Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,5123,APC Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,5123,APC Biopsy of rectum,45100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,5123,APC Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,5123,APC Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,5123,APC Removal of anorectal lesion,45108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,5123,APC Removal of rectum,45110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of rectum,45110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of rectum,45110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of rectum,45110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of rectum,45112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of rectum,45112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of rectum,45112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of rectum,45112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial proctectomy,45113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial proctectomy,45113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial proctectomy,45113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial proctectomy,45113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of rectum,45116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove rectum w/reservoir,45119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove rectum w/reservoir,45119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove rectum w/reservoir,45119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove rectum w/reservoir,45119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of rectum,45120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of rectum,45120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of rectum,45120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of rectum,45120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of rectum and colon,45121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of rectum and colon,45121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of rectum and colon,45121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of rectum and colon,45121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial proctectomy,45123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial proctectomy,45123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial proctectomy,45123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial proctectomy,45123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pelvic exenteration,45126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pelvic exenteration,45126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pelvic exenteration,45126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pelvic exenteration,45126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of rectal prolapse,45130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Excision of rectal prolapse,45130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Excision of rectal prolapse,45130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Excision of rectal prolapse,45130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Excision of rectal prolapse,45130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Excision of rectal prolapse,45130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Excision of rectal prolapse,45135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of rectal prolapse,45135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of rectal prolapse,45135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of rectal prolapse,45135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excise ileoanal reservior,45136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excise ileoanal reservior,45136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excise ileoanal reservior,45136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excise ileoanal reservior,45136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4466, Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4466, Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Excision of rectal stricture,45150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,8006,APC Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,8006,APC Excision of rectal lesion,45160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,8006,APC Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,7422, Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,7422, Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,7422,APC Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,7422,APC Exc rect tum transanal part,45171,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,7422,APC Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,13320, Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,13320, Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,13320,APC Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,13320,APC Exc rect tum transanal full,45172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,13320,APC Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,13320, Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,13320, Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,13320,APC Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,13320,APC Destruction rectal tumor,45190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,13320,APC Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,855,3314,APC Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,855,3314,APC Proctosigmoidoscopy dx,45300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,855,3314,APC Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Proctosigmoidoscopy dilate,45303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy w/bx,45305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,6404,APC Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,6404,APC Proctosigmoidoscopy fb,45307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,6404,APC Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,5123,APC Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,5123,APC Proctosigmoidoscopy removal,45308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,5123,APC Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy removal,45309,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy removal,45315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Proctosigmoidoscopy bleed,45317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,6404,APC Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,6404,APC Proctosigmoidoscopy ablate,45320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,6404,APC Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,8006,APC Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,8006,APC Proctosigmoidoscopy volvul,45321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,8006,APC Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7530.41, Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7530.41, Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,7530.41, Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,7530.41, Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,7530.41, Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,7530.41, Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,1544,7530.41,APC Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,1544,7530.41,APC Proctosigmoidoscopy W/Stent,45327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,1544,7530.41,APC Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Diagnostic sigmoidoscopy,45330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy and biopsy,45331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy w/fb removal,45332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy & polypectomy,45333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy for bleeding,45334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy w/submuc inj,45335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy & decompress,45337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy w/tumr remove,45338,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,3314, Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,3314, Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,3314, Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,3314, Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,3314, Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,3314, Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,3314,APC Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,3314,APC Sig w/tndsc balloon dilation,45340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,3314,APC Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy W/Ultrasound,45341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Sigmoidoscopy W/Us Guide Bx,45342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Sigmoidoscopy w/ablation,45346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7530.41, Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7530.41, Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,7530.41, Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,7530.41, Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1544,7530.41, Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1544,7530.41, Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,1544,7530.41,APC Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,1544,7530.41,APC Sigmoidoscopy w/plcmt stent,45347,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,1544,7530.41,APC Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6312, Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6312, Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,6312, Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,6312, Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1544,6312, Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1544,6312, Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,6312,APC Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,6312,APC Sigmoidoscopy w/resection,45349,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,6312,APC Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Sgmdsc w/band ligation,45350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1098.6,4466, Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1098.6,4466, Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,4466, Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,4466, Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1098.6,4466, Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1098.6,4466, Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,4466,APC Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,4466,APC Diagnostic colonoscopy,45378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,4466,APC Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/fb removal,45379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,4466, Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,4466, Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy and biopsy,45380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,4466, Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,4466, Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy submucous njx,45381,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/control bleed,45382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/lesion removal,45384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/lesion removal,45385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/balloon dilat,45386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/ablation,45388,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,7530.41, Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,7530.41, Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,7530.41, Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,7530.41, Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2816,7530.41, Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2816,7530.41, Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7458.7,,,,,,,fee schedule,2816,7530.41,APC Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7530.41,,,,,,,fee schedule,2816,7530.41,APC Colonoscopy w/stent plcmt,45389,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7171.82,,,,,,,fee schedule,2816,7530.41,APC Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6312, Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6312, Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,6312, Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,6312, Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2816,6312, Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2816,6312, Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,6312,APC Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,6312,APC Colonoscopy w/resection,45390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,6312,APC Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/endoscope us,45391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1413.65,4466, Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/endoscopic fnb,45392,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4466,APC Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/decompression,45393,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Lap removal of rectum,45395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap removal of rectum,45395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap removal of rectum,45395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap removal of rectum,45395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap remove rectum w/pouch,45397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap remove rectum w/pouch,45397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap remove rectum w/pouch,45397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap remove rectum w/pouch,45397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Colonoscopy w/band ligation,45398,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,7422, Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,7422, Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1098.6,7422, Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1098.6,7422, Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1098.6,7422, Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1098.6,7422, Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,7422,APC Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,7422,APC Unlisted procedure colon,45399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,7422,APC Laparoscopic proc,45400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscopic proc,45400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscopic proc,45400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscopic proc,45400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Lap proctopexy w/sig resect,45402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Lap proctopexy w/sig resect,45402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Lap proctopexy w/sig resect,45402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Lap proctopexy w/sig resect,45402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc rectum,45499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,5123,APC Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,5123,APC Repair of rectum,45500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,5123,APC Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,6404,APC Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,6404,APC Repair of rectum,45505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,6404,APC Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,18617, Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,18617, Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1098.6,18617, Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1098.6,18617, Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1098.6,18617, Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1098.6,18617, Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,18617,APC Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,18617,APC Treatment of rectal prolapse,45520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,18617,APC Correct rectal prolapse,45540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Correct rectal prolapse,45540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Correct rectal prolapse,45540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Correct rectal prolapse,45540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Correct rectal prolapse,45540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Correct rectal prolapse,45540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,18617, Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,18617, Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,18617,APC Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,18617,APC Correct rectal prolapse,45541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,18617,APC Repair rectum/remove sigmoid,45550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair rectum/remove sigmoid,45550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair rectum/remove sigmoid,45550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair rectum/remove sigmoid,45550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,8006,APC Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,8006,APC Repair of rectocele,45560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,8006,APC Exploration/repair of rectum,45562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration/repair of rectum,45562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration/repair of rectum,45562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration/repair of rectum,45562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploration/repair of rectum,45563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration/repair of rectum,45563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration/repair of rectum,45563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration/repair of rectum,45563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair rect/bladder fistula,45800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair rect/bladder fistula,45800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair rect/bladder fistula,45800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair rect/bladder fistula,45800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair rectourethral fistula,45820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair rectourethral fistula,45820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair rectourethral fistula,45820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair rectourethral fistula,45820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair fistula w/colostomy,45825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,855,3314,APC Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,855,3314,APC Reduction of rectal prolapse,45900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,855,3314,APC Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Dilation of anal sphincter,45905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Dilation of rectal narrowing,45910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Remove rectal obstruction,45915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,4466,APC Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,4466,APC Surg dx exam anorectal,45990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,4466,APC Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1098.6,18617, Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1098.6,18617, Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1098.6,18617, Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1098.6,18617, Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1098.6,18617, Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1098.6,18617, Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,18617,APC Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,18617,APC Rectum surgery procedure,45999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,18617,APC Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Placement of seton,46020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Removal of rectal marker,46030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1413.65,5098, Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1413.65,5098, Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,5098, Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,5098, Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1413.65,5098, Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1413.65,5098, Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,5098,APC Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,5098,APC Incision of rectal abscess,46040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,5098,APC Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,5123,APC Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,5123,APC Incision of rectal abscess,46045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,5123,APC Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,4097, Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,4097, Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1098.6,4097, Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1098.6,4097, Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,4097, Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,4097, Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,4097,APC Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,4097,APC Incision of anal abscess,46050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,4097,APC Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,5123,APC Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,5123,APC Incision of rectal abscess,46060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,5123,APC Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,428,18617,APC Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,428,18617,APC Incision of anal septum,46070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,428,18617,APC Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5098, Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5098, Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3279.01,5098, Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3279.01,5098, Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5098, Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5098, Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5098,APC Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5098,APC Incision of anal sphincter,46080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5098,APC Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Incise external hemorrhoid,46083,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,5123,APC Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,5123,APC Removal of anal fissure,46200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,5123,APC Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Excise anal ext tag/papilla,46220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,855,3314,APC Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,855,3314,APC Ligation of hemorrhoid(s),46221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,855,3314,APC Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,4097,APC Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,4097,APC Removal of anal tags,46230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,4097,APC Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,6404, Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,6404, Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3279.01,6404, Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3279.01,6404, Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,6404, Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,6404, Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,6404,APC Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,6404,APC Remove ext hem groups 2+,46250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,6404,APC Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Remove int/ext hem 1 group,46255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Remove in/ex hem grp & fiss,46257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Remove in/ex hem grp w/fistu,46258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem groups 2+,46260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem grps & fiss,46261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3279.01,6404, Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,6404,APC Remove in/ex hem grps w/fist,46262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,6404,APC Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Remove anal fist subq,46270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Remove anal fist inter,46275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3279.01,6312, Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3279.01,6312, Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,6312, Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,6312, Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3279.01,6312, Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3279.01,6312, Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,6312,APC Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,6312,APC Remove anal fist complex,46280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,6312,APC Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,5123,APC Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,5123,APC Remove anal fist 2 stage,46285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,5123,APC Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3279.01,6404, Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3279.01,6404, Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3279.01,6404, Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3279.01,6404, Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3279.01,6404, Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3279.01,6404, Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,6404,APC Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,6404,APC Repair anal fistula,46288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,6404,APC Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Removal of hemorrhoid clot,46320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1098.6,18617, Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1098.6,18617, Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,18617, Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,18617, Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1098.6,18617, Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1098.6,18617, Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,18617,APC Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,18617,APC Injection into hemorrhoid(s),46500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,18617,APC Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,4097, Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,4097, Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,4097, Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,4097, Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1413.65,4097, Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1413.65,4097, Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,4097,APC Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,4097,APC Chemodenervation anal musc,46505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,4097,APC Diagnostic anoscopy spx,46600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,1866, Diagnostic anoscopy spx,46600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,1866, Diagnostic anoscopy spx,46600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,1866, Diagnostic anoscopy spx,46600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,1866, Diagnostic anoscopy spx,46600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,1866,APC Diagnostic anoscopy spx,46600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,1866,APC Diagnostic anoscopy spx,46600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,1866,APC Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,3314, Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,3314, Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,3314, Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,3314, Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,527.74,3314, Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,527.74,3314, Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,3314,APC Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,3314,APC Diagnostic anoscopy,46601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,3314,APC Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,18617, Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,18617, Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,18617, Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,18617, Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1413.65,18617, Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1413.65,18617, Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,18617,APC Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,18617,APC Anoscopy and dilation,46604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,18617,APC Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,18617, Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,18617, Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,18617, Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,18617, Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1413.65,18617, Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1413.65,18617, Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,18617,APC Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,18617,APC Anoscopy and biopsy,46606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,18617,APC Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,6312, Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,6312, Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,6312, Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,6312, Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1413.65,6312, Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1413.65,6312, Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,6312,APC Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,6312,APC Diagnostic anoscopy & biopsy,46607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,6312,APC Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Anoscopy remove for body,46608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,5123,APC Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,5123,APC Anoscopy remove lesion,46610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,5123,APC Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,3314, Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,3314, Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,3314, Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,3314, Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,3314, Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,3314, Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,3314,APC Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,3314,APC Anoscopy,46611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,3314,APC Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,5123,APC Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,5123,APC Anoscopy remove lesions,46612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,5123,APC Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,18617, Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,18617, Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,18617, Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,18617, Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1413.65,18617, Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1413.65,18617, Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,18617,APC Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,18617,APC Anoscopy control bleeding,46614,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,18617,APC Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,5123,APC Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,5123,APC Anoscopy,46615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,5123,APC Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Repair of anal stricture,46700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Repair of anal stricture,46705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of anal stricture,46705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of anal stricture,46705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of anal stricture,46705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,6404,APC Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,6404,APC Repr of anal fistula w/glue,46706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,6404,APC Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,13320, Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,13320, Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,13320, Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,13320, Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1406,13320, Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1406,13320, Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1406,13320,APC Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1406,13320,APC Repair anorectal fist w/plug,46707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1406,13320,APC Repr per/vag pouch sngl proc,46710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Repr per/vag pouch sngl proc,46710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Repr per/vag pouch sngl proc,46710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Repr per/vag pouch sngl proc,46710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Repr per/vag pouch dbl proc,46712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Repr per/vag pouch dbl proc,46712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Repr per/vag pouch dbl proc,46712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Repr per/vag pouch dbl proc,46712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Rep perf anoper fistu,46715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rep perf anoper fistu,46715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rep perf anoper fistu,46715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rep perf anoper fistu,46715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rep perf anoper/vestib fistu,46716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rep perf anoper/vestib fistu,46716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rep perf anoper/vestib fistu,46716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rep perf anoper/vestib fistu,46716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Construction of absent anus,46730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Construction of absent anus,46730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Construction of absent anus,46730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Construction of absent anus,46730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Construction of absent anus,46735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Construction of absent anus,46735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Construction of absent anus,46735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Construction of absent anus,46735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Construction of absent anus,46740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Construction of absent anus,46740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Construction of absent anus,46740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Construction of absent anus,46740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of imperforated anus,46742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of imperforated anus,46742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of imperforated anus,46742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of imperforated anus,46742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46748,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46748,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46748,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of cloacal anomaly,46748,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,8006,APC Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,8006,APC Repair of anal sphincter,46750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,8006,APC Repair of anal sphincter,46751,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of anal sphincter,46751,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of anal sphincter,46751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of anal sphincter,46751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,5123, Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,5123, Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3279.01,5123, Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3279.01,5123, Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,5123, Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,5123, Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,5123,APC Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,5123,APC Reconstruction of anus,46753,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,5123,APC Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,6404,APC Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,6404,APC Removal of suture from anus,46754,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,6404,APC Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,4466, Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,4466, Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,4466, Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,4466, Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,855,4466, Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,855,4466, Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,855,4466,APC Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,855,4466,APC Repair of anal sphincter,46760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,855,4466,APC Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3279.01,8006, Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,8006,APC Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,8006,APC Repair of anal sphincter,46761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,8006,APC Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,3314, Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,3314, Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,3314, Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,3314, Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,480.23,3314, Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,480.23,3314, Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,3314,APC Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,3314,APC Destruction anal lesion(s),46900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,3314,APC Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2437.45,18617, Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2437.45,18617, Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,18617, Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,18617, Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2437.45,18617, Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2437.45,18617, Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,18617,APC Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,18617,APC Destruction anal lesion(s),46910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,18617,APC Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,237.02,18617, Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,237.02,18617, Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Cryosurgery anal lesion(s),46916,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,6404,APC Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,6404,APC Laser surgery anal lesions,46917,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,6404,APC Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,5123,APC Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,5123,APC Excision of anal lesion(s),46922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,5123,APC Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,5123,APC Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,5123,APC Destruction anal lesion(s),46924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,5123,APC Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1413.65,7422, Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1413.65,7422, Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1413.65,7422, Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1413.65,7422, Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1413.65,7422, Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1413.65,7422, Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,7422,APC Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,7422,APC Destroy internal hemorrhoids,46930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,7422,APC Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,1544,18617,APC Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,1544,18617,APC Treatment of anal fissure,46940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,1544,18617,APC Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,5123, Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,5123, Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1098.6,5123, Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1098.6,5123, Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1098.6,5123, Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1098.6,5123, Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,5123,APC Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,5123,APC Treatment of anal fissure,46942,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,5123,APC Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,18617, Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,18617, Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,18617,APC Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,18617,APC Remove by ligat int hem grp,46945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,18617,APC Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,5123, Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,5123, Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2762,5123, Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2762,5123, Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,5123, Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,5123, Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2762,5123,APC Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2762,5123,APC Remove by ligat int hem grps,46946,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2762,5123,APC Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3279.01,9918, Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3279.01,9918, Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3279.01,9918, Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3279.01,9918, Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3279.01,9918, Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3279.01,9918, Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,3279.01,9918,APC Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,3279.01,9918,APC Hemorrhoidopexy by stapling,46947,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,3279.01,9918,APC Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,9918, Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,9918, Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,9918,APC Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,9918,APC Int hrhc tranal dartlzj 2+,46948,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,9918,APC Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,18617, Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,18617, Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1098.6,18617, Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1098.6,18617, Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1098.6,18617, Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1098.6,18617, Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,18617,APC Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,18617,APC Anus surgery procedure,46999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,18617,APC Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Needle biopsy of liver,47000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Needle biopsy liver add-on,47001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Needle biopsy liver add-on,47001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Needle biopsy liver add-on,47001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Needle biopsy liver add-on,47001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Open drainage liver lesion,47010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open drainage liver lesion,47010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open drainage liver lesion,47010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open drainage liver lesion,47010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Inject/aspirate liver cyst,47015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Inject/aspirate liver cyst,47015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Inject/aspirate liver cyst,47015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Inject/aspirate liver cyst,47015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Wedge biopsy of liver,47100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Wedge biopsy of liver,47100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Wedge biopsy of liver,47100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Wedge biopsy of liver,47100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of liver,47120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of liver,47120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of liver,47120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,1406,18617, Partial removal of liver,47120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,1406,18617, Partial removal of liver,47120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of liver,47120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive removal of liver,47122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive removal of liver,47122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive removal of liver,47122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive removal of liver,47122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of liver,47125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of liver,47125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of liver,47125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of liver,47125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of liver,47130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of liver,47130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of liver,47130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of liver,47130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of donor liver,47133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of donor liver,47133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of donor liver,47133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of donor liver,47133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplantation of liver,47135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplantation of liver,47135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplantation of liver,47135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplantation of liver,47135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal donor liver,47142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor liver whole,47143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor liver whole,47143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor liver whole,47143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor liver whole,47143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor liver 3-segment,47144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor liver 3-segment,47144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor liver 3-segment,47144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor liver 3-segment,47144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor liver lobe split,47145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor liver lobe split,47145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor liver lobe split,47145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor liver lobe split,47145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor liver/venous,47146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor liver/venous,47146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor liver/venous,47146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor liver/venous,47146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor liver/arterial,47147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor liver/arterial,47147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor liver/arterial,47147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor liver/arterial,47147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgery for liver lesion,47300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgery for liver lesion,47300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgery for liver lesion,47300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgery for liver lesion,47300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair liver wound,47350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair liver wound,47350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair liver wound,47350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair liver wound,47350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair liver wound,47360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair liver wound,47360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair liver wound,47360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair liver wound,47360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair liver wound,47361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair liver wound,47361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair liver wound,47361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair liver wound,47361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair liver wound,47362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair liver wound,47362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair liver wound,47362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair liver wound,47362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4224,18617, Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4224,18617, Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4224,18617,APC Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4224,18617,APC Laparo ablate liver tumor rf,47370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4224,18617,APC Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,18617, Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,18617, Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4224,18617,APC Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4224,18617,APC Laparo ablate liver cryosurg,47371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4224,18617,APC Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,18617,APC Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,18617,APC Laparoscope procedure liver,47379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,18617,APC Open ablate liver tumor rf,47380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Open ablate liver tumor rf,47380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Open ablate liver tumor rf,47380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Open ablate liver tumor rf,47380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Open ablate liver tumor cryo,47381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Open ablate liver tumor cryo,47381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Open ablate liver tumor cryo,47381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Open ablate liver tumor cryo,47381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,18617,APC Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,18617,APC Percut ablate liver rf,47382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,18617,APC Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,13320, Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,13320, Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4062,13320, Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4062,13320, Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,13320, Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,13320, Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4062,13320,APC Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4062,13320,APC Perq abltj lvr cryoablation,47383,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4062,13320,APC Abltj ire liver 1+ tum perq,47384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Abltj ire liver 1+ tum perq,47384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Abltj ire liver 1+ tum perq,47384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Abltj ire liver 1+ tum perq,47384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Abltj ire liver 1+ tum perq,47384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4224,18617,APC Abltj ire liver 1+ tum perq,47384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4224,18617,APC Abltj ire liver 1+ tum perq,47384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4224,18617,APC Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,836.55,18617, Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,836.55,18617, Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Liver surgery procedure,47399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Incision of liver duct,47400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of liver duct,47400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of liver duct,47400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of liver duct,47400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of bile duct,47420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of bile duct,47420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of bile duct,47420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of bile duct,47420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of bile duct,47425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of bile duct,47425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of bile duct,47425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of bile duct,47425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise bile duct sphincter,47460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise bile duct sphincter,47460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise bile duct sphincter,47460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise bile duct sphincter,47460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,1406,18617,APC Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,1406,18617,APC Incision of gallbladder,47490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,1406,18617,APC Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,4441.17, Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,4441.17, Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4441.17, Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4441.17, Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,4441.17, Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,4441.17, Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,4441.17,APC Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,4441.17,APC Injection for cholangiogram,47531,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,4441.17,APC Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,13320,APC Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,13320,APC Injection for cholangiogram,47532,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,13320,APC Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,13320,APC Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,13320,APC Plmt biliary drainage cath,47533,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,13320,APC Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,13320,APC Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,13320,APC Plmt biliary drainage cath,47534,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,13320,APC Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,13320,APC Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,13320,APC Conversion ext bil drg cath,47535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,13320,APC Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,13320,APC Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,13320,APC Exchange biliary drg cath,47536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,13320,APC Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,428,3314,APC Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,428,3314,APC Removal biliary drg cath,47537,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,428,3314,APC Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47538,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47539,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,13320,APC Perq plmt bile duct stent,47540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,13320,APC Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,13320, Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,13320, Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,428,13320,APC Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,428,13320,APC Plmt access bil tree sm bwl,47541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,428,13320,APC Dilate biliary duct/ampulla,47542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Dilate biliary duct/ampulla,47542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Dilate biliary duct/ampulla,47542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Dilate biliary duct/ampulla,47542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Endoluminal bx biliary tree,47543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Endoluminal bx biliary tree,47543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Endoluminal bx biliary tree,47543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Endoluminal bx biliary tree,47543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Removal duct glbldr calculi,47544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Removal duct glbldr calculi,47544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Removal duct glbldr calculi,47544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Removal duct glbldr calculi,47544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,2816,11081,APC Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,2816,11081,APC Biliary endo perq dx w/speci,47552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,2816,11081,APC Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,3408,9420,APC Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,3408,9420,APC Biliary endoscopy thru skin,47553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,3408,9420,APC Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13185.37, Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13185.37, Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,13185.37, Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,13185.37, Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13185.37, Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13185.37, Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,13185.37,APC Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,13185.37,APC Biliary endoscopy thru skin,47554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,13185.37,APC Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8030.21, Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8030.21, Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8030.21, Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8030.21, Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8030.21, Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8030.21, Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,3408,8030.21,APC Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,3408,8030.21,APC Biliary endoscopy thru skin,47555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,3408,8030.21,APC Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,13320, Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,13320, Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,13320,APC Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,13320,APC Biliary endoscopy thru skin,47556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,13320,APC Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,13320, Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,13320, Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,13320,APC Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,13320,APC Laparoscopic cholecystectomy,47562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,13320,APC Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,13320,APC Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,13320,APC Laparo cholecystectomy/graph,47563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,13320,APC Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13320, Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13320, Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4147,13320,APC Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4147,13320,APC Laparo cholecystectomy/explr,47564,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4147,13320,APC Laparo cholecystoenterostomy,47570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,18617, Laparo cholecystoenterostomy,47570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,18617, Laparo cholecystoenterostomy,47570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Laparo cholecystoenterostomy,47570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Laparo cholecystoenterostomy,47570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Laparo cholecystoenterostomy,47570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,18617, Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,18617, Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc biliary,47579,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Removal of gallbladder,47600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Removal of gallbladder,47600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Removal of gallbladder,47600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal of gallbladder,47600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal of gallbladder,47600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal of gallbladder,47600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Removal of gallbladder,47605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of gallbladder,47605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of gallbladder,47605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of gallbladder,47605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of gallbladder,47610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Removal of gallbladder,47620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Removal of gallbladder,47620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Removal of gallbladder,47620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Removal of gallbladder,47620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Exploration of bile ducts,47700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration of bile ducts,47700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration of bile ducts,47700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration of bile ducts,47700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bile duct revision,47701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bile duct revision,47701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bile duct revision,47701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bile duct revision,47701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of bile duct tumor,47712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of bile duct cyst,47715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of bile duct cyst,47715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of bile duct cyst,47715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of bile duct cyst,47715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse upper gi structures,47721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse upper gi structures,47721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse upper gi structures,47721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse upper gi structures,47721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse gallbladder & bowel,47741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse liver ducts & bowel,47765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse liver ducts & bowel,47765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse liver ducts & bowel,47765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse liver ducts & bowel,47765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse bile ducts and bowel,47785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruction of bile ducts,47800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruction of bile ducts,47800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruction of bile ducts,47800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruction of bile ducts,47800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Placement bile duct support,47801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Placement bile duct support,47801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Placement bile duct support,47801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Placement bile duct support,47801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse liver duct & intestine,47802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse liver duct & intestine,47802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse liver duct & intestine,47802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse liver duct & intestine,47802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Suture bile duct injury,47900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Suture bile duct injury,47900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Suture bile duct injury,47900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Suture bile duct injury,47900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1071.46,18617, Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1071.46,18617, Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1071.46,18617, Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1071.46,18617, Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1071.46,18617, Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1071.46,18617, Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,18617,APC Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,18617,APC Bile tract surgery procedure,47999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,18617,APC Drainage of abdomen,48000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drainage of abdomen,48000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drainage of abdomen,48000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drainage of abdomen,48000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Placement of drain pancreas,48001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Placement of drain pancreas,48001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Placement of drain pancreas,48001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Placement of drain pancreas,48001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of pancreatic stone,48020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pancreatic stone,48020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pancreatic stone,48020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pancreatic stone,48020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy of pancreas open,48100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Biopsy of pancreas open,48100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Biopsy of pancreas open,48100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Biopsy of pancreas open,48100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Needle biopsy pancreas,48102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Resect/Debride Pancreas,48105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/Debride Pancreas,48105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/Debride Pancreas,48105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/Debride Pancreas,48105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of pancreas lesion,48120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pancreas lesion,48120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pancreas lesion,48120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pancreas lesion,48120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pancreatectomy,48146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pancreatectomy,48146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pancreatectomy,48146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pancreatectomy,48146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of pancreatic duct,48148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pancreatic duct,48148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pancreatic duct,48148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pancreatic duct,48148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of pancreas,48150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pancreatectomy,48152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pancreatectomy,48152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pancreatectomy,48152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pancreatectomy,48152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pancreatectomy,48153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pancreatectomy,48153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pancreatectomy,48153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pancreatectomy,48153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pancreatectomy,48154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pancreatectomy,48154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pancreatectomy,48154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pancreatectomy,48154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of pancreas,48155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pancreas,48155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pancreas,48155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pancreas,48155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pancreas removal/transplant,48160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pancreas removal/transplant,48160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pancreas removal/transplant,48160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pancreas removal/transplant,48160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Injection intraop add-on,48400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Injection intraop add-on,48400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Injection intraop add-on,48400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Injection intraop add-on,48400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgery of pancreatic cyst,48500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgery of pancreatic cyst,48500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgery of pancreatic cyst,48500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgery of pancreatic cyst,48500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drain pancreatic pseudocyst,48510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drain pancreatic pseudocyst,48510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drain pancreatic pseudocyst,48510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drain pancreatic pseudocyst,48510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse pancreas cyst and bowel,48540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pancreatorrhaphy,48545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pancreatorrhaphy,48545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pancreatorrhaphy,48545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pancreatorrhaphy,48545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Duodenal exclusion,48547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Duodenal exclusion,48547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Duodenal exclusion,48547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Duodenal exclusion,48547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fuse Pancreas and Bowel,48548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fuse Pancreas and Bowel,48548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fuse Pancreas and Bowel,48548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fuse Pancreas and Bowel,48548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Donor pancreatectomy,48550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Donor pancreatectomy,48550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Donor pancreatectomy,48550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Donor pancreatectomy,48550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor pancreas,48551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor pancreas,48551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor pancreas,48551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor pancreas,48551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor pancreas/venous,48552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor pancreas/venous,48552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor pancreas/venous,48552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor pancreas/venous,48552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transpl allograft pancreas,48554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transpl allograft pancreas,48554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transpl allograft pancreas,48554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transpl allograft pancreas,48554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal allograft pancreas,48556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal allograft pancreas,48556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal allograft pancreas,48556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal allograft pancreas,48556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,836.55,18617, Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,836.55,18617, Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Pancreas surgery procedure,48999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Exploration of abdomen,49000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Exploration of abdomen,49000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Exploration of abdomen,49000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exploration of abdomen,49000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exploration of abdomen,49000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exploration of abdomen,49000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Reopening of abdomen,49002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reopening of abdomen,49002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reopening of abdomen,49002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reopening of abdomen,49002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,428,18617,APC Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,428,18617,APC Exploration behind abdomen,49010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,428,18617,APC Prpertl pel pack hemrrg trma,49013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prpertl pel pack hemrrg trma,49013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prpertl pel pack hemrrg trma,49013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prpertl pel pack hemrrg trma,49013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reexploration pelvic wound,49014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reexploration pelvic wound,49014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reexploration pelvic wound,49014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reexploration pelvic wound,49014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drainage abdom abscess open,49020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drainage abdom abscess open,49020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drainage abdom abscess open,49020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drainage abdom abscess open,49020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drain open abdom abscess,49040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drain open abdom abscess,49040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drain open abdom abscess,49040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drain open abdom abscess,49040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drain open retroperi abscess,49060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Drain open retroperi abscess,49060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Drain open retroperi abscess,49060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Drain open retroperi abscess,49060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Drain open retroperi abscess,49060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Drain open retroperi abscess,49060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Drain to peritoneal cavity,49062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Drain to peritoneal cavity,49062,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Drain to peritoneal cavity,49062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Drain to peritoneal cavity,49062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Drain to peritoneal cavity,49062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Drain to peritoneal cavity,49062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,4166, Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,4166, Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,4166, Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,4166, Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,4166, Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,4166, Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,4166,APC Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,4166,APC Abd paracentesis,49082,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,4166,APC Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,4166, Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,4166, Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,4166, Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,4166, Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,4166, Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,4166, Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,4166,APC Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,4166,APC Abd paracentesis w/imaging,49083,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,4166,APC Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1071.46,4166, Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1071.46,4166, Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,4166, Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,4166, Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,4166, Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,4166, Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,4166,APC Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,4166,APC Peritoneal lavage,49084,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,4166,APC Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Biopsy abdominal mass,49180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,9918, Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,9918, Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1951.11,9918, Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1951.11,9918, Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1951.11,9918, Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1951.11,9918, Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,9918,APC Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,9918,APC Sclerotx fluid collection,49185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,9918,APC Opn exc/dstr ntra-abd 5 cm/<,49186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd 5 cm/<,49186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd 5 cm/<,49186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd 5 cm/<,49186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd 5.1-10,49187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd 5.1-10,49187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd 5.1-10,49187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd 5.1-10,49187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 10.1-20,49188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 10.1-20,49188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 10.1-20,49188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 10.1-20,49188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 20.1-30,49189,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 20.1-30,49189,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 20.1-30,49189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Opn exc/dst ntra-abd 20.1-30,49189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd >30 cm,49190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd >30 cm,49190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd >30 cm,49190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Opn exc/dstr ntra-abd >30 cm,49190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exc abd tum 5 cm or less,49203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Exc abd tum 5 cm or less,49203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Exc abd tum 5 cm or less,49203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exc abd tum 5 cm or less,49203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exc abd tum 5 cm or less,49203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exc abd tum 5 cm or less,49203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Exc abd tum over 5 cm,49204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Exc abd tum over 5 cm,49204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Exc abd tum over 5 cm,49204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exc abd tum over 5 cm,49204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exc abd tum over 5 cm,49204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exc abd tum over 5 cm,49204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Exc abd tum over 10 cm,49205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Exc abd tum over 10 cm,49205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Exc abd tum over 10 cm,49205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exc abd tum over 10 cm,49205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exc abd tum over 10 cm,49205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exc abd tum over 10 cm,49205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Excise sacral spine tumor,49215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excise sacral spine tumor,49215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excise sacral spine tumor,49215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excise sacral spine tumor,49215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,6404,APC Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,6404,APC Excision of umbilicus,49250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,6404,APC Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,18617, Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,18617, Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,18617,APC Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,18617,APC Removal of omentum,49255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,18617,APC Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,8006,APC Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,8006,APC Diag laparo separate proc,49320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,8006,APC Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,11081,APC Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,11081,APC Laparoscopy biopsy,49321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,11081,APC Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,9420,APC Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,9420,APC Laparoscopy aspiration,49322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,9420,APC Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3408,11081, Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3408,11081, Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,11081,APC Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,11081,APC Laparo drain lymphocele,49323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,11081,APC Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,13320,APC Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,13320,APC Lap insert tunnel ip cath,49324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,13320,APC Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,13320,APC Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,13320,APC Lap Revision Perm IP Cath,49325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,13320,APC Lap w/Omentopexy Add-on,49326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,13320, Lap w/Omentopexy Add-on,49326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,13320, Lap w/Omentopexy Add-on,49326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Lap w/Omentopexy Add-on,49326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Lap w/Omentopexy Add-on,49326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Lap w/Omentopexy Add-on,49326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Lap ins device for rt,49327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,13320, Lap ins device for rt,49327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,13320, Lap ins device for rt,49327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Lap ins device for rt,49327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Lap ins device for rt,49327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Lap ins device for rt,49327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,18617, Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,18617, Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,1544,18617,APC Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,1544,18617,APC Laparo proc abdm/per/oment,49329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,1544,18617,APC Air injection into abdomen,49400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Air injection into abdomen,49400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Air injection into abdomen,49400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Air injection into abdomen,49400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,2816,6404,APC Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,2816,6404,APC Remove foreign body adbomen,49402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,2816,6404,APC Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,13320, Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,13320, Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,13320, Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,13320, Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1951.11,13320, Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1951.11,13320, Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,13320,APC Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,13320,APC Image cath fluid colxn visc,49405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,13320,APC Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1951.11,13320, Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1951.11,13320, Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,13320, Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,13320, Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1951.11,13320, Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1951.11,13320, Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,13320,APC Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,13320,APC Image cath fluid peri/retro,49406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,13320,APC Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1951.11,5098, Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1951.11,5098, Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1951.11,5098, Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1951.11,5098, Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1951.11,5098, Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1951.11,5098, Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,5098,APC Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,5098,APC Image cath fluid trns/vgnl,49407,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,5098,APC Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4466, Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4466, Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,4466, Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,4466, Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,4466, Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,4466, Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1700.54,,,,,,,fee schedule,1544,4466,APC Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1716.89,,,,,,,fee schedule,1544,4466,APC Ins mark abd/pel for rt perq,49411,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1635.14,,,,,,,fee schedule,1544,4466,APC Ins device for rt guide open,49412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Ins device for rt guide open,49412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Ins device for rt guide open,49412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Ins device for rt guide open,49412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Ins device for rt guide open,49412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Ins device for rt guide open,49412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,13320, Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,13320, Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,2816,13320,APC Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,2816,13320,APC Insert tun ip cath perc,49418,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,2816,13320,APC Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,8006, Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,8006, Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2762,8006, Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2762,8006, Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,8006, Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,8006, Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,2762,8006,APC Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,2762,8006,APC Insert tun ip cath w/port,49419,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,2762,8006,APC Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,8006, Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,8006, Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2762,8006, Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2762,8006, Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,8006, Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,8006, Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,2762,8006,APC Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,2762,8006,APC Ins tun ip cath for dial opn,49421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,2762,8006,APC Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1544,4097,APC Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1544,4097,APC Remove tunneled ip cath,49422,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1544,4097,APC Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,18617,APC Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,18617,APC Exchange drainage catheter,49423,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,18617,APC Assess cyst contrast inject,49424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Assess cyst contrast inject,49424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Assess cyst contrast inject,49424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Assess cyst contrast inject,49424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Insert abdomen-venous drain,49425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Insert abdomen-venous drain,49425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Insert abdomen-venous drain,49425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Insert abdomen-venous drain,49425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Insert abdomen-venous drain,49425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Insert abdomen-venous drain,49425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,2816,5123,APC Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,2816,5123,APC Revise abdomen-venous shunt,49426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,2816,5123,APC Injection abdominal shunt,49427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection abdominal shunt,49427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection abdominal shunt,49427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection abdominal shunt,49427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Ligation of shunt,49428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ligation of shunt,49428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ligation of shunt,49428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ligation of shunt,49428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,18617, Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,18617, Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,2816,18617,APC Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,2816,18617,APC Removal of shunt,49429,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,2816,18617,APC Insert Subq Exten to IP Cath,49435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Insert Subq Exten to IP Cath,49435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Insert Subq Exten to IP Cath,49435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Insert Subq Exten to IP Cath,49435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5098, Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5098, Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,5098, Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,5098, Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,5098, Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,5098, Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,5098,APC Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,5098,APC Embedded IP Cath Exit-Site,49436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,5098,APC Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4166, Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4166, Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4166, Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4166, Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2266.89,4166, Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2266.89,4166, Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4166,APC Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4166,APC Place gastrostomy tube perc,49440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4166,APC Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2266.89,4166, Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2266.89,4166, Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2266.89,4166, Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2266.89,4166, Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2266.89,4166, Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2266.89,4166, Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,2266.89,4166,APC Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,2266.89,4166,APC Place duod/jej tube perc,49441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,2266.89,4166,APC Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1413.65,7422, Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1413.65,7422, Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1413.65,7422, Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1413.65,7422, Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1413.65,7422, Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1413.65,7422, Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1470.19,,,,,,,fee schedule,1413.65,7422,APC Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1484.33,,,,,,,fee schedule,1413.65,7422,APC Place cecostomy tube perc,49442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1413.65,,,,,,,fee schedule,1413.65,7422,APC Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2357.57,,,,,,,fee schedule,1544,4097,APC Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2380.24,,,,,,,fee schedule,1544,4097,APC Change g-tube to g-j perc,49446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2266.89,,,,,,,fee schedule,1544,4097,APC Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Replace g/c tube perc,49450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Replace duod/jej tube perc,49451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Replace g-j tube perc,49452,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,3314, Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,3314, Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1071.46,3314, Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1071.46,3314, Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1071.46,3314, Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1071.46,3314, Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3314,APC Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3314,APC Fix g/colon tube w/device,49460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3314,APC Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,281.87,18617, Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,281.87,18617, Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,281.87,18617, Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,281.87,18617, Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,281.87,18617, Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,281.87,18617, Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,18617,APC Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,18617,APC Fluoro exam of g/colon tube,49465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,18617,APC Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,18617,APC Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,18617,APC Rpr hern preemie reduc,49491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,18617,APC Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,18617,APC Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,18617,APC Rpr ing hern premie blocked,49492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,18617,APC Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,6312,APC Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,6312,APC Rpr ing hernia baby reduc,49495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,6312,APC Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,428,6312,APC Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,428,6312,APC Rpr ing hernia baby blocked,49496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,428,6312,APC Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8030.21, Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8030.21, Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8030.21, Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8030.21, Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8030.21, Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8030.21, Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,8030.21,APC Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,8030.21,APC Rpr ing hernia init reduce,49500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,8030.21,APC Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,13320,APC Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,13320,APC Rpr ing hernia init blocked,49501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,13320,APC Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,8006,APC Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,8006,APC Prp i/hern init reduc >5 yr,49505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,8006,APC Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,13320,APC Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,13320,APC Prp i/hern init block >5 yr,49507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,13320,APC Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9918, Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9918, Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,9918, Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,9918, Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4224,9918, Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4224,9918, Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,9918,APC Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,9918,APC Rerepair ing hernia reduce,49520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,9918,APC Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,13320,APC Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,13320,APC Rerepair ing hernia blocked,49521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,13320,APC Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,8006,APC Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,8006,APC Repair ing hernia sliding,49525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,8006,APC Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,2816,9420,APC Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,2816,9420,APC Repair lumbar hernia,49540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,2816,9420,APC Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,3291,7422,APC Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,3291,7422,APC Rpr rem hernia init reduce,49550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,3291,7422,APC Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,13320,APC Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,13320,APC Rpr fem hernia init blocked,49553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,13320,APC Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,3291,8006,APC Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,3291,8006,APC Rerepair fem hernia reduce,49555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,3291,8006,APC Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,13320,APC Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,13320,APC Rerepair fem hernia blocked,49557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,13320,APC Rpr ventral hern init reduc,49560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Rpr ventral hern init reduc,49560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Rpr ventral hern init block,49561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Rpr ventral hern init block,49561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Rerepair ventrl hern reduce,49565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,8190,9420, Rerepair ventrl hern reduce,49565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,8190,9420, Rerepair ventrl hern block,49566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,8190,9420, Rerepair ventrl hern block,49566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,8190,9420, Hernia repair w/mesh,49568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Hernia repair w/mesh,49568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Rpr epigastric hern reduce,49570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Rpr epigastric hern reduce,49570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Rpr epigastric hern blocked,49572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Rpr epigastric hern blocked,49572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Rpr umbil hern reduc < 5 yr,49580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4457,5123, Rpr umbil hern reduc < 5 yr,49580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4457,5123, Rpr umbil hern block < 5 yr,49582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,4097, Rpr umbil hern block < 5 yr,49582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,4097, Rpr umbil hern reduc > 5 yr,49585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,5567,6404, Rpr umbil hern reduc > 5 yr,49585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,5567,6404, Rpr umbil hern block > 5 yr,49587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Rpr umbil hern block > 5 yr,49587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Repair spigelian hernia,49590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Repair spigelian hernia,49590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,8006,APC Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,8006,APC Rpr aa hrn 1st < 3 cm rdc,49591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,8006,APC Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,13320,APC Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,13320,APC Rpr aa hrn 1st < 3 ncr/strn,49592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,13320,APC Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn 1st 3-10 rdc,49593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,13320,APC Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,13320,APC Rpr aa hrn 1st 3-10 ncr/strn,49594,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,13320,APC Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn 1st > 10 rdc,49595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn 1st > 10 ncr/strn,49596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st > 10 ncr/strn,49596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st > 10 ncr/strn,49596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st > 10 ncr/strn,49596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st > 10 ncr/strn,49596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Rpr aa hrn 1st > 10 ncr/strn,49596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6312, Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6312, Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,6312, Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,6312, Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6312, Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6312, Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,6312,APC Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,6312,APC Repair umbilical lesion,49600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,6312,APC Repair umbilical lesion,49605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Repair umbilical lesion,49605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Repair umbilical lesion,49605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,18617, Repair umbilical lesion,49605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,18617, Repair umbilical lesion,49605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Repair umbilical lesion,49605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Repair umbilical lesion,49606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair umbilical lesion,49611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,8006,APC Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,8006,APC Rpr aa hrn rcr < 3 rdc,49613,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,8006,APC Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,13320,APC Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,13320,APC Rpr aa hrn rcr < 3 ncr/strn,49614,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,13320,APC Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8030.21, Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn rcr 3-10 rdc,49615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,8030.21,APC Rpr aa hrn rcr 3-10 ncr/strn,49616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr 3-10 ncr/strn,49616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr 3-10 ncr/strn,49616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr 3-10 ncr/strn,49616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr 3-10 ncr/strn,49616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr 3-10 ncr/strn,49616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr > 10 rdc,49617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr > 10 rdc,49617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr > 10 rdc,49617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr > 10 rdc,49617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr > 10 rdc,49617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr > 10 rdc,49617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Rpr aa hrn rcr > 10 ncr/strn,49618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr > 10 ncr/strn,49618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr > 10 ncr/strn,49618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr > 10 ncr/strn,49618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr > 10 ncr/strn,49618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Rpr aa hrn rcr > 10 ncr/strn,49618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Rpr parastomal hernia rdc,49621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6312, Rpr parastomal hernia rdc,49621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6312, Rpr parastomal hernia rdc,49621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6312, Rpr parastomal hernia rdc,49621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6312, Rpr parastomal hrna ncr/strn,49622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Rpr parastomal hrna ncr/strn,49622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Rpr parastomal hrna ncr/strn,49622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Rpr parastomal hrna ncr/strn,49622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Rmvl ninfct mesh hernia rpr,49623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Rmvl ninfct mesh hernia rpr,49623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Rmvl ninfct mesh hernia rpr,49623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Rmvl ninfct mesh hernia rpr,49623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,11081,APC Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,11081,APC Lap ing hernia repair init,49650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,11081,APC Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4147,11081,APC Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4147,11081,APC Lap ing hernia repair recur,49651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4147,11081,APC Lap vent/abd hernia repair,49652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,9637,11081, Lap vent/abd hernia repair,49652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,9637,11081, Lap vent/abd hern proc comp,49653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,11336,13036, Lap vent/abd hern proc comp,49653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,11336,13036, Lap inc hernia repair,49654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,13338,15339, Lap inc hernia repair,49654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,13338,15339, Lap inc hern repair comp,49655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,13338,15339, Lap inc hern repair comp,49655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,13338,15339, Lap inc hernia repair recur,49656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,13338,15339, Lap inc hernia repair recur,49656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,13338,15339, Lap inc hern recur comp,49657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,13338,15339, Lap inc hern recur comp,49657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,13338,15339, Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,18617,APC Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,18617,APC Laparo proc hernia repair,49659,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,18617,APC Repair of abdominal wall,49900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of abdominal wall,49900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of abdominal wall,49900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of abdominal wall,49900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Omental flap extra-abdom,49904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Omental flap extra-abdom,49904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Omental flap extra-abdom,49904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Omental flap extra-abdom,49904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Omental flap intra-abdom,49905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Omental flap intra-abdom,49905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Omental flap intra-abdom,49905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Omental flap intra-abdom,49905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Free omental flap microvasc,49906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Free omental flap microvasc,49906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Free omental flap microvasc,49906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Free omental flap microvasc,49906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,18617, Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,18617, Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1071.46,18617, Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1071.46,18617, Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1071.46,18617, Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1071.46,18617, Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,18617,APC Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,18617,APC Abdomen surgery procedure,49999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,18617,APC Exploration of kidney,50010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration of kidney,50010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration of kidney,50010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration of kidney,50010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,18617, Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,18617, Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2469.46,18617, Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2469.46,18617, Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2469.46,18617, Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2469.46,18617, Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,18617,APC Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,18617,APC Renal abscess open drain,50020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,18617,APC Drainage of kidney,50040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Drainage of kidney,50040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Drainage of kidney,50040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Drainage of kidney,50040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Drainage of kidney,50040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Drainage of kidney,50040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Exploration of kidney,50045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration of kidney,50045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration of kidney,50045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration of kidney,50045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of kidney,50065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of kidney,50065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of kidney,50065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of kidney,50065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of kidney,50070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of kidney,50070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of kidney,50070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of kidney,50070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,18617, Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,18617, Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,4224,18617,APC Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,4224,18617,APC Removal of kidney stone,50080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,4224,18617,APC Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,18617, Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,18617, Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3291,18617,APC Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3291,18617,APC Removal of kidney stone,50081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3291,18617,APC Revise kidney blood vessels,50100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise kidney blood vessels,50100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise kidney blood vessels,50100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise kidney blood vessels,50100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploration of kidney,50120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration of kidney,50120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration of kidney,50120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration of kidney,50120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore and drain kidney,50125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore and drain kidney,50125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore and drain kidney,50125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore and drain kidney,50125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney stone,50130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exploration of kidney,50135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exploration of kidney,50135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exploration of kidney,50135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exploration of kidney,50135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Renal biopsy perq,50200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Renal biopsy open,50205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Renal biopsy open,50205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Renal biopsy open,50205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Renal biopsy open,50205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove kidney open,50220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove kidney open,50220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove kidney open,50220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove kidney open,50220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal kidney open complex,50225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal kidney open complex,50225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal kidney open complex,50225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal kidney open complex,50225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal kidney open radical,50230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal kidney open radical,50230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal kidney open radical,50230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal kidney open radical,50230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney & ureter,50236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of kidney,50240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of kidney,50240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of kidney,50240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of kidney,50240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cryoablate renal mass open,50250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Cryoablate renal mass open,50250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Cryoablate renal mass open,50250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Cryoablate renal mass open,50250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Removal of kidney lesion,50280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney lesion,50280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney lesion,50280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney lesion,50280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney lesion,50290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney lesion,50290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney lesion,50290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney lesion,50290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove cadaver donor kidney,50300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove cadaver donor kidney,50300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove cadaver donor kidney,50300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove cadaver donor kidney,50300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove kidney living donor,50320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove kidney living donor,50320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove kidney living donor,50320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove kidney living donor,50320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep cadaver renal allograft,50323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep cadaver renal allograft,50323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep cadaver renal allograft,50323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep cadaver renal allograft,50323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep donor renal graft,50325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep donor renal graft,50325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep donor renal graft,50325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep donor renal graft,50325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep renal graft/venous,50327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep renal graft/venous,50327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep renal graft/venous,50327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep renal graft/venous,50327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep renal graft/arterial,50328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep renal graft/arterial,50328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep renal graft/arterial,50328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep renal graft/arterial,50328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Prep renal graft/ureteral,50329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Prep renal graft/ureteral,50329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Prep renal graft/ureteral,50329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Prep renal graft/ureteral,50329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of kidney,50340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of kidney,50340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of kidney,50340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of kidney,50340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplantation of kidney,50365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove transplanted kidney,50370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove transplanted kidney,50370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove transplanted kidney,50370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove transplanted kidney,50370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reimplantation of kidney,50380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reimplantation of kidney,50380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reimplantation of kidney,50380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reimplantation of kidney,50380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4466, Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4466, Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4466, Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4466, Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,4466, Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,4466, Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,4466,APC Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,4466,APC Change ureter stent percut,50382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,4466,APC Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,4097,APC Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,4097,APC Remove ureter stent percut,50384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,4097,APC Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,7422, Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,7422, Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,7422,APC Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,7422,APC Change stent via transureth,50385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,7422,APC Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,3314,APC Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,3314,APC Remove stent via transureth,50386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,3314,APC Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4466, Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4466, Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4466, Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4466, Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,4466, Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,4466, Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,4466,APC Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,4466,APC Change nephroureteral cath,50387,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,4466,APC Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,3314, Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,3314, Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,823.75,3314, Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,823.75,3314, Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,823.75,3314, Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,823.75,3314, Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,3314,APC Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,3314,APC Remove renal tube w/fluoro,50389,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,3314,APC Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Drainage of kidney lesion,50390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Instll rx agnt into rnal tub,50391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,3314, Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,3314, Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,823.75,3314, Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,823.75,3314, Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,823.75,3314, Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,823.75,3314, Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,3314,APC Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,3314,APC Measure kidney pressure,50396,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,3314,APC Revision of kidney/ureter,50400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of kidney/ureter,50400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of kidney/ureter,50400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of kidney/ureter,50400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of kidney/ureter,50405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of kidney/ureter,50405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of kidney/ureter,50405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of kidney/ureter,50405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,428,5098,APC Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,428,5098,APC Njx px nfrosgrm &/urtrgrm,50430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,428,5098,APC Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,428,5098,APC Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,428,5098,APC Njx px nfrosgrm &/urtrgrm,50431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,428,5098,APC Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,9918, Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,9918, Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9918, Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9918, Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,428,9918, Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,428,9918, Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,9918,APC Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,9918,APC Plmt nephrostomy catheter,50432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,9918,APC Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,653.18,9918, Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,653.18,9918, Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,653.18,,,,,,,fee schedule,653.18,9918, Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,821.52,,,,,,,fee schedule,653.18,9918, Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,653.18,9918, Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,653.18,9918, Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,653.18,9918,APC Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,653.18,9918,APC Plmt nephroureteral catheter,50433,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,653.18,9918,APC Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,653.18,5098, Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,653.18,5098, Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,653.18,,,,,,,fee schedule,653.18,5098, Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,821.52,,,,,,,fee schedule,653.18,5098, Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,653.18,5098, Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,653.18,5098, Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,653.18,5098,APC Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,653.18,5098,APC Convert nephrostomy catheter,50434,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,653.18,5098,APC Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,5098, Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,5098, Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,5098,APC Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,5098,APC Exchange nephrostomy cath,50435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,5098,APC Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,13320, Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,13320, Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,13320,APC Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,13320,APC Dilat xst trc ndurlgc px,50436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,13320,APC Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,18617, Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,18617, Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Dilat xst trc new access rcs,50437,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Repair of kidney wound,50500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of kidney wound,50500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of kidney wound,50500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of kidney wound,50500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Close kidney-skin fistula,50520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Close kidney-skin fistula,50520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Close kidney-skin fistula,50520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Close kidney-skin fistula,50520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Close kidney-skin fistula,50520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Close kidney-skin fistula,50520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Close nephrovisceral fistula,50525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Close nephrovisceral fistula,50525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Close nephrovisceral fistula,50525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Close nephrovisceral fistula,50525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Close nephrovisceral fistula,50526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Close nephrovisceral fistula,50526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Close nephrovisceral fistula,50526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Close nephrovisceral fistula,50526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of horseshoe kidney,50540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of horseshoe kidney,50540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of horseshoe kidney,50540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of horseshoe kidney,50540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13185.37, Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13185.37, Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13185.37, Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13185.37, Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13185.37, Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13185.37, Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,13185.37,APC Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,13185.37,APC Laparo ablate renal cyst,50541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,13185.37,APC Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,18617, Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,18617, Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4147,18617,APC Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4147,18617,APC Laparo ablate renal mass,50542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4147,18617,APC Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4147,18617, Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4147,18617, Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4147,18617,APC Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4147,18617,APC Laparo partial nephrectomy,50543,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4147,18617,APC Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17041, Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17041, Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,17041,APC Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,17041,APC Laparoscopy pyeloplasty,50544,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,17041,APC Laparo Radical Nephrectomy,50545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laparo Radical Nephrectomy,50545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laparo Radical Nephrectomy,50545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laparo Radical Nephrectomy,50545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscopic nephrectomy,50546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laparoscopic nephrectomy,50546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laparoscopic nephrectomy,50546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laparoscopic nephrectomy,50546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laparo removal donor kidney,50547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laparo removal donor kidney,50547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laparo removal donor kidney,50547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laparo removal donor kidney,50547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laparo remove w/ureter,50548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laparo remove w/ureter,50548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laparo remove w/ureter,50548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laparo remove w/ureter,50548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,18617, Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,18617, Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc renal,50549,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy,50551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy,50553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11742.31, Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11742.31, Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11742.31, Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11742.31, Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11742.31, Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11742.31, Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,1544,11742.31,APC Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,1544,11742.31,APC Kidney endoscopy & biopsy,50555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,1544,11742.31,APC Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13036, Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13036, Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,13036, Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,13036, Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,13036, Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,13036, Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,1544,13036,APC Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,1544,13036,APC Kidney endoscopy & treatment,50557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,1544,13036,APC Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy & treatment,50561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,11081,APC Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,13036, Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,13036, Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2762,13036, Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2762,13036, Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,13036, Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,13036, Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,2762,13036,APC Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,2762,13036,APC Renal scope w/tumor resect,50562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,2762,13036,APC Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4372.43, Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4372.43, Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,4372.43, Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,4372.43, Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4372.43, Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4372.43, Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,4372.43,APC Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,4372.43,APC Kidney endoscopy,50570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,4372.43,APC Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,428,3314,APC Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,428,3314,APC Kidney endoscopy,50572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,428,3314,APC Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy & biopsy,50574,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,11081,APC Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1406,18617,APC Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1406,18617,APC Kidney endoscopy,50575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1406,18617,APC Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,1544,18617,APC Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,1544,18617,APC Kidney endoscopy & treatment,50576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,1544,18617,APC Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,18617,APC Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,18617,APC Kidney endoscopy & treatment,50580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,18617,APC Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,13320, Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,13320, Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4062,13320, Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4062,13320, Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,13320, Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,13320, Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4062,13320,APC Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4062,13320,APC Fragmenting of kidney stone,50590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4062,13320,APC Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2762,11081, Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2762,11081, Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2762,11081, Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2762,11081, Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,11081, Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,11081, Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,2762,11081,APC Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,2762,11081,APC Perc rf ablate renal tumor,50592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,2762,11081,APC Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,13320, Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,13320, Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4062,13320, Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4062,13320, Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4062,13320, Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4062,13320, Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4062,13320,APC Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4062,13320,APC Perc cryo ablate renal tum,50593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4062,13320,APC Exploration of ureter,50600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Exploration of ureter,50600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Exploration of ureter,50600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Exploration of ureter,50600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Insert ureteral support,50605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Insert ureteral support,50605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Insert ureteral support,50605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Insert ureteral support,50605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Endoluminal bx urtr rnl plvs,50606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,653.18,1866, Endoluminal bx urtr rnl plvs,50606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,653.18,1866, Endoluminal bx urtr rnl plvs,50606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,653.18,,,,,,,fee schedule,653.18,1866, Endoluminal bx urtr rnl plvs,50606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,821.52,,,,,,,fee schedule,653.18,1866, Removal of ureter stone,50610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of ureter stone,50630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of ureter,50650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Removal of ureter,50650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Removal of ureter,50650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Removal of ureter,50650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Removal of ureter,50660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Removal of ureter,50660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Removal of ureter,50660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Removal of ureter,50660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Injection for ureter x-ray,50684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for ureter x-ray,50684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for ureter x-ray,50684,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for ureter x-ray,50684,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,152.01,18617, Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,152.01,18617, Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,152.01,18617, Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,152.01,18617, Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,152.01,18617, Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,152.01,18617, Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,18617,APC Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,18617,APC Measure ureter pressure,50686,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,18617,APC Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,4097,APC Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,4097,APC Change of ureter tube/stent,50688,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,4097,APC Injection for ureter x-ray,50690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for ureter x-ray,50690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for ureter x-ray,50690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for ureter x-ray,50690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50693,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50694,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,428,13320, Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,13320,APC Plmt ureteral stent prq,50695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,13320,APC Revision of ureter,50700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of ureter,50700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of ureter,50700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of ureter,50700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ureteral embolization/occl,50705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Ureteral embolization/occl,50705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Ureteral embolization/occl,50705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Ureteral embolization/occl,50705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Balloon dilate urtrl strix,50706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Balloon dilate urtrl strix,50706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Balloon dilate urtrl strix,50706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Balloon dilate urtrl strix,50706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Release of ureter,50715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release of ureter,50715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release of ureter,50715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release of ureter,50715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release of ureter,50722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release of ureter,50722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release of ureter,50722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release of ureter,50722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release/revise ureter,50725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release/revise ureter,50725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release/revise ureter,50725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release/revise ureter,50725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1406,18617,APC Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1406,18617,APC Revise ureter,50727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1406,18617,APC Revise ureter,50728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise ureter,50728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise ureter,50728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise ureter,50728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of ureter & kidney,50750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of ureters,50760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of ureters,50760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of ureters,50760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of ureters,50760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Splicing of ureters,50770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Splicing of ureters,50770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Splicing of ureters,50770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Splicing of ureters,50770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reimplant ureter in bladder,50785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant ureter in bowel,50800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant ureter in bowel,50800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant ureter in bowel,50800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant ureter in bowel,50800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of ureter & bowel,50810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of ureter & bowel,50810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of ureter & bowel,50810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of ureter & bowel,50810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Urine shunt to intestine,50815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Urine shunt to intestine,50815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Urine shunt to intestine,50815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Urine shunt to intestine,50815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Construct bowel bladder,50825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise urine flow,50830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise urine flow,50830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise urine flow,50830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise urine flow,50830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace ureter by bowel,50840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace ureter by bowel,50840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace ureter by bowel,50840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace ureter by bowel,50840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Appendico-vesicostomy,50845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Appendico-vesicostomy,50845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Appendico-vesicostomy,50845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Appendico-vesicostomy,50845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplant ureter to skin,50860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplant ureter to skin,50860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplant ureter to skin,50860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplant ureter to skin,50860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of ureter,50900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of ureter,50900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of ureter,50900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of ureter,50900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Closure ureter/skin fistula,50920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Closure ureter/skin fistula,50920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Closure ureter/skin fistula,50920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Closure ureter/skin fistula,50920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Closure ureter/bowel fistula,50930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Closure ureter/bowel fistula,50930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Closure ureter/bowel fistula,50930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Closure ureter/bowel fistula,50930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release of ureter,50940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release of ureter,50940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release of ureter,50940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release of ureter,50940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,9420, Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,9420, Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3560,9420, Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3560,9420, Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3560,9420, Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3560,9420, Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3560,9420,APC Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3560,9420,APC Laparoscopy ureterolithotomy,50945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3560,9420,APC Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,17041, Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,17041, Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,17041, Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,17041, Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,17041, Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,17041, Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3560,17041,APC Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3560,17041,APC Laparo New Ureter/Bladder,50947,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3560,17041,APC Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,17939, Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,17939, Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,17939, Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,17939, Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,17939, Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,17939, Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3560,17939,APC Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3560,17939,APC Laparo New Ureter/Bladder,50948,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3560,17939,APC Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,18617, Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,18617, Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,18617,APC Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,18617,APC Laparoscope proc ureter,50949,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,18617,APC Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,5123,APC Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,5123,APC Endoscopy of ureter,50951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,5123,APC Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,8006,APC Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,8006,APC Endoscopy of ureter,50953,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,8006,APC Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,11081,APC Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,11081,APC Ureter endoscopy & biopsy,50955,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,11081,APC Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50957,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,8006,APC Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,8006,APC Ureter endoscopy & treatment,50961,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,8006,APC Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,4372.43, Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,4372.43, Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4372.43, Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4372.43, Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,4372.43, Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,4372.43, Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,4372.43,APC Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,4372.43,APC Ureter endoscopy,50970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,4372.43,APC Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,8006,APC Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,8006,APC Ureter endoscopy & catheter,50972,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,8006,APC Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,11081,APC Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,11081,APC Ureter endoscopy & biopsy,50974,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,11081,APC Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,9420, Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,9420,APC Ureter endoscopy & treatment,50980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,9420,APC Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,6404, Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,6404, Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4164.22,6404, Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4164.22,6404, Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,6404, Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,6404, Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,6404,APC Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,6404,APC Incise & treat bladder,51020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,6404,APC Incise & treat bladder,51030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Incise & treat bladder,51030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Incise & treat bladder,51030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Incise & treat bladder,51030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Incise & treat bladder,51030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Incise & treat bladder,51030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2469.46,6312, Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2469.46,6312, Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,6312, Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,6312, Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2469.46,6312, Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2469.46,6312, Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,6312,APC Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,6312,APC Incise & drain bladder,51040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,6312,APC Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2469.46,6312, Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2469.46,6312, Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,6312, Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,6312, Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2469.46,6312, Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2469.46,6312, Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,6312,APC Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,6312,APC Incise bladder/drain ureter,51045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,6312,APC Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,8006,APC Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,8006,APC Removal of bladder stone,51050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,8006,APC Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1406,18617,APC Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1406,18617,APC Removal of ureter stone,51060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1406,18617,APC Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,8006, Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,8006, Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4164.22,8006, Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4164.22,8006, Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,8006, Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,8006, Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,8006,APC Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,8006,APC Remove ureter calculus,51065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,8006,APC Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,4097,APC Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,4097,APC Drainage of bladder abscess,51080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,4097,APC Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,18617, Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,18617, Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,18617, Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,18617, Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Drain bladder by needle,51100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1014.47,18617, Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1014.47,18617, Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1014.47,18617, Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1014.47,18617, Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1014.47,18617, Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1014.47,18617, Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,18617,APC Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,18617,APC Drain bladder by trocar/cath,51101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,18617,APC Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4466, Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4466, Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4466, Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4466, Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,4466, Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,4466, Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,4466,APC Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,4466,APC Drain bl w/cath insertion,51102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,4466,APC Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,11081,APC Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,11081,APC Removal of bladder cyst,51500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,11081,APC Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,6312, Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,6312, Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4164.22,6312, Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4164.22,6312, Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,6312, Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,6312, Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,6312,APC Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,6312,APC Removal of bladder lesion,51520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,6312,APC Removal of bladder lesion,51525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of bladder lesion,51525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of bladder lesion,51525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of bladder lesion,51525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of bladder lesion,51530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of bladder lesion,51530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of bladder lesion,51530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of bladder lesion,51530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1406,18617,APC Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1406,18617,APC Repair of ureter lesion,51535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1406,18617,APC Partial removal of bladder,51550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Partial removal of bladder,51550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Partial removal of bladder,51550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Partial removal of bladder,51550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Partial removal of bladder,51550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Partial removal of bladder,51550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Partial removal of bladder,51555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Partial removal of bladder,51555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Partial removal of bladder,51555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Partial removal of bladder,51555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise bladder & ureter(s),51565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise bladder & ureter(s),51565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise bladder & ureter(s),51565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise bladder & ureter(s),51565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of bladder,51570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of bladder,51570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of bladder,51570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of bladder,51570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of bladder & nodes,51585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove bladder/revise tract,51595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove bladder/create pouch,51596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove bladder/create pouch,51596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove bladder/create pouch,51596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove bladder/create pouch,51596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of pelvic structures,51597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pelvic structures,51597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pelvic structures,51597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pelvic structures,51597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Injection for bladder x-ray,51600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Injection for bladder x-ray,51600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Preparation for bladder xray,51605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Preparation for bladder xray,51605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Injection for bladder x-ray,51610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Injection for bladder x-ray,51610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,18617, Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,18617, Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,18617, Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,18617, Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Irrigation of bladder,51700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Insert bladder catheter,51701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,1866, Insert bladder catheter,51701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,1866, Insert bladder catheter,51701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,1866, Insert bladder catheter,51701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,1866, Insert bladder catheter,51701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,1866,APC Insert bladder catheter,51701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,1866,APC Insert bladder catheter,51701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,1866,APC Insert temp bladder cath,51702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,1866, Insert temp bladder cath,51702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,1866, Insert temp bladder cath,51702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,1866, Insert temp bladder cath,51702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,1866, Insert temp bladder cath,51702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,1866,APC Insert temp bladder cath,51702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,1866,APC Insert temp bladder cath,51702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,1866,APC Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,152.01,3314, Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,152.01,3314, Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,152.01,3314, Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,152.01,3314, Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,152.01,3314, Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,152.01,3314, Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,3314,APC Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,3314,APC Insert bladder cath complex,51703,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,3314,APC Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Change of bladder tube,51705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,3314, Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,3314, Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,823.75,3314, Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,823.75,3314, Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,823.75,3314, Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,823.75,3314, Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,3314,APC Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,3314,APC Change of bladder tube,51710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,3314,APC Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Endoscopic injection/implant,51715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,3314, Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,3314, Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,823.75,3314, Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,823.75,3314, Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,823.75,3314, Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,823.75,3314, Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,3314,APC Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,3314,APC Treatment of bladder lesion,51720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,3314,APC Ins trurl ablt trnsdc thr us,51721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ins trurl ablt trnsdc thr us,51721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ins trurl ablt trnsdc thr us,51721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ins trurl ablt trnsdc thr us,51721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Simple cystometrogram,51725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,295.16,3314, Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,295.16,3314, Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Complex cystometrogram,51726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,730.31,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,836.32,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,730.31,18617, Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,730.31,18617,APC Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,730.31,18617,APC Cystometrogram w/up,51727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,730.31,18617,APC Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,18617, Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,18617, Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,823.75,18617, Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,823.75,18617, Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,823.75,18617, Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,823.75,18617, Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,18617,APC Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,18617,APC Cystometrogram w/vp,51728,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,18617,APC Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,730.31,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,836.32,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,730.31,18617, Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,730.31,18617,APC Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,730.31,18617,APC Cystometrogram w/vp&up,51729,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,730.31,18617,APC Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,131.22,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,150.26,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,131.22,18617, Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,131.22,18617,APC Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,131.22,18617,APC Urine flow measurement,51736,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,131.22,18617,APC Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,211.67,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,242.39,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,211.67,18617, Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,211.67,18617,APC Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,211.67,18617,APC Electro-uroflowmetry first,51741,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,211.67,18617,APC Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,616.63,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,706.14,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,152.01,18617, Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,18617,APC Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,18617,APC Anal/urinary muscle study,51784,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,18617,APC Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,647.38,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,741.35,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Anal/urinary muscle study,51785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,805.93,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,922.91,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Urinary reflex study,51792,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Intraabdominal pressure test,51797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Intraabdominal pressure test,51797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Intraabdominal pressure test,51797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,828.77,,,,,,,fee schedule,428,1866, Intraabdominal pressure test,51797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Intraabdominal pressure test,51797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,949.07,,,,,,,fee schedule,428,1866, Intraabdominal pressure test,51797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.56,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.17,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,45.56,18617, Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,45.56,18617,APC Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,45.56,18617,APC Us urine capacity measure,51798,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,45.56,18617,APC Revision of bladder/urethra,51800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Revision of bladder/urethra,51800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Revision of bladder/urethra,51800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Revision of bladder/urethra,51800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Revision of urinary tract,51820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Revision of urinary tract,51820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Revision of urinary tract,51820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Revision of urinary tract,51820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,18617, Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,18617, Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,428,18617,APC Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,428,18617,APC Attach bladder/urethra,51840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,428,18617,APC Attach bladder/urethra,51841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Attach bladder/urethra,51841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Attach bladder/urethra,51841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Attach bladder/urethra,51841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,18617,APC Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,18617,APC Repair bladder neck,51845,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,18617,APC Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,18617, Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,18617, Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,2816,18617,APC Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,2816,18617,APC Repair of bladder wound,51860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,2816,18617,APC Repair of bladder wound,51865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Repair of bladder wound,51865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Repair of bladder wound,51865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Repair of bladder wound,51865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Repair of bladder wound,51865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Repair of bladder wound,51865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,6404,APC Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,6404,APC Repair of bladder opening,51880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,6404,APC Repair bladder/vagina lesion,51900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Repair bladder/vagina lesion,51900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Repair bladder/vagina lesion,51900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Repair bladder/vagina lesion,51900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Repair bladder/vagina lesion,51900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Repair bladder/vagina lesion,51900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Close bladder-uterus fistula,51920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Close bladder-uterus fistula,51920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Close bladder-uterus fistula,51920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Close bladder-uterus fistula,51920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Close bladder-uterus fistula,51920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Close bladder-uterus fistula,51920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Hysterectomy/bladder repair,51925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Hysterectomy/bladder repair,51925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Hysterectomy/bladder repair,51925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Hysterectomy/bladder repair,51925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Correction of bladder defect,51940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Correction of bladder defect,51940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Correction of bladder defect,51940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Correction of bladder defect,51940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of bladder & bowel,51960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of bladder & bowel,51960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of bladder & bowel,51960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of bladder & bowel,51960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Construct bladder opening,51980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Construct bladder opening,51980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Construct bladder opening,51980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Construct bladder opening,51980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,13036,APC Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,13036,APC Laparo urethral suspension,51990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,13036,APC Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,11081,APC Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,11081,APC Laparo sling operation,51992,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,11081,APC Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,18617, Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,18617, Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparoscope proc bla,51999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,3314, Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,3314, Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,823.75,3314, Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,823.75,3314, Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,823.75,3314, Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,823.75,3314, Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,3314,APC Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,3314,APC Cystoscopy,52000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,3314,APC Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Cystoscopy removal of clots,52001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy & ureter catheter,52005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Cystoscopy and biopsy,52007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,823.75,11081, Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,823.75,11081, Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,823.75,11081, Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,823.75,11081, Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,823.75,11081, Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,823.75,11081, Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,11081,APC Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,11081,APC Cystoscopy & duct catheter,52010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,11081,APC Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy w/biopsy(s),52204,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52214,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52224,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52234,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Cystoscopy and treatment,52235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,8006,APC Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,8006,APC Cystoscopy and treatment,52240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,8006,APC Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,8006, Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,8006, Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4164.22,8006, Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4164.22,8006, Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,8006, Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,8006, Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,8006,APC Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,8006,APC Cystoscopy and radiotracer,52250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,8006,APC Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4166, Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4166, Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4166, Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4166, Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2469.46,4166, Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2469.46,4166, Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4166,APC Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4166,APC Cystoscopy and treatment,52265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4166,APC Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy & revise urethra,52270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy & revise urethra,52275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,13320,APC Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,13320,APC Cystoscopy implant stent,52282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,13320,APC Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Cysto rx balo cath urtl strx,52284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Cysto rx balo cath urtl strx,52284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Cysto rx balo cath urtl strx,52284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Cysto rx balo cath urtl strx,52284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Cysto rx balo cath urtl strx,52284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,13320,APC Cysto rx balo cath urtl strx,52284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,13320,APC Cysto rx balo cath urtl strx,52284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,13320,APC Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,823.75,4466, Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,823.75,4466, Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,823.75,4466, Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,823.75,4466, Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,823.75,4466, Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,823.75,4466, Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,4466,APC Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,4466,APC Cystoscopy and treatment,52285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,4466,APC Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,7422, Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,7422, Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,7422, Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,7422, Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2469.46,7422, Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2469.46,7422, Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,7422,APC Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,7422,APC Cystoscopy chemodenervation,52287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,7422,APC Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Cystoscopy and treatment,52301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Cystoscopy and treatment,52315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,8006,APC Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,8006,APC Remove bladder stone,52317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,8006,APC Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Remove bladder stone,52318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3291,8006,APC Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3291,8006,APC Cystoscopy and treatment,52320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3291,8006,APC Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,9420,APC Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,9420,APC Cystoscopy stone removal,52325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,9420,APC Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Cystoscopy inject material,52327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Cystoscopy and treatment,52332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Create passage to kidney,52334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Cysto W/Ureter Stricture Tx,52341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,8006,APC Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,8006,APC Cysto W/Up Stricture Tx,52342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,8006,APC Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5098,APC Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5098,APC Cysto W/Renal Stricture Tx,52343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5098,APC Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,8006,APC Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,8006,APC Cysto/uretero stricture tx,52344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,8006,APC Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,8006,APC Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,8006,APC Cysto/Uretero W/Up Stricture,52345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,8006,APC Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,9420,APC Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,9420,APC Cystouretero W/Renal Strict,52346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,9420,APC Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Cystouretero & or pyeloscope,52351,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,8006, Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,8006, Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4164.22,8006, Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4164.22,8006, Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,8006, Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,8006, Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,8006,APC Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,8006,APC Cystouretero w/stone remove,52352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,8006,APC Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,8006,APC Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,8006,APC Cystouretero W/Lithotripsy,52353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,8006,APC Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,9420,APC Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,9420,APC Cystouretero W/Biopsy,52354,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,9420,APC Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,9420,APC Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,9420,APC Cystouretero W/Excise Tumor,52355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,9420,APC Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,13320, Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,13320, Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,13320,APC Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,13320,APC Cysto/uretero w/lithotripsy,52356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,13320,APC Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Cystouretero W/Congen Repr,52400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Cystourethro cut ejacul duct,52402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Cystourethro w/implant,52441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Cystourethro w/implant,52441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Cystourethro w/implant,52441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Cystourethro w/implant,52441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Cystourethro w/addl implant,52442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Cystourethro w/addl implant,52442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Cystourethro w/addl implant,52442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Cystourethro w/addl implant,52442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Cysto 1st trurl prst8 comis,52443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Cysto 1st trurl prst8 comis,52443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Cysto 1st trurl prst8 comis,52443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Cysto 1st trurl prst8 comis,52443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Cysto 1st trurl prst8 comis,52443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3408,18617,APC Cysto 1st trurl prst8 comis,52443,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3408,18617,APC Cysto 1st trurl prst8 comis,52443,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3408,18617,APC Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Incision of prostate,52450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Revision of bladder neck,52500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Trurl rbtc wtrjt rescj prst8,52597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Trurl rbtc wtrjt rescj prst8,52597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Trurl rbtc wtrjt rescj prst8,52597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Trurl rbtc wtrjt rescj prst8,52597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Trurl rbtc wtrjt rescj prst8,52597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,2816,18617,APC Trurl rbtc wtrjt rescj prst8,52597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,2816,18617,APC Trurl rbtc wtrjt rescj prst8,52597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,2816,18617,APC Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,9420,APC Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,9420,APC Prostatectomy (TURP),52601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,9420,APC Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Remove prostate regrowth,52630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Relieve bladder contracture,52640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Laser surgery of prostate,52647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3291,13320,APC Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3291,13320,APC Laser surgery of prostate,52648,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3291,13320,APC Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3291,13320,APC Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3291,13320,APC Prostate laser enucleation,52649,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3291,13320,APC Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Drainage of prostate abscess,52700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,6404,APC Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,6404,APC Incision of urethra,53000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,6404,APC Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,8006,APC Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,8006,APC Incision of urethra,53010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,8006,APC Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,4097,APC Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,4097,APC Incision of urethra,53020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,4097,APC Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,18617,APC Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,18617,APC Incision of urethra,53025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,18617,APC Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,9420,APC Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,9420,APC Drainage of urethra abscess,53040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,9420,APC Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,18617,APC Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,18617,APC Drainage of urethra abscess,53060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,18617,APC Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,428,5098,APC Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,428,5098,APC Drainage of urinary leakage,53080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,428,5098,APC Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1406,18617, Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1406,18617, Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1406,18617,APC Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1406,18617,APC Drainage of urinary leakage,53085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1406,18617,APC Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,6404,APC Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,6404,APC Biopsy of urethra,53200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,6404,APC Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3291,8006,APC Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3291,8006,APC Removal of urethra,53210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3291,8006,APC Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3291,11081,APC Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3291,11081,APC Removal of urethra,53215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3291,11081,APC Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Treatment of urethra lesion,53220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Removal of urethra lesion,53230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,9420,APC Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,9420,APC Removal of urethra lesion,53235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,9420,APC Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Surgery for urethra pouch,53240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,4466,APC Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,4466,APC Removal of urethra gland,53250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,4466,APC Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Treatment of urethra lesion,53260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Treatment of urethra lesion,53265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Removal of urethra gland,53270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Repair of urethra defect,53275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,9420,APC Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,9420,APC Revise urethra stage 1,53400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,9420,APC Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Revise urethra stage 2,53405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,13036,APC Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,13036,APC Reconstruction of urethra,53410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,13036,APC Reconstruction of urethra,53415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruction of urethra,53415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruction of urethra,53415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruction of urethra,53415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,11081,APC Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,11081,APC Reconstruct urethra stage 1,53420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,11081,APC Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,11081,APC Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,11081,APC Reconstruct urethra stage 2,53425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,11081,APC Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,9420,APC Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,9420,APC Reconstruction of urethra,53430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,9420,APC Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,11081,APC Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,11081,APC Reconstruct urethra/bladder,53431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,11081,APC Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,16365.32, Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,16365.32, Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,16365.32, Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,16365.32, Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,16365.32, Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,16365.32, Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16209.46,,,,,,,fee schedule,2816,16365.32,APC Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16365.32,,,,,,,fee schedule,2816,16365.32,APC Male sling procedure,53440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15586.02,,,,,,,fee schedule,2816,16365.32,APC Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,9420, Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,9420, Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,9420,APC Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,9420,APC Remove/revise male sling,53442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,9420,APC Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,25708.93, Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,25708.93, Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,25708.93, Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,25708.93, Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,25708.93, Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,25708.93, Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,2816,25708.93,APC Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,2816,25708.93,APC Insert tandem cuff,53444,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,2816,25708.93,APC Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,25708.93, Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,25708.93, Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,25708.93, Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,25708.93, Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,25708.93, Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,25708.93, Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,1544,25708.93,APC Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,1544,25708.93,APC Insert uro/ves nck sphincter,53445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,1544,25708.93,APC Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,8006,APC Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,8006,APC Remove uro sphincter,53446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,8006,APC Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,25708.93, Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,25708.93, Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,25708.93, Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,25708.93, Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,25708.93, Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,25708.93, Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,1544,25708.93,APC Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,1544,25708.93,APC Remove/replace ur sphincter,53447,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,1544,25708.93,APC Remov/replc ur sphinctr comp,53448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remov/replc ur sphinctr comp,53448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remov/replc ur sphinctr comp,53448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remov/replc ur sphinctr comp,53448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11742.31, Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11742.31, Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,11742.31, Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,11742.31, Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11742.31, Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11742.31, Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,1544,11742.31,APC Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,1544,11742.31,APC Repair uro sphincter,53449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,1544,11742.31,APC Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,5123,APC Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,5123,APC Revision of urethra,53450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,5123,APC Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4224,18617, Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4224,18617, Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16209.46,,,,,,,fee schedule,4224,18617,APC Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16365.32,,,,,,,fee schedule,4224,18617,APC Tprnl balo cntnc dev bi,53451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15586.02,,,,,,,fee schedule,4224,18617,APC Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3408,18617,APC Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3408,18617,APC Tprnl balo cntnc dev uni,53452,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3408,18617,APC Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,18617, Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,18617, Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Tprnl balo cntnc dev rmvl ea,53453,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Tprnl balo cntnc dev adjmt,53454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,8006,APC Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,8006,APC Revision of urethra,53460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,8006,APC Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3291,18617,APC Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3291,18617,APC Urethrlys transvag w/ scope,53500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3291,18617,APC Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Repair of urethra injury,53502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,9420,APC Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,9420,APC Repair of urethra injury,53505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,9420,APC Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,9420,APC Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,9420,APC Repair of urethra injury,53510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,9420,APC Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Repair of urethra injury,53515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Repair of urethra defect,53520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Dilate urethra stricture,53600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,157.18,3314, Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,157.18,3314, Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,3314, Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,3314, Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,157.18,3314, Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,157.18,3314, Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,3314,APC Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,3314,APC Dilate urethra stricture,53601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,3314,APC Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Dilate urethra stricture,53605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,823.75,18617, Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,823.75,18617, Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,823.75,18617, Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,823.75,18617, Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,823.75,18617, Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,823.75,18617, Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,18617,APC Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,18617,APC Dilate urethra stricture,53620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,18617,APC Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Dilate urethra stricture,53621,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Description Not Available,53640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,53640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,53640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,53640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,152.01,18617, Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,152.01,18617, Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,152.01,18617, Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,152.01,18617, Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,152.01,18617, Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,152.01,18617, Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,18617,APC Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,18617,APC Dilation of urethra,53660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,18617,APC Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Dilation of urethra,53661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,4097,APC Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,4097,APC Dilation of urethra,53665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,4097,APC Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4062,18617, Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4062,18617, Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4062,18617,APC Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4062,18617,APC Prostatic microwave thermotx,53850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4062,18617,APC Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,18617, Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,18617, Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Prostatic rf thermotx,53852,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,13320, Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,13320, Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,13320,APC Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,13320,APC Trurl dstrj prst8 tiss rf wv,53854,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,13320,APC Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,18617,APC Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,18617,APC Insert prost urethral stent,53855,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,18617,APC Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,9918, Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,9918, Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9918, Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9918, Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,428,9918, Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,428,9918, Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,9918,APC Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,9918,APC Transurethral rf treatment,53860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,9918,APC Cysto insj dev ischmc rmdlg,53865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Cysto insj dev ischmc rmdlg,53865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Cysto insj dev ischmc rmdlg,53865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Cysto insj dev ischmc rmdlg,53865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Cysto insj dev ischmc rmdlg,53865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3408,18617,APC Cysto insj dev ischmc rmdlg,53865,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3408,18617,APC Cysto insj dev ischmc rmdlg,53865,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3408,18617,APC Cathj rmvl dev ischmc rmdlg,53866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,18617, Cathj rmvl dev ischmc rmdlg,53866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,18617, Cathj rmvl dev ischmc rmdlg,53866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Cathj rmvl dev ischmc rmdlg,53866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Cathj rmvl dev ischmc rmdlg,53866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Cathj rmvl dev ischmc rmdlg,53866,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Cathj rmvl dev ischmc rmdlg,53866,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,18617, Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,18617, Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,295.16,18617, Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,295.16,18617, Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Urology surgery procedure,53899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,4466,APC Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,4466,APC Slitting of prepuce,54000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,4466,APC Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Slitting of prepuce,54001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1951.11,6312, Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1951.11,6312, Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1951.11,6312, Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1951.11,6312, Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1951.11,6312, Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1951.11,6312, Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1951.11,6312,APC Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1951.11,6312,APC Drain penis lesion,54015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1951.11,6312,APC Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,480.23,18617, Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,480.23,18617, Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,480.23,18617, Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,480.23,18617, Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,480.23,18617, Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,480.23,18617, Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,18617,APC Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,18617,APC Destruction penis lesion(s),54050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,18617,APC Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1406,18617,APC Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1406,18617,APC Destruction penis lesion(s),54055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1406,18617,APC Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Cryosurgery penis lesion(s),54056,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1544,4097,APC Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1544,4097,APC Laser surg penis lesion(s),54057,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1544,4097,APC Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1544,4097,APC Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1544,4097,APC Excision of penis lesion(s),54060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1544,4097,APC Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1544,4097,APC Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1544,4097,APC Destruction penis lesion(s),54065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1544,4097,APC Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy of penis,54100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,5123,APC Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,5123,APC Biopsy of penis,54105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,5123,APC Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Treatment of penis lesion,54110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,11081,APC Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,11081,APC Treat penis lesion graft,54111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,11081,APC Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,17041, Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,17041, Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,2816,17041, Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,2816,17041, Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,17041, Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,17041, Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,2816,17041,APC Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,2816,17041,APC Treat penis lesion graft,54112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,2816,17041,APC Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,6404,APC Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,6404,APC Treatment of penis lesion,54115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,6404,APC Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,8006,APC Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,8006,APC Partial removal of penis,54120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,8006,APC Removal of penis,54125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Removal of penis,54125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Removal of penis,54125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal of penis,54125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal of penis,54125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal of penis,54125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Remove penis & nodes,54130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove penis & nodes,54130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove penis & nodes,54130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove penis & nodes,54130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove penis & nodes,54135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove penis & nodes,54135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove penis & nodes,54135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove penis & nodes,54135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,1544,5123,APC Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,1544,5123,APC Circumcision w/regionl block,54150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,1544,5123,APC Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,823.75,5123, Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,823.75,5123, Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,823.75,5123, Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,823.75,5123, Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,823.75,5123, Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,823.75,5123, Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,856.7,,,,,,,fee schedule,823.75,5123,APC Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,864.94,,,,,,,fee schedule,823.75,5123,APC Circumcision neonate,54160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,823.75,,,,,,,fee schedule,823.75,5123,APC Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Circum 28 days or older,54161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Lysis penil circumic lesion,54162,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Repair of circumcision,54163,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,5123, Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,5123, Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,5123, Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,5123, Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,5123, Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,5123, Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5123,APC Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5123,APC Frenulotomy of penis,54164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5123,APC Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Treatment of penis lesion,54200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,9420,APC Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,9420,APC Treatment of penis lesion,54205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,9420,APC Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Treatment of penis lesion,54220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Prepare penis study,54230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Prepare penis study,54230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Prepare penis study,54230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Prepare penis study,54230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,295.16,18617, Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,295.16,18617, Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,295.16,18617, Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,295.16,18617, Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Dynamic cavernosometry,54231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,295.16,18617, Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,295.16,18617, Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,18617, Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,18617, Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Penile injection,54235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,260.03,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,297.77,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,255.08,18617, Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,18617,APC Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,18617,APC Penis study,54240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,18617,APC Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,337.85,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,386.89,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Penis study,54250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Revision of penis,54300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Revision of penis,54304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,11081,APC Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,11081,APC Reconstruction of urethra,54308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,11081,APC Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,5098,APC Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,5098,APC Reconstruction of urethra,54312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,5098,APC Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11742.31, Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11742.31, Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11742.31, Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11742.31, Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11742.31, Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11742.31, Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3408,11742.31,APC Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3408,11742.31,APC Reconstruction of urethra,54316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3408,11742.31,APC Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,5098,APC Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,5098,APC Reconstruction of urethra,54318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,5098,APC Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Reconstruction of urethra,54322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,9420,APC Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,9420,APC Reconstruction of urethra,54324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,9420,APC Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,13036,APC Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,13036,APC Reconstruction of urethra,54326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,13036,APC Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,5098,APC Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,5098,APC Revise penis/urethra,54328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,5098,APC Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,18617, Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,18617, Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3291,18617,APC Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3291,18617,APC Revise penis/urethra,54332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3291,18617,APC Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,18617, Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,18617, Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,18617,APC Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,18617,APC Revise penis/urethra,54336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,18617,APC Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,8006,APC Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,8006,APC Secondary urethral surgery,54340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,8006,APC Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3408,13036,APC Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3408,13036,APC Secondary urethral surgery,54344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3408,13036,APC Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,13036,APC Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,13036,APC Secondary urethral surgery,54348,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,13036,APC Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18686, Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18686, Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3408,18686, Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3408,18686, Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,18686, Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,18686, Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,18686,APC Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,18686,APC Reconstruct urethra/penis,54352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,18686,APC Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,8006,APC Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,8006,APC Penis plastic surgery,54360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,8006,APC Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,5098,APC Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,5098,APC Repair penis,54380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,5098,APC Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2469.46,5098, Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2469.46,5098, Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,5098, Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,5098, Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2469.46,5098, Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2469.46,5098, Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,5098,APC Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,5098,APC Repair penis,54385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,5098,APC Repair penis and bladder,54390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair penis and bladder,54390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair penis and bladder,54390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair penis and bladder,54390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,16365.32, Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,16365.32, Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,16365.32, Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,16365.32, Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,16365.32, Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,16365.32, Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16209.46,,,,,,,fee schedule,3408,16365.32,APC Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16365.32,,,,,,,fee schedule,3408,16365.32,APC Insert semi-rigid prosthesis,54400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15586.02,,,,,,,fee schedule,3408,16365.32,APC Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,25708.93, Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,25708.93, Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,25708.93, Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,25708.93, Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,25708.93, Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,25708.93, Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,3408,25708.93,APC Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,3408,25708.93,APC Insert self-contd prosthesis,54401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,3408,25708.93,APC Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,25708.93, Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,25708.93, Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,25708.93, Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,25708.93, Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,25708.93, Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,25708.93, Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,3408,25708.93,APC Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,3408,25708.93,APC Insert multi-comp penis pros,54405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,3408,25708.93,APC Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,8006,APC Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,8006,APC Remove muti-comp penis pros,54406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,8006,APC Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,9420,APC Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,9420,APC Repair multi-comp penis pros,54408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,9420,APC Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,25708.93, Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,25708.93, Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,25708.93, Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,25708.93, Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,25708.93, Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,25708.93, Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,3408,25708.93,APC Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,3408,25708.93,APC Remove/replace penis prosth,54410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,3408,25708.93,APC Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,25708.93, Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,25708.93, Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,25708.93, Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,25708.93, Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,25708.93, Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,25708.93, Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,3291,25708.93,APC Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,3291,25708.93,APC Remov/replc penis pros comp,54411,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,3291,25708.93,APC Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Remove self-contd penis pros,54415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,25708.93, Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,25708.93, Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,25708.93, Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,25708.93, Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,25708.93, Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,25708.93, Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,3408,25708.93,APC Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,3408,25708.93,APC Remv/repl penis contain pros,54416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,3408,25708.93,APC Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,25708.93, Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,25708.93, Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,25708.93, Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,25708.93, Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,25708.93, Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,25708.93, Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25464.09,,,,,,,fee schedule,4224,25708.93,APC Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25708.93,,,,,,,fee schedule,4224,25708.93,APC Remv/replc penis pros compl,54417,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24484.7,,,,,,,fee schedule,4224,25708.93,APC Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,6312, Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,6312, Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,6312, Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,6312, Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3563,6312, Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3563,6312, Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3563,6312,APC Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3563,6312,APC Revision of penis,54420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3563,6312,APC Revision of penis,54430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revision of penis,54430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revision of penis,54430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revision of penis,54430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,6312, Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,6312, Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4164.22,6312, Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4164.22,6312, Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,6312, Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,6312, Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,6312,APC Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,6312,APC Revision of penis,54435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,6312,APC Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,9918, Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,9918, Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,9918, Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,9918, Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,428,9918, Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,428,9918, Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,9918,APC Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,9918,APC Repair corporeal tear,54437,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,9918,APC Replantation of penis,54438,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replantation of penis,54438,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replantation of penis,54438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replantation of penis,54438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,8006, Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,8006, Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4164.22,8006, Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4164.22,8006, Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,8006, Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,8006, Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,8006,APC Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,8006,APC Repair of penis,54440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,8006,APC Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,295.16,3314, Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,295.16,3314, Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,295.16,3314, Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,295.16,3314, Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,295.16,3314, Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,295.16,3314, Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,3314,APC Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,3314,APC Preputial stretching,54450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,3314,APC Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,6404,APC Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,6404,APC Biopsy of testis,54500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,6404,APC Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,6404,APC Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,6404,APC Biopsy of testis,54505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,6404,APC Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Excise Lesion Testis,54512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Removal of testis,54520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Orchiectomy partial,54522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,6404,APC Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,6404,APC Removal of testis,54530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,6404,APC Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1406,18617,APC Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1406,18617,APC Extensive testis surgery,54535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1406,18617,APC Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,6404,APC Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,6404,APC Exploration for testis,54550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,6404,APC Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,18617,APC Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,18617,APC Exploration for testis,54560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,18617,APC Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,8006, Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,8006, Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4164.22,8006, Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4164.22,8006, Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,8006, Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,8006, Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,8006,APC Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,8006,APC Reduce testis torsion,54600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,8006,APC Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,6404,APC Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,6404,APC Suspension of testis,54620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,6404,APC Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,4224,6404,APC Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,4224,6404,APC Suspension of testis,54640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,4224,6404,APC Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3563,18617, Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3563,18617, Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,18617, Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,18617, Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3563,18617, Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3563,18617, Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,3563,18617,APC Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,3563,18617,APC Orchiopexy (Fowler-Stephens),54650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,3563,18617,APC Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,13036,APC Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,13036,APC Revision of testis,54660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,13036,APC Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,5098, Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,5098, Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,5098, Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,5098, Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2138,5098, Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2138,5098, Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2138,5098,APC Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2138,5098,APC Repair testis injury,54670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2138,5098,APC Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,5098,APC Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,5098,APC Relocation of testis(es),54680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,5098,APC Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3560,13320, Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3560,13320, Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3560,13320,APC Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3560,13320,APC Laparoscopy orchiectomy,54690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3560,13320,APC Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,428,7498.94, Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,428,7498.94, Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7498.94, Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7498.94, Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7498.94, Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7498.94, Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,7498.94,APC Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,7498.94,APC Laparoscopy orchiopexy,54692,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,7498.94,APC Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,428,18617,APC Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,428,18617,APC Laparoscope proc testis,54699,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,428,18617,APC Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Drainage of scrotum,54700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Biopsy of epididymis,54800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Remove epididymis lesion,54830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2469.46,6312, Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2469.46,6312, Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2469.46,6312, Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2469.46,6312, Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2469.46,6312, Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2469.46,6312, Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,6312,APC Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,6312,APC Remove epididymis lesion,54840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,6312,APC Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Removal of epididymis,54860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,6404, Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,6404, Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4164.22,6404, Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4164.22,6404, Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,6404, Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,6404, Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,6404,APC Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,6404,APC Removal of epididymis,54861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,6404,APC Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,6404,APC Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,6404,APC Explore Epididymis,54865,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,6404,APC Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,6312,APC Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,6312,APC Fusion of spermatic ducts,54900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,6312,APC Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,428,6312, Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,6312,APC Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,6312,APC Fusion of spermatic ducts,54901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,6312,APC Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,18617, Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,18617, Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Drainage of hydrocele,55000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,3408,5123,APC Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,3408,5123,APC Removal of hydrocele,55040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,3408,5123,APC Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,3291,7422,APC Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,3291,7422,APC Removal of hydroceles,55041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,3291,7422,APC Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,6312, Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,6312, Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4164.22,6312, Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4164.22,6312, Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,6312, Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,6312, Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,6312,APC Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,6312,APC Repair of hydrocele,55060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,6312,APC Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Drainage of scrotum abscess,55100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Explore scrotum,55110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Removal of scrotum lesion,55120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,8006,APC Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,8006,APC Removal of scrotum,55150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,8006,APC Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,8006,APC Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,8006,APC Revision of scrotum,55175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,8006,APC Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,2816,8006,APC Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,2816,8006,APC Revision of scrotum,55180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,2816,8006,APC Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,4466,APC Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,4466,APC Incision of sperm duct,55200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,4466,APC Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2469.46,4466, Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2469.46,4466, Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2469.46,4466, Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2469.46,4466, Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2469.46,4466, Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2469.46,4466, Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,2469.46,4466,APC Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,2469.46,4466,APC Removal of sperm duct(s),55250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,2469.46,4466,APC Prepare sperm duct x-ray,55300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Prepare sperm duct x-ray,55300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Prepare sperm duct x-ray,55300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Prepare sperm duct x-ray,55300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,5123,APC Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,5123,APC Repair of sperm duct,55400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,5123,APC Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,3408,5123,APC Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,3408,5123,APC Removal of hydrocele,55500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,3408,5123,APC Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,6404, Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,6404, Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4164.22,6404, Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4164.22,6404, Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,6404, Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,6404, Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,6404,APC Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,6404,APC Removal of sperm cord lesion,55520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,6404,APC Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4164.22,6404, Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4164.22,6404, Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4164.22,6404, Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4164.22,6404, Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4164.22,6404, Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4164.22,6404, Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,4164.22,6404,APC Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,4164.22,6404,APC Revise spermatic cord veins,55530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,4164.22,6404,APC Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8030.21, Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8030.21, Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,8030.21, Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,8030.21, Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8030.21, Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8030.21, Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,4224,8030.21,APC Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,4224,8030.21,APC Revise spermatic cord veins,55535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,4224,8030.21,APC Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4398.88,,,,,,,fee schedule,3291,8006,APC Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4441.17,,,,,,,fee schedule,3291,8006,APC Revise hernia & sperm veins,55540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4229.69,,,,,,,fee schedule,3291,8006,APC Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3560,13320, Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3560,13320, Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3560,13320,APC Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3560,13320,APC Laparo ligate spermatic vein,55550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3560,13320,APC Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,18617, Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,18617, Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparo proc spermatic cord,55559,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,428,3314,APC Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,428,3314,APC Incise sperm duct pouch,55600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,428,3314,APC Incise sperm duct pouch,55605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Incise sperm duct pouch,55605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Incise sperm duct pouch,55605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Incise sperm duct pouch,55605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Incise sperm duct pouch,55605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Incise sperm duct pouch,55605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Remove sperm duct pouch,55650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Remove sperm duct pouch,55650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Remove sperm duct pouch,55650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Remove sperm duct pouch,55650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Remove sperm duct pouch,55650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Remove sperm duct pouch,55650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,4372.43, Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,4372.43, Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4372.43, Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4372.43, Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,4372.43, Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,4372.43, Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,428,4372.43,APC Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,428,4372.43,APC Remove sperm pouch lesion,55680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,428,4372.43,APC Biopsy of prostate,55700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Biopsy of prostate,55700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Biopsy of prostate,55700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Biopsy of prostate,55700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Biopsy of prostate,55700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Biopsy of prostate,55700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,5123,APC Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,5123,APC Biopsy of prostate,55705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,5123,APC Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,6404, Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,6404, Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,6404,APC Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,6404,APC Prostate saturation sampling,55706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,6404,APC Bx prst8 trct us guided,55707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bx prst8 trct us guided,55707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bx prst8 trct us guided,55707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bx prst8 trct us guided,55707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Bx prst8 trct us guided,55707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct us guided,55707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct us guided,55707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct us w/mri fus 1,55708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bx prst8 trct us w/mri fus 1,55708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bx prst8 trct us w/mri fus 1,55708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bx prst8 trct us w/mri fus 1,55708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Bx prst8 trct us w/mri fus 1,55708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct us w/mri fus 1,55708,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct us w/mri fus 1,55708,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprnl us guided,55709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl us guided,55709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl us guided,55709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl us guided,55709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl us guided,55709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprnl us guided,55709,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprnl us guided,55709,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprn us w/mri fus 1,55710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bx prst8 tprn us w/mri fus 1,55710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bx prst8 tprn us w/mri fus 1,55710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bx prst8 tprn us w/mri fus 1,55710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Bx prst8 tprn us w/mri fus 1,55710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprn us w/mri fus 1,55710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprn us w/mri fus 1,55710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct mri-us 1st,55711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bx prst8 trct mri-us 1st,55711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bx prst8 trct mri-us 1st,55711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bx prst8 trct mri-us 1st,55711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Bx prst8 trct mri-us 1st,55711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct mri-us 1st,55711,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Bx prst8 trct mri-us 1st,55711,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprnl mri-us 1st,55712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl mri-us 1st,55712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl mri-us 1st,55712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl mri-us 1st,55712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Bx prst8 tprnl mri-us 1st,55712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprnl mri-us 1st,55712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2816,18617,APC Bx prst8 tprnl mri-us 1st,55712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2816,18617,APC Bx prst8 in-bore ct/mri bx 1,55713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri bx 1,55713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri bx 1,55713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri bx 1,55713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri bx 1,55713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,18617,APC Bx prst8 in-bore ct/mri bx 1,55713,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,18617,APC Bx prst8 in-bore ct/mri bx 1,55713,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,18617,APC Bx prst8 in-bore ct/mri 1,55714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri 1,55714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri 1,55714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri 1,55714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Bx prst8 in-bore ct/mri 1,55714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,18617,APC Bx prst8 in-bore ct/mri 1,55714,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,18617,APC Bx prst8 in-bore ct/mri 1,55714,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,18617,APC Bx prst8 ea add mri-us/ct/mr,55715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Bx prst8 ea add mri-us/ct/mr,55715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4372.43, Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4372.43, Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4372.43, Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4372.43, Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4372.43, Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4372.43, Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1544,4372.43,APC Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1544,4372.43,APC Drainage of prostate abscess,55720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1544,4372.43,APC Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,2138,4466,APC Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,2138,4466,APC Drainage of prostate abscess,55725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,2138,4466,APC Removal of prostate,55801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of prostate,55801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of prostate,55801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of prostate,55801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of prostate,55821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of prostate,55821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of prostate,55821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of prostate,55821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of prostate,55831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of prostate,55831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of prostate,55831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of prostate,55831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55842,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55845,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Extensive prostate surgery,55845,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,18617, Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,18617, Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,18617,APC Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,18617,APC Surgical exposure prostate,55860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,18617,APC Extensive prostate surgery,55862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive prostate surgery,55865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,428,18617,APC Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,428,18617,APC Laparo radical prostatectomy,55866,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,428,18617,APC Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,18617, Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,18617, Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,18617,APC Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,18617,APC Laps surg prst8ect smpl stot,55867,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,18617,APC Lap srg prst8ct lymph nod bx,55868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Lap srg prst8ct lymph nod bx,55868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Lap srg prst8ct lymph nod bx,55868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Lap srg prst8ct lymph nod bx,55868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Lap srg prst8ct lymph nod bx,55868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,18617,APC Lap srg prst8ct lymph nod bx,55868,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,18617,APC Lap srg prst8ct lymph nod bx,55868,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,18617,APC Lap srg prst8ct bi pl lmphad,55869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Lap srg prst8ct bi pl lmphad,55869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Lap srg prst8ct bi pl lmphad,55869,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Lap srg prst8ct bi pl lmphad,55869,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Lap srg prst8ct bi pl lmphad,55869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,18617,APC Lap srg prst8ct bi pl lmphad,55869,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,18617,APC Lap srg prst8ct bi pl lmphad,55869,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,18617,APC Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,855,3314,APC Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,855,3314,APC Electroejaculation,55870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,855,3314,APC Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,13320, Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,13320, Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3560,13320,APC Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3560,13320,APC Cryoablate Prostate,55873,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3560,13320,APC Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,13320, Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,13320, Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,1544,13320,APC Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,1544,13320,APC Tprnl plmt biodegrdabl matrl,55874,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,1544,13320,APC Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,3408,13320,APC Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,3408,13320,APC Transperi needle place pros,55875,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,3408,13320,APC Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1700.54,,,,,,,fee schedule,1544,4097,APC Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1716.89,,,,,,,fee schedule,1544,4097,APC Place rt device/marker pros,55876,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1635.14,,,,,,,fee schedule,1544,4097,APC Abltj ire prst8 1+ tum perq,55877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Abltj ire prst8 1+ tum perq,55877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Abltj ire prst8 1+ tum perq,55877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Abltj ire prst8 1+ tum perq,55877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Abltj ire prst8 1+ tum perq,55877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,2816,18617,APC Abltj ire prst8 1+ tum perq,55877,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,2816,18617,APC Abltj ire prst8 1+ tum perq,55877,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,2816,18617,APC Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,13320, Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,13320, Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,2816,13320,APC Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,2816,13320,APC Abltj mal prst8 tiss hifu,55880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,2816,13320,APC Ablt trurl prst8 tis thrm us,55881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ablt trurl prst8 tis thrm us,55881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ablt trurl prst8 tis thrm us,55881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ablt trurl prst8 tis thrm us,55881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ablt trurl prst8 tis trnsdcr,55882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Ablt trurl prst8 tis trnsdcr,55882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Ablt trurl prst8 tis trnsdcr,55882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Ablt trurl prst8 tis trnsdcr,55882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Ablt trurl prst8 tis trnsdcr,55882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16209.46,,,,,,,fee schedule,3408,18617,APC Ablt trurl prst8 tis trnsdcr,55882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16365.32,,,,,,,fee schedule,3408,18617,APC Ablt trurl prst8 tis trnsdcr,55882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15586.02,,,,,,,fee schedule,3408,18617,APC Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,295.16,18617, Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,295.16,18617, Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,295.16,18617, Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,295.16,18617, Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,295.16,18617, Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,295.16,18617, Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.96,,,,,,,fee schedule,295.16,18617,APC Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.91,,,,,,,fee schedule,295.16,18617,APC Genital surgery procedure,55899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.16,,,,,,,fee schedule,295.16,18617,APC Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1544,13320, Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1544,13320, Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,1544,13320,APC Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,1544,13320,APC Place needles pelvic for rt,55920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,1544,13320,APC Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,1406,18617,APC Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,1406,18617,APC Sex transformation m to f,55970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,1406,18617,APC Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4330.79,,,,,,,fee schedule,1406,18617,APC Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4372.43,,,,,,,fee schedule,1406,18617,APC Sex transformation f to m,55980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4164.22,,,,,,,fee schedule,1406,18617,APC Description Not Available,56300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,56399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,56399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,56399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,56399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,359.99,4466, I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,359.99,4466, I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,4466, I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,4466, I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,359.99,4466, I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,359.99,4466, I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,4466,APC I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,4466,APC I & D of vulva/perineum,56405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,4466,APC Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,238.83,3314, Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,238.83,3314, Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,3314, Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,3314, Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,238.83,3314, Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,238.83,3314, Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,3314,APC Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,3314,APC Drainage of gland abscess,56420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,3314,APC Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,4466,APC Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,4466,APC Surgery for vulva lesion,56440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,4466,APC Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,4097,APC Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,4097,APC Lysis of labial lesion(s),56441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,4097,APC Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,4097,APC Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,4097,APC Hymenotomy,56442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,4097,APC Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1544,18617,APC Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1544,18617,APC Destroy vulva lesions sim,56501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1544,18617,APC Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2437.45,5123, Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2437.45,5123, Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2437.45,5123, Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2437.45,5123, Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2437.45,5123, Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2437.45,5123, Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,5123,APC Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,5123,APC Destroy vulva lesion/s compl,56515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,5123,APC Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1088.08,3314, Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1088.08,3314, Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1088.08,3314, Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1088.08,3314, Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1088.08,3314, Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1088.08,3314, Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,1088.08,3314,APC Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1088.08,3314,APC Biopsy of vulva/perineum,56605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,1088.08,3314,APC Biopsy of vulva/perineum,56606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Biopsy of vulva/perineum,56606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Biopsy of vulva/perineum,56606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Biopsy of vulva/perineum,56606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Partial removal of vulva,56620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,9918, Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,9918, Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3560,9918, Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3560,9918, Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3560,9918, Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3560,9918, Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3560,9918,APC Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3560,9918,APC Complete removal of vulva,56625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3560,9918,APC Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,18617, Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,18617, Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,428,18617,APC Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,428,18617,APC Extensive vulva surgery,56630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,428,18617,APC Extensive vulva surgery,56631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive vulva surgery,56640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,4097,APC Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,4097,APC Partial removal of hymen,56700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,4097,APC Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,6404,APC Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,6404,APC Remove vagina gland lesion,56740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,6404,APC Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,6404,APC Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,6404,APC Repair of vagina,56800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,6404,APC Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,428,18617,APC Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,428,18617,APC Repair clitoris,56805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,428,18617,APC Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Repair of perineum,56810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,238.83,18617, Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,238.83,18617, Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,18617, Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,18617, Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Exam of vulva w/scope,56820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,3314, Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,3314, Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Exam/biopsy of vulva w/scope,56821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,5123,APC Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,5123,APC Exploration of vagina,57000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,5123,APC Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,6404,APC Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,6404,APC Drainage of pelvic abscess,57010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,6404,APC Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6205.1, Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6205.1, Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,6205.1, Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,6205.1, Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6205.1, Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6205.1, Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,2816,6205.1,APC Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,2816,6205.1,APC Drainage of pelvic fluid,57020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,2816,6205.1,APC I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,18617, I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,18617, I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,18617, I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,18617, I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2138,18617, I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2138,18617, I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2138,18617,APC I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2138,18617,APC I & d vaginal hematoma pp,57022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2138,18617,APC I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,6404,APC I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,6404,APC I & d vag hematoma non-ob,57023,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,6404,APC Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,18617,APC Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,18617,APC Destroy vag lesions simple,57061,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,18617,APC Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,5123,APC Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,5123,APC Destroy vag lesions complex,57065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,5123,APC Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1088.08,3314, Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1088.08,3314, Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1088.08,3314, Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1088.08,3314, Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1088.08,3314, Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1088.08,3314, Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,1088.08,3314,APC Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1088.08,3314,APC Biopsy of vagina,57100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,1088.08,3314,APC Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,5123,APC Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,5123,APC Biopsy of vagina,57105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,5123,APC Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,18617,APC Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,18617,APC Remove vagina wall partial,57106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,18617,APC Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,18617, Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,18617, Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,18617,APC Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,18617,APC Remove vagina tissue part,57107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,18617,APC Description Not Available,57108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,57108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,57108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,57108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18686, Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18686, Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1544,18686, Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1544,18686, Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18686, Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18686, Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,18686,APC Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,18686,APC Vaginectomy partial w/nodes,57109,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,18686,APC Remove vagina wall complete,57110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Remove vagina wall complete,57110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Remove vagina wall complete,57110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Remove vagina wall complete,57110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Remove vagina tissue compl,57111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Remove vagina tissue compl,57111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Remove vagina tissue compl,57111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Remove vagina tissue compl,57111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,18617,APC Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,18617,APC Closure of vagina,57120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,18617,APC Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,5123,APC Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,5123,APC Remove vagina lesion,57130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,5123,APC Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,5123,APC Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,5123,APC Remove vagina lesion,57135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,5123,APC Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,69.69,18617, Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,69.69,18617, Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Treat vagina infection,57150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,2816,6404,APC Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,2816,6404,APC Insert uteri tandem/ovoids,57155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,2816,6404,APC Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,359.99,4166, Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,359.99,4166, Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,4166, Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,4166, Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,4166, Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,4166, Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,4166,APC Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,4166,APC Ins vag brachytx device,57156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,4166,APC Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,238.83,18617, Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,238.83,18617, Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,18617, Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,18617, Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Insert pessary/other device,57160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,238.83,18617, Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,238.83,18617, Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,18617, Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,18617, Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Fitting of diaphragm/cap,57170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,238.83,3314, Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,238.83,3314, Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,3314, Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,3314, Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,238.83,3314, Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,238.83,3314, Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,3314,APC Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,3314,APC Treat vaginal bleeding,57180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,3314,APC Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,6404,APC Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,6404,APC Repair of vagina,57200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,6404,APC Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,6404,APC Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,6404,APC Repair vagina/perineum,57210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,6404,APC Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,11081,APC Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,11081,APC Revision of urethra,57220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,11081,APC Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,8006,APC Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,8006,APC Repair of urethral lesion,57230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,8006,APC Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,9420,APC Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,9420,APC Repair bladder & vagina,57240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,9420,APC Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,9420,APC Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,9420,APC Repair rectum & vagina,57250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,9420,APC Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,11081,APC Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,11081,APC Repair of vagina,57260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,11081,APC Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,4147,11081,APC Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,4147,11081,APC Extensive repair of vagina,57265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,4147,11081,APC Insert mesh/pelvic flr addon,57267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,5028, Insert mesh/pelvic flr addon,57267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,5028, Insert mesh/pelvic flr addon,57267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5028, Insert mesh/pelvic flr addon,57267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5028, Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,8006,APC Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,8006,APC Repair of bowel bulge,57268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,8006,APC Repair of bowel pouch,57270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of bowel pouch,57270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of bowel pouch,57270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of bowel pouch,57270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Suspension of vagina,57280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Suspension of vagina,57280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Suspension of vagina,57280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Suspension of vagina,57280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3291,18617,APC Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3291,18617,APC Colpopexy extraperitoneal,57282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3291,18617,APC Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3291,18617,APC Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3291,18617,APC Colpopexy intraperitoneal,57283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3291,18617,APC Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,18617,APC Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,18617,APC Repair paravag defect open,57284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,18617,APC Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13320, Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13320, Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,4224,13320,APC Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,4224,13320,APC Repair paravag defect vag,57285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,4224,13320,APC Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,18617,APC Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,18617,APC Revise/Remove Sling Repair,57287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,18617,APC Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,11081,APC Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,11081,APC Repair bladder defect,57288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,11081,APC Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3291,11081,APC Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3291,11081,APC Repair bladder & vagina,57289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3291,11081,APC Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,8006,APC Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,8006,APC Construction of vagina,57291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,8006,APC Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4224,18617, Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4224,18617, Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,4224,18617,APC Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,4224,18617,APC Construct vagina with graft,57292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,4224,18617,APC Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,6404,APC Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,6404,APC Revise vag graft via vagina,57295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,6404,APC Revise vag graft open abd,57296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise vag graft open abd,57296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise vag graft open abd,57296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise vag graft open abd,57296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,8006,APC Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,8006,APC Repair rectum-vagina fistula,57300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,8006,APC Repair rectum-vagina fistula,57305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair rectum-vagina fistula,57305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair rectum-vagina fistula,57305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair rectum-vagina fistula,57305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Fistula repair & colostomy,57307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fistula repair & colostomy,57307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fistula repair & colostomy,57307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fistula repair & colostomy,57307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fistula repair transperine,57308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fistula repair transperine,57308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fistula repair transperine,57308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fistula repair transperine,57308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3408,11081,APC Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3408,11081,APC Repair urethrovaginal lesion,57310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3408,11081,APC Repair urethrovaginal lesion,57311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Repair urethrovaginal lesion,57311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Repair urethrovaginal lesion,57311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Repair urethrovaginal lesion,57311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Repair urethrovaginal lesion,57311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Repair urethrovaginal lesion,57311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,11081,APC Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,11081,APC Repair bladder-vagina lesion,57320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,11081,APC Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,1406,18617,APC Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,1406,18617,APC Repair bladder-vagina lesion,57330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,1406,18617,APC Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,18617,APC Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,18617,APC Repair vagina,57335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,18617,APC Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,5123,APC Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,5123,APC Dilation of vagina,57400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,5123,APC Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,4466,APC Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,4466,APC Pelvic examination,57410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,4466,APC Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,5123,APC Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,5123,APC Remove vaginal foreign body,57415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,5123,APC Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,3314, Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,3314, Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Exam of vagina w/scope,57420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1088.08,3314, Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1088.08,3314, Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1088.08,3314, Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1088.08,3314, Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1088.08,3314, Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1088.08,3314, Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,1088.08,3314,APC Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1088.08,3314,APC Exam/biopsy of vag w/scope,57421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,1088.08,3314,APC Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,17041, Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,17041, Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,17041,APC Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,17041,APC Repair paravag defect lap,57423,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,17041,APC Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,18617, Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,18617, Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,18617,APC Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,18617,APC Laparoscopy surg colpopexy,57425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,18617,APC Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3291,17041, Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3291,17041, Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3291,17041,APC Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3291,17041,APC Revise prosth vag graft lap,57426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3291,17041,APC Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,238.83,4166, Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,238.83,4166, Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,4166, Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,4166, Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,238.83,4166, Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,238.83,4166, Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,4166,APC Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,4166,APC Exam of cervix w/scope,57452,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,4166,APC Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,359.99,4166, Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,359.99,4166, Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,359.99,4166, Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,359.99,4166, Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,4166, Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,4166, Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,4166,APC Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,4166,APC Bx/curett of cervix w/scope,57454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,4166,APC Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,3314, Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,3314, Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Biopsy of cervix w/scope,57455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,3314, Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,3314, Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Endocerv curettage w/scope,57456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,18617, Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,18617, Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,18617,APC Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,18617,APC Bx of cervix w/scope leep,57460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,18617,APC Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5044, Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5044, Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,3408,5044, Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,3408,5044, Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,5044,APC Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,5044,APC Conz of cervix w/scope leep,57461,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,5044,APC Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1088.08,3314, Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1088.08,3314, Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1088.08,3314, Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1088.08,3314, Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1088.08,3314, Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1088.08,3314, Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,1088.08,3314,APC Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1088.08,3314,APC Biopsy of cervix,57500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,1088.08,3314,APC Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1088.08,3314, Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1088.08,3314, Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1088.08,3314, Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1088.08,3314, Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1088.08,3314, Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1088.08,3314, Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,1088.08,3314,APC Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1088.08,3314,APC Endocervical curettage,57505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,1088.08,3314,APC Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,18617, Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,18617, Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,18617,APC Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,18617,APC Cauterization of cervix,57510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,18617,APC Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,3314, Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,3314, Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Cryocautery of cervix,57511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,5123,APC Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,5123,APC Laser surgery of cervix,57513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,5123,APC Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,5123,APC Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,5123,APC Conization of cervix,57520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,5123,APC Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,4466,APC Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,4466,APC Conization of cervix,57522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,4466,APC Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,8006,APC Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,8006,APC Removal of cervix,57530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,8006,APC Removal of cervix radical,57531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of cervix radical,57531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of cervix radical,57531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of cervix radical,57531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of residual cervix,57540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of residual cervix,57540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of residual cervix,57540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of residual cervix,57540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove cervix/repair pelvis,57545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove cervix/repair pelvis,57545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove cervix/repair pelvis,57545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove cervix/repair pelvis,57545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,13036,APC Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,13036,APC Removal of residual cervix,57550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,13036,APC Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1406,18617, Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1406,18617, Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,1406,18617,APC Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,1406,18617,APC Remove cervix/repair vagina,57555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,1406,18617,APC Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,9420,APC Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,9420,APC Remove cervix repair bowel,57556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,9420,APC D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,5098,APC D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,5098,APC D&C oF Cervical Stump,57558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,5098,APC Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,5123,APC Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,5123,APC Revision of cervix,57700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,5123,APC Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,5123,APC Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,5123,APC Revision of cervix,57720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,5123,APC Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,5123,APC Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,5123,APC Dilation of cervical canal,57800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,5123,APC Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,238.83,18617, Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,238.83,18617, Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,18617, Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,18617, Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Biopsy of uterus lining,58100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Bx done w/colposcopy add-on,58110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Bx done w/colposcopy add-on,58110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Bx done w/colposcopy add-on,58110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Bx done w/colposcopy add-on,58110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,4466,APC Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,4466,APC Dilation and curettage,58120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,4466,APC Myomectomy abdom method,58140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,18617, Myomectomy abdom method,58140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,18617, Myomectomy abdom method,58140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Myomectomy abdom method,58140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Myomectomy abdom method,58140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Myomectomy abdom method,58140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Myomectomy vag method,58145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Myomectomy abdom complex,58146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Myomectomy abdom complex,58146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Myomectomy abdom complex,58146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Myomectomy abdom complex,58146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Myomectomy abdom complex,58146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Myomectomy abdom complex,58146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Total hysterectomy,58150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Total hysterectomy,58150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Total hysterectomy,58150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,18617, Total hysterectomy,58150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,18617, Total hysterectomy,58150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Total hysterectomy,58150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Total hysterectomy,58152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Total hysterectomy,58152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Total hysterectomy,58152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Total hysterectomy,58152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Partial hysterectomy,58180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Partial hysterectomy,58180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Partial hysterectomy,58180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,18617, Partial hysterectomy,58180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,18617, Partial hysterectomy,58180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Partial hysterectomy,58180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Extensive hysterectomy,58210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Removal of pelvis contents,58240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pelvis contents,58240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pelvis contents,58240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pelvis contents,58240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,13320, Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,13320, Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,13320,APC Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,13320,APC Vaginal hysterectomy,58260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,13320,APC Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,13320,APC Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,13320,APC Vag hyst including t/o,58262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,13320,APC Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13320, Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13320, Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,13320,APC Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,13320,APC Vag hyst w/t/o & vag repair,58263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,13320,APC Vag hyst w/urinary repair,58267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vag hyst w/urinary repair,58267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vag hyst w/urinary repair,58267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vag hyst w/urinary repair,58267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,13320,APC Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,13320,APC Vag hyst w/enterocele repair,58270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,13320,APC Hysterectomy/revise vagina,58275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Hysterectomy/revise vagina,58275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Hysterectomy/revise vagina,58275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Hysterectomy/revise vagina,58275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Hysterectomy/revise vagina,58275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Hysterectomy/revise vagina,58275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Hysterectomy/revise vagina,58280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Hysterectomy/revise vagina,58280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Hysterectomy/revise vagina,58280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Hysterectomy/revise vagina,58280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extensive hysterectomy,58285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Extensive hysterectomy,58285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Extensive hysterectomy,58285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Extensive hysterectomy,58285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Extensive hysterectomy,58285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Extensive hysterectomy,58285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3291,18617,APC Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3291,18617,APC Vag hyst complex,58290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3291,18617,APC Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,18617,APC Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,18617,APC Vag hyst incl t/o complex,58291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,18617,APC Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,18617, Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,18617, Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3291,18617,APC Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3291,18617,APC Vag hyst t/o & repair compl,58292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3291,18617,APC Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,18617, Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,18617, Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,18617,APC Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,18617,APC Vag hyst w/enterocele compl,58294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,18617,APC Insert intrauterine device,58300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Insert intrauterine device,58300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Insert intrauterine device,58300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Insert intrauterine device,58300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Insert intrauterine device,58300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Insert intrauterine device,58300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,359.99,3314, Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,359.99,3314, Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Remove intrauterine device,58301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,359.99,3314, Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,359.99,3314, Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,359.99,3314, Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,359.99,3314, Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Artificial insemination,58321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,238.83,3314, Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,238.83,3314, Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,238.83,3314, Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,238.83,3314, Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,238.83,3314, Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,238.83,3314, Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,3314,APC Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,3314,APC Artificial insemination,58322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,3314,APC Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,238.83,3314, Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,238.83,3314, Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,238.83,3314, Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,238.83,3314, Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,238.83,3314, Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,238.83,3314, Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,3314,APC Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,3314,APC Sperm washing,58323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,3314,APC Catheter for hysterography,58340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Catheter for hysterography,58340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Catheter for hysterography,58340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Catheter for hysterography,58340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,18617,APC Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,18617,APC Reopen fallopian tube,58345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,18617,APC Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,17041, Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,17041, Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,2816,17041, Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,2816,17041, Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,17041, Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,17041, Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,2816,17041,APC Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,2816,17041,APC Insert heyman uteri capsule,58346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,2816,17041,APC Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,9420,APC Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,9420,APC Reopen fallopian tube,58350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,9420,APC Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,9918, Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,9918, Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,4147,9918,APC Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,4147,9918,APC Endometr ablate thermal,58353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,4147,9918,APC Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,18617, Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,18617, Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,18617,APC Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,18617,APC Endometrial cryoablation,58356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,18617,APC Suspension of uterus,58400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Suspension of uterus,58400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Suspension of uterus,58400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Suspension of uterus,58400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Suspension of uterus,58410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Suspension of uterus,58410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Suspension of uterus,58410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Suspension of uterus,58410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of ruptured uterus,58520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair of ruptured uterus,58520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair of ruptured uterus,58520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair of ruptured uterus,58520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revision of uterus,58540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Revision of uterus,58540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Revision of uterus,58540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Revision of uterus,58540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13320, Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13320, Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,13320,APC Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,13320,APC Lsh uterus 250 g or less,58541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,13320,APC Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,15339, Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,15339, Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,15339,APC Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,15339,APC Lsh w/t/o ut 250 g or less,58542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,15339,APC LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,13320,APC LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,13320,APC LSH Uterus Above 250 g,58543,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,13320,APC LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,15339, LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,15339, LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,15339,APC LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,15339,APC LSH w/t/o Uterus Above 250 g,58544,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,15339,APC Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,13320, Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,13320, Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3560,13320,APC Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3560,13320,APC Laparoscopic myomectomy,58545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3560,13320,APC Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17041, Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17041, Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,17041, Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,17041, Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,17041, Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,17041, Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4147,17041,APC Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4147,17041,APC Laparo-myomectomy complex,58546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4147,17041,APC Lap Radical Hyst,58548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lap Radical Hyst,58548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lap Radical Hyst,58548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lap Radical Hyst,58548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,13320, Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,13320, Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3560,13320,APC Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3560,13320,APC Laparo-asst vag hysterectomy,58550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3560,13320,APC Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15339, Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15339, Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,15339, Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,15339, Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,4147,15339, Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,4147,15339, Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4147,15339,APC Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4147,15339,APC Laparo-vag hyst incl t/o,58552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4147,15339,APC Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15339, Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15339, Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,15339, Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,15339, Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,4147,15339, Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,4147,15339, Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4147,15339,APC Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4147,15339,APC Laparo-vag hyst complex,58553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4147,15339,APC Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17041, Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17041, Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,17041, Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,17041, Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,4147,17041, Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,4147,17041, Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,4147,17041,APC Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,4147,17041,APC Laparo-vag hyst w/t/o compl,58554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,4147,17041,APC Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,5123,APC Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,5123,APC Hysteroscopy dx sep proc,58555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,5123,APC Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,5123,APC Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,5123,APC Hysteroscopy biopsy,58558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,5123,APC Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,2816,6404,APC Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,2816,6404,APC Hysteroscopy lysis,58559,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,2816,6404,APC Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,8006,APC Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,8006,APC Hysteroscopy resect septum,58560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,8006,APC Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,8006,APC Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,8006,APC Hysteroscopy remove myoma,58561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,8006,APC Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,5123,APC Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,5123,APC Hysteroscopy remove fb,58562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,5123,APC Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,13320,APC Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,13320,APC Hysteroscopy ablation,58563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,13320,APC Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,13320, Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,13320, Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3408,13320,APC Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3408,13320,APC Hysteroscopy sterilization,58565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3408,13320,APC Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,15339, Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,15339, Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3560,15339, Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3560,15339, Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,15339, Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,15339, Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3560,15339,APC Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3560,15339,APC Tlh uterus 250 g or less,58570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3560,15339,APC Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,17041, Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,17041, Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,17041, Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,17041, Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,17041, Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,17041, Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3560,17041,APC Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3560,17041,APC Tlh w/t/o 250 g or less,58571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3560,17041,APC Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,17041, Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,17041, Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,17041, Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,17041, Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,17041, Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,17041, Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3560,17041,APC Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3560,17041,APC Tlh uterus over 250 g,58572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3560,17041,APC Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,17041, Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,17041, Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,17041, Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,17041, Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,17041, Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,17041, Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3560,17041,APC Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3560,17041,APC Tlh w/t/o uterus over 250 g,58573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3560,17041,APC Laps tot hyst resj mal,58575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laps tot hyst resj mal,58575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laps tot hyst resj mal,58575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laps tot hyst resj mal,58575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,18617, Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,18617, Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparo proc uterus,58578,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,238.83,18617, Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,238.83,18617, Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,238.83,18617, Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,238.83,18617, Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Hysteroscope procedure,58579,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Transcrv abltj utrn fibrd rf,58580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Transcrv abltj utrn fibrd rf,58580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Transcrv abltj utrn fibrd rf,58580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Transcrv abltj utrn fibrd rf,58580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Transcrv abltj utrn fibrd rf,58580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3291,18617,APC Transcrv abltj utrn fibrd rf,58580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3291,18617,APC Transcrv abltj utrn fibrd rf,58580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3291,18617,APC Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,7422, Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,7422, Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,7422, Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,7422, Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2816,7422, Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2816,7422, Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,7422,APC Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,7422,APC Division of fallopian tube,58600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,7422,APC Division of fallopian tube,58605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Division of fallopian tube,58605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Division of fallopian tube,58605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Division of fallopian tube,58605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ligate oviduct(s) add-on,58611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Ligate oviduct(s) add-on,58611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Ligate oviduct(s) add-on,58611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Ligate oviduct(s) add-on,58611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,18617, Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,18617, Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,18617,APC Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,18617,APC Occlude fallopian tube(s),58615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,18617,APC Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,8006,APC Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,8006,APC Laparoscopy lysis,58660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,8006,APC Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,11081,APC Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,11081,APC Laparoscopy remove adnexa,58661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,11081,APC Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,9420,APC Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,9420,APC Laparoscopy excise lesions,58662,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,9420,APC Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,7498.94,APC Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,7498.94,APC Laparoscopy tubal cautery,58670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,7498.94,APC Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,7498.94, Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,7498.94,APC Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,7498.94,APC Laparoscopy tubal block,58671,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,7498.94,APC Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17939, Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17939, Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,17939, Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,17939, Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,17939, Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,17939, Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3291,17939,APC Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3291,17939,APC Laparoscopy fimbrioplasty,58672,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3291,17939,APC Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13185.37, Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13185.37, Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,13185.37, Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,13185.37, Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13185.37, Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13185.37, Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,13185.37,APC Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,13185.37,APC Laparoscopy salpingostomy,58673,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,13185.37,APC Laps abltj uterine fibroids,58674,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17041, Laps abltj uterine fibroids,58674,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17041, Laps abltj uterine fibroids,58674,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3291,17041, Laps abltj uterine fibroids,58674,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3291,17041, Laps abltj uterine fibroids,58674,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3291,17041,APC Laps abltj uterine fibroids,58674,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3291,17041,APC Laps abltj uterine fibroids,58674,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3291,17041,APC Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,18617, Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,18617, Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparo proc oviduct-ovary,58679,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Removal of fallopian tube,58700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Removal of fallopian tube,58700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Removal of fallopian tube,58700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal of fallopian tube,58700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal of fallopian tube,58700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal of fallopian tube,58700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Removal of ovary/tube(s),58720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of ovary/tube(s),58720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of ovary/tube(s),58720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of ovary/tube(s),58720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Adhesiolysis tube ovary,58740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Adhesiolysis tube ovary,58740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Adhesiolysis tube ovary,58740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Adhesiolysis tube ovary,58740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repair oviduct,58750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repair oviduct,58750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repair oviduct,58750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Repair oviduct,58750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Repair oviduct,58750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repair oviduct,58750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Revise ovarian tube(s),58752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Revise ovarian tube(s),58752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Revise ovarian tube(s),58752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Revise ovarian tube(s),58752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Fimbrioplasty,58760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Fimbrioplasty,58760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Fimbrioplasty,58760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Fimbrioplasty,58760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,428,18617,APC Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,428,18617,APC Create new tubal opening,58770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,428,18617,APC Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,5098, Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,5098, Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,5098, Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,5098, Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2138,5098, Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2138,5098, Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2138,5098,APC Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2138,5098,APC Drainage of ovarian cyst(s),58800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2138,5098,APC Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,18617, Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,18617, Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,18617, Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,18617, Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2138,18617, Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2138,18617, Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2138,18617,APC Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2138,18617,APC Drainage of ovarian cyst(s),58805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2138,18617,APC Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,428,5098,APC Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,428,5098,APC Drain ovary abscess open,58820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,428,5098,APC Drain ovary abscess percut,58822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Drain ovary abscess percut,58822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Drain ovary abscess percut,58822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Drain ovary abscess percut,58822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Transposition ovary(s),58825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Transposition ovary(s),58825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Transposition ovary(s),58825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Transposition ovary(s),58825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,5098,APC Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,5098,APC Biopsy of ovary(s),58900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,5098,APC Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,18617, Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,18617, Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9110.59,,,,,,,fee schedule,3408,18617,APC Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9198.2,,,,,,,fee schedule,3408,18617,APC Partial removal of ovary(s),58920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8760.19,,,,,,,fee schedule,3408,18617,APC Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,18617,APC Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,18617,APC Removal of ovarian cyst(s),58925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,18617,APC Removal of ovary(s),58940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,18617, Removal of ovary(s),58940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,18617, Removal of ovary(s),58940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal of ovary(s),58940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal of ovary(s),58940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal of ovary(s),58940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Removal of ovary(s),58943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of ovary(s),58943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of ovary(s),58943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of ovary(s),58943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect ovarian malignancy,58952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tah rad dissect for debulk,58953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tah rad dissect for debulk,58953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tah rad dissect for debulk,58953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tah rad dissect for debulk,58953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tah rad debulk/lymph remove,58954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tah rad debulk/lymph remove,58954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tah rad debulk/lymph remove,58954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tah rad debulk/lymph remove,58954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bso omentectomy w/tah,58956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bso omentectomy w/tah,58956,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bso omentectomy w/tah,58956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bso omentectomy w/tah,58956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect Recurrent Gyn Mal,58957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Resect Recurrent Gyn Mal,58957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Resect Recurrent Gyn Mal,58957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Resect Recurrent Gyn Mal,58957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Resect Recurrent Gyn Mal,58957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Resect Recurrent Gyn Mal,58957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Resect Recur Gyn Mal w/Lym,58958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Resect Recur Gyn Mal w/Lym,58958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Resect Recur Gyn Mal w/Lym,58958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Resect Recur Gyn Mal w/Lym,58958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Resect Recur Gyn Mal w/Lym,58958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Resect Recur Gyn Mal w/Lym,58958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Exploration of abdomen,58960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,428,18617, Exploration of abdomen,58960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,428,18617, Exploration of abdomen,58960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Exploration of abdomen,58960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Exploration of abdomen,58960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Exploration of abdomen,58960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1088.08,4097, Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1088.08,4097, Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1088.08,4097, Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1088.08,4097, Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1088.08,4097, Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1088.08,4097, Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,1088.08,4097,APC Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1088.08,4097,APC Retrieval of oocyte,58970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,1088.08,4097,APC Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,855,3314,APC Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,855,3314,APC Transfer of embryo,58974,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,855,3314,APC Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,359.99,3314, Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,359.99,3314, Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Transfer of embryo,58976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,238.83,18617, Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,238.83,18617, Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,238.83,18617, Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,238.83,18617, Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Genital surgery procedure,58999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,214.64,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,245.8,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,214.64,18617, Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,214.64,18617,APC Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,214.64,18617,APC Amniocentesis diagnostic,59000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,214.64,18617,APC Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,18617, Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,18617, Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,359.99,18617, Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,359.99,18617, Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,359.99,18617, Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,359.99,18617, Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,18617,APC Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,18617,APC Amniocentesis therapeutic,59001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,18617,APC Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,359.99,18617, Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,359.99,18617, Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,359.99,18617, Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,359.99,18617, Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,359.99,18617, Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,359.99,18617, Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,18617,APC Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,18617,APC Fetal cord puncture prenatal,59012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,18617,APC Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1088.08,18617, Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1088.08,18617, Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1088.08,18617, Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1088.08,18617, Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1088.08,18617, Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1088.08,18617, Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1131.6,,,,,,,fee schedule,1088.08,18617,APC Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1088.08,18617,APC Chorion biopsy,59015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1088.08,,,,,,,fee schedule,1088.08,18617,APC Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,176.25,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,201.84,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,176.25,18617, Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,176.25,18617,APC Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,176.25,18617,APC Fetal contract stress test,59020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,176.25,18617,APC Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.4,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,131.01,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,114.4,18617, Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,114.4,18617,APC Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,114.4,18617,APC Fetal non-stress test,59025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,114.4,18617,APC Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,359.99,18617, Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,359.99,18617, Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,359.99,18617, Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,359.99,18617, Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,359.99,18617, Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,359.99,18617, Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,18617,APC Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,18617,APC Fetal scalp blood sample,59030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,18617,APC Fetal monitor w/report,59050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,133.23,18617, Fetal monitor w/report,59050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,133.23,18617, Fetal monitor w/report,59050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,133.23,,,,,,,fee schedule,133.23,18617, Fetal monitor w/report,59050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,152.56,,,,,,,fee schedule,133.23,18617, Fetal monitor w/report,59050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,133.23,18617, Fetal monitor w/report,59050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,133.23,18617, Fetal monitor/interpret only,59051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Fetal monitor/interpret only,59051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Fetal monitor/interpret only,59051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Fetal monitor/interpret only,59051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Fetal monitor/interpret only,59051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Fetal monitor/interpret only,59051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,359.99,3314, Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,359.99,3314, Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Transabdom amnioinfus w/us,59070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,359.99,3314, Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,359.99,3314, Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Umbilical cord occlud w/us,59072,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,359.99,3314, Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,359.99,3314, Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Fetal fluid drainage w/us,59074,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,359.99,3314, Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,359.99,3314, Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Fetal shunt placement w/us,59076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,6205.1, Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,6205.1, Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6205.1, Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6205.1, Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,6205.1, Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,6205.1, Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,428,6205.1,APC Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,428,6205.1,APC Remove uterus lesion,59100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,428,6205.1,APC Treat ectopic pregnancy,59120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Treat ectopic pregnancy,59120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Treat ectopic pregnancy,59120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Treat ectopic pregnancy,59120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Treat ectopic pregnancy,59121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,18617,APC Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,18617,APC Treat ectopic pregnancy,59150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,18617,APC Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,18617,APC Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,18617,APC Treat ectopic pregnancy,59151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,18617,APC D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3408,6404,APC D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3408,6404,APC D & c after delivery,59160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3408,6404,APC Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,359.99,3314, Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,359.99,3314, Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,359.99,3314, Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,359.99,3314, Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Insert cervical dilator,59200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,18617, Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,18617, Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,2816,18617,APC Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,2816,18617,APC Episiotomy or vaginal repair,59300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,2816,18617,APC Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,5123,APC Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,5123,APC Revision of cervix,59320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,5123,APC Revision of cervix,59325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Revision of cervix,59325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Revision of cervix,59325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Revision of cervix,59325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Revision of cervix,59325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Revision of cervix,59325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Repair of uterus,59350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of uterus,59350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of uterus,59350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of uterus,59350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Obstetrical care,59400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Obstetrical care,59400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Obstetrical care,59400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Obstetrical care,59400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,18617, Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,18617, Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1544,18617,APC Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1544,18617,APC Obstetrical care,59409,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1544,18617,APC Obstetrical care,59410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Obstetrical care,59410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Obstetrical care,59410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Obstetrical care,59410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Obstetrical care,59410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Obstetrical care,59410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,4097, Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,4097, Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,4097, Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,4097, Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1406,4097, Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1406,4097, Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1406,4097,APC Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1406,4097,APC Antepartum manipulation,59412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1406,4097,APC Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,1406,18617,APC Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,1406,18617,APC Deliver placenta,59414,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,1406,18617,APC Antepartum care only,59425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Antepartum care only,59425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Antepartum care only,59425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Antepartum care only,59425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Antepartum care only,59425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Antepartum care only,59425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Antepartum care only,59426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Antepartum care only,59426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Antepartum care only,59426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Antepartum care only,59426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Care after delivery,59430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Care after delivery,59430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Care after delivery,59430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Care after delivery,59430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Care after delivery,59430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Care after delivery,59430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Cesarean delivery,59510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cesarean delivery,59510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cesarean delivery,59510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cesarean delivery,59510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cesarean delivery only,59514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cesarean delivery only,59514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cesarean delivery only,59514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cesarean delivery only,59514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cesarean delivery,59515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Cesarean delivery,59515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Cesarean delivery,59515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Cesarean delivery,59515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Remove uterus after cesarean,59525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove uterus after cesarean,59525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove uterus after cesarean,59525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove uterus after cesarean,59525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vbac delivery,59610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vbac delivery,59610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vbac delivery,59610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vbac delivery,59610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,18617, Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,18617, Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,428,18617,APC Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,428,18617,APC Vbac delivery only,59612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,428,18617,APC Vbac care after delivery,59614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Vbac care after delivery,59614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Vbac care after delivery,59614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Vbac care after delivery,59614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Vbac care after delivery,59614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Vbac care after delivery,59614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Attempted vbac delivery,59618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Attempted vbac delivery,59618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Attempted vbac delivery,59618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Attempted vbac delivery,59618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Attempted vbac delivery only,59620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Attempted vbac delivery only,59620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Attempted vbac delivery only,59620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Attempted vbac delivery only,59620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Attempted vbac after care,59622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Attempted vbac after care,59622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Attempted vbac after care,59622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Attempted vbac after care,59622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Treatment of miscarriage,59812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3291,7422, Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3291,7422, Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Care of miscarriage,59820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Treatment of miscarriage,59821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Treat uterus infection,59830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Treat uterus infection,59830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Treat uterus infection,59830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Treat uterus infection,59830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Treat uterus infection,59830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Treat uterus infection,59830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Abortion,59840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Abortion,59841,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Abortion,59850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Abortion,59850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Abortion,59850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Abortion,59850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Abortion,59850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Abortion,59850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Abortion,59851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4466, Abortion,59851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4466, Abortion,59851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Abortion,59851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Abortion,59851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Abortion,59851,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Abortion,59852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Abortion,59852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Abortion,59852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Abortion,59852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Abortion,59855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Abortion,59855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Abortion,59855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Abortion,59855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Abortion,59855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Abortion,59855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Abortion,59856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Abortion,59856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Abortion,59856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Abortion,59856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Abortion,59856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Abortion,59856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Abortion,59857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Abortion,59857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Abortion,59857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Abortion,59857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,359.99,3314, Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,359.99,3314, Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,359.99,3314, Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,359.99,3314, Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,359.99,3314, Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,359.99,3314, Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.39,,,,,,,fee schedule,359.99,3314,APC Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,377.99,,,,,,,fee schedule,359.99,3314,APC Abortion (mpr),59866,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,359.99,,,,,,,fee schedule,359.99,3314,APC Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Evacuate mole of uterus,59870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3291,7422, Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3291,7422, Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.13,,,,,,,fee schedule,3291,7422,APC Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.37,,,,,,,fee schedule,3291,7422,APC Remove cerclage suture,59871,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.16,,,,,,,fee schedule,3291,7422,APC Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,238.83,18617, Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,238.83,18617, Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,238.83,18617, Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,238.83,18617, Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Fetal invas px w/us,59897,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,18617, Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,18617, Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,18617, Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,18617, Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2138,18617, Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2138,18617, Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,2138,18617,APC Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,2138,18617,APC Laparo proc ob care/deliver,59898,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,2138,18617,APC Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,238.83,18617, Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,238.83,18617, Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,238.83,18617, Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,238.83,18617, Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,238.83,18617, Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,238.83,18617, Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,18617,APC Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,18617,APC Maternity care procedure,59899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,18617,APC Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1544,3314,APC Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1544,3314,APC Drain thyroid/tongue cyst,60000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1544,3314,APC Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Biopsy of thyroid,60100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9420, Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9420, Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,9420, Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,9420, Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,9420, Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,9420, Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,2816,9420,APC Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,2816,9420,APC Remove thyroid lesion,60200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,2816,9420,APC Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,18617,APC Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,18617,APC Partial thyroid excision,60210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,18617,APC Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,18617,APC Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,18617,APC Partial thyroid excision,60212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,18617,APC Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,2816,11081,APC Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,2816,11081,APC Partial removal of thyroid,60220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,2816,11081,APC Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,11081,APC Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,11081,APC Partial removal of thyroid,60225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,11081,APC Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,18617, Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,18617, Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4147,18617,APC Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4147,18617,APC Removal of thyroid,60240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4147,18617,APC Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,18617, Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,18617, Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,18617,APC Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,18617,APC Removal of thyroid,60252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,18617,APC Extensive thyroid surgery,60254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Extensive thyroid surgery,60254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Extensive thyroid surgery,60254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Extensive thyroid surgery,60254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Repeat thyroid surgery,60260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Removal of thyroid,60270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Removal of thyroid,60270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Removal of thyroid,60270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Removal of thyroid,60270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Removal of thyroid,60270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Removal of thyroid,60270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Removal of thyroid,60271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,8006,APC Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,8006,APC Remove thyroid duct lesion,60280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,8006,APC Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,4224,9420,APC Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,4224,9420,APC Remove thyroid duct lesion,60281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,4224,9420,APC Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,18617, Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,18617, Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,18617, Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,18617, Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Aspir/inj thyroid cyst,60300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,18617, Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,18617, Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,18617,APC Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,18617,APC Explore parathyroid glands,60500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,18617,APC Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,13320, Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,13320, Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13320,APC Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13320,APC Re-explore parathyroids,60502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13320,APC Explore parathyroid glands,60505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore parathyroid glands,60505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore parathyroid glands,60505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Explore parathyroid glands,60505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Explore parathyroid glands,60505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore parathyroid glands,60505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Autotransplant parathyroid,60512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Autotransplant parathyroid,60512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Autotransplant parathyroid,60512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Autotransplant parathyroid,60512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,18617, Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,18617, Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Removal of thymus gland,60520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Removal of thymus gland,60521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of thymus gland,60521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of thymus gland,60521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of thymus gland,60521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of thymus gland,60522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of thymus gland,60522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of thymus gland,60522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of thymus gland,60522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore adrenal gland,60540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Explore adrenal gland,60540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Explore adrenal gland,60540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Explore adrenal gland,60540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Explore adrenal gland,60545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore adrenal gland,60545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore adrenal gland,60545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore adrenal gland,60545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove carotid body lesion,60605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscopy adrenalectomy,60650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Laparoscopy adrenalectomy,60650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Laparoscopy adrenalectomy,60650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Laparoscopy adrenalectomy,60650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,18617, Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,18617, Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,3408,18617,APC Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,3408,18617,APC Laparo proc endocrine,60659,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,3408,18617,APC Abltj 1/+thyr ndul 1lobe prq,60660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,2048.66, Abltj 1/+thyr ndul 1lobe prq,60660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,2048.66, Abltj 1/+thyr ndul 1lobe prq,60660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,2048.66,APC Abltj 1/+thyr ndul 1lobe prq,60660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,2048.66,APC Abltj 1/+thyr ndul 1lobe prq,60660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,2048.66,APC Abltj 1/+thyr ndul addl prq,60661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Abltj 1/+thyr ndul addl prq,60661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7427.53,,,,,,,fee schedule,1544,18617,APC Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7498.94,,,,,,,fee schedule,1544,18617,APC Endocrine surgery procedure,60699,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7141.85,,,,,,,fee schedule,1544,18617,APC Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,428,3314,APC Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,428,3314,APC Remove cranial cavity fluid,61000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,428,3314,APC Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,3314, Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,428,3314,APC Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,428,3314,APC Remove cranial cavity fluid,61001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,428,3314,APC Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Remove brain cavity fluid,61020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,833.89,3314, Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,833.89,3314, Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Injection into brain canal,61026,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Remove brain canal fluid,61050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Injection into brain canal,61055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Brain canal shunt procedure,61070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Twist drill hole,61105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Twist drill hole,61105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Twist drill hole,61105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Twist drill hole,61105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,61106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,61106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,61106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,61106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drill skull for implantation,61107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drill skull for implantation,61107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drill skull for implantation,61107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drill skull for implantation,61107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Drill skull for drainage,61108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Drill skull for drainage,61108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Drill skull for drainage,61108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Drill skull for drainage,61108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Burr hole for puncture,61120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Burr hole for puncture,61120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Burr hole for puncture,61120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Burr hole for puncture,61120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,61130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,61130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,61130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,61130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pierce skull for biopsy,61140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull for biopsy,61140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull for biopsy,61140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull for biopsy,61140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pierce skull & remove clot,61154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull & remove clot,61154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull & remove clot,61154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull & remove clot,61154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull for drainage,61156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pierce skull implant device,61210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull implant device,61210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull implant device,61210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull implant device,61210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13036, Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13036, Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3408,13036, Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3408,13036, Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,13036, Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,13036, Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,3408,13036,APC Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,3408,13036,APC Insert brain-fluid device,61215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,3408,13036,APC Pierce skull & explore,61250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull & explore,61250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull & explore,61250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull & explore,61250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pierce skull & explore,61253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce skull & explore,61253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce skull & explore,61253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce skull & explore,61253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open skull for exploration,61304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for exploration,61304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for exploration,61304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for exploration,61304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open skull for exploration,61305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for exploration,61305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for exploration,61305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for exploration,61305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open skull for drainage,61312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for drainage,61312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for drainage,61312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for drainage,61312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open skull for drainage,61313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for drainage,61313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for drainage,61313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for drainage,61313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open skull for drainage,61314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for drainage,61314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for drainage,61314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for drainage,61314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open skull for drainage,61315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for drainage,61315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for drainage,61315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for drainage,61315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implt cran bone flap to abdo,61316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Implt cran bone flap to abdo,61316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Open skull for drainage,61320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for drainage,61320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for drainage,61320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for drainage,61320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open skull for drainage,61321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open skull for drainage,61321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open skull for drainage,61321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open skull for drainage,61321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Decompressive craniotomy,61322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Decompressive craniotomy,61322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Decompressive craniotomy,61322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Decompressive craniotomy,61322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Decompressive lobectomy,61323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Decompressive lobectomy,61323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Decompressive lobectomy,61323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Decompressive lobectomy,61323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Decompress eye socket,61330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Explore orbit/remove lesion,61333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Explore orbit/remove lesion,61333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Explore orbit/remove lesion,61333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Explore orbit/remove lesion,61333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Subtemporal decompression,61340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Subtemporal decompression,61340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Subtemporal decompression,61340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Subtemporal decompression,61340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull (press relief),61343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull (press relief),61343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull (press relief),61343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull (press relief),61343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Relieve cranial pressure,61345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Relieve cranial pressure,61345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Relieve cranial pressure,61345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Relieve cranial pressure,61345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull for surgery,61460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of skull lesion,61500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Removal of skull lesion,61500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Removal of skull lesion,61500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4081,18617, Removal of skull lesion,61500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4081,18617, Removal of skull lesion,61500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Removal of skull lesion,61500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Remove infected skull bone,61501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove infected skull bone,61501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove infected skull bone,61501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove infected skull bone,61501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implt brain chemotx add-on,61517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implt brain chemotx add-on,61517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implt brain chemotx add-on,61517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implt brain chemotx add-on,61517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove brain lining lesion,61519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain abscess,61522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61524,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61524,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove brain electrodes,61535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove brain electrodes,61535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove brain electrodes,61535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove brain electrodes,61535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain lesion,61536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove & treat brain lesion,61544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove & treat brain lesion,61544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove & treat brain lesion,61544,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove & treat brain lesion,61544,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of brain tumor,61545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of brain tumor,61545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of brain tumor,61545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of brain tumor,61545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of pituitary gland,61548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release of skull seams,61550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release of skull seams,61550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release of skull seams,61550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release of skull seams,61550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release of skull seams,61552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release of skull seams,61552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release of skull seams,61552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release of skull seams,61552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull/sutures,61557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of skull/sutures,61559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of skull tumor,61564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of brain tissue,61566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of brain tissue,61567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove foreign body brain,61570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove foreign body brain,61570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove foreign body brain,61570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove foreign body brain,61570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull for brain wound,61571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Skull base/brainstem surgery,61576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Craniofacial approach skull,61583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect nasopharynx skull,61586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect nasopharynx skull,61586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect nasopharynx skull,61586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect nasopharynx skull,61586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Infratemporal approach/skull,61591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Orbitocranial approach/skull,61592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transtemporal approach/skull,61595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transtemporal approach/skull,61595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transtemporal approach/skull,61595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transtemporal approach/skull,61595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transcochlear approach/skull,61596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transcochlear approach/skull,61596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transcochlear approach/skull,61596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transcochlear approach/skull,61596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transcondylar approach/skull,61597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transcondylar approach/skull,61597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transcondylar approach/skull,61597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transcondylar approach/skull,61597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transpetrosal approach/skull,61598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transpetrosal approach/skull,61598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transpetrosal approach/skull,61598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transpetrosal approach/skull,61598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise cranial lesion,61608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transect artery sinus,61611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transect artery sinus,61611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transect artery sinus,61611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transect artery sinus,61611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove aneurysm sinus,61613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove aneurysm sinus,61613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove aneurysm sinus,61613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove aneurysm sinus,61613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Resect/excise lesion skull,61616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair dura,61618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair dura,61618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair dura,61618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair dura,61618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair dura,61619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair dura,61619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair dura,61619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair dura,61619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,18617, Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,18617, Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3560,18617,APC Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3560,18617,APC Endovasc tempory vessel occl,61623,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3560,18617,APC Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,22738.78, Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,22738.78, Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,22738.78, Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,22738.78, Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,22738.78, Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,22738.78, Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4147,22738.78,APC Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4147,22738.78,APC Transcath occlusion cns,61624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4147,22738.78,APC Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18686, Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18686, Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,3560,18686, Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,3560,18686, Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18686, Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18686, Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,3560,18686,APC Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,3560,18686,APC Transcath occlusion non-cns,61626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,3560,18686,APC Intracranial angioplasty,61630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,5098, Intracranial angioplasty,61630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,5098, Intracranial angioplasty,61630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1406,5098, Intracranial angioplasty,61630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1406,5098, Intracran angioplsty w/stent,61635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,5098, Intracran angioplsty w/stent,61635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,5098, Intracran angioplsty w/stent,61635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1406,5098, Intracran angioplsty w/stent,61635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1406,5098, Dilate ic vasospasm init,61640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,5098, Dilate ic vasospasm init,61640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,5098, Dilate ic vasospasm init,61640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1406,5098, Dilate ic vasospasm init,61640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1406,5098, Dilate ic vasospasm add-on,61641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,428,4466, Dilate ic vasospasm add-on,61642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,428,4466, Perq art m-thrombect &/nfs,61645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Perq art m-thrombect &/nfs,61645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Perq art m-thrombect &/nfs,61645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Perq art m-thrombect &/nfs,61645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Evasc prlng admn rx agnt 1st,61650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt 1st,61650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt 1st,61650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt 1st,61650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt 1st,61650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt 1st,61650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt add,61651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt add,61651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt add,61651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt add,61651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt add,61651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Evasc prlng admn rx agnt add,61651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Intracranial vessel surgery,61680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intracranial vessel surgery,61692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Brain aneurysm repr complx,61698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Brain aneurysm repr simple,61700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Brain aneurysm repr simple,61700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Brain aneurysm repr simple,61700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Brain aneurysm repr simple,61700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Inner skull vessel surgery,61702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Inner skull vessel surgery,61702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Inner skull vessel surgery,61702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Inner skull vessel surgery,61702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Clamp neck artery,61703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Clamp neck artery,61703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Clamp neck artery,61703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Clamp neck artery,61703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise circulation to head,61705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise circulation to head,61705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise circulation to head,61705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise circulation to head,61705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise circulation to head,61708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise circulation to head,61708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise circulation to head,61708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise circulation to head,61708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise circulation to head,61710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise circulation to head,61710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise circulation to head,61710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise circulation to head,61710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of skull arteries,61711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of skull arteries,61711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of skull arteries,61711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of skull arteries,61711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,61712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,61712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,61712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,61712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mrgfus strtctc ablt trgt icr,61715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Mrgfus strtctc ablt trgt icr,61715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Mrgfus strtctc ablt trgt icr,61715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Mrgfus strtctc ablt trgt icr,61715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Mrgfus strtctc ablt trgt icr,61715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,3408,18617,APC Mrgfus strtctc ablt trgt icr,61715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,3408,18617,APC Mrgfus strtctc ablt trgt icr,61715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,3408,18617,APC Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,1406,18617,APC Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,1406,18617,APC Incise skull/brain surgery,61720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,1406,18617,APC Incise skull/brain surgery,61735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull/brain surgery,61735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Litt icr 1 traj 1 smpl les,61736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Litt icr 1 traj 1 smpl les,61736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Litt icr 1 traj 1 smpl les,61736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Litt icr 1 traj 1 smpl les,61736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Litt icr mlt trj mlt/cplx ls,61737,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Litt icr mlt trj mlt/cplx ls,61737,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Litt icr mlt trj mlt/cplx ls,61737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Litt icr mlt trj mlt/cplx ls,61737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull/brain biopsy,61750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull/brain biopsy,61750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull/brain biopsy,61750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull/brain biopsy,61750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Brain biopsy w/ct/mr guide,61751,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Brain biopsy w/ct/mr guide,61751,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Brain biopsy w/ct/mr guide,61751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Brain biopsy w/ct/mr guide,61751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant brain electrodes,61760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18686, Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18686, Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,1406,18686, Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,1406,18686, Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1406,18686, Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1406,18686, Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,1406,18686,APC Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,1406,18686,APC Incise skull for treatment,61770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,1406,18686,APC Scan proc cranial intra,61781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Scan proc cranial intra,61781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Scan proc cranial extra,61782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Scan proc cranial extra,61782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Scan proc cranial extra,61782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Scan proc cranial extra,61782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Scan proc spinal,61783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Scan proc spinal,61783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Scan proc spinal,61783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Scan proc spinal,61783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,6404, Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,6404, Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,6404, Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,6404, Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Treat trigeminal nerve,61790,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,6404, Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,6404, Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,6404, Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,6404, Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Treat trigeminal tract,61791,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Srs cranial lesion simple,61796,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Srs cranial lesion simple,61796,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Srs cranial lesion simple,61796,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Srs cranial lesion simple,61796,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Srs cranial lesion simple,61796,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Srs cranial lesion simple,61796,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Srs cran les simple addl,61797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Srs cran les simple addl,61797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Srs cran les simple addl,61797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Srs cran les simple addl,61797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Srs cran les simple addl,61797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Srs cran les simple addl,61797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Srs cranial lesion complex,61798,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Srs cranial lesion complex,61798,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Srs cranial lesion complex,61798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Srs cranial lesion complex,61798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Srs cranial lesion complex,61798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Srs cranial lesion complex,61798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Srs cran les complex addl,61799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Srs cran les complex addl,61799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Srs cran les complex addl,61799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Srs cran les complex addl,61799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Srs cran les complex addl,61799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Srs cran les complex addl,61799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Apply srs headframe add-on,61800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Apply srs headframe add-on,61800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Apply srs headframe add-on,61800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Apply srs headframe add-on,61800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Apply srs headframe add-on,61800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Apply srs headframe add-on,61800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Implant neuroelectrodes,61850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant neuroelectrodes,61850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant neuroelectrodes,61850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant neuroelectrodes,61850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,61855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,61855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,61855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,61855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant neuroelectrodes,61860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant neuroelectrodes,61860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant neuroelectrodes,61860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant neuroelectrodes,61860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61863,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61863,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,61865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,61865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,61865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,61865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61867,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant neuroelectrode,61867,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant neuroelectrde addl,61868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1406,18617,APC Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1406,18617,APC Revise/remove neuroelectrode,61880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1406,18617,APC Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,38276.26, Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,38276.26, Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,38276.26, Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,38276.26, Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,38276.26, Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,38276.26, Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,2816,38276.26,APC Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,2816,38276.26,APC Insrt/redo neurostim 1 array,61885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,2816,38276.26,APC Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38276.26, Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38276.26, Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,38276.26, Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,38276.26, Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,38276.26, Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,38276.26, Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,3408,38276.26,APC Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,3408,38276.26,APC Implant neurostim arrays,61886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,3408,38276.26,APC Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,13821.53, Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,13821.53, Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2762,13821.53, Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2762,13821.53, Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,13821.53, Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,13821.53, Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,2762,13821.53,APC Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,2762,13821.53,APC Revise/remove neuroreceiver,61888,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,2762,13821.53,APC Ins sk-mnt crnl nstm pg/rcvr,61889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ins sk-mnt crnl nstm pg/rcvr,61889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ins sk-mnt crnl nstm pg/rcvr,61889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ins sk-mnt crnl nstm pg/rcvr,61889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rev/rplcmt sk-mnt crnl nstm,61891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38276.26, Rev/rplcmt sk-mnt crnl nstm,61891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38276.26, Rev/rplcmt sk-mnt crnl nstm,61891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,38276.26, Rev/rplcmt sk-mnt crnl nstm,61891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,38276.26, Rev/rplcmt sk-mnt crnl nstm,61891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,3408,38276.26,APC Rev/rplcmt sk-mnt crnl nstm,61891,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,3408,38276.26,APC Rev/rplcmt sk-mnt crnl nstm,61891,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,3408,38276.26,APC Rmv sk-mnt crnl nstm pg/rcvr,61892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Rmv sk-mnt crnl nstm pg/rcvr,61892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Rmv sk-mnt crnl nstm pg/rcvr,61892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Rmv sk-mnt crnl nstm pg/rcvr,61892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Rmv sk-mnt crnl nstm pg/rcvr,61892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,13320,APC Rmv sk-mnt crnl nstm pg/rcvr,61892,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,13320,APC Rmv sk-mnt crnl nstm pg/rcvr,61892,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,13320,APC Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Treat skull fracture,62000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Treat skull fracture,62005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treat skull fracture,62005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treat skull fracture,62005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treat skull fracture,62005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treatment of head injury,62010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Treatment of head injury,62010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Treatment of head injury,62010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Treatment of head injury,62010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair brain fluid leakage,62100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair brain fluid leakage,62100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair brain fluid leakage,62100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair brain fluid leakage,62100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reduction of skull defect,62117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair skull cavity lesion,62120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair skull cavity lesion,62120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair skull cavity lesion,62120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair skull cavity lesion,62120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise skull repair,62121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise skull repair,62121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise skull repair,62121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise skull repair,62121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of skull defect,62140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of skull defect,62140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of skull defect,62140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of skull defect,62140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of skull defect,62141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of skull defect,62141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of skull defect,62141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of skull defect,62141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove skull plate/flap,62142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove skull plate/flap,62142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove skull plate/flap,62142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove skull plate/flap,62142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace skull plate/flap,62143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace skull plate/flap,62143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace skull plate/flap,62143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace skull plate/flap,62143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of skull & brain,62145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of skull & brain,62145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of skull & brain,62145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of skull & brain,62145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of skull with graft,62147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Neuroendoscopy add-on,62160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Neuroendoscopy add-on,62160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Neuroendoscopy add-on,62160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Neuroendoscopy add-on,62160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Dissect brain w/scope,62161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Dissect brain w/scope,62161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Dissect brain w/scope,62161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Dissect brain w/scope,62161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove colloid cyst w/scope,62162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove colloid cyst w/scope,62162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove colloid cyst w/scope,62162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove colloid cyst w/scope,62162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove brain tumor w/scope,62164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove brain tumor w/scope,62164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove brain tumor w/scope,62164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove brain tumor w/scope,62164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove pituit tumor w/scope,62165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove pituit tumor w/scope,62165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove pituit tumor w/scope,62165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove pituit tumor w/scope,62165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,11081,APC Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,11081,APC Replace/irrigate catheter,62194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,11081,APC Establish brain cavity shunt,62200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Brain cavity shunt w/scope,62201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Brain cavity shunt w/scope,62201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Brain cavity shunt w/scope,62201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Brain cavity shunt w/scope,62201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Establish brain cavity shunt,62223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,11081, Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,1544,11081,APC Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,1544,11081,APC Replace/irrigate catheter,62225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,1544,11081,APC Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,13036,APC Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,13036,APC Replace/revise brain shunt,62230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,13036,APC Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,362.84,3314, Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,362.84,3314, Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.84,3314, Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.84,3314, Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.84,3314, Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.84,3314, Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.35,,,,,,,fee schedule,362.84,3314,APC Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.98,,,,,,,fee schedule,362.84,3314,APC Csf Shunt Reprogram,62252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.84,,,,,,,fee schedule,362.84,3314,APC Remove brain cavity shunt,62256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,18617, Remove brain cavity shunt,62256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,18617, Remove brain cavity shunt,62256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Remove brain cavity shunt,62256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Remove brain cavity shunt,62256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Remove brain cavity shunt,62256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Replace brain cavity shunt,62258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Replace brain cavity shunt,62258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Replace brain cavity shunt,62258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Replace brain cavity shunt,62258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,4097, Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,4097, Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1044.87,4097, Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1044.87,4097, Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,4097, Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,4097, Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4097,APC Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4097,APC Epidural lysis mult sessions,62263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4097,APC Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Epidural lysis on single day,62264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,3314, Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,3314, Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,836.55,3314, Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,836.55,3314, Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,836.55,3314, Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,836.55,3314, Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,3314,APC Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,3314,APC Interdiscal perq aspir dx,62267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,3314,APC Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Drain spinal cord cyst,62268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,3314,APC Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,3314,APC Needle biopsy spinal cord,62269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,3314,APC Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Spinal fluid tap diagnostic,62270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Drain cerebro spinal fluid,62272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Inject epidural patch,62273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Description Not Available,62274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,62275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,62276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,62277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,62278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,62279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Treat spinal cord lesion,62280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Treat spinal cord lesion,62281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,4097, Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,4097, Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1044.87,4097, Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1044.87,4097, Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,4097, Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,4097, Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4097,APC Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4097,APC Treat spinal canal lesion,62282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4097,APC Injection for myelogram,62284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for myelogram,62284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for myelogram,62284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for myelogram,62284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2306.84,13320, Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2306.84,13320, Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2306.84,13320, Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2306.84,13320, Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2306.84,13320, Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2306.84,13320, Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,13320,APC Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,13320,APC Percutaneous diskectomy,62287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,13320,APC Description Not Available,62288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,62289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Inject for spine disk x-ray,62290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inject for spine disk x-ray,62290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inject for spine disk x-ray,62290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inject for spine disk x-ray,62290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Inject for spine disk x-ray,62291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inject for spine disk x-ray,62291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inject for spine disk x-ray,62291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inject for spine disk x-ray,62291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4166, Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4166, Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4166, Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4166, Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2138,4166, Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2138,4166, Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2138,4166,APC Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2138,4166,APC Injection into disk lesion,62292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2138,4166,APC Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1044.87,5098, Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1044.87,5098, Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,5098, Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,5098, Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1044.87,5098, Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1044.87,5098, Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,5098,APC Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,5098,APC Injection into spinal artery,62294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,5098,APC Description Not Available,62298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,62298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,62298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,62298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,6312, Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,6312, Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,6312, Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,6312, Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,855,6312, Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,855,6312, Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,855,6312,APC Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,855,6312,APC Myelography lumbar injection,62303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,855,6312,APC Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,926.08,6312, Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,6312,APC Myelography lumbar injection,62305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,6312,APC Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar crv/thrc,62320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar crv/thrc,62321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Njx interlaminar lmbr/sac,62322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar lmbr/sac,62323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar crv/thrc,62324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar crv/thrc,62325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar lmbr/sac,62326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC Njx interlaminar lmbr/sac,62327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Dx lmbr spi pnxr w/fluor/ct,62328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Ther spi pnxr csf fluor/ct,62329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Dcmprn prq rmv lig flv 1lmbr,62330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Dcmprn prq rmv lig flv 1lmbr,62330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Dcmprn prq rmv lig flv 1lmbr,62330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Dcmprn prq rmv lig flv 1lmbr,62330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Dcmprn prq rmv lig flv 1lmbr,62330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,18617,APC Dcmprn prq rmv lig flv 1lmbr,62330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,18617,APC Dcmprn prq rmv lig flv 1lmbr,62330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,18617,APC Dcmprn prq rmv lig flv addl,62331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Dcmprn prq rmv lig flv addl,62331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,10885.67, Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,10885.67, Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,10885.67, Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,10885.67, Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,10885.67, Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,10885.67, Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,10885.67,APC Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,10885.67,APC Implant spinal canal cath,62350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,10885.67,APC Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,13320, Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,13320, Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,2816,13320,APC Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,2816,13320,APC Implant spinal canal cath,62351,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,2816,13320,APC Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,6404, Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,6404, Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,6404, Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,6404, Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Remove spinal canal catheter,62355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,22357, Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,22357, Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,22357, Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,22357, Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,22357, Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,22357, Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22144.08,,,,,,,fee schedule,2816,22357,APC Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22357,,,,,,,fee schedule,2816,22357,APC Insert spine infusion device,62360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21292.39,,,,,,,fee schedule,2816,22357,APC Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22144.08,,,,,,,fee schedule,2816,22357,APC Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22357,,,,,,,fee schedule,2816,22357,APC Implant spine infusion pump,62361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21292.39,,,,,,,fee schedule,2816,22357,APC Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,22357, Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22144.08,,,,,,,fee schedule,2816,22357,APC Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22357,,,,,,,fee schedule,2816,22357,APC Implant spine infusion pump,62362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21292.39,,,,,,,fee schedule,2816,22357,APC Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,2816,6404,APC Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,2816,6404,APC Remove spine infusion device,62365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,2816,6404,APC Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,362.84,4466, Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,362.84,4466, Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.84,4466, Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.84,4466, Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,362.84,4466, Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,362.84,4466, Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.35,,,,,,,fee schedule,362.84,4466,APC Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.98,,,,,,,fee schedule,362.84,4466,APC Analyze spine infus pump,62367,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.84,,,,,,,fee schedule,362.84,4466,APC Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,362.84,4466, Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,362.84,4466, Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.84,4466, Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.84,4466, Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,362.84,4466, Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,362.84,4466, Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.35,,,,,,,fee schedule,362.84,4466,APC Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.98,,,,,,,fee schedule,362.84,4466,APC Analyze sp inf pump w/reprog,62368,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.84,,,,,,,fee schedule,362.84,4466,APC Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,362.84,18617, Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,362.84,18617, Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.84,18617, Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.84,18617, Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.84,18617, Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.84,18617, Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.35,,,,,,,fee schedule,362.84,18617,APC Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.98,,,,,,,fee schedule,362.84,18617,APC Anal sp inf pmp w/reprg&fill,62369,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.84,,,,,,,fee schedule,362.84,18617,APC Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,362.84,18617, Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,362.84,18617, Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.84,18617, Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.84,18617, Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.84,18617, Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.84,18617, Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.35,,,,,,,fee schedule,362.84,18617,APC Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.98,,,,,,,fee schedule,362.84,18617,APC Anl sp inf pmp w/mdreprg&fil,62370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.84,,,,,,,fee schedule,362.84,18617,APC Ndsc dcmprn 1 ntrspc lumbar,62380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Ndsc dcmprn 1 ntrspc lumbar,62380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Ndsc dcmprn 1 ntrspc lumbar,62380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Ndsc dcmprn 1 ntrspc lumbar,62380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Ndsc dcmprn 1 ntrspc lumbar,62380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Ndsc dcmprn 1 ntrspc lumbar,62380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Ndsc dcmprn 1 ntrspc lumbar,62380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13036, Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13036, Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,13036, Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,13036, Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3560,13036, Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3560,13036, Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,13036,APC Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,13036,APC Remove spine lamina 1/2 crvl,63001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,13036,APC Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,11081, Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,11081, Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,11081, Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,11081, Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3560,11081, Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3560,11081, Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,11081,APC Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,11081,APC Remove spine lamina 1/2 thrc,63003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,11081,APC Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,11081, Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,11081, Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Remove spine lamina 1/2 lmbr,63005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1/2 scrl,63011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,11081, Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,11081, Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Remove lamina/facets lumbar,63012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13036, Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13036, Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,13036, Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,13036, Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3560,13036, Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3560,13036, Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,13036,APC Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,13036,APC Remove spine lamina >2 crvcl,63015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,13036,APC Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,15339, Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,15339, Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3560,15339, Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3560,15339, Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3560,15339, Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3560,15339, Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,15339,APC Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,15339,APC Remove spine lamina >2 thrc,63016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,15339,APC Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13036, Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13036, Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,13036, Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,13036, Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,4224,13036, Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,4224,13036, Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4224,13036,APC Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4224,13036,APC Remove spine lamina >2 lmbr,63017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4224,13036,APC Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3408,11081, Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3408,11081, Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3408,11081,APC Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3408,11081,APC Neck spine disk surgery,63020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3408,11081,APC Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,11081, Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,11081, Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Low back disk surgery,63030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Lamot rpr anulr dfct 1 lmbr,63032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Lamot rpr anulr dfct 1 lmbr,63032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Lamot rpr anulr dfct 1 lmbr,63032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Lamot rpr anulr dfct 1 lmbr,63032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Spinal disk surgery add-on,63035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7555, Spinal disk surgery add-on,63035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7555, Spinal disk surgery add-on,63035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7555, Spinal disk surgery add-on,63035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7555, Spinal disk surgery add-on,63035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,428,7555, Spinal disk surgery add-on,63035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,428,7555, Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Laminotomy single cervical,63040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,11081, Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,11081, Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Laminotomy single lumbar,63042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Laminotomy addl cervical,63043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7555, Laminotomy addl cervical,63043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7555, Laminotomy addl cervical,63043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1544,7555, Laminotomy addl cervical,63043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1544,7555, Laminotomy addl lumbar,63044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7555, Laminotomy addl lumbar,63044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7555, Laminotomy addl lumbar,63044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1544,7555, Laminotomy addl lumbar,63044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1544,7555, Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1 crvl,63045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1 thrc,63046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,11081, Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,11081, Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,11081,APC Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,11081,APC Remove spine lamina 1 lmbr,63047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,11081,APC Remove spinal lamina add-on,63048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7555, Remove spinal lamina add-on,63048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7555, Remove spinal lamina add-on,63048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7555, Remove spinal lamina add-on,63048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7555, Remove spinal lamina add-on,63048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,428,7555, Remove spinal lamina add-on,63048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,428,7555, Cervical laminoplsty 2/> seg,63050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cervical laminoplsty 2/> seg,63050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cervical laminoplsty 2/> seg,63050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cervical laminoplsty 2/> seg,63050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, C-laminoplasty w/graft/plate,63051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, C-laminoplasty w/graft/plate,63051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, C-laminoplasty w/graft/plate,63051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, C-laminoplasty w/graft/plate,63051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lam facetc/frmt arthrd lum 1,63052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,7555, Lam facetc/frmt arthrd lum 1,63052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,7555, Lam facetc/frmt arthrd lum 1,63052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7555, Lam facetc/frmt arthrd lum 1,63052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7555, Lam facetc/frmt arthrd lum 1,63052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,428,7555, Lam facetc/frmt arthrd lum 1,63052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,428,7555, Lam factc/frmt arthrd lum ea,63053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,7555, Lam factc/frmt arthrd lum ea,63053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,7555, Lam factc/frmt arthrd lum ea,63053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7555, Lam factc/frmt arthrd lum ea,63053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7555, Lam factc/frmt arthrd lum ea,63053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,428,7555, Lam factc/frmt arthrd lum ea,63053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,428,7555, Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13320, Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13320, Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13320,APC Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13320,APC Decompress spinal cord thrc,63055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13320,APC Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3560,13320, Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3560,13320, Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,13320,APC Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,13320,APC Decompress spinal cord lmbr,63056,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,13320,APC Decompress spine cord add-on,63057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Decompress spine cord add-on,63057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Decompress spine cord add-on,63057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Decompress spine cord add-on,63057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,13320, Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,13320, Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,1406,13320, Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,1406,13320, Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1406,13320, Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1406,13320, Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,13320,APC Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,13320,APC Decompress spinal cord thrc,63064,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,13320,APC Decompress spine cord add-on,63066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Decompress spine cord add-on,63066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,18617, Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,18617, Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Neck spine disk surgery,63075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Neck spine disk surgery,63076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6253, Neck spine disk surgery,63076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6253, Neck spine disk surgery,63076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6253, Neck spine disk surgery,63076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6253, Spine disk surgery thorax,63077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Spine disk surgery thorax,63077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Spine disk surgery thorax,63077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Spine disk surgery thorax,63077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Spine disk surgery thorax,63078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Spine disk surgery thorax,63078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Spine disk surgery thorax,63078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Spine disk surgery thorax,63078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn crvl,63081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn crvl,63081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn crvl,63081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn crvl,63081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remov vertbr dcmprn thrclmbr,63087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remov vertbr dcmprn thrclmbr,63087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remov vertbr dcmprn thrclmbr,63087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remov vertbr dcmprn thrclmbr,63087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn thrc,63101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert body dcmprn lmbr,63102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise spinal cord tract(s),63170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Incise spinal cord tract(s),63170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Incise spinal cord tract(s),63170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Incise spinal cord tract(s),63170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Drainage of spinal cyst,63173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Incise spine nrv half segmnt,63185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Incise spine nrv half segmnt,63185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Incise spine nrv half segmnt,63185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Incise spine nrv half segmnt,63185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Incise spine nrv >2 segmnts,63190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Incise spine nrv >2 segmnts,63190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Incise spine nrv >2 segmnts,63190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Incise spine nrv >2 segmnts,63190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Incise spine accessory nerve,63191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Incise spine accessory nerve,63191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Incise spine accessory nerve,63191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Incise spine accessory nerve,63191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Incise spine&cord 2 trx thrc,63197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Incise spine&cord 2 trx thrc,63197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Incise spine&cord 2 trx thrc,63197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Incise spine&cord 2 trx thrc,63197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Release spinal cord lumbar,63200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Release spinal cord lumbar,63200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Release spinal cord lumbar,63200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Release spinal cord lumbar,63200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls crvl,63250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls crvl,63250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls crvl,63250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls crvl,63250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls thrc,63251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls thrc,63251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls thrc,63251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Revise spinal cord vsls thrc,63251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Revise spine cord vsl thrlmb,63252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Revise spine cord vsl thrlmb,63252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Revise spine cord vsl thrlmb,63252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Revise spine cord vsl thrlmb,63252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Excise intraspinl lesion crv,63265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion thrc,63266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion lmbr,63267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,13036, Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion scrl,63268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,13036,APC Excise intrspinl lesion crvl,63270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion crvl,63270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion crvl,63270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion crvl,63270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion thrc,63271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion thrc,63271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion thrc,63271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion thrc,63271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion lmbr,63272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion lmbr,63272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion lmbr,63272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion lmbr,63272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion scrl,63273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion scrl,63273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion scrl,63273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Excise intrspinl lesion scrl,63273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn crvl,63275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn crvl,63275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn crvl,63275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn crvl,63275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn thrc,63276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn thrc,63276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn thrc,63276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn thrc,63276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn lmbr,63277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn lmbr,63277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn lmbr,63277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn lmbr,63277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn scrl,63278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn scrl,63278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn scrl,63278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc xdrl spine lesn scrl,63278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn crvl,63280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn crvl,63280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn crvl,63280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn crvl,63280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn thrc,63281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn thrc,63281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn thrc,63281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn thrc,63281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn lmbr,63282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn lmbr,63282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn lmbr,63282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn lmbr,63282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn scrl,63283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn scrl,63283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn scrl,63283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc idrl spine lesn scrl,63283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn cervl,63285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn cervl,63285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn cervl,63285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn cervl,63285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrc,63286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrc,63286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrc,63286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrc,63286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrlmb,63287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrlmb,63287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrlmb,63287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc idrl imed lesn thrlmb,63287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Bx/exc xdrl/idrl lsn any lvl,63290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Bx/exc xdrl/idrl lsn any lvl,63290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Bx/exc xdrl/idrl lsn any lvl,63290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Bx/exc xdrl/idrl lsn any lvl,63290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Repair laminectomy defect,63295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7555, Repair laminectomy defect,63295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7555, Repair laminectomy defect,63295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,1406,7555, Repair laminectomy defect,63295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,1406,7555, Remove vert xdrl body crvcl,63300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert xdrl body crvcl,63300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert xdrl body crvcl,63300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert xdrl body crvcl,63300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrc,63301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrc,63301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrc,63301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrc,63301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrlmb,63302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrlmb,63302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrlmb,63302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert xdrl body thrlmb,63302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remov vert xdrl bdy lmbr/sac,63303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remov vert xdrl bdy lmbr/sac,63303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remov vert xdrl bdy lmbr/sac,63303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remov vert xdrl bdy lmbr/sac,63303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert idrl body crvcl,63304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert idrl body crvcl,63304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert idrl body crvcl,63304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert idrl body crvcl,63304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vert idrl body thrc,63305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vert idrl body thrc,63305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vert idrl body thrc,63305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vert idrl body thrc,63305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy thrclmbr,63306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy thrclmbr,63306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy thrclmbr,63306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy thrclmbr,63306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy lmbr/sac,63307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy lmbr/sac,63307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy lmbr/sac,63307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remov vert idrl bdy lmbr/sac,63307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove vertebral body add-on,63308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,6312, Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,6312, Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2306.84,6312, Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2306.84,6312, Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2306.84,6312, Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2306.84,6312, Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6312,APC Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6312,APC Remove spinal cord lesion,63600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6312,APC Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,9420, Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,9420, Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,9420,APC Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,9420,APC Stimulation of spinal cord,63610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,9420,APC Srs spinal lesion,63620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Srs spinal lesion,63620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Srs spinal lesion,63620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Srs spinal lesion,63620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Srs spinal lesion,63620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Srs spinal lesion,63620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Srs spinal lesion addl,63621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Srs spinal lesion addl,63621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Srs spinal lesion addl,63621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Srs spinal lesion addl,63621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Srs spinal lesion addl,63621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Srs spinal lesion addl,63621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,13320, Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,13320, Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7829.85,,,,,,,fee schedule,2816,13320,APC Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7905.14,,,,,,,fee schedule,2816,13320,APC Implant neuroelectrodes,63650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7528.7,,,,,,,fee schedule,2816,13320,APC Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,24064.14, Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,24064.14, Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3560,24064.14, Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3560,24064.14, Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3560,24064.14, Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3560,24064.14, Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23834.95,,,,,,,fee schedule,3560,24064.14,APC Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24064.14,,,,,,,fee schedule,3560,24064.14,APC Implant neuroelectrodes,63655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22918.22,,,,,,,fee schedule,3560,24064.14,APC Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9918, Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9918, Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,9918, Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,9918, Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,9918, Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,9918, Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,9918,APC Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,9918,APC Remove spine eltrd perq aray,63661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,9918,APC Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9918, Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9918, Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,9918, Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,9918, Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,9918, Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,9918, Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,9918,APC Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,9918,APC Remove spine eltrd plate,63662,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,9918,APC Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9918, Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9918, Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,9918, Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,9918, Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,9918, Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,9918, Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7829.85,,,,,,,fee schedule,1544,9918,APC Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7905.14,,,,,,,fee schedule,1544,9918,APC Revise spine eltrd perq aray,63663,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7528.7,,,,,,,fee schedule,1544,9918,APC Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13821.53, Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13821.53, Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,13821.53, Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,13821.53, Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,1544,13821.53, Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,1544,13821.53, Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,1544,13821.53,APC Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,1544,13821.53,APC Revise spine eltrd plate,63664,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,1544,13821.53,APC Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,38276.26, Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,38276.26, Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,38276.26, Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,38276.26, Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,38276.26, Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,38276.26, Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,2816,38276.26,APC Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,2816,38276.26,APC Insrt/redo spine n generator,63685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,2816,38276.26,APC Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,6404,APC Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,6404,APC Revise/remove neuroreceiver,63688,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,6404,APC Description Not Available,63690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,63690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,63690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,63690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,63691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,63691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,63691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,63691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair of spinal herniation,63706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair spinal fluid leakage,63709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Graft repair of spine defect,63710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Graft repair of spine defect,63710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Graft repair of spine defect,63710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Graft repair of spine defect,63710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Install spinal shunt,63740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Install spinal shunt,63740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Install spinal shunt,63740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Install spinal shunt,63740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,18617, Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,18617, Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,18617,APC Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,18617,APC Install spinal shunt,63741,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,18617,APC Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,3408,11081,APC Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,3408,11081,APC Revision of spinal shunt,63744,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,3408,11081,APC Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,8006, Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,8006, Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2306.84,8006, Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2306.84,8006, Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,8006, Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,8006, Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,8006,APC Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,8006,APC Removal of spinal shunt,63746,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,8006,APC N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC N block inj trigeminal,64400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC N block inj facial,64402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,984, N block inj facial,64402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,984, N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC N block inj occipital,64405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC N block inj vagus,64408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC N block inj phrenic,64410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,4097, N block inj phrenic,64410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,4097, N block inj cervical plexus,64413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,984, N block inj cervical plexus,64413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,984, N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block inj brachial plexus,64415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block cont infuse b plex,64416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block inj axillary,64417,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC N block inj suprascapular,64418,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC N block inj intercost sng,64420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block inj intercost mlt,64421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC N block inj ilio-ing/hypogi,64425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block inj pudendal,64430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,833.89,3314, N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,833.89,3314, N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC N block inj paracervical,64435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Description Not Available,64440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,64440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,64440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,64440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,64441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,64441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,64441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,64441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,64442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,64442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,64442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,64442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,64443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,64443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,64443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,64443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC N block inj sciatic sng,64445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1044.87,3314, N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1044.87,3314, N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N blk inj sciatic cont inf,64446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,833.89,3314, N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,833.89,3314, N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC N block inj fem single,64447,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1044.87,4097, N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1044.87,4097, N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1044.87,4097, N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1044.87,4097, N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,4097, N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,4097, N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4097,APC N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4097,APC N block inj fem cont inf,64448,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4097,APC N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block inj lumbar plexus,64449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC N block other peripheral,64450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Njx aa&/strd nrv nrvtg si jt,64451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Njx aa&/strd gnclr nrv brnch,64454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC N block inj plantar digit,64455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,428,18617,APC Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,428,18617,APC Pvb thoracic single inj site,64461,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,428,18617,APC Pvb thoracic 2nd+ inj site,64462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Pvb thoracic 2nd+ inj site,64462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Pvb thoracic 2nd+ inj site,64462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Pvb thoracic 2nd+ inj site,64462,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,18617, Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,18617, Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,428,18617,APC Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,428,18617,APC Pvb thoracic cont infusion,64463,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,428,18617,APC Thrc fascial pln blk uni njx,64466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Thrc fascial pln blk uni njx,64466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Thrc fascial pln blk uni nfs,64467,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Thrc fascial pln blk uni nfs,64467,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Thrc fascial pln blk bi njx,64468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Thrc fascial pln blk bi njx,64468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Thrc fascial pln blk bi nfs,64469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Thrc fascial pln blk bi nfs,64469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Lwr xtr fscl pln blk uni njx,64473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Lwr xtr fscl pln blk uni njx,64473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Lwr xtr fscl pln blk uni nfs,64474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Lwr xtr fscl pln blk uni nfs,64474,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Inj foramen epidural c/t,64479,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Inj foramen epidural add-on,64480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inj foramen epidural add-on,64480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inj foramen epidural add-on,64480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inj foramen epidural add-on,64480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Inj foramen epidural l/s,64483,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Inj foramen epidural add-on,64484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inj foramen epidural add-on,64484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inj foramen epidural add-on,64484,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inj foramen epidural add-on,64484,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Tap block unil by injection,64486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Tap block unil by injection,64486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Tap block unil by injection,64486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Tap block unil by injection,64486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Tap block uni by infusion,64487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Tap block uni by infusion,64487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Tap block uni by infusion,64487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Tap block uni by infusion,64487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Tap block bi injection,64488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Tap block bi injection,64488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Tap block bi injection,64488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Tap block bi injection,64488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Tap block bi by infusion,64489,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Tap block bi by infusion,64489,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Tap block bi by infusion,64489,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Tap block bi by infusion,64489,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Inj paravert f jnt c/t 1 lev,64490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Inj paravert f jnt c/t 2 lev,64491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inj paravert f jnt c/t 2 lev,64491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inj paravert f jnt c/t 2 lev,64491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inj paravert f jnt c/t 2 lev,64491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Inj paravert f jnt c/t 3 lev,64492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inj paravert f jnt c/t 3 lev,64492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inj paravert f jnt c/t 3 lev,64492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inj paravert f jnt c/t 3 lev,64492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Inj paravert f jnt l/s 1 lev,64493,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Inj paravert f jnt l/s 2 lev,64494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 2 lev,64494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 2 lev,64494,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 2 lev,64494,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 3 lev,64495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 3 lev,64495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 3 lev,64495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Inj paravert f jnt l/s 3 lev,64495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC N block spenopalatine gangl,64505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block stellate ganglion,64510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1044.87,4466, N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1044.87,4466, N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,4466, N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,4466, N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC N block inj hypogas plxs,64517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block lumbar/thoracic,64520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC N block inj celiac pelus,64530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,1544,13821.53,APC Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,1544,13821.53,APC Implant neuroelectrodes,64553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,1544,13821.53,APC Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,18617, Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,18617, Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7829.85,,,,,,,fee schedule,1544,18617,APC Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7905.14,,,,,,,fee schedule,1544,18617,APC Implant neuroelectrodes,64555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7528.7,,,,,,,fee schedule,1544,18617,APC Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7829.85,,,,,,,fee schedule,3408,8006,APC Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7905.14,,,,,,,fee schedule,3408,8006,APC Implant neuroelectrodes,64561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7528.7,,,,,,,fee schedule,3408,8006,APC Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Neuroeltrd stim post tibial,64566,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Perq elec nrv field stimj cn,64567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1071.46,18617, Perq elec nrv field stimj cn,64567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1071.46,18617, Perq elec nrv field stimj cn,64567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1071.46,18617, Perq elec nrv field stimj cn,64567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1071.46,18617, Perq elec nrv field stimj cn,64567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,18617,APC Perq elec nrv field stimj cn,64567,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,18617,APC Perq elec nrv field stimj cn,64567,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,18617,APC Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,54635.78, Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,54635.78, Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,54635.78, Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,54635.78, Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,54635.78, Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,54635.78, Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54115.44,,,,,,,fee schedule,2816,54635.78,APC Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54635.78,,,,,,,fee schedule,2816,54635.78,APC Inc for vagus n elect impl,64568,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52034.08,,,,,,,fee schedule,2816,54635.78,APC Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13821.53, Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13821.53, Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,13821.53, Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,13821.53, Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,13821.53, Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,13821.53, Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,2816,13821.53,APC Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,2816,13821.53,APC Revise/repl vagus n eltrd,64569,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,2816,13821.53,APC Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,13320, Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,13320, Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,1544,13320,APC Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,1544,13320,APC Remove vagus n eltrd,64570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,1544,13320,APC Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,13821.53, Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,1544,13821.53,APC Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,1544,13821.53,APC Implant neuroelectrodes,64575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,1544,13821.53,APC Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,24064.14, Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,24064.14, Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,1544,24064.14, Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,1544,24064.14, Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,24064.14, Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,24064.14, Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23834.95,,,,,,,fee schedule,1544,24064.14,APC Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24064.14,,,,,,,fee schedule,1544,24064.14,APC Implant neuroelectrodes,64580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22918.22,,,,,,,fee schedule,1544,24064.14,APC Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,7905.14, Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,7905.14, Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,7905.14, Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,7905.14, Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,7905.14, Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,7905.14, Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7829.85,,,,,,,fee schedule,3408,7905.14,APC Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7905.14,,,,,,,fee schedule,3408,7905.14,APC Implant neuroelectrodes,64581,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7528.7,,,,,,,fee schedule,3408,7905.14,APC Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,38276.26, Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,38276.26, Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,2816,38276.26, Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,2816,38276.26, Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,38276.26, Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,38276.26, Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,2816,38276.26,APC Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,2816,38276.26,APC Opn mpltj hpglsl nstm ary pg,64582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,2816,38276.26,APC Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,2816,18617, Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,2816,18617, Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,2816,18617,APC Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,2816,18617,APC Rev/rplct hpglsl nstm ary pg,64583,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,2816,18617,APC Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,1544,18617, Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,1544,18617, Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,1544,18617,APC Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,1544,18617,APC Rmvl hpglsl nstim ary pg,64584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,1544,18617,APC Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4336.61, Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4336.61, Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4336.61, Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4336.61, Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4336.61, Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4336.61, Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,4336.61,APC Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,4336.61,APC Revise/remove neuroelectrode,64585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,4336.61,APC Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,24064.14, Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,24064.14, Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,24064.14, Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,24064.14, Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,24064.14, Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,24064.14, Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23834.95,,,,,,,fee schedule,2816,24064.14,APC Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24064.14,,,,,,,fee schedule,2816,24064.14,APC Insrt/redo pn/gastr stimul,64590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22918.22,,,,,,,fee schedule,2816,24064.14,APC Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,6404,APC Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,6404,APC Revise/rmv pn/gastr stimul,64595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,6404,APC Ins/rplcmt prq eltrd ra pn 1,64596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Ins/rplcmt prq eltrd ra pn 1,64596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Ins/rplcmt prq eltrd ra pn 1,64596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Ins/rplcmt prq eltrd ra pn 1,64596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Ins/rplcmt prq eltrd ra pn 1,64596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,2816,18617,APC Ins/rplcmt prq eltrd ra pn 1,64596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,2816,18617,APC Ins/rplcmt prq eltrd ra pn 1,64596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,2816,18617,APC Ins/rplcm prq eltrd ra pn ea,64597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Ins/rplcm prq eltrd ra pn ea,64597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Revj/rmvl nea pn w/int nstim,64598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Revj/rmvl nea pn w/int nstim,64598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Revj/rmvl nea pn w/int nstim,64598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Revj/rmvl nea pn w/int nstim,64598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Revj/rmvl nea pn w/int nstim,64598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,1544,13320,APC Revj/rmvl nea pn w/int nstim,64598,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,1544,13320,APC Revj/rmvl nea pn w/int nstim,64598,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,1544,13320,APC Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,4097, Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,4097, Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1044.87,4097, Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1044.87,4097, Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,4097, Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,4097, Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4097,APC Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4097,APC Injection treatment of nerve,64600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4097,APC Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,5123,APC Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,5123,APC Injection treatment of nerve,64605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,5123,APC Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,5123,APC Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,5123,APC Injection treatment of nerve,64610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,5123,APC Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC Chemodenerv saliv glands,64611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Destroy nerve face muscle,64612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC Chemodenerv musc migraine,64615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC Chemodenerv musc neck dyston,64616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,18617, Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,18617, Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,833.89,18617, Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,833.89,18617, Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,833.89,18617, Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,833.89,18617, Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,18617,APC Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,18617,APC Chemodener muscle larynx emg,64617,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,18617,APC Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Injection treatment of nerve,64620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,4097,APC Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,4097,APC Dstrj nulyt agt gnclr nrv,64624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,4097,APC Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2306.84,9918, Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2306.84,9918, Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2306.84,9918, Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2306.84,9918, Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2306.84,9918, Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2306.84,9918, Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,9918,APC Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,9918,APC Rf abltj nrv nrvtg si jt,64625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,9918,APC Trml dstrj ios bvn 1st 2 l/s,64628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Trml dstrj ios bvn 1st 2 l/s,64628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Trml dstrj ios bvn 1st 2 l/s,64628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Trml dstrj ios bvn 1st 2 l/s,64628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Trml dstrj ios bvn 1st 2 l/s,64628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Trml dstrj ios bvn 1st 2 l/s,64628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Trml dstrj ios bvn 1st 2 l/s,64628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Trml dstrj ios bvn ea addl,64629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Trml dstrj ios bvn ea addl,64629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC Injection treatment of nerve,64630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,18617, N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,18617, N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC N block inj common digit,64632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,4097,APC Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,4097,APC Destroy cerv/thor facet jnt,64633,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,4097,APC Destroy c/th facet jnt addl,64634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Destroy c/th facet jnt addl,64634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Destroy c/th facet jnt addl,64634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Destroy c/th facet jnt addl,64634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,7422, Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,7422, Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,7422,APC Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,7422,APC Destroy lumb/sac facet jnt,64635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,7422,APC Destroy l/s facet jnt addl,64636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Destroy l/s facet jnt addl,64636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Destroy l/s facet jnt addl,64636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Destroy l/s facet jnt addl,64636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1044.87,3314, Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,3314,APC Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,3314,APC Injection treatment of nerve,64640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,3314,APC Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,18617,APC Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,18617,APC Chemodenerv 1 extremity 1-4,64642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,18617,APC Chemodenerv 1 extrem 1-4 ea,64643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Chemodenerv 1 extrem 1-4 ea,64643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Chemodenerv 1 extrem 1-4 ea,64643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Chemodenerv 1 extrem 1-4 ea,64643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,833.89,18617, Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,18617,APC Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,18617,APC Chemodenerv 1 extrem 5/> mus,64644,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,18617,APC Chemodenerv 1 extrem 5/> ea,64645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Chemodenerv 1 extrem 5/> ea,64645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Chemodenerv 1 extrem 5/> ea,64645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Chemodenerv 1 extrem 5/> ea,64645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,18617,APC Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,18617,APC Chemodenerv trunk musc 1-5,64646,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,18617,APC Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,833.89,18617, Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,18617,APC Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,18617,APC Chemodenerv trunk musc 6/>,64647,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,18617,APC Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Chemodenerv eccrine glands,64650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,362.62,3314, Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,3314,APC Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,3314,APC Chemodenerv eccrine glands,64653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,3314,APC 1st opn implt bat modulj sys,64654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,54635.78, 1st opn implt bat modulj sys,64654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,54635.78, 1st opn implt bat modulj sys,64654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,54635.78, 1st opn implt bat modulj sys,64654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,54635.78, 1st opn implt bat modulj sys,64654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54115.44,,,,,,,fee schedule,3291,54635.78,APC 1st opn implt bat modulj sys,64654,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54635.78,,,,,,,fee schedule,3291,54635.78,APC 1st opn implt bat modulj sys,64654,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52034.08,,,,,,,fee schedule,3291,54635.78,APC Revj/rplcmt bat mod sys lead,64655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Revj/rplcmt bat mod sys lead,64655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Revj/rplcmt bat mod sys lead,64655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Revj/rplcmt bat mod sys lead,64655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Revj/rplcmt bat mod sys lead,64655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,3408,18617,APC Revj/rplcmt bat mod sys lead,64655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,3408,18617,APC Revj/rplcmt bat mod sys lead,64655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,3408,18617,APC Revj/rplcmt bat mod sys pg,64656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,38276.26, Revj/rplcmt bat mod sys pg,64656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,38276.26, Revj/rplcmt bat mod sys pg,64656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,38276.26, Revj/rplcmt bat mod sys pg,64656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,38276.26, Revj/rplcmt bat mod sys pg,64656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,3408,38276.26,APC Revj/rplcmt bat mod sys pg,64656,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,3408,38276.26,APC Revj/rplcmt bat mod sys pg,64656,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,3408,38276.26,APC Rmvl bat modulj sys tot sys,64657,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys tot sys,64657,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys tot sys,64657,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys tot sys,64657,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys tot sys,64657,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,2816,18617,APC Rmvl bat modulj sys tot sys,64657,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,2816,18617,APC Rmvl bat modulj sys tot sys,64657,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,2816,18617,APC Rmvl bat modul sys lead only,64658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rmvl bat modul sys lead only,64658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rmvl bat modul sys lead only,64658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rmvl bat modul sys lead only,64658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rmvl bat modul sys lead only,64658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,18617,APC Rmvl bat modul sys lead only,64658,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,18617,APC Rmvl bat modul sys lead only,64658,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,18617,APC Rmvl bat modulj sys pg only,64659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys pg only,64659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys pg only,64659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys pg only,64659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rmvl bat modulj sys pg only,64659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4295.31,,,,,,,fee schedule,2816,18617,APC Rmvl bat modulj sys pg only,64659,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4336.61,,,,,,,fee schedule,2816,18617,APC Rmvl bat modulj sys pg only,64659,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4130.11,,,,,,,fee schedule,2816,18617,APC Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC Injection treatment of nerve,64680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1044.87,4466, Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1086.66,,,,,,,fee schedule,1044.87,4466,APC Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1097.11,,,,,,,fee schedule,1044.87,4466,APC Injection treatment of nerve,64681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1044.87,,,,,,,fee schedule,1044.87,4466,APC Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,5123,APC Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,5123,APC Revise finger/toe nerve,64702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,5123,APC Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,5123,APC Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,5123,APC Revise hand/foot nerve,64704,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,5123,APC Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,6404, Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,6404, Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,6404, Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,6404, Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Revise arm/leg nerve,64708,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,11081, Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,11081, Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2306.84,11081, Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2306.84,11081, Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,11081, Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,11081, Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,11081,APC Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,11081,APC Revision of sciatic nerve,64712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,11081,APC Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,11081, Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,11081, Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2306.84,11081, Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2306.84,11081, Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,11081, Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,11081, Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,11081,APC Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,11081,APC Revision of arm nerve(s),64713,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,11081,APC Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,9420, Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,9420, Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2306.84,9420, Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2306.84,9420, Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,9420, Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,9420, Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,9420,APC Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,9420,APC Revise low back nerve(s),64714,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,9420,APC Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,8006, Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,8006, Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2306.84,8006, Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2306.84,8006, Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,8006, Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,8006, Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,8006,APC Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,8006,APC Revision of cranial nerve,64716,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,8006,APC Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5123,APC Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5123,APC Revise ulnar nerve at elbow,64718,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5123,APC Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,5123, Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5123,APC Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5123,APC Revise ulnar nerve at wrist,64719,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5123,APC Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,4466, Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,4466, Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2306.84,4466, Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2306.84,4466, Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,4466, Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,4466, Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,4466,APC Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,4466,APC Carpal tunnel surgery,64721,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,4466,APC Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,6404,APC Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,6404,APC Relieve pressure on nerve(s),64722,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,6404,APC Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1544,4097,APC Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1544,4097,APC Release foot/toe nerve,64726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1544,4097,APC Internal nerve revision,64727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Internal nerve revision,64727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Internal nerve revision,64727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Internal nerve revision,64727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Dcmprn median nrv carpl tunl,64728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,18617, Dcmprn median nrv carpl tunl,64728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,18617, Dcmprn median nrv carpl tunl,64728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2306.84,18617, Dcmprn median nrv carpl tunl,64728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2306.84,18617, Dcmprn median nrv carpl tunl,64728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,18617,APC Dcmprn median nrv carpl tunl,64728,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,18617,APC Dcmprn median nrv carpl tunl,64728,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,18617,APC Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,4466, Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,4466, Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2306.84,4466, Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2306.84,4466, Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,4466, Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,4466, Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,4466,APC Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,4466,APC Incision of brow nerve,64732,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,4466,APC Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,5123, Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,5123, Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,5123, Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,5123, Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,5123, Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,5123, Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5123,APC Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5123,APC Incision of cheek nerve,64734,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5123,APC Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,5123, Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,5123, Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,5123, Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,5123, Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,5123, Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,5123, Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5123,APC Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5123,APC Incision of chin nerve,64736,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5123,APC Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,11081, Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,11081, Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2306.84,11081, Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2306.84,11081, Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,11081, Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,11081, Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,11081,APC Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,11081,APC Incision of jaw nerve,64738,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,11081,APC Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4466, Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4466, Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4466, Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4466, Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2138,4466, Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2138,4466, Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2138,4466,APC Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2138,4466,APC Incision of tongue nerve,64740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2138,4466,APC Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,9420, Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,9420, Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,2306.84,9420, Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,2306.84,9420, Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,9420, Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,9420, Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,9420,APC Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,9420,APC Incision of facial nerve,64742,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,9420,APC Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,6404, Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,6404, Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,6404, Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,6404, Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Incise nerve back of head,64744,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,8006, Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,8006, Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2306.84,8006, Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2306.84,8006, Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,8006, Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,8006, Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,8006,APC Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,8006,APC Incise diaphragm nerve,64746,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,8006,APC Incision of stomach nerves,64755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of stomach nerves,64755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of stomach nerves,64755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of stomach nerves,64755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incision of vagus nerve,64760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incision of vagus nerve,64760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incision of vagus nerve,64760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incision of vagus nerve,64760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,17041, Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,17041, Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,1406,17041, Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,1406,17041, Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1406,17041, Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1406,17041, Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1406,17041,APC Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1406,17041,APC Incise hip/thigh nerve,64763,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1406,17041,APC Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,5098, Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,5098, Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,5098, Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,5098, Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1406,5098, Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1406,5098, Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1406,5098,APC Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1406,5098,APC Incise hip/thigh nerve,64766,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1406,5098,APC Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,6404, Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,6404, Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,6404, Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,6404, Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Sever cranial nerve,64771,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,6404, Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,6404, Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,6404, Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,6404, Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Incision of spinal nerve,64772,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,6404, Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,6404, Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,6404, Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,6404, Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Remove skin nerve lesion,64774,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,5098, Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,5098, Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2306.84,5098, Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2306.84,5098, Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,5098, Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,5098, Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5098,APC Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5098,APC Remove digit nerve lesion,64776,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5098,APC Digit nerve surgery add-on,64778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Digit nerve surgery add-on,64778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Digit nerve surgery add-on,64778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Digit nerve surgery add-on,64778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,5123, Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,5123, Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,5123, Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,5123, Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,5123, Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,5123, Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5123,APC Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5123,APC Remove limb nerve lesion,64782,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5123,APC Limb nerve surgery add-on,64783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Limb nerve surgery add-on,64783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Limb nerve surgery add-on,64783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Limb nerve surgery add-on,64783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,6404, Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,6404, Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2306.84,6404, Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2306.84,6404, Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,6404, Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,6404, Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,6404,APC Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,6404,APC Remove nerve lesion,64784,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,6404,APC Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,3408,8006,APC Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,3408,8006,APC Remove sciatic nerve lesion,64786,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,3408,8006,APC Implant nerve end,64787,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Implant nerve end,64787,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Implant nerve end,64787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Implant nerve end,64787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,5123, Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,5123, Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,5123, Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,5123, Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,5123, Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,5123, Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5123,APC Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5123,APC Remove skin nerve lesion,64788,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5123,APC Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,8006, Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,8006, Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2306.84,8006, Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2306.84,8006, Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,8006, Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,8006, Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,8006,APC Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,8006,APC Removal of nerve lesion,64790,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,8006,APC Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,3408,11081,APC Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,3408,11081,APC Removal of nerve lesion,64792,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,3408,11081,APC Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,5123, Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,5123, Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2306.84,5123, Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2306.84,5123, Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,5123, Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,5123, Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,5123,APC Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,5123,APC Biopsy of nerve,64795,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,5123,APC Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,11081, Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,11081, Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2306.84,11081, Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2306.84,11081, Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,11081, Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,11081, Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,11081,APC Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,11081,APC Sympathectomy cervical,64802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,11081,APC Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,428,18617,APC Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,428,18617,APC Remove sympathetic nerves,64804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,428,18617,APC Remove sympathetic nerves,64809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove sympathetic nerves,64809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove sympathetic nerves,64809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove sympathetic nerves,64809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove sympathetic nerves,64818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove sympathetic nerves,64818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove sympathetic nerves,64818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove sympathetic nerves,64818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,1406,18617,APC Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,1406,18617,APC Sympathectomy digital artery,64820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,1406,18617,APC Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3865.36,6404, Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3865.36,6404, Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3865.36,6404, Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3865.36,6404, Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3865.36,6404, Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3865.36,6404, Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3865.36,6404,APC Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3865.36,6404,APC Remove sympathetic nerves,64821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3865.36,6404,APC Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2816,13036, Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2816,13036, Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,13036,APC Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,13036,APC Remove sympathetic nerves,64822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,13036,APC Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,4466,APC Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,4466,APC Sympathectomy supfc palmar,64823,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,4466,APC Description Not Available,64830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,64830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,64830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,64830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2306.84,8006, Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2306.84,8006, Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2306.84,8006, Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2306.84,8006, Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2306.84,8006, Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2306.84,8006, Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,8006,APC Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,8006,APC Repair of digit nerve,64831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,8006,APC Repair nerve add-on,64832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Repair nerve add-on,64832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Repair nerve add-on,64832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Repair nerve add-on,64832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,2816,8006,APC Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,2816,8006,APC Repair of hand or foot nerve,64834,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,2816,8006,APC Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,3408,8006,APC Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,3408,8006,APC Repair of hand or foot nerve,64835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,3408,8006,APC Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,3408,9420,APC Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,3408,9420,APC Repair of hand or foot nerve,64836,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,3408,9420,APC Repair nerve add-on,64837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Repair nerve add-on,64837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Repair nerve add-on,64837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Repair nerve add-on,64837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,10885.67, Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,10885.67, Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,10885.67, Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,10885.67, Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,10885.67, Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,10885.67, Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,10885.67,APC Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,10885.67,APC Repair of leg nerve,64840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,10885.67,APC Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,10885.67, Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,10885.67, Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,10885.67, Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,10885.67, Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,10885.67, Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,10885.67, Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,10885.67,APC Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,10885.67,APC Repair/transpose nerve,64856,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,10885.67,APC Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,2816,8006,APC Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,2816,8006,APC Repair arm/leg nerve,64857,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,2816,8006,APC Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2306.84,11081, Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2306.84,11081, Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2306.84,11081, Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2306.84,11081, Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2306.84,11081, Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2306.84,11081, Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,11081,APC Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,11081,APC Repair sciatic nerve,64858,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,11081,APC Nerve surgery,64859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Nerve surgery,64859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Nerve surgery,64859,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Nerve surgery,64859,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2306.84,13036, Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2306.84,13036, Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2306.84,13036, Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2306.84,13036, Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2306.84,13036, Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2306.84,13036, Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,2306.84,13036,APC Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,2306.84,13036,APC Repair of arm nerves,64861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,2306.84,13036,APC Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,428,5098,APC Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,428,5098,APC Repair of low back nerves,64862,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,428,5098,APC Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,3408,17041,APC Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,3408,17041,APC Repair of facial nerve,64864,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,3408,17041,APC Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4035.65,11081, Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4035.65,11081, Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4035.65,11081, Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4035.65,11081, Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4035.65,11081, Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4035.65,11081, Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,4035.65,11081,APC Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,4035.65,11081,APC Repair of facial nerve,64865,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,4035.65,11081,APC Fusion of facial/other nerve,64866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of facial/other nerve,64866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of facial/other nerve,64866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of facial/other nerve,64866,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fusion of facial/other nerve,64868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fusion of facial/other nerve,64868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fusion of facial/other nerve,64868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fusion of facial/other nerve,64868,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Subsequent repair of nerve,64872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Subsequent repair of nerve,64872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Subsequent repair of nerve,64872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Subsequent repair of nerve,64872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Repair & revise nerve add-on,64874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Repair & revise nerve add-on,64874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Repair & revise nerve add-on,64874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Repair & revise nerve add-on,64874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Repair nerve/shorten bone,64876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5044, Repair nerve/shorten bone,64876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5044, Repair nerve/shorten bone,64876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5044, Repair nerve/shorten bone,64876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5044, Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,17939, Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,17939, Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,2816,17939, Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,2816,17939, Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,17939, Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,17939, Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,17939,APC Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,17939,APC Nerve graft head/neck <=4 cm,64885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,17939,APC Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,17041, Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,17041, Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,2816,17041, Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,2816,17041, Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,17041, Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,17041, Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,17041,APC Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,17041,APC Nerve graft head/neck >4 cm,64886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,17041,APC Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,11081, Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,11081, Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,11081, Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,11081, Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,11081, Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,11081, Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,11081,APC Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,11081,APC Nerve graft hand/foot <=4 cm,64890,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,11081,APC Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,10885.67, Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,10885.67, Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,10885.67, Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,10885.67, Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,10885.67, Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,10885.67, Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,10885.67,APC Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,10885.67,APC Nerve graft hand/foot >4 cm,64891,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,10885.67,APC Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,13036, Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,13036, Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,13036,APC Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,13036,APC Nerve graft arm/leg <4 cm,64892,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,13036,APC Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,2816,8006,APC Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,2816,8006,APC Nerve graft arm/leg >4 cm,64893,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,2816,8006,APC Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,10885.67, Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,10885.67, Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,10885.67, Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,10885.67, Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,10885.67, Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,10885.67, Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,3408,10885.67,APC Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,3408,10885.67,APC Nerve graft hand/foot <=4 cm,64895,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,3408,10885.67,APC Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,3408,17041,APC Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,3408,17041,APC Nerve graft hand/foot >4 cm,64896,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,3408,17041,APC Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,3408,17041,APC Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,3408,17041,APC Nerve graft arm/leg <=4 cm,64897,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,3408,17041,APC Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,17041, Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,3408,17041,APC Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,3408,17041,APC Nerve graft arm/leg >4 cm,64898,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,3408,17041,APC Nerve graft add-on,64901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Nerve graft add-on,64901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Nerve graft add-on,64901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Nerve graft add-on,64901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Nerve graft add-on,64902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,428,4166, Nerve graft add-on,64902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,428,4166, Nerve graft add-on,64902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,4166, Nerve graft add-on,64902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,4166, Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,15339, Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,15339, Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,15339,APC Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,15339,APC Nerve pedicle transfer,64905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,15339,APC Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,10885.67, Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,10885.67, Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,10885.67, Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,10885.67, Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,428,10885.67, Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,428,10885.67, Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,428,10885.67,APC Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,428,10885.67,APC Nerve pedicle transfer,64907,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,428,10885.67,APC Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13036, Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13036, Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,2816,13036, Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,2816,13036, Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2816,13036, Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2816,13036, Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,13036,APC Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,13036,APC Nerve repair w/allograft,64910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,13036,APC Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,15339, Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,15339, Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,2816,15339, Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,2816,15339, Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2816,15339, Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2816,15339, Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,15339,APC Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,15339,APC Neurorraphy w/vein autograft,64911,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,15339,APC Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,2816,18617, Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,2816,18617, Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10782,,,,,,,fee schedule,2816,18617,APC Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10885.67,,,,,,,fee schedule,2816,18617,APC Nrv rpr w/nrv algrft 1st,64912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10367.3,,,,,,,fee schedule,2816,18617,APC Nrv rpr w/nrv algrft ea addl,64913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Nrv rpr w/nrv algrft ea addl,64913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Nrv rpr w/nrv algrft ea addl,64913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Nrv rpr w/nrv algrft ea addl,64913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,362.62,18617, Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,362.62,18617, Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,362.62,18617, Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,362.62,18617, Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,362.62,18617, Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,362.62,18617, Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,18617,APC Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,18617,APC Nervous system surgery,64999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,18617,APC Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,8006,APC Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,8006,APC Revise eye,65091,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,8006,APC Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,8006,APC Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,8006,APC Revise eye with implant,65093,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,8006,APC Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,8006,APC Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,8006,APC Removal of eye,65101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,8006,APC Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,8006,APC Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,8006,APC Remove eye/insert implant,65103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,8006,APC Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,9420,APC Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,9420,APC Remove eye/attach implant,65105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,9420,APC Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,11081,APC Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,11081,APC Removal of eye,65110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,11081,APC Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17041, Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17041, Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4147,17041, Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4147,17041, Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,17041, Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,17041, Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4147,17041,APC Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4147,17041,APC Remove eye/revise socket,65112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4147,17041,APC Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,9918, Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,9918, Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4147,9918,APC Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4147,9918,APC Remove eye/revise socket,65114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4147,9918,APC Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,7422, Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,7422, Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,7422, Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,7422, Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1406,7422, Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1406,7422, Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1406,7422,APC Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1406,7422,APC Revise ocular implant,65125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1406,7422,APC Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,8006,APC Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,8006,APC Insert ocular implant,65130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,8006,APC Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,2816,5123,APC Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,2816,5123,APC Insert ocular implant,65135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,2816,5123,APC Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,11081,APC Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,11081,APC Attach ocular implant,65140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,11081,APC Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,2816,6404,APC Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,2816,6404,APC Revise ocular implant,65150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,2816,6404,APC Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,8006,APC Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,8006,APC Reinsert ocular implant,65155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,8006,APC Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,1544,5123,APC Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,1544,5123,APC Removal of ocular implant,65175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,1544,5123,APC Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Remove foreign body from eye,65205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Remove foreign body from eye,65210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Remove foreign body from eye,65220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Remove foreign body from eye,65222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,4466, Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,4466, Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,4466, Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,4466, Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,4466, Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,4466, Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,4466,APC Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,4466,APC Remove foreign body from eye,65235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,4466,APC Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,428,5098,APC Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,428,5098,APC Remove foreign body from eye,65260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,428,5098,APC Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6404, Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6404, Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2726.34,6404, Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2726.34,6404, Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6404, Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6404, Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6404,APC Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6404,APC Remove foreign body from eye,65265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6404,APC Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Repair of eye wound,65270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,5123, Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Repair of eye wound,65272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Repair of eye wound,65273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Repair of eye wound,65273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Repair of eye wound,65273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Repair of eye wound,65273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,9420,APC Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,9420,APC Repair of eye wound,65275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,9420,APC Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,4224,8006,APC Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,4224,8006,APC Repair of eye wound,65280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,4224,8006,APC Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,11081, Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,11081, Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,11081, Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,11081, Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,11081, Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,11081, Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,4224,11081,APC Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,4224,11081,APC Repair of eye wound,65285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,4224,11081,APC Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,4166, Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,4166, Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,4166, Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,4166, Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2138,4166, Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2138,4166, Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2138,4166,APC Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2138,4166,APC Repair of eye wound,65286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2138,4166,APC Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,5123,APC Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,5123,APC Repair of eye socket wound,65290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,5123,APC Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1177.66,3314, Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1177.66,3314, Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,3314, Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,3314, Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1177.66,3314, Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1177.66,3314, Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,3314,APC Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,3314,APC Removal of eye lesion,65400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,3314,APC Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Biopsy of cornea,65410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Removal of eye lesion,65420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2808.63,7422, Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2808.63,7422, Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,7422, Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,7422, Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2808.63,7422, Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2808.63,7422, Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,7422,APC Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,7422,APC Removal of eye lesion,65426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,7422,APC Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,527.74,18617, Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,527.74,18617, Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Corneal smear,65430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1177.66,3314, Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1177.66,3314, Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,3314, Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,3314, Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1177.66,3314, Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1177.66,3314, Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,3314,APC Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,3314,APC Curette/treat cornea,65435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,3314,APC Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,18617,APC Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,18617,APC Curette/treat cornea,65436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,18617,APC Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,18617, Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,18617, Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,18617, Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,18617, Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Treatment of corneal lesion,65450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,18617,APC Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,18617,APC Revision of cornea,65600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,18617,APC Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4147,9918,APC Corneal transplant,65755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4147,9918,APC Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,13320, Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,13320, Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4147,13320,APC Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4147,13320,APC Corneal trnspl endothelial,65756,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4147,13320,APC Revision of cornea,65760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Revision of cornea,65760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Revision of cornea,65760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Revision of cornea,65760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Revision of cornea,65765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Revision of cornea,65765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Revision of cornea,65765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Revision of cornea,65765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Corneal tissue transplant,65767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Corneal tissue transplant,65767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Corneal tissue transplant,65767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Corneal tissue transplant,65767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,18617, Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,18617, Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17822.18,,,,,,,fee schedule,4147,18617,APC Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17993.55,,,,,,,fee schedule,4147,18617,APC Revise cornea with implant,65770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17136.71,,,,,,,fee schedule,4147,18617,APC Radial keratotomy,65771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Radial keratotomy,65771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Radial keratotomy,65771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Radial keratotomy,65771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,1177.66,6312, Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,1177.66,6312, Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,6312, Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,6312, Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,1177.66,6312, Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,1177.66,6312, Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,6312,APC Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,6312,APC Correction of astigmatism,65772,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,6312,APC Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,6312, Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,6312, Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Correction of astigmatism,65775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1177.66,4466, Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1177.66,4466, Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1177.66,4466, Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1177.66,4466, Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1177.66,4466, Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1177.66,4466, Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,4466,APC Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,4466,APC Cover eye w/membrane,65778,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,4466,APC Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1544,8006, Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1544,8006, Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,1544,8006,APC Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,1544,8006,APC Cover eye w/membrane suture,65779,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,1544,8006,APC Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,8006,APC Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,8006,APC Ocular reconst transplant,65780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,8006,APC Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13036, Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13036, Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,3291,13036, Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,3291,13036, Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,13036, Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,13036, Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3291,13036,APC Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3291,13036,APC Ocular reconst transplant,65781,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3291,13036,APC Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,7422,APC Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,7422,APC Ocular reconst transplant,65782,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,7422,APC Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,18617, Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,18617, Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,428,18617,APC Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,428,18617,APC Impltj ntrstrml crnl rng seg,65785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,428,18617,APC Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,4097,APC Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,4097,APC Drainage of eye,65800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,4097,APC Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Drainage of eye,65810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,5123, Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Drainage of eye,65815,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,1544,6404,APC Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,1544,6404,APC Relieve inner eye pressure,65820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,1544,6404,APC Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,6312, Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,6312, Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Incision of eye,65850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,649.74,4166, Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,649.74,4166, Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,4166, Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,4166, Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,4166, Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,4166, Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,4166,APC Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,4166,APC Trabeculoplasty laser surg,65855,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,4166,APC Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,649.74,6253, Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,649.74,6253, Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,6253, Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,6253, Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,6253, Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,6253, Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,6253,APC Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,6253,APC Incise inner eye adhesions,65860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,6253,APC Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,5123,APC Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,5123,APC Incise inner eye adhesions,65865,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,5123,APC Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Incise inner eye adhesions,65870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Incise inner eye adhesions,65875,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4224,6404,APC Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4224,6404,APC Incise inner eye adhesions,65880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4224,6404,APC Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2726.34,7422, Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2726.34,7422, Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,7422, Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,7422, Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2726.34,7422, Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2726.34,7422, Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,7422,APC Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,7422,APC Remove eye lesion,65900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,7422,APC Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,2726.34,9918, Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,2726.34,9918, Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,9918, Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,9918, Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2726.34,9918, Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2726.34,9918, Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,9918,APC Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,9918,APC Remove implant of eye,65920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,9918,APC Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2726.34,7422, Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2726.34,7422, Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,7422, Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,7422, Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2726.34,7422, Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2726.34,7422, Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,7422,APC Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,7422,APC Remove blood clot from eye,65930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,7422,APC Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,4097,APC Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,4097,APC Injection treatment of eye,66020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,4097,APC Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,4097,APC Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,4097,APC Injection treatment of eye,66030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,4097,APC Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,2808.63,9918, Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,2808.63,9918, Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,9918, Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,9918, Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2808.63,9918, Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2808.63,9918, Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,9918,APC Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,9918,APC Remove eye lesion,66130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,9918,APC Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4224,6404,APC Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4224,6404,APC Glaucoma surgery,66150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4224,6404,APC Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4224,6404,APC Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4224,6404,APC Glaucoma surgery,66155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4224,6404,APC Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,5123, Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,5123, Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,5123, Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,5123, Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Glaucoma surgery,66160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,6312, Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,6312, Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Glaucoma surgery,66170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,6312, Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,6312, Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Incision of eye,66172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3291,7422, Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3291,7422, Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3291,7422,APC Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3291,7422,APC Translum dil eye canal,66174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3291,7422,APC Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3291,8006,APC Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3291,8006,APC Trnslum dil eye canal w/stnt,66175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3291,8006,APC Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,13320, Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,13320, Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,4224,13320,APC Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,4224,13320,APC Aqueous shunt eye w/o graft,66179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,4224,13320,APC Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3291,9420,APC Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3291,9420,APC Aqueous shunt eye w/graft,66180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3291,9420,APC Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,13320, Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,13320, Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3408,13320,APC Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3408,13320,APC Insert ant drainage device,66183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3408,13320,APC Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2726.34,13320, Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2726.34,13320, Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,13320, Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,13320, Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2726.34,13320, Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2726.34,13320, Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,13320,APC Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,13320,APC Revision of aqueous shunt,66184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,13320,APC Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,8006, Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,8006, Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2726.34,8006, Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2726.34,8006, Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,8006, Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,8006, Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,8006,APC Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,8006,APC Revise aqueous shunt eye,66185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,8006,APC Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,4224,9420,APC Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,4224,9420,APC Repair/graft eye lesion,66225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,4224,9420,APC Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Follow-up surgery of eye,66250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,3314,APC Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,3314,APC Incision of iris,66500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,3314,APC Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,6404,APC Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,6404,APC Incision of iris,66505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,6404,APC Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3408,8006,APC Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3408,8006,APC Remove iris and lesion,66600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3408,8006,APC Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2726.34,5123, Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2726.34,5123, Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2726.34,5123, Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2726.34,5123, Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,5098, Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,5098, Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,5098, Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,5098, Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2138,5098, Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2138,5098, Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2138,5098,APC Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2138,5098,APC Removal of iris,66625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2138,5098,APC Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2726.34,5123, Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2726.34,5123, Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2726.34,5123, Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2726.34,5123, Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2726.34,5123, Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2726.34,5123, Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2726.34,5123, Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2726.34,5123, Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Removal of iris,66635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Repair iris & ciliary body,66680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,5123, Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Repair iris & ciliary body,66682,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Implantation iris prosthesis,66683,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,20418.21, Implantation iris prosthesis,66683,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,20418.21, Implantation iris prosthesis,66683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,20418.21, Implantation iris prosthesis,66683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,20418.21, Implantation iris prosthesis,66683,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20223.75,,,,,,,fee schedule,3291,20418.21,APC Implantation iris prosthesis,66683,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20418.21,,,,,,,fee schedule,3291,20418.21,APC Implantation iris prosthesis,66683,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19445.91,,,,,,,fee schedule,3291,20418.21,APC Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,4466, Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,4466, Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,4466, Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,4466, Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,4466, Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,4466, Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,4466,APC Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,4466,APC Destruction ciliary body,66700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,4466,APC Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Ciliary transsleral therapy,66710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,5123, Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,5123, Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,5123, Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,5123, Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Ciliary endoscopic ablation,66711,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Destruction ciliary body,66720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,5123, Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,5123, Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,5123, Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,5123, Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Destruction ciliary body,66740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3314, Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3314, Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC Revision of iris,66761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3314, Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3314, Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC Revision of iris,66762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3314, Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3314, Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC Removal of inner eye lesion,66770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,3314, Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,3314, Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,3314,APC Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,3314,APC Incision secondary cataract,66820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,3314,APC After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,649.74,4466, After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,649.74,4466, After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,4466, After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,4466, After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,649.74,4466, After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,649.74,4466, After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,4466,APC After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,4466,APC After cataract laser surgery,66821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,4466,APC Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,6312, Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,6312, Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Reposition intraocular lens,66825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2138,6312, Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2138,6312, Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,6312, Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,6312, Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2138,6312, Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2138,6312, Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2138,6312,APC Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2138,6312,APC Removal of lens lesion,66830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2138,6312,APC Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,6312, Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,6312, Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Removal of lens material,66840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,2726.34,9918, Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,2726.34,9918, Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,9918, Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,9918, Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2726.34,9918, Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2726.34,9918, Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,9918,APC Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,9918,APC Removal of lens material,66850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,9918,APC Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4224,8006,APC Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4224,8006,APC Removal of lens material,66852,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4224,8006,APC Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,6312, Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,6312, Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Extraction of lens,66920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3291,8006,APC Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3291,8006,APC Extraction of lens,66930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3291,8006,APC Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2138,7422, Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2138,7422, Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,7422, Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,7422, Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2138,7422, Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2138,7422, Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2138,7422,APC Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2138,7422,APC Extraction of lens,66940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2138,7422,APC Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2726.34,9701, Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2726.34,9701, Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,9701, Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,9701, Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,2726.34,9701, Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,2726.34,9701, Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,9701,APC Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,9701,APC Cataract surgery complex,66982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,9701,APC Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,9701,APC Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,9701,APC Cataract surg w/iol 1 stage,66983,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,9701,APC Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,2726.34,9701, Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,9701,APC Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,9701,APC Cataract surg w/iol 1 stage,66984,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,9701,APC Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,2726.34,8190, Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,2726.34,8190, Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2726.34,8190, Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2726.34,8190, Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6825,,,,,,,fee schedule,2726.34,8190, Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8190,,,,,,,fee schedule,2726.34,8190, Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,8190,APC Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,8190,APC Insert lens prosthesis,66985,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,8190,APC Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,2726.34,8190, Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,2726.34,8190, Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2726.34,8190, Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2726.34,8190, Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6825,,,,,,,fee schedule,2726.34,8190, Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8190,,,,,,,fee schedule,2726.34,8190, Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,8190,APC Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,8190,APC Exchange lens prosthesis,66986,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,8190,APC Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3560,13320,APC Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3560,13320,APC Xcapsl ctrc rmvl cplx w/ecp,66987,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3560,13320,APC Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3560,13320, Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3560,13320,APC Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3560,13320,APC Xcapsl ctrc rmvl w/ecp,66988,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3560,13320,APC Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,9701, Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,9701, Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3560,9701, Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3560,9701, Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,3560,9701, Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,3560,9701, Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3560,9701,APC Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3560,9701,APC Xcpsl ctrc rmvl cplx insj 1+,66989,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3560,9701,APC Ophthalmic endoscope add-on,66990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Ophthalmic endoscope add-on,66990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Ophthalmic endoscope add-on,66990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Ophthalmic endoscope add-on,66990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,9701, Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,9701, Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3560,9701, Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3560,9701, Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,3560,9701, Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,3560,9701, Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3560,9701,APC Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3560,9701,APC Xcapsl ctrc rmvl insj 1+,66991,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3560,9701,APC Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,18617, Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,18617, Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,18617,APC Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,18617,APC Eye surgery procedure,66999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,18617,APC Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6404, Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6404, Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2726.34,6404, Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2726.34,6404, Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6404, Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6404, Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6404,APC Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6404,APC Partial removal of eye fluid,67005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6404,APC Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,8006, Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,8006, Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2726.34,8006, Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2726.34,8006, Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,8006, Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,8006, Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,8006,APC Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,8006,APC Partial removal of eye fluid,67010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,8006,APC Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,6404,APC Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,6404,APC Release of eye fluid,67015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,6404,APC Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,8006,APC Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,8006,APC Replace eye fluid,67025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,8006,APC Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18686, Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18686, Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,4224,18686, Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,4224,18686, Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,18686, Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,18686, Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17142.58,,,,,,,fee schedule,4224,18686,APC Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17307.42,,,,,,,fee schedule,4224,18686,APC Implant eye drug system,67027,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16483.25,,,,,,,fee schedule,4224,18686,APC Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,390.2,3314, Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,390.2,3314, Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,390.2,3314, Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,390.2,3314, Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,390.2,3314, Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,390.2,3314, Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,3314,APC Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,3314,APC Injection eye drug,67028,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,3314,APC Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1544,6404,APC Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1544,6404,APC Incise inner eye strands,67030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1544,6404,APC Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,649.74,4466, Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,649.74,4466, Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,4466, Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,4466, Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,649.74,4466, Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,649.74,4466, Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,4466,APC Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,4466,APC Laser surgery eye strands,67031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,4466,APC Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4224,8006,APC Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4224,8006,APC Removal of inner eye fluid,67036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4224,8006,APC Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4147,9918,APC Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4147,9918,APC Laser treatment of retina,67039,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4147,9918,APC Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4147,9918,APC Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4147,9918,APC Laser treatment of retina,67040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4147,9918,APC Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3291,13320,APC Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3291,13320,APC Vit for macular pucker,67041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3291,13320,APC Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,13320, Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,13320, Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3291,13320,APC Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3291,13320,APC Vit for macular hole,67042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3291,13320,APC Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,13320, Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,13320, Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4147,13320,APC Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4147,13320,APC Vit for membrane dissect,67043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4147,13320,APC Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6253, Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6253, Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,6253, Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,6253, Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2726.34,6253, Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2726.34,6253, Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6253,APC Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6253,APC Repair detached retina crtx,67101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6253,APC Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,649.74,3972, Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,649.74,3972, Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3972, Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3972, Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3972, Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3972, Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3972,APC Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3972,APC Repair detached retina pc,67105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3972,APC Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3291,8006,APC Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3291,8006,APC Repair detached retina,67107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3291,8006,APC Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,4147,9918,APC Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,4147,9918,APC Repair detached retina,67108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,4147,9918,APC Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1406,18617,APC Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1406,18617,APC Repair detached retina,67110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1406,18617,APC Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,13320, Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,13320, Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,13320, Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,13320, Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3291,13320, Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3291,13320, Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6537.75,,,,,,,fee schedule,3291,13320,APC Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6600.61,,,,,,,fee schedule,3291,13320,APC Repair retinal detach cplx,67113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6286.29,,,,,,,fee schedule,3291,13320,APC Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,6404, Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,6404, Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,6404, Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,6404, Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,6404, Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,6404, Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,2816,6404,APC Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,2816,6404,APC Release encircling material,67115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,2816,6404,APC Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,5123, Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,5123, Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,5123, Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,5123, Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,5123, Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,5123, Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,5123,APC Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,5123,APC Remove eye implant material,67120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,5123,APC Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2726.34,6404, Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2726.34,6404, Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2726.34,6404, Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2726.34,6404, Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2726.34,6404, Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2726.34,6404, Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6404,APC Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6404,APC Remove eye implant material,67121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6404,APC Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,374.96,4466, Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,374.96,4466, Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,374.96,4466, Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,374.96,4466, Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,374.96,4466, Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,374.96,4466, Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,4466,APC Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,4466,APC Treatment of retina,67141,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,4466,APC Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3314, Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3314, Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC Treatment of retina,67145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,374.96,3972, Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,374.96,3972, Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,374.96,3972, Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,374.96,3972, Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3972, Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3972, Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3972,APC Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3972,APC Treatment of retinal lesion,67208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3972,APC Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,649.74,3972, Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,649.74,3972, Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3972, Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3972, Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3972, Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3972, Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3972,APC Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3972,APC Treatment of retinal lesion,67210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3972,APC Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,8006,APC Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,8006,APC Treatment of retinal lesion,67218,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,8006,APC Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3314, Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3314, Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC Treatment of choroid lesion,67220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3314, Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3314, Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC Ocular Photodynamic Ther,67221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC Eye photodynamic ther add-on,67225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Eye photodynamic ther add-on,67225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Eye photodynamic ther add-on,67225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Eye photodynamic ther add-on,67225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,1544,8006,APC Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,1544,8006,APC Dstrj extensive retinopathy,67227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,1544,8006,APC Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,3314, Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,3314, Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC Treatment x10sv retinopathy,67228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,649.74,18617, Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,649.74,18617, Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,649.74,18617, Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,649.74,18617, Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,649.74,18617, Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,649.74,18617, Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,18617,APC Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,18617,APC Tr retinal les preterm inf,67229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,18617,APC Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,8006, Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,8006, Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2808.63,8006, Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2808.63,8006, Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,8006, Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,8006, Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,8006,APC Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,8006,APC Reinforce eye wall,67250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,8006,APC Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5078.32,,,,,,,fee schedule,3408,6404,APC Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5127.15,,,,,,,fee schedule,3408,6404,APC Reinforce/graft eye wall,67255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4883,,,,,,,fee schedule,3408,6404,APC Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1406,18617, Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1406,18617, Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,1406,18617,APC Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,1406,18617,APC Eye surgery procedure,67299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,1406,18617,APC Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5123, Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5123, Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5123, Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5123, Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Revise eye muscle,67311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,6404,APC Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,6404,APC Revise two eye muscles,67312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,6404,APC Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,6312, Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,6312, Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Revise eye muscle,67314,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6404, Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6404, Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2808.63,6404, Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2808.63,6404, Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6404, Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6404, Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6404,APC Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6404,APC Revise two eye muscles,67316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6404,APC Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,6312, Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,6312, Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Revise eye muscle(s),67318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Revise eye muscle(s) add-on,67320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Revise eye muscle(s) add-on,67320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Revise eye muscle(s) add-on,67320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,6253, Revise eye muscle(s) add-on,67320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,6253, Eye surgery follow-up add-on,67331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Eye surgery follow-up add-on,67331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Eye surgery follow-up add-on,67331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,6253, Eye surgery follow-up add-on,67331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,6253, Rerevise eye muscles add-on,67332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Rerevise eye muscles add-on,67332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Rerevise eye muscles add-on,67332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,6253, Rerevise eye muscles add-on,67332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,6253, Revise eye muscle w/suture,67334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Revise eye muscle w/suture,67334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Revise eye muscle w/suture,67334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,6253, Revise eye muscle w/suture,67334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,6253, Eye suture during surgery,67335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Eye suture during surgery,67335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Eye suture during surgery,67335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,6253, Eye suture during surgery,67335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,6253, Revise eye muscle add-on,67340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,428,6253, Revise eye muscle add-on,67340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,428,6253, Revise eye muscle add-on,67340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,6253, Revise eye muscle add-on,67340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,6253, Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,2808.63,9918, Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,2808.63,9918, Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,9918, Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,9918, Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2808.63,9918, Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2808.63,9918, Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,9918,APC Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,9918,APC Release eye tissue,67343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,9918,APC Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Destroy nerve of eye muscle,67345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,9420, Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,9420, Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1544,9420, Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1544,9420, Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,9420, Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,9420, Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,1544,9420,APC Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,1544,9420,APC Biopsy eye muscle,67346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,1544,9420,APC Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,18617, Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,18617, Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,374.96,18617, Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,374.96,18617, Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Unlisted px extraocular musc,67399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,6404,APC Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,6404,APC Explore/biopsy eye socket,67400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,6404,APC Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,6312, Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,6312, Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Explore/drain eye socket,67405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,7422,APC Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,7422,APC Explore/treat eye socket,67412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,7422,APC Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2808.63,7422, Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,7422,APC Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,7422,APC Explore/treat eye socket,67413,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,7422,APC Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,18617, Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,18617, Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,18617,APC Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,18617,APC Explr/decompress eye socket,67414,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,18617,APC Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,6404, Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,6404, Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,6404, Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,6404, Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,6404, Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,6404, Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,6404,APC Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,6404,APC Aspiration orbital contents,67415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,6404,APC Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,11081,APC Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,11081,APC Explore/treat eye socket,67420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,11081,APC Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2138,7422, Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2138,7422, Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,7422, Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,7422, Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2138,7422, Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2138,7422, Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,2138,7422,APC Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,2138,7422,APC Explore/treat eye socket,67430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,2138,7422,APC Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,7422,APC Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,7422,APC Explore/drain eye socket,67440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,7422,APC Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,11081,APC Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,11081,APC Explr/decompress eye socket,67445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,11081,APC Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,8006,APC Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,8006,APC Explore/biopsy eye socket,67450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,8006,APC Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,18617, Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,18617, Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,374.96,18617, Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,374.96,18617, Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Inject/treat eye socket,67500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Inject/treat eye socket,67505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Inject/treat eye socket,67515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Sprchoroidal spc njx rx agt,67516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,390.2,18617, Sprchoroidal spc njx rx agt,67516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,390.2,18617, Sprchoroidal spc njx rx agt,67516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,390.2,18617, Sprchoroidal spc njx rx agt,67516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,390.2,18617, Sprchoroidal spc njx rx agt,67516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,18617,APC Sprchoroidal spc njx rx agt,67516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,18617,APC Sprchoroidal spc njx rx agt,67516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,18617,APC Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,8006,APC Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,8006,APC Insert eye socket implant,67550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,8006,APC Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,2816,8006,APC Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,2816,8006,APC Revise eye socket implant,67560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,2816,8006,APC Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,6404,APC Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,6404,APC Decompress optic nerve,67570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,6404,APC Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,18617, Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,18617, Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,374.96,18617, Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,374.96,18617, Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Orbit surgery procedure,67599,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Drainage of eyelid abscess,67700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1177.66,3314, Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1177.66,3314, Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,3314, Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,3314, Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1177.66,3314, Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1177.66,3314, Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,3314,APC Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,3314,APC Incision of eyelid,67710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,3314,APC Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,4097,APC Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,4097,APC Incision of eyelid fold,67715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,4097,APC Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Remove eyelid lesion,67800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1177.66,3314, Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1177.66,3314, Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,3314, Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,3314, Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1177.66,3314, Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1177.66,3314, Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,3314,APC Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,3314,APC Remove eyelid lesions,67801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,3314,APC Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Remove eyelid lesions,67805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Remove eyelid lesion(s),67808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Biopsy eyelid & lid margin,67810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Revise eyelashes,67820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,3314, Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,3314, Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Revise eyelashes,67825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1177.66,4466, Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1177.66,4466, Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,4466, Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,4466, Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1177.66,4466, Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1177.66,4466, Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,4466,APC Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,4466,APC Revise eyelashes,67830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,4466,APC Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,5123, Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,5123, Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,5123, Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,5123, Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Revise eyelashes,67835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1177.66,4166, Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1177.66,4166, Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,4166, Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,4166, Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1177.66,4166, Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1177.66,4166, Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,4166,APC Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,4166,APC Remove eyelid lesion,67840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,4166,APC Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1177.66,3314, Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1177.66,3314, Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,3314, Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,3314, Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1177.66,3314, Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1177.66,3314, Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,3314,APC Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,3314,APC Treat eyelid lesion,67850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,3314,APC Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1177.66,3314, Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1177.66,3314, Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1177.66,3314, Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1177.66,3314, Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1177.66,3314, Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1177.66,3314, Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,1177.66,3314,APC Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,1177.66,3314,APC Closure of eyelid by suture,67875,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,1177.66,3314,APC Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5098,APC Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5098,APC Revision of eyelid,67880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5098,APC Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5098, Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5098,APC Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5098,APC Revision of eyelid,67882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5098,APC Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,6312, Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,6312, Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair brow defect,67900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,2808.63,7422, Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,2808.63,7422, Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,7422, Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,7422, Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2808.63,7422, Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2808.63,7422, Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,7422,APC Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,7422,APC Repair eyelid defect,67901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,7422,APC Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,7422,APC Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,7422,APC Repair eyelid defect,67902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,7422,APC Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,7422, Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3291,7422,APC Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3291,7422,APC Repair eyelid defect,67906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3291,7422,APC Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67908,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Revise eyelid defect,67909,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5123, Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5123, Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5123, Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5123, Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Revise eyelid defect,67911,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5123, Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5123, Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5123, Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5123, Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Correction eyelid w/implant,67912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5098,APC Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5098,APC Repair eyelid defect,67914,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5098,APC Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2762,6404, Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2762,6404, Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2762,6404, Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2762,6404, Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,6404, Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,6404, Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2762,6404,APC Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2762,6404,APC Repair eyelid defect,67915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2762,6404,APC Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67916,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67917,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5098, Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5098,APC Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5098,APC Repair eyelid defect,67921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5098,APC Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2138,18617, Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2138,18617, Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,18617, Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,18617, Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2138,18617, Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2138,18617, Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2138,18617,APC Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2138,18617,APC Repair eyelid defect,67922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2138,18617,APC Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67923,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid defect,67924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2138,7422, Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2138,7422, Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,7422, Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,7422, Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2138,7422, Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2138,7422, Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2138,7422,APC Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2138,7422,APC Repair eyelid wound,67930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2138,7422,APC Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Repair eyelid wound,67935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,18617, Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,18617, Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,18617, Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,18617, Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Remove eyelid foreign body,67938,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67961,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5123, Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Revision of eyelid,67966,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6404,APC Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6404,APC Reconstruction of eyelid,67971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6404,APC Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,6404, Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6404,APC Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6404,APC Reconstruction of eyelid,67973,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6404,APC Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,8006,APC Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,8006,APC Reconstruction of eyelid,67974,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,8006,APC Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5098, Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5098, Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,5098, Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,5098, Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5098, Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5098, Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5098,APC Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5098,APC Reconstruction of eyelid,67975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5098,APC Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,18617, Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,18617, Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,374.96,18617, Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,374.96,18617, Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Revision of eyelid,67999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,855,18617, Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,855,18617, Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,855,18617,APC Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,855,18617,APC Incise/drain eyelid lining,68020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,855,18617,APC Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,18617, Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,18617, Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,18617, Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,18617, Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Treatment of eyelid lesions,68040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5098, Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5098, Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,5098, Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,5098, Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1544,5098, Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1544,5098, Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,5098,APC Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,5098,APC Biopsy of eyelid lining,68100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,5098,APC Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,4166, Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,4166, Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2762,4166, Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2762,4166, Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,4166, Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,4166, Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2762,4166,APC Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2762,4166,APC Remove eyelid lining lesion,68110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2762,4166,APC Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,5123, Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,5123, Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,5123, Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,5123, Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Remove eyelid lining lesion,68115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,6404, Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,6404, Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2808.63,6404, Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2808.63,6404, Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,6404, Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,6404, Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6404,APC Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6404,APC Remove eyelid lining lesion,68130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6404,APC Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,4097,APC Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,4097,APC Remove eyelid lining lesion,68135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,4097,APC Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,527.74,18617, Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,527.74,18617, Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Treat eyelid by injection,68200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,6312, Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,6312, Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Revise/graft eyelid lining,68320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,8006,APC Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,8006,APC Revise/graft eyelid lining,68325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,8006,APC Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,6404,APC Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,6404,APC Revise/graft eyelid lining,68326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,6404,APC Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6404, Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6404, Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2808.63,6404, Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2808.63,6404, Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6404, Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6404, Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6404,APC Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6404,APC Revise/graft eyelid lining,68328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6404,APC Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2726.34,6312, Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2726.34,6312, Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2726.34,6312, Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2726.34,6312, Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2726.34,6312, Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2726.34,6312, Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2835.39,,,,,,,fee schedule,2726.34,6312,APC Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2862.65,,,,,,,fee schedule,2726.34,6312,APC Revise eyelid lining,68330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2726.34,,,,,,,fee schedule,2726.34,6312,APC Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,8006, Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,8006,APC Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,8006,APC Revise/graft eyelid lining,68335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,8006,APC Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6404, Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6404, Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2808.63,6404, Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2808.63,6404, Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6404, Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6404, Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6404,APC Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6404,APC Separate eyelid adhesions,68340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6404,APC Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,2816,5123,APC Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,2816,5123,APC Revise eyelid lining,68360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,2816,5123,APC Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,6404, Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,6404, Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2808.63,6404, Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2808.63,6404, Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,6404, Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,6404, Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6404,APC Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6404,APC Revise eyelid lining,68362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6404,APC Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Harvest eye tissue alograft,68371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,18617, Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,18617, Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,374.96,18617, Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,374.96,18617, Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Eyelid lining surgery,68399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,855,3314, Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,855,3314, Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,3314, Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,3314, Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,855,3314, Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,855,3314, Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1224.76,,,,,,,fee schedule,855,3314,APC Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1236.54,,,,,,,fee schedule,855,3314,APC Incise/drain tear gland,68400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1177.66,,,,,,,fee schedule,855,3314,APC Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,7422, Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,7422, Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,7422, Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,7422, Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1544,7422, Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1544,7422, Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,7422,APC Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,7422,APC Incise/drain tear sac,68420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,7422,APC Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Incise tear duct opening,68440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,9420,APC Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,9420,APC Removal of tear gland,68500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,9420,APC Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,6404,APC Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,6404,APC Partial removal tear gland,68505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,6404,APC Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,5123,APC Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,5123,APC Biopsy of tear gland,68510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,5123,APC Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,6404,APC Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,6404,APC Removal of tear sac,68520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,6404,APC Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,8006,APC Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,8006,APC Biopsy of tear sac,68525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,8006,APC Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,18617, Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,18617, Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,374.96,18617, Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,374.96,18617, Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Clearance of tear duct,68530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,2808.63,5098, Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,2808.63,5098, Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,5098, Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,5098, Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,2808.63,5098, Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,2808.63,5098, Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5098,APC Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5098,APC Remove tear gland lesion,68540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5098,APC Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,11081, Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,11081, Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3408,11081, Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3408,11081, Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,11081, Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,11081, Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,3408,11081,APC Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,3408,11081,APC Remove tear gland lesion,68550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,3408,11081,APC Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,5123, Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,5123, Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,5123, Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,5123, Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,5123, Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,5123, Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,5123,APC Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,5123,APC Repair tear ducts,68700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,5123,APC Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,4097, Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,4097, Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,374.96,4097, Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,374.96,4097, Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,4097, Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,4097, Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,4097,APC Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,4097,APC Revise tear duct opening,68705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,4097,APC Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,6404,APC Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,6404,APC Create tear sac drain,68720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,6404,APC Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,9420, Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,9420, Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4224,9420, Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4224,9420, Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,9420, Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,9420, Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,9420,APC Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,9420,APC Create tear duct drain,68745,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,9420,APC Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6404, Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6404, Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,6404, Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,6404, Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,4224,6404, Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,4224,6404, Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4830.11,,,,,,,fee schedule,4224,6404,APC Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4876.55,,,,,,,fee schedule,4224,6404,APC Create tear duct drain,68750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4644.34,,,,,,,fee schedule,4224,6404,APC Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Close tear duct opening,68760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Close tear duct opening,68761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,2808.63,6312, Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,2808.63,6312, Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,6312, Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,6312, Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,2808.63,6312, Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,2808.63,6312, Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,6312,APC Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,6312,APC Close tear system fistula,68770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,6312,APC Description Not Available,68800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,68800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,68800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,68800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,527.74,18617, Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,527.74,18617, Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,527.74,18617, Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,527.74,18617, Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,527.74,18617, Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,527.74,18617, Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,18617,APC Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,18617,APC Dilate tear duct opening,68801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,18617,APC Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,3314, Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,3314, Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,3314, Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,3314, Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,374.96,3314, Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,374.96,3314, Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,3314,APC Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,3314,APC Probe nasolacrimal duct,68810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,3314,APC Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Probe nasolacrimal duct,68811,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2808.63,4466, Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,4466,APC Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,4466,APC Probe nasolacrimal duct,68815,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,4466,APC Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2808.63,7422, Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2808.63,7422, Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2808.63,7422, Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2808.63,7422, Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,2808.63,7422, Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,2808.63,7422, Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,2808.63,7422,APC Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,2808.63,7422,APC Probe nl duct w/balloon,68816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,2808.63,7422,APC Description Not Available,68820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,68820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,68820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,68820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,68825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,68825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,68825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,68825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,68830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Description Not Available,68830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Description Not Available,68830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Description Not Available,68830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,374.96,18617, Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,374.96,18617, Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,374.96,18617, Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,374.96,18617, Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Explore/irrigate tear ducts,68840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Insj rx elut implt lac canal,68841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,3314, Insj rx elut implt lac canal,68841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,3314, Insj rx elut implt lac canal,68841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,3314, Insj rx elut implt lac canal,68841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,3314, Insj rx elut implt lac canal,68841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,1544,3314,APC Insj rx elut implt lac canal,68841,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,1544,3314,APC Insj rx elut implt lac canal,68841,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,1544,3314,APC Injection for tear sac x-ray,68850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Injection for tear sac x-ray,68850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Injection for tear sac x-ray,68850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Injection for tear sac x-ray,68850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,374.96,18617, Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,374.96,18617, Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,374.96,18617, Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,374.96,18617, Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,374.96,18617, Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,374.96,18617, Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,389.96,,,,,,,fee schedule,374.96,18617,APC Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,393.71,,,,,,,fee schedule,374.96,18617,APC Tear duct system surgery,68899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,374.96,,,,,,,fee schedule,374.96,18617,APC Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,18617, Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,18617, Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,18617, Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,18617, Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Drain external ear lesion,69000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1544,18617, Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1544,18617, Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,18617,APC Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,18617,APC Drain external ear lesion,69005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,18617,APC Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,836.55,18617, Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,836.55,18617, Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,836.55,18617, Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,836.55,18617, Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Drain outer ear canal lesion,69020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Pierce earlobes,69090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pierce earlobes,69090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pierce earlobes,69090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pierce earlobes,69090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,3314, Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,3314, Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,3314, Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,3314, Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,3314, Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,3314, Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,3314,APC Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,3314,APC Biopsy of external ear,69100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,3314,APC Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Biopsy of external ear canal,69105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,1544,5123,APC Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,1544,5123,APC Remove external ear partial,69110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,1544,5123,APC Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Removal of external ear,69120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8006, Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8006, Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,2816,8006, Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,2816,8006, Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,8006, Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,8006, Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,8006,APC Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,8006,APC Remove ear canal lesion(s),69140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,8006,APC Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4466, Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4466, Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,2816,4466, Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,2816,4466, Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,4466, Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,4466, Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3568.73,,,,,,,fee schedule,2816,4466,APC Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3603.04,,,,,,,fee schedule,2816,4466,APC Remove ear canal lesion(s),69145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3431.47,,,,,,,fee schedule,2816,4466,APC Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9420, Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9420, Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3408,9420, Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3408,9420, Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,9420, Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,9420, Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,9420,APC Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,9420,APC Extensive ear canal surgery,69150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,9420,APC Extensive ear/neck surgery,69155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Extensive ear/neck surgery,69155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Extensive ear/neck surgery,69155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Extensive ear/neck surgery,69155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,157.18,18617, Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,157.18,18617, Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,157.18,18617, Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,157.18,18617, Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,157.18,18617, Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,157.18,18617, Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,18617,APC Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,18617,APC Clear outer ear canal,69200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,18617,APC Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4097, Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4097, Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4097, Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4097, Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4097, Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4097, Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2029.15,,,,,,,fee schedule,1544,4097,APC Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2048.66,,,,,,,fee schedule,1544,4097,APC Clear outer ear canal,69205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1951.11,,,,,,,fee schedule,1544,4097,APC Remove impacted ear wax uni,69209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Remove impacted ear wax uni,69209,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Remove impacted ear wax uni,69209,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,69.69,18617, Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,18617,APC Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,18617,APC Remove impacted ear wax uni,69210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,18617,APC Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,237.02,18617, Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,237.02,18617, Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,18617, Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,18617, Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,237.02,18617, Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,237.02,18617, Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,18617,APC Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,18617,APC Clean out mastoid cavity,69220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,18617,APC Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,637.13,18617, Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,637.13,18617, Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,18617, Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,18617, Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,637.13,18617, Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,637.13,18617, Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,18617,APC Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,18617,APC Clean out mastoid cavity,69222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,18617,APC Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Revise external ear,69300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,8006, Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,8006, Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3408,8006, Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3408,8006, Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,8006, Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,8006, Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,8006,APC Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,8006,APC Rebuild outer ear canal,69310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,8006,APC Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Rebuild outer ear canal,69320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,279.8,18617, Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,279.8,18617, Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,279.8,18617, Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,279.8,18617, Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Outer ear surgery procedure,69399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,279.8,5044, Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,279.8,5044, Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,5044, Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,5044, Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,279.8,5044, Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,279.8,5044, Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,5044,APC Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,5044,APC Incision of eardrum,69420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,5044,APC Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5098, Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5098, Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3408,5098, Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3408,5098, Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5098, Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5098, Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,5098,APC Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,5098,APC Incision of eardrum,69421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,5098,APC Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,4112.54, Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,4112.54, Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1544,4112.54, Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1544,4112.54, Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,4112.54, Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,4112.54, Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,4112.54,APC Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,4112.54,APC Remove ventilating tube,69424,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,4112.54,APC Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,637.13,5044, Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,637.13,5044, Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,637.13,5044, Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,637.13,5044, Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,637.13,5044, Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,637.13,5044, Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,637.13,5044,APC Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,637.13,5044,APC Create eardrum opening,69433,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,637.13,5044,APC Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1832.96,5098, Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1832.96,5098, Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,5098, Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,5098, Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1832.96,5098, Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1832.96,5098, Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,5098,APC Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,5098,APC Create eardrum opening,69436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,5098,APC Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5123, Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5123, Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3408,5123, Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3408,5123, Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,5123, Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,5123, Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,5123,APC Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,5123,APC Exploration of middle ear,69440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,5123,APC Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,5123, Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,5123, Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1544,5123, Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1544,5123, Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,5123, Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,5123, Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,5123,APC Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,5123,APC Eardrum revision,69450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,5123,APC Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Mastoidectomy,69501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Mastoidectomy,69502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Remove mastoid structures,69505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Extensive mastoid surgery,69511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Extensive mastoid surgery,69530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Remove part of temporal bone,69535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove part of temporal bone,69535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove part of temporal bone,69535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove part of temporal bone,69535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1832.96,18617, Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1832.96,18617, Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,18617, Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,18617, Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1832.96,18617, Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1832.96,18617, Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,18617,APC Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,18617,APC Remove ear lesion,69540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,18617,APC Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Remove ear lesion,69550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Remove ear lesion,69552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Remove ear lesion,69554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Remove ear lesion,69554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Remove ear lesion,69554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Remove ear lesion,69554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Mastoid surgery revision,69605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,6962,8006, Mastoid surgery revision,69605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,6962,8006, Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1832.96,18617, Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1832.96,18617, Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,18617, Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,18617, Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1832.96,18617, Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1832.96,18617, Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,18617,APC Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,18617,APC Repair of eardrum,69610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,18617,APC Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,5123, Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,5123, Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,2816,5123, Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,2816,5123, Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,2816,5123, Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,2816,5123, Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,2816,5123,APC Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,2816,5123,APC Repair of eardrum,69620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,2816,5123,APC Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,8006, Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,8006, Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3291,8006, Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3291,8006, Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,8006, Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,8006, Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,8006,APC Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,8006,APC Repair eardrum structures,69631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,8006,APC Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Rebuild eardrum structures,69632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,11081, Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,11081, Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,11081, Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,11081, Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,11081, Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,11081, Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,11081,APC Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,11081,APC Rebuild eardrum structures,69633,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,11081,APC Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Repair eardrum structures,69635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Rebuild eardrum structures,69636,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Rebuild eardrum structures,69637,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Revise middle ear & mastoid,69641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69643,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,15339,APC Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,15339,APC Revise middle ear & mastoid,69644,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,15339,APC Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,13036, Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,13036,APC Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,15339, Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,15339,APC Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,15339,APC Revise middle ear & mastoid,69646,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,15339,APC Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3916.7,9918, Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3916.7,9918, Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3916.7,9918, Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3916.7,9918, Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3916.7,9918, Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3916.7,9918, Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,9918,APC Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,9918,APC Release middle ear bone,69650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,9918,APC Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,9420, Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,9420,APC Revise middle ear bone,69662,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,9420,APC Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,8006, Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,8006, Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,3916.7,8006, Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,3916.7,8006, Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,8006, Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,8006, Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,8006,APC Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,8006,APC Repair middle ear structures,69666,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,8006,APC Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,3916.7,6404, Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,3916.7,6404, Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3916.7,6404, Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3916.7,6404, Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5259,,,,,,,fee schedule,3916.7,6404, Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6312,,,,,,,fee schedule,3916.7,6404, Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,6404,APC Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,6404,APC Repair middle ear structures,69667,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,6404,APC Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,15339, Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,15339, Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3408,15339, Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3408,15339, Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,15339, Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,15339, Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3408,15339,APC Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3408,15339,APC Remove mastoid air cells,69670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3408,15339,APC Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,6404, Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,6404, Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,6404, Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,6404, Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,3408,6404, Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,3408,6404, Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3408,6404,APC Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3408,6404,APC Remove middle ear nerve,69676,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3408,6404,APC Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,1832.96,5123, Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,1832.96,5123, Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,1832.96,5123, Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,1832.96,5123, Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,1832.96,5123, Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,1832.96,5123, Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,5123,APC Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,5123,APC Close mastoid fistula,69700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,5123,APC Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,1544,13320, Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,1544,13320, Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1544,13320,APC Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1544,13320,APC Nps surg dilat eust tube uni,69705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1544,13320,APC Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,13320, Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,13320, Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,2816,13320,APC Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,2816,13320,APC Nps surg dilat eust tube bi,69706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,2816,13320,APC Implant/replace hearing aid,69710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,428,5098, Implant/replace hearing aid,69710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,428,5098, Implant/replace hearing aid,69710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,5098, Implant/replace hearing aid,69710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,5098, Implant/replace hearing aid,69710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4248,,,,,,,fee schedule,428,5098, Implant/replace hearing aid,69710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5098,,,,,,,fee schedule,428,5098, Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,8006, Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,8006, Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1544,8006, Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1544,8006, Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,1544,8006, Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,1544,8006, Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1544,8006,APC Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1544,8006,APC Remove/repair hearing aid,69711,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1544,8006,APC Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4062,18617, Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4062,18617, Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4062,18617,APC Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4062,18617,APC Implant Temple Bone W/Stimul,69714,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4062,18617,APC Temple Bne Implnt W/Stimulat,69715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,9637,11081, Temple Bne Implnt W/Stimulat,69715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,9637,11081, Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4062,18617, Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4062,18617, Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4062,18617,APC Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4062,18617,APC Impltj oi implt skl tc esp,69716,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4062,18617,APC Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,4062,18617, Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,4062,18617, Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,4062,18617,APC Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,4062,18617,APC Temple Bone Implant Revision,69717,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,4062,18617,APC Revise Temple Bone Implant,69718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,13338,15339, Revise Temple Bone Implant,69718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,13338,15339, Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4062,18617, Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4062,18617, Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4062,18617,APC Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4062,18617,APC Revj/rplcmt oi implt tc esp,69719,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4062,18617,APC Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,15339, Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,15339, Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13338,,,,,,,fee schedule,3291,15339, Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15339,,,,,,,fee schedule,3291,15339, Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,3291,15339, Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,3291,15339, Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,15339,APC Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,15339,APC Release facial nerve,69720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,15339,APC Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,3291,18617, Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,3291,18617, Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,3291,18617,APC Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,3291,18617,APC Release facial nerve,69725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,3291,18617,APC Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,9701,APC Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,9701,APC Rmvl oi implt skl perq esp,69726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,9701,APC Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8084,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9701,,,,,,,fee schedule,2816,9701, Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,9701,APC Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,9701,APC Rmvl oi implt skl tc esp,69727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,9701,APC Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,2816,18617, Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,2816,18617, Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,2816,18617,APC Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,2816,18617,APC Rmv ntr oi imp sktc esp>=100,69728,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,2816,18617,APC Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4062,18617, Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4062,18617, Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4062,18617,APC Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4062,18617,APC Impl oi implt sk tc esp>=100,69729,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4062,18617,APC Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4062,,,,,,,fee schedule,4062,18617, Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4920,,,,,,,fee schedule,4062,18617, Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,4062,18617, Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,4062,18617, Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4062,18617, Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4062,18617, Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,4062,18617,APC Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,4062,18617,APC Rplc oi implt sk tc esp>=100,69730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,4062,18617,APC Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7422, Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7422, Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7422, Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7422, Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7422, Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7422, Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,7422,APC Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,7422,APC Repair facial nerve,69740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,7422,APC Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,428,7422, Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,428,7422, Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,7422, Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,7422, Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,428,7422, Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,428,7422, Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,428,7422,APC Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,428,7422,APC Repair facial nerve,69745,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,428,7422,APC Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,279.8,18617, Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,279.8,18617, Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Middle ear surgery procedure,69799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,1832.96,7422, Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,1832.96,7422, Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1832.96,7422, Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1832.96,7422, Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6186,,,,,,,fee schedule,1832.96,7422, Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7422,,,,,,,fee schedule,1832.96,7422, Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1832.96,7422,APC Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1832.96,7422,APC Incise inner ear,69801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1832.96,7422,APC Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Explore inner ear,69805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,9918, Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,9918, Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,9918, Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,9918, Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,9918, Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,9918, Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,9918,APC Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,9918,APC Explore inner ear,69806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,9918,APC Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Remove inner ear,69905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,11081, Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,11081, Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4147,11081, Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4147,11081, Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,11081, Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,11081, Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4147,11081,APC Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4147,11081,APC Remove inner ear & mastoid,69910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4147,11081,APC Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3563,9918, Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3563,9918, Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,3563,9918, Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,3563,9918, Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3563,9918, Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3563,9918, Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3563,9918,APC Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3563,9918,APC Incise inner ear nerve,69915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3563,9918,APC Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,40899.02, Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,40899.02, Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4147,40899.02, Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4147,40899.02, Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,4147,40899.02, Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,4147,40899.02, Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40509.5,,,,,,,fee schedule,4147,40899.02,APC Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40899.02,,,,,,,fee schedule,4147,40899.02,APC Implant cochlear device,69930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38951.45,,,,,,,fee schedule,4147,40899.02,APC Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,279.8,18617, Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,279.8,18617, Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Inner ear surgery procedure,69949,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Incise inner ear nerve,69950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Incise inner ear nerve,69950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Incise inner ear nerve,69950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Incise inner ear nerve,69950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,4224,18617, Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,4224,18617, Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Release facial nerve,69955,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6962,,,,,,,fee schedule,1406,18617, Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8006,,,,,,,fee schedule,1406,18617, Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Release inner ear canal,69960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,4224,18617, Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,4224,18617, Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,4224,18617,APC Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,4224,18617,APC Remove inner ear lesion,69970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,4224,18617,APC Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,279.8,18617, Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,279.8,18617, Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,279.8,18617, Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,279.8,18617, Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,279.8,18617, Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,279.8,18617, Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,18617,APC Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,18617,APC Temporal bone surgery,69979,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,18617,APC Microsurgery add-on,69990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,428,1866, Microsurgery add-on,69990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,428,1866, Microsurgery add-on,69990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,1866, Microsurgery add-on,69990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,1866, Contrast x-ray of brain,70010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,795.07,,,,,,,fee schedule,267.79,999.99, Contrast x-ray of brain,70010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,999.99,,,,,,,fee schedule,267.79,999.99, Contrast x-ray of brain,70010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,267.79,,,,,,,fee schedule,267.79,999.99, Contrast x-ray of brain,70010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,321.34,,,,,,,fee schedule,267.79,999.99, Contrast x-ray of brain,70010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,267.79,999.99,APC Contrast x-ray of brain,70010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,267.79,999.99,APC Contrast x-ray of brain,70010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,267.79,999.99,APC Contrast x-ray of brain,70015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,385.81,,,,,,,fee schedule,385.81,972.38, Contrast x-ray of brain,70015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,485.24,,,,,,,fee schedule,385.81,972.38, Contrast x-ray of brain,70015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,758.43,,,,,,,fee schedule,385.81,972.38, Contrast x-ray of brain,70015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,910.12,,,,,,,fee schedule,385.81,972.38, Contrast x-ray of brain,70015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,385.81,972.38,APC Contrast x-ray of brain,70015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,385.81,972.38,APC Contrast x-ray of brain,70015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,385.81,972.38,APC X-ray eye for foreign body,70030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.69,,,,,,,fee schedule,86.69,200.69, X-ray eye for foreign body,70030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.03,,,,,,,fee schedule,86.69,200.69, X-ray eye for foreign body,70030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,167.24,,,,,,,fee schedule,86.69,200.69, X-ray eye for foreign body,70030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.69,,,,,,,fee schedule,86.69,200.69, X-ray eye for foreign body,70030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,86.69,200.69,APC X-ray eye for foreign body,70030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,86.69,200.69,APC X-ray eye for foreign body,70030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,86.69,200.69,APC X-ray exam of jaw <4views,70100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.15,,,,,,,fee schedule,101.15,250.17, X-ray exam of jaw <4views,70100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.22,,,,,,,fee schedule,101.15,250.17, X-ray exam of jaw <4views,70100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.48,,,,,,,fee schedule,101.15,250.17, X-ray exam of jaw <4views,70100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.17,,,,,,,fee schedule,101.15,250.17, X-ray exam of jaw <4views,70100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,101.15,250.17,APC X-ray exam of jaw <4views,70100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,101.15,250.17,APC X-ray exam of jaw <4views,70100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,101.15,250.17,APC X-ray exam of jaw 4/> views,70110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,127.28,,,,,,,fee schedule,123.5,263.89, X-ray exam of jaw 4/> views,70110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,160.09,,,,,,,fee schedule,123.5,263.89, X-ray exam of jaw 4/> views,70110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,219.91,,,,,,,fee schedule,123.5,263.89, X-ray exam of jaw 4/> views,70110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,263.89,,,,,,,fee schedule,123.5,263.89, X-ray exam of jaw 4/> views,70110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,263.89,APC X-ray exam of jaw 4/> views,70110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,263.89,APC X-ray exam of jaw 4/> views,70110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,263.89,APC X-ray exam of mastoids,70120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.52,,,,,,,fee schedule,116.52,244.7, X-ray exam of mastoids,70120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,146.55,,,,,,,fee schedule,116.52,244.7, X-ray exam of mastoids,70120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,203.92,,,,,,,fee schedule,116.52,244.7, X-ray exam of mastoids,70120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,244.7,,,,,,,fee schedule,116.52,244.7, X-ray exam of mastoids,70120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,116.52,244.7,APC X-ray exam of mastoids,70120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,116.52,244.7,APC X-ray exam of mastoids,70120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,116.52,244.7,APC X-ray exam of mastoids,70130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,165.06,,,,,,,fee schedule,123.5,379.42, X-ray exam of mastoids,70130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,207.6,,,,,,,fee schedule,123.5,379.42, X-ray exam of mastoids,70130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,316.18,,,,,,,fee schedule,123.5,379.42, X-ray exam of mastoids,70130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,379.42,,,,,,,fee schedule,123.5,379.42, X-ray exam of mastoids,70130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,379.42,APC X-ray exam of mastoids,70130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,379.42,APC X-ray exam of mastoids,70130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,379.42,APC X-ray exam of middle ear,70134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,158.39,,,,,,,fee schedule,158.39,677.78, X-ray exam of middle ear,70134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,199.21,,,,,,,fee schedule,158.39,677.78, X-ray exam of middle ear,70134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,309.31,,,,,,,fee schedule,158.39,677.78, X-ray exam of middle ear,70134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,371.17,,,,,,,fee schedule,158.39,677.78, X-ray exam of middle ear,70134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,158.39,677.78,APC X-ray exam of middle ear,70134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,158.39,677.78,APC X-ray exam of middle ear,70134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,158.39,677.78,APC X-ray exam of facial bones,70140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.68,,,,,,,fee schedule,102.81,186.9, X-ray exam of facial bones,70140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,148.01,,,,,,,fee schedule,102.81,186.9, X-ray exam of facial bones,70140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,155.75,,,,,,,fee schedule,102.81,186.9, X-ray exam of facial bones,70140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,102.81,186.9, X-ray exam of facial bones,70140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,186.9,APC X-ray exam of facial bones,70140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,186.9,APC X-ray exam of facial bones,70140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,186.9,APC X-ray exam of facial bones,70150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,150.77,,,,,,,fee schedule,123.5,288.63, X-ray exam of facial bones,70150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,189.62,,,,,,,fee schedule,123.5,288.63, X-ray exam of facial bones,70150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,240.53,,,,,,,fee schedule,123.5,288.63, X-ray exam of facial bones,70150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,288.63,,,,,,,fee schedule,123.5,288.63, X-ray exam of facial bones,70150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,288.63,APC X-ray exam of facial bones,70150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,288.63,APC X-ray exam of facial bones,70150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,288.63,APC X-ray exam of nasal bones,70160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.99,,,,,,,fee schedule,99.99,244.7, X-ray exam of nasal bones,70160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.76,,,,,,,fee schedule,99.99,244.7, X-ray exam of nasal bones,70160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,203.92,,,,,,,fee schedule,99.99,244.7, X-ray exam of nasal bones,70160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,244.7,,,,,,,fee schedule,99.99,244.7, X-ray exam of nasal bones,70160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,99.99,244.7,APC X-ray exam of nasal bones,70160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,99.99,244.7,APC X-ray exam of nasal bones,70160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,99.99,244.7,APC X-ray exam of tear duct,70170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.73,,,,,,,fee schedule,181.73,295.96, X-ray exam of tear duct,70170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,228.57,,,,,,,fee schedule,181.73,295.96, X-ray exam of tear duct,70170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,240.36,,,,,,,fee schedule,181.73,295.96, X-ray exam of tear duct,70170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,288.43,,,,,,,fee schedule,181.73,295.96, X-ray exam of tear duct,70170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,181.73,295.96,APC X-ray exam of tear duct,70170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,181.73,295.96,APC X-ray exam of tear duct,70170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,181.73,295.96,APC X-ray exam of eye sockets,70190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.32,,,,,,,fee schedule,102.81,222.66, X-ray exam of eye sockets,70190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,152.59,,,,,,,fee schedule,102.81,222.66, X-ray exam of eye sockets,70190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,185.55,,,,,,,fee schedule,102.81,222.66, X-ray exam of eye sockets,70190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,222.66,,,,,,,fee schedule,102.81,222.66, X-ray exam of eye sockets,70190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,222.66,APC X-ray exam of eye sockets,70190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,222.66,APC X-ray exam of eye sockets,70190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,222.66,APC X-ray exam of eye sockets,70200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,154.43,,,,,,,fee schedule,123.5,285.93, X-ray exam of eye sockets,70200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,194.24,,,,,,,fee schedule,123.5,285.93, X-ray exam of eye sockets,70200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,238.28,,,,,,,fee schedule,123.5,285.93, X-ray exam of eye sockets,70200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,285.93,,,,,,,fee schedule,123.5,285.93, X-ray exam of eye sockets,70200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,285.93,APC X-ray exam of eye sockets,70200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,285.93,APC X-ray exam of eye sockets,70200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,285.93,APC X-ray exam of sinuses,70210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.35,,,,,,,fee schedule,102.81,197.92, X-ray exam of sinuses,70210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.08,,,,,,,fee schedule,102.81,197.92, X-ray exam of sinuses,70210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.93,,,,,,,fee schedule,102.81,197.92, X-ray exam of sinuses,70210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.92,,,,,,,fee schedule,102.81,197.92, X-ray exam of sinuses,70210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,197.92,APC X-ray exam of sinuses,70210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,197.92,APC X-ray exam of sinuses,70210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,197.92,APC X-ray exam of sinuses,70220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,149.63,,,,,,,fee schedule,102.81,225.43, X-ray exam of sinuses,70220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,188.2,,,,,,,fee schedule,102.81,225.43, X-ray exam of sinuses,70220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,187.86,,,,,,,fee schedule,102.81,225.43, X-ray exam of sinuses,70220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,225.43,,,,,,,fee schedule,102.81,225.43, X-ray exam of sinuses,70220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,225.43,APC X-ray exam of sinuses,70220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,225.43,APC X-ray exam of sinuses,70220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,225.43,APC X-ray exam pituitary saddle,70240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.99,,,,,,,fee schedule,88.99,197.92, X-ray exam pituitary saddle,70240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.92,,,,,,,fee schedule,88.99,197.92, X-ray exam pituitary saddle,70240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.93,,,,,,,fee schedule,88.99,197.92, X-ray exam pituitary saddle,70240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.92,,,,,,,fee schedule,88.99,197.92, X-ray exam pituitary saddle,70240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,88.99,197.92,APC X-ray exam pituitary saddle,70240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,88.99,197.92,APC X-ray exam pituitary saddle,70240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,88.99,197.92,APC X-ray exam of skull,70250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.12,,,,,,,fee schedule,123.5,225.43, X-ray exam of skull,70250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,158.62,,,,,,,fee schedule,123.5,225.43, X-ray exam of skull,70250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,187.86,,,,,,,fee schedule,123.5,225.43, X-ray exam of skull,70250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,225.43,,,,,,,fee schedule,123.5,225.43, X-ray exam of skull,70250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,225.43,APC X-ray exam of skull,70250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,225.43,APC X-ray exam of skull,70250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,225.43,APC X-ray exam of skull,70260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,180.71,,,,,,,fee schedule,123.5,258.42, X-ray exam of skull,70260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,227.29,,,,,,,fee schedule,123.5,258.42, X-ray exam of skull,70260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,215.35,,,,,,,fee schedule,123.5,258.42, X-ray exam of skull,70260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,258.42,,,,,,,fee schedule,123.5,258.42, X-ray exam of skull,70260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,258.42,APC X-ray exam of skull,70260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,258.42,APC X-ray exam of skull,70260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,258.42,APC X-ray exam of teeth,70300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.93,,,,,,,fee schedule,54.92,107.95, X-ray exam of teeth,70300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.35,,,,,,,fee schedule,54.92,107.95, X-ray exam of teeth,70300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.92,,,,,,,fee schedule,54.92,107.95, X-ray exam of teeth,70300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.9,,,,,,,fee schedule,54.92,107.95, X-ray exam of teeth,70300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,54.92,107.95,APC X-ray exam of teeth,70300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,54.92,107.95,APC X-ray exam of teeth,70300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,54.92,107.95,APC X-ray exam of teeth,70310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.17,,,,,,,fee schedule,88.17,295.96, X-ray exam of teeth,70310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,110.9,,,,,,,fee schedule,88.17,295.96, X-ray exam of teeth,70310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,224.53,,,,,,,fee schedule,88.17,295.96, X-ray exam of teeth,70310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,269.44,,,,,,,fee schedule,88.17,295.96, X-ray exam of teeth,70310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,88.17,295.96,APC X-ray exam of teeth,70310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,88.17,295.96,APC X-ray exam of teeth,70310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,88.17,295.96,APC Full mouth x-ray of teeth,70320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,146.14,,,,,,,fee schedule,146.14,351.91, Full mouth x-ray of teeth,70320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,183.81,,,,,,,fee schedule,146.14,351.91, Full mouth x-ray of teeth,70320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,293.25,,,,,,,fee schedule,146.14,351.91, Full mouth x-ray of teeth,70320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,351.91,,,,,,,fee schedule,146.14,351.91, Full mouth x-ray of teeth,70320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,146.14,351.91,APC Full mouth x-ray of teeth,70320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,146.14,351.91,APC Full mouth x-ray of teeth,70320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,146.14,351.91,APC X-ray exam of jaw joint,70328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.16,,,,,,,fee schedule,97.16,214.41, X-ray exam of jaw joint,70328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.21,,,,,,,fee schedule,97.16,214.41, X-ray exam of jaw joint,70328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,178.68,,,,,,,fee schedule,97.16,214.41, X-ray exam of jaw joint,70328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,214.41,,,,,,,fee schedule,97.16,214.41, X-ray exam of jaw joint,70328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,97.16,214.41,APC X-ray exam of jaw joint,70328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,97.16,214.41,APC X-ray exam of jaw joint,70328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,97.16,214.41,APC X-ray exam of jaw joints,70330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.44,,,,,,,fee schedule,102.81,343.66, X-ray exam of jaw joints,70330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,196.76,,,,,,,fee schedule,102.81,343.66, X-ray exam of jaw joints,70330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,286.38,,,,,,,fee schedule,102.81,343.66, X-ray exam of jaw joints,70330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,343.66,,,,,,,fee schedule,102.81,343.66, X-ray exam of jaw joints,70330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,343.66,APC X-ray exam of jaw joints,70330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,343.66,APC X-ray exam of jaw joints,70330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,343.66,APC X-ray exam of jaw joint,70332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,384.21,,,,,,,fee schedule,281.87,483.23, X-ray exam of jaw joint,70332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,483.23,,,,,,,fee schedule,281.87,483.23, X-ray exam of jaw joint,70332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,394.09,,,,,,,fee schedule,281.87,483.23, X-ray exam of jaw joint,70332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,472.9,,,,,,,fee schedule,281.87,483.23, X-ray exam of jaw joint,70332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,483.23,APC X-ray exam of jaw joint,70332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,483.23,APC X-ray exam of jaw joint,70332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,483.23,APC Magnetic image jaw joint,70336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1795.96,,,,,,,fee schedule,281.87,2258.84, Magnetic image jaw joint,70336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2258.84,,,,,,,fee schedule,281.87,2258.84, Magnetic image jaw joint,70336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2258.84,APC Magnetic image jaw joint,70336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2258.84,APC Magnetic image jaw joint,70336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2258.84,APC X-ray head for orthodontia,70350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.67,,,,,,,fee schedule,57.23,107.95, X-ray head for orthodontia,70350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.98,,,,,,,fee schedule,57.23,107.95, X-ray head for orthodontia,70350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.23,,,,,,,fee schedule,57.23,107.95, X-ray head for orthodontia,70350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,68.68,,,,,,,fee schedule,57.23,107.95, X-ray head for orthodontia,70350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,57.23,107.95,APC X-ray head for orthodontia,70350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,57.23,107.95,APC X-ray head for orthodontia,70350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,57.23,107.95,APC Panoramic x-ray of jaws,70355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.49,,,,,,,fee schedule,59.54,142.74, Panoramic x-ray of jaws,70355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,142.74,,,,,,,fee schedule,59.54,142.74, Panoramic x-ray of jaws,70355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.54,,,,,,,fee schedule,59.54,142.74, Panoramic x-ray of jaws,70355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.45,,,,,,,fee schedule,59.54,142.74, Panoramic x-ray of jaws,70355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,59.54,142.74,APC Panoramic x-ray of jaws,70355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,59.54,142.74,APC Panoramic x-ray of jaws,70355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,59.54,142.74,APC X-ray exam of neck,70360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.69,,,,,,,fee schedule,86.69,186.9, X-ray exam of neck,70360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.03,,,,,,,fee schedule,86.69,186.9, X-ray exam of neck,70360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,155.75,,,,,,,fee schedule,86.69,186.9, X-ray exam of neck,70360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,86.69,186.9, X-ray exam of neck,70360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,86.69,186.9,APC X-ray exam of neck,70360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,86.69,186.9,APC X-ray exam of neck,70360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,86.69,186.9,APC Throat x-ray & fluoroscopy,70370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,233.03,,,,,,,fee schedule,102.81,742.34, Throat x-ray & fluoroscopy,70370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,293.09,,,,,,,fee schedule,102.81,742.34, Throat x-ray & fluoroscopy,70370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,618.62,,,,,,,fee schedule,102.81,742.34, Throat x-ray & fluoroscopy,70370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,742.34,,,,,,,fee schedule,102.81,742.34, Throat x-ray & fluoroscopy,70370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,742.34,APC Throat x-ray & fluoroscopy,70370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,742.34,APC Throat x-ray & fluoroscopy,70370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,742.34,APC Speech evaluation complex,70371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,430.59,,,,,,,fee schedule,281.87,563.62, Speech evaluation complex,70371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,541.57,,,,,,,fee schedule,281.87,563.62, Speech evaluation complex,70371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,469.68,,,,,,,fee schedule,281.87,563.62, Speech evaluation complex,70371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,563.62,,,,,,,fee schedule,281.87,563.62, Speech evaluation complex,70371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,563.62,APC Speech evaluation complex,70371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,563.62,APC Speech evaluation complex,70371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,563.62,APC X-ray exam of salivary gland,70380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,122.02,,,,,,,fee schedule,102.81,244.7, X-ray exam of salivary gland,70380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,153.46,,,,,,,fee schedule,102.81,244.7, X-ray exam of salivary gland,70380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,203.92,,,,,,,fee schedule,102.81,244.7, X-ray exam of salivary gland,70380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,244.7,,,,,,,fee schedule,102.81,244.7, X-ray exam of salivary gland,70380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,244.7,APC X-ray exam of salivary gland,70380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,244.7,APC X-ray exam of salivary gland,70380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,244.7,APC X-ray exam of salivary duct,70390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,310.35,,,,,,,fee schedule,281.87,808.38, X-ray exam of salivary duct,70390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,390.34,,,,,,,fee schedule,281.87,808.38, X-ray exam of salivary duct,70390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,673.65,,,,,,,fee schedule,281.87,808.38, X-ray exam of salivary duct,70390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,808.38,,,,,,,fee schedule,281.87,808.38, X-ray exam of salivary duct,70390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,808.38,APC X-ray exam of salivary duct,70390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,808.38,APC X-ray exam of salivary duct,70390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,808.38,APC Ct head/brain w/o dye,70450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,794.05,,,,,,,fee schedule,123.5,998.7, Ct head/brain w/o dye,70450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,998.7,,,,,,,fee schedule,123.5,998.7, Ct head/brain w/o dye,70450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,998.7,APC Ct head/brain w/o dye,70450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,998.7,APC Ct head/brain w/o dye,70450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,998.7,APC Ct head/brain w/dye,70460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,969.79,,,,,,,fee schedule,207.21,1219.73, Ct head/brain w/dye,70460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1219.73,,,,,,,fee schedule,207.21,1219.73, Ct head/brain w/dye,70460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1219.73,APC Ct head/brain w/dye,70460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1219.73,APC Ct head/brain w/dye,70460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1219.73,APC Ct head/brain w/o & w/dye,70470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1188.65,,,,,,,fee schedule,207.21,1495, Ct head/brain w/o & w/dye,70470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1495,,,,,,,fee schedule,207.21,1495, Ct head/brain w/o & w/dye,70470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1495,APC Ct head/brain w/o & w/dye,70470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1495,APC Ct head/brain w/o & w/dye,70470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1495,APC Cta h&n c+ w/noncontrast img,70471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,432.75,APC Cta h&n c+ w/noncontrast img,70471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,432.75,APC Cta h&n c+ w/noncontrast img,70471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,432.75,APC Ct cere prfu aly c+wo ct/cta,70473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,217.57,APC Ct cere prfu aly c+wo ct/cta,70473,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,217.57,APC Ct cere prfu aly c+wo ct/cta,70473,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,217.57,APC Ct orbit/ear/fossa w/o dye,70480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,864.47,,,,,,,fee schedule,123.5,1087.28, Ct orbit/ear/fossa w/o dye,70480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1087.28,,,,,,,fee schedule,123.5,1087.28, Ct orbit/ear/fossa w/o dye,70480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1087.28,APC Ct orbit/ear/fossa w/o dye,70480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1087.28,APC Ct orbit/ear/fossa w/o dye,70480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1087.28,APC Ct orbit/ear/fossa w/dye,70481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1010.38,,,,,,,fee schedule,207.21,1270.79, Ct orbit/ear/fossa w/dye,70481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1270.79,,,,,,,fee schedule,207.21,1270.79, Ct orbit/ear/fossa w/dye,70481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1270.79,APC Ct orbit/ear/fossa w/dye,70481,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1270.79,APC Ct orbit/ear/fossa w/dye,70481,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1270.79,APC Ct orbit/ear/fossa w/o&w/dye,70482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1217.46,,,,,,,fee schedule,207.21,1531.23, Ct orbit/ear/fossa w/o&w/dye,70482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1531.23,,,,,,,fee schedule,207.21,1531.23, Ct orbit/ear/fossa w/o&w/dye,70482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1531.23,APC Ct orbit/ear/fossa w/o&w/dye,70482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1531.23,APC Ct orbit/ear/fossa w/o&w/dye,70482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1531.23,APC Ct maxillofacial w/o dye,70486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,840.61,,,,,,,fee schedule,123.5,1057.26, Ct maxillofacial w/o dye,70486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1057.26,,,,,,,fee schedule,123.5,1057.26, Ct maxillofacial w/o dye,70486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1057.26,APC Ct maxillofacial w/o dye,70486,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1057.26,APC Ct maxillofacial w/o dye,70486,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1057.26,APC Ct maxillofacial w/dye,70487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,998.48,,,,,,,fee schedule,207.21,1255.82, Ct maxillofacial w/dye,70487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1255.82,,,,,,,fee schedule,207.21,1255.82, Ct maxillofacial w/dye,70487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1255.82,APC Ct maxillofacial w/dye,70487,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1255.82,APC Ct maxillofacial w/dye,70487,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1255.82,APC Ct maxillofacial w/o & w/dye,70488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1211.35,,,,,,,fee schedule,207.21,1523.55, Ct maxillofacial w/o & w/dye,70488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1523.55,,,,,,,fee schedule,207.21,1523.55, Ct maxillofacial w/o & w/dye,70488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1523.55,APC Ct maxillofacial w/o & w/dye,70488,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1523.55,APC Ct maxillofacial w/o & w/dye,70488,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1523.55,APC Ct soft tissue neck w/o dye,70490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,864.47,,,,,,,fee schedule,123.5,1087.28, Ct soft tissue neck w/o dye,70490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1087.28,,,,,,,fee schedule,123.5,1087.28, Ct soft tissue neck w/o dye,70490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1087.28,APC Ct soft tissue neck w/o dye,70490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1087.28,APC Ct soft tissue neck w/o dye,70490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1087.28,APC Ct soft tissue neck w/dye,70491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1010.38,,,,,,,fee schedule,207.21,1270.79, Ct soft tissue neck w/dye,70491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1270.79,,,,,,,fee schedule,207.21,1270.79, Ct soft tissue neck w/dye,70491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1270.79,APC Ct soft tissue neck w/dye,70491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1270.79,APC Ct soft tissue neck w/dye,70491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1270.79,APC Ct sft tsue nck w/o & w/dye,70492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1216.15,,,,,,,fee schedule,207.21,1529.59, Ct sft tsue nck w/o & w/dye,70492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1529.59,,,,,,,fee schedule,207.21,1529.59, Ct sft tsue nck w/o & w/dye,70492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1529.59,APC Ct sft tsue nck w/o & w/dye,70492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1529.59,APC Ct sft tsue nck w/o & w/dye,70492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1529.59,APC Ct angiography head,70496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1757.93,,,,,,,fee schedule,207.21,2211.01, Ct angiography head,70496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2211.01,,,,,,,fee schedule,207.21,2211.01, Ct angiography head,70496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2211.01,APC Ct angiography head,70496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2211.01,APC Ct angiography head,70496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2211.01,APC Ct angiography neck,70498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1757.93,,,,,,,fee schedule,207.21,2211.01, Ct angiography neck,70498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2211.01,,,,,,,fee schedule,207.21,2211.01, Ct angiography neck,70498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2211.01,APC Ct angiography neck,70498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2211.01,APC Ct angiography neck,70498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2211.01,APC Mri orbit/face/neck w/o dye,70540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1752.81,,,,,,,fee schedule,281.87,2204.56, Mri orbit/face/neck w/o dye,70540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2204.56,,,,,,,fee schedule,281.87,2204.56, Mri orbit/face/neck w/o dye,70540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2204.56,APC Mri orbit/face/neck w/o dye,70540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2204.56,APC Mri orbit/face/neck w/o dye,70540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2204.56,APC Mri Orbit/Face/Neck W/Dye,70542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2103.64,,,,,,,fee schedule,412.14,2645.81, Mri Orbit/Face/Neck W/Dye,70542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2645.81,,,,,,,fee schedule,412.14,2645.81, Mri Orbit/Face/Neck W/Dye,70542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2645.81,APC Mri Orbit/Face/Neck W/Dye,70542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2645.81,APC Mri Orbit/Face/Neck W/Dye,70542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2645.81,APC Mri orbt/fac/nck w/o &w/dye,70543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3753.81,,,,,,,fee schedule,412.14,4721.29, Mri orbt/fac/nck w/o &w/dye,70543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4721.29,,,,,,,fee schedule,412.14,4721.29, Mri orbt/fac/nck w/o &w/dye,70543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4721.29,APC Mri orbt/fac/nck w/o &w/dye,70543,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4721.29,APC Mri orbt/fac/nck w/o &w/dye,70543,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4721.29,APC Mr Angiography Head W/O Dye,70544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1749.55,,,,,,,fee schedule,281.87,2200.47, Mr Angiography Head W/O Dye,70544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2200.47,,,,,,,fee schedule,281.87,2200.47, Mr Angiography Head W/O Dye,70544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2200.47,APC Mr Angiography Head W/O Dye,70544,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2200.47,APC Mr Angiography Head W/O Dye,70544,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2200.47,APC Mr Angiography Head W/Dye,70545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1748.21,,,,,,,fee schedule,412.14,2198.78, Mr Angiography Head W/Dye,70545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2198.78,,,,,,,fee schedule,412.14,2198.78, Mr Angiography Head W/Dye,70545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2198.78,APC Mr Angiography Head W/Dye,70545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2198.78,APC Mr Angiography Head W/Dye,70545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2198.78,APC Mr angiograph head w/o&w/dye,70546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3340.71,,,,,,,fee schedule,412.14,4201.72, Mr angiograph head w/o&w/dye,70546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4201.72,,,,,,,fee schedule,412.14,4201.72, Mr angiograph head w/o&w/dye,70546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4201.72,APC Mr angiograph head w/o&w/dye,70546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4201.72,APC Mr angiograph head w/o&w/dye,70546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4201.72,APC Mr Angiography Neck W/O Dye,70547,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1748.21,,,,,,,fee schedule,281.87,2198.78, Mr Angiography Neck W/O Dye,70547,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2198.78,,,,,,,fee schedule,281.87,2198.78, Mr Angiography Neck W/O Dye,70547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2198.78,APC Mr Angiography Neck W/O Dye,70547,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2198.78,APC Mr Angiography Neck W/O Dye,70547,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2198.78,APC Mr Angiography Neck W/Dye,70548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1748.21,,,,,,,fee schedule,412.14,2198.78, Mr Angiography Neck W/Dye,70548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2198.78,,,,,,,fee schedule,412.14,2198.78, Mr Angiography Neck W/Dye,70548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2198.78,APC Mr Angiography Neck W/Dye,70548,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2198.78,APC Mr Angiography Neck W/Dye,70548,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2198.78,APC Mr angiograph neck w/o&w/dye,70549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3340.71,,,,,,,fee schedule,412.14,4201.72, Mr angiograph neck w/o&w/dye,70549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4201.72,,,,,,,fee schedule,412.14,4201.72, Mr angiograph neck w/o&w/dye,70549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4201.72,APC Mr angiograph neck w/o&w/dye,70549,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4201.72,APC Mr angiograph neck w/o&w/dye,70549,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4201.72,APC Mri brain stem w/o dye,70551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1795.96,,,,,,,fee schedule,281.87,2258.84, Mri brain stem w/o dye,70551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2258.84,,,,,,,fee schedule,281.87,2258.84, Mri brain stem w/o dye,70551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2258.84,APC Mri brain stem w/o dye,70551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2258.84,APC Mri brain stem w/o dye,70551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2258.84,APC Mri brain stem w/dye,70552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2154.65,,,,,,,fee schedule,412.14,2709.97, Mri brain stem w/dye,70552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2709.97,,,,,,,fee schedule,412.14,2709.97, Mri brain stem w/dye,70552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2709.97,APC Mri brain stem w/dye,70552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2709.97,APC Mri brain stem w/dye,70552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2709.97,APC Mri brain stem w/o & w/dye,70553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3836.46,,,,,,,fee schedule,412.14,4825.23, Mri brain stem w/o & w/dye,70553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4825.23,,,,,,,fee schedule,412.14,4825.23, Mri brain stem w/o & w/dye,70553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4825.23,APC Mri brain stem w/o & w/dye,70553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4825.23,APC Mri brain stem w/o & w/dye,70553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4825.23,APC Fmri brain by tech,70554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1168.16,,,,,,,fee schedule,281.87,1469.23, Fmri brain by tech,70554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1469.23,,,,,,,fee schedule,281.87,1469.23, Fmri brain by tech,70554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1469.23,APC Fmri brain by tech,70554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1469.23,APC Fmri brain by tech,70554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1469.23,APC Fmri brain by phys/psych,70555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1048.76,,,,,,,fee schedule,281.87,1319.06, Fmri brain by phys/psych,70555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1319.06,,,,,,,fee schedule,281.87,1319.06, Fmri brain by phys/psych,70555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1319.06,APC Fmri brain by phys/psych,70555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1319.06,APC Fmri brain by phys/psych,70555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1319.06,APC Mri brain w/o dye,70557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,961.49,,,,,,,fee schedule,645.5,1209.3, Mri brain w/o dye,70557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1209.3,,,,,,,fee schedule,645.5,1209.3, Mri brain w/o dye,70557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,1209.3,APC Mri brain w/o dye,70557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,1209.3,APC Mri brain w/o dye,70557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,1209.3,APC Mri brain w/dye,70558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2377.03,,,,,,,fee schedule,207.21,2989.67, Mri brain w/dye,70558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2989.67,,,,,,,fee schedule,207.21,2989.67, Mri brain w/dye,70558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2989.67,APC Mri brain w/dye,70558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2989.67,APC Mri brain w/dye,70558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2989.67,APC Mri brain w/o & w/dye,70559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1798.7,,,,,,,fee schedule,207.21,2262.28, Mri brain w/o & w/dye,70559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2262.28,,,,,,,fee schedule,207.21,2262.28, Mri brain w/o & w/dye,70559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2262.28,APC Mri brain w/o & w/dye,70559,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2262.28,APC Mri brain w/o & w/dye,70559,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2262.28,APC X-ray exam chest 1 view,71045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.57,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 1 view,71045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,347.85,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 1 view,71045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.08,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 1 view,71045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.9,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 1 view,71045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 1 view,71045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 1 view,71045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 2 views,71046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.57,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 2 views,71046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,347.85,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 2 views,71046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,160.37,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 2 views,71046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,192.45,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 2 views,71046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 2 views,71046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 2 views,71046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 3 views,71047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.57,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 3 views,71047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,347.85,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 3 views,71047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,201.61,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 3 views,71047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,241.93,,,,,,,fee schedule,102.81,347.85, X-ray exam chest 3 views,71047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 3 views,71047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 3 views,71047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,347.85,APC X-ray exam chest 4+ views,71048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.57,,,,,,,fee schedule,123.5,347.85, X-ray exam chest 4+ views,71048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,347.85,,,,,,,fee schedule,123.5,347.85, X-ray exam chest 4+ views,71048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,215.35,,,,,,,fee schedule,123.5,347.85, X-ray exam chest 4+ views,71048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,258.42,,,,,,,fee schedule,123.5,347.85, X-ray exam chest 4+ views,71048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,347.85,APC X-ray exam chest 4+ views,71048,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,347.85,APC X-ray exam chest 4+ views,71048,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,347.85,APC X-ray exam ribs uni 2 views,71100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.82,,,,,,,fee schedule,102.81,217.19, X-ray exam ribs uni 2 views,71100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.67,,,,,,,fee schedule,102.81,217.19, X-ray exam ribs uni 2 views,71100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.99,,,,,,,fee schedule,102.81,217.19, X-ray exam ribs uni 2 views,71100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,217.19,,,,,,,fee schedule,102.81,217.19, X-ray exam ribs uni 2 views,71100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,217.19,APC X-ray exam ribs uni 2 views,71100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,217.19,APC X-ray exam ribs uni 2 views,71100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,217.19,APC X-ray exam unilat ribs/chest,71101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,137.58,,,,,,,fee schedule,123.5,244.7, X-ray exam unilat ribs/chest,71101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,173.04,,,,,,,fee schedule,123.5,244.7, X-ray exam unilat ribs/chest,71101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,203.92,,,,,,,fee schedule,123.5,244.7, X-ray exam unilat ribs/chest,71101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,244.7,,,,,,,fee schedule,123.5,244.7, X-ray exam unilat ribs/chest,71101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,244.7,APC X-ray exam unilat ribs/chest,71101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,244.7,APC X-ray exam unilat ribs/chest,71101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,244.7,APC X-ray exam ribs bil 3 views,71110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.27,,,,,,,fee schedule,123.5,250.17, X-ray exam ribs bil 3 views,71110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,192.77,,,,,,,fee schedule,123.5,250.17, X-ray exam ribs bil 3 views,71110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.48,,,,,,,fee schedule,123.5,250.17, X-ray exam ribs bil 3 views,71110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.17,,,,,,,fee schedule,123.5,250.17, X-ray exam ribs bil 3 views,71110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,250.17,APC X-ray exam ribs bil 3 views,71110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,250.17,APC X-ray exam ribs bil 3 views,71110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,250.17,APC X-ray exam ribs/chest4/> vws,71111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,176.06,,,,,,,fee schedule,123.5,307.9, X-ray exam ribs/chest4/> vws,71111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,221.43,,,,,,,fee schedule,123.5,307.9, X-ray exam ribs/chest4/> vws,71111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,256.58,,,,,,,fee schedule,123.5,307.9, X-ray exam ribs/chest4/> vws,71111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,307.9,,,,,,,fee schedule,123.5,307.9, X-ray exam ribs/chest4/> vws,71111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,307.9,APC X-ray exam ribs/chest4/> vws,71111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,307.9,APC X-ray exam ribs/chest4/> vws,71111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,307.9,APC X-ray exam breastbone 2/>vws,71120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,124.17,,,,,,,fee schedule,102.81,200.69, X-ray exam breastbone 2/>vws,71120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,156.17,,,,,,,fee schedule,102.81,200.69, X-ray exam breastbone 2/>vws,71120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,167.24,,,,,,,fee schedule,102.81,200.69, X-ray exam breastbone 2/>vws,71120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.69,,,,,,,fee schedule,102.81,200.69, X-ray exam breastbone 2/>vws,71120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,200.69,APC X-ray exam breastbone 2/>vws,71120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,200.69,APC X-ray exam breastbone 2/>vws,71120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,200.69,APC X-ray strenoclavic jt 3/>vws,71130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.47,,,,,,,fee schedule,102.81,255.65, X-ray strenoclavic jt 3/>vws,71130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,169.13,,,,,,,fee schedule,102.81,255.65, X-ray strenoclavic jt 3/>vws,71130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,213.04,,,,,,,fee schedule,102.81,255.65, X-ray strenoclavic jt 3/>vws,71130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,255.65,,,,,,,fee schedule,102.81,255.65, X-ray strenoclavic jt 3/>vws,71130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,255.65,APC X-ray strenoclavic jt 3/>vws,71130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,255.65,APC X-ray strenoclavic jt 3/>vws,71130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,255.65,APC Ct thorax w/o dye,71250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1008.93,,,,,,,fee schedule,123.5,1268.96, Ct thorax w/o dye,71250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1268.96,,,,,,,fee schedule,123.5,1268.96, Ct thorax w/o dye,71250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1268.96,APC Ct thorax w/o dye,71250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1268.96,APC Ct thorax w/o dye,71250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1268.96,APC Ct thorax w/dye,71260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1183.85,,,,,,,fee schedule,207.21,1488.96, Ct thorax w/dye,71260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1488.96,,,,,,,fee schedule,207.21,1488.96, Ct thorax w/dye,71260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1488.96,APC Ct thorax w/dye,71260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1488.96,APC Ct thorax w/dye,71260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1488.96,APC Ct thorax w/o & w/dye,71270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1451.71,,,,,,,fee schedule,207.21,1825.86, Ct thorax w/o & w/dye,71270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1825.86,,,,,,,fee schedule,207.21,1825.86, Ct thorax w/o & w/dye,71270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1825.86,APC Ct thorax w/o & w/dye,71270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1825.86,APC Ct thorax w/o & w/dye,71270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1825.86,APC Ct thorax lung cancer scr c-,71271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,235.42,,,,,,,fee schedule,123.5,296.09, Ct thorax lung cancer scr c-,71271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.09,,,,,,,fee schedule,123.5,296.09, Ct thorax lung cancer scr c-,71271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,296.09,APC Ct thorax lung cancer scr c-,71271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,296.09,APC Ct thorax lung cancer scr c-,71271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,296.09,APC Ct angiography chest,71275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1776.99,,,,,,,fee schedule,207.21,2234.98, Ct angiography chest,71275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2234.98,,,,,,,fee schedule,207.21,2234.98, Ct angiography chest,71275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2234.98,APC Ct angiography chest,71275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2234.98,APC Ct angiography chest,71275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2234.98,APC Mri chest w/o dye,71550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1776.99,,,,,,,fee schedule,281.87,2234.98, Mri chest w/o dye,71550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2234.98,,,,,,,fee schedule,281.87,2234.98, Mri chest w/o dye,71550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2234.98,APC Mri chest w/o dye,71550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2234.98,APC Mri chest w/o dye,71550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2234.98,APC Mri Chest W/Dye,71551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2127.82,,,,,,,fee schedule,926.08,2676.23, Mri Chest W/Dye,71551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2676.23,,,,,,,fee schedule,926.08,2676.23, Mri Chest W/Dye,71551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2676.23,APC Mri Chest W/Dye,71551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2676.23,APC Mri Chest W/Dye,71551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2676.23,APC Mri chest w/o & w/dye,71552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3754.22,,,,,,,fee schedule,412.14,4721.8, Mri chest w/o & w/dye,71552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4721.8,,,,,,,fee schedule,412.14,4721.8, Mri chest w/o & w/dye,71552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4721.8,APC Mri chest w/o & w/dye,71552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4721.8,APC Mri chest w/o & w/dye,71552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4721.8,APC Mri angio chest w or w/o dye,71555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1849.8,,,,,,,fee schedule,1849.8,2326.55, Mri angio chest w or w/o dye,71555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2326.55,,,,,,,fee schedule,1849.8,2326.55, X-ray exam of spine 1 view,72020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.02,,,,,,,fee schedule,83.02,137.42, X-ray exam of spine 1 view,72020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,104.42,,,,,,,fee schedule,83.02,137.42, X-ray exam of spine 1 view,72020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,114.52,,,,,,,fee schedule,83.02,137.42, X-ray exam of spine 1 view,72020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,137.42,,,,,,,fee schedule,83.02,137.42, X-ray exam of spine 1 view,72020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,83.02,137.42,APC X-ray exam of spine 1 view,72020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,83.02,137.42,APC X-ray exam of spine 1 view,72020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,83.02,137.42,APC X-ray exam neck spine 2-3 vw,72040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.8,,,,,,,fee schedule,102.81,239.15, X-ray exam neck spine 2-3 vw,72040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,150.68,,,,,,,fee schedule,102.81,239.15, X-ray exam neck spine 2-3 vw,72040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,199.3,,,,,,,fee schedule,102.81,239.15, X-ray exam neck spine 2-3 vw,72040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,239.15,,,,,,,fee schedule,102.81,239.15, X-ray exam neck spine 2-3 vw,72040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,239.15,APC X-ray exam neck spine 2-3 vw,72040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,239.15,APC X-ray exam neck spine 2-3 vw,72040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,239.15,APC X-ray exam neck spine 4/5vws,72050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,174.89,,,,,,,fee schedule,123.5,338.18, X-ray exam neck spine 4/5vws,72050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,219.97,,,,,,,fee schedule,123.5,338.18, X-ray exam neck spine 4/5vws,72050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,281.82,,,,,,,fee schedule,123.5,338.18, X-ray exam neck spine 4/5vws,72050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,338.18,,,,,,,fee schedule,123.5,338.18, X-ray exam neck spine 4/5vws,72050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,338.18,APC X-ray exam neck spine 4/5vws,72050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,338.18,APC X-ray exam neck spine 4/5vws,72050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,338.18,APC X-ray exam neck spine 6/>vws,72052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,216.33,,,,,,,fee schedule,123.5,398.68, X-ray exam neck spine 6/>vws,72052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,272.08,,,,,,,fee schedule,123.5,398.68, X-ray exam neck spine 6/>vws,72052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,332.24,,,,,,,fee schedule,123.5,398.68, X-ray exam neck spine 6/>vws,72052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,398.68,,,,,,,fee schedule,123.5,398.68, X-ray exam neck spine 6/>vws,72052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,398.68,APC X-ray exam neck spine 6/>vws,72052,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,398.68,APC X-ray exam neck spine 6/>vws,72052,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,398.68,APC X-ray exam thorac spine 2vws,72070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.47,,,,,,,fee schedule,123.5,192.45, X-ray exam thorac spine 2vws,72070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,159.06,,,,,,,fee schedule,123.5,192.45, X-ray exam thorac spine 2vws,72070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,160.37,,,,,,,fee schedule,123.5,192.45, X-ray exam thorac spine 2vws,72070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,192.45,,,,,,,fee schedule,123.5,192.45, X-ray exam thorac spine 2vws,72070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,192.45,APC X-ray exam thorac spine 2vws,72070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,192.45,APC X-ray exam thorac spine 2vws,72070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,192.45,APC X-ray exam thorac spine 3vws,72072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.17,,,,,,,fee schedule,123.5,239.15, X-ray exam thorac spine 3vws,72072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,173.78,,,,,,,fee schedule,123.5,239.15, X-ray exam thorac spine 3vws,72072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,199.3,,,,,,,fee schedule,123.5,239.15, X-ray exam thorac spine 3vws,72072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,239.15,,,,,,,fee schedule,123.5,239.15, X-ray exam thorac spine 3vws,72072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,239.15,APC X-ray exam thorac spine 3vws,72072,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,239.15,APC X-ray exam thorac spine 3vws,72072,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,239.15,APC X-ray exam thorac spine4/>vw,72074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,163.16,,,,,,,fee schedule,123.5,272.14, X-ray exam thorac spine4/>vw,72074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,205.22,,,,,,,fee schedule,123.5,272.14, X-ray exam thorac spine4/>vw,72074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,226.78,,,,,,,fee schedule,123.5,272.14, X-ray exam thorac spine4/>vw,72074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,272.14,,,,,,,fee schedule,123.5,272.14, X-ray exam thorac spine4/>vw,72074,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,272.14,APC X-ray exam thorac spine4/>vw,72074,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,272.14,APC X-ray exam thorac spine4/>vw,72074,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,272.14,APC X-ray exam thoracolmb 2/> vw,72080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.15,,,,,,,fee schedule,102.81,203.4, X-ray exam thoracolmb 2/> vw,72080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,162.43,,,,,,,fee schedule,102.81,203.4, X-ray exam thoracolmb 2/> vw,72080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,169.5,,,,,,,fee schedule,102.81,203.4, X-ray exam thoracolmb 2/> vw,72080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,203.4,,,,,,,fee schedule,102.81,203.4, X-ray exam thoracolmb 2/> vw,72080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,203.4,APC X-ray exam thoracolmb 2/> vw,72080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,203.4,APC X-ray exam thoracolmb 2/> vw,72080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,203.4,APC X-ray exam entire spi 1 vw,72081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.75,,,,,,,fee schedule,102.81,250.17, X-ray exam entire spi 1 vw,72081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,174.51,,,,,,,fee schedule,102.81,250.17, X-ray exam entire spi 1 vw,72081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.48,,,,,,,fee schedule,102.81,250.17, X-ray exam entire spi 1 vw,72081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.17,,,,,,,fee schedule,102.81,250.17, X-ray exam entire spi 1 vw,72081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,250.17,APC X-ray exam entire spi 1 vw,72081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,250.17,APC X-ray exam entire spi 1 vw,72081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,250.17,APC X-ray exam entire spi 2/3 vw,72082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,216.1,,,,,,,fee schedule,123.5,456.41, X-ray exam entire spi 2/3 vw,72082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,271.79,,,,,,,fee schedule,123.5,456.41, X-ray exam entire spi 2/3 vw,72082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,380.34,,,,,,,fee schedule,123.5,456.41, X-ray exam entire spi 2/3 vw,72082,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,456.41,,,,,,,fee schedule,123.5,456.41, X-ray exam entire spi 2/3 vw,72082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,456.41,APC X-ray exam entire spi 2/3 vw,72082,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,456.41,APC X-ray exam entire spi 2/3 vw,72082,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,456.41,APC X-ray exam entire spi 4/5 vw,72083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.75,,,,,,,fee schedule,123.5,514.14, X-ray exam entire spi 4/5 vw,72083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,174.51,,,,,,,fee schedule,123.5,514.14, X-ray exam entire spi 4/5 vw,72083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,428.45,,,,,,,fee schedule,123.5,514.14, X-ray exam entire spi 4/5 vw,72083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,514.14,,,,,,,fee schedule,123.5,514.14, X-ray exam entire spi 4/5 vw,72083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,514.14,APC X-ray exam entire spi 4/5 vw,72083,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,514.14,APC X-ray exam entire spi 4/5 vw,72083,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,514.14,APC X-ray exam entire spi 6/> vw,72084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.75,,,,,,,fee schedule,123.5,651.56, X-ray exam entire spi 6/> vw,72084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,174.51,,,,,,,fee schedule,123.5,651.56, X-ray exam entire spi 6/> vw,72084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,542.97,,,,,,,fee schedule,123.5,651.56, X-ray exam entire spi 6/> vw,72084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,651.56,,,,,,,fee schedule,123.5,651.56, X-ray exam entire spi 6/> vw,72084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,651.56,APC X-ray exam entire spi 6/> vw,72084,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,651.56,APC X-ray exam entire spi 6/> vw,72084,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,651.56,APC X-ray exam l-s spine 2/3 vws,72100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.15,,,,,,,fee schedule,123.5,241.93, X-ray exam l-s spine 2/3 vws,72100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,162.43,,,,,,,fee schedule,123.5,241.93, X-ray exam l-s spine 2/3 vws,72100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,201.61,,,,,,,fee schedule,123.5,241.93, X-ray exam l-s spine 2/3 vws,72100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,241.93,,,,,,,fee schedule,123.5,241.93, X-ray exam l-s spine 2/3 vws,72100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,241.93,APC X-ray exam l-s spine 2/3 vws,72100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,241.93,APC X-ray exam l-s spine 2/3 vws,72100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,241.93,APC X-ray exam l-2 spine 4/>vws,72110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,177.57,,,,,,,fee schedule,123.5,327.17, X-ray exam l-2 spine 4/>vws,72110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,223.33,,,,,,,fee schedule,123.5,327.17, X-ray exam l-2 spine 4/>vws,72110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,272.64,,,,,,,fee schedule,123.5,327.17, X-ray exam l-2 spine 4/>vws,72110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,327.17,,,,,,,fee schedule,123.5,327.17, X-ray exam l-2 spine 4/>vws,72110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,327.17,APC X-ray exam l-2 spine 4/>vws,72110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,327.17,APC X-ray exam l-2 spine 4/>vws,72110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,327.17,APC X-ray exam l-s spine bending,72114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,224.33,,,,,,,fee schedule,123.5,387.66, X-ray exam l-s spine bending,72114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,282.15,,,,,,,fee schedule,123.5,387.66, X-ray exam l-s spine bending,72114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,323.05,,,,,,,fee schedule,123.5,387.66, X-ray exam l-s spine bending,72114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,387.66,,,,,,,fee schedule,123.5,387.66, X-ray exam l-s spine bending,72114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,387.66,APC X-ray exam l-s spine bending,72114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,387.66,APC X-ray exam l-s spine bending,72114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,387.66,APC X-ray bend only l-s spine,72120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,160.49,,,,,,,fee schedule,123.5,247.4, X-ray bend only l-s spine,72120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,201.85,,,,,,,fee schedule,123.5,247.4, X-ray bend only l-s spine,72120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,206.17,,,,,,,fee schedule,123.5,247.4, X-ray bend only l-s spine,72120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,247.4,,,,,,,fee schedule,123.5,247.4, X-ray bend only l-s spine,72120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,247.4,APC X-ray bend only l-s spine,72120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,247.4,APC X-ray bend only l-s spine,72120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,247.4,APC Ct neck spine w/o dye,72125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1008.93,,,,,,,fee schedule,123.5,1268.96, Ct neck spine w/o dye,72125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1268.96,,,,,,,fee schedule,123.5,1268.96, Ct neck spine w/o dye,72125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1268.96,APC Ct neck spine w/o dye,72125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1268.96,APC Ct neck spine w/o dye,72125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1268.96,APC Ct neck spine w/dye,72126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1179.19,,,,,,,fee schedule,412.14,1483.11, Ct neck spine w/dye,72126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1483.11,,,,,,,fee schedule,412.14,1483.11, Ct neck spine w/dye,72126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1483.11,APC Ct neck spine w/dye,72126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1483.11,APC Ct neck spine w/dye,72126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1483.11,APC Ct neck spine w/o & w/dye,72127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1434.98,,,,,,,fee schedule,207.21,1804.82, Ct neck spine w/o & w/dye,72127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1804.82,,,,,,,fee schedule,207.21,1804.82, Ct neck spine w/o & w/dye,72127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1804.82,APC Ct neck spine w/o & w/dye,72127,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1804.82,APC Ct neck spine w/o & w/dye,72127,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1804.82,APC Ct chest spine w/o dye,72128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1008.93,,,,,,,fee schedule,123.5,1268.96, Ct chest spine w/o dye,72128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1268.96,,,,,,,fee schedule,123.5,1268.96, Ct chest spine w/o dye,72128,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1268.96,APC Ct chest spine w/o dye,72128,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1268.96,APC Ct chest spine w/o dye,72128,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1268.96,APC Ct chest spine w/dye,72129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1180.21,,,,,,,fee schedule,207.21,1484.39, Ct chest spine w/dye,72129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1484.39,,,,,,,fee schedule,207.21,1484.39, Ct chest spine w/dye,72129,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1484.39,APC Ct chest spine w/dye,72129,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1484.39,APC Ct chest spine w/dye,72129,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1484.39,APC Ct chest spine w/o & w/dye,72130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1434.98,,,,,,,fee schedule,207.21,1804.82, Ct chest spine w/o & w/dye,72130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1804.82,,,,,,,fee schedule,207.21,1804.82, Ct chest spine w/o & w/dye,72130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1804.82,APC Ct chest spine w/o & w/dye,72130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1804.82,APC Ct chest spine w/o & w/dye,72130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1804.82,APC Ct lumbar spine w/o dye,72131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1008.93,,,,,,,fee schedule,123.5,1268.96, Ct lumbar spine w/o dye,72131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1268.96,,,,,,,fee schedule,123.5,1268.96, Ct lumbar spine w/o dye,72131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1268.96,APC Ct lumbar spine w/o dye,72131,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1268.96,APC Ct lumbar spine w/o dye,72131,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1268.96,APC Ct lumbar spine w/dye,72132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1179.19,,,,,,,fee schedule,412.14,1483.11, Ct lumbar spine w/dye,72132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1483.11,,,,,,,fee schedule,412.14,1483.11, Ct lumbar spine w/dye,72132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1483.11,APC Ct lumbar spine w/dye,72132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1483.11,APC Ct lumbar spine w/dye,72132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1483.11,APC Ct lumbar spine w/o & w/dye,72133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1434.98,,,,,,,fee schedule,207.21,1804.82, Ct lumbar spine w/o & w/dye,72133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1804.82,,,,,,,fee schedule,207.21,1804.82, Ct lumbar spine w/o & w/dye,72133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1804.82,APC Ct lumbar spine w/o & w/dye,72133,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1804.82,APC Ct lumbar spine w/o & w/dye,72133,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1804.82,APC Mri neck spine w/o dye,72141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1815.17,,,,,,,fee schedule,281.87,2283, Mri neck spine w/o dye,72141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2283,,,,,,,fee schedule,281.87,2283, Mri neck spine w/o dye,72141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2283,APC Mri neck spine w/o dye,72141,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2283,APC Mri neck spine w/o dye,72141,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2283,APC Mri neck spine w/dye,72142,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2178.54,,,,,,,fee schedule,412.14,2740.02, Mri neck spine w/dye,72142,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2740.02,,,,,,,fee schedule,412.14,2740.02, Mri neck spine w/dye,72142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2740.02,APC Mri neck spine w/dye,72142,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2740.02,APC Mri neck spine w/dye,72142,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2740.02,APC Mri chest spine w/o dye,72146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1985.46,,,,,,,fee schedule,281.87,2497.18, Mri chest spine w/o dye,72146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2497.18,,,,,,,fee schedule,281.87,2497.18, Mri chest spine w/o dye,72146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2497.18,APC Mri chest spine w/o dye,72146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2497.18,APC Mri chest spine w/o dye,72146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2497.18,APC Mri chest spine w/dye,72147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2177.2,,,,,,,fee schedule,412.14,2738.34, Mri chest spine w/dye,72147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2738.34,,,,,,,fee schedule,412.14,2738.34, Mri chest spine w/dye,72147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2738.34,APC Mri chest spine w/dye,72147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2738.34,APC Mri chest spine w/dye,72147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2738.34,APC Mri lumbar spine w/o dye,72148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1966.26,,,,,,,fee schedule,281.87,2473.03, Mri lumbar spine w/o dye,72148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2473.03,,,,,,,fee schedule,281.87,2473.03, Mri lumbar spine w/o dye,72148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2473.03,APC Mri lumbar spine w/o dye,72148,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2473.03,APC Mri lumbar spine w/o dye,72148,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2473.03,APC Mri lumbar spine w/dye,72149,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2155.99,,,,,,,fee schedule,412.14,2711.66, Mri lumbar spine w/dye,72149,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2711.66,,,,,,,fee schedule,412.14,2711.66, Mri lumbar spine w/dye,72149,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2711.66,APC Mri lumbar spine w/dye,72149,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2711.66,APC Mri lumbar spine w/dye,72149,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2711.66,APC Mri neck spine w/o & w/dye,72156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3871.11,,,,,,,fee schedule,412.14,4868.82, Mri neck spine w/o & w/dye,72156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4868.82,,,,,,,fee schedule,412.14,4868.82, Mri neck spine w/o & w/dye,72156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4868.82,APC Mri neck spine w/o & w/dye,72156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4868.82,APC Mri neck spine w/o & w/dye,72156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4868.82,APC Mri chest spine w/o & w/dye,72157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3868.76,,,,,,,fee schedule,412.14,4865.86, Mri chest spine w/o & w/dye,72157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4865.86,,,,,,,fee schedule,412.14,4865.86, Mri chest spine w/o & w/dye,72157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4865.86,APC Mri chest spine w/o & w/dye,72157,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4865.86,APC Mri chest spine w/o & w/dye,72157,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4865.86,APC Mri lumbar spine w/o & w/dye,72158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3836.46,,,,,,,fee schedule,412.14,4825.23, Mri lumbar spine w/o & w/dye,72158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4825.23,,,,,,,fee schedule,412.14,4825.23, Mri lumbar spine w/o & w/dye,72158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4825.23,APC Mri lumbar spine w/o & w/dye,72158,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4825.23,APC Mri lumbar spine w/o & w/dye,72158,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4825.23,APC Mr angio spine w/o&w/dye,72159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2254.26,,,,,,,fee schedule,2254.26,2835.26, Mr angio spine w/o&w/dye,72159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2835.26,,,,,,,fee schedule,2254.26,2835.26, X-ray exam of pelvis,72170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.99,,,,,,,fee schedule,99.99,162.16, X-ray exam of pelvis,72170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.76,,,,,,,fee schedule,99.99,162.16, X-ray exam of pelvis,72170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,135.14,,,,,,,fee schedule,99.99,162.16, X-ray exam of pelvis,72170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,162.16,,,,,,,fee schedule,99.99,162.16, X-ray exam of pelvis,72170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,99.99,162.16,APC X-ray exam of pelvis,72170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,99.99,162.16,APC X-ray exam of pelvis,72170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,99.99,162.16,APC X-ray exam of pelvis,72190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,127.98,,,,,,,fee schedule,123.5,250.17, X-ray exam of pelvis,72190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,160.97,,,,,,,fee schedule,123.5,250.17, X-ray exam of pelvis,72190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.48,,,,,,,fee schedule,123.5,250.17, X-ray exam of pelvis,72190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.17,,,,,,,fee schedule,123.5,250.17, X-ray exam of pelvis,72190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,250.17,APC X-ray exam of pelvis,72190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,250.17,APC X-ray exam of pelvis,72190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,250.17,APC Ct angiograph pelv w/o&w/dye,72191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1939.95,,,,,,,fee schedule,207.21,2439.94, Ct angiograph pelv w/o&w/dye,72191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2439.94,,,,,,,fee schedule,207.21,2439.94, Ct angiograph pelv w/o&w/dye,72191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2439.94,APC Ct angiograph pelv w/o&w/dye,72191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2439.94,APC Ct angiograph pelv w/o&w/dye,72191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2439.94,APC Ct pelvis w/o dye,72192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,998.16,,,,,,,fee schedule,123.5,1255.42, Ct pelvis w/o dye,72192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1255.42,,,,,,,fee schedule,123.5,1255.42, Ct pelvis w/o dye,72192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1255.42,APC Ct pelvis w/o dye,72192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1255.42,APC Ct pelvis w/o dye,72192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1255.42,APC Ct pelvis w/dye,72193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1137.93,,,,,,,fee schedule,207.21,1431.21, Ct pelvis w/dye,72193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1431.21,,,,,,,fee schedule,207.21,1431.21, Ct pelvis w/dye,72193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1431.21,APC Ct pelvis w/dye,72193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1431.21,APC Ct pelvis w/dye,72193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1431.21,APC Ct pelvis w/o & w/dye,72194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1374.48,,,,,,,fee schedule,207.21,1728.73, Ct pelvis w/o & w/dye,72194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1728.73,,,,,,,fee schedule,207.21,1728.73, Ct pelvis w/o & w/dye,72194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1728.73,APC Ct pelvis w/o & w/dye,72194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1728.73,APC Ct pelvis w/o & w/dye,72194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1728.73,APC Mri Pelvis W/O Dye,72195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1778.01,,,,,,,fee schedule,281.87,2236.26, Mri Pelvis W/O Dye,72195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2236.26,,,,,,,fee schedule,281.87,2236.26, Mri Pelvis W/O Dye,72195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2236.26,APC Mri Pelvis W/O Dye,72195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2236.26,APC Mri Pelvis W/O Dye,72195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2236.26,APC Mri pelvis w/dye,72196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2127.82,,,,,,,fee schedule,412.14,2676.23, Mri pelvis w/dye,72196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2676.23,,,,,,,fee schedule,412.14,2676.23, Mri pelvis w/dye,72196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2676.23,APC Mri pelvis w/dye,72196,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2676.23,APC Mri pelvis w/dye,72196,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2676.23,APC Mri pelvis w/o & w/dye,72197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3778.72,,,,,,,fee schedule,412.14,4752.62, Mri pelvis w/o & w/dye,72197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4752.62,,,,,,,fee schedule,412.14,4752.62, Mri pelvis w/o & w/dye,72197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4752.62,APC Mri pelvis w/o & w/dye,72197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4752.62,APC Mri pelvis w/o & w/dye,72197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4752.62,APC Mr angio pelvis w/o & w/dye,72198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1847.33,,,,,,,fee schedule,1847.33,2323.44, Mr angio pelvis w/o & w/dye,72198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2323.44,,,,,,,fee schedule,1847.33,2323.44, X-ray exam si joints,72200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.99,,,,,,,fee schedule,99.99,208.94, X-ray exam si joints,72200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.76,,,,,,,fee schedule,99.99,208.94, X-ray exam si joints,72200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,174.12,,,,,,,fee schedule,99.99,208.94, X-ray exam si joints,72200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,208.94,,,,,,,fee schedule,99.99,208.94, X-ray exam si joints,72200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,99.99,208.94,APC X-ray exam si joints,72200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,99.99,208.94,APC X-ray exam si joints,72200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,99.99,208.94,APC X-ray exam si joints 3/> vws,72202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.68,,,,,,,fee schedule,117.68,236.45, X-ray exam si joints 3/> vws,72202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,148.01,,,,,,,fee schedule,117.68,236.45, X-ray exam si joints 3/> vws,72202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,197.04,,,,,,,fee schedule,117.68,236.45, X-ray exam si joints 3/> vws,72202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,236.45,,,,,,,fee schedule,117.68,236.45, X-ray exam si joints 3/> vws,72202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,117.68,236.45,APC X-ray exam si joints 3/> vws,72202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,117.68,236.45,APC X-ray exam si joints 3/> vws,72202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,117.68,236.45,APC X-ray exam sacrum tailbone,72220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108.69,,,,,,,fee schedule,102.81,200.69, X-ray exam sacrum tailbone,72220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.7,,,,,,,fee schedule,102.81,200.69, X-ray exam sacrum tailbone,72220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,167.24,,,,,,,fee schedule,102.81,200.69, X-ray exam sacrum tailbone,72220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.69,,,,,,,fee schedule,102.81,200.69, X-ray exam sacrum tailbone,72220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,200.69,APC X-ray exam sacrum tailbone,72220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,200.69,APC X-ray exam sacrum tailbone,72220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,200.69,APC Myelography neck spine,72240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,806.33,,,,,,,fee schedule,474.3,1014.15, Myelography neck spine,72240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1014.15,,,,,,,fee schedule,474.3,1014.15, Myelography neck spine,72240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,474.3,,,,,,,fee schedule,474.3,1014.15, Myelography neck spine,72240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,569.16,,,,,,,fee schedule,474.3,1014.15, Myelography neck spine,72240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,474.3,1014.15,APC Myelography neck spine,72240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,474.3,1014.15,APC Myelography neck spine,72240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,474.3,1014.15,APC Myelography thoracic spine,72255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,744.64,,,,,,,fee schedule,446.81,972.38, Myelography thoracic spine,72255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,936.56,,,,,,,fee schedule,446.81,972.38, Myelography thoracic spine,72255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,446.81,,,,,,,fee schedule,446.81,972.38, Myelography thoracic spine,72255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,536.17,,,,,,,fee schedule,446.81,972.38, Myelography thoracic spine,72255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,446.81,972.38,APC Myelography thoracic spine,72255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,446.81,972.38,APC Myelography thoracic spine,72255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,446.81,972.38,APC Myelography l-s spine,72265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,698.08,,,,,,,fee schedule,478.86,972.38, Myelography l-s spine,72265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,878,,,,,,,fee schedule,478.86,972.38, Myelography l-s spine,72265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,478.86,,,,,,,fee schedule,478.86,972.38, Myelography l-s spine,72265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,574.64,,,,,,,fee schedule,478.86,972.38, Myelography l-s spine,72265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,478.86,972.38,APC Myelography l-s spine,72265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,478.86,972.38,APC Myelography l-s spine,72265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,478.86,972.38,APC Myelogphy 2/> spine regions,72270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1062.3,,,,,,,fee schedule,607.18,1336.08, Myelogphy 2/> spine regions,72270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1336.08,,,,,,,fee schedule,607.18,1336.08, Myelogphy 2/> spine regions,72270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,607.18,,,,,,,fee schedule,607.18,1336.08, Myelogphy 2/> spine regions,72270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,728.62,,,,,,,fee schedule,607.18,1336.08, Myelogphy 2/> spine regions,72270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,607.18,1336.08,APC Myelogphy 2/> spine regions,72270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,607.18,1336.08,APC Myelogphy 2/> spine regions,72270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,607.18,1336.08,APC Discography cerv/thor spine,72285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1349.6,,,,,,,fee schedule,529.28,2422.18, Discography cerv/thor spine,72285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1697.43,,,,,,,fee schedule,529.28,2422.18, Discography cerv/thor spine,72285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,529.28,,,,,,,fee schedule,529.28,2422.18, Discography cerv/thor spine,72285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.13,,,,,,,fee schedule,529.28,2422.18, Discography cerv/thor spine,72285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,529.28,2422.18,APC Discography cerv/thor spine,72285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,529.28,2422.18,APC Discography cerv/thor spine,72285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,529.28,2422.18,APC X-ray of lower spine disk,72295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1226.07,,,,,,,fee schedule,497.17,2422.18, X-ray of lower spine disk,72295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1542.07,,,,,,,fee schedule,497.17,2422.18, X-ray of lower spine disk,72295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,497.17,,,,,,,fee schedule,497.17,2422.18, X-ray of lower spine disk,72295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,596.6,,,,,,,fee schedule,497.17,2422.18, X-ray of lower spine disk,72295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2399.12,,,,,,,fee schedule,497.17,2422.18,APC X-ray of lower spine disk,72295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2422.18,,,,,,,fee schedule,497.17,2422.18,APC X-ray of lower spine disk,72295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2306.84,,,,,,,fee schedule,497.17,2422.18,APC X-ray exam of collar bone,73000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.51,,,,,,,fee schedule,97.51,203.4, X-ray exam of collar bone,73000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.65,,,,,,,fee schedule,97.51,203.4, X-ray exam of collar bone,73000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,169.5,,,,,,,fee schedule,97.51,203.4, X-ray exam of collar bone,73000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,203.4,,,,,,,fee schedule,97.51,203.4, X-ray exam of collar bone,73000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,97.51,203.4,APC X-ray exam of collar bone,73000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,97.51,203.4,APC X-ray exam of collar bone,73000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,97.51,203.4,APC X-ray exam of shoulder blade,73010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.99,,,,,,,fee schedule,99.99,129.68, X-ray exam of shoulder blade,73010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.76,,,,,,,fee schedule,99.99,129.68, X-ray exam of shoulder blade,73010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,105.34,,,,,,,fee schedule,99.99,129.68, X-ray exam of shoulder blade,73010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,126.4,,,,,,,fee schedule,99.99,129.68, X-ray exam of shoulder blade,73010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,99.99,129.68,APC X-ray exam of shoulder blade,73010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,99.99,129.68,APC X-ray exam of shoulder blade,73010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,99.99,129.68,APC X-ray exam of shoulder,73020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.69,,,,,,,fee schedule,89.69,118.16, X-ray exam of shoulder,73020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,112.8,,,,,,,fee schedule,89.69,118.16, X-ray exam of shoulder,73020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.46,,,,,,,fee schedule,89.69,118.16, X-ray exam of shoulder,73020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,118.16,,,,,,,fee schedule,89.69,118.16, X-ray exam of shoulder,73020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,89.69,118.16,APC X-ray exam of shoulder,73020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,89.69,118.16,APC X-ray exam of shoulder,73020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,89.69,118.16,APC X-ray exam of shoulder,73030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.85,,,,,,,fee schedule,102.81,214.41, X-ray exam of shoulder,73030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.17,,,,,,,fee schedule,102.81,214.41, X-ray exam of shoulder,73030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,178.68,,,,,,,fee schedule,102.81,214.41, X-ray exam of shoulder,73030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,214.41,,,,,,,fee schedule,102.81,214.41, X-ray exam of shoulder,73030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,214.41,APC X-ray exam of shoulder,73030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,214.41,APC X-ray exam of shoulder,73030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,214.41,APC Contrast x-ray of shoulder,73040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,380.51,,,,,,,fee schedule,380.51,868.88, Contrast x-ray of shoulder,73040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,478.58,,,,,,,fee schedule,380.51,868.88, Contrast x-ray of shoulder,73040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,724.07,,,,,,,fee schedule,380.51,868.88, Contrast x-ray of shoulder,73040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,868.88,,,,,,,fee schedule,380.51,868.88, Contrast x-ray of shoulder,73040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,380.51,868.88,APC Contrast x-ray of shoulder,73040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,380.51,868.88,APC Contrast x-ray of shoulder,73040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,380.51,868.88,APC X-ray exam of shoulders,73050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.82,,,,,,,fee schedule,102.81,164.93, X-ray exam of shoulders,73050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,159.5,,,,,,,fee schedule,102.81,164.93, X-ray exam of shoulders,73050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,137.45,,,,,,,fee schedule,102.81,164.93, X-ray exam of shoulders,73050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,164.93,,,,,,,fee schedule,102.81,164.93, X-ray exam of shoulders,73050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,164.93,APC X-ray exam of shoulders,73050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,164.93,APC X-ray exam of shoulders,73050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,164.93,APC X-ray exam of humerus,73060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108.69,,,,,,,fee schedule,102.81,200.69, X-ray exam of humerus,73060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.7,,,,,,,fee schedule,102.81,200.69, X-ray exam of humerus,73060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,167.24,,,,,,,fee schedule,102.81,200.69, X-ray exam of humerus,73060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.69,,,,,,,fee schedule,102.81,200.69, X-ray exam of humerus,73060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,200.69,APC X-ray exam of humerus,73060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,200.69,APC X-ray exam of humerus,73060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,200.69,APC X-ray exam of elbow,73070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96.35,,,,,,,fee schedule,96.35,175.95, X-ray exam of elbow,73070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.18,,,,,,,fee schedule,96.35,175.95, X-ray exam of elbow,73070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.63,,,,,,,fee schedule,96.35,175.95, X-ray exam of elbow,73070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,175.95,,,,,,,fee schedule,96.35,175.95, X-ray exam of elbow,73070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,96.35,175.95,APC X-ray exam of elbow,73070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,96.35,175.95,APC X-ray exam of elbow,73070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,96.35,175.95,APC X-ray exam of elbow,73080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108.69,,,,,,,fee schedule,102.81,203.4, X-ray exam of elbow,73080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.7,,,,,,,fee schedule,102.81,203.4, X-ray exam of elbow,73080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,169.5,,,,,,,fee schedule,102.81,203.4, X-ray exam of elbow,73080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,203.4,,,,,,,fee schedule,102.81,203.4, X-ray exam of elbow,73080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,203.4,APC X-ray exam of elbow,73080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,203.4,APC X-ray exam of elbow,73080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,203.4,APC Contrast x-ray of elbow,73085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,382.87,,,,,,,fee schedule,382.87,615.87, Contrast x-ray of elbow,73085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,481.55,,,,,,,fee schedule,382.87,615.87, Contrast x-ray of elbow,73085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,513.22,,,,,,,fee schedule,382.87,615.87, Contrast x-ray of elbow,73085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,615.87,,,,,,,fee schedule,382.87,615.87, Contrast x-ray of elbow,73085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,382.87,615.87,APC Contrast x-ray of elbow,73085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,382.87,615.87,APC Contrast x-ray of elbow,73085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,382.87,615.87,APC X-ray exam of forearm,73090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.51,,,,,,,fee schedule,97.51,178.66, X-ray exam of forearm,73090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.65,,,,,,,fee schedule,97.51,178.66, X-ray exam of forearm,73090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,148.88,,,,,,,fee schedule,97.51,178.66, X-ray exam of forearm,73090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,178.66,,,,,,,fee schedule,97.51,178.66, X-ray exam of forearm,73090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,97.51,178.66,APC X-ray exam of forearm,73090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,97.51,178.66,APC X-ray exam of forearm,73090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,97.51,178.66,APC X-ray exam of arm infant,73092,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.5,,,,,,,fee schedule,93.5,197.92, X-ray exam of arm infant,73092,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.6,,,,,,,fee schedule,93.5,197.92, X-ray exam of arm infant,73092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.93,,,,,,,fee schedule,93.5,197.92, X-ray exam of arm infant,73092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.92,,,,,,,fee schedule,93.5,197.92, X-ray exam of arm infant,73092,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,93.5,197.92,APC X-ray exam of arm infant,73092,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,93.5,197.92,APC X-ray exam of arm infant,73092,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,93.5,197.92,APC X-ray exam of wrist,73100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.5,,,,,,,fee schedule,93.5,214.41, X-ray exam of wrist,73100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.6,,,,,,,fee schedule,93.5,214.41, X-ray exam of wrist,73100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,178.68,,,,,,,fee schedule,93.5,214.41, X-ray exam of wrist,73100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,214.41,,,,,,,fee schedule,93.5,214.41, X-ray exam of wrist,73100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,93.5,214.41,APC X-ray exam of wrist,73100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,93.5,214.41,APC X-ray exam of wrist,73100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,93.5,214.41,APC X-ray exam of wrist,73110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.33,,,,,,,fee schedule,101.33,272.14, X-ray exam of wrist,73110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.44,,,,,,,fee schedule,101.33,272.14, X-ray exam of wrist,73110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,226.78,,,,,,,fee schedule,101.33,272.14, X-ray exam of wrist,73110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,272.14,,,,,,,fee schedule,101.33,272.14, X-ray exam of wrist,73110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,101.33,272.14,APC X-ray exam of wrist,73110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,101.33,272.14,APC X-ray exam of wrist,73110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,101.33,272.14,APC Contrast x-ray of wrist,73115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,310.21,,,,,,,fee schedule,310.21,893.62, Contrast x-ray of wrist,73115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,390.16,,,,,,,fee schedule,310.21,893.62, Contrast x-ray of wrist,73115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,744.69,,,,,,,fee schedule,310.21,893.62, Contrast x-ray of wrist,73115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,893.62,,,,,,,fee schedule,310.21,893.62, Contrast x-ray of wrist,73115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,310.21,893.62,APC Contrast x-ray of wrist,73115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,310.21,893.62,APC Contrast x-ray of wrist,73115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,310.21,893.62,APC X-ray exam of hand,73120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.5,,,,,,,fee schedule,93.5,195.15, X-ray exam of hand,73120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.6,,,,,,,fee schedule,93.5,195.15, X-ray exam of hand,73120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,162.62,,,,,,,fee schedule,93.5,195.15, X-ray exam of hand,73120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,195.15,,,,,,,fee schedule,93.5,195.15, X-ray exam of hand,73120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,93.5,195.15,APC X-ray exam of hand,73120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,93.5,195.15,APC X-ray exam of hand,73120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,93.5,195.15,APC X-ray exam of hand,73130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.33,,,,,,,fee schedule,101.33,239.15, X-ray exam of hand,73130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.44,,,,,,,fee schedule,101.33,239.15, X-ray exam of hand,73130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,199.3,,,,,,,fee schedule,101.33,239.15, X-ray exam of hand,73130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,239.15,,,,,,,fee schedule,101.33,239.15, X-ray exam of hand,73130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,101.33,239.15,APC X-ray exam of hand,73130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,101.33,239.15,APC X-ray exam of hand,73130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,101.33,239.15,APC X-ray exam of finger(s),73140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.38,,,,,,,fee schedule,79.38,261.19, X-ray exam of finger(s),73140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.84,,,,,,,fee schedule,79.38,261.19, X-ray exam of finger(s),73140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,217.66,,,,,,,fee schedule,79.38,261.19, X-ray exam of finger(s),73140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,261.19,,,,,,,fee schedule,79.38,261.19, X-ray exam of finger(s),73140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,79.38,261.19,APC X-ray exam of finger(s),73140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,79.38,261.19,APC X-ray exam of finger(s),73140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,79.38,261.19,APC Ct upper extremity w/o dye,73200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,865.46,,,,,,,fee schedule,123.5,1088.52, Ct upper extremity w/o dye,73200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1088.52,,,,,,,fee schedule,123.5,1088.52, Ct upper extremity w/o dye,73200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1088.52,APC Ct upper extremity w/o dye,73200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1088.52,APC Ct upper extremity w/o dye,73200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1088.52,APC Ct upper extremity w/dye,73201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1008.93,,,,,,,fee schedule,412.14,1268.96, Ct upper extremity w/dye,73201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1268.96,,,,,,,fee schedule,412.14,1268.96, Ct upper extremity w/dye,73201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1268.96,APC Ct upper extremity w/dye,73201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1268.96,APC Ct upper extremity w/dye,73201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1268.96,APC Ct uppr extremity w/o&w/dye,73202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1228.86,,,,,,,fee schedule,207.21,1545.58, Ct uppr extremity w/o&w/dye,73202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1545.58,,,,,,,fee schedule,207.21,1545.58, Ct uppr extremity w/o&w/dye,73202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1545.58,APC Ct uppr extremity w/o&w/dye,73202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1545.58,APC Ct uppr extremity w/o&w/dye,73202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1545.58,APC Ct angio upr extrm w/o&w/dye,73206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1796.08,,,,,,,fee schedule,207.21,2258.99, Ct angio upr extrm w/o&w/dye,73206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2258.99,,,,,,,fee schedule,207.21,2258.99, Ct angio upr extrm w/o&w/dye,73206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2258.99,APC Ct angio upr extrm w/o&w/dye,73206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2258.99,APC Ct angio upr extrm w/o&w/dye,73206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2258.99,APC Mri Upper Extremity W/O Dye,73218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1752.81,,,,,,,fee schedule,281.87,2204.56, Mri Upper Extremity W/O Dye,73218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2204.56,,,,,,,fee schedule,281.87,2204.56, Mri Upper Extremity W/O Dye,73218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2204.56,APC Mri Upper Extremity W/O Dye,73218,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2204.56,APC Mri Upper Extremity W/O Dye,73218,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2204.56,APC Mri Upper Extremity W/Dye,73219,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.98,,,,,,,fee schedule,412.14,2647.5, Mri Upper Extremity W/Dye,73219,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2647.5,,,,,,,fee schedule,412.14,2647.5, Mri Upper Extremity W/Dye,73219,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2647.5,APC Mri Upper Extremity W/Dye,73219,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2647.5,APC Mri Upper Extremity W/Dye,73219,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2647.5,APC Mri uppr extremity w/o&w/dye,73220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3753.81,,,,,,,fee schedule,412.14,4721.29, Mri uppr extremity w/o&w/dye,73220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4721.29,,,,,,,fee schedule,412.14,4721.29, Mri uppr extremity w/o&w/dye,73220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4721.29,APC Mri uppr extremity w/o&w/dye,73220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4721.29,APC Mri uppr extremity w/o&w/dye,73220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4721.29,APC Mri joint upr extrem w/o dye,73221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1752.81,,,,,,,fee schedule,281.87,2204.56, Mri joint upr extrem w/o dye,73221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2204.56,,,,,,,fee schedule,281.87,2204.56, Mri joint upr extrem w/o dye,73221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2204.56,APC Mri joint upr extrem w/o dye,73221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2204.56,APC Mri joint upr extrem w/o dye,73221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2204.56,APC Mri joint upr extrem w/dye,73222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2103.64,,,,,,,fee schedule,926.08,2645.81, Mri joint upr extrem w/dye,73222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2645.81,,,,,,,fee schedule,926.08,2645.81, Mri joint upr extrem w/dye,73222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2645.81,APC Mri joint upr extrem w/dye,73222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2645.81,APC Mri joint upr extrem w/dye,73222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2645.81,APC Mri joint upr extr w/o&w/dye,73223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3753.81,,,,,,,fee schedule,412.14,4721.29, Mri joint upr extr w/o&w/dye,73223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4721.29,,,,,,,fee schedule,412.14,4721.29, Mri joint upr extr w/o&w/dye,73223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4721.29,APC Mri joint upr extr w/o&w/dye,73223,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4721.29,APC Mri joint upr extr w/o&w/dye,73223,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4721.29,APC Mr angio upr extr w/o&w/dye,73225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2197.69,,,,,,,fee schedule,2197.69,2764.11, Mr angio upr extr w/o&w/dye,73225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2764.11,,,,,,,fee schedule,2197.69,2764.11, X-ray exam hip uni 1 view,73501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.22,,,,,,,fee schedule,102.81,197.92, X-ray exam hip uni 1 view,73501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.95,,,,,,,fee schedule,102.81,197.92, X-ray exam hip uni 1 view,73501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.93,,,,,,,fee schedule,102.81,197.92, X-ray exam hip uni 1 view,73501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.92,,,,,,,fee schedule,102.81,197.92, X-ray exam hip uni 1 view,73501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,197.92,APC X-ray exam hip uni 1 view,73501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,197.92,APC X-ray exam hip uni 1 view,73501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,197.92,APC X-ray exam hip uni 2-3 views,73502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.22,,,,,,,fee schedule,102.81,305.2, X-ray exam hip uni 2-3 views,73502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.95,,,,,,,fee schedule,102.81,305.2, X-ray exam hip uni 2-3 views,73502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,254.33,,,,,,,fee schedule,102.81,305.2, X-ray exam hip uni 2-3 views,73502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,305.2,,,,,,,fee schedule,102.81,305.2, X-ray exam hip uni 2-3 views,73502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,305.2,APC X-ray exam hip uni 2-3 views,73502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,305.2,APC X-ray exam hip uni 2-3 views,73502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,305.2,APC X-ray exam hip uni 4/> views,73503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.22,,,,,,,fee schedule,119.22,387.66, X-ray exam hip uni 4/> views,73503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.95,,,,,,,fee schedule,119.22,387.66, X-ray exam hip uni 4/> views,73503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,323.05,,,,,,,fee schedule,119.22,387.66, X-ray exam hip uni 4/> views,73503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,387.66,,,,,,,fee schedule,119.22,387.66, X-ray exam hip uni 4/> views,73503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,119.22,387.66,APC X-ray exam hip uni 4/> views,73503,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,119.22,387.66,APC X-ray exam hip uni 4/> views,73503,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,119.22,387.66,APC X-ray exam hips bi 2 views,73521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.42,,,,,,,fee schedule,123.5,252.95, X-ray exam hips bi 2 views,73521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,171.58,,,,,,,fee schedule,123.5,252.95, X-ray exam hips bi 2 views,73521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,210.79,,,,,,,fee schedule,123.5,252.95, X-ray exam hips bi 2 views,73521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,252.95,,,,,,,fee schedule,123.5,252.95, X-ray exam hips bi 2 views,73521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,252.95,APC X-ray exam hips bi 2 views,73521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,252.95,APC X-ray exam hips bi 2 views,73521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,252.95,APC X-ray exam hips bi 3-4 views,73522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.42,,,,,,,fee schedule,123.5,329.94, X-ray exam hips bi 3-4 views,73522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,171.58,,,,,,,fee schedule,123.5,329.94, X-ray exam hips bi 3-4 views,73522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,274.95,,,,,,,fee schedule,123.5,329.94, X-ray exam hips bi 3-4 views,73522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,329.94,,,,,,,fee schedule,123.5,329.94, X-ray exam hips bi 3-4 views,73522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,329.94,APC X-ray exam hips bi 3-4 views,73522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,329.94,APC X-ray exam hips bi 3-4 views,73522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,329.94,APC X-ray exam hips bi 5/> views,73523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.42,,,,,,,fee schedule,123.5,387.66, X-ray exam hips bi 5/> views,73523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,171.58,,,,,,,fee schedule,123.5,387.66, X-ray exam hips bi 5/> views,73523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,323.05,,,,,,,fee schedule,123.5,387.66, X-ray exam hips bi 5/> views,73523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,387.66,,,,,,,fee schedule,123.5,387.66, X-ray exam hips bi 5/> views,73523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,387.66,APC X-ray exam hips bi 5/> views,73523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,387.66,APC X-ray exam hips bi 5/> views,73523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,387.66,APC Contrast x-ray of hip,73525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,381.53,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of hip,73525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,479.86,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of hip,73525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,694.27,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of hip,73525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,833.12,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of hip,73525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,381.53,833.12,APC Contrast x-ray of hip,73525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,381.53,833.12,APC Contrast x-ray of hip,73525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,381.53,833.12,APC X-ray exam of femur 1,73551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108.69,,,,,,,fee schedule,102.81,175.95, X-ray exam of femur 1,73551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.7,,,,,,,fee schedule,102.81,175.95, X-ray exam of femur 1,73551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.63,,,,,,,fee schedule,102.81,175.95, X-ray exam of femur 1,73551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,175.95,,,,,,,fee schedule,102.81,175.95, X-ray exam of femur 1,73551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,175.95,APC X-ray exam of femur 1,73551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,175.95,APC X-ray exam of femur 1,73551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,175.95,APC X-ray exam of femur 2/>,73552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108.69,,,,,,,fee schedule,102.81,222.66, X-ray exam of femur 2/>,73552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.7,,,,,,,fee schedule,102.81,222.66, X-ray exam of femur 2/>,73552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,185.55,,,,,,,fee schedule,102.81,222.66, X-ray exam of femur 2/>,73552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,222.66,,,,,,,fee schedule,102.81,222.66, X-ray exam of femur 2/>,73552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,222.66,APC X-ray exam of femur 2/>,73552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,222.66,APC X-ray exam of femur 2/>,73552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,222.66,APC X-ray exam of knee 1 or 2,73560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.99,,,,,,,fee schedule,99.99,217.19, X-ray exam of knee 1 or 2,73560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.76,,,,,,,fee schedule,99.99,217.19, X-ray exam of knee 1 or 2,73560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.99,,,,,,,fee schedule,99.99,217.19, X-ray exam of knee 1 or 2,73560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,217.19,,,,,,,fee schedule,99.99,217.19, X-ray exam of knee 1 or 2,73560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,99.99,217.19,APC X-ray exam of knee 1 or 2,73560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,99.99,217.19,APC X-ray exam of knee 1 or 2,73560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,99.99,217.19,APC X-ray exam of knee 3,73562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.85,,,,,,,fee schedule,102.81,263.89, X-ray exam of knee 3,73562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.17,,,,,,,fee schedule,102.81,263.89, X-ray exam of knee 3,73562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,219.91,,,,,,,fee schedule,102.81,263.89, X-ray exam of knee 3,73562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,263.89,,,,,,,fee schedule,102.81,263.89, X-ray exam of knee 3,73562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,263.89,APC X-ray exam of knee 3,73562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,263.89,APC X-ray exam of knee 3,73562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,263.89,APC X-ray exam knee 4 or more,73564,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,122.48,,,,,,,fee schedule,122.48,299.65, X-ray exam knee 4 or more,73564,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,154.05,,,,,,,fee schedule,122.48,299.65, X-ray exam knee 4 or more,73564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,249.71,,,,,,,fee schedule,122.48,299.65, X-ray exam knee 4 or more,73564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,299.65,,,,,,,fee schedule,122.48,299.65, X-ray exam knee 4 or more,73564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,122.48,299.65,APC X-ray exam knee 4 or more,73564,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,122.48,299.65,APC X-ray exam knee 4 or more,73564,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,122.48,299.65,APC X-ray exam of knees,73565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96,,,,,,,fee schedule,96,263.89, X-ray exam of knees,73565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,120.74,,,,,,,fee schedule,96,263.89, X-ray exam of knees,73565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,219.91,,,,,,,fee schedule,96,263.89, X-ray exam of knees,73565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,263.89,,,,,,,fee schedule,96,263.89, X-ray exam of knees,73565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,96,263.89,APC X-ray exam of knees,73565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,96,263.89,APC X-ray exam of knees,73565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,96,263.89,APC Contrast x-ray of knee joint,73580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,451.52,,,,,,,fee schedule,412.14,662.65, Contrast x-ray of knee joint,73580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,567.89,,,,,,,fee schedule,412.14,662.65, Contrast x-ray of knee joint,73580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,552.21,,,,,,,fee schedule,412.14,662.65, Contrast x-ray of knee joint,73580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,662.65,,,,,,,fee schedule,412.14,662.65, Contrast x-ray of knee joint,73580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,662.65,APC Contrast x-ray of knee joint,73580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,662.65,APC Contrast x-ray of knee joint,73580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,662.65,APC X-ray exam of lower leg,73590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.99,,,,,,,fee schedule,99.99,197.92, X-ray exam of lower leg,73590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.76,,,,,,,fee schedule,99.99,197.92, X-ray exam of lower leg,73590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.93,,,,,,,fee schedule,99.99,197.92, X-ray exam of lower leg,73590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.92,,,,,,,fee schedule,99.99,197.92, X-ray exam of lower leg,73590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,99.99,197.92,APC X-ray exam of lower leg,73590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,99.99,197.92,APC X-ray exam of lower leg,73590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,99.99,197.92,APC X-ray exam of leg infant,73592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.5,,,,,,,fee schedule,93.5,197.92, X-ray exam of leg infant,73592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.6,,,,,,,fee schedule,93.5,197.92, X-ray exam of leg infant,73592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.93,,,,,,,fee schedule,93.5,197.92, X-ray exam of leg infant,73592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.92,,,,,,,fee schedule,93.5,197.92, X-ray exam of leg infant,73592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,93.5,197.92,APC X-ray exam of leg infant,73592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,93.5,197.92,APC X-ray exam of leg infant,73592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,93.5,197.92,APC X-ray exam of ankle,73600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.5,,,,,,,fee schedule,93.5,203.4, X-ray exam of ankle,73600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.6,,,,,,,fee schedule,93.5,203.4, X-ray exam of ankle,73600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,169.5,,,,,,,fee schedule,93.5,203.4, X-ray exam of ankle,73600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,203.4,,,,,,,fee schedule,93.5,203.4, X-ray exam of ankle,73600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,93.5,203.4,APC X-ray exam of ankle,73600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,93.5,203.4,APC X-ray exam of ankle,73600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,93.5,203.4,APC X-ray exam of ankle,73610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.33,,,,,,,fee schedule,101.33,233.68, X-ray exam of ankle,73610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.44,,,,,,,fee schedule,101.33,233.68, X-ray exam of ankle,73610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,194.73,,,,,,,fee schedule,101.33,233.68, X-ray exam of ankle,73610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,233.68,,,,,,,fee schedule,101.33,233.68, X-ray exam of ankle,73610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,101.33,233.68,APC X-ray exam of ankle,73610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,101.33,233.68,APC X-ray exam of ankle,73610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,101.33,233.68,APC Contrast x-ray of ankle,73615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,381.53,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of ankle,73615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,479.86,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of ankle,73615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,694.27,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of ankle,73615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,833.12,,,,,,,fee schedule,381.53,833.12, Contrast x-ray of ankle,73615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,381.53,833.12,APC Contrast x-ray of ankle,73615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,381.53,833.12,APC Contrast x-ray of ankle,73615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,381.53,833.12,APC X-ray exam of foot,73620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.5,,,,,,,fee schedule,93.5,175.95, X-ray exam of foot,73620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.6,,,,,,,fee schedule,93.5,175.95, X-ray exam of foot,73620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.63,,,,,,,fee schedule,93.5,175.95, X-ray exam of foot,73620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,175.95,,,,,,,fee schedule,93.5,175.95, X-ray exam of foot,73620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,93.5,175.95,APC X-ray exam of foot,73620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,93.5,175.95,APC X-ray exam of foot,73620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,93.5,175.95,APC X-ray exam of foot,73630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.33,,,,,,,fee schedule,101.33,217.19, X-ray exam of foot,73630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.44,,,,,,,fee schedule,101.33,217.19, X-ray exam of foot,73630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.99,,,,,,,fee schedule,101.33,217.19, X-ray exam of foot,73630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,217.19,,,,,,,fee schedule,101.33,217.19, X-ray exam of foot,73630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,101.33,217.19,APC X-ray exam of foot,73630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,101.33,217.19,APC X-ray exam of foot,73630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,101.33,217.19,APC X-ray exam of heel,73650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.85,,,,,,,fee schedule,90.85,173.18, X-ray exam of heel,73650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.27,,,,,,,fee schedule,90.85,173.18, X-ray exam of heel,73650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,144.32,,,,,,,fee schedule,90.85,173.18, X-ray exam of heel,73650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,173.18,,,,,,,fee schedule,90.85,173.18, X-ray exam of heel,73650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,90.85,173.18,APC X-ray exam of heel,73650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,90.85,173.18,APC X-ray exam of heel,73650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,90.85,173.18,APC X-ray exam of toe(s),73660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.38,,,,,,,fee schedule,79.38,189.67, X-ray exam of toe(s),73660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.84,,,,,,,fee schedule,79.38,189.67, X-ray exam of toe(s),73660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,158.06,,,,,,,fee schedule,79.38,189.67, X-ray exam of toe(s),73660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,189.67,,,,,,,fee schedule,79.38,189.67, X-ray exam of toe(s),73660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,79.38,189.67,APC X-ray exam of toe(s),73660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,79.38,189.67,APC X-ray exam of toe(s),73660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,79.38,189.67,APC Ct lower extremity w/o dye,73700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,865.46,,,,,,,fee schedule,123.5,1088.52, Ct lower extremity w/o dye,73700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1088.52,,,,,,,fee schedule,123.5,1088.52, Ct lower extremity w/o dye,73700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1088.52,APC Ct lower extremity w/o dye,73700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1088.52,APC Ct lower extremity w/o dye,73700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1088.52,APC Ct lower extremity w/dye,73701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1008.93,,,,,,,fee schedule,207.21,1268.96, Ct lower extremity w/dye,73701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1268.96,,,,,,,fee schedule,207.21,1268.96, Ct lower extremity w/dye,73701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1268.96,APC Ct lower extremity w/dye,73701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1268.96,APC Ct lower extremity w/dye,73701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1268.96,APC Ct lwr extremity w/o&w/dye,73702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1227.85,,,,,,,fee schedule,207.21,1544.3, Ct lwr extremity w/o&w/dye,73702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1544.3,,,,,,,fee schedule,207.21,1544.3, Ct lwr extremity w/o&w/dye,73702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1544.3,APC Ct lwr extremity w/o&w/dye,73702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1544.3,APC Ct lwr extremity w/o&w/dye,73702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1544.3,APC Ct angio lwr extr w/o&w/dye,73706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1811.5,,,,,,,fee schedule,207.21,2278.39, Ct angio lwr extr w/o&w/dye,73706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2278.39,,,,,,,fee schedule,207.21,2278.39, Ct angio lwr extr w/o&w/dye,73706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2278.39,APC Ct angio lwr extr w/o&w/dye,73706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2278.39,APC Ct angio lwr extr w/o&w/dye,73706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2278.39,APC Mri Lower Extremity W/O Dye,73718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1752.81,,,,,,,fee schedule,281.87,2204.56, Mri Lower Extremity W/O Dye,73718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2204.56,,,,,,,fee schedule,281.87,2204.56, Mri Lower Extremity W/O Dye,73718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2204.56,APC Mri Lower Extremity W/O Dye,73718,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2204.56,APC Mri Lower Extremity W/O Dye,73718,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2204.56,APC Mri Lower Extremity W/Dye,73719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2103.64,,,,,,,fee schedule,412.14,2645.81, Mri Lower Extremity W/Dye,73719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2645.81,,,,,,,fee schedule,412.14,2645.81, Mri Lower Extremity W/Dye,73719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2645.81,APC Mri Lower Extremity W/Dye,73719,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2645.81,APC Mri Lower Extremity W/Dye,73719,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2645.81,APC Mri lwr extremity w/o&w/dye,73720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3752.5,,,,,,,fee schedule,412.14,4719.64, Mri lwr extremity w/o&w/dye,73720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4719.64,,,,,,,fee schedule,412.14,4719.64, Mri lwr extremity w/o&w/dye,73720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4719.64,APC Mri lwr extremity w/o&w/dye,73720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4719.64,APC Mri lwr extremity w/o&w/dye,73720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4719.64,APC Mri jnt of lwr extre w/o dye,73721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1752.81,,,,,,,fee schedule,281.87,2204.56, Mri jnt of lwr extre w/o dye,73721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2204.56,,,,,,,fee schedule,281.87,2204.56, Mri jnt of lwr extre w/o dye,73721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2204.56,APC Mri jnt of lwr extre w/o dye,73721,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2204.56,APC Mri jnt of lwr extre w/o dye,73721,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2204.56,APC Mri Joint Of Lwr Extr W/Dye,73722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2103.64,,,,,,,fee schedule,926.08,2645.81, Mri Joint Of Lwr Extr W/Dye,73722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2645.81,,,,,,,fee schedule,926.08,2645.81, Mri Joint Of Lwr Extr W/Dye,73722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2645.81,APC Mri Joint Of Lwr Extr W/Dye,73722,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2645.81,APC Mri Joint Of Lwr Extr W/Dye,73722,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2645.81,APC Mri joint lwr extr w/o&w/dye,73723,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3753.81,,,,,,,fee schedule,412.14,4721.29, Mri joint lwr extr w/o&w/dye,73723,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4721.29,,,,,,,fee schedule,412.14,4721.29, Mri joint lwr extr w/o&w/dye,73723,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4721.29,APC Mri joint lwr extr w/o&w/dye,73723,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4721.29,APC Mri joint lwr extr w/o&w/dye,73723,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4721.29,APC Mr ang lwr ext w or w/o dye,73725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1850.96,,,,,,,fee schedule,1850.96,2328.02, Mr ang lwr ext w or w/o dye,73725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2328.02,,,,,,,fee schedule,1850.96,2328.02, X-ray exam abdomen 1 view,74018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,130.92,,,,,,,fee schedule,102.81,178.66, X-ray exam abdomen 1 view,74018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,164.66,,,,,,,fee schedule,102.81,178.66, X-ray exam abdomen 1 view,74018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,148.88,,,,,,,fee schedule,102.81,178.66, X-ray exam abdomen 1 view,74018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,178.66,,,,,,,fee schedule,102.81,178.66, X-ray exam abdomen 1 view,74018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,178.66,APC X-ray exam abdomen 1 view,74018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,178.66,APC X-ray exam abdomen 1 view,74018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,178.66,APC X-ray exam abdomen 2 views,74019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,130.92,,,,,,,fee schedule,123.5,214.41, X-ray exam abdomen 2 views,74019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,164.66,,,,,,,fee schedule,123.5,214.41, X-ray exam abdomen 2 views,74019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,178.68,,,,,,,fee schedule,123.5,214.41, X-ray exam abdomen 2 views,74019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,214.41,,,,,,,fee schedule,123.5,214.41, X-ray exam abdomen 2 views,74019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,214.41,APC X-ray exam abdomen 2 views,74019,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,214.41,APC X-ray exam abdomen 2 views,74019,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,214.41,APC X-ray exam abdomen 3+ views,74021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,130.92,,,,,,,fee schedule,123.5,250.17, X-ray exam abdomen 3+ views,74021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,164.66,,,,,,,fee schedule,123.5,250.17, X-ray exam abdomen 3+ views,74021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.48,,,,,,,fee schedule,123.5,250.17, X-ray exam abdomen 3+ views,74021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.17,,,,,,,fee schedule,123.5,250.17, X-ray exam abdomen 3+ views,74021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,250.17,APC X-ray exam abdomen 3+ views,74021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,250.17,APC X-ray exam abdomen 3+ views,74021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,250.17,APC X-ray exam series abdomen,74022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.71,,,,,,,fee schedule,123.5,288.63, X-ray exam series abdomen,74022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,193.32,,,,,,,fee schedule,123.5,288.63, X-ray exam series abdomen,74022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,240.53,,,,,,,fee schedule,123.5,288.63, X-ray exam series abdomen,74022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,288.63,,,,,,,fee schedule,123.5,288.63, X-ray exam series abdomen,74022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,288.63,APC X-ray exam series abdomen,74022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,288.63,APC X-ray exam series abdomen,74022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,288.63,APC Ct abdomen w/o dye,74150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,979.39,,,,,,,fee schedule,123.5,1231.81, Ct abdomen w/o dye,74150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1231.81,,,,,,,fee schedule,123.5,1231.81, Ct abdomen w/o dye,74150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1231.81,APC Ct abdomen w/o dye,74150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1231.81,APC Ct abdomen w/o dye,74150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1231.81,APC Ct abdomen w/dye,74160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1156.99,,,,,,,fee schedule,207.21,1455.18, Ct abdomen w/dye,74160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1455.18,,,,,,,fee schedule,207.21,1455.18, Ct abdomen w/dye,74160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1455.18,APC Ct abdomen w/dye,74160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1455.18,APC Ct abdomen w/dye,74160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1455.18,APC Ct abdomen w/o & w/dye,74170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1404.31,,,,,,,fee schedule,207.21,1766.24, Ct abdomen w/o & w/dye,74170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1766.24,,,,,,,fee schedule,207.21,1766.24, Ct abdomen w/o & w/dye,74170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1766.24,APC Ct abdomen w/o & w/dye,74170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1766.24,APC Ct abdomen w/o & w/dye,74170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1766.24,APC Ct angio abd&pelv w/o&w/dye,74174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3893,,,,,,,fee schedule,412.14,4896.35, Ct angio abd&pelv w/o&w/dye,74174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4896.35,,,,,,,fee schedule,412.14,4896.35, Ct angio abd&pelv w/o&w/dye,74174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4896.35,APC Ct angio abd&pelv w/o&w/dye,74174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4896.35,APC Ct angio abd&pelv w/o&w/dye,74174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4896.35,APC Ct angio abdom w/o & w/dye,74175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1953.05,,,,,,,fee schedule,207.21,2456.41, Ct angio abdom w/o & w/dye,74175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2456.41,,,,,,,fee schedule,207.21,2456.41, Ct angio abdom w/o & w/dye,74175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2456.41,APC Ct angio abdom w/o & w/dye,74175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2456.41,APC Ct angio abdom w/o & w/dye,74175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2456.41,APC Ct abd & pelvis w/o contrast,74176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2429.38,,,,,,,fee schedule,281.87,3055.51, Ct abd & pelvis w/o contrast,74176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3055.51,,,,,,,fee schedule,281.87,3055.51, Ct abd & pelvis w/o contrast,74176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,3055.51,APC Ct abd & pelvis w/o contrast,74176,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,3055.51,APC Ct abd & pelvis w/o contrast,74176,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,3055.51,APC Ct abd & pelv w/contrast,74177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3319.55,,,,,,,fee schedule,412.14,4175.11, Ct abd & pelv w/contrast,74177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4175.11,,,,,,,fee schedule,412.14,4175.11, Ct abd & pelv w/contrast,74177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4175.11,APC Ct abd & pelv w/contrast,74177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4175.11,APC Ct abd & pelv w/contrast,74177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4175.11,APC Ct abd & pelv 1/> regns,74178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3716.01,,,,,,,fee schedule,412.14,4673.75, Ct abd & pelv 1/> regns,74178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4673.75,,,,,,,fee schedule,412.14,4673.75, Ct abd & pelv 1/> regns,74178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4673.75,APC Ct abd & pelv 1/> regns,74178,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4673.75,APC Ct abd & pelv 1/> regns,74178,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4673.75,APC Mri abdomen w/o dye,74181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1776.99,,,,,,,fee schedule,281.87,2234.98, Mri abdomen w/o dye,74181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2234.98,,,,,,,fee schedule,281.87,2234.98, Mri abdomen w/o dye,74181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2234.98,APC Mri abdomen w/o dye,74181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2234.98,APC Mri abdomen w/o dye,74181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2234.98,APC Mri Abdomen W/Dye,74182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2127.82,,,,,,,fee schedule,412.14,2676.23, Mri Abdomen W/Dye,74182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2676.23,,,,,,,fee schedule,412.14,2676.23, Mri Abdomen W/Dye,74182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2676.23,APC Mri Abdomen W/Dye,74182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2676.23,APC Mri Abdomen W/Dye,74182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2676.23,APC Mri abdomen w/o & w/dye,74183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3778.72,,,,,,,fee schedule,412.14,4752.62, Mri abdomen w/o & w/dye,74183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4752.62,,,,,,,fee schedule,412.14,4752.62, Mri abdomen w/o & w/dye,74183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,4752.62,APC Mri abdomen w/o & w/dye,74183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,4752.62,APC Mri abdomen w/o & w/dye,74183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,4752.62,APC Mri angio abdom w orw/o dye,74185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1847.33,,,,,,,fee schedule,1847.33,2323.44, Mri angio abdom w orw/o dye,74185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2323.44,,,,,,,fee schedule,1847.33,2323.44, X-ray exam of peritoneum,74190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,260.56,,,,,,,fee schedule,224.36,677.78, X-ray exam of peritoneum,74190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,327.72,,,,,,,fee schedule,224.36,677.78, X-ray exam of peritoneum,74190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,224.36,,,,,,,fee schedule,224.36,677.78, X-ray exam of peritoneum,74190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,269.23,,,,,,,fee schedule,224.36,677.78, X-ray exam of peritoneum,74190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,224.36,677.78,APC X-ray exam of peritoneum,74190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,224.36,677.78,APC X-ray exam of peritoneum,74190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,224.36,677.78,APC Contrst x-ray exam of throat,74210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,224.33,,,,,,,fee schedule,207.21,555.37, Contrst x-ray exam of throat,74210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,282.15,,,,,,,fee schedule,207.21,555.37, Contrst x-ray exam of throat,74210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,462.81,,,,,,,fee schedule,207.21,555.37, Contrst x-ray exam of throat,74210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,555.37,,,,,,,fee schedule,207.21,555.37, Contrst x-ray exam of throat,74210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,555.37,APC Contrst x-ray exam of throat,74210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,555.37,APC Contrst x-ray exam of throat,74210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,555.37,APC Contrast x-ray esophagus,74220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,239.9,,,,,,,fee schedule,207.21,571.86, Contrast x-ray esophagus,74220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,301.73,,,,,,,fee schedule,207.21,571.86, Contrast x-ray esophagus,74220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,476.55,,,,,,,fee schedule,207.21,571.86, Contrast x-ray esophagus,74220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,571.86,,,,,,,fee schedule,207.21,571.86, Contrast x-ray esophagus,74220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,571.86,APC Contrast x-ray esophagus,74220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,571.86,APC Contrast x-ray esophagus,74220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,571.86,APC X-ray xm esophagus 2cntrst,74221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,530.26,,,,,,,fee schedule,207.21,666.93, X-ray xm esophagus 2cntrst,74221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,666.93,,,,,,,fee schedule,207.21,666.93, X-ray xm esophagus 2cntrst,74221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,529.28,,,,,,,fee schedule,207.21,666.93, X-ray xm esophagus 2cntrst,74221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.13,,,,,,,fee schedule,207.21,666.93, X-ray xm esophagus 2cntrst,74221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,666.93,APC X-ray xm esophagus 2cntrst,74221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,666.93,APC X-ray xm esophagus 2cntrst,74221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,666.93,APC Cine/vid x-ray throat/esoph,74230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,267.66,,,,,,,fee schedule,207.21,822.11, Cine/vid x-ray throat/esoph,74230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,336.65,,,,,,,fee schedule,207.21,822.11, Cine/vid x-ray throat/esoph,74230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,685.09,,,,,,,fee schedule,207.21,822.11, Cine/vid x-ray throat/esoph,74230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,822.11,,,,,,,fee schedule,207.21,822.11, Cine/vid x-ray throat/esoph,74230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,822.11,APC Cine/vid x-ray throat/esoph,74230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,822.11,APC Cine/vid x-ray throat/esoph,74230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,822.11,APC Remove esophagus obstruction,74235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,559.07,,,,,,,fee schedule,559.07,703.16, Remove esophagus obstruction,74235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,703.16,,,,,,,fee schedule,559.07,703.16, X-ray upper gi delay w/o kub,74240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,316.2,,,,,,,fee schedule,207.21,701.11, X-ray upper gi delay w/o kub,74240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,397.7,,,,,,,fee schedule,207.21,701.11, X-ray upper gi delay w/o kub,74240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,584.26,,,,,,,fee schedule,207.21,701.11, X-ray upper gi delay w/o kub,74240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,701.11,,,,,,,fee schedule,207.21,701.11, X-ray upper gi delay w/o kub,74240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,701.11,APC X-ray upper gi delay w/o kub,74240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,701.11,APC X-ray upper gi delay w/o kub,74240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,701.11,APC Contrst x-ray uppr gi tract,74246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,342.22,,,,,,,fee schedule,207.21,800.14, Contrst x-ray uppr gi tract,74246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,430.42,,,,,,,fee schedule,207.21,800.14, Contrst x-ray uppr gi tract,74246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,666.78,,,,,,,fee schedule,207.21,800.14, Contrst x-ray uppr gi tract,74246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,800.14,,,,,,,fee schedule,207.21,800.14, Contrst x-ray uppr gi tract,74246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,800.14,APC Contrst x-ray uppr gi tract,74246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,800.14,APC Contrst x-ray uppr gi tract,74246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,800.14,APC X-ray sm int f-thru std,74248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,505.99,,,,,,,fee schedule,505.99,636.4, X-ray sm int f-thru std,74248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,636.4,,,,,,,fee schedule,505.99,636.4, X-ray exam of small bowel,74250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,258.06,,,,,,,fee schedule,207.21,692.86, X-ray exam of small bowel,74250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,324.57,,,,,,,fee schedule,207.21,692.86, X-ray exam of small bowel,74250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,577.38,,,,,,,fee schedule,207.21,692.86, X-ray exam of small bowel,74250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,692.86,,,,,,,fee schedule,207.21,692.86, X-ray exam of small bowel,74250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,692.86,APC X-ray exam of small bowel,74250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,692.86,APC X-ray exam of small bowel,74250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,692.86,APC X-ray exam of small bowel,74251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,295.19,,,,,,,fee schedule,207.21,2537.97, X-ray exam of small bowel,74251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,371.27,,,,,,,fee schedule,207.21,2537.97, X-ray exam of small bowel,74251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2114.98,,,,,,,fee schedule,207.21,2537.97, X-ray exam of small bowel,74251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2537.97,,,,,,,fee schedule,207.21,2537.97, X-ray exam of small bowel,74251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,2537.97,APC X-ray exam of small bowel,74251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,2537.97,APC X-ray exam of small bowel,74251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,2537.97,APC Ct colonography dx,74261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,869.04,,,,,,,fee schedule,123.5,1093.02, Ct colonography dx,74261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1093.02,,,,,,,fee schedule,123.5,1093.02, Ct colonography dx,74261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1093.02,APC Ct colonography dx,74261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1093.02,APC Ct colonography dx,74261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1093.02,APC Ct colonography dx w/dye,74262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1076.93,,,,,,,fee schedule,207.21,1354.49, Ct colonography dx w/dye,74262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1354.49,,,,,,,fee schedule,207.21,1354.49, Ct colonography dx w/dye,74262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1354.49,APC Ct colonography dx w/dye,74262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1354.49,APC Ct colonography dx w/dye,74262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1354.49,APC Ct colonography screening,74263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Ct colonography screening,74263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Ct colonography screening,74263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Contrast x-ray exam of colon,74270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,351.24,,,,,,,fee schedule,207.21,866.11, Contrast x-ray exam of colon,74270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,441.76,,,,,,,fee schedule,207.21,866.11, Contrast x-ray exam of colon,74270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,721.76,,,,,,,fee schedule,207.21,866.11, Contrast x-ray exam of colon,74270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,866.11,,,,,,,fee schedule,207.21,866.11, Contrast x-ray exam of colon,74270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,866.11,APC Contrast x-ray exam of colon,74270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,866.11,APC Contrast x-ray exam of colon,74270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,866.11,APC Contrast x-ray exam of colon,74280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,471.59,,,,,,,fee schedule,207.21,1325.29, Contrast x-ray exam of colon,74280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,593.14,,,,,,,fee schedule,207.21,1325.29, Contrast x-ray exam of colon,74280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1104.41,,,,,,,fee schedule,207.21,1325.29, Contrast x-ray exam of colon,74280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1325.29,,,,,,,fee schedule,207.21,1325.29, Contrast x-ray exam of colon,74280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1325.29,APC Contrast x-ray exam of colon,74280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1325.29,APC Contrast x-ray exam of colon,74280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1325.29,APC Contrast x-ray exam of colon,74283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,686.15,,,,,,,fee schedule,207.21,1289.6, Contrast x-ray exam of colon,74283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,862.99,,,,,,,fee schedule,207.21,1289.6, Contrast x-ray exam of colon,74283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1074.67,,,,,,,fee schedule,207.21,1289.6, Contrast x-ray exam of colon,74283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1289.6,,,,,,,fee schedule,207.21,1289.6, Contrast x-ray exam of colon,74283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1289.6,APC Contrast x-ray exam of colon,74283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1289.6,APC Contrast x-ray exam of colon,74283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1289.6,APC Contrast x-ray gallbladder,74290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.71,,,,,,,fee schedule,153.71,577.41, Contrast x-ray gallbladder,74290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,193.32,,,,,,,fee schedule,153.71,577.41, Contrast x-ray gallbladder,74290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,481.17,,,,,,,fee schedule,153.71,577.41, Contrast x-ray gallbladder,74290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,577.41,,,,,,,fee schedule,153.71,577.41, Contrast x-ray gallbladder,74290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,153.71,577.41,APC Contrast x-ray gallbladder,74290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,153.71,577.41,APC Contrast x-ray gallbladder,74290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,153.71,577.41,APC X-ray bile ducts/pancreas,74300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,157.95,,,,,,,fee schedule,157.95,198.66, X-ray bile ducts/pancreas,74300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,198.66,,,,,,,fee schedule,157.95,198.66, X-ray bile duct endoscopy,74328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,551.68,,,,,,,fee schedule,551.68,693.86, X-ray bile duct endoscopy,74328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,693.86,,,,,,,fee schedule,551.68,693.86, X-ray for pancreas endoscopy,74329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,551.68,,,,,,,fee schedule,551.68,693.86, X-ray for pancreas endoscopy,74329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,693.86,,,,,,,fee schedule,551.68,693.86, X-ray bile/panc endoscopy,74330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,583.83,,,,,,,fee schedule,583.83,734.31, X-ray bile/panc endoscopy,74330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,734.31,,,,,,,fee schedule,583.83,734.31, X-ray guide for GI tube,74340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,451.84,,,,,,,fee schedule,451.84,568.29, X-ray guide for GI tube,74340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,568.29,,,,,,,fee schedule,451.84,568.29, X-ray guide intestinal tube,74355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,487.63,,,,,,,fee schedule,487.63,613.31, X-ray guide intestinal tube,74355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,613.31,,,,,,,fee schedule,487.63,613.31, X-ray guide gi dilation,74360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,527.84,,,,,,,fee schedule,527.84,663.89, X-ray guide gi dilation,74360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,663.89,,,,,,,fee schedule,527.84,663.89, X-ray bile duct dilation,74363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,990.86,,,,,,,fee schedule,990.86,1246.23, X-ray bile duct dilation,74363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1246.23,,,,,,,fee schedule,990.86,1246.23, Contrst x-ray urinary tract,74400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,315.09,,,,,,,fee schedule,207.21,923.77, Contrst x-ray urinary tract,74400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,396.3,,,,,,,fee schedule,207.21,923.77, Contrst x-ray urinary tract,74400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,769.81,,,,,,,fee schedule,207.21,923.77, Contrst x-ray urinary tract,74400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,923.77,,,,,,,fee schedule,207.21,923.77, Contrst x-ray urinary tract,74400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,923.77,APC Contrst x-ray urinary tract,74400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,923.77,APC Contrst x-ray urinary tract,74400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,923.77,APC Contrst x-ray urinary tract,74410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,351.06,,,,,,,fee schedule,207.21,981.57, Contrst x-ray urinary tract,74410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,441.54,,,,,,,fee schedule,207.21,981.57, Contrst x-ray urinary tract,74410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,817.97,,,,,,,fee schedule,207.21,981.57, Contrst x-ray urinary tract,74410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,981.57,,,,,,,fee schedule,207.21,981.57, Contrst x-ray urinary tract,74410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,981.57,APC Contrst x-ray urinary tract,74410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,981.57,APC Contrst x-ray urinary tract,74410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,981.57,APC Contrst x-ray urinary tract,74415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,374.72,,,,,,,fee schedule,207.21,1058.56, Contrst x-ray urinary tract,74415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,471.3,,,,,,,fee schedule,207.21,1058.56, Contrst x-ray urinary tract,74415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,882.13,,,,,,,fee schedule,207.21,1058.56, Contrst x-ray urinary tract,74415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1058.56,,,,,,,fee schedule,207.21,1058.56, Contrst x-ray urinary tract,74415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,1058.56,APC Contrst x-ray urinary tract,74415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,1058.56,APC Contrst x-ray urinary tract,74415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,1058.56,APC Contrst x-ray urinary tract,74420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,423,,,,,,,fee schedule,371.16,532.02, Contrst x-ray urinary tract,74420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,532.02,,,,,,,fee schedule,371.16,532.02, Contrst x-ray urinary tract,74420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,371.16,,,,,,,fee schedule,371.16,532.02, Contrst x-ray urinary tract,74420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,445.39,,,,,,,fee schedule,371.16,532.02, Contrst x-ray urinary tract,74420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,371.16,532.02,APC Contrst x-ray urinary tract,74420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,371.16,532.02,APC Contrst x-ray urinary tract,74420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,371.16,532.02,APC Contrst x-ray urinary tract,74425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.36,,,,,,,fee schedule,241.36,926.61, Contrst x-ray urinary tract,74425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,303.56,,,,,,,fee schedule,241.36,926.61, Contrst x-ray urinary tract,74425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,772.18,,,,,,,fee schedule,241.36,926.61, Contrst x-ray urinary tract,74425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,926.61,,,,,,,fee schedule,241.36,926.61, Contrst x-ray urinary tract,74425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,241.36,926.61,APC Contrst x-ray urinary tract,74425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,241.36,926.61,APC Contrst x-ray urinary tract,74425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,241.36,926.61,APC Contrast x-ray bladder,74430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,198.4,,,,,,,fee schedule,180.99,432.75, Contrast x-ray bladder,74430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,249.54,,,,,,,fee schedule,180.99,432.75, Contrast x-ray bladder,74430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.99,,,,,,,fee schedule,180.99,432.75, Contrast x-ray bladder,74430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,217.19,,,,,,,fee schedule,180.99,432.75, Contrast x-ray bladder,74430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,180.99,432.75,APC Contrast x-ray bladder,74430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,180.99,432.75,APC Contrast x-ray bladder,74430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,180.99,432.75,APC X-ray male genital tract,74440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,218.66,,,,,,,fee schedule,218.66,659.87, X-ray male genital tract,74440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,275.01,,,,,,,fee schedule,218.66,659.87, X-ray male genital tract,74440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,549.9,,,,,,,fee schedule,218.66,659.87, X-ray male genital tract,74440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,659.87,,,,,,,fee schedule,218.66,659.87, X-ray male genital tract,74440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,218.66,659.87,APC X-ray male genital tract,74440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,218.66,659.87,APC X-ray male genital tract,74440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,218.66,659.87,APC X-ray exam of penis,74445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,344.98,,,,,,,fee schedule,123.5,433.89, X-ray exam of penis,74445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,433.89,,,,,,,fee schedule,123.5,433.89, X-ray exam of penis,74445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,272.41,,,,,,,fee schedule,123.5,433.89, X-ray exam of penis,74445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,326.89,,,,,,,fee schedule,123.5,433.89, X-ray exam of penis,74445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,433.89,APC X-ray exam of penis,74445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,433.89,APC X-ray exam of penis,74445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,433.89,APC X-ray urethra/bladder,74450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,257.54,,,,,,,fee schedule,257.54,423.01, X-ray urethra/bladder,74450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,323.91,,,,,,,fee schedule,257.54,423.01, X-ray urethra/bladder,74450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,352.51,,,,,,,fee schedule,257.54,423.01, X-ray urethra/bladder,74450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,423.01,,,,,,,fee schedule,257.54,423.01, X-ray urethra/bladder,74450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,257.54,423.01,APC X-ray urethra/bladder,74450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,257.54,423.01,APC X-ray urethra/bladder,74450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,257.54,423.01,APC X-ray urethra/bladder,74455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,275.58,,,,,,,fee schedule,275.58,731.39, X-ray urethra/bladder,74455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,346.6,,,,,,,fee schedule,275.58,731.39, X-ray urethra/bladder,74455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,609.49,,,,,,,fee schedule,275.58,731.39, X-ray urethra/bladder,74455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,731.39,,,,,,,fee schedule,275.58,731.39, X-ray urethra/bladder,74455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,275.58,731.39,APC X-ray urethra/bladder,74455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,275.58,731.39,APC X-ray urethra/bladder,74455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,275.58,731.39,APC X-ray exam of kidney lesion,74470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,262.16,,,,,,,fee schedule,262.16,677.78, X-ray exam of kidney lesion,74470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,329.73,,,,,,,fee schedule,262.16,677.78, X-ray exam of kidney lesion,74470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,299.84,,,,,,,fee schedule,262.16,677.78, X-ray exam of kidney lesion,74470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,359.81,,,,,,,fee schedule,262.16,677.78, X-ray exam of kidney lesion,74470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,262.16,677.78,APC X-ray exam of kidney lesion,74470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,262.16,677.78,APC X-ray exam of kidney lesion,74470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,262.16,677.78,APC X-ray guide gu dilation,74485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,525.2,,,,,,,fee schedule,525.2,2592.94, X-ray guide gu dilation,74485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,660.56,,,,,,,fee schedule,525.2,2592.94, X-ray guide gu dilation,74485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.77,,,,,,,fee schedule,525.2,2592.94, X-ray guide gu dilation,74485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,668.12,,,,,,,fee schedule,525.2,2592.94, X-ray guide gu dilation,74485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2568.24,,,,,,,fee schedule,525.2,2592.94,APC X-ray guide gu dilation,74485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2592.94,,,,,,,fee schedule,525.2,2592.94,APC X-ray guide gu dilation,74485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2469.46,,,,,,,fee schedule,525.2,2592.94,APC X-ray measurement of pelvis,74710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,202.04,,,,,,,fee schedule,202.04,254.11, X-ray measurement of pelvis,74710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,254.11,,,,,,,fee schedule,202.04,254.11, Mri fetal sngl/1st gestation,74712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,796,,,,,,,fee schedule,281.87,1001.16, Mri fetal sngl/1st gestation,74712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1001.16,,,,,,,fee schedule,281.87,1001.16, Mri fetal sngl/1st gestation,74712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1001.16,APC Mri fetal sngl/1st gestation,74712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1001.16,APC Mri fetal sngl/1st gestation,74712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1001.16,APC X-ray female genital tract,74740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,244.99,,,,,,,fee schedule,244.99,624.12, X-ray female genital tract,74740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,308.14,,,,,,,fee schedule,244.99,624.12, X-ray female genital tract,74740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,520.1,,,,,,,fee schedule,244.99,624.12, X-ray female genital tract,74740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,624.12,,,,,,,fee schedule,244.99,624.12, X-ray female genital tract,74740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,244.99,624.12,APC X-ray female genital tract,74740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,244.99,624.12,APC X-ray female genital tract,74740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,244.99,624.12,APC X-ray fallopian tube,74742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,537.27,,,,,,,fee schedule,537.27,675.75, X-ray fallopian tube,74742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,675.75,,,,,,,fee schedule,537.27,675.75, X-ray exam of perineum,74775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,305.43,,,,,,,fee schedule,281.87,425.78, X-ray exam of perineum,74775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,384.15,,,,,,,fee schedule,281.87,425.78, X-ray exam of perineum,74775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,354.82,,,,,,,fee schedule,281.87,425.78, X-ray exam of perineum,74775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,425.78,,,,,,,fee schedule,281.87,425.78, X-ray exam of perineum,74775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,425.78,APC X-ray exam of perineum,74775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,425.78,APC X-ray exam of perineum,74775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,425.78,APC Cardiac mri for morph,75557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,896.77,,,,,,,fee schedule,281.87,1127.9, Cardiac mri for morph,75557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1127.9,,,,,,,fee schedule,281.87,1127.9, Cardiac mri for morph,75557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1127.9,APC Cardiac mri for morph,75557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1127.9,APC Cardiac mri for morph,75557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1127.9,APC Cardiac mri w/stress img,75559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1103.36,,,,,,,fee schedule,645.5,1387.73, Cardiac mri w/stress img,75559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1387.73,,,,,,,fee schedule,645.5,1387.73, Cardiac mri w/stress img,75559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,1387.73,APC Cardiac mri w/stress img,75559,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,1387.73,APC Cardiac mri w/stress img,75559,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,1387.73,APC Cardiac mri for morph w/dye,75561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1436.52,,,,,,,fee schedule,412.14,1806.76, Cardiac mri for morph w/dye,75561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1806.76,,,,,,,fee schedule,412.14,1806.76, Cardiac mri for morph w/dye,75561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1806.76,APC Cardiac mri for morph w/dye,75561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1806.76,APC Cardiac mri for morph w/dye,75561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1806.76,APC Card mri w/stress img & dye,75563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1745.3,,,,,,,fee schedule,926.08,2195.12, Card mri w/stress img & dye,75563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2195.12,,,,,,,fee schedule,926.08,2195.12, Card mri w/stress img & dye,75563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2195.12,APC Card mri w/stress img & dye,75563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2195.12,APC Card mri w/stress img & dye,75563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2195.12,APC Card mri veloc flow mapping,75565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3300.03,,,,,,,fee schedule,3300.03,4150.55, Card mri veloc flow mapping,75565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4150.55,,,,,,,fee schedule,3300.03,4150.55, Ct hrt w/o dye w/ca test,75571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,166.39,,,,,,,fee schedule,102.81,209.28, Ct hrt w/o dye w/ca test,75571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,209.28,,,,,,,fee schedule,102.81,209.28, Ct hrt w/o dye w/ca test,75571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,209.28,APC Ct hrt w/o dye w/ca test,75571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,209.28,APC Ct hrt w/o dye w/ca test,75571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,209.28,APC Ct hrt w/3d image,75572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1192.81,,,,,,,fee schedule,412.14,1500.23, Ct hrt w/3d image,75572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1500.23,,,,,,,fee schedule,412.14,1500.23, Ct hrt w/3d image,75572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1500.23,APC Ct hrt w/3d image,75572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1500.23,APC Ct hrt w/3d image,75572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1500.23,APC Ct hrt w/3d image congen,75573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2169,,,,,,,fee schedule,412.14,2728.02, Ct hrt w/3d image congen,75573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2728.02,,,,,,,fee schedule,412.14,2728.02, Ct hrt w/3d image congen,75573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2728.02,APC Ct hrt w/3d image congen,75573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2728.02,APC Ct hrt w/3d image congen,75573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2728.02,APC Ct angio hrt w/3d image,75574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1601.26,,,,,,,fee schedule,412.14,2013.95, Ct angio hrt w/3d image,75574,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2013.95,,,,,,,fee schedule,412.14,2013.95, Ct angio hrt w/3d image,75574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2013.95,APC Ct angio hrt w/3d image,75574,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2013.95,APC Ct angio hrt w/3d image,75574,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2013.95,APC N-invas est c ffr sw aly cta,75580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2901.91,,,,,,,fee schedule,1014.47,3649.83, N-invas est c ffr sw aly cta,75580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3649.83,,,,,,,fee schedule,1014.47,3649.83, N-invas est c ffr sw aly cta,75580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,3649.83,APC N-invas est c ffr sw aly cta,75580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,3649.83,APC N-invas est c ffr sw aly cta,75580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,3649.83,APC Contrast exam thoracic aorta,75600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1828.99,,,,,,,fee schedule,1095.23,3916.58, Contrast exam thoracic aorta,75600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2300.38,,,,,,,fee schedule,1095.23,3916.58, Contrast exam thoracic aorta,75600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1095.23,,,,,,,fee schedule,1095.23,3916.58, Contrast exam thoracic aorta,75600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1314.27,,,,,,,fee schedule,1095.23,3916.58, Contrast exam thoracic aorta,75600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1095.23,3916.58,APC Contrast exam thoracic aorta,75600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1095.23,3916.58,APC Contrast exam thoracic aorta,75600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1095.23,3916.58,APC Contrast exam thoracic aorta,75605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1935.24,,,,,,,fee schedule,469.68,6902.26, Contrast exam thoracic aorta,75605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2434.01,,,,,,,fee schedule,469.68,6902.26, Contrast exam thoracic aorta,75605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,469.68,,,,,,,fee schedule,469.68,6902.26, Contrast exam thoracic aorta,75605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,563.62,,,,,,,fee schedule,469.68,6902.26, Contrast exam thoracic aorta,75605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,469.68,6902.26,APC Contrast exam thoracic aorta,75605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,469.68,6902.26,APC Contrast exam thoracic aorta,75605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,469.68,6902.26,APC Contrast exam abdominl aorta,75625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1933.58,,,,,,,fee schedule,412.39,3916.58, Contrast exam abdominl aorta,75625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2431.92,,,,,,,fee schedule,412.39,3916.58, Contrast exam abdominl aorta,75625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,412.39,,,,,,,fee schedule,412.39,3916.58, Contrast exam abdominl aorta,75625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,494.87,,,,,,,fee schedule,412.39,3916.58, Contrast exam abdominl aorta,75625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,412.39,3916.58,APC Contrast exam abdominl aorta,75625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,412.39,3916.58,APC Contrast exam abdominl aorta,75625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,412.39,3916.58,APC X-ray aorta leg arteries,75630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2119.21,,,,,,,fee schedule,444.44,3916.58, X-ray aorta leg arteries,75630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2665.4,,,,,,,fee schedule,444.44,3916.58, X-ray aorta leg arteries,75630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,444.44,,,,,,,fee schedule,444.44,3916.58, X-ray aorta leg arteries,75630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,533.33,,,,,,,fee schedule,444.44,3916.58, X-ray aorta leg arteries,75630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,444.44,3916.58,APC X-ray aorta leg arteries,75630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,444.44,3916.58,APC X-ray aorta leg arteries,75630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,444.44,3916.58,APC Ct Angio Abdominal Arteries,75635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2553.5,,,,,,,fee schedule,207.21,3211.61, Ct Angio Abdominal Arteries,75635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3211.61,,,,,,,fee schedule,207.21,3211.61, Ct Angio Abdominal Arteries,75635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,3211.61,APC Ct Angio Abdominal Arteries,75635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,3211.61,APC Ct Angio Abdominal Arteries,75635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,3211.61,APC Artery x-rays spine,75705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2107.68,,,,,,,fee schedule,932.49,6902.26, Artery x-rays spine,75705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2650.9,,,,,,,fee schedule,932.49,6902.26, Artery x-rays spine,75705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,932.49,,,,,,,fee schedule,932.49,6902.26, Artery x-rays spine,75705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1118.99,,,,,,,fee schedule,932.49,6902.26, Artery x-rays spine,75705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,932.49,6902.26,APC Artery x-rays spine,75705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,932.49,6902.26,APC Artery x-rays spine,75705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,932.49,6902.26,APC Artery x-rays arm/leg,75710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1935.94,,,,,,,fee schedule,474.24,3916.58, Artery x-rays arm/leg,75710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2434.89,,,,,,,fee schedule,474.24,3916.58, Artery x-rays arm/leg,75710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,474.24,,,,,,,fee schedule,474.24,3916.58, Artery x-rays arm/leg,75710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,569.09,,,,,,,fee schedule,474.24,3916.58, Artery x-rays arm/leg,75710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,474.24,3916.58,APC Artery x-rays arm/leg,75710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,474.24,3916.58,APC Artery x-rays arm/leg,75710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,474.24,3916.58,APC Artery x-rays arms/legs,75716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1960.93,,,,,,,fee schedule,494.86,3916.58, Artery x-rays arms/legs,75716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2466.33,,,,,,,fee schedule,494.86,3916.58, Artery x-rays arms/legs,75716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,494.86,,,,,,,fee schedule,494.86,3916.58, Artery x-rays arms/legs,75716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,593.83,,,,,,,fee schedule,494.86,3916.58, Artery x-rays arms/legs,75716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,494.86,3916.58,APC Artery x-rays arms/legs,75716,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,494.86,3916.58,APC Artery x-rays arms/legs,75716,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,494.86,3916.58,APC Artery x-rays abdomen,75726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1931.22,,,,,,,fee schedule,533.84,6902.26, Artery x-rays abdomen,75726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2428.96,,,,,,,fee schedule,533.84,6902.26, Artery x-rays abdomen,75726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,533.84,,,,,,,fee schedule,533.84,6902.26, Artery x-rays abdomen,75726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,640.61,,,,,,,fee schedule,533.84,6902.26, Artery x-rays abdomen,75726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,533.84,6902.26,APC Artery x-rays abdomen,75726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,533.84,6902.26,APC Artery x-rays abdomen,75726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,533.84,6902.26,APC Artery x-rays adrenal gland,75731,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1932.27,,,,,,,fee schedule,687.28,3916.58, Artery x-rays adrenal gland,75731,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2430.28,,,,,,,fee schedule,687.28,3916.58, Artery x-rays adrenal gland,75731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,687.28,,,,,,,fee schedule,687.28,3916.58, Artery x-rays adrenal gland,75731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,824.74,,,,,,,fee schedule,687.28,3916.58, Artery x-rays adrenal gland,75731,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,687.28,3916.58,APC Artery x-rays adrenal gland,75731,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,687.28,3916.58,APC Artery x-rays adrenal gland,75731,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,687.28,3916.58,APC Artery x-rays adrenals,75733,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1961.25,,,,,,,fee schedule,772.06,3916.58, Artery x-rays adrenals,75733,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2466.73,,,,,,,fee schedule,772.06,3916.58, Artery x-rays adrenals,75733,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,772.06,,,,,,,fee schedule,772.06,3916.58, Artery x-rays adrenals,75733,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,926.47,,,,,,,fee schedule,772.06,3916.58, Artery x-rays adrenals,75733,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,772.06,3916.58,APC Artery x-rays adrenals,75733,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,772.06,3916.58,APC Artery x-rays adrenals,75733,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,772.06,3916.58,APC Artery x-rays pelvis,75736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1933.58,,,,,,,fee schedule,634.61,6902.26, Artery x-rays pelvis,75736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2431.92,,,,,,,fee schedule,634.61,6902.26, Artery x-rays pelvis,75736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,634.61,,,,,,,fee schedule,634.61,6902.26, Artery x-rays pelvis,75736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,761.54,,,,,,,fee schedule,634.61,6902.26, Artery x-rays pelvis,75736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,634.61,6902.26,APC Artery x-rays pelvis,75736,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,634.61,6902.26,APC Artery x-rays pelvis,75736,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,634.61,6902.26,APC Artery x-rays lung,75741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1959.91,,,,,,,fee schedule,485.68,3916.58, Artery x-rays lung,75741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2465.05,,,,,,,fee schedule,485.68,3916.58, Artery x-rays lung,75741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,485.68,,,,,,,fee schedule,485.68,3916.58, Artery x-rays lung,75741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,582.81,,,,,,,fee schedule,485.68,3916.58, Artery x-rays lung,75741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,485.68,3916.58,APC Artery x-rays lung,75741,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,485.68,3916.58,APC Artery x-rays lung,75741,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,485.68,3916.58,APC Artery x-rays lungs,75743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2016.08,,,,,,,fee schedule,494.86,3916.58, Artery x-rays lungs,75743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2535.68,,,,,,,fee schedule,494.86,3916.58, Artery x-rays lungs,75743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,494.86,,,,,,,fee schedule,494.86,3916.58, Artery x-rays lungs,75743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,593.83,,,,,,,fee schedule,494.86,3916.58, Artery x-rays lungs,75743,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,494.86,3916.58,APC Artery x-rays lungs,75743,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,494.86,3916.58,APC Artery x-rays lungs,75743,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,494.86,3916.58,APC Artery x-rays lung,75746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1932.56,,,,,,,fee schedule,570.45,3916.58, Artery x-rays lung,75746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2430.64,,,,,,,fee schedule,570.45,3916.58, Artery x-rays lung,75746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,570.45,,,,,,,fee schedule,570.45,3916.58, Artery x-rays lung,75746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,684.55,,,,,,,fee schedule,570.45,3916.58, Artery x-rays lung,75746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,570.45,3916.58,APC Artery x-rays lung,75746,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,570.45,3916.58,APC Artery x-rays lung,75746,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,570.45,3916.58,APC Artery x-rays chest,75756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1940.88,,,,,,,fee schedule,765.19,3916.58, Artery x-rays chest,75756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2441.11,,,,,,,fee schedule,765.19,3916.58, Artery x-rays chest,75756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,765.19,,,,,,,fee schedule,765.19,3916.58, Artery x-rays chest,75756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,918.23,,,,,,,fee schedule,765.19,3916.58, Artery x-rays chest,75756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,765.19,3916.58,APC Artery x-rays chest,75756,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,765.19,3916.58,APC Artery x-rays chest,75756,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,765.19,3916.58,APC Artery x-ray each vessel,75774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1804.64,,,,,,,fee schedule,1804.64,2269.75, Artery x-ray each vessel,75774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2269.75,,,,,,,fee schedule,1804.64,2269.75, Lymph vessel x-ray arm/leg,75801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,887.17,,,,,,,fee schedule,741.06,1689.4, Lymph vessel x-ray arm/leg,75801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1115.82,,,,,,,fee schedule,741.06,1689.4, Lymph vessel x-ray arm/leg,75801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1407.83,,,,,,,fee schedule,741.06,1689.4, Lymph vessel x-ray arm/leg,75801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1689.4,,,,,,,fee schedule,741.06,1689.4, Lymph vessel x-ray arm/leg,75801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,741.06,1689.4,APC Lymph vessel x-ray arm/leg,75801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,741.06,1689.4,APC Lymph vessel x-ray arm/leg,75801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,741.06,1689.4,APC Lymph vessel x-ray arms/legs,75803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,941.41,,,,,,,fee schedule,941.41,1952.6, Lymph vessel x-ray arms/legs,75803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1184.05,,,,,,,fee schedule,941.41,1952.6, Lymph vessel x-ray arms/legs,75803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1339.16,,,,,,,fee schedule,941.41,1952.6, Lymph vessel x-ray arms/legs,75803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1607,,,,,,,fee schedule,941.41,1952.6, Lymph vessel x-ray arms/legs,75803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,941.41,1952.6,APC Lymph vessel x-ray arms/legs,75803,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,941.41,1952.6,APC Lymph vessel x-ray arms/legs,75803,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,941.41,1952.6,APC Lymph vessel x-ray trunk,75805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,981.14,,,,,,,fee schedule,981.14,3916.58, Lymph vessel x-ray trunk,75805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1234.01,,,,,,,fee schedule,981.14,3916.58, Lymph vessel x-ray trunk,75805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1478.8,,,,,,,fee schedule,981.14,3916.58, Lymph vessel x-ray trunk,75805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1774.57,,,,,,,fee schedule,981.14,3916.58, Lymph vessel x-ray trunk,75805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,981.14,3916.58,APC Lymph vessel x-ray trunk,75805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,981.14,3916.58,APC Lymph vessel x-ray trunk,75805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,981.14,3916.58,APC Lymph vessel x-ray trunk,75807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1037.42,,,,,,,fee schedule,1037.42,3916.58, Lymph vessel x-ray trunk,75807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1304.79,,,,,,,fee schedule,1037.42,3916.58, Lymph vessel x-ray trunk,75807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1419.26,,,,,,,fee schedule,1037.42,3916.58, Lymph vessel x-ray trunk,75807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1703.12,,,,,,,fee schedule,1037.42,3916.58, Lymph vessel x-ray trunk,75807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1037.42,3916.58,APC Lymph vessel x-ray trunk,75807,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1037.42,3916.58,APC Lymph vessel x-ray trunk,75807,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1037.42,3916.58,APC Nonvascular shunt x-ray,75809,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.43,,,,,,,fee schedule,123.5,489.4, Nonvascular shunt x-ray,75809,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,233.22,,,,,,,fee schedule,123.5,489.4, Nonvascular shunt x-ray,75809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,407.83,,,,,,,fee schedule,123.5,489.4, Nonvascular shunt x-ray,75809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,489.4,,,,,,,fee schedule,123.5,489.4, Nonvascular shunt x-ray,75809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,489.4,APC Nonvascular shunt x-ray,75809,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,489.4,APC Nonvascular shunt x-ray,75809,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,489.4,APC Vein x-ray spleen/liver,75810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1931.22,,,,,,,fee schedule,1931.22,3916.58, Vein x-ray spleen/liver,75810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2428.96,,,,,,,fee schedule,1931.22,3916.58, Vein x-ray spleen/liver,75810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2630.22,,,,,,,fee schedule,1931.22,3916.58, Vein x-ray spleen/liver,75810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3156.27,,,,,,,fee schedule,1931.22,3916.58, Vein x-ray spleen/liver,75810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,1931.22,3916.58,APC Vein x-ray spleen/liver,75810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,1931.22,3916.58,APC Vein x-ray spleen/liver,75810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,1931.22,3916.58,APC Vein x-ray arm/leg,75820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,248.4,,,,,,,fee schedule,248.4,1952.6, Vein x-ray arm/leg,75820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,312.42,,,,,,,fee schedule,248.4,1952.6, Vein x-ray arm/leg,75820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,407.83,,,,,,,fee schedule,248.4,1952.6, Vein x-ray arm/leg,75820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,489.4,,,,,,,fee schedule,248.4,1952.6, Vein x-ray arm/leg,75820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,248.4,1952.6,APC Vein x-ray arm/leg,75820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,248.4,1952.6,APC Vein x-ray arm/leg,75820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,248.4,1952.6,APC Vein x-ray arms/legs,75822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,379.7,,,,,,,fee schedule,379.7,1952.6, Vein x-ray arms/legs,75822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,477.56,,,,,,,fee schedule,379.7,1952.6, Vein x-ray arms/legs,75822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,451.37,,,,,,,fee schedule,379.7,1952.6, Vein x-ray arms/legs,75822,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,541.65,,,,,,,fee schedule,379.7,1952.6, Vein x-ray arms/legs,75822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,379.7,1952.6,APC Vein x-ray arms/legs,75822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,379.7,1952.6,APC Vein x-ray arms/legs,75822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,379.7,1952.6,APC Vein x-ray trunk,75825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1933.29,,,,,,,fee schedule,423.89,3916.58, Vein x-ray trunk,75825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2431.56,,,,,,,fee schedule,423.89,3916.58, Vein x-ray trunk,75825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,423.89,,,,,,,fee schedule,423.89,3916.58, Vein x-ray trunk,75825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,508.66,,,,,,,fee schedule,423.89,3916.58, Vein x-ray trunk,75825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,423.89,3916.58,APC Vein x-ray trunk,75825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,423.89,3916.58,APC Vein x-ray trunk,75825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,423.89,3916.58,APC Vein x-ray chest,75827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1932.27,,,,,,,fee schedule,453.68,2430.28, Vein x-ray chest,75827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2430.28,,,,,,,fee schedule,453.68,2430.28, Vein x-ray chest,75827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,453.68,,,,,,,fee schedule,453.68,2430.28, Vein x-ray chest,75827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,544.42,,,,,,,fee schedule,453.68,2430.28, Vein x-ray chest,75827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,453.68,2430.28,APC Vein x-ray chest,75827,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,453.68,2430.28,APC Vein x-ray chest,75827,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,453.68,2430.28,APC Vein x-ray kidney,75831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1933.29,,,,,,,fee schedule,471.93,3916.58, Vein x-ray kidney,75831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2431.56,,,,,,,fee schedule,471.93,3916.58, Vein x-ray kidney,75831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,471.93,,,,,,,fee schedule,471.93,3916.58, Vein x-ray kidney,75831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,566.32,,,,,,,fee schedule,471.93,3916.58, Vein x-ray kidney,75831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,471.93,3916.58,APC Vein x-ray kidney,75831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,471.93,3916.58,APC Vein x-ray kidney,75831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,471.93,3916.58,APC Vein x-ray kidneys,75833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1991.81,,,,,,,fee schedule,545.28,3916.58, Vein x-ray kidneys,75833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2505.16,,,,,,,fee schedule,545.28,3916.58, Vein x-ray kidneys,75833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,545.28,,,,,,,fee schedule,545.28,3916.58, Vein x-ray kidneys,75833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,654.33,,,,,,,fee schedule,545.28,3916.58, Vein x-ray kidneys,75833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,545.28,3916.58,APC Vein x-ray kidneys,75833,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,545.28,3916.58,APC Vein x-ray kidneys,75833,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,545.28,3916.58,APC Vein x-ray adrenal gland,75840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1934.6,,,,,,,fee schedule,515.48,3916.58, Vein x-ray adrenal gland,75840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2433.2,,,,,,,fee schedule,515.48,3916.58, Vein x-ray adrenal gland,75840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,515.48,,,,,,,fee schedule,515.48,3916.58, Vein x-ray adrenal gland,75840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,618.57,,,,,,,fee schedule,515.48,3916.58, Vein x-ray adrenal gland,75840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,515.48,3916.58,APC Vein x-ray adrenal gland,75840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,515.48,3916.58,APC Vein x-ray adrenal gland,75840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,515.48,3916.58,APC Vein x-ray adrenal glands,75842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1988.43,,,,,,,fee schedule,609.44,2500.91, Vein x-ray adrenal glands,75842,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2500.91,,,,,,,fee schedule,609.44,2500.91, Vein x-ray adrenal glands,75842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,609.44,,,,,,,fee schedule,609.44,2500.91, Vein x-ray adrenal glands,75842,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,731.32,,,,,,,fee schedule,609.44,2500.91, Vein x-ray neck,75860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1933.9,,,,,,,fee schedule,501.73,3916.58, Vein x-ray neck,75860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2432.33,,,,,,,fee schedule,501.73,3916.58, Vein x-ray neck,75860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,501.73,,,,,,,fee schedule,501.73,3916.58, Vein x-ray neck,75860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,602.08,,,,,,,fee schedule,501.73,3916.58, Vein x-ray neck,75860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray neck,75860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray neck,75860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray skull,75870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1933.9,,,,,,,fee schedule,673.6,3916.58, Vein x-ray skull,75870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2432.33,,,,,,,fee schedule,673.6,3916.58, Vein x-ray skull,75870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,673.6,,,,,,,fee schedule,673.6,3916.58, Vein x-ray skull,75870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,808.32,,,,,,,fee schedule,673.6,3916.58, Vein x-ray skull,75870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,673.6,3916.58,APC Vein x-ray skull,75870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,673.6,3916.58,APC Vein x-ray skull,75870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,673.6,3916.58,APC Vein x-ray skull epidural,75872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1939.4,,,,,,,fee schedule,515.48,2439.24, Vein x-ray skull epidural,75872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2439.24,,,,,,,fee schedule,515.48,2439.24, Vein x-ray skull epidural,75872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,515.48,,,,,,,fee schedule,515.48,2439.24, Vein x-ray skull epidural,75872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,618.57,,,,,,,fee schedule,515.48,2439.24, Vein x-ray skull epidural,75872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,515.48,2439.24,APC Vein x-ray skull epidural,75872,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,515.48,2439.24,APC Vein x-ray skull epidural,75872,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,515.48,2439.24,APC Vein x-ray eye socket,75880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,247.38,,,,,,,fee schedule,247.38,778.11, Vein x-ray eye socket,75880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,311.14,,,,,,,fee schedule,247.38,778.11, Vein x-ray eye socket,75880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,513.17,,,,,,,fee schedule,247.38,778.11, Vein x-ray eye socket,75880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,615.8,,,,,,,fee schedule,247.38,778.11, Vein x-ray eye socket,75880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.7,,,,,,,fee schedule,247.38,778.11,APC Vein x-ray eye socket,75880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.11,,,,,,,fee schedule,247.38,778.11,APC Vein x-ray eye socket,75880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.06,,,,,,,fee schedule,247.38,778.11,APC Vein x-ray liver w/hemodynam,75885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1981.3,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2491.95,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,497.17,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,596.6,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,497.17,3916.58,APC Vein x-ray liver w/hemodynam,75885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,497.17,3916.58,APC Vein x-ray liver w/hemodynam,75885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,497.17,3916.58,APC Vein x-ray liver w/o hemodyn,75887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1980.28,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver w/o hemodyn,75887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2490.67,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver w/o hemodyn,75887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,501.73,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver w/o hemodyn,75887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,602.08,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver w/o hemodyn,75887,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray liver w/o hemodyn,75887,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray liver w/o hemodyn,75887,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray liver w/hemodynam,75889,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1931.22,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75889,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2428.96,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,497.17,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,596.6,,,,,,,fee schedule,497.17,3916.58, Vein x-ray liver w/hemodynam,75889,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,497.17,3916.58,APC Vein x-ray liver w/hemodynam,75889,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,497.17,3916.58,APC Vein x-ray liver w/hemodynam,75889,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,497.17,3916.58,APC Vein x-ray liver,75891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1931.22,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver,75891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2428.96,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver,75891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,501.73,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver,75891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,602.08,,,,,,,fee schedule,501.73,3916.58, Vein x-ray liver,75891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray liver,75891,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,501.73,3916.58,APC Vein x-ray liver,75891,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,501.73,3916.58,APC Venous sampling by catheter,75893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1834.46,,,,,,,fee schedule,549.84,6902.26, Venous sampling by catheter,75893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2307.26,,,,,,,fee schedule,549.84,6902.26, Venous sampling by catheter,75893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,549.84,,,,,,,fee schedule,549.84,6902.26, Venous sampling by catheter,75893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,659.81,,,,,,,fee schedule,549.84,6902.26, Venous sampling by catheter,75893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6836.52,,,,,,,fee schedule,549.84,6902.26,APC Venous sampling by catheter,75893,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6902.26,,,,,,,fee schedule,549.84,6902.26,APC Venous sampling by catheter,75893,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6573.58,,,,,,,fee schedule,549.84,6902.26,APC X-rays transcath therapy,75894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3561.32,,,,,,,fee schedule,3561.32,4479.18, X-rays transcath therapy,75894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4479.18,,,,,,,fee schedule,3561.32,4479.18, Follow-up angiography,75898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,418.34,,,,,,,fee schedule,302.15,3916.58, Follow-up angiography,75898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,526.16,,,,,,,fee schedule,302.15,3916.58, Follow-up angiography,75898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,302.15,,,,,,,fee schedule,302.15,3916.58, Follow-up angiography,75898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,362.58,,,,,,,fee schedule,302.15,3916.58, Follow-up angiography,75898,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,302.15,3916.58,APC Follow-up angiography,75898,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,302.15,3916.58,APC Follow-up angiography,75898,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,302.15,3916.58,APC Remove cva device obstruct,75901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,339.34,,,,,,,fee schedule,339.34,426.79, Remove cva device obstruct,75901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,426.79,,,,,,,fee schedule,339.34,426.79, Remove cva lumen obstruct,75902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,323.77,,,,,,,fee schedule,323.77,407.21, Remove cva lumen obstruct,75902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,407.21,,,,,,,fee schedule,323.77,407.21, Vascular biopsy,75970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1736.05,,,,,,,fee schedule,1736.05,2183.48, Vascular biopsy,75970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2183.48,,,,,,,fee schedule,1736.05,2183.48, Xray control catheter change,75984,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,388.02,,,,,,,fee schedule,388.02,488.02, Xray control catheter change,75984,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,488.02,,,,,,,fee schedule,388.02,488.02, Abscess drainage under x-ray,75989,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,631.73,,,,,,,fee schedule,631.73,794.55, Abscess drainage under x-ray,75989,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,794.55,,,,,,,fee schedule,631.73,794.55, Fluoroscope examination,76000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,209.03,,,,,,,fee schedule,192.42,295.96, Fluoroscope examination,76000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,262.9,,,,,,,fee schedule,192.42,295.96, Fluoroscope examination,76000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,192.42,,,,,,,fee schedule,192.42,295.96, Fluoroscope examination,76000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,230.91,,,,,,,fee schedule,192.42,295.96, Fluoroscope examination,76000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,192.42,295.96,APC Fluoroscope examination,76000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,192.42,295.96,APC Fluoroscope examination,76000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,192.42,295.96,APC X-ray nose to rectum,76010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.15,,,,,,,fee schedule,101.15,173.18, X-ray nose to rectum,76010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.22,,,,,,,fee schedule,101.15,173.18, X-ray nose to rectum,76010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,144.32,,,,,,,fee schedule,101.15,173.18, X-ray nose to rectum,76010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,173.18,,,,,,,fee schedule,101.15,173.18, X-ray nose to rectum,76010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,101.15,173.18,APC X-ray nose to rectum,76010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,101.15,173.18,APC X-ray nose to rectum,76010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,101.15,173.18,APC Mr sfty implt&/fb asmt stf 1,76014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Mr sfty implt&/fb asmt stf 1,76014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Mr sfty implt&/fb asmt stf 1,76014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Mr safety deter phys/qhp,76016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Mr safety deter phys/qhp,76016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Mr safety deter phys/qhp,76016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Mr sfty med physics xm cstmz,76017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Mr sfty med physics xm cstmz,76017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Mr sfty med physics xm cstmz,76017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Mr safety implt pos&/immoblj,76019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Mr safety implt pos&/immoblj,76019,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Mr safety implt pos&/immoblj,76019,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC X-ray exam of fistula,76080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,234.49,,,,,,,fee schedule,234.49,677.78, X-ray exam of fistula,76080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,294.92,,,,,,,fee schedule,234.49,677.78, X-ray exam of fistula,76080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,242.84,,,,,,,fee schedule,234.49,677.78, X-ray exam of fistula,76080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,291.41,,,,,,,fee schedule,234.49,677.78, X-ray exam of fistula,76080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,234.49,677.78,APC X-ray exam of fistula,76080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,234.49,677.78,APC X-ray exam of fistula,76080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,234.49,677.78,APC X-ray exam breast specimen,76098,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.19,,,,,,,fee schedule,84.19,677.78, X-ray exam breast specimen,76098,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.88,,,,,,,fee schedule,84.19,677.78, X-ray exam breast specimen,76098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,190.17,,,,,,,fee schedule,84.19,677.78, X-ray exam breast specimen,76098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,228.2,,,,,,,fee schedule,84.19,677.78, X-ray exam breast specimen,76098,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,84.19,677.78,APC X-ray exam breast specimen,76098,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,84.19,677.78,APC X-ray exam breast specimen,76098,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,84.19,677.78,APC X-ray exam of body section,76100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,269.15,,,,,,,fee schedule,123.5,511.36, X-ray exam of body section,76100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,338.51,,,,,,,fee schedule,123.5,511.36, X-ray exam of body section,76100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,426.14,,,,,,,fee schedule,123.5,511.36, X-ray exam of body section,76100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,511.36,,,,,,,fee schedule,123.5,511.36, X-ray exam of body section,76100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,511.36,APC X-ray exam of body section,76100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,511.36,APC X-ray exam of body section,76100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,511.36,APC Cine/video x-rays,76120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,209.32,,,,,,,fee schedule,123.5,816.63, Cine/video x-rays,76120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,263.26,,,,,,,fee schedule,123.5,816.63, Cine/video x-rays,76120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,680.53,,,,,,,fee schedule,123.5,816.63, Cine/video x-rays,76120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,816.63,,,,,,,fee schedule,123.5,816.63, Cine/video x-rays,76120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,816.63,APC Cine/video x-rays,76120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,816.63,APC Cine/video x-rays,76120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,816.63,APC Cine/video x-rays add-on,76125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.27,,,,,,,fee schedule,153.27,192.77, Cine/video x-rays add-on,76125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,192.77,,,,,,,fee schedule,153.27,192.77, Med physic dos eval rad exps,76145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,369.19,,,,,,,fee schedule,369.19,4341.44, Med physic dos eval rad exps,76145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,464.34,,,,,,,fee schedule,369.19,4341.44, Med physic dos eval rad exps,76145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3617.86,,,,,,,fee schedule,369.19,4341.44, Med physic dos eval rad exps,76145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4341.44,,,,,,,fee schedule,369.19,4341.44, Med physic dos eval rad exps,76145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,369.19,4341.44,APC Med physic dos eval rad exps,76145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,369.19,4341.44,APC Med physic dos eval rad exps,76145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,369.19,4341.44,APC 3d render w/intrp postproces,76376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,278.25,,,,,,,fee schedule,278.25,349.97, 3d render w/intrp postproces,76376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,349.97,,,,,,,fee schedule,278.25,349.97, 3d render w/intrp postproces,76377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,382.17,,,,,,,fee schedule,382.17,480.67, 3d render w/intrp postproces,76377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,480.67,,,,,,,fee schedule,382.17,480.67, CAT scan follow-up study,76380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,644.74,,,,,,,fee schedule,102.81,810.91, CAT scan follow-up study,76380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,810.91,,,,,,,fee schedule,102.81,810.91, CAT scan follow-up study,76380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,810.91,APC CAT scan follow-up study,76380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,810.91,APC CAT scan follow-up study,76380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,810.91,APC Mr spectroscopy,76390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1598.26,,,,,,,fee schedule,102.81,2010.18, Mr spectroscopy,76390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2010.18,,,,,,,fee schedule,102.81,2010.18, Mr spectroscopy,76390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,2010.18,APC Mr spectroscopy,76390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,2010.18,APC Mr spectroscopy,76390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,2010.18,APC Mr elastography,76391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,670.93,,,,,,,fee schedule,281.87,843.85, Mr elastography,76391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,843.85,,,,,,,fee schedule,281.87,843.85, Mr elastography,76391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,843.85,APC Mr elastography,76391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,843.85,APC Mr elastography,76391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,843.85,APC Fluoroscopic procedure,76496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.02,,,,,,,fee schedule,102.81,354.47, Fluoroscopic procedure,76496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,139.63,,,,,,,fee schedule,102.81,354.47, Fluoroscopic procedure,76496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,295.39,,,,,,,fee schedule,102.81,354.47, Fluoroscopic procedure,76496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,354.47,,,,,,,fee schedule,102.81,354.47, Fluoroscopic procedure,76496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,354.47,APC Fluoroscopic procedure,76496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,354.47,APC Fluoroscopic procedure,76496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,354.47,APC Ct procedure,76497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.16,,,,,,,fee schedule,102.81,147.35, Ct procedure,76497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,147.35,,,,,,,fee schedule,102.81,147.35, Ct procedure,76497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,147.35,APC Ct procedure,76497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,147.35,APC Ct procedure,76497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,147.35,APC Mri procedure,76498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,922.67,,,,,,,fee schedule,102.81,1160.48, Mri procedure,76498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1160.48,,,,,,,fee schedule,102.81,1160.48, Mri procedure,76498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,1160.48,APC Mri procedure,76498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,1160.48,APC Mri procedure,76498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,1160.48,APC Radiographic procedure,76499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58,,,,,,,fee schedule,58,736.04, Radiographic procedure,76499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.94,,,,,,,fee schedule,58,736.04, Radiographic procedure,76499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.36,,,,,,,fee schedule,58,736.04, Radiographic procedure,76499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.04,,,,,,,fee schedule,58,736.04, Radiographic procedure,76499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,58,736.04,APC Radiographic procedure,76499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,58,736.04,APC Radiographic procedure,76499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,58,736.04,APC Echo exam of head,76506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,307.3,,,,,,,fee schedule,123.5,679.14, Echo exam of head,76506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,386.5,,,,,,,fee schedule,123.5,679.14, Echo exam of head,76506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,565.95,,,,,,,fee schedule,123.5,679.14, Echo exam of head,76506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,679.14,,,,,,,fee schedule,123.5,679.14, Echo exam of head,76506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,679.14,APC Echo exam of head,76506,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,679.14,APC Echo exam of head,76506,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,679.14,APC Ophth us b & quant a,76510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,570.53,,,,,,,fee schedule,157.18,717.58, Ophth us b & quant a,76510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,717.58,,,,,,,fee schedule,157.18,717.58, Ophth us b & quant a,76510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.48,,,,,,,fee schedule,157.18,717.58, Ophth us b & quant a,76510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.17,,,,,,,fee schedule,157.18,717.58, Ophth us b & quant a,76510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,717.58,APC Ophth us b & quant a,76510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,717.58,APC Ophth us b & quant a,76510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,717.58,APC Ophth us quant a only,76511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,442.67,,,,,,,fee schedule,123.5,556.76, Ophth us quant a only,76511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,556.76,,,,,,,fee schedule,123.5,556.76, Ophth us quant a only,76511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,151.19,,,,,,,fee schedule,123.5,556.76, Ophth us quant a only,76511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,181.43,,,,,,,fee schedule,123.5,556.76, Ophth us quant a only,76511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,556.76,APC Ophth us quant a only,76511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,556.76,APC Ophth us quant a only,76511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,556.76,APC Ophth us b w/non-quant a,76512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,418.08,,,,,,,fee schedule,123.5,525.83, Ophth us b w/non-quant a,76512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,525.83,,,,,,,fee schedule,123.5,525.83, Ophth us b w/non-quant a,76512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,123.7,,,,,,,fee schedule,123.5,525.83, Ophth us b w/non-quant a,76512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,148.44,,,,,,,fee schedule,123.5,525.83, Ophth us b w/non-quant a,76512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,525.83,APC Ophth us b w/non-quant a,76512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,525.83,APC Ophth us b w/non-quant a,76512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,525.83,APC Echo exam of eye water bath,76513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,329.73,,,,,,,fee schedule,123.5,414.71, Echo exam of eye water bath,76513,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,414.71,,,,,,,fee schedule,123.5,414.71, Echo exam of eye water bath,76513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,297.82,,,,,,,fee schedule,123.5,414.71, Echo exam of eye water bath,76513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,357.38,,,,,,,fee schedule,123.5,414.71, Echo exam of eye water bath,76513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,414.71,APC Echo exam of eye water bath,76513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,414.71,APC Echo exam of eye water bath,76513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,414.71,APC Echo exam of eye thickness,76514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.02,,,,,,,fee schedule,25.18,49.08, Echo exam of eye thickness,76514,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.08,,,,,,,fee schedule,25.18,49.08, Echo exam of eye thickness,76514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,25.18,,,,,,,fee schedule,25.18,49.08, Echo exam of eye thickness,76514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.21,,,,,,,fee schedule,25.18,49.08, Echo exam of eye thickness,76514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,25.18,49.08,APC Echo exam of eye thickness,76514,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,25.18,49.08,APC Echo exam of eye thickness,76514,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,25.18,49.08,APC Echo exam of eye,76516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,265.13,,,,,,,fee schedule,123.5,333.46, Echo exam of eye,76516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333.46,,,,,,,fee schedule,123.5,333.46, Echo exam of eye,76516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,169.5,,,,,,,fee schedule,123.5,333.46, Echo exam of eye,76516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,203.4,,,,,,,fee schedule,123.5,333.46, Echo exam of eye,76516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,333.46,APC Echo exam of eye,76516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,333.46,APC Echo exam of eye,76516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,333.46,APC Echo exam of eye,76519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,277.12,,,,,,,fee schedule,123.5,348.54, Echo exam of eye,76519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,348.54,,,,,,,fee schedule,123.5,348.54, Echo exam of eye,76519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,263.46,,,,,,,fee schedule,123.5,348.54, Echo exam of eye,76519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,316.15,,,,,,,fee schedule,123.5,348.54, Echo exam of eye,76519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,348.54,APC Echo exam of eye,76519,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,348.54,APC Echo exam of eye,76519,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,348.54,APC Echo exam of eye,76529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,258.67,,,,,,,fee schedule,102.81,445.39, Echo exam of eye,76529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,325.34,,,,,,,fee schedule,102.81,445.39, Echo exam of eye,76529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,371.16,,,,,,,fee schedule,102.81,445.39, Echo exam of eye,76529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,445.39,,,,,,,fee schedule,102.81,445.39, Echo exam of eye,76529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,445.39,APC Echo exam of eye,76529,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,445.39,APC Echo exam of eye,76529,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,445.39,APC Us exam of head and neck,76536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,289.17,,,,,,,fee schedule,123.5,692.86, Us exam of head and neck,76536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,363.69,,,,,,,fee schedule,123.5,692.86, Us exam of head and neck,76536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,577.38,,,,,,,fee schedule,123.5,692.86, Us exam of head and neck,76536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,692.86,,,,,,,fee schedule,123.5,692.86, Us exam of head and neck,76536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,692.86,APC Us exam of head and neck,76536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,692.86,APC Us exam of head and neck,76536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,692.86,APC Us exam chest,76604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,271.33,,,,,,,fee schedule,123.5,341.26, Us exam chest,76604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,341.26,,,,,,,fee schedule,123.5,341.26, Us exam chest,76604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.48,,,,,,,fee schedule,123.5,341.26, Us exam chest,76604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.17,,,,,,,fee schedule,123.5,341.26, Us exam chest,76604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,341.26,APC Us exam chest,76604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,341.26,APC Us exam chest,76604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,341.26,APC Ultrasound breast complete,76641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,234.49,,,,,,,fee schedule,123.5,563.62, Ultrasound breast complete,76641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,294.92,,,,,,,fee schedule,123.5,563.62, Ultrasound breast complete,76641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,469.68,,,,,,,fee schedule,123.5,563.62, Ultrasound breast complete,76641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,563.62,,,,,,,fee schedule,123.5,563.62, Ultrasound breast complete,76641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,563.62,APC Ultrasound breast complete,76641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,563.62,APC Ultrasound breast complete,76641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,563.62,APC Ultrasound breast limited,76642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,234.49,,,,,,,fee schedule,102.81,437.14, Ultrasound breast limited,76642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,294.92,,,,,,,fee schedule,102.81,437.14, Ultrasound breast limited,76642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,364.29,,,,,,,fee schedule,102.81,437.14, Ultrasound breast limited,76642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,437.14,,,,,,,fee schedule,102.81,437.14, Ultrasound breast limited,76642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,437.14,APC Ultrasound breast limited,76642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,437.14,APC Ultrasound breast limited,76642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,437.14,APC Us exam abdom complete,76700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,407.43,,,,,,,fee schedule,123.5,648.86, Us exam abdom complete,76700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,512.44,,,,,,,fee schedule,123.5,648.86, Us exam abdom complete,76700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,540.71,,,,,,,fee schedule,123.5,648.86, Us exam abdom complete,76700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,648.86,,,,,,,fee schedule,123.5,648.86, Us exam abdom complete,76700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,648.86,APC Us exam abdom complete,76700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,648.86,APC Us exam abdom complete,76700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,648.86,APC Echo exam of abdomen,76705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,293.97,,,,,,,fee schedule,123.5,492.17, Echo exam of abdomen,76705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,369.73,,,,,,,fee schedule,123.5,492.17, Echo exam of abdomen,76705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,410.14,,,,,,,fee schedule,123.5,492.17, Echo exam of abdomen,76705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,492.17,,,,,,,fee schedule,123.5,492.17, Echo exam of abdomen,76705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,492.17,APC Echo exam of abdomen,76705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,492.17,APC Echo exam of abdomen,76705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,492.17,APC Us abdl aorta screen aaa,76706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,368.17,,,,,,,fee schedule,123.5,668.12, Us abdl aorta screen aaa,76706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,463.06,,,,,,,fee schedule,123.5,668.12, Us abdl aorta screen aaa,76706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.77,,,,,,,fee schedule,123.5,668.12, Us abdl aorta screen aaa,76706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,668.12,,,,,,,fee schedule,123.5,668.12, Us abdl aorta screen aaa,76706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,668.12,APC Us abdl aorta screen aaa,76706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,668.12,APC Us abdl aorta screen aaa,76706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,668.12,APC Us exam abdo back wall comp,76770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,394.33,,,,,,,fee schedule,123.5,607.62, Us exam abdo back wall comp,76770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,495.97,,,,,,,fee schedule,123.5,607.62, Us exam abdo back wall comp,76770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,506.35,,,,,,,fee schedule,123.5,607.62, Us exam abdo back wall comp,76770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,607.62,,,,,,,fee schedule,123.5,607.62, Us exam abdo back wall comp,76770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,607.62,APC Us exam abdo back wall comp,76770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,607.62,APC Us exam abdo back wall comp,76770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,607.62,APC Us exam abdo back wall lim,76775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,292.8,,,,,,,fee schedule,123.5,368.27, Us exam abdo back wall lim,76775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,368.27,,,,,,,fee schedule,123.5,368.27, Us exam abdo back wall lim,76775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,224.53,,,,,,,fee schedule,123.5,368.27, Us exam abdo back wall lim,76775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,269.44,,,,,,,fee schedule,123.5,368.27, Us exam abdo back wall lim,76775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,368.27,APC Us exam abdo back wall lim,76775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,368.27,APC Us exam abdo back wall lim,76775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,368.27,APC Us exam k transpl w/doppler,76776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,277.5,,,,,,,fee schedule,123.5,923.77, Us exam k transpl w/doppler,76776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,349.02,,,,,,,fee schedule,123.5,923.77, Us exam k transpl w/doppler,76776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,769.81,,,,,,,fee schedule,123.5,923.77, Us exam k transpl w/doppler,76776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,923.77,,,,,,,fee schedule,123.5,923.77, Us exam k transpl w/doppler,76776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,923.77,APC Us exam k transpl w/doppler,76776,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,923.77,APC Us exam k transpl w/doppler,76776,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,923.77,APC Us exam spinal canal,76800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,378.47,,,,,,,fee schedule,123.5,921.14, Us exam spinal canal,76800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,476.02,,,,,,,fee schedule,123.5,921.14, Us exam spinal canal,76800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,767.61,,,,,,,fee schedule,123.5,921.14, Us exam spinal canal,76800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,921.14,,,,,,,fee schedule,123.5,921.14, Us exam spinal canal,76800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,921.14,APC Us exam spinal canal,76800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,921.14,APC Us exam spinal canal,76800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,921.14,APC Ob us < 14 wks single fetus,76801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,455.94,,,,,,,fee schedule,123.5,585.65, Ob us < 14 wks single fetus,76801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,573.45,,,,,,,fee schedule,123.5,585.65, Ob us < 14 wks single fetus,76801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,488.05,,,,,,,fee schedule,123.5,585.65, Ob us < 14 wks single fetus,76801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,585.65,,,,,,,fee schedule,123.5,585.65, Ob us < 14 wks single fetus,76801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,585.65,APC Ob us < 14 wks single fetus,76801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,585.65,APC Ob us < 14 wks single fetus,76801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,585.65,APC Ob us < 14 wks addl fetus,76802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,290.88,,,,,,,fee schedule,290.88,365.85, Ob us < 14 wks addl fetus,76802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,365.85,,,,,,,fee schedule,290.88,365.85, Ob us >/= 14 wks sngl fetus,76805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,455.94,,,,,,,fee schedule,123.5,734.09, Ob us >/= 14 wks sngl fetus,76805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,573.45,,,,,,,fee schedule,123.5,734.09, Ob us >/= 14 wks sngl fetus,76805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,611.75,,,,,,,fee schedule,123.5,734.09, Ob us >/= 14 wks sngl fetus,76805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,734.09,,,,,,,fee schedule,123.5,734.09, Ob us >/= 14 wks sngl fetus,76805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,734.09,APC Ob us >/= 14 wks sngl fetus,76805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,734.09,APC Ob us >/= 14 wks sngl fetus,76805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,734.09,APC Ob us >/= 14 wks addl fetus,76810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325.11,,,,,,,fee schedule,325.11,408.9, Ob us >/= 14 wks addl fetus,76810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,408.9,,,,,,,fee schedule,325.11,408.9, Ob us detailed sngl fetus,76811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,837.76,,,,,,,fee schedule,281.87,1053.68, Ob us detailed sngl fetus,76811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1053.68,,,,,,,fee schedule,281.87,1053.68, Ob us detailed sngl fetus,76811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,607.07,,,,,,,fee schedule,281.87,1053.68, Ob us detailed sngl fetus,76811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,728.48,,,,,,,fee schedule,281.87,1053.68, Ob us detailed sngl fetus,76811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1053.68,APC Ob us detailed sngl fetus,76811,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1053.68,APC Ob us detailed sngl fetus,76811,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1053.68,APC Ob us detailed addl fetus,76812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,483.76,,,,,,,fee schedule,483.76,608.44, Ob us detailed addl fetus,76812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,608.44,,,,,,,fee schedule,483.76,608.44, Ob us nuchal meas 1 gest,76813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,210.92,,,,,,,fee schedule,123.5,497.64, Ob us nuchal meas 1 gest,76813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,265.28,,,,,,,fee schedule,123.5,497.64, Ob us nuchal meas 1 gest,76813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,414.7,,,,,,,fee schedule,123.5,497.64, Ob us nuchal meas 1 gest,76813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.64,,,,,,,fee schedule,123.5,497.64, Ob us nuchal meas 1 gest,76813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,497.64,APC Ob us nuchal meas 1 gest,76813,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,497.64,APC Ob us nuchal meas 1 gest,76813,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,497.64,APC Ob us nuchal meas add-on,76814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,172.74,,,,,,,fee schedule,172.74,217.26, Ob us nuchal meas add-on,76814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,217.26,,,,,,,fee schedule,172.74,217.26, Ob us limited fetus(s),76815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,306.25,,,,,,,fee schedule,123.5,417.88, Ob us limited fetus(s),76815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,385.18,,,,,,,fee schedule,123.5,417.88, Ob us limited fetus(s),76815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,348.23,,,,,,,fee schedule,123.5,417.88, Ob us limited fetus(s),76815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,417.88,,,,,,,fee schedule,123.5,417.88, Ob us limited fetus(s),76815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,417.88,APC Ob us limited fetus(s),76815,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,417.88,APC Ob us limited fetus(s),76815,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,417.88,APC Ob us follow-up per fetus,76816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.06,,,,,,,fee schedule,123.5,577.41, Ob us follow-up per fetus,76816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,376.14,,,,,,,fee schedule,123.5,577.41, Ob us follow-up per fetus,76816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,481.17,,,,,,,fee schedule,123.5,577.41, Ob us follow-up per fetus,76816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,577.41,,,,,,,fee schedule,123.5,577.41, Ob us follow-up per fetus,76816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,577.41,APC Ob us follow-up per fetus,76816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,577.41,APC Ob us follow-up per fetus,76816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,577.41,APC Transvaginal us obstetric,76817,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,333.08,,,,,,,fee schedule,123.5,472.9, Transvaginal us obstetric,76817,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,418.92,,,,,,,fee schedule,123.5,472.9, Transvaginal us obstetric,76817,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,394.09,,,,,,,fee schedule,123.5,472.9, Transvaginal us obstetric,76817,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,472.9,,,,,,,fee schedule,123.5,472.9, Transvaginal us obstetric,76817,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,472.9,APC Transvaginal us obstetric,76817,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,472.9,APC Transvaginal us obstetric,76817,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,472.9,APC Fetal biophys profile w/nst,76818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,403.24,,,,,,,fee schedule,123.5,571.79, Fetal biophys profile w/nst,76818,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,507.17,,,,,,,fee schedule,123.5,571.79, Fetal biophys profile w/nst,76818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,476.5,,,,,,,fee schedule,123.5,571.79, Fetal biophys profile w/nst,76818,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,571.79,,,,,,,fee schedule,123.5,571.79, Fetal biophys profile w/nst,76818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,571.79,APC Fetal biophys profile w/nst,76818,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,571.79,APC Fetal biophys profile w/nst,76818,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,571.79,APC Fetal biophys profil w/o nst,76819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,354.15,,,,,,,fee schedule,123.5,445.42, Fetal biophys profil w/o nst,76819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,445.42,,,,,,,fee schedule,123.5,445.42, Fetal biophys profil w/o nst,76819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,341.36,,,,,,,fee schedule,123.5,445.42, Fetal biophys profil w/o nst,76819,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,409.63,,,,,,,fee schedule,123.5,445.42, Fetal biophys profil w/o nst,76819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,445.42,APC Fetal biophys profil w/o nst,76819,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,445.42,APC Fetal biophys profil w/o nst,76819,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,445.42,APC Umbilical artery echo,76820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,312.97,,,,,,,fee schedule,123.5,393.63, Umbilical artery echo,76820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,393.63,,,,,,,fee schedule,123.5,393.63, Umbilical artery echo,76820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.63,,,,,,,fee schedule,123.5,393.63, Umbilical artery echo,76820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,175.95,,,,,,,fee schedule,123.5,393.63, Umbilical artery echo,76820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,393.63,APC Umbilical artery echo,76820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,393.63,APC Umbilical artery echo,76820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,393.63,APC Middle cerebral artery echo,76821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,346.76,,,,,,,fee schedule,123.5,461.88, Middle cerebral artery echo,76821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,436.13,,,,,,,fee schedule,123.5,461.88, Middle cerebral artery echo,76821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,384.9,,,,,,,fee schedule,123.5,461.88, Middle cerebral artery echo,76821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,461.88,,,,,,,fee schedule,123.5,461.88, Middle cerebral artery echo,76821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,461.88,APC Middle cerebral artery echo,76821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,461.88,APC Middle cerebral artery echo,76821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,461.88,APC Echo exam of fetal heart,76825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,553.95,,,,,,,fee schedule,553.95,1514.97, Echo exam of fetal heart,76825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,696.72,,,,,,,fee schedule,553.95,1514.97, Echo exam of fetal heart,76825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1262.47,,,,,,,fee schedule,553.95,1514.97, Echo exam of fetal heart,76825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1514.97,,,,,,,fee schedule,553.95,1514.97, Echo exam of fetal heart,76825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,553.95,1514.97,APC Echo exam of fetal heart,76825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,553.95,1514.97,APC Echo exam of fetal heart,76825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,553.95,1514.97,APC Echo exam of fetal heart,76826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,237.4,,,,,,,fee schedule,237.4,973.32, Echo exam of fetal heart,76826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,298.58,,,,,,,fee schedule,237.4,973.32, Echo exam of fetal heart,76826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,811.1,,,,,,,fee schedule,237.4,973.32, Echo exam of fetal heart,76826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,973.32,,,,,,,fee schedule,237.4,973.32, Echo exam of fetal heart,76826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,237.4,973.32,APC Echo exam of fetal heart,76826,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,237.4,973.32,APC Echo exam of fetal heart,76826,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,237.4,973.32,APC Echo exam of fetal heart,76827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,339.54,,,,,,,fee schedule,123.5,427.05, Echo exam of fetal heart,76827,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,427.05,,,,,,,fee schedule,123.5,427.05, Echo exam of fetal heart,76827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,293.25,,,,,,,fee schedule,123.5,427.05, Echo exam of fetal heart,76827,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,351.91,,,,,,,fee schedule,123.5,427.05, Echo exam of fetal heart,76827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,427.05,APC Echo exam of fetal heart,76827,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,427.05,APC Echo exam of fetal heart,76827,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,427.05,APC Echo exam of fetal heart,76828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,253.2,,,,,,,fee schedule,123.5,318.46, Echo exam of fetal heart,76828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,318.46,,,,,,,fee schedule,123.5,318.46, Echo exam of fetal heart,76828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,155.75,,,,,,,fee schedule,123.5,318.46, Echo exam of fetal heart,76828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,123.5,318.46, Echo exam of fetal heart,76828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,318.46,APC Echo exam of fetal heart,76828,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,318.46,APC Echo exam of fetal heart,76828,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,318.46,APC Transvaginal us non-ob,76830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,326.24,,,,,,,fee schedule,123.5,717.6, Transvaginal us non-ob,76830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,410.32,,,,,,,fee schedule,123.5,717.6, Transvaginal us non-ob,76830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,598,,,,,,,fee schedule,123.5,717.6, Transvaginal us non-ob,76830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,717.6,,,,,,,fee schedule,123.5,717.6, Transvaginal us non-ob,76830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,717.6,APC Transvaginal us non-ob,76830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,717.6,APC Transvaginal us non-ob,76830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,717.6,APC Echo exam uterus,76831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,332.38,,,,,,,fee schedule,281.87,679.14, Echo exam uterus,76831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,418.05,,,,,,,fee schedule,281.87,679.14, Echo exam uterus,76831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,565.95,,,,,,,fee schedule,281.87,679.14, Echo exam uterus,76831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,679.14,,,,,,,fee schedule,281.87,679.14, Echo exam uterus,76831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,679.14,APC Echo exam uterus,76831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,679.14,APC Echo exam uterus,76831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,679.14,APC Us exam pelvic complete,76856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,326.24,,,,,,,fee schedule,123.5,604.92, Us exam pelvic complete,76856,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,410.32,,,,,,,fee schedule,123.5,604.92, Us exam pelvic complete,76856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,504.1,,,,,,,fee schedule,123.5,604.92, Us exam pelvic complete,76856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,604.92,,,,,,,fee schedule,123.5,604.92, Us exam pelvic complete,76856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,604.92,APC Us exam pelvic complete,76856,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,604.92,APC Us exam pelvic complete,76856,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,604.92,APC Us exam pelvic limited,76857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,295.92,,,,,,,fee schedule,123.5,372.19, Us exam pelvic limited,76857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,372.19,,,,,,,fee schedule,123.5,372.19, Us exam pelvic limited,76857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.99,,,,,,,fee schedule,123.5,372.19, Us exam pelvic limited,76857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,217.19,,,,,,,fee schedule,123.5,372.19, Us exam pelvic limited,76857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,372.19,APC Us exam pelvic limited,76857,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,372.19,APC Us exam pelvic limited,76857,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,372.19,APC Us exam scrotum,76870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,317.77,,,,,,,fee schedule,123.5,580.11, Us exam scrotum,76870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,399.67,,,,,,,fee schedule,123.5,580.11, Us exam scrotum,76870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,483.43,,,,,,,fee schedule,123.5,580.11, Us exam scrotum,76870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,580.11,,,,,,,fee schedule,123.5,580.11, Us exam scrotum,76870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,580.11,APC Us exam scrotum,76870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,580.11,APC Us exam scrotum,76870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,580.11,APC Us transrectal,76872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,392.53,,,,,,,fee schedule,123.5,1396.74, Us transrectal,76872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,493.7,,,,,,,fee schedule,123.5,1396.74, Us transrectal,76872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1163.95,,,,,,,fee schedule,123.5,1396.74, Us transrectal,76872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1396.74,,,,,,,fee schedule,123.5,1396.74, Us transrectal,76872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1396.74,APC Us transrectal,76872,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1396.74,APC Us transrectal,76872,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1396.74,APC Echograp trans r pros study,76873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,551.21,,,,,,,fee schedule,123.5,827.58, Echograp trans r pros study,76873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,693.28,,,,,,,fee schedule,123.5,827.58, Echograp trans r pros study,76873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,689.65,,,,,,,fee schedule,123.5,827.58, Echograp trans r pros study,76873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,827.58,,,,,,,fee schedule,123.5,827.58, Echograp trans r pros study,76873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,827.58,APC Echograp trans r pros study,76873,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,827.58,APC Echograp trans r pros study,76873,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,827.58,APC Us xtr non-vasc complete,76881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,293.97,,,,,,,fee schedule,75.59,369.73, Us xtr non-vasc complete,76881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,369.73,,,,,,,fee schedule,75.59,369.73, Us xtr non-vasc complete,76881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75.59,,,,,,,fee schedule,75.59,369.73, Us xtr non-vasc complete,76881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.71,,,,,,,fee schedule,75.59,369.73, Us xtr non-vasc complete,76881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,75.59,369.73,APC Us xtr non-vasc complete,76881,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,75.59,369.73,APC Us xtr non-vasc complete,76881,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,75.59,369.73,APC Us xtr non-vasc lmtd,76882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,293.97,,,,,,,fee schedule,123.5,369.73, Us xtr non-vasc lmtd,76882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,369.73,,,,,,,fee schedule,123.5,369.73, Us xtr non-vasc lmtd,76882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,213.04,,,,,,,fee schedule,123.5,369.73, Us xtr non-vasc lmtd,76882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,255.65,,,,,,,fee schedule,123.5,369.73, Us xtr non-vasc lmtd,76882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,369.73,APC Us xtr non-vasc lmtd,76882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,369.73,APC Us xtr non-vasc lmtd,76882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,369.73,APC Us nrv&acc strux 1xtr compre,76883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,186.15,,,,,,,fee schedule,98.46,234.13, Us nrv&acc strux 1xtr compre,76883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,234.13,,,,,,,fee schedule,98.46,234.13, Us nrv&acc strux 1xtr compre,76883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.46,,,,,,,fee schedule,98.46,234.13, Us nrv&acc strux 1xtr compre,76883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,118.16,,,,,,,fee schedule,98.46,234.13, Us nrv&acc strux 1xtr compre,76883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,98.46,234.13,APC Us nrv&acc strux 1xtr compre,76883,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,98.46,234.13,APC Us nrv&acc strux 1xtr compre,76883,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,98.46,234.13,APC Us exam infant hips dynamic,76885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,333.34,,,,,,,fee schedule,102.81,833.06, Us exam infant hips dynamic,76885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,419.25,,,,,,,fee schedule,102.81,833.06, Us exam infant hips dynamic,76885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,694.21,,,,,,,fee schedule,102.81,833.06, Us exam infant hips dynamic,76885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,833.06,,,,,,,fee schedule,102.81,833.06, Us exam infant hips dynamic,76885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,833.06,APC Us exam infant hips dynamic,76885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,833.06,APC Us exam infant hips dynamic,76885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,833.06,APC Us exam infant hips static,76886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,298.77,,,,,,,fee schedule,102.81,582.88, Us exam infant hips static,76886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,375.77,,,,,,,fee schedule,102.81,582.88, Us exam infant hips static,76886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,485.74,,,,,,,fee schedule,102.81,582.88, Us exam infant hips static,76886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,582.88,,,,,,,fee schedule,102.81,582.88, Us exam infant hips static,76886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,582.88,APC Us exam infant hips static,76886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,582.88,APC Us exam infant hips static,76886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,582.88,APC Echo guide for heart biopsy,76932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325.57,,,,,,,fee schedule,325.57,409.48, Echo guide for heart biopsy,76932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,409.48,,,,,,,fee schedule,325.57,409.48, Echo guide for artery repair,76936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1204.1,,,,,,,fee schedule,255.08,1514.43, Echo guide for artery repair,76936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1514.43,,,,,,,fee schedule,255.08,1514.43, Echo guide for artery repair,76936,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1157.02,,,,,,,fee schedule,255.08,1514.43, Echo guide for artery repair,76936,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1388.43,,,,,,,fee schedule,255.08,1514.43, Echo guide for artery repair,76936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,1514.43,APC Echo guide for artery repair,76936,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,1514.43,APC Echo guide for artery repair,76936,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,1514.43,APC Us guide vascular access,76937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.92,,,,,,,fee schedule,111.92,140.76, Us guide vascular access,76937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,140.76,,,,,,,fee schedule,111.92,140.76, Us guide tissue ablation,76940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,579.7,,,,,,,fee schedule,579.7,729.11, Us guide tissue ablation,76940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,729.11,,,,,,,fee schedule,579.7,729.11, Echo guide for transfusion,76941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,436.79,,,,,,,fee schedule,436.79,549.37, Echo guide for transfusion,76941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,549.37,,,,,,,fee schedule,436.79,549.37, Echo guide for biopsy,76942,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,494.44,,,,,,,fee schedule,494.44,621.87, Echo guide for biopsy,76942,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,621.87,,,,,,,fee schedule,494.44,621.87, Echo guide villus sampling,76945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,322.89,,,,,,,fee schedule,322.89,406.11, Echo guide villus sampling,76945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,406.11,,,,,,,fee schedule,322.89,406.11, Echo guide for amniocentesis,76946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,277.35,,,,,,,fee schedule,277.35,348.83, Echo guide for amniocentesis,76946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,348.83,,,,,,,fee schedule,277.35,348.83, Echo guide ova aspiration,76948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.04,,,,,,,fee schedule,276.04,347.19, Echo guide ova aspiration,76948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,347.19,,,,,,,fee schedule,276.04,347.19, Echo guidance radiotherapy,76965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,992.14,,,,,,,fee schedule,992.14,1247.84, Echo guidance radiotherapy,76965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1247.84,,,,,,,fee schedule,992.14,1247.84, GI endoscopic ultrasound,76975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,347.8,,,,,,,fee schedule,281.87,475.19, GI endoscopic ultrasound,76975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,437.44,,,,,,,fee schedule,281.87,475.19, GI endoscopic ultrasound,76975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,395.99,,,,,,,fee schedule,281.87,475.19, GI endoscopic ultrasound,76975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,475.19,,,,,,,fee schedule,281.87,475.19, GI endoscopic ultrasound,76975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,475.19,APC GI endoscopic ultrasound,76975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,475.19,APC GI endoscopic ultrasound,76975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,475.19,APC Us bone density measure,76977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.82,,,,,,,fee schedule,32.05,155.73, Us bone density measure,76977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,155.73,,,,,,,fee schedule,32.05,155.73, Us bone density measure,76977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.05,,,,,,,fee schedule,32.05,155.73, Us bone density measure,76977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.46,,,,,,,fee schedule,32.05,155.73, Us bone density measure,76977,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,32.05,155.73,APC Us bone density measure,76977,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,32.05,155.73,APC Us bone density measure,76977,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,32.05,155.73,APC Us trgt dyn mbubb 1st les,76978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,587.06,,,,,,,fee schedule,412.14,1201.52, Us trgt dyn mbubb 1st les,76978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,738.37,,,,,,,fee schedule,412.14,1201.52, Us trgt dyn mbubb 1st les,76978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1001.27,,,,,,,fee schedule,412.14,1201.52, Us trgt dyn mbubb 1st les,76978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1201.52,,,,,,,fee schedule,412.14,1201.52, Us trgt dyn mbubb 1st les,76978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1201.52,APC Us trgt dyn mbubb 1st les,76978,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1201.52,APC Us trgt dyn mbubb 1st les,76978,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1201.52,APC Use parenchyma,76981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,327.4,,,,,,,fee schedule,123.5,629.66, Use parenchyma,76981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,411.79,,,,,,,fee schedule,123.5,629.66, Use parenchyma,76981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,524.72,,,,,,,fee schedule,123.5,629.66, Use parenchyma,76981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,629.66,,,,,,,fee schedule,123.5,629.66, Use parenchyma,76981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,629.66,APC Use parenchyma,76981,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,629.66,APC Use parenchyma,76981,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,629.66,APC Use 1st target lesion,76982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,327.4,,,,,,,fee schedule,123.5,538.88, Use 1st target lesion,76982,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,411.79,,,,,,,fee schedule,123.5,538.88, Use 1st target lesion,76982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,449.06,,,,,,,fee schedule,123.5,538.88, Use 1st target lesion,76982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,538.88,,,,,,,fee schedule,123.5,538.88, Use 1st target lesion,76982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,538.88,APC Use 1st target lesion,76982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,538.88,APC Use 1st target lesion,76982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,538.88,APC Echo examination procedure,76999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.65,,,,,,,fee schedule,102.81,736.04, Echo examination procedure,76999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,207.08,,,,,,,fee schedule,102.81,736.04, Echo examination procedure,76999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.36,,,,,,,fee schedule,102.81,736.04, Echo examination procedure,76999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.04,,,,,,,fee schedule,102.81,736.04, Echo examination procedure,76999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,736.04,APC Echo examination procedure,76999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,736.04,APC Echo examination procedure,76999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,736.04,APC Fluoroguide for Vein Device,77001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,359.18,,,,,,,fee schedule,359.18,451.75, Fluoroguide for Vein Device,77001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,451.75,,,,,,,fee schedule,359.18,451.75, Needle localization by xray,77002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,239.11,,,,,,,fee schedule,239.11,300.74, Needle localization by xray,77002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,300.74,,,,,,,fee schedule,239.11,300.74, Fluoroguide for Spine Inject,77003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,196.92,,,,,,,fee schedule,196.92,247.67, Fluoroguide for Spine Inject,77003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,247.67,,,,,,,fee schedule,196.92,247.67, CT Scan for Localization,77011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2360.88,,,,,,,fee schedule,2360.88,2969.36, CT Scan for Localization,77011,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2969.36,,,,,,,fee schedule,2360.88,2969.36, Ct scan for needle biopsy,77012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,680.77,,,,,,,fee schedule,680.77,856.22, Ct scan for needle biopsy,77012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,856.22,,,,,,,fee schedule,680.77,856.22, CT Scan for Therapy Guide,77014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,636.62,,,,,,,fee schedule,636.62,800.7, CT Scan for Therapy Guide,77014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,800.7,,,,,,,fee schedule,636.62,800.7, MR Guidance for Needle Place,77021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1548.29,,,,,,,fee schedule,1548.29,1947.34, MR Guidance for Needle Place,77021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1947.34,,,,,,,fee schedule,1548.29,1947.34, Mri breast c- unilateral,77046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2928.68,,,,,,,fee schedule,281.87,3683.5, Mri breast c- unilateral,77046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3683.5,,,,,,,fee schedule,281.87,3683.5, Mri breast c- unilateral,77046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,3683.5,APC Mri breast c- unilateral,77046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,3683.5,APC Mri breast c- unilateral,77046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,3683.5,APC Mri breast c- bilateral,77047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3152.52,,,,,,,fee schedule,281.87,3965.02, Mri breast c- bilateral,77047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3965.02,,,,,,,fee schedule,281.87,3965.02, Mri breast c- bilateral,77047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,3965.02,APC Mri breast c- bilateral,77047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,3965.02,APC Mri breast c- bilateral,77047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,3965.02,APC Mri breast c-+ w/cad uni,77048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2928.68,,,,,,,fee schedule,2928.68,3683.5, Mri breast c-+ w/cad uni,77048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3683.5,,,,,,,fee schedule,2928.68,3683.5, Mri breast c-+ w/cad bi,77049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3152.52,,,,,,,fee schedule,3152.52,3965.02, Mri breast c-+ w/cad bi,77049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3965.02,,,,,,,fee schedule,3152.52,3965.02, X-Ray of Mammary Duct,77053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,530.35,,,,,,,fee schedule,254.33,667.04, X-Ray of Mammary Duct,77053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,667.04,,,,,,,fee schedule,254.33,667.04, X-Ray of Mammary Duct,77053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,254.33,,,,,,,fee schedule,254.33,667.04, X-Ray of Mammary Duct,77053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,305.2,,,,,,,fee schedule,254.33,667.04, X-Ray of Mammary Duct,77053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,254.33,667.04,APC X-Ray of Mammary Duct,77053,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,254.33,667.04,APC X-Ray of Mammary Duct,77053,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,254.33,667.04,APC X-ray of mammary ducts,77054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,455.5,,,,,,,fee schedule,281.87,572.9, X-ray of mammary ducts,77054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,572.9,,,,,,,fee schedule,281.87,572.9, X-ray of mammary ducts,77054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,332.24,,,,,,,fee schedule,281.87,572.9, X-ray of mammary ducts,77054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,398.68,,,,,,,fee schedule,281.87,572.9, X-ray of mammary ducts,77054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,572.9,APC X-ray of mammary ducts,77054,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,572.9,APC X-ray of mammary ducts,77054,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,572.9,APC Breast tomosynthesis uni,77061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.24,,,,,,,fee schedule,68.24,720.37, Breast tomosynthesis uni,77061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.83,,,,,,,fee schedule,68.24,720.37, Breast tomosynthesis uni,77061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,600.31,,,,,,,fee schedule,68.24,720.37, Breast tomosynthesis uni,77061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,720.37,,,,,,,fee schedule,68.24,720.37, Breast tomosynthesis bi,77062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.24,,,,,,,fee schedule,68.24,923.77, Breast tomosynthesis bi,77062,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.83,,,,,,,fee schedule,68.24,923.77, Breast tomosynthesis bi,77062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,769.81,,,,,,,fee schedule,68.24,923.77, Breast tomosynthesis bi,77062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,923.77,,,,,,,fee schedule,68.24,923.77, Breast tomosynthesis bi,77063,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.03,,,,,,,fee schedule,58.03,197.99, Breast tomosynthesis bi,77063,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.98,,,,,,,fee schedule,58.03,197.99, Breast tomosynthesis bi,77063,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.99,,,,,,,fee schedule,58.03,197.99, Breast tomosynthesis bi,77063,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.99,,,,,,,fee schedule,58.03,197.99, Breast tomosynthesis bi,77063,HCPCS,,,,,facility,outpatient,,,TC,,,Aetna,Medicare Managed Care Plan,28.64,,,,,,,fee schedule,27.54,28.92,APC Breast tomosynthesis bi,77063,HCPCS,,,,,facility,outpatient,,,TC,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.92,,,,,,,fee schedule,27.54,28.92,APC Breast tomosynthesis bi,77063,HCPCS,,,,,facility,outpatient,,,TC,,,Kaiser,Medicare Managed Care Plan,27.54,,,,,,,fee schedule,27.54,28.92,APC Dx mammo incl cad uni,77065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,286.08,,,,,,,fee schedule,286.08,720.37, Dx mammo incl cad uni,77065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,359.81,,,,,,,fee schedule,286.08,720.37, Dx mammo incl cad uni,77065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,600.31,,,,,,,fee schedule,286.08,720.37, Dx mammo incl cad uni,77065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,720.37,,,,,,,fee schedule,286.08,720.37, Dx mammo incl cad uni,77065,HCPCS,,,,,facility,outpatient,,,TC,,,Aetna,Medicare Managed Care Plan,105.55,,,,,,,fee schedule,101.49,106.56,APC Dx mammo incl cad uni,77065,HCPCS,,,,,facility,outpatient,,,TC,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,106.56,,,,,,,fee schedule,101.49,106.56,APC Dx mammo incl cad uni,77065,HCPCS,,,,,facility,outpatient,,,TC,,,Kaiser,Medicare Managed Care Plan,101.49,,,,,,,fee schedule,101.49,106.56,APC Dx mammo incl cad bi,77066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,363.2,,,,,,,fee schedule,363.2,923.77, Dx mammo incl cad bi,77066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,456.8,,,,,,,fee schedule,363.2,923.77, Dx mammo incl cad bi,77066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,769.81,,,,,,,fee schedule,363.2,923.77, Dx mammo incl cad bi,77066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,923.77,,,,,,,fee schedule,363.2,923.77, Dx mammo incl cad bi,77066,HCPCS,,,,,facility,outpatient,,,TC,,,Aetna,Medicare Managed Care Plan,135.4,,,,,,,fee schedule,130.19,136.7,APC Dx mammo incl cad bi,77066,HCPCS,,,,,facility,outpatient,,,TC,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,136.7,,,,,,,fee schedule,130.19,136.7,APC Dx mammo incl cad bi,77066,HCPCS,,,,,facility,outpatient,,,TC,,,Kaiser,Medicare Managed Care Plan,130.19,,,,,,,fee schedule,130.19,136.7,APC Scr mammo bi incl cad,77067,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,274.38,,,,,,,fee schedule,274.38,761.61, Scr mammo bi incl cad,77067,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,345.1,,,,,,,fee schedule,274.38,761.61, Scr mammo bi incl cad,77067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,634.67,,,,,,,fee schedule,274.38,761.61, Scr mammo bi incl cad,77067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,761.61,,,,,,,fee schedule,274.38,761.61, Scr mammo bi incl cad,77067,HCPCS,,,,,facility,outpatient,,,TC,,,Aetna,Medicare Managed Care Plan,111.69,,,,,,,fee schedule,107.39,112.76,APC Scr mammo bi incl cad,77067,HCPCS,,,,,facility,outpatient,,,TC,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,112.76,,,,,,,fee schedule,107.39,112.76,APC Scr mammo bi incl cad,77067,HCPCS,,,,,facility,outpatient,,,TC,,,Kaiser,Medicare Managed Care Plan,107.39,,,,,,,fee schedule,107.39,112.76,APC X-Ray Stress View,77071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.58,,,,,,,fee schedule,102.81,736.04, X-Ray Stress View,77071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,152.91,,,,,,,fee schedule,102.81,736.04, X-Ray Stress View,77071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.36,,,,,,,fee schedule,102.81,736.04, X-Ray Stress View,77071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.04,,,,,,,fee schedule,102.81,736.04, X-Ray Stress View,77071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,736.04,APC X-Ray Stress View,77071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,736.04,APC X-Ray Stress View,77071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,736.04,APC X-Rays for Bone Age,77072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,137.53,,,,,,,fee schedule,116.83,172.97, X-Rays for Bone Age,77072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,172.97,,,,,,,fee schedule,116.83,172.97, X-Rays for Bone Age,77072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.83,,,,,,,fee schedule,116.83,172.97, X-Rays for Bone Age,77072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.19,,,,,,,fee schedule,116.83,172.97, X-Rays for Bone Age,77072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,116.83,172.97,APC X-Rays for Bone Age,77072,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,116.83,172.97,APC X-Rays for Bone Age,77072,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,116.83,172.97,APC X-rays bone length studies,77073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,177.02,,,,,,,fee schedule,123.5,266.67, X-rays bone length studies,77073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,222.64,,,,,,,fee schedule,123.5,266.67, X-rays bone length studies,77073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,222.22,,,,,,,fee schedule,123.5,266.67, X-rays bone length studies,77073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,266.67,,,,,,,fee schedule,123.5,266.67, X-rays bone length studies,77073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,266.67,APC X-rays bone length studies,77073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,266.67,APC X-rays bone length studies,77073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,266.67,APC X-rays bone survey limited,77074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,235.74,,,,,,,fee schedule,123.5,368.4, X-rays bone survey limited,77074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.5,,,,,,,fee schedule,123.5,368.4, X-rays bone survey limited,77074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,307,,,,,,,fee schedule,123.5,368.4, X-rays bone survey limited,77074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,368.4,,,,,,,fee schedule,123.5,368.4, X-rays bone survey limited,77074,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,368.4,APC X-rays bone survey limited,77074,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,368.4,APC X-rays bone survey limited,77074,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,368.4,APC X-rays bone survey complete,77075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325.63,,,,,,,fee schedule,123.5,607.55, X-rays bone survey complete,77075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,409.55,,,,,,,fee schedule,123.5,607.55, X-rays bone survey complete,77075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,506.29,,,,,,,fee schedule,123.5,607.55, X-rays bone survey complete,77075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,607.55,,,,,,,fee schedule,123.5,607.55, X-rays bone survey complete,77075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,607.55,APC X-rays bone survey complete,77075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,607.55,APC X-rays bone survey complete,77075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,607.55,APC X-rays bone survey infant,77076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,395.06,,,,,,,fee schedule,123.5,613.1, X-rays bone survey infant,77076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,496.88,,,,,,,fee schedule,123.5,613.1, X-rays bone survey infant,77076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,510.91,,,,,,,fee schedule,123.5,613.1, X-rays bone survey infant,77076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,613.1,,,,,,,fee schedule,123.5,613.1, X-rays bone survey infant,77076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,613.1,APC X-rays bone survey infant,77076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,613.1,APC X-rays bone survey infant,77076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,613.1,APC Joint survey single view,77077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,135.34,,,,,,,fee schedule,123.5,252.95, Joint survey single view,77077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,170.23,,,,,,,fee schedule,123.5,252.95, Joint survey single view,77077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,210.79,,,,,,,fee schedule,123.5,252.95, Joint survey single view,77077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,252.95,,,,,,,fee schedule,123.5,252.95, Joint survey single view,77077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,252.95,APC Joint survey single view,77077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,252.95,APC Joint survey single view,77077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,252.95,APC Ct bone density axial,77078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,212.2,,,,,,,fee schedule,102.81,266.89, Ct bone density axial,77078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,266.89,,,,,,,fee schedule,102.81,266.89, Ct bone density axial,77078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,266.89,APC Ct bone density axial,77078,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,266.89,APC Ct bone density axial,77078,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,266.89,APC Dxa bone density axial,77080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,213.77,,,,,,,fee schedule,123.5,268.86, Dxa bone density axial,77080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.86,,,,,,,fee schedule,123.5,268.86, Dxa bone density axial,77080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,203.92,,,,,,,fee schedule,123.5,268.86, Dxa bone density axial,77080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,244.7,,,,,,,fee schedule,123.5,268.86, Dxa bone density axial,77080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,268.86,APC Dxa bone density axial,77080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,268.86,APC Dxa bone density axial,77080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,268.86,APC Dxa bone density/peripheral,77081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.65,,,,,,,fee schedule,95.65,184.2, Dxa bone density/peripheral,77081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,120.3,,,,,,,fee schedule,95.65,184.2, Dxa bone density/peripheral,77081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,153.5,,,,,,,fee schedule,95.65,184.2, Dxa bone density/peripheral,77081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,184.2,,,,,,,fee schedule,95.65,184.2, Dxa bone density/peripheral,77081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,95.65,184.2,APC Dxa bone density/peripheral,77081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,95.65,184.2,APC Dxa bone density/peripheral,77081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,95.65,184.2,APC Magnetic image bone marrow,77084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,852.25,,,,,,,fee schedule,281.87,1071.9, Magnetic image bone marrow,77084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1071.9,,,,,,,fee schedule,281.87,1071.9, Magnetic image bone marrow,77084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1071.9,APC Magnetic image bone marrow,77084,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1071.9,APC Magnetic image bone marrow,77084,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1071.9,APC Dxa bone density study,77085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,293.01,,,,,,,fee schedule,123.5,368.53, Dxa bone density study,77085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,368.53,,,,,,,fee schedule,123.5,368.53, Dxa bone density study,77085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,270.27,,,,,,,fee schedule,123.5,368.53, Dxa bone density study,77085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,324.32,,,,,,,fee schedule,123.5,368.53, Dxa bone density study,77085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,368.53,APC Dxa bone density study,77085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,368.53,APC Dxa bone density study,77085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,368.53,APC Fracture assessment via dxa,77086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,103.92,,,,,,,fee schedule,102.81,211.64, Fracture assessment via dxa,77086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.7,,,,,,,fee schedule,102.81,211.64, Fracture assessment via dxa,77086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,176.37,,,,,,,fee schedule,102.81,211.64, Fracture assessment via dxa,77086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,211.64,,,,,,,fee schedule,102.81,211.64, Fracture assessment via dxa,77086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,211.64,APC Fracture assessment via dxa,77086,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,211.64,APC Fracture assessment via dxa,77086,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,211.64,APC Tbs techl prep&transmis data,77090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.36,,,,,,,fee schedule,102.81,736.04, Tbs techl prep&transmis data,77090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.04,,,,,,,fee schedule,102.81,736.04, Tbs techl prep&transmis data,77090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,736.04,APC Tbs techl prep&transmis data,77090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,736.04,APC Tbs techl prep&transmis data,77090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,736.04,APC Tbs techl calculation only,77091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.36,,,,,,,fee schedule,102.81,736.04, Tbs techl calculation only,77091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.04,,,,,,,fee schedule,102.81,736.04, Tbs techl calculation only,77091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,736.04,APC Tbs techl calculation only,77091,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,736.04,APC Tbs techl calculation only,77091,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,736.04,APC Radiation therapy planning,77261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,235.88,,,,,,,fee schedule,235.88,296.68, Radiation therapy planning,77261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.68,,,,,,,fee schedule,235.88,296.68, Radiation therapy planning,77262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,355.25,,,,,,,fee schedule,355.25,446.81, Radiation therapy planning,77262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,446.81,,,,,,,fee schedule,355.25,446.81, Radiation therapy planning,77263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,527.47,,,,,,,fee schedule,527.47,663.41, Radiation therapy planning,77263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,663.41,,,,,,,fee schedule,527.47,663.41, Set radiation therapy field,77280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,595.04,,,,,,,fee schedule,158.78,748.4, Set radiation therapy field,77280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,748.4,,,,,,,fee schedule,158.78,748.4, Set radiation therapy field,77280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,748.4,APC Set radiation therapy field,77280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,748.4,APC Set radiation therapy field,77280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,748.4,APC Set radiation therapy field,77285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,944.56,,,,,,,fee schedule,442.33,1188, Set radiation therapy field,77285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1188,,,,,,,fee schedule,442.33,1188, Set radiation therapy field,77285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,1188,APC Set radiation therapy field,77285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,1188,APC Set radiation therapy field,77285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,1188,APC Set radiation therapy field,77290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1158.27,,,,,,,fee schedule,442.33,1456.79, Set radiation therapy field,77290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1456.79,,,,,,,fee schedule,442.33,1456.79, Set radiation therapy field,77290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,1456.79,APC Set radiation therapy field,77290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,1456.79,APC Set radiation therapy field,77290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,1456.79,APC 3-d radiotherapy plan,77295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4618.52,,,,,,,fee schedule,1635.14,5808.86, 3-d radiotherapy plan,77295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5808.86,,,,,,,fee schedule,1635.14,5808.86, 3-d radiotherapy plan,77295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1700.54,,,,,,,fee schedule,1635.14,5808.86,APC 3-d radiotherapy plan,77295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1716.89,,,,,,,fee schedule,1635.14,5808.86,APC 3-d radiotherapy plan,77295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1635.14,,,,,,,fee schedule,1635.14,5808.86,APC Radiation therapy planning,77299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,100.98,,,,,,,fee schedule,100.98,166.72, Radiation therapy planning,77299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127,,,,,,,fee schedule,100.98,166.72, Radiation therapy planning,77299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,100.98,166.72,APC Radiation therapy planning,77299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,100.98,166.72,APC Radiation therapy planning,77299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,100.98,166.72,APC Radiation therapy dose plan,77300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,287.1,,,,,,,fee schedule,158.78,361.1, Radiation therapy dose plan,77300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,361.1,,,,,,,fee schedule,158.78,361.1, Radiation therapy dose plan,77300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,361.1,APC Radiation therapy dose plan,77300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,361.1,APC Radiation therapy dose plan,77300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,361.1,APC Radiotherapy dose plan imrt,77301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5178.2,,,,,,,fee schedule,1635.14,6512.79, Radiotherapy dose plan imrt,77301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6512.79,,,,,,,fee schedule,1635.14,6512.79, Radiotherapy dose plan imrt,77301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1700.54,,,,,,,fee schedule,1635.14,6512.79,APC Radiotherapy dose plan imrt,77301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1716.89,,,,,,,fee schedule,1635.14,6512.79,APC Radiotherapy dose plan imrt,77301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1635.14,,,,,,,fee schedule,1635.14,6512.79,APC Telethx isodose plan simple,77306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,495.54,,,,,,,fee schedule,442.33,623.26, Telethx isodose plan simple,77306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,623.26,,,,,,,fee schedule,442.33,623.26, Telethx isodose plan simple,77306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,623.26,APC Telethx isodose plan simple,77306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,623.26,APC Telethx isodose plan simple,77306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,623.26,APC Telethx isodose plan cplx,77307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,623.9,,,,,,,fee schedule,442.33,784.7, Telethx isodose plan cplx,77307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,784.7,,,,,,,fee schedule,442.33,784.7, Telethx isodose plan cplx,77307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,784.7,APC Telethx isodose plan cplx,77307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,784.7,APC Telethx isodose plan cplx,77307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,784.7,APC Brachytx isodose plan simple,77316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,480.32,,,,,,,fee schedule,442.33,604.12, Brachytx isodose plan simple,77316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,604.12,,,,,,,fee schedule,442.33,604.12, Brachytx isodose plan simple,77316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,604.12,APC Brachytx isodose plan simple,77316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,604.12,APC Brachytx isodose plan simple,77316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,604.12,APC Brachytx isodose intermed,77317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,707.22,,,,,,,fee schedule,442.33,889.49, Brachytx isodose intermed,77317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,889.49,,,,,,,fee schedule,442.33,889.49, Brachytx isodose intermed,77317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,889.49,APC Brachytx isodose intermed,77317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,889.49,APC Brachytx isodose intermed,77317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,889.49,APC Brachytx isodose complex,77318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1028.57,,,,,,,fee schedule,442.33,1293.66, Brachytx isodose complex,77318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1293.66,,,,,,,fee schedule,442.33,1293.66, Brachytx isodose complex,77318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,1293.66,APC Brachytx isodose complex,77318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,1293.66,APC Brachytx isodose complex,77318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,1293.66,APC Special teletx port plan,77321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,714.64,,,,,,,fee schedule,442.33,898.82, Special teletx port plan,77321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,898.82,,,,,,,fee schedule,442.33,898.82, Special teletx port plan,77321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,898.82,APC Special teletx port plan,77321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,898.82,APC Special teletx port plan,77321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,898.82,APC Special radiation dosimetry,77331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,210.68,,,,,,,fee schedule,158.78,264.98, Special radiation dosimetry,77331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,264.98,,,,,,,fee schedule,158.78,264.98, Special radiation dosimetry,77331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,264.98,APC Special radiation dosimetry,77331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,264.98,APC Special radiation dosimetry,77331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,264.98,APC Radiation treatment aid(s),77332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,273.83,,,,,,,fee schedule,158.78,344.41, Radiation treatment aid(s),77332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,344.41,,,,,,,fee schedule,158.78,344.41, Radiation treatment aid(s),77332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,344.41,APC Radiation treatment aid(s),77332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,344.41,APC Radiation treatment aid(s),77332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,344.41,APC Radiation treatment aid(s),77333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,400.24,,,,,,,fee schedule,158.78,503.4, Radiation treatment aid(s),77333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,503.4,,,,,,,fee schedule,158.78,503.4, Radiation treatment aid(s),77333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,503.4,APC Radiation treatment aid(s),77333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,503.4,APC Radiation treatment aid(s),77333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,503.4,APC Radiation treatment aid(s),77334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,653.18,,,,,,,fee schedule,442.33,821.52, Radiation treatment aid(s),77334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,821.52,,,,,,,fee schedule,442.33,821.52, Radiation treatment aid(s),77334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,821.52,APC Radiation treatment aid(s),77334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,821.52,APC Radiation treatment aid(s),77334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,821.52,APC Radiation physics consult,77336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,413.34,,,,,,,fee schedule,158.78,519.87, Radiation physics consult,77336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,519.87,,,,,,,fee schedule,158.78,519.87, Radiation physics consult,77336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,519.87,APC Radiation physics consult,77336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,519.87,APC Radiation physics consult,77336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,519.87,APC Design mlc device for imrt,77338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1077.51,,,,,,,fee schedule,442.33,1355.22, Design mlc device for imrt,77338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1355.22,,,,,,,fee schedule,442.33,1355.22, Design mlc device for imrt,77338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.02,,,,,,,fee schedule,442.33,1355.22,APC Design mlc device for imrt,77338,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.45,,,,,,,fee schedule,442.33,1355.22,APC Design mlc device for imrt,77338,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.33,,,,,,,fee schedule,442.33,1355.22,APC Radiation physics consult,77370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,483.32,,,,,,,fee schedule,158.78,607.89, Radiation physics consult,77370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,607.89,,,,,,,fee schedule,158.78,607.89, Radiation physics consult,77370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,607.89,APC Radiation physics consult,77370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,607.89,APC Radiation physics consult,77370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,607.89,APC Srs multisource,77371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22211.27,,,,,,,fee schedule,8700.95,27935.83, Srs multisource,77371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27935.83,,,,,,,fee schedule,8700.95,27935.83, Srs multisource,77371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9048.99,,,,,,,fee schedule,8700.95,27935.83,APC Srs multisource,77371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9136,,,,,,,fee schedule,8700.95,27935.83,APC Srs multisource,77371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8700.95,,,,,,,fee schedule,8700.95,27935.83,APC Srs linear based,77372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2864.78,,,,,,,fee schedule,2864.78,9136, Srs linear based,77372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3603.12,,,,,,,fee schedule,2864.78,9136, Srs linear based,77372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9048.99,,,,,,,fee schedule,2864.78,9136,APC Srs linear based,77372,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9136,,,,,,,fee schedule,2864.78,9136,APC Srs linear based,77372,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8700.95,,,,,,,fee schedule,2864.78,9136,APC SBRT Delivery,77373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5303.85,,,,,,,fee schedule,2112.31,6670.83, SBRT Delivery,77373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6670.83,,,,,,,fee schedule,2112.31,6670.83, SBRT Delivery,77373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2196.8,,,,,,,fee schedule,2112.31,6670.83,APC SBRT Delivery,77373,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2217.92,,,,,,,fee schedule,2112.31,6670.83,APC SBRT Delivery,77373,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2112.31,,,,,,,fee schedule,2112.31,6670.83,APC Ntsty modul rad tx dlvr smpl,77385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2408.58,,,,,,,fee schedule,2408.58,3029.35, Ntsty modul rad tx dlvr smpl,77385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3029.35,,,,,,,fee schedule,2408.58,3029.35, Ntsty modul rad tx dlvr cplx,77386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2408.58,,,,,,,fee schedule,2408.58,3029.35, Ntsty modul rad tx dlvr cplx,77386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3029.35,,,,,,,fee schedule,2408.58,3029.35, Guidance for radiaj tx dlvr,77387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,392.06,,,,,,,fee schedule,392.06,493.11, Guidance for radiaj tx dlvr,77387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,493.11,,,,,,,fee schedule,392.06,493.11, External radiation dosimetry,77399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.76,,,,,,,fee schedule,158.78,304.07, External radiation dosimetry,77399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,304.07,,,,,,,fee schedule,158.78,304.07, External radiation dosimetry,77399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.13,,,,,,,fee schedule,158.78,304.07,APC External radiation dosimetry,77399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.72,,,,,,,fee schedule,158.78,304.07,APC External radiation dosimetry,77399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.78,,,,,,,fee schedule,158.78,304.07,APC Radiation treatment delivery,77401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,247.03,,,,,,,fee schedule,247.03,310.7, Radiation treatment delivery,77401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,310.7,,,,,,,fee schedule,247.03,310.7, Radiation treatment delivery,77402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,247.03,,,,,,,fee schedule,120.53,310.7, Radiation treatment delivery,77402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,310.7,,,,,,,fee schedule,120.53,310.7, Radiation treatment delivery,77402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.35,,,,,,,fee schedule,120.53,310.7,APC Radiation treatment delivery,77402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.56,,,,,,,fee schedule,120.53,310.7,APC Radiation treatment delivery,77402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.53,,,,,,,fee schedule,120.53,310.7,APC Radiation treatment delivery,77407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,290.68,,,,,,,fee schedule,290.68,478.42, Radiation treatment delivery,77407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,365.6,,,,,,,fee schedule,290.68,478.42, Radiation treatment delivery,77407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,473.87,,,,,,,fee schedule,290.68,478.42,APC Radiation treatment delivery,77407,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,478.42,,,,,,,fee schedule,290.68,478.42,APC Radiation treatment delivery,77407,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,455.64,,,,,,,fee schedule,290.68,478.42,APC Radiation treatment delivery,77412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,323.68,,,,,,,fee schedule,323.68,685.38, Radiation treatment delivery,77412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,407.1,,,,,,,fee schedule,323.68,685.38, Radiation treatment delivery,77412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,323.68,685.38,APC Radiation treatment delivery,77412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,323.68,685.38,APC Radiation treatment delivery,77412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,323.68,685.38,APC Radiology port images(s),77417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.67,,,,,,,fee schedule,82.67,103.98, Radiology port images(s),77417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.98,,,,,,,fee schedule,82.67,103.98, Neutron beam tx complex,77423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1983.54,,,,,,,fee schedule,652.74,2494.77, Neutron beam tx complex,77423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2494.77,,,,,,,fee schedule,652.74,2494.77, Neutron beam tx complex,77423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,2494.77,APC Neutron beam tx complex,77423,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,2494.77,APC Neutron beam tx complex,77423,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,2494.77,APC Io rad tx delivery by x-ray,77424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3632.49,,,,,,,fee schedule,3632.49,9136, Io rad tx delivery by x-ray,77424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4568.7,,,,,,,fee schedule,3632.49,9136, Io rad tx delivery by x-ray,77424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9048.99,,,,,,,fee schedule,3632.49,9136,APC Io rad tx delivery by x-ray,77424,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9136,,,,,,,fee schedule,3632.49,9136,APC Io rad tx delivery by x-ray,77424,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8700.95,,,,,,,fee schedule,3632.49,9136,APC Io rad tx deliver by elctrns,77425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3632.49,,,,,,,fee schedule,3632.49,9136, Io rad tx deliver by elctrns,77425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4568.7,,,,,,,fee schedule,3632.49,9136, Io rad tx deliver by elctrns,77425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9048.99,,,,,,,fee schedule,3632.49,9136,APC Io rad tx deliver by elctrns,77425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9136,,,,,,,fee schedule,3632.49,9136,APC Io rad tx deliver by elctrns,77425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8700.95,,,,,,,fee schedule,3632.49,9136,APC Radiation tx management x5,77427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,541.49,,,,,,,fee schedule,541.49,681.05, Radiation tx management x5,77427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,681.05,,,,,,,fee schedule,541.49,681.05, Radiation therapy management,77431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,309.16,,,,,,,fee schedule,309.16,388.84, Radiation therapy management,77431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,388.84,,,,,,,fee schedule,309.16,388.84, Stereotactic radiation trmt,77432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1344.45,,,,,,,fee schedule,1344.45,1690.96, Stereotactic radiation trmt,77432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1690.96,,,,,,,fee schedule,1344.45,1690.96, SBRT Management,77435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2109.58,,,,,,,fee schedule,2109.58,2653.28, SBRT Management,77435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2653.28,,,,,,,fee schedule,2109.58,2653.28, Surf radj ther tx planning,77436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Surf radj ther tx planning,77436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Surf radj ther tx planning,77436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Special radiation treatment,77470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1887.92,,,,,,,fee schedule,652.74,2374.5, Special radiation treatment,77470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2374.5,,,,,,,fee schedule,652.74,2374.5, Special radiation treatment,77470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,2374.5,APC Special radiation treatment,77470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,2374.5,APC Special radiation treatment,77470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,2374.5,APC Proton trmt simple w/o comp,77520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,986.11,,,,,,,fee schedule,652.74,1240.26, Proton trmt simple w/o comp,77520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1240.26,,,,,,,fee schedule,652.74,1240.26, Proton trmt simple w/o comp,77520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,1240.26,APC Proton trmt simple w/o comp,77520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,1240.26,APC Proton trmt simple w/o comp,77520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,1240.26,APC Proton trmt simple w/comp,77522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2991.77,,,,,,,fee schedule,1476.38,3762.85, Proton trmt simple w/comp,77522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3762.85,,,,,,,fee schedule,1476.38,3762.85, Proton trmt simple w/comp,77522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1535.43,,,,,,,fee schedule,1476.38,3762.85,APC Proton trmt simple w/comp,77522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1550.19,,,,,,,fee schedule,1476.38,3762.85,APC Proton trmt simple w/comp,77522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1476.38,,,,,,,fee schedule,1476.38,3762.85,APC Proton trmt intermediate,77523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3913.66,,,,,,,fee schedule,1476.38,4922.33, Proton trmt intermediate,77523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4922.33,,,,,,,fee schedule,1476.38,4922.33, Proton trmt intermediate,77523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1535.43,,,,,,,fee schedule,1476.38,4922.33,APC Proton trmt intermediate,77523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1550.19,,,,,,,fee schedule,1476.38,4922.33,APC Proton trmt intermediate,77523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1476.38,,,,,,,fee schedule,1476.38,4922.33,APC Proton treatment complex,77525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1388.54,,,,,,,fee schedule,1388.54,1746.41, Proton treatment complex,77525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1746.41,,,,,,,fee schedule,1388.54,1746.41, Proton treatment complex,77525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1535.43,,,,,,,fee schedule,1388.54,1746.41,APC Proton treatment complex,77525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1550.19,,,,,,,fee schedule,1388.54,1746.41,APC Proton treatment complex,77525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1476.38,,,,,,,fee schedule,1388.54,1746.41,APC Hyperthermia treatment,77600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,677.91,,,,,,,fee schedule,455.64,852.63, Hyperthermia treatment,77600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,852.63,,,,,,,fee schedule,455.64,852.63, Hyperthermia treatment,77600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,473.87,,,,,,,fee schedule,455.64,852.63,APC Hyperthermia treatment,77600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,478.42,,,,,,,fee schedule,455.64,852.63,APC Hyperthermia treatment,77600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,455.64,,,,,,,fee schedule,455.64,852.63,APC Hyperthermia treatment,77605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,909.38,,,,,,,fee schedule,822.78,1143.75, Hyperthermia treatment,77605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1143.75,,,,,,,fee schedule,822.78,1143.75, Hyperthermia treatment,77605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,855.69,,,,,,,fee schedule,822.78,1143.75,APC Hyperthermia treatment,77605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,863.92,,,,,,,fee schedule,822.78,1143.75,APC Hyperthermia treatment,77605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,822.78,,,,,,,fee schedule,822.78,1143.75,APC Hyperthermia treatment,77610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,679.25,,,,,,,fee schedule,652.74,854.32, Hyperthermia treatment,77610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,854.32,,,,,,,fee schedule,652.74,854.32, Hyperthermia treatment,77610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,854.32,APC Hyperthermia treatment,77610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,854.32,APC Hyperthermia treatment,77610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,854.32,APC Hyperthermia treatment,77615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,904.28,,,,,,,fee schedule,652.74,1137.35, Hyperthermia treatment,77615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1137.35,,,,,,,fee schedule,652.74,1137.35, Hyperthermia treatment,77615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,1137.35,APC Hyperthermia treatment,77615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,1137.35,APC Hyperthermia treatment,77615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,1137.35,APC Hyperthermia treatment,77620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,692.84,,,,,,,fee schedule,652.74,871.41, Hyperthermia treatment,77620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,871.41,,,,,,,fee schedule,652.74,871.41, Hyperthermia treatment,77620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,871.41,APC Hyperthermia treatment,77620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,871.41,APC Hyperthermia treatment,77620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,871.41,APC Infuse radioactive materials,77750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,987.22,,,,,,,fee schedule,455.64,1241.66, Infuse radioactive materials,77750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1241.66,,,,,,,fee schedule,455.64,1241.66, Infuse radioactive materials,77750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,473.87,,,,,,,fee schedule,455.64,1241.66,APC Infuse radioactive materials,77750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,478.42,,,,,,,fee schedule,455.64,1241.66,APC Infuse radioactive materials,77750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,455.64,,,,,,,fee schedule,455.64,1241.66,APC Apply intrcav radiat simple,77761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,951.57,,,,,,,fee schedule,652.74,1196.82, Apply intrcav radiat simple,77761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1196.82,,,,,,,fee schedule,652.74,1196.82, Apply intrcav radiat simple,77761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,1196.82,APC Apply intrcav radiat simple,77761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,1196.82,APC Apply intrcav radiat simple,77761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,1196.82,APC Apply intrcav radiat interm,77762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1435.33,,,,,,,fee schedule,652.74,1805.26, Apply intrcav radiat interm,77762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1805.26,,,,,,,fee schedule,652.74,1805.26, Apply intrcav radiat interm,77762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,678.85,,,,,,,fee schedule,652.74,1805.26,APC Apply intrcav radiat interm,77762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,685.38,,,,,,,fee schedule,652.74,1805.26,APC Apply intrcav radiat interm,77762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,652.74,,,,,,,fee schedule,652.74,1805.26,APC Apply intrcav radiat compl,77763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2022.89,,,,,,,fee schedule,822.78,2544.25, Apply intrcav radiat compl,77763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2544.25,,,,,,,fee schedule,822.78,2544.25, Apply intrcav radiat compl,77763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,855.69,,,,,,,fee schedule,822.78,2544.25,APC Apply intrcav radiat compl,77763,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,863.92,,,,,,,fee schedule,822.78,2544.25,APC Apply intrcav radiat compl,77763,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,822.78,,,,,,,fee schedule,822.78,2544.25,APC Hdr rdncl skn surf brachytx,77767,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,565.56,,,,,,,fee schedule,455.64,711.32, Hdr rdncl skn surf brachytx,77767,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,711.32,,,,,,,fee schedule,455.64,711.32, Hdr rdncl skn surf brachytx,77767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,473.87,,,,,,,fee schedule,455.64,711.32,APC Hdr rdncl skn surf brachytx,77767,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,478.42,,,,,,,fee schedule,455.64,711.32,APC Hdr rdncl skn surf brachytx,77767,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,455.64,,,,,,,fee schedule,455.64,711.32,APC Hdr rdncl skn surf brachytx,77768,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,565.56,,,,,,,fee schedule,455.64,711.32, Hdr rdncl skn surf brachytx,77768,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,711.32,,,,,,,fee schedule,455.64,711.32, Hdr rdncl skn surf brachytx,77768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,473.87,,,,,,,fee schedule,455.64,711.32,APC Hdr rdncl skn surf brachytx,77768,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,478.42,,,,,,,fee schedule,455.64,711.32,APC Hdr rdncl skn surf brachytx,77768,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,455.64,,,,,,,fee schedule,455.64,711.32,APC Hdr rdncl ntrstl/icav brchtx,77770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3728.52,,,,,,,fee schedule,822.78,4689.48, Hdr rdncl ntrstl/icav brchtx,77770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4689.48,,,,,,,fee schedule,822.78,4689.48, Hdr rdncl ntrstl/icav brchtx,77770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,855.69,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,863.92,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,822.78,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3728.52,,,,,,,fee schedule,822.78,4689.48, Hdr rdncl ntrstl/icav brchtx,77771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4689.48,,,,,,,fee schedule,822.78,4689.48, Hdr rdncl ntrstl/icav brchtx,77771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,855.69,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77771,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,863.92,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77771,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,822.78,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3728.52,,,,,,,fee schedule,822.78,4689.48, Hdr rdncl ntrstl/icav brchtx,77772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4689.48,,,,,,,fee schedule,822.78,4689.48, Hdr rdncl ntrstl/icav brchtx,77772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,855.69,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77772,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,863.92,,,,,,,fee schedule,822.78,4689.48,APC Hdr rdncl ntrstl/icav brchtx,77772,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,822.78,,,,,,,fee schedule,822.78,4689.48,APC Apply interstit radiat compl,77778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2537,,,,,,,fee schedule,822.78,3190.86, Apply interstit radiat compl,77778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3190.86,,,,,,,fee schedule,822.78,3190.86, Apply interstit radiat compl,77778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,855.69,,,,,,,fee schedule,822.78,3190.86,APC Apply interstit radiat compl,77778,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,863.92,,,,,,,fee schedule,822.78,3190.86,APC Apply interstit radiat compl,77778,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,822.78,,,,,,,fee schedule,822.78,3190.86,APC Apply surf ldr radionuclide,77789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,245.95,,,,,,,fee schedule,120.53,309.34, Apply surf ldr radionuclide,77789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,309.34,,,,,,,fee schedule,120.53,309.34, Apply surf ldr radionuclide,77789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.35,,,,,,,fee schedule,120.53,309.34,APC Apply surf ldr radionuclide,77789,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.56,,,,,,,fee schedule,120.53,309.34,APC Apply surf ldr radionuclide,77789,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.53,,,,,,,fee schedule,120.53,309.34,APC Radiation handling,77790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,240.51,,,,,,,fee schedule,240.51,302.5, Radiation handling,77790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,302.5,,,,,,,fee schedule,240.51,302.5, Radium/radioisotope therapy,77799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,629.03,,,,,,,fee schedule,120.53,791.15, Radium/radioisotope therapy,77799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,791.15,,,,,,,fee schedule,120.53,791.15, Radium/radioisotope therapy,77799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.35,,,,,,,fee schedule,120.53,791.15,APC Radium/radioisotope therapy,77799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.56,,,,,,,fee schedule,120.53,791.15,APC Radium/radioisotope therapy,77799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.53,,,,,,,fee schedule,120.53,791.15,APC Thyroid uptake measurement,78012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,745.05,,,,,,,fee schedule,472.27,937.07, Thyroid uptake measurement,78012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,937.07,,,,,,,fee schedule,472.27,937.07, Thyroid uptake measurement,78012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,937.07,APC Thyroid uptake measurement,78012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,937.07,APC Thyroid uptake measurement,78012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,937.07,APC Thyroid imaging w/blood flow,78013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,745.05,,,,,,,fee schedule,472.27,937.07, Thyroid imaging w/blood flow,78013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,937.07,,,,,,,fee schedule,472.27,937.07, Thyroid imaging w/blood flow,78013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,937.07,APC Thyroid imaging w/blood flow,78013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,937.07,APC Thyroid imaging w/blood flow,78013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,937.07,APC Thyroid imaging w/blood flow,78014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,745.05,,,,,,,fee schedule,472.27,937.07, Thyroid imaging w/blood flow,78014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,937.07,,,,,,,fee schedule,472.27,937.07, Thyroid imaging w/blood flow,78014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,937.07,APC Thyroid imaging w/blood flow,78014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,937.07,APC Thyroid imaging w/blood flow,78014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,937.07,APC Thyroid met imaging,78015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,467.9,,,,,,,fee schedule,467.9,588.49, Thyroid met imaging,78015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,588.49,,,,,,,fee schedule,467.9,588.49, Thyroid met imaging,78015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,467.9,588.49,APC Thyroid met imaging,78015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,467.9,588.49,APC Thyroid met imaging,78015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,467.9,588.49,APC Thyroid met imaging/studies,78016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,618.23,,,,,,,fee schedule,472.27,777.57, Thyroid met imaging/studies,78016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,777.57,,,,,,,fee schedule,472.27,777.57, Thyroid met imaging/studies,78016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,777.57,APC Thyroid met imaging/studies,78016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,777.57,APC Thyroid met imaging/studies,78016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,777.57,APC Thyroid met imaging body,78018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,895.2,,,,,,,fee schedule,641.43,1125.93, Thyroid met imaging body,78018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1125.93,,,,,,,fee schedule,641.43,1125.93, Thyroid met imaging body,78018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1125.93,APC Thyroid met imaging body,78018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1125.93,APC Thyroid met imaging body,78018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1125.93,APC Thyroid met uptake,78020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,288.24,,,,,,,fee schedule,288.24,362.52, Thyroid met uptake,78020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,362.52,,,,,,,fee schedule,288.24,362.52, Parathyroid planar imaging,78070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,716.33,,,,,,,fee schedule,472.27,900.95, Parathyroid planar imaging,78070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,900.95,,,,,,,fee schedule,472.27,900.95, Parathyroid planar imaging,78070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,900.95,APC Parathyroid planar imaging,78070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,900.95,APC Parathyroid planar imaging,78070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,900.95,APC Parathyrd planar w/wo subtrj,78071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,937.14,,,,,,,fee schedule,472.27,1178.67, Parathyrd planar w/wo subtrj,78071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1178.67,,,,,,,fee schedule,472.27,1178.67, Parathyrd planar w/wo subtrj,78071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1178.67,APC Parathyrd planar w/wo subtrj,78071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1178.67,APC Parathyrd planar w/wo subtrj,78071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1178.67,APC Parathyrd planar w/spect&ct,78072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,937.14,,,,,,,fee schedule,641.43,1178.67, Parathyrd planar w/spect&ct,78072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1178.67,,,,,,,fee schedule,641.43,1178.67, Parathyrd planar w/spect&ct,78072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1178.67,APC Parathyrd planar w/spect&ct,78072,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1178.67,APC Parathyrd planar w/spect&ct,78072,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1178.67,APC Adrenal cortex & medulla img,78075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,874.98,,,,,,,fee schedule,874.98,1605.9, Adrenal cortex & medulla img,78075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1100.49,,,,,,,fee schedule,874.98,1605.9, Adrenal cortex & medulla img,78075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,874.98,1605.9,APC Adrenal cortex & medulla img,78075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,874.98,1605.9,APC Adrenal cortex & medulla img,78075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,874.98,1605.9,APC Endocrine nuclear procedure,78099,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,548.51,,,,,,,fee schedule,472.27,689.87, Endocrine nuclear procedure,78099,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,689.87,,,,,,,fee schedule,472.27,689.87, Endocrine nuclear procedure,78099,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,689.87,APC Endocrine nuclear procedure,78099,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,689.87,APC Endocrine nuclear procedure,78099,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,689.87,APC Bone marrow imaging ltd,78102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,375.01,,,,,,,fee schedule,375.01,495.88, Bone marrow imaging ltd,78102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,471.66,,,,,,,fee schedule,375.01,495.88, Bone marrow imaging ltd,78102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,375.01,495.88,APC Bone marrow imaging ltd,78102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,375.01,495.88,APC Bone marrow imaging ltd,78102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,375.01,495.88,APC Bone marrow imaging mult,78103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,564.13,,,,,,,fee schedule,472.27,709.53, Bone marrow imaging mult,78103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,709.53,,,,,,,fee schedule,472.27,709.53, Bone marrow imaging mult,78103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,709.53,APC Bone marrow imaging mult,78103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,709.53,APC Bone marrow imaging mult,78103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,709.53,APC Bone marrow imaging body,78104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,696.25,,,,,,,fee schedule,472.27,875.69, Bone marrow imaging body,78104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,875.69,,,,,,,fee schedule,472.27,875.69, Bone marrow imaging body,78104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,875.69,APC Bone marrow imaging body,78104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,875.69,APC Bone marrow imaging body,78104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,875.69,APC Plasma volume single,78110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,165.03,,,,,,,fee schedule,165.03,1605.9, Plasma volume single,78110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,207.56,,,,,,,fee schedule,165.03,1605.9, Plasma volume single,78110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,165.03,1605.9,APC Plasma volume single,78110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,165.03,1605.9,APC Plasma volume single,78110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,165.03,1605.9,APC Plasma volume multiple,78111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,393.81,,,,,,,fee schedule,393.81,1605.9, Plasma volume multiple,78111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,495.31,,,,,,,fee schedule,393.81,1605.9, Plasma volume multiple,78111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,393.81,1605.9,APC Plasma volume multiple,78111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,393.81,1605.9,APC Plasma volume multiple,78111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,393.81,1605.9,APC Red cell mass single,78120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,280,,,,,,,fee schedule,280,495.88, Red cell mass single,78120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,352.17,,,,,,,fee schedule,280,495.88, Red cell mass single,78120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,280,495.88,APC Red cell mass single,78120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,280,495.88,APC Red cell mass single,78120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,280,495.88,APC Red cell mass multiple,78121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,454.66,,,,,,,fee schedule,454.66,673.51, Red cell mass multiple,78121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,571.84,,,,,,,fee schedule,454.66,673.51, Red cell mass multiple,78121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,454.66,673.51,APC Red cell mass multiple,78121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,454.66,673.51,APC Red cell mass multiple,78121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,454.66,673.51,APC Blood volume,78122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,712.75,,,,,,,fee schedule,641.43,896.44, Blood volume,78122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,896.44,,,,,,,fee schedule,641.43,896.44, Blood volume,78122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,896.44,APC Blood volume,78122,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,896.44,APC Blood volume,78122,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,896.44,APC Red cell survival study,78130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,495.57,,,,,,,fee schedule,472.27,623.3, Red cell survival study,78130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,623.3,,,,,,,fee schedule,472.27,623.3, Red cell survival study,78130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,623.3,APC Red cell survival study,78130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,623.3,APC Red cell survival study,78130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,623.3,APC Red cell sequestration,78140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,645.26,,,,,,,fee schedule,472.27,811.57, Red cell sequestration,78140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,811.57,,,,,,,fee schedule,472.27,811.57, Red cell sequestration,78140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,811.57,APC Red cell sequestration,78140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,811.57,APC Red cell sequestration,78140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,811.57,APC Spleen imaging,78185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,394.65,,,,,,,fee schedule,394.65,496.37, Spleen imaging,78185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,496.37,,,,,,,fee schedule,394.65,496.37, Spleen imaging,78185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,394.65,496.37,APC Spleen imaging,78185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,394.65,496.37,APC Spleen imaging,78185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,394.65,496.37,APC Platelet survival,78191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1115.9,,,,,,,fee schedule,472.27,1403.5, Platelet survival,78191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1403.5,,,,,,,fee schedule,472.27,1403.5, Platelet survival,78191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1403.5,APC Platelet survival,78191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1403.5,APC Platelet survival,78191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1403.5,APC Lymph system imaging,78195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,764.25,,,,,,,fee schedule,641.43,961.23, Lymph system imaging,78195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,961.23,,,,,,,fee schedule,641.43,961.23, Lymph system imaging,78195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,961.23,APC Lymph system imaging,78195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,961.23,APC Lymph system imaging,78195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,961.23,APC Blood/lymph nuclear exam,78199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,483.41,,,,,,,fee schedule,472.27,608, Blood/lymph nuclear exam,78199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,608,,,,,,,fee schedule,472.27,608, Blood/lymph nuclear exam,78199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,608,APC Blood/lymph nuclear exam,78199,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,608,APC Blood/lymph nuclear exam,78199,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,608,APC Liver imaging,78201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,400.59,,,,,,,fee schedule,400.59,673.51, Liver imaging,78201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,503.84,,,,,,,fee schedule,400.59,673.51, Liver imaging,78201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,400.59,673.51,APC Liver imaging,78201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,400.59,673.51,APC Liver imaging,78201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,400.59,673.51,APC Liver imaging with flow,78202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,481.66,,,,,,,fee schedule,481.66,673.51, Liver imaging with flow,78202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,605.8,,,,,,,fee schedule,481.66,673.51, Liver imaging with flow,78202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,481.66,673.51,APC Liver imaging with flow,78202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,481.66,673.51,APC Liver imaging with flow,78202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,481.66,673.51,APC Liver and spleen imaging,78215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,486,,,,,,,fee schedule,472.27,611.26, Liver and spleen imaging,78215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,611.26,,,,,,,fee schedule,472.27,611.26, Liver and spleen imaging,78215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,611.26,APC Liver and spleen imaging,78215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,611.26,APC Liver and spleen imaging,78215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,611.26,APC Liver & spleen image/flow,78216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,575.28,,,,,,,fee schedule,472.27,723.55, Liver & spleen image/flow,78216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,723.55,,,,,,,fee schedule,472.27,723.55, Liver & spleen image/flow,78216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,723.55,APC Liver & spleen image/flow,78216,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,723.55,APC Liver & spleen image/flow,78216,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,723.55,APC Hepatobiliary system imaging,78226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,645.55,,,,,,,fee schedule,472.27,811.93, Hepatobiliary system imaging,78226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,811.93,,,,,,,fee schedule,472.27,811.93, Hepatobiliary system imaging,78226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,811.93,APC Hepatobiliary system imaging,78226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,811.93,APC Hepatobiliary system imaging,78226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,811.93,APC Hepatobil syst image w/drug,78227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,645.55,,,,,,,fee schedule,641.43,811.93, Hepatobil syst image w/drug,78227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,811.93,,,,,,,fee schedule,641.43,811.93, Hepatobil syst image w/drug,78227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,811.93,APC Hepatobil syst image w/drug,78227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,811.93,APC Hepatobil syst image w/drug,78227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,811.93,APC Salivary gland imaging,78230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,377.78,,,,,,,fee schedule,377.78,495.88, Salivary gland imaging,78230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.14,,,,,,,fee schedule,377.78,495.88, Salivary gland imaging,78230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,377.78,495.88,APC Salivary gland imaging,78230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,377.78,495.88,APC Salivary gland imaging,78230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,377.78,495.88,APC Serial salivary imaging,78231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,525.84,,,,,,,fee schedule,472.27,661.36, Serial salivary imaging,78231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,661.36,,,,,,,fee schedule,472.27,661.36, Serial salivary imaging,78231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,661.36,APC Serial salivary imaging,78231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,661.36,APC Serial salivary imaging,78231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,661.36,APC Salivary gland function exam,78232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,567.71,,,,,,,fee schedule,472.27,714.03, Salivary gland function exam,78232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,714.03,,,,,,,fee schedule,472.27,714.03, Salivary gland function exam,78232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,714.03,APC Salivary gland function exam,78232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,714.03,APC Salivary gland function exam,78232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,714.03,APC Esophageal motility study,78258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,519.96,,,,,,,fee schedule,472.27,653.97, Esophageal motility study,78258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,653.97,,,,,,,fee schedule,472.27,653.97, Esophageal motility study,78258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,653.97,APC Esophageal motility study,78258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,653.97,APC Esophageal motility study,78258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,653.97,APC Gastric mucosa imaging,78261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,683.53,,,,,,,fee schedule,472.27,859.7, Gastric mucosa imaging,78261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,859.7,,,,,,,fee schedule,472.27,859.7, Gastric mucosa imaging,78261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,859.7,APC Gastric mucosa imaging,78261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,859.7,APC Gastric mucosa imaging,78261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,859.7,APC Gastroesophageal reflux exam,78262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,701.02,,,,,,,fee schedule,472.27,881.69, Gastroesophageal reflux exam,78262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,881.69,,,,,,,fee schedule,472.27,881.69, Gastroesophageal reflux exam,78262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,881.69,APC Gastroesophageal reflux exam,78262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,881.69,APC Gastroesophageal reflux exam,78262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,881.69,APC Gastric emptying imag study,78264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,700.61,,,,,,,fee schedule,472.27,881.18, Gastric emptying imag study,78264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,881.18,,,,,,,fee schedule,472.27,881.18, Gastric emptying imag study,78264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,881.18,APC Gastric emptying imag study,78264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,881.18,APC Gastric emptying imag study,78264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,881.18,APC Gastric emptying imag study,78265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,968.01,,,,,,,fee schedule,472.27,1217.5, Gastric emptying imag study,78265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1217.5,,,,,,,fee schedule,472.27,1217.5, Gastric emptying imag study,78265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1217.5,APC Gastric emptying imag study,78265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1217.5,APC Gastric emptying imag study,78265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1217.5,APC Gastric emptying imag study,78266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1284.36,,,,,,,fee schedule,641.43,1615.38, Gastric emptying imag study,78266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1615.38,,,,,,,fee schedule,641.43,1615.38, Gastric emptying imag study,78266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1615.38,APC Gastric emptying imag study,78266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1615.38,APC Gastric emptying imag study,78266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1615.38,APC Breath tst attain/anal c-14,78267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.69,,,,,,,fee schedule,11.06,40.19, Breath tst attain/anal c-14,78267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.19,,,,,,,fee schedule,11.06,40.19, Breath tst attain/anal c-14,78267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.5,,,,,,,fee schedule,11.06,40.19,APC Breath tst attain/anal c-14,78267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.61,,,,,,,fee schedule,11.06,40.19,APC Breath tst attain/anal c-14,78267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.06,,,,,,,fee schedule,11.06,40.19,APC Breath test analysis c-14,78268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,305.86,,,,,,,fee schedule,94.41,344.44, Breath test analysis c-14,78268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,344.44,,,,,,,fee schedule,94.41,344.44, Breath test analysis c-14,78268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,98.19,,,,,,,fee schedule,94.41,344.44,APC Breath test analysis c-14,78268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,99.13,,,,,,,fee schedule,94.41,344.44,APC Breath test analysis c-14,78268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,94.41,,,,,,,fee schedule,94.41,344.44,APC Acute GI blood loss imaging,78278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,836.89,,,,,,,fee schedule,472.27,1052.58, Acute GI blood loss imaging,78278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1052.58,,,,,,,fee schedule,472.27,1052.58, Acute GI blood loss imaging,78278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1052.58,APC Acute GI blood loss imaging,78278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1052.58,APC Acute GI blood loss imaging,78278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1052.58,APC GI protein loss exam,78282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,828.07,,,,,,,fee schedule,472.27,1041.49, GI protein loss exam,78282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1041.49,,,,,,,fee schedule,472.27,1041.49, GI protein loss exam,78282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1041.49,APC GI protein loss exam,78282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1041.49,APC GI protein loss exam,78282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1041.49,APC Meckels divert exam,78290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,535.03,,,,,,,fee schedule,472.27,672.93, Meckels divert exam,78290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,672.93,,,,,,,fee schedule,472.27,672.93, Meckels divert exam,78290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,672.93,APC Meckels divert exam,78290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,672.93,APC Meckels divert exam,78290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,672.93,APC Leveen/shunt patency exam,78291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,569.84,,,,,,,fee schedule,472.27,716.7, Leveen/shunt patency exam,78291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,716.7,,,,,,,fee schedule,472.27,716.7, Leveen/shunt patency exam,78291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,716.7,APC Leveen/shunt patency exam,78291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,716.7,APC Leveen/shunt patency exam,78291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,716.7,APC GI nuclear procedure,78299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,817.86,,,,,,,fee schedule,472.27,1028.64, GI nuclear procedure,78299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1028.64,,,,,,,fee schedule,472.27,1028.64, GI nuclear procedure,78299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1028.64,APC GI nuclear procedure,78299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1028.64,APC GI nuclear procedure,78299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1028.64,APC Bone imaging limited area,78300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,447.44,,,,,,,fee schedule,447.44,562.76, Bone imaging limited area,78300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,562.76,,,,,,,fee schedule,447.44,562.76, Bone imaging limited area,78300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,447.44,562.76,APC Bone imaging limited area,78300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,447.44,562.76,APC Bone imaging limited area,78300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,447.44,562.76,APC Bone imaging multiple areas,78305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,644.39,,,,,,,fee schedule,472.27,810.47, Bone imaging multiple areas,78305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,810.47,,,,,,,fee schedule,472.27,810.47, Bone imaging multiple areas,78305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,810.47,APC Bone imaging multiple areas,78305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,810.47,APC Bone imaging multiple areas,78305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,810.47,APC Bone imaging whole body,78306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,733.52,,,,,,,fee schedule,472.27,922.58, Bone imaging whole body,78306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,922.58,,,,,,,fee schedule,472.27,922.58, Bone imaging whole body,78306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,922.58,APC Bone imaging whole body,78306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,922.58,APC Bone imaging whole body,78306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,922.58,APC Bone imaging 3 phase,78315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,829.7,,,,,,,fee schedule,472.27,1043.54, Bone imaging 3 phase,78315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1043.54,,,,,,,fee schedule,472.27,1043.54, Bone imaging 3 phase,78315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1043.54,APC Bone imaging 3 phase,78315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1043.54,APC Bone imaging 3 phase,78315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1043.54,APC Bone mineral single photon,78350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,140.81,,,,,,,fee schedule,140.81,177.11, Bone mineral single photon,78350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,177.11,,,,,,,fee schedule,140.81,177.11, Bone mineral dual photon,78351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.1,,,,,,,fee schedule,48.1,60.5, Bone mineral dual photon,78351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.5,,,,,,,fee schedule,48.1,60.5, Musculoskeletal nuclear exam,78399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,322.4,,,,,,,fee schedule,322.4,495.88, Musculoskeletal nuclear exam,78399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,405.49,,,,,,,fee schedule,322.4,495.88, Musculoskeletal nuclear exam,78399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,322.4,495.88,APC Musculoskeletal nuclear exam,78399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,322.4,495.88,APC Musculoskeletal nuclear exam,78399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,322.4,495.88,APC Non-imaging heart function,78414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,594.75,,,,,,,fee schedule,594.75,748.03, Non-imaging heart function,78414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,748.03,,,,,,,fee schedule,594.75,748.03, Non-imaging heart function,78414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,594.75,748.03,APC Non-imaging heart function,78414,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,594.75,748.03,APC Non-imaging heart function,78414,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,594.75,748.03,APC Cardiac shunt imaging,78428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,444.97,,,,,,,fee schedule,444.97,559.65, Cardiac shunt imaging,78428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,559.65,,,,,,,fee schedule,444.97,559.65, Cardiac shunt imaging,78428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,444.97,559.65,APC Cardiac shunt imaging,78428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,444.97,559.65,APC Cardiac shunt imaging,78428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,444.97,559.65,APC Myocrd img pet 1 std w/ct,78429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4199.39,,,,,,,fee schedule,1689.26,5281.71, Myocrd img pet 1 std w/ct,78429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5281.71,,,,,,,fee schedule,1689.26,5281.71, Myocrd img pet 1 std w/ct,78429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,5281.71,APC Myocrd img pet 1 std w/ct,78429,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,5281.71,APC Myocrd img pet 1 std w/ct,78429,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,5281.71,APC Myocrd img pet rst/strs w/ct,78430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4199.39,,,,,,,fee schedule,1689.26,5281.71, Myocrd img pet rst/strs w/ct,78430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5281.71,,,,,,,fee schedule,1689.26,5281.71, Myocrd img pet rst/strs w/ct,78430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,5281.71,APC Myocrd img pet rst/strs w/ct,78430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,5281.71,APC Myocrd img pet rst/strs w/ct,78430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,5281.71,APC Myocrd img pet rst&strs ct,78431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6548.96,,,,,,,fee schedule,2602.25,8236.83, Myocrd img pet rst&strs ct,78431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8236.83,,,,,,,fee schedule,2602.25,8236.83, Myocrd img pet rst&strs ct,78431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2706.34,,,,,,,fee schedule,2602.25,8236.83,APC Myocrd img pet rst&strs ct,78431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2732.37,,,,,,,fee schedule,2602.25,8236.83,APC Myocrd img pet rst&strs ct,78431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2602.25,,,,,,,fee schedule,2602.25,8236.83,APC Myocrd img pet 2rtracer,78432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8003.96,,,,,,,fee schedule,1792.84,10066.83, Myocrd img pet 2rtracer,78432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10066.83,,,,,,,fee schedule,1792.84,10066.83, Myocrd img pet 2rtracer,78432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1864.56,,,,,,,fee schedule,1792.84,10066.83,APC Myocrd img pet 2rtracer,78432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1882.49,,,,,,,fee schedule,1792.84,10066.83,APC Myocrd img pet 2rtracer,78432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1792.84,,,,,,,fee schedule,1792.84,10066.83,APC Myocrd img pet 2rtracer ct,78433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8003.96,,,,,,,fee schedule,2602.25,10066.83, Myocrd img pet 2rtracer ct,78433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10066.83,,,,,,,fee schedule,2602.25,10066.83, Myocrd img pet 2rtracer ct,78433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2706.34,,,,,,,fee schedule,2602.25,10066.83,APC Myocrd img pet 2rtracer ct,78433,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2732.37,,,,,,,fee schedule,2602.25,10066.83,APC Myocrd img pet 2rtracer ct,78433,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2602.25,,,,,,,fee schedule,2602.25,10066.83,APC Aqmbf pet rest & rx stress,78434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1062.15,,,,,,,fee schedule,1062.15,1335.9, Aqmbf pet rest & rx stress,78434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1335.9,,,,,,,fee schedule,1062.15,1335.9, Vascular flow imaging,78445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,340.41,,,,,,,fee schedule,340.41,495.88, Vascular flow imaging,78445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,428.15,,,,,,,fee schedule,340.41,495.88, Vascular flow imaging,78445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,340.41,495.88,APC Vascular flow imaging,78445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,340.41,495.88,APC Vascular flow imaging,78445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,340.41,495.88,APC Ht muscle image spect sing,78451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1160.45,,,,,,,fee schedule,1160.45,1605.9, Ht muscle image spect sing,78451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1459.53,,,,,,,fee schedule,1160.45,1605.9, Ht muscle image spect sing,78451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1160.45,1605.9,APC Ht muscle image spect sing,78451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1160.45,1605.9,APC Ht muscle image spect sing,78451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1160.45,1605.9,APC Ht muscle image spect mult,78452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1878.29,,,,,,,fee schedule,1529.43,2362.38, Ht muscle image spect mult,78452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2362.38,,,,,,,fee schedule,1529.43,2362.38, Ht muscle image spect mult,78452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1529.43,2362.38,APC Ht muscle image spect mult,78452,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1529.43,2362.38,APC Ht muscle image spect mult,78452,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1529.43,2362.38,APC Ht muscle image planar sing,78453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,469.88,,,,,,,fee schedule,469.88,1605.9, Ht muscle image planar sing,78453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,590.98,,,,,,,fee schedule,469.88,1605.9, Ht muscle image planar sing,78453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,469.88,1605.9,APC Ht muscle image planar sing,78453,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,469.88,1605.9,APC Ht muscle image planar sing,78453,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,469.88,1605.9,APC Ht musc image planar mult,78454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,859,,,,,,,fee schedule,859,1605.9, Ht musc image planar mult,78454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1080.4,,,,,,,fee schedule,859,1605.9, Ht musc image planar mult,78454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,859,1605.9,APC Ht musc image planar mult,78454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,859,1605.9,APC Ht musc image planar mult,78454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,859,1605.9,APC Acute venous thrombus image,78456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,724.91,,,,,,,fee schedule,724.91,1605.9, Acute venous thrombus image,78456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,911.74,,,,,,,fee schedule,724.91,1605.9, Acute venous thrombus image,78456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,724.91,1605.9,APC Acute venous thrombus image,78456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,724.91,1605.9,APC Acute venous thrombus image,78456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,724.91,1605.9,APC Venous thrombosis imaging,78457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,496.48,,,,,,,fee schedule,496.48,673.51, Venous thrombosis imaging,78457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,624.43,,,,,,,fee schedule,496.48,673.51, Venous thrombosis imaging,78457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,496.48,673.51,APC Venous thrombosis imaging,78457,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,496.48,673.51,APC Venous thrombosis imaging,78457,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,496.48,673.51,APC Ven thrombosis images bilat,78458,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,707.83,,,,,,,fee schedule,472.27,890.26, Ven thrombosis images bilat,78458,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,890.26,,,,,,,fee schedule,472.27,890.26, Ven thrombosis images bilat,78458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,890.26,APC Ven thrombosis images bilat,78458,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,890.26,APC Ven thrombosis images bilat,78458,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,890.26,APC Heart muscle imaging (PET),78459,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3081.22,,,,,,,fee schedule,1529.43,3875.35, Heart muscle imaging (PET),78459,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3875.35,,,,,,,fee schedule,1529.43,3875.35, Heart muscle imaging (PET),78459,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1529.43,3875.35,APC Heart muscle imaging (PET),78459,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1529.43,3875.35,APC Heart muscle imaging (PET),78459,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1529.43,3875.35,APC Heart infarct image,78466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,478.2,,,,,,,fee schedule,472.27,601.45, Heart infarct image,78466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,601.45,,,,,,,fee schedule,472.27,601.45, Heart infarct image,78466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,601.45,APC Heart infarct image,78466,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,601.45,APC Heart infarct image,78466,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,601.45,APC Heart infarct image (ef),78468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,638.57,,,,,,,fee schedule,638.57,803.15, Heart infarct image (ef),78468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,803.15,,,,,,,fee schedule,638.57,803.15, Heart infarct image (ef),78468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,638.57,803.15,APC Heart infarct image (ef),78468,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,638.57,803.15,APC Heart infarct image (ef),78468,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,638.57,803.15,APC Heart infarct image (3D),78469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,874.8,,,,,,,fee schedule,641.43,1100.27, Heart infarct image (3D),78469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1100.27,,,,,,,fee schedule,641.43,1100.27, Heart infarct image (3D),78469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1100.27,APC Heart infarct image (3D),78469,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1100.27,APC Heart infarct image (3D),78469,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1100.27,APC Gated heart planar single,78472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,927.45,,,,,,,fee schedule,472.27,1166.48, Gated heart planar single,78472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1166.48,,,,,,,fee schedule,472.27,1166.48, Gated heart planar single,78472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1166.48,APC Gated heart planar single,78472,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1166.48,APC Gated heart planar single,78472,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1166.48,APC Gated heart multiple,78473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1387.43,,,,,,,fee schedule,472.27,1745.01, Gated heart multiple,78473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1745.01,,,,,,,fee schedule,472.27,1745.01, Gated heart multiple,78473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1745.01,APC Gated heart multiple,78473,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1745.01,APC Gated heart multiple,78473,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1745.01,APC Heart first pass single,78481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,889.41,,,,,,,fee schedule,641.43,1118.64, Heart first pass single,78481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1118.64,,,,,,,fee schedule,641.43,1118.64, Heart first pass single,78481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1118.64,APC Heart first pass single,78481,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1118.64,APC Heart first pass single,78481,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1118.64,APC Heart first pass multiple,78483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1337.41,,,,,,,fee schedule,641.43,1682.1, Heart first pass multiple,78483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1682.1,,,,,,,fee schedule,641.43,1682.1, Heart first pass multiple,78483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1682.1,APC Heart first pass multiple,78483,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1682.1,APC Heart first pass multiple,78483,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1682.1,APC Heart image (pet) single,78491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2542.06,,,,,,,fee schedule,1689.26,3197.23, Heart image (pet) single,78491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3197.23,,,,,,,fee schedule,1689.26,3197.23, Heart image (pet) single,78491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,3197.23,APC Heart image (pet) single,78491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,3197.23,APC Heart image (pet) single,78491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,3197.23,APC Heart image (pet) multiple,78492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2777.42,,,,,,,fee schedule,1689.26,3493.25, Heart image (pet) multiple,78492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3493.25,,,,,,,fee schedule,1689.26,3493.25, Heart image (pet) multiple,78492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,3493.25,APC Heart image (pet) multiple,78492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,3493.25,APC Heart image (pet) multiple,78492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,3493.25,APC Heart image spect,78494,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1171.22,,,,,,,fee schedule,472.27,1473.08, Heart image spect,78494,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1473.08,,,,,,,fee schedule,472.27,1473.08, Heart image spect,78494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1473.08,APC Heart image spect,78494,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1473.08,APC Heart image spect,78494,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1473.08,APC Heart first pass add-on,78496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1056.36,,,,,,,fee schedule,1056.36,1328.62, Heart first pass add-on,78496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1328.62,,,,,,,fee schedule,1056.36,1328.62, Cardiovascular nuclear exam,78499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1058.54,,,,,,,fee schedule,472.27,1331.36, Cardiovascular nuclear exam,78499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1331.36,,,,,,,fee schedule,472.27,1331.36, Cardiovascular nuclear exam,78499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1331.36,APC Cardiovascular nuclear exam,78499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1331.36,APC Cardiovascular nuclear exam,78499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1331.36,APC Lung ventilation imaging,78579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,776.3,,,,,,,fee schedule,472.27,976.38, Lung ventilation imaging,78579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,976.38,,,,,,,fee schedule,472.27,976.38, Lung ventilation imaging,78579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,976.38,APC Lung ventilation imaging,78579,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,976.38,APC Lung ventilation imaging,78579,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,976.38,APC Lung perfusion imaging,78580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,597.31,,,,,,,fee schedule,472.27,751.25, Lung perfusion imaging,78580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,751.25,,,,,,,fee schedule,472.27,751.25, Lung perfusion imaging,78580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,751.25,APC Lung perfusion imaging,78580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,751.25,APC Lung perfusion imaging,78580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,751.25,APC Lung ventilat&perfus imaging,78582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,961.17,,,,,,,fee schedule,641.43,1208.9, Lung ventilat&perfus imaging,78582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1208.9,,,,,,,fee schedule,641.43,1208.9, Lung ventilat&perfus imaging,78582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1208.9,APC Lung ventilat&perfus imaging,78582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1208.9,APC Lung ventilat&perfus imaging,78582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1208.9,APC Lung perfusion differential,78597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1187.63,,,,,,,fee schedule,472.27,1493.72, Lung perfusion differential,78597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1493.72,,,,,,,fee schedule,472.27,1493.72, Lung perfusion differential,78597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1493.72,APC Lung perfusion differential,78597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1493.72,APC Lung perfusion differential,78597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1493.72,APC Lung perf&ventilat diferentl,78598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1187.63,,,,,,,fee schedule,641.43,1493.72, Lung perf&ventilat diferentl,78598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1493.72,,,,,,,fee schedule,641.43,1493.72, Lung perf&ventilat diferentl,78598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1493.72,APC Lung perf&ventilat diferentl,78598,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1493.72,APC Lung perf&ventilat diferentl,78598,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1493.72,APC Respiratory nuclear exam,78599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,605.4,,,,,,,fee schedule,472.27,761.43, Respiratory nuclear exam,78599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,761.43,,,,,,,fee schedule,472.27,761.43, Respiratory nuclear exam,78599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,761.43,APC Respiratory nuclear exam,78599,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,761.43,APC Respiratory nuclear exam,78599,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,761.43,APC Brain image < 4 views,78600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,470.9,,,,,,,fee schedule,470.9,592.26, Brain image < 4 views,78600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,592.26,,,,,,,fee schedule,470.9,592.26, Brain image < 4 views,78600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,470.9,592.26,APC Brain image < 4 views,78600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,470.9,592.26,APC Brain image < 4 views,78600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,470.9,592.26,APC Brain image w/flow < 4 views,78601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,555.02,,,,,,,fee schedule,472.27,698.07, Brain image w/flow < 4 views,78601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,698.07,,,,,,,fee schedule,472.27,698.07, Brain image w/flow < 4 views,78601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,698.07,APC Brain image w/flow < 4 views,78601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,698.07,APC Brain image w/flow < 4 views,78601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,698.07,APC Brain image 4+ views,78605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,558.66,,,,,,,fee schedule,558.66,702.65, Brain image 4+ views,78605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,702.65,,,,,,,fee schedule,558.66,702.65, Brain image 4+ views,78605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,558.66,702.65,APC Brain image 4+ views,78605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,558.66,702.65,APC Brain image 4+ views,78605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,558.66,702.65,APC Brain image w/flow 4 + views,78606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,642.09,,,,,,,fee schedule,641.43,807.58, Brain image w/flow 4 + views,78606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,807.58,,,,,,,fee schedule,641.43,807.58, Brain image w/flow 4 + views,78606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,807.58,APC Brain image w/flow 4 + views,78606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,807.58,APC Brain image w/flow 4 + views,78606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,807.58,APC Brain imaging (PET),78608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2978.5,,,,,,,fee schedule,1689.26,3746.16, Brain imaging (PET),78608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3746.16,,,,,,,fee schedule,1689.26,3746.16, Brain imaging (PET),78608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,3746.16,APC Brain imaging (PET),78608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,3746.16,APC Brain imaging (PET),78608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,3746.16,APC Brain imaging (PET),78609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,233.96,,,,,,,fee schedule,233.96,294.26, Brain imaging (PET),78609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,294.26,,,,,,,fee schedule,233.96,294.26, Brain flow imaging only,78610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,271.1,,,,,,,fee schedule,271.1,673.51, Brain flow imaging only,78610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,340.97,,,,,,,fee schedule,271.1,673.51, Brain flow imaging only,78610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,271.1,673.51,APC Brain flow imaging only,78610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,271.1,673.51,APC Brain flow imaging only,78610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,271.1,673.51,APC Cerebrospinal fluid scan,78630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,811.37,,,,,,,fee schedule,641.43,1020.48, Cerebrospinal fluid scan,78630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1020.48,,,,,,,fee schedule,641.43,1020.48, Cerebrospinal fluid scan,78630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1020.48,APC Cerebrospinal fluid scan,78630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1020.48,APC Cerebrospinal fluid scan,78630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1020.48,APC CSF ventriculography,78635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,455.94,,,,,,,fee schedule,455.94,673.51, CSF ventriculography,78635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,573.45,,,,,,,fee schedule,455.94,673.51, CSF ventriculography,78635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,455.94,673.51,APC CSF ventriculography,78635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,455.94,673.51,APC CSF ventriculography,78635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,455.94,673.51,APC CSF shunt evaluation,78645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,568.61,,,,,,,fee schedule,568.61,715.16, CSF shunt evaluation,78645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,715.16,,,,,,,fee schedule,568.61,715.16, CSF shunt evaluation,78645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,568.61,715.16,APC CSF shunt evaluation,78645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,568.61,715.16,APC CSF shunt evaluation,78645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,568.61,715.16,APC CSF leakage imaging,78650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,744.26,,,,,,,fee schedule,744.26,1605.9, CSF leakage imaging,78650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,936.08,,,,,,,fee schedule,744.26,1605.9, CSF leakage imaging,78650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,744.26,1605.9,APC CSF leakage imaging,78650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,744.26,1605.9,APC CSF leakage imaging,78650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,744.26,1605.9,APC Nuclear exam of tear flow,78660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,382.02,,,,,,,fee schedule,382.02,495.88, Nuclear exam of tear flow,78660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,480.48,,,,,,,fee schedule,382.02,495.88, Nuclear exam of tear flow,78660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,382.02,495.88,APC Nuclear exam of tear flow,78660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,382.02,495.88,APC Nuclear exam of tear flow,78660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,382.02,495.88,APC Nervous system nuclear exam,78699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,714.96,,,,,,,fee schedule,472.27,899.23, Nervous system nuclear exam,78699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,899.23,,,,,,,fee schedule,472.27,899.23, Nervous system nuclear exam,78699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,899.23,APC Nervous system nuclear exam,78699,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,899.23,APC Nervous system nuclear exam,78699,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,899.23,APC Kidney imaging morphol,78700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,496.74,,,,,,,fee schedule,472.27,624.76, Kidney imaging morphol,78700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,624.76,,,,,,,fee schedule,472.27,624.76, Kidney imaging morphol,78700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,624.76,APC Kidney imaging morphol,78700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,624.76,APC Kidney imaging morphol,78700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,624.76,APC Kidney imaging with flow,78701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,572.69,,,,,,,fee schedule,472.27,720.29, Kidney imaging with flow,78701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,720.29,,,,,,,fee schedule,472.27,720.29, Kidney imaging with flow,78701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,720.29,APC Kidney imaging with flow,78701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,720.29,APC Kidney imaging with flow,78701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,720.29,APC K flow/funct image w/o drug,78707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,776.77,,,,,,,fee schedule,641.43,976.96, K flow/funct image w/o drug,78707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,976.96,,,,,,,fee schedule,641.43,976.96, K flow/funct image w/o drug,78707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,976.96,APC K flow/funct image w/o drug,78707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,976.96,APC K flow/funct image w/o drug,78707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,976.96,APC K flow/funct image w/drug,78708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,818.7,,,,,,,fee schedule,641.43,1029.7, K flow/funct image w/drug,78708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1029.7,,,,,,,fee schedule,641.43,1029.7, K flow/funct image w/drug,78708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1029.7,APC K flow/funct image w/drug,78708,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1029.7,APC K flow/funct image w/drug,78708,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1029.7,APC K flow/funct image multiple,78709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,850.83,,,,,,,fee schedule,641.43,1070.11, K flow/funct image multiple,78709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1070.11,,,,,,,fee schedule,641.43,1070.11, K flow/funct image multiple,78709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1070.11,APC K flow/funct image multiple,78709,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1070.11,APC K flow/funct image multiple,78709,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1070.11,APC Kidney function study,78725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,311.69,,,,,,,fee schedule,311.69,495.88, Kidney function study,78725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,392.02,,,,,,,fee schedule,311.69,495.88, Kidney function study,78725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,311.69,495.88,APC Kidney function study,78725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,311.69,495.88,APC Kidney function study,78725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,311.69,495.88,APC Urinary bladder retention,78730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,262.34,,,,,,,fee schedule,262.34,329.95, Urinary bladder retention,78730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,329.95,,,,,,,fee schedule,262.34,329.95, Ureteral reflux study,78740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,389.01,,,,,,,fee schedule,389.01,495.88, Ureteral reflux study,78740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,489.27,,,,,,,fee schedule,389.01,495.88, Ureteral reflux study,78740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,389.01,495.88,APC Ureteral reflux study,78740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,389.01,495.88,APC Ureteral reflux study,78740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,389.01,495.88,APC Testicular imaging w/flow,78761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,560.84,,,,,,,fee schedule,472.27,705.39, Testicular imaging w/flow,78761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,705.39,,,,,,,fee schedule,472.27,705.39, Testicular imaging w/flow,78761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,705.39,APC Testicular imaging w/flow,78761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,705.39,APC Testicular imaging w/flow,78761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,705.39,APC Genitourinary nuclear exam,78799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,782.64,,,,,,,fee schedule,472.27,984.36, Genitourinary nuclear exam,78799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984.36,,,,,,,fee schedule,472.27,984.36, Genitourinary nuclear exam,78799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,984.36,APC Genitourinary nuclear exam,78799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,984.36,APC Genitourinary nuclear exam,78799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,984.36,APC Tumor imaging limited area,78800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,581.07,,,,,,,fee schedule,472.27,730.83, Tumor imaging limited area,78800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,730.83,,,,,,,fee schedule,472.27,730.83, Tumor imaging limited area,78800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,730.83,APC Tumor imaging limited area,78800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,730.83,APC Tumor imaging limited area,78800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,730.83,APC Tumor imaging mult areas,78801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,717.11,,,,,,,fee schedule,472.27,901.93, Tumor imaging mult areas,78801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,901.93,,,,,,,fee schedule,472.27,901.93, Tumor imaging mult areas,78801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,901.93,APC Tumor imaging mult areas,78801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,901.93,APC Tumor imaging mult areas,78801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,901.93,APC Tumor imaging whole body,78802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,909.55,,,,,,,fee schedule,641.43,1143.97, Tumor imaging whole body,78802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1143.97,,,,,,,fee schedule,641.43,1143.97, Tumor imaging whole body,78802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1143.97,APC Tumor imaging whole body,78802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1143.97,APC Tumor imaging whole body,78802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1143.97,APC Tumor imaging (3D),78803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1090.17,,,,,,,fee schedule,641.43,1371.15, Tumor imaging (3D),78803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1371.15,,,,,,,fee schedule,641.43,1371.15, Tumor imaging (3D),78803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,1371.15,APC Tumor imaging (3D),78803,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,1371.15,APC Tumor imaging (3D),78803,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,1371.15,APC Tumor imaging whole body,78804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1681.22,,,,,,,fee schedule,641.43,2114.53, Tumor imaging whole body,78804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2114.53,,,,,,,fee schedule,641.43,2114.53, Tumor imaging whole body,78804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.09,,,,,,,fee schedule,641.43,2114.53,APC Tumor imaging whole body,78804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.51,,,,,,,fee schedule,641.43,2114.53,APC Tumor imaging whole body,78804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.43,,,,,,,fee schedule,641.43,2114.53,APC Iv inj ra drug dx study,78808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1206.78,,,,,,,fee schedule,472.27,1517.8, Iv inj ra drug dx study,78808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1517.8,,,,,,,fee schedule,472.27,1517.8, Iv inj ra drug dx study,78808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,1517.8,APC Iv inj ra drug dx study,78808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,1517.8,APC Iv inj ra drug dx study,78808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,1517.8,APC Pet image ltd area,78811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2182.15,,,,,,,fee schedule,1529.43,2744.56, Pet image ltd area,78811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2744.56,,,,,,,fee schedule,1529.43,2744.56, Pet image ltd area,78811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1529.43,2744.56,APC Pet image ltd area,78811,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1529.43,2744.56,APC Pet image ltd area,78811,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1529.43,2744.56,APC Pet image skull-thigh,78812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2956.91,,,,,,,fee schedule,1689.26,3719, Pet image skull-thigh,78812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3719,,,,,,,fee schedule,1689.26,3719, Pet image skull-thigh,78812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,3719,APC Pet image skull-thigh,78812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,3719,APC Pet image skull-thigh,78812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,3719,APC Pet image full body,78813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3341.29,,,,,,,fee schedule,1689.26,4202.45, Pet image full body,78813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4202.45,,,,,,,fee schedule,1689.26,4202.45, Pet image full body,78813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,4202.45,APC Pet image full body,78813,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,4202.45,APC Pet image full body,78813,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,4202.45,APC Pet image w/ct lmtd,78814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3442.21,,,,,,,fee schedule,1689.26,4329.38, Pet image w/ct lmtd,78814,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4329.38,,,,,,,fee schedule,1689.26,4329.38, Pet image w/ct lmtd,78814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,4329.38,APC Pet image w/ct lmtd,78814,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,4329.38,APC Pet image w/ct lmtd,78814,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,4329.38,APC Pet image w/ct skull-thigh,78815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3059.72,,,,,,,fee schedule,1689.26,3848.31, Pet image w/ct skull-thigh,78815,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3848.31,,,,,,,fee schedule,1689.26,3848.31, Pet image w/ct skull-thigh,78815,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,3848.31,APC Pet image w/ct skull-thigh,78815,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,3848.31,APC Pet image w/ct skull-thigh,78815,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,3848.31,APC Pet image w/ct full body,78816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3160.9,,,,,,,fee schedule,1689.26,3975.57, Pet image w/ct full body,78816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3975.57,,,,,,,fee schedule,1689.26,3975.57, Pet image w/ct full body,78816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1689.26,3975.57,APC Pet image w/ct full body,78816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1689.26,3975.57,APC Pet image w/ct full body,78816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1689.26,3975.57,APC Rp loclzj tum spect w/ct 1,78830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1090.46,,,,,,,fee schedule,1090.46,1605.9, Rp loclzj tum spect w/ct 1,78830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1371.51,,,,,,,fee schedule,1090.46,1605.9, Rp loclzj tum spect w/ct 1,78830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1090.46,1605.9,APC Rp loclzj tum spect w/ct 1,78830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1090.46,1605.9,APC Rp loclzj tum spect w/ct 1,78830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1090.46,1605.9,APC Rp loclzj tum spect 2 areas,78831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1090.46,,,,,,,fee schedule,1090.46,1605.9, Rp loclzj tum spect 2 areas,78831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1371.51,,,,,,,fee schedule,1090.46,1605.9, Rp loclzj tum spect 2 areas,78831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1590.6,,,,,,,fee schedule,1090.46,1605.9,APC Rp loclzj tum spect 2 areas,78831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1605.9,,,,,,,fee schedule,1090.46,1605.9,APC Rp loclzj tum spect 2 areas,78831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1529.43,,,,,,,fee schedule,1090.46,1605.9,APC Rp loclzj tum spect w/ct 2,78832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1090.46,,,,,,,fee schedule,1090.46,1773.72, Rp loclzj tum spect w/ct 2,78832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1371.51,,,,,,,fee schedule,1090.46,1773.72, Rp loclzj tum spect w/ct 2,78832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1756.83,,,,,,,fee schedule,1090.46,1773.72,APC Rp loclzj tum spect w/ct 2,78832,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1773.72,,,,,,,fee schedule,1090.46,1773.72,APC Rp loclzj tum spect w/ct 2,78832,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1689.26,,,,,,,fee schedule,1090.46,1773.72,APC Rp quan meas single area,78835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,369.95,,,,,,,fee schedule,369.95,465.3, Rp quan meas single area,78835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,465.3,,,,,,,fee schedule,369.95,465.3, Nuclear diagnostic exam,78999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,717.11,,,,,,,fee schedule,472.27,901.93, Nuclear diagnostic exam,78999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,901.93,,,,,,,fee schedule,472.27,901.93, Nuclear diagnostic exam,78999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,901.93,APC Nuclear diagnostic exam,78999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,901.93,APC Nuclear diagnostic exam,78999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,901.93,APC Nuclear rx oral admin,79005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,659.67,,,,,,,fee schedule,275.65,829.69, Nuclear rx oral admin,79005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,829.69,,,,,,,fee schedule,275.65,829.69, Nuclear rx oral admin,79005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,829.69,APC Nuclear rx oral admin,79005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,829.69,APC Nuclear rx oral admin,79005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,829.69,APC Nuclear rx iv admin,79101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,687.52,,,,,,,fee schedule,275.65,864.71, Nuclear rx iv admin,79101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,864.71,,,,,,,fee schedule,275.65,864.71, Nuclear rx iv admin,79101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,864.71,APC Nuclear rx iv admin,79101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,864.71,APC Nuclear rx iv admin,79101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,864.71,APC Nuclear rx intracav admin,79200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,694.68,,,,,,,fee schedule,275.65,873.72, Nuclear rx intracav admin,79200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,873.72,,,,,,,fee schedule,275.65,873.72, Nuclear rx intracav admin,79200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,873.72,APC Nuclear rx intracav admin,79200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,873.72,APC Nuclear rx intracav admin,79200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,873.72,APC Nuclr rx interstit colloid,79300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,783.98,,,,,,,fee schedule,275.65,986.04, Nuclr rx interstit colloid,79300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,986.04,,,,,,,fee schedule,275.65,986.04, Nuclr rx interstit colloid,79300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,986.04,APC Nuclr rx interstit colloid,79300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,986.04,APC Nuclr rx interstit colloid,79300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,986.04,APC Hematopoietic nuclear tx,79403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,972.23,,,,,,,fee schedule,275.65,1222.81, Hematopoietic nuclear tx,79403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1222.81,,,,,,,fee schedule,275.65,1222.81, Hematopoietic nuclear tx,79403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,1222.81,APC Hematopoietic nuclear tx,79403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,1222.81,APC Hematopoietic nuclear tx,79403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,1222.81,APC Nuclear rx intra-articular,79440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,697.64,,,,,,,fee schedule,275.65,877.45, Nuclear rx intra-articular,79440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,877.45,,,,,,,fee schedule,275.65,877.45, Nuclear rx intra-articular,79440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,877.45,APC Nuclear rx intra-articular,79440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,877.45,APC Nuclear rx intra-articular,79440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,877.45,APC Nuclear rx intra-arterial,79445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,764.52,,,,,,,fee schedule,275.65,961.56, Nuclear rx intra-arterial,79445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,961.56,,,,,,,fee schedule,275.65,961.56, Nuclear rx intra-arterial,79445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,961.56,APC Nuclear rx intra-arterial,79445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,961.56,APC Nuclear rx intra-arterial,79445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,961.56,APC Nuclear medicine therapy,79999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,703.26,,,,,,,fee schedule,275.65,884.51, Nuclear medicine therapy,79999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,884.51,,,,,,,fee schedule,275.65,884.51, Nuclear medicine therapy,79999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.68,,,,,,,fee schedule,275.65,884.51,APC Nuclear medicine therapy,79999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,289.43,,,,,,,fee schedule,275.65,884.51,APC Nuclear medicine therapy,79999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.65,,,,,,,fee schedule,275.65,884.51,APC Metabolic panel ionized ca,80047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.93,,,,,,,fee schedule,13.73,50.01, Metabolic panel ionized ca,80047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.85,,,,,,,fee schedule,13.73,50.01, Metabolic panel ionized ca,80047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.73,50.01, Metabolic panel ionized ca,80047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.73,50.01, Metabolic panel ionized ca,80047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.28,,,,,,,fee schedule,13.73,50.01,APC Metabolic panel ionized ca,80047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.42,,,,,,,fee schedule,13.73,50.01,APC Metabolic panel ionized ca,80047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.73,,,,,,,fee schedule,13.73,50.01,APC Metabolic panel total ca,80048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.45,,,,,,,fee schedule,8.46,43.3, Metabolic panel total ca,80048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.3,,,,,,,fee schedule,8.46,43.3, Metabolic panel total ca,80048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.46,43.3, Metabolic panel total ca,80048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.46,43.3, Metabolic panel total ca,80048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.8,,,,,,,fee schedule,8.46,43.3,APC Metabolic panel total ca,80048,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.88,,,,,,,fee schedule,8.46,43.3,APC Metabolic panel total ca,80048,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.46,,,,,,,fee schedule,8.46,43.3,APC General health panel,80050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,126.03,,,,,,,fee schedule,126.03,144.03, General health panel,80050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,144.03,,,,,,,fee schedule,126.03,144.03, Electrolyte panel,80051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.85,,,,,,,fee schedule,7.01,35.87, Electrolyte panel,80051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.87,,,,,,,fee schedule,7.01,35.87, Electrolyte panel,80051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,7.01,35.87, Electrolyte panel,80051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,7.01,35.87, Electrolyte panel,80051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.29,,,,,,,fee schedule,7.01,35.87,APC Electrolyte panel,80051,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.36,,,,,,,fee schedule,7.01,35.87,APC Electrolyte panel,80051,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.01,,,,,,,fee schedule,7.01,35.87,APC Comprehen metabolic panel,80053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48,,,,,,,fee schedule,10.56,54.06, Comprehen metabolic panel,80053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.06,,,,,,,fee schedule,10.56,54.06, Comprehen metabolic panel,80053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.56,54.06, Comprehen metabolic panel,80053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.56,54.06, Comprehen metabolic panel,80053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.98,,,,,,,fee schedule,10.56,54.06,APC Comprehen metabolic panel,80053,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.09,,,,,,,fee schedule,10.56,54.06,APC Comprehen metabolic panel,80053,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.56,,,,,,,fee schedule,10.56,54.06,APC Obstetric panel,80055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,286.03,,,,,,,fee schedule,47.81,322.12, Obstetric panel,80055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,322.12,,,,,,,fee schedule,47.81,322.12, Obstetric panel,80055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,152.07,,,,,,,fee schedule,47.81,322.12, Obstetric panel,80055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,173.79,,,,,,,fee schedule,47.81,322.12, Obstetric panel,80055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.72,,,,,,,fee schedule,47.81,322.12,APC Obstetric panel,80055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50.2,,,,,,,fee schedule,47.81,322.12,APC Obstetric panel,80055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.81,,,,,,,fee schedule,47.81,322.12,APC Lipid panel,80061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.84,,,,,,,fee schedule,13.39,68.52, Lipid panel,80061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.52,,,,,,,fee schedule,13.39,68.52, Lipid panel,80061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.39,68.52, Lipid panel,80061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.39,68.52, Lipid panel,80061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.93,,,,,,,fee schedule,13.39,68.52,APC Lipid panel,80061,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.06,,,,,,,fee schedule,13.39,68.52,APC Lipid panel,80061,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.39,,,,,,,fee schedule,13.39,68.52,APC Renal function panel,80069,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.42,,,,,,,fee schedule,8.68,44.4, Renal function panel,80069,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.4,,,,,,,fee schedule,8.68,44.4, Renal function panel,80069,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.68,44.4, Renal function panel,80069,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.68,44.4, Renal function panel,80069,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.03,,,,,,,fee schedule,8.68,44.4,APC Renal function panel,80069,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.11,,,,,,,fee schedule,8.68,44.4,APC Renal function panel,80069,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.68,,,,,,,fee schedule,8.68,44.4,APC Acute hepatitis panel,80074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,216.26,,,,,,,fee schedule,47.63,243.54, Acute hepatitis panel,80074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,243.54,,,,,,,fee schedule,47.63,243.54, Acute hepatitis panel,80074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,151.02,,,,,,,fee schedule,47.63,243.54, Acute hepatitis panel,80074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,172.59,,,,,,,fee schedule,47.63,243.54, Acute hepatitis panel,80074,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.54,,,,,,,fee schedule,47.63,243.54,APC Acute hepatitis panel,80074,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50.01,,,,,,,fee schedule,47.63,243.54,APC Acute hepatitis panel,80074,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.63,,,,,,,fee schedule,47.63,243.54,APC Hepatic function panel,80076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.12,,,,,,,fee schedule,8.17,41.8, Hepatic function panel,80076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.8,,,,,,,fee schedule,8.17,41.8, Hepatic function panel,80076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.17,41.8, Hepatic function panel,80076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.17,41.8, Hepatic function panel,80076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.5,,,,,,,fee schedule,8.17,41.8,APC Hepatic function panel,80076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.58,,,,,,,fee schedule,8.17,41.8,APC Hepatic function panel,80076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.17,,,,,,,fee schedule,8.17,41.8,APC Obstetric panel,80081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,447.85,,,,,,,fee schedule,74.86,504.35, Obstetric panel,80081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,504.35,,,,,,,fee schedule,74.86,504.35, Obstetric panel,80081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,238.51,,,,,,,fee schedule,74.86,504.35, Obstetric panel,80081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,272.58,,,,,,,fee schedule,74.86,504.35, Obstetric panel,80081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.85,,,,,,,fee schedule,74.86,504.35,APC Obstetric panel,80081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.6,,,,,,,fee schedule,74.86,504.35,APC Obstetric panel,80081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.86,,,,,,,fee schedule,74.86,504.35,APC Drug assay acetaminophen,80143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.58,,,,,,,fee schedule,18.64,68.22, Drug assay acetaminophen,80143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.22,,,,,,,fee schedule,18.64,68.22, Drug assay acetaminophen,80143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,68.22, Drug assay acetaminophen,80143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,68.22, Drug assay acetaminophen,80143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,68.22,APC Drug assay acetaminophen,80143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,68.22,APC Drug assay acetaminophen,80143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,68.22,APC Drug assay adalimumab,80145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.35,,,,,,,fee schedule,38.57,141.17, Drug assay adalimumab,80145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.17,,,,,,,fee schedule,38.57,141.17, Drug assay adalimumab,80145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.57,141.17, Drug assay adalimumab,80145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.57,141.17, Drug assay adalimumab,80145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,141.17,APC Drug assay adalimumab,80145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,141.17,APC Drug assay adalimumab,80145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,141.17,APC Assay of amikacin,80150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.45,,,,,,,fee schedule,15.08,77.08, Assay of amikacin,80150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.08,,,,,,,fee schedule,15.08,77.08, Assay of amikacin,80150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.08,77.08, Assay of amikacin,80150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.08,77.08, Assay of amikacin,80150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.68,,,,,,,fee schedule,15.08,77.08,APC Assay of amikacin,80150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.83,,,,,,,fee schedule,15.08,77.08,APC Assay of amikacin,80150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.08,,,,,,,fee schedule,15.08,77.08,APC Drug assay amiodarone,80151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.58,,,,,,,fee schedule,18.64,68.22, Drug assay amiodarone,80151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.22,,,,,,,fee schedule,18.64,68.22, Drug assay amiodarone,80151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,68.22, Drug assay amiodarone,80151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,68.22, Drug assay amiodarone,80151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,68.22,APC Drug assay amiodarone,80151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,68.22,APC Drug assay amiodarone,80151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,68.22,APC Drug assay caffeine,80155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.73,,,,,,,fee schedule,38.57,140.46, Drug assay caffeine,80155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.64,,,,,,,fee schedule,38.57,140.46, Drug assay caffeine,80155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.57,140.46, Drug assay caffeine,80155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.57,140.46, Drug assay caffeine,80155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,140.46,APC Drug assay caffeine,80155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,140.46,APC Drug assay caffeine,80155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,140.46,APC Assay carbamazepine total,80156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.11,,,,,,,fee schedule,14.57,74.44, Assay carbamazepine total,80156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.44,,,,,,,fee schedule,14.57,74.44, Assay carbamazepine total,80156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.57,74.44, Assay carbamazepine total,80156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.57,74.44, Assay carbamazepine total,80156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.15,,,,,,,fee schedule,14.57,74.44,APC Assay carbamazepine total,80156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.3,,,,,,,fee schedule,14.57,74.44,APC Assay carbamazepine total,80156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.57,,,,,,,fee schedule,14.57,74.44,APC Assay carbamazepine free,80157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.19,,,,,,,fee schedule,13.25,67.78, Assay carbamazepine free,80157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.78,,,,,,,fee schedule,13.25,67.78, Assay carbamazepine free,80157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,67.78, Assay carbamazepine free,80157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,67.78, Assay carbamazepine free,80157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,67.78,APC Assay carbamazepine free,80157,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,67.78,APC Assay carbamazepine free,80157,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,67.78,APC Drug assay cyclosporine,80158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,18.05,92.34, Drug assay cyclosporine,80158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,18.05,92.34, Drug assay cyclosporine,80158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.05,92.34, Drug assay cyclosporine,80158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.05,92.34, Drug assay cyclosporine,80158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.77,,,,,,,fee schedule,18.05,92.34,APC Drug assay cyclosporine,80158,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.95,,,,,,,fee schedule,18.05,92.34,APC Drug assay cyclosporine,80158,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.05,,,,,,,fee schedule,18.05,92.34,APC Drug assay clozapine,80159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,20.15,92.34, Drug assay clozapine,80159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,20.15,92.34, Drug assay clozapine,80159,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.15,92.34, Drug assay clozapine,80159,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.15,92.34, Drug assay clozapine,80159,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.96,,,,,,,fee schedule,20.15,92.34,APC Drug assay clozapine,80159,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.16,,,,,,,fee schedule,20.15,92.34,APC Drug assay clozapine,80159,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.15,,,,,,,fee schedule,20.15,92.34,APC "Asy carbamazepin 10,11-epxid",80161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.58,,,,,,,fee schedule,18.64,68.22, "Asy carbamazepin 10,11-epxid",80161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.22,,,,,,,fee schedule,18.64,68.22, "Asy carbamazepin 10,11-epxid",80161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,68.22, "Asy carbamazepin 10,11-epxid",80161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,68.22, "Asy carbamazepin 10,11-epxid",80161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,68.22,APC "Asy carbamazepin 10,11-epxid",80161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,68.22,APC "Asy carbamazepin 10,11-epxid",80161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,68.22,APC Assay of digoxin total,80162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.29,,,,,,,fee schedule,13.28,67.89, Assay of digoxin total,80162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.89,,,,,,,fee schedule,13.28,67.89, Assay of digoxin total,80162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.28,67.89, Assay of digoxin total,80162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.28,67.89, Assay of digoxin total,80162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.81,,,,,,,fee schedule,13.28,67.89,APC Assay of digoxin total,80162,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.94,,,,,,,fee schedule,13.28,67.89,APC Assay of digoxin total,80162,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.28,,,,,,,fee schedule,13.28,67.89,APC Assay of digoxin free,80163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.73,,,,,,,fee schedule,13.28,66.14, Assay of digoxin free,80163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.14,,,,,,,fee schedule,13.28,66.14, Assay of digoxin free,80163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.28,66.14, Assay of digoxin free,80163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.28,66.14, Assay of digoxin free,80163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.81,,,,,,,fee schedule,13.28,66.14,APC Assay of digoxin free,80163,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.94,,,,,,,fee schedule,13.28,66.14,APC Assay of digoxin free,80163,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.28,,,,,,,fee schedule,13.28,66.14,APC Assay dipropylacetic acd tot,80164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.52,,,,,,,fee schedule,13.54,69.28, Assay dipropylacetic acd tot,80164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.28,,,,,,,fee schedule,13.54,69.28, Assay dipropylacetic acd tot,80164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.54,69.28, Assay dipropylacetic acd tot,80164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.54,69.28, Assay dipropylacetic acd tot,80164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.08,,,,,,,fee schedule,13.54,69.28,APC Assay dipropylacetic acd tot,80164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.22,,,,,,,fee schedule,13.54,69.28,APC Assay dipropylacetic acd tot,80164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.54,,,,,,,fee schedule,13.54,69.28,APC Dipropylacetic acid free,80165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.93,,,,,,,fee schedule,13.54,67.49, Dipropylacetic acid free,80165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.49,,,,,,,fee schedule,13.54,67.49, Dipropylacetic acid free,80165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.54,67.49, Dipropylacetic acid free,80165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.54,67.49, Dipropylacetic acid free,80165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.08,,,,,,,fee schedule,13.54,67.49,APC Dipropylacetic acid free,80165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.22,,,,,,,fee schedule,13.54,67.49,APC Dipropylacetic acid free,80165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.54,,,,,,,fee schedule,13.54,67.49,APC Drug assay felbamate,80167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.58,,,,,,,fee schedule,18.64,68.22, Drug assay felbamate,80167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.22,,,,,,,fee schedule,18.64,68.22, Drug assay felbamate,80167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,68.22, Drug assay felbamate,80167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,68.22, Drug assay felbamate,80167,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,68.22,APC Drug assay felbamate,80167,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,68.22,APC Drug assay felbamate,80167,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,68.22,APC Assay of ethosuximide,80168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.41,,,,,,,fee schedule,16.34,77.04, Assay of ethosuximide,80168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.04,,,,,,,fee schedule,16.34,77.04, Assay of ethosuximide,80168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.34,77.04, Assay of ethosuximide,80168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.34,77.04, Assay of ethosuximide,80168,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.99,,,,,,,fee schedule,16.34,77.04,APC Assay of ethosuximide,80168,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.16,,,,,,,fee schedule,16.34,77.04,APC Assay of ethosuximide,80168,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.34,,,,,,,fee schedule,16.34,77.04,APC Drug assay everolimus,80169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.87,,,,,,,fee schedule,13.73,68.55, Drug assay everolimus,80169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.55,,,,,,,fee schedule,13.73,68.55, Drug assay everolimus,80169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.73,68.55, Drug assay everolimus,80169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.73,68.55, Drug assay everolimus,80169,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.28,,,,,,,fee schedule,13.73,68.55,APC Drug assay everolimus,80169,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.42,,,,,,,fee schedule,13.73,68.55,APC Drug assay everolimus,80169,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.73,,,,,,,fee schedule,13.73,68.55,APC Assay of gentamicin,80170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.43,,,,,,,fee schedule,16.38,83.81, Assay of gentamicin,80170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.81,,,,,,,fee schedule,16.38,83.81, Assay of gentamicin,80170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.38,83.81, Assay of gentamicin,80170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.38,83.81, Assay of gentamicin,80170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.04,,,,,,,fee schedule,16.38,83.81,APC Assay of gentamicin,80170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.2,,,,,,,fee schedule,16.38,83.81,APC Assay of gentamicin,80170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.38,,,,,,,fee schedule,16.38,83.81,APC Drug screen quant gabapentin,80171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,21.67,78.57, Drug screen quant gabapentin,80171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,21.67,78.57, Drug screen quant gabapentin,80171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.75,,,,,,,fee schedule,21.67,78.57, Drug screen quant gabapentin,80171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,78.57,,,,,,,fee schedule,21.67,78.57, Drug screen quant gabapentin,80171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.54,,,,,,,fee schedule,21.67,78.57,APC Drug screen quant gabapentin,80171,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.75,,,,,,,fee schedule,21.67,78.57,APC Drug screen quant gabapentin,80171,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.67,,,,,,,fee schedule,21.67,78.57,APC Assay Of Haloperidol,80173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.11,,,,,,,fee schedule,15.78,74.44, Assay Of Haloperidol,80173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.44,,,,,,,fee schedule,15.78,74.44, Assay Of Haloperidol,80173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.01,,,,,,,fee schedule,15.78,74.44, Assay Of Haloperidol,80173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.15,,,,,,,fee schedule,15.78,74.44, Assay Of Haloperidol,80173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.41,,,,,,,fee schedule,15.78,74.44,APC Assay Of Haloperidol,80173,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.57,,,,,,,fee schedule,15.78,74.44,APC Assay Of Haloperidol,80173,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.78,,,,,,,fee schedule,15.78,74.44,APC Drug screen quan lamotrigine,80175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,13.25,66.21, Drug screen quan lamotrigine,80175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,13.25,66.21, Drug screen quan lamotrigine,80175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,66.21, Drug screen quan lamotrigine,80175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,66.21, Drug screen quan lamotrigine,80175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,66.21,APC Drug screen quan lamotrigine,80175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,66.21,APC Drug screen quan lamotrigine,80175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,66.21,APC Assay of lidocaine,80176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.69,,,,,,,fee schedule,14.69,75.1, Assay of lidocaine,80176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.1,,,,,,,fee schedule,14.69,75.1, Assay of lidocaine,80176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.69,75.1, Assay of lidocaine,80176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.69,75.1, Assay of lidocaine,80176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.28,,,,,,,fee schedule,14.69,75.1,APC Assay of lidocaine,80176,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.42,,,,,,,fee schedule,14.69,75.1,APC Assay of lidocaine,80176,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.69,,,,,,,fee schedule,14.69,75.1,APC Drug scrn quan levetiracetam,80177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,13.25,66.21, Drug scrn quan levetiracetam,80177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,13.25,66.21, Drug scrn quan levetiracetam,80177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,66.21, Drug scrn quan levetiracetam,80177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,66.21, Drug scrn quan levetiracetam,80177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,66.21,APC Drug scrn quan levetiracetam,80177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,66.21,APC Drug scrn quan levetiracetam,80177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,66.21,APC Assay of lithium,80178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.03,,,,,,,fee schedule,6.61,33.82, Assay of lithium,80178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.82,,,,,,,fee schedule,6.61,33.82, Assay of lithium,80178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.61,33.82, Assay of lithium,80178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.61,33.82, Assay of lithium,80178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.87,,,,,,,fee schedule,6.61,33.82,APC Assay of lithium,80178,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.94,,,,,,,fee schedule,6.61,33.82,APC Assay of lithium,80178,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.61,,,,,,,fee schedule,6.61,33.82,APC Drug assay salicylate,80179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.58,,,,,,,fee schedule,18.64,68.22, Drug assay salicylate,80179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.22,,,,,,,fee schedule,18.64,68.22, Drug assay salicylate,80179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,68.22, Drug assay salicylate,80179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,68.22, Drug assay salicylate,80179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,68.22,APC Drug assay salicylate,80179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,68.22,APC Drug assay salicylate,80179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,68.22,APC Drug scrn quan mycophenolate,80180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.05,,,,,,,fee schedule,18.05,90.15, Drug scrn quan mycophenolate,80180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.15,,,,,,,fee schedule,18.05,90.15, Drug scrn quan mycophenolate,80180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.05,90.15, Drug scrn quan mycophenolate,80180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.05,90.15, Drug scrn quan mycophenolate,80180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.77,,,,,,,fee schedule,18.05,90.15,APC Drug scrn quan mycophenolate,80180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.95,,,,,,,fee schedule,18.05,90.15,APC Drug scrn quan mycophenolate,80180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.05,,,,,,,fee schedule,18.05,90.15,APC Drug assay flecainide,80181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.58,,,,,,,fee schedule,18.64,68.22, Drug assay flecainide,80181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.22,,,,,,,fee schedule,18.64,68.22, Drug assay flecainide,80181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,68.22, Drug assay flecainide,80181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,68.22, Drug assay flecainide,80181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,68.22,APC Drug assay flecainide,80181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,68.22,APC Drug assay flecainide,80181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,68.22,APC Drug scrn quant oxcarbazepin,80183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,13.25,66.21, Drug scrn quant oxcarbazepin,80183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,13.25,66.21, Drug scrn quant oxcarbazepin,80183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,66.21, Drug scrn quant oxcarbazepin,80183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,66.21, Drug scrn quant oxcarbazepin,80183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,66.21,APC Drug scrn quant oxcarbazepin,80183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,66.21,APC Drug scrn quant oxcarbazepin,80183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,66.21,APC Assay of phenobarbital,80184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.03,,,,,,,fee schedule,15.3,58.6, Assay of phenobarbital,80184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.6,,,,,,,fee schedule,15.3,58.6, Assay of phenobarbital,80184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.3,58.6, Assay of phenobarbital,80184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.3,58.6, Assay of phenobarbital,80184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.91,,,,,,,fee schedule,15.3,58.6,APC Assay of phenobarbital,80184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.07,,,,,,,fee schedule,15.3,58.6,APC Assay of phenobarbital,80184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.3,,,,,,,fee schedule,15.3,58.6,APC Assay of phenytoin total,80185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.19,,,,,,,fee schedule,13.25,67.78, Assay of phenytoin total,80185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.78,,,,,,,fee schedule,13.25,67.78, Assay of phenytoin total,80185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,67.78, Assay of phenytoin total,80185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,67.78, Assay of phenytoin total,80185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,67.78,APC Assay of phenytoin total,80185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,67.78,APC Assay of phenytoin total,80185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,67.78,APC Assay of phenytoin free,80186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.5,,,,,,,fee schedule,13.76,70.38, Assay of phenytoin free,80186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.38,,,,,,,fee schedule,13.76,70.38, Assay of phenytoin free,80186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.76,70.38, Assay of phenytoin free,80186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.76,70.38, Assay of phenytoin free,80186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.31,,,,,,,fee schedule,13.76,70.38,APC Assay of phenytoin free,80186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.45,,,,,,,fee schedule,13.76,70.38,APC Assay of phenytoin free,80186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.76,,,,,,,fee schedule,13.76,70.38,APC Drug assay posaconazole,80187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,27.11,99.22, Drug assay posaconazole,80187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.22,,,,,,,fee schedule,27.11,99.22, Drug assay posaconazole,80187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.11,99.22, Drug assay posaconazole,80187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.11,99.22, Drug assay posaconazole,80187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.19,,,,,,,fee schedule,27.11,99.22,APC Drug assay posaconazole,80187,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,27.11,99.22,APC Drug assay posaconazole,80187,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,27.11,99.22,APC Assay of primidone,80188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.34,,,,,,,fee schedule,16.59,84.84, Assay of primidone,80188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.84,,,,,,,fee schedule,16.59,84.84, Assay of primidone,80188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.59,84.84, Assay of primidone,80188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.59,84.84, Assay of primidone,80188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.25,,,,,,,fee schedule,16.59,84.84,APC Assay of primidone,80188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.42,,,,,,,fee schedule,16.59,84.84,APC Assay of primidone,80188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.59,,,,,,,fee schedule,16.59,84.84,APC Drug assay itraconzaole,80189,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,27.11,99.22, Drug assay itraconzaole,80189,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.22,,,,,,,fee schedule,27.11,99.22, Drug assay itraconzaole,80189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.11,99.22, Drug assay itraconzaole,80189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.11,99.22, Drug assay itraconzaole,80189,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.19,,,,,,,fee schedule,27.11,99.22,APC Drug assay itraconzaole,80189,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,27.11,99.22,APC Drug assay itraconzaole,80189,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,27.11,99.22,APC Assay of procainamide,80190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.08,,,,,,,fee schedule,60,217.83, Assay of procainamide,80190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.68,,,,,,,fee schedule,60,217.83, Assay of procainamide,80190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,190.6,,,,,,,fee schedule,60,217.83, Assay of procainamide,80190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,217.83,,,,,,,fee schedule,60,217.83, Assay of procainamide,80190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,62.4,,,,,,,fee schedule,60,217.83,APC Assay of procainamide,80190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,63,,,,,,,fee schedule,60,217.83,APC Assay of procainamide,80190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,60,,,,,,,fee schedule,60,217.83,APC Assay of procainamide,80192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.08,,,,,,,fee schedule,16.75,85.68, Assay of procainamide,80192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.68,,,,,,,fee schedule,16.75,85.68, Assay of procainamide,80192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.75,85.68, Assay of procainamide,80192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.75,85.68, Assay of procainamide,80192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.42,,,,,,,fee schedule,16.75,85.68,APC Assay of procainamide,80192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.59,,,,,,,fee schedule,16.75,85.68,APC Assay of procainamide,80192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.75,,,,,,,fee schedule,16.75,85.68,APC Drug assay leflunomide,80193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.35,,,,,,,fee schedule,38.57,141.17, Drug assay leflunomide,80193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.17,,,,,,,fee schedule,38.57,141.17, Drug assay leflunomide,80193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.57,141.17, Drug assay leflunomide,80193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.57,141.17, Drug assay leflunomide,80193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,141.17,APC Drug assay leflunomide,80193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,141.17,APC Drug assay leflunomide,80193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,141.17,APC Assay of quinidine,80194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.27,,,,,,,fee schedule,14.6,74.63, Assay of quinidine,80194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.63,,,,,,,fee schedule,14.6,74.63, Assay of quinidine,80194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.6,74.63, Assay of quinidine,80194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.6,74.63, Assay of quinidine,80194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.18,,,,,,,fee schedule,14.6,74.63,APC Assay of quinidine,80194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.33,,,,,,,fee schedule,14.6,74.63,APC Assay of quinidine,80194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.6,,,,,,,fee schedule,14.6,74.63,APC Assay of sirolimus,80195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.21,,,,,,,fee schedule,13.73,71.19, Assay of sirolimus,80195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.19,,,,,,,fee schedule,13.73,71.19, Assay of sirolimus,80195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.73,71.19, Assay of sirolimus,80195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.73,71.19, Assay of sirolimus,80195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.28,,,,,,,fee schedule,13.73,71.19,APC Assay of sirolimus,80195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.42,,,,,,,fee schedule,13.73,71.19,APC Assay of sirolimus,80195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.73,,,,,,,fee schedule,13.73,71.19,APC Assay of tacrolimus,80197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.3,,,,,,,fee schedule,13.73,70.16, Assay of tacrolimus,80197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.16,,,,,,,fee schedule,13.73,70.16, Assay of tacrolimus,80197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.73,70.16, Assay of tacrolimus,80197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.73,70.16, Assay of tacrolimus,80197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.28,,,,,,,fee schedule,13.73,70.16,APC Assay of tacrolimus,80197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.42,,,,,,,fee schedule,13.73,70.16,APC Assay of tacrolimus,80197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.73,,,,,,,fee schedule,13.73,70.16,APC Assay of theophylline,80198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.25,,,,,,,fee schedule,14.14,72.36, Assay of theophylline,80198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.36,,,,,,,fee schedule,14.14,72.36, Assay of theophylline,80198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.14,72.36, Assay of theophylline,80198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.14,72.36, Assay of theophylline,80198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.71,,,,,,,fee schedule,14.14,72.36,APC Assay of theophylline,80198,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.85,,,,,,,fee schedule,14.14,72.36,APC Assay of theophylline,80198,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.14,,,,,,,fee schedule,14.14,72.36,APC Drug screen quant tiagabine,80199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.05,,,,,,,fee schedule,27.11,98.79, Drug screen quant tiagabine,80199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.15,,,,,,,fee schedule,27.11,98.79, Drug screen quant tiagabine,80199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.11,98.79, Drug screen quant tiagabine,80199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.11,98.79, Drug screen quant tiagabine,80199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.19,,,,,,,fee schedule,27.11,98.79,APC Drug screen quant tiagabine,80199,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,27.11,98.79,APC Drug screen quant tiagabine,80199,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,27.11,98.79,APC Assay of tobramycin,80200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.19,,,,,,,fee schedule,16.13,82.42, Assay of tobramycin,80200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.42,,,,,,,fee schedule,16.13,82.42, Assay of tobramycin,80200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.13,82.42, Assay of tobramycin,80200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.13,82.42, Assay of tobramycin,80200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.78,,,,,,,fee schedule,16.13,82.42,APC Assay of tobramycin,80200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.94,,,,,,,fee schedule,16.13,82.42,APC Assay of tobramycin,80200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.13,,,,,,,fee schedule,16.13,82.42,APC Assay of topiramate,80201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.15,,,,,,,fee schedule,11.92,60.98, Assay of topiramate,80201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.98,,,,,,,fee schedule,11.92,60.98, Assay of topiramate,80201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.92,60.98, Assay of topiramate,80201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.92,60.98, Assay of topiramate,80201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.4,,,,,,,fee schedule,11.92,60.98,APC Assay of topiramate,80201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.52,,,,,,,fee schedule,11.92,60.98,APC Assay of topiramate,80201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.92,,,,,,,fee schedule,11.92,60.98,APC Assay of vancomycin,80202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.52,,,,,,,fee schedule,13.54,69.28, Assay of vancomycin,80202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.28,,,,,,,fee schedule,13.54,69.28, Assay of vancomycin,80202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.54,69.28, Assay of vancomycin,80202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.54,69.28, Assay of vancomycin,80202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.08,,,,,,,fee schedule,13.54,69.28,APC Assay of vancomycin,80202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.22,,,,,,,fee schedule,13.54,69.28,APC Assay of vancomycin,80202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.54,,,,,,,fee schedule,13.54,69.28,APC Drug screen quant zonisamide,80203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,13.25,66.21, Drug screen quant zonisamide,80203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,13.25,66.21, Drug screen quant zonisamide,80203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,66.21, Drug screen quant zonisamide,80203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,66.21, Drug screen quant zonisamide,80203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,66.21,APC Drug screen quant zonisamide,80203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,66.21,APC Drug screen quant zonisamide,80203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,66.21,APC Drug assay methotrexate,80204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.35,,,,,,,fee schedule,38.57,141.17, Drug assay methotrexate,80204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.17,,,,,,,fee schedule,38.57,141.17, Drug assay methotrexate,80204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.57,141.17, Drug assay methotrexate,80204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.57,141.17, Drug assay methotrexate,80204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,141.17,APC Drug assay methotrexate,80204,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,141.17,APC Drug assay methotrexate,80204,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,141.17,APC Drug assay rufinamide,80210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,27.11,99.22, Drug assay rufinamide,80210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.22,,,,,,,fee schedule,27.11,99.22, Drug assay rufinamide,80210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.11,99.22, Drug assay rufinamide,80210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.11,99.22, Drug assay rufinamide,80210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.19,,,,,,,fee schedule,27.11,99.22,APC Drug assay rufinamide,80210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,27.11,99.22,APC Drug assay rufinamide,80210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,27.11,99.22,APC Drug asy hydroxychloroquine,80220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.58,,,,,,,fee schedule,18.64,68.22, Drug asy hydroxychloroquine,80220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.22,,,,,,,fee schedule,18.64,68.22, Drug asy hydroxychloroquine,80220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,68.22, Drug asy hydroxychloroquine,80220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,68.22, Drug asy hydroxychloroquine,80220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,68.22,APC Drug asy hydroxychloroquine,80220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,68.22,APC Drug asy hydroxychloroquine,80220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,68.22,APC Drug assay infliximab,80230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.35,,,,,,,fee schedule,38.57,141.17, Drug assay infliximab,80230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.17,,,,,,,fee schedule,38.57,141.17, Drug assay infliximab,80230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.57,141.17, Drug assay infliximab,80230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.57,141.17, Drug assay infliximab,80230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,141.17,APC Drug assay infliximab,80230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,141.17,APC Drug assay infliximab,80230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,141.17,APC Drug assay lacosamide,80235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,27.11,99.22, Drug assay lacosamide,80235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.22,,,,,,,fee schedule,27.11,99.22, Drug assay lacosamide,80235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.11,99.22, Drug assay lacosamide,80235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.11,99.22, Drug assay lacosamide,80235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.19,,,,,,,fee schedule,27.11,99.22,APC Drug assay lacosamide,80235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,27.11,99.22,APC Drug assay lacosamide,80235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,27.11,99.22,APC Drug assay vedolizumab,80280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.35,,,,,,,fee schedule,38.57,141.17, Drug assay vedolizumab,80280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.17,,,,,,,fee schedule,38.57,141.17, Drug assay vedolizumab,80280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.57,141.17, Drug assay vedolizumab,80280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.57,141.17, Drug assay vedolizumab,80280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,38.57,141.17,APC Drug assay vedolizumab,80280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.5,,,,,,,fee schedule,38.57,141.17,APC Drug assay vedolizumab,80280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.57,,,,,,,fee schedule,38.57,141.17,APC Drug assay voriconazole,80285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,27.11,99.22, Drug assay voriconazole,80285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.22,,,,,,,fee schedule,27.11,99.22, Drug assay voriconazole,80285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.11,99.22, Drug assay voriconazole,80285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.11,99.22, Drug assay voriconazole,80285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.19,,,,,,,fee schedule,27.11,99.22,APC Drug assay voriconazole,80285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,27.11,99.22,APC Drug assay voriconazole,80285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,27.11,99.22,APC Quantitative assay drug,80299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.17,,,,,,,fee schedule,18.64,70.02, Quantitative assay drug,80299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.02,,,,,,,fee schedule,18.64,70.02, Quantitative assay drug,80299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.64,70.02, Quantitative assay drug,80299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.64,70.02, Quantitative assay drug,80299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.39,,,,,,,fee schedule,18.64,70.02,APC Quantitative assay drug,80299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,70.02,APC Quantitative assay drug,80299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,70.02,APC Drug test prsmv dir opt obs,80305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.04,,,,,,,fee schedule,12.6,74.37, Drug test prsmv dir opt obs,80305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.37,,,,,,,fee schedule,12.6,74.37, Drug test prsmv dir opt obs,80305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.6,74.37, Drug test prsmv dir opt obs,80305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.6,74.37, Drug test prsmv dir opt obs,80305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.1,,,,,,,fee schedule,12.6,74.37,APC Drug test prsmv dir opt obs,80305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.23,,,,,,,fee schedule,12.6,74.37,APC Drug test prsmv dir opt obs,80305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.6,,,,,,,fee schedule,12.6,74.37,APC Drug test prsmv instrmnt,80306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.04,,,,,,,fee schedule,17.14,74.37, Drug test prsmv instrmnt,80306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.37,,,,,,,fee schedule,17.14,74.37, Drug test prsmv instrmnt,80306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.14,74.37, Drug test prsmv instrmnt,80306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.14,74.37, Drug test prsmv instrmnt,80306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.83,,,,,,,fee schedule,17.14,74.37,APC Drug test prsmv instrmnt,80306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18,,,,,,,fee schedule,17.14,74.37,APC Drug test prsmv instrmnt,80306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.14,,,,,,,fee schedule,17.14,74.37,APC Drug test prsmv chem anlyzr,80307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.04,,,,,,,fee schedule,62.14,226.17, Drug test prsmv chem anlyzr,80307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.37,,,,,,,fee schedule,62.14,226.17, Drug test prsmv chem anlyzr,80307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,197.9,,,,,,,fee schedule,62.14,226.17, Drug test prsmv chem anlyzr,80307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,226.17,,,,,,,fee schedule,62.14,226.17, Drug test prsmv chem anlyzr,80307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.63,,,,,,,fee schedule,62.14,226.17,APC Drug test prsmv chem anlyzr,80307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.25,,,,,,,fee schedule,62.14,226.17,APC Drug test prsmv chem anlyzr,80307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.14,,,,,,,fee schedule,62.14,226.17,APC Drug screen quantalcohols,80320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.49,,,,,,,fee schedule,78.49,88.39, Drug screen quantalcohols,80320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.39,,,,,,,fee schedule,78.49,88.39, Alcohols biomarkers 1or 2,80321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.08,,,,,,,fee schedule,49.08,55.27, Alcohols biomarkers 1or 2,80321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.27,,,,,,,fee schedule,49.08,55.27, Alcohols biomarkers 3/more,80322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.08,,,,,,,fee schedule,49.08,55.27, Alcohols biomarkers 3/more,80322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.27,,,,,,,fee schedule,49.08,55.27, Alkaloids nos,80323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.31,,,,,,,fee schedule,136.31,153.5, Alkaloids nos,80323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,153.5,,,,,,,fee schedule,136.31,153.5, Drug screen amphetamines 1/2,80324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.59,,,,,,,fee schedule,70.59,79.5, Drug screen amphetamines 1/2,80324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.5,,,,,,,fee schedule,70.59,79.5, Amphetamines 3or 4,80325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.59,,,,,,,fee schedule,70.59,79.5, Amphetamines 3or 4,80325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.5,,,,,,,fee schedule,70.59,79.5, Amphetamines 5 or more,80326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.59,,,,,,,fee schedule,70.59,79.5, Amphetamines 5 or more,80326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.5,,,,,,,fee schedule,70.59,79.5, Anabolic steroid 1 or 2,80327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.23,,,,,,,fee schedule,117.23,132.02, Anabolic steroid 1 or 2,80327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,132.02,,,,,,,fee schedule,117.23,132.02, Anabolic steroid 3 or more,80328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.23,,,,,,,fee schedule,117.23,132.02, Anabolic steroid 3 or more,80328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,132.02,,,,,,,fee schedule,117.23,132.02, Analgesics non-opioid 1 or 2,80329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.91,,,,,,,fee schedule,91.91,103.5, Analgesics non-opioid 1 or 2,80329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.5,,,,,,,fee schedule,91.91,103.5, Analgesics non-opioid 3-5,80330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.91,,,,,,,fee schedule,91.91,103.5, Analgesics non-opioid 3-5,80330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.5,,,,,,,fee schedule,91.91,103.5, Analgesics non-opioid 6/more,80331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.91,,,,,,,fee schedule,91.91,103.5, Analgesics non-opioid 6/more,80331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.5,,,,,,,fee schedule,91.91,103.5, Antidepressant tricyclic 1/2,80335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.28,,,,,,,fee schedule,81.28,91.54, Antidepressant tricyclic 1/2,80335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.54,,,,,,,fee schedule,81.28,91.54, Antidepressant tricyclic 3-5,80336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.28,,,,,,,fee schedule,81.28,91.54, Antidepressant tricyclic 3-5,80336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.54,,,,,,,fee schedule,81.28,91.54, Tricyclic & cyclicals 6/more,80337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.28,,,,,,,fee schedule,81.28,91.54, Tricyclic & cyclicals 6/more,80337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.54,,,,,,,fee schedule,81.28,91.54, Antiepileptics nos 1-3,80339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.31,,,,,,,fee schedule,67.31,75.8, Antiepileptics nos 1-3,80339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.8,,,,,,,fee schedule,67.31,75.8, Antiepileptics nos 4-6,80340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.31,,,,,,,fee schedule,67.31,75.8, Antiepileptics nos 4-6,80340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.8,,,,,,,fee schedule,67.31,75.8, Antiepileptics nos 7/more,80341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.31,,,,,,,fee schedule,67.31,75.8, Antiepileptics nos 7/more,80341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.8,,,,,,,fee schedule,67.31,75.8, Antipsychotics nos 1-3,80342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.72,,,,,,,fee schedule,70.72,79.64, Antipsychotics nos 1-3,80342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.64,,,,,,,fee schedule,70.72,79.64, Antipsychotics nos 4-6,80343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.72,,,,,,,fee schedule,70.72,79.64, Antipsychotics nos 4-6,80343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.64,,,,,,,fee schedule,70.72,79.64, Antipsychotics nos 7/more,80344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.72,,,,,,,fee schedule,70.72,79.64, Antipsychotics nos 7/more,80344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.64,,,,,,,fee schedule,70.72,79.64, Drug screening barbiturates,80345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.03,,,,,,,fee schedule,52.03,58.6, Drug screening barbiturates,80345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.6,,,,,,,fee schedule,52.03,58.6, Benzodiazepines1-12,80346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.53,,,,,,,fee schedule,71.53,80.56, Benzodiazepines1-12,80346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.56,,,,,,,fee schedule,71.53,80.56, Benzodiazepines 13 or more,80347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.53,,,,,,,fee schedule,71.53,80.56, Benzodiazepines 13 or more,80347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.56,,,,,,,fee schedule,71.53,80.56, Drug screening cocaine,80353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.34,,,,,,,fee schedule,63.34,71.33, Drug screening cocaine,80353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.33,,,,,,,fee schedule,63.34,71.33, Drug screening methadone,80358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.97,,,,,,,fee schedule,73.97,83.3, Drug screening methadone,80358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.3,,,,,,,fee schedule,73.97,83.3, Opiates 1 or more,80361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.71,,,,,,,fee schedule,116.71,131.43, Opiates 1 or more,80361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,131.43,,,,,,,fee schedule,116.71,131.43, Opioids & opiate analogs 1/2,80362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.37,,,,,,,fee schedule,88.37,99.52, Opioids & opiate analogs 1/2,80362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.52,,,,,,,fee schedule,88.37,99.52, Opioids & opiate analogs 3/4,80363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.37,,,,,,,fee schedule,88.37,99.52, Opioids & opiate analogs 3/4,80363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.52,,,,,,,fee schedule,88.37,99.52, Opioid &opiate analog 5/more,80364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.37,,,,,,,fee schedule,88.37,99.52, Opioid &opiate analog 5/more,80364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.52,,,,,,,fee schedule,88.37,99.52, Skeletal muscle relaxant 1/2,80369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.05,,,,,,,fee schedule,80.05,90.15, Skeletal muscle relaxant 1/2,80369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.15,,,,,,,fee schedule,80.05,90.15, Skel musc relaxant 3 or more,80370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.05,,,,,,,fee schedule,80.05,90.15, Skel musc relaxant 3 or more,80370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.15,,,,,,,fee schedule,80.05,90.15, Drug/substance nos 1-3,80375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.97,,,,,,,fee schedule,73.97,83.3, Drug/substance nos 1-3,80375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.3,,,,,,,fee schedule,73.97,83.3, Acth stimulation panel,80400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,148.07,,,,,,,fee schedule,32.62,166.75, Acth stimulation panel,80400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,166.75,,,,,,,fee schedule,32.62,166.75, Acth stimulation panel,80400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,104.16,,,,,,,fee schedule,32.62,166.75, Acth stimulation panel,80400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,119.04,,,,,,,fee schedule,32.62,166.75, Acth stimulation panel,80400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.92,,,,,,,fee schedule,32.62,166.75,APC Acth stimulation panel,80400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34.25,,,,,,,fee schedule,32.62,166.75,APC Acth stimulation panel,80400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.62,,,,,,,fee schedule,32.62,166.75,APC Acth stimulation panel,80402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,394.75,,,,,,,fee schedule,86.96,444.54, Acth stimulation panel,80402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,444.54,,,,,,,fee schedule,86.96,444.54, Acth stimulation panel,80402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.07,,,,,,,fee schedule,86.96,444.54, Acth stimulation panel,80402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,316.65,,,,,,,fee schedule,86.96,444.54, Acth stimulation panel,80402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,90.44,,,,,,,fee schedule,86.96,444.54,APC Acth stimulation panel,80402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,91.31,,,,,,,fee schedule,86.96,444.54,APC Acth stimulation panel,80402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,86.96,,,,,,,fee schedule,86.96,444.54,APC Acth stimulation panel,80406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,355.36,,,,,,,fee schedule,78.26,400.18, Acth stimulation panel,80406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,400.18,,,,,,,fee schedule,78.26,400.18, Acth stimulation panel,80406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,248.93,,,,,,,fee schedule,78.26,400.18, Acth stimulation panel,80406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,284.49,,,,,,,fee schedule,78.26,400.18, Acth stimulation panel,80406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,81.39,,,,,,,fee schedule,78.26,400.18,APC Acth stimulation panel,80406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,82.17,,,,,,,fee schedule,78.26,400.18,APC Acth stimulation panel,80406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,78.26,,,,,,,fee schedule,78.26,400.18,APC Aldosterone suppression eval,80408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,569.86,,,,,,,fee schedule,125.5,641.74, Aldosterone suppression eval,80408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,641.74,,,,,,,fee schedule,125.5,641.74, Aldosterone suppression eval,80408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,398.92,,,,,,,fee schedule,125.5,641.74, Aldosterone suppression eval,80408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,455.91,,,,,,,fee schedule,125.5,641.74, Aldosterone suppression eval,80408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,130.52,,,,,,,fee schedule,125.5,641.74,APC Aldosterone suppression eval,80408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,131.78,,,,,,,fee schedule,125.5,641.74,APC Aldosterone suppression eval,80408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,125.5,,,,,,,fee schedule,125.5,641.74,APC Calcitonin stimul panel,80410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,364.75,,,,,,,fee schedule,80.37,410.76, Calcitonin stimul panel,80410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,410.76,,,,,,,fee schedule,80.37,410.76, Calcitonin stimul panel,80410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,255.18,,,,,,,fee schedule,80.37,410.76, Calcitonin stimul panel,80410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,291.63,,,,,,,fee schedule,80.37,410.76, Calcitonin stimul panel,80410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,83.58,,,,,,,fee schedule,80.37,410.76,APC Calcitonin stimul panel,80410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,84.39,,,,,,,fee schedule,80.37,410.76,APC Calcitonin stimul panel,80410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,80.37,,,,,,,fee schedule,80.37,410.76,APC CRH stimulation panel,80412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1496.63,,,,,,,fee schedule,801.62,2913.99, CRH stimulation panel,80412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1685.43,,,,,,,fee schedule,801.62,2913.99, CRH stimulation panel,80412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2549.74,,,,,,,fee schedule,801.62,2913.99, CRH stimulation panel,80412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2913.99,,,,,,,fee schedule,801.62,2913.99, CRH stimulation panel,80412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,833.68,,,,,,,fee schedule,801.62,2913.99,APC CRH stimulation panel,80412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,841.7,,,,,,,fee schedule,801.62,2913.99,APC CRH stimulation panel,80412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,801.62,,,,,,,fee schedule,801.62,2913.99,APC Testosterone response,80414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,234.52,,,,,,,fee schedule,51.64,264.11, Testosterone response,80414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,264.11,,,,,,,fee schedule,51.64,264.11, Testosterone response,80414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.56,,,,,,,fee schedule,51.64,264.11, Testosterone response,80414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,188.07,,,,,,,fee schedule,51.64,264.11, Testosterone response,80414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.71,,,,,,,fee schedule,51.64,264.11,APC Testosterone response,80414,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.22,,,,,,,fee schedule,51.64,264.11,APC Testosterone response,80414,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.64,,,,,,,fee schedule,51.64,264.11,APC Estradiol response panel,80415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,253.76,,,,,,,fee schedule,55.89,285.77, Estradiol response panel,80415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,285.77,,,,,,,fee schedule,55.89,285.77, Estradiol response panel,80415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,178.11,,,,,,,fee schedule,55.89,285.77, Estradiol response panel,80415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,203.55,,,,,,,fee schedule,55.89,285.77, Estradiol response panel,80415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.13,,,,,,,fee schedule,55.89,285.77,APC Estradiol response panel,80415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.68,,,,,,,fee schedule,55.89,285.77,APC Estradiol response panel,80415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.89,,,,,,,fee schedule,55.89,285.77,APC Renin stimulation panel,80416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,599.24,,,,,,,fee schedule,209.32,760.65, Renin stimulation panel,80416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,674.83,,,,,,,fee schedule,209.32,760.65, Renin stimulation panel,80416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,665.57,,,,,,,fee schedule,209.32,760.65, Renin stimulation panel,80416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,760.65,,,,,,,fee schedule,209.32,760.65, Renin stimulation panel,80416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,217.69,,,,,,,fee schedule,209.32,760.65,APC Renin stimulation panel,80416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,219.79,,,,,,,fee schedule,209.32,760.65,APC Renin stimulation panel,80416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,209.32,760.65,APC Renin stimulation panel,80417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,199.75,,,,,,,fee schedule,43.99,224.94, Renin stimulation panel,80417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,224.94,,,,,,,fee schedule,43.99,224.94, Renin stimulation panel,80417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,139.57,,,,,,,fee schedule,43.99,224.94, Renin stimulation panel,80417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,159.51,,,,,,,fee schedule,43.99,224.94, Renin stimulation panel,80417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.75,,,,,,,fee schedule,43.99,224.94,APC Renin stimulation panel,80417,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.19,,,,,,,fee schedule,43.99,224.94,APC Renin stimulation panel,80417,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,43.99,,,,,,,fee schedule,43.99,224.94,APC Pituitary evaluation panel,80418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2631.72,,,,,,,fee schedule,579.48,2963.72, Pituitary evaluation panel,80418,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2963.72,,,,,,,fee schedule,579.48,2963.72, Pituitary evaluation panel,80418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1843.56,,,,,,,fee schedule,579.48,2963.72, Pituitary evaluation panel,80418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2106.93,,,,,,,fee schedule,579.48,2963.72, Pituitary evaluation panel,80418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,602.66,,,,,,,fee schedule,579.48,2963.72,APC Pituitary evaluation panel,80418,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,608.45,,,,,,,fee schedule,579.48,2963.72,APC Pituitary evaluation panel,80418,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,579.48,,,,,,,fee schedule,579.48,2963.72,APC Dexamethasone panel,80420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,327.08,,,,,,,fee schedule,161.88,588.03, Dexamethasone panel,80420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,368.34,,,,,,,fee schedule,161.88,588.03, Dexamethasone panel,80420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,514.53,,,,,,,fee schedule,161.88,588.03, Dexamethasone panel,80420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,588.03,,,,,,,fee schedule,161.88,588.03, Dexamethasone panel,80420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,168.36,,,,,,,fee schedule,161.88,588.03,APC Dexamethasone panel,80420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,169.97,,,,,,,fee schedule,161.88,588.03,APC Dexamethasone panel,80420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,161.88,,,,,,,fee schedule,161.88,588.03,APC Glucagon tolerance panel,80422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,209.24,,,,,,,fee schedule,46.07,235.63, Glucagon tolerance panel,80422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,235.63,,,,,,,fee schedule,46.07,235.63, Glucagon tolerance panel,80422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.87,,,,,,,fee schedule,46.07,235.63, Glucagon tolerance panel,80422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,167.85,,,,,,,fee schedule,46.07,235.63, Glucagon tolerance panel,80422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,47.91,,,,,,,fee schedule,46.07,235.63,APC Glucagon tolerance panel,80422,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48.37,,,,,,,fee schedule,46.07,235.63,APC Glucagon tolerance panel,80422,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.07,,,,,,,fee schedule,46.07,235.63,APC Glucagon tolerance panel,80424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,229.32,,,,,,,fee schedule,50.5,258.25, Glucagon tolerance panel,80424,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,258.25,,,,,,,fee schedule,50.5,258.25, Glucagon tolerance panel,80424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,160.41,,,,,,,fee schedule,50.5,258.25, Glucagon tolerance panel,80424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,183.33,,,,,,,fee schedule,50.5,258.25, Glucagon tolerance panel,80424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.52,,,,,,,fee schedule,50.5,258.25,APC Glucagon tolerance panel,80424,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.03,,,,,,,fee schedule,50.5,258.25,APC Glucagon tolerance panel,80424,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.5,,,,,,,fee schedule,50.5,258.25,APC Gonadotropin hormone panel,80426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,674.05,,,,,,,fee schedule,148.41,759.08, Gonadotropin hormone panel,80426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,759.08,,,,,,,fee schedule,148.41,759.08, Gonadotropin hormone panel,80426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,471.82,,,,,,,fee schedule,148.41,759.08, Gonadotropin hormone panel,80426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,539.22,,,,,,,fee schedule,148.41,759.08, Gonadotropin hormone panel,80426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,154.35,,,,,,,fee schedule,148.41,759.08,APC Gonadotropin hormone panel,80426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,155.83,,,,,,,fee schedule,148.41,759.08,APC Gonadotropin hormone panel,80426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,148.41,,,,,,,fee schedule,148.41,759.08,APC Growth hormone panel,80428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,302.77,,,,,,,fee schedule,66.7,340.97, Growth hormone panel,80428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,340.97,,,,,,,fee schedule,66.7,340.97, Growth hormone panel,80428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,212.47,,,,,,,fee schedule,66.7,340.97, Growth hormone panel,80428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,242.82,,,,,,,fee schedule,66.7,340.97, Growth hormone panel,80428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,69.37,,,,,,,fee schedule,66.7,340.97,APC Growth hormone panel,80428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,70.04,,,,,,,fee schedule,66.7,340.97,APC Growth hormone panel,80428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,66.7,,,,,,,fee schedule,66.7,340.97,APC Growth hormone panel,80430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,356.2,,,,,,,fee schedule,129.33,470.19, Growth hormone panel,80430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,401.14,,,,,,,fee schedule,129.33,470.19, Growth hormone panel,80430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,411.42,,,,,,,fee schedule,129.33,470.19, Growth hormone panel,80430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,470.19,,,,,,,fee schedule,129.33,470.19, Growth hormone panel,80430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,134.5,,,,,,,fee schedule,129.33,470.19,APC Growth hormone panel,80430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.8,,,,,,,fee schedule,129.33,470.19,APC Growth hormone panel,80430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,129.33,,,,,,,fee schedule,129.33,470.19,APC Insulin suppression panel,80432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,613.37,,,,,,,fee schedule,165.61,690.75, Insulin suppression panel,80432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,690.75,,,,,,,fee schedule,165.61,690.75, Insulin suppression panel,80432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,527.02,,,,,,,fee schedule,165.61,690.75, Insulin suppression panel,80432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,602.31,,,,,,,fee schedule,165.61,690.75, Insulin suppression panel,80432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,172.23,,,,,,,fee schedule,165.61,690.75,APC Insulin suppression panel,80432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,173.89,,,,,,,fee schedule,165.61,690.75,APC Insulin suppression panel,80432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,165.61,,,,,,,fee schedule,165.61,690.75,APC Insulin tolerance panel,80434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,459.23,,,,,,,fee schedule,285.03,1035.6, Insulin tolerance panel,80434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,517.16,,,,,,,fee schedule,285.03,1035.6, Insulin tolerance panel,80434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,906.15,,,,,,,fee schedule,285.03,1035.6, Insulin tolerance panel,80434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1035.6,,,,,,,fee schedule,285.03,1035.6, Insulin tolerance panel,80434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,296.43,,,,,,,fee schedule,285.03,1035.6,APC Insulin tolerance panel,80434,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,299.28,,,,,,,fee schedule,285.03,1035.6,APC Insulin tolerance panel,80434,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,285.03,,,,,,,fee schedule,285.03,1035.6,APC Insulin tolerance panel,80435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,467.51,,,,,,,fee schedule,103,526.49, Insulin tolerance panel,80435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,526.49,,,,,,,fee schedule,103,526.49, Insulin tolerance panel,80435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,328.1,,,,,,,fee schedule,103,526.49, Insulin tolerance panel,80435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,374.97,,,,,,,fee schedule,103,526.49, Insulin tolerance panel,80435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,107.12,,,,,,,fee schedule,103,526.49,APC Insulin tolerance panel,80435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,108.15,,,,,,,fee schedule,103,526.49,APC Insulin tolerance panel,80435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,103,,,,,,,fee schedule,103,526.49,APC Metyrapone panel,80436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,413.92,,,,,,,fee schedule,91.16,466.14, Metyrapone panel,80436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,466.14,,,,,,,fee schedule,91.16,466.14, Metyrapone panel,80436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,289.56,,,,,,,fee schedule,91.16,466.14, Metyrapone panel,80436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,330.93,,,,,,,fee schedule,91.16,466.14, Metyrapone panel,80436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,94.81,,,,,,,fee schedule,91.16,466.14,APC Metyrapone panel,80436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,95.72,,,,,,,fee schedule,91.16,466.14,APC Metyrapone panel,80436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.16,,,,,,,fee schedule,91.16,466.14,APC TRH stimulation panel,80438,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,228.83,,,,,,,fee schedule,50.41,257.7, TRH stimulation panel,80438,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,257.7,,,,,,,fee schedule,50.41,257.7, TRH stimulation panel,80438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,160.41,,,,,,,fee schedule,50.41,257.7, TRH stimulation panel,80438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,183.33,,,,,,,fee schedule,50.41,257.7, TRH stimulation panel,80438,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.43,,,,,,,fee schedule,50.41,257.7,APC TRH stimulation panel,80438,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.93,,,,,,,fee schedule,50.41,257.7,APC TRH stimulation panel,80438,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.41,,,,,,,fee schedule,50.41,257.7,APC TRH stimulation panel,80439,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,305.11,,,,,,,fee schedule,67.21,343.6, TRH stimulation panel,80439,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,343.6,,,,,,,fee schedule,67.21,343.6, TRH stimulation panel,80439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,213.52,,,,,,,fee schedule,67.21,343.6, TRH stimulation panel,80439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,244.02,,,,,,,fee schedule,67.21,343.6, TRH stimulation panel,80439,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,69.9,,,,,,,fee schedule,67.21,343.6,APC TRH stimulation panel,80439,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,70.57,,,,,,,fee schedule,67.21,343.6,APC TRH stimulation panel,80439,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,67.21,,,,,,,fee schedule,67.21,343.6,APC Path clin consltj sf 5-20,80503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.3,,,,,,,fee schedule,36.3,64.64, Path clin consltj sf 5-20,80503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.49,,,,,,,fee schedule,36.3,64.64, Path clin consltj sf 5-20,80503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,36.3,64.64,APC Path clin consltj sf 5-20,80503,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,36.3,64.64,APC Path clin consltj sf 5-20,80503,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,36.3,64.64,APC Path clin consltj mod 21-40,80504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.23,,,,,,,fee schedule,78.23,211.33, Path clin consltj mod 21-40,80504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.4,,,,,,,fee schedule,78.23,211.33, Path clin consltj mod 21-40,80504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,78.23,211.33,APC Path clin consltj mod 21-40,80504,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,78.23,211.33,APC Path clin consltj mod 21-40,80504,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,78.23,211.33,APC Path clin consltj high 41-60,80505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.95,,,,,,,fee schedule,146.95,211.33, Path clin consltj high 41-60,80505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,167.94,,,,,,,fee schedule,146.95,211.33, Path clin consltj high 41-60,80505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,146.95,211.33,APC Path clin consltj high 41-60,80505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,146.95,211.33,APC Path clin consltj high 41-60,80505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,146.95,211.33,APC Path clin consltj prolng svc,80506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.4,,,,,,,fee schedule,70.4,80.46, Path clin consltj prolng svc,80506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.46,,,,,,,fee schedule,70.4,80.46, Urinalysis nonauto w/scope,81000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.4,,,,,,,fee schedule,4.02,16.21, Urinalysis nonauto w/scope,81000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.21,,,,,,,fee schedule,4.02,16.21, Urinalysis nonauto w/scope,81000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,4.02,16.21, Urinalysis nonauto w/scope,81000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,4.02,16.21, Urinalysis nonauto w/scope,81000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.18,,,,,,,fee schedule,4.02,16.21,APC Urinalysis nonauto w/scope,81000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.22,,,,,,,fee schedule,4.02,16.21,APC Urinalysis nonauto w/scope,81000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.02,,,,,,,fee schedule,4.02,16.21,APC Urinalysis auto w/scope,81001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.4,,,,,,,fee schedule,3.17,16.21, Urinalysis auto w/scope,81001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.21,,,,,,,fee schedule,3.17,16.21, Urinalysis auto w/scope,81001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.42,,,,,,,fee schedule,3.17,16.21, Urinalysis auto w/scope,81001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.91,,,,,,,fee schedule,3.17,16.21, Urinalysis auto w/scope,81001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.3,,,,,,,fee schedule,3.17,16.21,APC Urinalysis auto w/scope,81001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.33,,,,,,,fee schedule,3.17,16.21,APC Urinalysis auto w/scope,81001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.17,,,,,,,fee schedule,3.17,16.21,APC Urinalysis nonauto w/o scope,81002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.6,,,,,,,fee schedule,3.48,13.08, Urinalysis nonauto w/o scope,81002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13.07,,,,,,,fee schedule,3.48,13.08, Urinalysis nonauto w/o scope,81002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.45,,,,,,,fee schedule,3.48,13.08, Urinalysis nonauto w/o scope,81002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.08,,,,,,,fee schedule,3.48,13.08, Urinalysis nonauto w/o scope,81002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.62,,,,,,,fee schedule,3.48,13.08,APC Urinalysis nonauto w/o scope,81002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.65,,,,,,,fee schedule,3.48,13.08,APC Urinalysis nonauto w/o scope,81002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.48,,,,,,,fee schedule,3.48,13.08,APC Urinalysis auto w/o scope,81003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.21,,,,,,,fee schedule,2.25,11.49, Urinalysis auto w/o scope,81003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.49,,,,,,,fee schedule,2.25,11.49, Urinalysis auto w/o scope,81003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.3,,,,,,,fee schedule,2.25,11.49, Urinalysis auto w/o scope,81003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.34,,,,,,,fee schedule,2.25,11.49, Urinalysis auto w/o scope,81003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.34,,,,,,,fee schedule,2.25,11.49,APC Urinalysis auto w/o scope,81003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.36,,,,,,,fee schedule,2.25,11.49,APC Urinalysis auto w/o scope,81003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.25,,,,,,,fee schedule,2.25,11.49,APC Urinalysis,81005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.85,,,,,,,fee schedule,2.17,11.09, Urinalysis,81005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.09,,,,,,,fee schedule,2.17,11.09, Urinalysis,81005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.3,,,,,,,fee schedule,2.17,11.09, Urinalysis,81005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.34,,,,,,,fee schedule,2.17,11.09, Urinalysis,81005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.26,,,,,,,fee schedule,2.17,11.09,APC Urinalysis,81005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.28,,,,,,,fee schedule,2.17,11.09,APC Urinalysis,81005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.17,,,,,,,fee schedule,2.17,11.09,APC Urine screen for bacteria,81007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.67,,,,,,,fee schedule,11.67,109.5, Urine screen for bacteria,81007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13.14,,,,,,,fee schedule,11.67,109.5, Urine screen for bacteria,81007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.81,,,,,,,fee schedule,11.67,109.5, Urine screen for bacteria,81007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.5,,,,,,,fee schedule,11.67,109.5, Urine screen for bacteria,81007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.18,,,,,,,fee schedule,11.67,109.5,APC Urine screen for bacteria,81007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.48,,,,,,,fee schedule,11.67,109.5,APC Urine screen for bacteria,81007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.98,,,,,,,fee schedule,11.67,109.5,APC Microscopic exam of urine,81015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.78,,,,,,,fee schedule,3.05,15.52, Microscopic exam of urine,81015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.52,,,,,,,fee schedule,3.05,15.52, Microscopic exam of urine,81015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.37,,,,,,,fee schedule,3.05,15.52, Microscopic exam of urine,81015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.71,,,,,,,fee schedule,3.05,15.52, Microscopic exam of urine,81015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.17,,,,,,,fee schedule,3.05,15.52,APC Microscopic exam of urine,81015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.2,,,,,,,fee schedule,3.05,15.52,APC Microscopic exam of urine,81015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.05,,,,,,,fee schedule,3.05,15.52,APC Urinalysis glass test,81020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.74,,,,,,,fee schedule,4.7,18.85, Urinalysis glass test,81020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.85,,,,,,,fee schedule,4.7,18.85, Urinalysis glass test,81020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.7,18.85, Urinalysis glass test,81020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.7,18.85, Urinalysis glass test,81020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.89,,,,,,,fee schedule,4.7,18.85,APC Urinalysis glass test,81020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.94,,,,,,,fee schedule,4.7,18.85,APC Urinalysis glass test,81020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.7,,,,,,,fee schedule,4.7,18.85,APC Urine pregnancy test,81025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.73,,,,,,,fee schedule,8.61,32.35, Urine pregnancy test,81025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.35,,,,,,,fee schedule,8.61,32.35, Urine pregnancy test,81025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.61,32.35, Urine pregnancy test,81025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.61,32.35, Urine pregnancy test,81025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.95,,,,,,,fee schedule,8.61,32.35,APC Urine pregnancy test,81025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.04,,,,,,,fee schedule,8.61,32.35,APC Urine pregnancy test,81025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.61,,,,,,,fee schedule,8.61,32.35,APC Urinalysis volume measure,81050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.62,,,,,,,fee schedule,3.64,15.34, Urinalysis volume measure,81050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.34,,,,,,,fee schedule,3.64,15.34, Urinalysis volume measure,81050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.45,,,,,,,fee schedule,3.64,15.34, Urinalysis volume measure,81050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.08,,,,,,,fee schedule,3.64,15.34, Urinalysis volume measure,81050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.79,,,,,,,fee schedule,3.64,15.34,APC Urinalysis volume measure,81050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.82,,,,,,,fee schedule,3.64,15.34,APC Urinalysis volume measure,81050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.64,,,,,,,fee schedule,3.64,15.34,APC Urinalysis test procedure,81099,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.18,,,,,,,fee schedule,24.18,44.82, Urinalysis test procedure,81099,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.23,,,,,,,fee schedule,24.18,44.82, Urinalysis test procedure,81099,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.22,,,,,,,fee schedule,24.18,44.82, Urinalysis test procedure,81099,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.82,,,,,,,fee schedule,24.18,44.82, Hpa-1 genotyping,81105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-1 genotyping,81105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-1 genotyping,81105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-1 genotyping,81105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-1 genotyping,81105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hpa-2 genotyping,81106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-2 genotyping,81106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-2 genotyping,81106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-2 genotyping,81106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-2 genotyping,81106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hpa-3 genotyping,81107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-3 genotyping,81107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-3 genotyping,81107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-3 genotyping,81107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-3 genotyping,81107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hpa-4 genotyping,81108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-4 genotyping,81108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-4 genotyping,81108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-4 genotyping,81108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-4 genotyping,81108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hpa-5 genotyping,81109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-5 genotyping,81109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-5 genotyping,81109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-5 genotyping,81109,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-5 genotyping,81109,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hpa-6 genotyping,81110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-6 genotyping,81110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-6 genotyping,81110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-6 genotyping,81110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-6 genotyping,81110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hpa-9 genotyping,81111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-9 genotyping,81111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-9 genotyping,81111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-9 genotyping,81111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-9 genotyping,81111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hpa-15 genotyping,81112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hpa-15 genotyping,81112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hpa-15 genotyping,81112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hpa-15 genotyping,81112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hpa-15 genotyping,81112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Idh1 common variants,81120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,614.51,,,,,,,fee schedule,193.25,702.3, Idh1 common variants,81120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,702.3,,,,,,,fee schedule,193.25,702.3, Idh1 common variants,81120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.98,,,,,,,fee schedule,193.25,702.3,APC Idh1 common variants,81120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,202.91,,,,,,,fee schedule,193.25,702.3,APC Idh1 common variants,81120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.25,,,,,,,fee schedule,193.25,702.3,APC Idh2 common variants,81121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,940.54,,,,,,,fee schedule,295.79,1074.9, Idh2 common variants,81121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1074.9,,,,,,,fee schedule,295.79,1074.9, Idh2 common variants,81121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,307.62,,,,,,,fee schedule,295.79,1074.9,APC Idh2 common variants,81121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,310.58,,,,,,,fee schedule,295.79,1074.9,APC Idh2 common variants,81121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.79,,,,,,,fee schedule,295.79,1074.9,APC DMD dup/delet analysis,81161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,455.46,,,,,,,fee schedule,279,1014.18, DMD dup/delet analysis,81161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,512.91,,,,,,,fee schedule,279,1014.18, DMD dup/delet analysis,81161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,887.41,,,,,,,fee schedule,279,1014.18, DMD dup/delet analysis,81161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1014.18,,,,,,,fee schedule,279,1014.18, DMD dup/delet analysis,81161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.16,,,,,,,fee schedule,279,1014.18,APC DMD dup/delet analysis,81161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,292.95,,,,,,,fee schedule,279,1014.18,APC DMD dup/delet analysis,81161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279,,,,,,,fee schedule,279,1014.18,APC Brca1&2 seq & full dup/del,81162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8079.05,,,,,,,fee schedule,1824.88,9098.25, Brca1&2 seq & full dup/del,81162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9098.25,,,,,,,fee schedule,1824.88,9098.25, Brca1&2 seq & full dup/del,81162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5804.64,,,,,,,fee schedule,1824.88,9098.25, Brca1&2 seq & full dup/del,81162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6633.87,,,,,,,fee schedule,1824.88,9098.25, Brca1&2 seq & full dup/del,81162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1897.88,,,,,,,fee schedule,1824.88,9098.25,APC Brca1&2 seq & full dup/del,81162,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1916.12,,,,,,,fee schedule,1824.88,9098.25,APC Brca1&2 seq & full dup/del,81162,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1824.88,,,,,,,fee schedule,1824.88,9098.25,APC Brca1&2 gene full seq alys,81163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9498.13,,,,,,,fee schedule,468,10696.35, Brca1&2 gene full seq alys,81163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10696.35,,,,,,,fee schedule,468,10696.35, Brca1&2 gene full seq alys,81163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1488.4,,,,,,,fee schedule,468,10696.35, Brca1&2 gene full seq alys,81163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1701.03,,,,,,,fee schedule,468,10696.35, Brca1&2 gene full seq alys,81163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,486.72,,,,,,,fee schedule,468,10696.35,APC Brca1&2 gene full seq alys,81163,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,491.4,,,,,,,fee schedule,468,10696.35,APC Brca1&2 gene full seq alys,81163,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,468,,,,,,,fee schedule,468,10696.35,APC Brca1&2 gen ful dup/del alys,81164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9498.13,,,,,,,fee schedule,584.23,10696.35, Brca1&2 gen ful dup/del alys,81164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10696.35,,,,,,,fee schedule,584.23,10696.35, Brca1&2 gen ful dup/del alys,81164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1858.16,,,,,,,fee schedule,584.23,10696.35, Brca1&2 gen ful dup/del alys,81164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2123.61,,,,,,,fee schedule,584.23,10696.35, Brca1&2 gen ful dup/del alys,81164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,607.6,,,,,,,fee schedule,584.23,10696.35,APC Brca1&2 gen ful dup/del alys,81164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,613.44,,,,,,,fee schedule,584.23,10696.35,APC Brca1&2 gen ful dup/del alys,81164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.23,,,,,,,fee schedule,584.23,10696.35,APC Brca1 gene full seq alys,81165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4976.56,,,,,,,fee schedule,282.88,5604.38, Brca1 gene full seq alys,81165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5604.38,,,,,,,fee schedule,282.88,5604.38, Brca1 gene full seq alys,81165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,5604.38, Brca1 gene full seq alys,81165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,5604.38, Brca1 gene full seq alys,81165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,5604.38,APC Brca1 gene full seq alys,81165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,5604.38,APC Brca1 gene full seq alys,81165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,5604.38,APC Brca1 gene full dup/del alys,81166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4976.56,,,,,,,fee schedule,301.35,5604.38, Brca1 gene full dup/del alys,81166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5604.38,,,,,,,fee schedule,301.35,5604.38, Brca1 gene full dup/del alys,81166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,958.23,,,,,,,fee schedule,301.35,5604.38, Brca1 gene full dup/del alys,81166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1095.12,,,,,,,fee schedule,301.35,5604.38, Brca1 gene full dup/del alys,81166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.4,,,,,,,fee schedule,301.35,5604.38,APC Brca1 gene full dup/del alys,81166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.42,,,,,,,fee schedule,301.35,5604.38,APC Brca1 gene full dup/del alys,81166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.35,,,,,,,fee schedule,301.35,5604.38,APC Brca2 gene full dup/del alys,81167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Brca2 gene full dup/del alys,81167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Brca2 gene full dup/del alys,81167,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Brca2 gene full dup/del alys,81167,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Brca2 gene full dup/del alys,81167,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Ccnd1/igh translocation alys,81168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,673.76,,,,,,,fee schedule,207.31,758.75, Ccnd1/igh translocation alys,81168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,758.75,,,,,,,fee schedule,207.31,758.75, Ccnd1/igh translocation alys,81168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,659.32,,,,,,,fee schedule,207.31,758.75, Ccnd1/igh translocation alys,81168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,753.51,,,,,,,fee schedule,207.31,758.75, Ccnd1/igh translocation alys,81168,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.6,,,,,,,fee schedule,207.31,758.75,APC Ccnd1/igh translocation alys,81168,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.68,,,,,,,fee schedule,207.31,758.75,APC Ccnd1/igh translocation alys,81168,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,207.31,758.75,APC Abl1 gene,81170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1070.91,,,,,,,fee schedule,300,1206.01, Abl1 gene,81170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1206.01,,,,,,,fee schedule,300,1206.01, Abl1 gene,81170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,954.08,,,,,,,fee schedule,300,1206.01, Abl1 gene,81170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1090.38,,,,,,,fee schedule,300,1206.01, Abl1 gene,81170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,312,,,,,,,fee schedule,300,1206.01,APC Abl1 gene,81170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,315,,,,,,,fee schedule,300,1206.01,APC Abl1 gene,81170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,300,,,,,,,fee schedule,300,1206.01,APC Aff2 gene detc abnor alleles,81171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Aff2 gene detc abnor alleles,81171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Aff2 gene detc abnor alleles,81171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Aff2 gene detc abnor alleles,81171,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Aff2 gene detc abnor alleles,81171,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Aff2 gene charac alleles,81172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Aff2 gene charac alleles,81172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Aff2 gene charac alleles,81172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Aff2 gene charac alleles,81172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Aff2 gene charac alleles,81172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Ar gene full gene sequence,81173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,958.23,,,,,,,fee schedule,301.35,1095.12, Ar gene full gene sequence,81173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1095.12,,,,,,,fee schedule,301.35,1095.12, Ar gene full gene sequence,81173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.4,,,,,,,fee schedule,301.35,1095.12,APC Ar gene full gene sequence,81173,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.42,,,,,,,fee schedule,301.35,1095.12,APC Ar gene full gene sequence,81173,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.35,,,,,,,fee schedule,301.35,1095.12,APC Ar gene known famil variant,81174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Ar gene known famil variant,81174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Ar gene known famil variant,81174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Ar gene known famil variant,81174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Ar gene known famil variant,81174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Asxl1 full gene sequence,81175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2151.87,,,,,,,fee schedule,676.5,2459.28, Asxl1 full gene sequence,81175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2459.28,,,,,,,fee schedule,676.5,2459.28, Asxl1 full gene sequence,81175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,703.56,,,,,,,fee schedule,676.5,2459.28,APC Asxl1 full gene sequence,81175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,710.32,,,,,,,fee schedule,676.5,2459.28,APC Asxl1 full gene sequence,81175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,676.5,,,,,,,fee schedule,676.5,2459.28,APC Asxl1 gene target seq alys,81176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,769.73,,,,,,,fee schedule,241.9,879.69, Asxl1 gene target seq alys,81176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,879.69,,,,,,,fee schedule,241.9,879.69, Asxl1 gene target seq alys,81176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,251.58,,,,,,,fee schedule,241.9,879.69,APC Asxl1 gene target seq alys,81176,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,254,,,,,,,fee schedule,241.9,879.69,APC Asxl1 gene target seq alys,81176,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,241.9,,,,,,,fee schedule,241.9,879.69,APC Atn1 gene detc abnor alleles,81177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Atn1 gene detc abnor alleles,81177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Atn1 gene detc abnor alleles,81177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Atn1 gene detc abnor alleles,81177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Atn1 gene detc abnor alleles,81177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Atxn1 gene detc abnor allele,81178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Atxn1 gene detc abnor allele,81178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Atxn1 gene detc abnor allele,81178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Atxn1 gene detc abnor allele,81178,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Atxn1 gene detc abnor allele,81178,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Atxn2 gene detc abnor allele,81179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Atxn2 gene detc abnor allele,81179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Atxn2 gene detc abnor allele,81179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Atxn2 gene detc abnor allele,81179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Atxn2 gene detc abnor allele,81179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Atxn3 gene detc abnor allele,81180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Atxn3 gene detc abnor allele,81180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Atxn3 gene detc abnor allele,81180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Atxn3 gene detc abnor allele,81180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Atxn3 gene detc abnor allele,81180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Atxn7 gene detc abnor allele,81181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Atxn7 gene detc abnor allele,81181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Atxn7 gene detc abnor allele,81181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Atxn7 gene detc abnor allele,81181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Atxn7 gene detc abnor allele,81181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Atxn8os gen detc abnor allel,81182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Atxn8os gen detc abnor allel,81182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Atxn8os gen detc abnor allel,81182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Atxn8os gen detc abnor allel,81182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Atxn8os gen detc abnor allel,81182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Atxn10 gene detc abnor allel,81183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Atxn10 gene detc abnor allel,81183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Atxn10 gene detc abnor allel,81183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Atxn10 gene detc abnor allel,81183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Atxn10 gene detc abnor allel,81183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Cacna1a gen detc abnor allel,81184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Cacna1a gen detc abnor allel,81184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Cacna1a gen detc abnor allel,81184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Cacna1a gen detc abnor allel,81184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Cacna1a gen detc abnor allel,81184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Cacna1a gene full gene seq,81185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2691.41,,,,,,,fee schedule,846.27,3075.9, Cacna1a gene full gene seq,81185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3075.9,,,,,,,fee schedule,846.27,3075.9, Cacna1a gene full gene seq,81185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,880.12,,,,,,,fee schedule,846.27,3075.9,APC Cacna1a gene full gene seq,81185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,888.58,,,,,,,fee schedule,846.27,3075.9,APC Cacna1a gene full gene seq,81185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,846.27,,,,,,,fee schedule,846.27,3075.9,APC Cacna1a gen known famil vrnt,81186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Cacna1a gen known famil vrnt,81186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Cacna1a gen known famil vrnt,81186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Cacna1a gen known famil vrnt,81186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Cacna1a gen known famil vrnt,81186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Cnbp gene detc abnor allele,81187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Cnbp gene detc abnor allele,81187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Cnbp gene detc abnor allele,81187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Cnbp gene detc abnor allele,81187,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Cnbp gene detc abnor allele,81187,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Cstb gene detc abnor allele,81188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Cstb gene detc abnor allele,81188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Cstb gene detc abnor allele,81188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Cstb gene detc abnor allele,81188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Cstb gene detc abnor allele,81188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Cstb gene full gene sequence,81189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Cstb gene full gene sequence,81189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Cstb gene full gene sequence,81189,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Cstb gene full gene sequence,81189,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Cstb gene full gene sequence,81189,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Cstb gene known famil vrnt,81190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Cstb gene known famil vrnt,81190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Cstb gene known famil vrnt,81190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Cstb gene known famil vrnt,81190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Cstb gene known famil vrnt,81190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Ntrk1 translocation analysis,81191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,673.76,,,,,,,fee schedule,207.31,758.75, Ntrk1 translocation analysis,81191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,758.75,,,,,,,fee schedule,207.31,758.75, Ntrk1 translocation analysis,81191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,659.32,,,,,,,fee schedule,207.31,758.75, Ntrk1 translocation analysis,81191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,753.51,,,,,,,fee schedule,207.31,758.75, Ntrk1 translocation analysis,81191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.6,,,,,,,fee schedule,207.31,758.75,APC Ntrk1 translocation analysis,81191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.68,,,,,,,fee schedule,207.31,758.75,APC Ntrk1 translocation analysis,81191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,207.31,758.75,APC Ntrk2 translocation analysis,81192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,673.76,,,,,,,fee schedule,207.31,758.75, Ntrk2 translocation analysis,81192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,758.75,,,,,,,fee schedule,207.31,758.75, Ntrk2 translocation analysis,81192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,659.32,,,,,,,fee schedule,207.31,758.75, Ntrk2 translocation analysis,81192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,753.51,,,,,,,fee schedule,207.31,758.75, Ntrk2 translocation analysis,81192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.6,,,,,,,fee schedule,207.31,758.75,APC Ntrk2 translocation analysis,81192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.68,,,,,,,fee schedule,207.31,758.75,APC Ntrk2 translocation analysis,81192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,207.31,758.75,APC Ntrk3 translocation analysis,81193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,673.76,,,,,,,fee schedule,207.31,758.75, Ntrk3 translocation analysis,81193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,758.75,,,,,,,fee schedule,207.31,758.75, Ntrk3 translocation analysis,81193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,659.32,,,,,,,fee schedule,207.31,758.75, Ntrk3 translocation analysis,81193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,753.51,,,,,,,fee schedule,207.31,758.75, Ntrk3 translocation analysis,81193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.6,,,,,,,fee schedule,207.31,758.75,APC Ntrk3 translocation analysis,81193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.68,,,,,,,fee schedule,207.31,758.75,APC Ntrk3 translocation analysis,81193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,207.31,758.75,APC Ntrk translocation analysis,81194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1684.41,,,,,,,fee schedule,518.28,1896.9, Ntrk translocation analysis,81194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1896.9,,,,,,,fee schedule,518.28,1896.9, Ntrk translocation analysis,81194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1648.79,,,,,,,fee schedule,518.28,1896.9, Ntrk translocation analysis,81194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1884.33,,,,,,,fee schedule,518.28,1896.9, Ntrk translocation analysis,81194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,539.01,,,,,,,fee schedule,518.28,1896.9,APC Ntrk translocation analysis,81194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,544.19,,,,,,,fee schedule,518.28,1896.9,APC Ntrk translocation analysis,81194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,518.28,,,,,,,fee schedule,518.28,1896.9,APC Cytog genom-wid alys hem mal,81195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1937.75,,,,,,,fee schedule,1863.22,1956.38,APC Cytog genom-wid alys hem mal,81195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1956.38,,,,,,,fee schedule,1863.22,1956.38,APC Cytog genom-wid alys hem mal,81195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1863.22,,,,,,,fee schedule,1863.22,1956.38,APC Aspa gene,81200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,486.88,,,,,,,fee schedule,47.25,548.3, Aspa gene,81200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,548.3,,,,,,,fee schedule,47.25,548.3, Aspa gene,81200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,149.99,,,,,,,fee schedule,47.25,548.3, Aspa gene,81200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,171.42,,,,,,,fee schedule,47.25,548.3, Aspa gene,81200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.14,,,,,,,fee schedule,47.25,548.3,APC Aspa gene,81200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.61,,,,,,,fee schedule,47.25,548.3,APC Aspa gene,81200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.25,,,,,,,fee schedule,47.25,548.3,APC Apc gene full sequence,81201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2864.81,,,,,,,fee schedule,780,3226.22, Apc gene full sequence,81201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3226.22,,,,,,,fee schedule,780,3226.22, Apc gene full sequence,81201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2481.02,,,,,,,fee schedule,780,3226.22, Apc gene full sequence,81201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2835.45,,,,,,,fee schedule,780,3226.22, Apc gene full sequence,81201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,811.2,,,,,,,fee schedule,780,3226.22,APC Apc gene full sequence,81201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,819,,,,,,,fee schedule,780,3226.22,APC Apc gene full sequence,81201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,780,,,,,,,fee schedule,780,3226.22,APC Apc gene known fam variants,81202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2282.74,,,,,,,fee schedule,280,2570.71, Apc gene known fam variants,81202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2570.71,,,,,,,fee schedule,280,2570.71, Apc gene known fam variants,81202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,890.53,,,,,,,fee schedule,280,2570.71, Apc gene known fam variants,81202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1017.75,,,,,,,fee schedule,280,2570.71, Apc gene known fam variants,81202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,291.2,,,,,,,fee schedule,280,2570.71,APC Apc gene known fam variants,81202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,294,,,,,,,fee schedule,280,2570.71,APC Apc gene known fam variants,81202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,280,,,,,,,fee schedule,280,2570.71,APC Apc gene dup/delet variants,81203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1433.12,,,,,,,fee schedule,200,1613.91, Apc gene dup/delet variants,81203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1613.91,,,,,,,fee schedule,200,1613.91, Apc gene dup/delet variants,81203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,636.41,,,,,,,fee schedule,200,1613.91, Apc gene dup/delet variants,81203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,727.32,,,,,,,fee schedule,200,1613.91, Apc gene dup/delet variants,81203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,208,,,,,,,fee schedule,200,1613.91,APC Apc gene dup/delet variants,81203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,210,,,,,,,fee schedule,200,1613.91,APC Apc gene dup/delet variants,81203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,200,,,,,,,fee schedule,200,1613.91,APC Ar gene charac alleles,81204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Ar gene charac alleles,81204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Ar gene charac alleles,81204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Ar gene charac alleles,81204,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Ar gene charac alleles,81204,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Bckdhb gene,81205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,467.55,,,,,,,fee schedule,94.99,526.53, Bckdhb gene,81205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,526.53,,,,,,,fee schedule,94.99,526.53, Bckdhb gene,81205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,302.06,,,,,,,fee schedule,94.99,526.53, Bckdhb gene,81205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,345.21,,,,,,,fee schedule,94.99,526.53, Bckdhb gene,81205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,98.79,,,,,,,fee schedule,94.99,526.53,APC Bckdhb gene,81205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,99.74,,,,,,,fee schedule,94.99,526.53,APC Bckdhb gene,81205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,94.99,,,,,,,fee schedule,94.99,526.53,APC Bcr/abl1 gene major bp,81206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,328.84,,,,,,,fee schedule,163.96,596.37, Bcr/abl1 gene major bp,81206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,370.32,,,,,,,fee schedule,163.96,596.37, Bcr/abl1 gene major bp,81206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,521.82,,,,,,,fee schedule,163.96,596.37, Bcr/abl1 gene major bp,81206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,596.37,,,,,,,fee schedule,163.96,596.37, Bcr/abl1 gene major bp,81206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,170.52,,,,,,,fee schedule,163.96,596.37,APC Bcr/abl1 gene major bp,81206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,172.16,,,,,,,fee schedule,163.96,596.37,APC Bcr/abl1 gene major bp,81206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,163.96,,,,,,,fee schedule,163.96,596.37,APC Bcr/abl1 gene minor bp,81207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,274.2,,,,,,,fee schedule,144.84,526.14, Bcr/abl1 gene minor bp,81207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,308.79,,,,,,,fee schedule,144.84,526.14, Bcr/abl1 gene minor bp,81207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,460.37,,,,,,,fee schedule,144.84,526.14, Bcr/abl1 gene minor bp,81207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,526.14,,,,,,,fee schedule,144.84,526.14, Bcr/abl1 gene minor bp,81207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,150.63,,,,,,,fee schedule,144.84,526.14,APC Bcr/abl1 gene minor bp,81207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,152.08,,,,,,,fee schedule,144.84,526.14,APC Bcr/abl1 gene minor bp,81207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,144.84,,,,,,,fee schedule,144.84,526.14,APC Bcr/abl1 gene other bp,81208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.87,,,,,,,fee schedule,214.62,779.7, Bcr/abl1 gene other bp,81208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,468.33,,,,,,,fee schedule,214.62,779.7, Bcr/abl1 gene other bp,81208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,682.24,,,,,,,fee schedule,214.62,779.7, Bcr/abl1 gene other bp,81208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,779.7,,,,,,,fee schedule,214.62,779.7, Bcr/abl1 gene other bp,81208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,223.2,,,,,,,fee schedule,214.62,779.7,APC Bcr/abl1 gene other bp,81208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,225.35,,,,,,,fee schedule,214.62,779.7,APC Bcr/abl1 gene other bp,81208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,214.62,,,,,,,fee schedule,214.62,779.7,APC Blm gene,81209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,151.71,,,,,,,fee schedule,39.31,170.85, Blm gene,81209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,170.85,,,,,,,fee schedule,39.31,170.85, Blm gene,81209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,124.98,,,,,,,fee schedule,39.31,170.85, Blm gene,81209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.83,,,,,,,fee schedule,39.31,170.85, Blm gene,81209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.88,,,,,,,fee schedule,39.31,170.85,APC Blm gene,81209,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.28,,,,,,,fee schedule,39.31,170.85,APC Blm gene,81209,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.31,,,,,,,fee schedule,39.31,170.85,APC Braf gene,81210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,169.62,,,,,,,fee schedule,169.62,638.04, Braf gene,81210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,191.02,,,,,,,fee schedule,169.62,638.04, Braf gene,81210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,558.29,,,,,,,fee schedule,169.62,638.04, Braf gene,81210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,638.04,,,,,,,fee schedule,169.62,638.04, Braf gene,81210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.42,,,,,,,fee schedule,169.62,638.04,APC Braf gene,81210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.17,,,,,,,fee schedule,169.62,638.04,APC Braf gene,81210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.4,,,,,,,fee schedule,169.62,638.04,APC Brca1&2 185&5385&6174 var,81212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1635.17,,,,,,,fee schedule,440,1841.46, Brca1&2 185&5385&6174 var,81212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1841.46,,,,,,,fee schedule,440,1841.46, Brca1&2 185&5385&6174 var,81212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1399.86,,,,,,,fee schedule,440,1841.46, Brca1&2 185&5385&6174 var,81212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1599.84,,,,,,,fee schedule,440,1841.46, Brca1&2 185&5385&6174 var,81212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,457.6,,,,,,,fee schedule,440,1841.46,APC Brca1&2 185&5385&6174 var,81212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462,,,,,,,fee schedule,440,1841.46,APC Brca1&2 185&5385&6174 var,81212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440,,,,,,,fee schedule,440,1841.46,APC Brca1 gene known fam variant,81215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1350.8,,,,,,,fee schedule,375.25,1521.21, Brca1 gene known fam variant,81215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1521.21,,,,,,,fee schedule,375.25,1521.21, Brca1 gene known fam variant,81215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1193.64,,,,,,,fee schedule,375.25,1521.21, Brca1 gene known fam variant,81215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1364.16,,,,,,,fee schedule,375.25,1521.21, Brca1 gene known fam variant,81215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,390.26,,,,,,,fee schedule,375.25,1521.21,APC Brca1 gene known fam variant,81215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,394.01,,,,,,,fee schedule,375.25,1521.21,APC Brca1 gene known fam variant,81215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,375.25,,,,,,,fee schedule,375.25,1521.21,APC Brca2 gene full sequence,81216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5943.44,,,,,,,fee schedule,185.12,6693.23, Brca2 gene full sequence,81216,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6693.23,,,,,,,fee schedule,185.12,6693.23, Brca2 gene full sequence,81216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,588.47,,,,,,,fee schedule,185.12,6693.23, Brca2 gene full sequence,81216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,672.54,,,,,,,fee schedule,185.12,6693.23, Brca2 gene full sequence,81216,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.52,,,,,,,fee schedule,185.12,6693.23,APC Brca2 gene full sequence,81216,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.38,,,,,,,fee schedule,185.12,6693.23,APC Brca2 gene full sequence,81216,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.12,,,,,,,fee schedule,185.12,6693.23,APC Brca2 gene known fam variant,81217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1350.8,,,,,,,fee schedule,375.25,1521.21, Brca2 gene known fam variant,81217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1521.21,,,,,,,fee schedule,375.25,1521.21, Brca2 gene known fam variant,81217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1193.64,,,,,,,fee schedule,375.25,1521.21, Brca2 gene known fam variant,81217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1364.16,,,,,,,fee schedule,375.25,1521.21, Brca2 gene known fam variant,81217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,390.26,,,,,,,fee schedule,375.25,1521.21,APC Brca2 gene known fam variant,81217,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,394.01,,,,,,,fee schedule,375.25,1521.21,APC Brca2 gene known fam variant,81217,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,375.25,,,,,,,fee schedule,375.25,1521.21,APC Cebpa gene full sequence,81218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1070.91,,,,,,,fee schedule,241.9,1206.01, Cebpa gene full sequence,81218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1206.01,,,,,,,fee schedule,241.9,1206.01, Cebpa gene full sequence,81218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,769.73,,,,,,,fee schedule,241.9,1206.01, Cebpa gene full sequence,81218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,879.69,,,,,,,fee schedule,241.9,1206.01, Cebpa gene full sequence,81218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,251.58,,,,,,,fee schedule,241.9,1206.01,APC Cebpa gene full sequence,81218,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,254,,,,,,,fee schedule,241.9,1206.01,APC Cebpa gene full sequence,81218,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,241.9,,,,,,,fee schedule,241.9,1206.01,APC Calr gene com variants,81219,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,538.46,,,,,,,fee schedule,121.63,606.39, Calr gene com variants,81219,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,606.39,,,,,,,fee schedule,121.63,606.39, Calr gene com variants,81219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,386.43,,,,,,,fee schedule,121.63,606.39, Calr gene com variants,81219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,441.63,,,,,,,fee schedule,121.63,606.39, Calr gene com variants,81219,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,126.5,,,,,,,fee schedule,121.63,606.39,APC Calr gene com variants,81219,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,127.71,,,,,,,fee schedule,121.63,606.39,APC Calr gene com variants,81219,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,121.63,,,,,,,fee schedule,121.63,606.39,APC Cftr gene com variants,81220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2717.98,,,,,,,fee schedule,556.6,3060.86, Cftr gene com variants,81220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3060.86,,,,,,,fee schedule,556.6,3060.86, Cftr gene com variants,81220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1770.67,,,,,,,fee schedule,556.6,3060.86, Cftr gene com variants,81220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2023.62,,,,,,,fee schedule,556.6,3060.86, Cftr gene com variants,81220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,578.86,,,,,,,fee schedule,556.6,3060.86,APC Cftr gene com variants,81220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,584.43,,,,,,,fee schedule,556.6,3060.86,APC Cftr gene com variants,81220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,556.6,,,,,,,fee schedule,556.6,3060.86,APC Cftr gene known fam variants,81221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.58,,,,,,,fee schedule,97.22,353.55, Cftr gene known fam variants,81221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,311.47,,,,,,,fee schedule,97.22,353.55, Cftr gene known fam variants,81221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,309.36,,,,,,,fee schedule,97.22,353.55, Cftr gene known fam variants,81221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,353.55,,,,,,,fee schedule,97.22,353.55, Cftr gene known fam variants,81221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,101.11,,,,,,,fee schedule,97.22,353.55,APC Cftr gene known fam variants,81221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,102.08,,,,,,,fee schedule,97.22,353.55,APC Cftr gene known fam variants,81221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,97.22,,,,,,,fee schedule,97.22,353.55,APC Cftr gene dup/delet variants,81222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,785.82,,,,,,,fee schedule,435.07,1581.99, Cftr gene dup/delet variants,81222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,884.95,,,,,,,fee schedule,435.07,1581.99, Cftr gene dup/delet variants,81222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1384.24,,,,,,,fee schedule,435.07,1581.99, Cftr gene dup/delet variants,81222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1581.99,,,,,,,fee schedule,435.07,1581.99, Cftr gene dup/delet variants,81222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,452.47,,,,,,,fee schedule,435.07,1581.99,APC Cftr gene dup/delet variants,81222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,456.82,,,,,,,fee schedule,435.07,1581.99,APC Cftr gene dup/delet variants,81222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,435.07,,,,,,,fee schedule,435.07,1581.99,APC Cftr gene full sequence,81223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4699.7,,,,,,,fee schedule,499,5292.58, Cftr gene full sequence,81223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5292.58,,,,,,,fee schedule,499,5292.58, Cftr gene full sequence,81223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1587.34,,,,,,,fee schedule,499,5292.58, Cftr gene full sequence,81223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1814.1,,,,,,,fee schedule,499,5292.58, Cftr gene full sequence,81223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,518.96,,,,,,,fee schedule,499,5292.58,APC Cftr gene full sequence,81223,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,523.95,,,,,,,fee schedule,499,5292.58,APC Cftr gene full sequence,81223,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,499,,,,,,,fee schedule,499,5292.58,APC Cftr gene intron poly t,81224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,204.1,,,,,,,fee schedule,168.75,613.05, Cftr gene intron poly t,81224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,229.85,,,,,,,fee schedule,168.75,613.05, Cftr gene intron poly t,81224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,536.42,,,,,,,fee schedule,168.75,613.05, Cftr gene intron poly t,81224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,613.05,,,,,,,fee schedule,168.75,613.05, Cftr gene intron poly t,81224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,175.5,,,,,,,fee schedule,168.75,613.05,APC Cftr gene intron poly t,81224,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,177.19,,,,,,,fee schedule,168.75,613.05,APC Cftr gene intron poly t,81224,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,168.75,,,,,,,fee schedule,168.75,613.05,APC Cyp2c19 gene com variants,81225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,372.16,,,,,,,fee schedule,291.36,1059.42, Cyp2c19 gene com variants,81225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,419.11,,,,,,,fee schedule,291.36,1059.42, Cyp2c19 gene com variants,81225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,926.99,,,,,,,fee schedule,291.36,1059.42, Cyp2c19 gene com variants,81225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1059.42,,,,,,,fee schedule,291.36,1059.42, Cyp2c19 gene com variants,81225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.01,,,,,,,fee schedule,291.36,1059.42,APC Cyp2c19 gene com variants,81225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.93,,,,,,,fee schedule,291.36,1059.42,APC Cyp2c19 gene com variants,81225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.36,,,,,,,fee schedule,291.36,1059.42,APC Cyp2d6 gene com variants,81226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1033.08,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gene com variants,81226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1163.4,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gene com variants,81226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1434.25,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gene com variants,81226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1639.14,,,,,,,fee schedule,450.91,1639.14, Cyp2d6 gene com variants,81226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,468.95,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 gene com variants,81226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,473.46,,,,,,,fee schedule,450.91,1639.14,APC Cyp2d6 gene com variants,81226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,450.91,,,,,,,fee schedule,450.91,1639.14,APC Cyp2c9 gene com variants,81227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,220.9,,,,,,,fee schedule,174.81,635.64, Cyp2c9 gene com variants,81227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,248.77,,,,,,,fee schedule,174.81,635.64, Cyp2c9 gene com variants,81227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Cyp2c9 gene com variants,81227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Cyp2c9 gene com variants,81227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Cyp2c9 gene com variants,81227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Cyp2c9 gene com variants,81227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Cytogen micrarray copy nmbr,81228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1328.15,,,,,,,fee schedule,900,3272.31, Cytogen micrarray copy nmbr,81228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1495.7,,,,,,,fee schedule,900,3272.31, Cytogen micrarray copy nmbr,81228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2863.27,,,,,,,fee schedule,900,3272.31, Cytogen micrarray copy nmbr,81228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3272.31,,,,,,,fee schedule,900,3272.31, Cytogen micrarray copy nmbr,81228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,936,,,,,,,fee schedule,900,3272.31,APC Cytogen micrarray copy nmbr,81228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,945,,,,,,,fee schedule,900,3272.31,APC Cytogen micrarray copy nmbr,81228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,900,,,,,,,fee schedule,900,3272.31,APC Cytogen m array copy no&snp,81229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1328.15,,,,,,,fee schedule,1160,4217.46, Cytogen m array copy no&snp,81229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1495.7,,,,,,,fee schedule,1160,4217.46, Cytogen m array copy no&snp,81229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3690.28,,,,,,,fee schedule,1160,4217.46, Cytogen m array copy no&snp,81229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4217.46,,,,,,,fee schedule,1160,4217.46, Cytogen m array copy no&snp,81229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1206.4,,,,,,,fee schedule,1160,4217.46,APC Cytogen m array copy no&snp,81229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1218,,,,,,,fee schedule,1160,4217.46,APC Cytogen m array copy no&snp,81229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1160,,,,,,,fee schedule,1160,4217.46,APC Cyp3a4 gene common variants,81230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Cyp3a4 gene common variants,81230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Cyp3a4 gene common variants,81230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Cyp3a4 gene common variants,81230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Cyp3a4 gene common variants,81230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Cyp3a5 gene common variants,81231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Cyp3a5 gene common variants,81231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Cyp3a5 gene common variants,81231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Cyp3a5 gene common variants,81231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Cyp3a5 gene common variants,81231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Dpyd gene common variants,81232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Dpyd gene common variants,81232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Dpyd gene common variants,81232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Dpyd gene common variants,81232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Dpyd gene common variants,81232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Btk gene common variants,81233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,558.29,,,,,,,fee schedule,175.4,638.04, Btk gene common variants,81233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,638.04,,,,,,,fee schedule,175.4,638.04, Btk gene common variants,81233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.42,,,,,,,fee schedule,175.4,638.04,APC Btk gene common variants,81233,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.17,,,,,,,fee schedule,175.4,638.04,APC Btk gene common variants,81233,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.4,,,,,,,fee schedule,175.4,638.04,APC Dmpk gene detc abnor allele,81234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Dmpk gene detc abnor allele,81234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Dmpk gene detc abnor allele,81234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Dmpk gene detc abnor allele,81234,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Dmpk gene detc abnor allele,81234,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Egfr gene com variants,81235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,749.78,,,,,,,fee schedule,324.58,1179.66, Egfr gene com variants,81235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,844.36,,,,,,,fee schedule,324.58,1179.66, Egfr gene com variants,81235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1032.2,,,,,,,fee schedule,324.58,1179.66, Egfr gene com variants,81235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1179.66,,,,,,,fee schedule,324.58,1179.66, Egfr gene com variants,81235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,337.56,,,,,,,fee schedule,324.58,1179.66,APC Egfr gene com variants,81235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,340.81,,,,,,,fee schedule,324.58,1179.66,APC Egfr gene com variants,81235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,324.58,,,,,,,fee schedule,324.58,1179.66,APC Ezh2 gene full gene sequence,81236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,1028.46, Ezh2 gene full gene sequence,81236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,1028.46, Ezh2 gene full gene sequence,81236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,1028.46,APC Ezh2 gene full gene sequence,81236,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,1028.46,APC Ezh2 gene full gene sequence,81236,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,1028.46,APC Ezh2 gene common variants,81237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,558.29,,,,,,,fee schedule,175.4,638.04, Ezh2 gene common variants,81237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,638.04,,,,,,,fee schedule,175.4,638.04, Ezh2 gene common variants,81237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.42,,,,,,,fee schedule,175.4,638.04,APC Ezh2 gene common variants,81237,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.17,,,,,,,fee schedule,175.4,638.04,APC Ezh2 gene common variants,81237,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.4,,,,,,,fee schedule,175.4,638.04,APC F9 full gene sequence,81238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1908.14,,,,,,,fee schedule,600,2180.73, F9 full gene sequence,81238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2180.73,,,,,,,fee schedule,600,2180.73, F9 full gene sequence,81238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,624,,,,,,,fee schedule,600,2180.73,APC F9 full gene sequence,81238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,630,,,,,,,fee schedule,600,2180.73,APC F9 full gene sequence,81238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,600,,,,,,,fee schedule,600,2180.73,APC Dmpk gene charac alleles,81239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Dmpk gene charac alleles,81239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Dmpk gene charac alleles,81239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Dmpk gene charac alleles,81239,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Dmpk gene charac alleles,81239,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC F2 gene,81240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,189.05,,,,,,,fee schedule,65.69,239.25, F2 gene,81240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.9,,,,,,,fee schedule,65.69,239.25, F2 gene,81240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,209.34,,,,,,,fee schedule,65.69,239.25, F2 gene,81240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,239.25,,,,,,,fee schedule,65.69,239.25, F2 gene,81240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,68.32,,,,,,,fee schedule,65.69,239.25,APC F2 gene,81240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.97,,,,,,,fee schedule,65.69,239.25,APC F2 gene,81240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,65.69,,,,,,,fee schedule,65.69,239.25,APC F5 gene,81241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,132.34,,,,,,,fee schedule,73.37,266.64, F5 gene,81241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.04,,,,,,,fee schedule,73.37,266.64, F5 gene,81241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,233.31,,,,,,,fee schedule,73.37,266.64, F5 gene,81241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,266.64,,,,,,,fee schedule,73.37,266.64, F5 gene,81241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.3,,,,,,,fee schedule,73.37,266.64,APC F5 gene,81241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77.04,,,,,,,fee schedule,73.37,266.64,APC F5 gene,81241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.37,,,,,,,fee schedule,73.37,266.64,APC Fancc gene,81242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,263.45,,,,,,,fee schedule,36.62,296.68, Fancc gene,81242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.68,,,,,,,fee schedule,36.62,296.68, Fancc gene,81242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.66,,,,,,,fee schedule,36.62,296.68, Fancc gene,81242,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,133.32,,,,,,,fee schedule,36.62,296.68, Fancc gene,81242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.08,,,,,,,fee schedule,36.62,296.68,APC Fancc gene,81242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.45,,,,,,,fee schedule,36.62,296.68,APC Fancc gene,81242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.62,,,,,,,fee schedule,36.62,296.68,APC Fmr1 gene detection,81243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,710.58,,,,,,,fee schedule,57.04,800.22, Fmr1 gene detection,81243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,800.22,,,,,,,fee schedule,57.04,800.22, Fmr1 gene detection,81243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,181.23,,,,,,,fee schedule,57.04,800.22, Fmr1 gene detection,81243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,207.12,,,,,,,fee schedule,57.04,800.22, Fmr1 gene detection,81243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,59.32,,,,,,,fee schedule,57.04,800.22,APC Fmr1 gene detection,81243,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.89,,,,,,,fee schedule,57.04,800.22,APC Fmr1 gene detection,81243,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,57.04,,,,,,,fee schedule,57.04,800.22,APC Fmr1 gene characterization,81244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.28,,,,,,,fee schedule,44.89,163.08, Fmr1 gene characterization,81244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.04,,,,,,,fee schedule,44.89,163.08, Fmr1 gene characterization,81244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,142.7,,,,,,,fee schedule,44.89,163.08, Fmr1 gene characterization,81244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,163.08,,,,,,,fee schedule,44.89,163.08, Fmr1 gene characterization,81244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.69,,,,,,,fee schedule,44.89,163.08,APC Fmr1 gene characterization,81244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,47.13,,,,,,,fee schedule,44.89,163.08,APC Fmr1 gene characterization,81244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.89,,,,,,,fee schedule,44.89,163.08,APC Flt3 gene,81245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,357.08,,,,,,,fee schedule,165.51,601.14, Flt3 gene,81245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,402.12,,,,,,,fee schedule,165.51,601.14, Flt3 gene,81245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,526,,,,,,,fee schedule,165.51,601.14, Flt3 gene,81245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,601.14,,,,,,,fee schedule,165.51,601.14, Flt3 gene,81245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,172.13,,,,,,,fee schedule,165.51,601.14,APC Flt3 gene,81245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,173.79,,,,,,,fee schedule,165.51,601.14,APC Flt3 gene,81245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,165.51,,,,,,,fee schedule,165.51,601.14,APC Flt3 gene analysis,81246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,269.88,,,,,,,fee schedule,83,303.93, Flt3 gene analysis,81246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,303.93,,,,,,,fee schedule,83,303.93, Flt3 gene analysis,81246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,263.52,,,,,,,fee schedule,83,303.93, Flt3 gene analysis,81246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,301.17,,,,,,,fee schedule,83,303.93, Flt3 gene analysis,81246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,86.32,,,,,,,fee schedule,83,303.93,APC Flt3 gene analysis,81246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,87.15,,,,,,,fee schedule,83,303.93,APC Flt3 gene analysis,81246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,83,,,,,,,fee schedule,83,303.93,APC G6pd gene alys cmn variant,81247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, G6pd gene alys cmn variant,81247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, G6pd gene alys cmn variant,81247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC G6pd gene alys cmn variant,81247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC G6pd gene alys cmn variant,81247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC G6pd known familial variant,81248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1193.64,,,,,,,fee schedule,375.25,1364.16, G6pd known familial variant,81248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1364.16,,,,,,,fee schedule,375.25,1364.16, G6pd known familial variant,81248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,390.26,,,,,,,fee schedule,375.25,1364.16,APC G6pd known familial variant,81248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,394.01,,,,,,,fee schedule,375.25,1364.16,APC G6pd known familial variant,81248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,375.25,,,,,,,fee schedule,375.25,1364.16,APC G6pd full gene sequence,81249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1908.14,,,,,,,fee schedule,600,2180.73, G6pd full gene sequence,81249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2180.73,,,,,,,fee schedule,600,2180.73, G6pd full gene sequence,81249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,624,,,,,,,fee schedule,600,2180.73,APC G6pd full gene sequence,81249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,630,,,,,,,fee schedule,600,2180.73,APC G6pd full gene sequence,81249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,600,,,,,,,fee schedule,600,2180.73,APC G6pc gene,81250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,355.81,,,,,,,fee schedule,58.49,400.7, G6pc gene,81250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,400.7,,,,,,,fee schedule,58.49,400.7, G6pc gene,81250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,186.43,,,,,,,fee schedule,58.49,400.7, G6pc gene,81250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,213.06,,,,,,,fee schedule,58.49,400.7, G6pc gene,81250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.83,,,,,,,fee schedule,58.49,400.7,APC G6pc gene,81250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61.41,,,,,,,fee schedule,58.49,400.7,APC G6pc gene,81250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58.49,,,,,,,fee schedule,58.49,400.7,APC Gba gene,81251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,677.66,,,,,,,fee schedule,47.25,763.15, Gba gene,81251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,763.15,,,,,,,fee schedule,47.25,763.15, Gba gene,81251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,149.99,,,,,,,fee schedule,47.25,763.15, Gba gene,81251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,171.42,,,,,,,fee schedule,47.25,763.15, Gba gene,81251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.14,,,,,,,fee schedule,47.25,763.15,APC Gba gene,81251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.61,,,,,,,fee schedule,47.25,763.15,APC Gba gene,81251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.25,,,,,,,fee schedule,47.25,763.15,APC Gjb2 gene full sequence,81252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,923.75,,,,,,,fee schedule,101.12,1040.28, Gjb2 gene full sequence,81252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1040.28,,,,,,,fee schedule,101.12,1040.28, Gjb2 gene full sequence,81252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,321.85,,,,,,,fee schedule,101.12,1040.28, Gjb2 gene full sequence,81252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,367.83,,,,,,,fee schedule,101.12,1040.28, Gjb2 gene full sequence,81252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,105.16,,,,,,,fee schedule,101.12,1040.28,APC Gjb2 gene full sequence,81252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,106.18,,,,,,,fee schedule,101.12,1040.28,APC Gjb2 gene full sequence,81252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,101.12,,,,,,,fee schedule,101.12,1040.28,APC Gjb2 gene known fam variants,81253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325.68,,,,,,,fee schedule,61.52,366.77, Gjb2 gene known fam variants,81253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,366.77,,,,,,,fee schedule,61.52,366.77, Gjb2 gene known fam variants,81253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,195.83,,,,,,,fee schedule,61.52,366.77, Gjb2 gene known fam variants,81253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,223.8,,,,,,,fee schedule,61.52,366.77, Gjb2 gene known fam variants,81253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,63.98,,,,,,,fee schedule,61.52,366.77,APC Gjb2 gene known fam variants,81253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.6,,,,,,,fee schedule,61.52,366.77,APC Gjb2 gene known fam variants,81253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.52,,,,,,,fee schedule,61.52,366.77,APC Gjb6 gene com variants,81254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.84,,,,,,,fee schedule,35,127.38, Gjb6 gene com variants,81254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,107.93,,,,,,,fee schedule,35,127.38, Gjb6 gene com variants,81254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35,127.38, Gjb6 gene com variants,81254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35,127.38, Gjb6 gene com variants,81254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.4,,,,,,,fee schedule,35,127.38,APC Gjb6 gene com variants,81254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.75,,,,,,,fee schedule,35,127.38,APC Gjb6 gene com variants,81254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35,,,,,,,fee schedule,35,127.38,APC Hexa gene,81255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,733.53,,,,,,,fee schedule,51.45,826.06, Hexa gene,81255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,826.06,,,,,,,fee schedule,51.45,826.06, Hexa gene,81255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.54,,,,,,,fee schedule,51.45,826.06, Hexa gene,81255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,51.45,826.06, Hexa gene,81255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.51,,,,,,,fee schedule,51.45,826.06,APC Hexa gene,81255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.02,,,,,,,fee schedule,51.45,826.06,APC Hexa gene,81255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.45,,,,,,,fee schedule,51.45,826.06,APC Hfe gene,81256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,230.75,,,,,,,fee schedule,65.36,259.86, Hfe gene,81256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,259.86,,,,,,,fee schedule,65.36,259.86, Hfe gene,81256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.32,,,,,,,fee schedule,65.36,259.86, Hfe gene,81256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,238.08,,,,,,,fee schedule,65.36,259.86, Hfe gene,81256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,67.97,,,,,,,fee schedule,65.36,259.86,APC Hfe gene,81256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.63,,,,,,,fee schedule,65.36,259.86,APC Hfe gene,81256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,65.36,,,,,,,fee schedule,65.36,259.86,APC Hba1/hba2 gene,81257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,657.77,,,,,,,fee schedule,102.26,740.75, Hba1/hba2 gene,81257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,740.75,,,,,,,fee schedule,102.26,740.75, Hba1/hba2 gene,81257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,324.98,,,,,,,fee schedule,102.26,740.75, Hba1/hba2 gene,81257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,371.4,,,,,,,fee schedule,102.26,740.75, Hba1/hba2 gene,81257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.35,,,,,,,fee schedule,102.26,740.75,APC Hba1/hba2 gene,81257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.37,,,,,,,fee schedule,102.26,740.75,APC Hba1/hba2 gene,81257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.26,,,,,,,fee schedule,102.26,740.75,APC Hba1/hba2 gene fam vrnt,81258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1193.64,,,,,,,fee schedule,375.25,1364.16, Hba1/hba2 gene fam vrnt,81258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1364.16,,,,,,,fee schedule,375.25,1364.16, Hba1/hba2 gene fam vrnt,81258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,390.26,,,,,,,fee schedule,375.25,1364.16,APC Hba1/hba2 gene fam vrnt,81258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,394.01,,,,,,,fee schedule,375.25,1364.16,APC Hba1/hba2 gene fam vrnt,81258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,375.25,,,,,,,fee schedule,375.25,1364.16,APC Hba1/hba2 full gene sequence,81259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1908.14,,,,,,,fee schedule,600,2180.73, Hba1/hba2 full gene sequence,81259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2180.73,,,,,,,fee schedule,600,2180.73, Hba1/hba2 full gene sequence,81259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,624,,,,,,,fee schedule,600,2180.73,APC Hba1/hba2 full gene sequence,81259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,630,,,,,,,fee schedule,600,2180.73,APC Hba1/hba2 full gene sequence,81259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,600,,,,,,,fee schedule,600,2180.73,APC Ikbkap gene,81260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,263.45,,,,,,,fee schedule,39.31,296.68, Ikbkap gene,81260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.68,,,,,,,fee schedule,39.31,296.68, Ikbkap gene,81260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,124.98,,,,,,,fee schedule,39.31,296.68, Ikbkap gene,81260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.83,,,,,,,fee schedule,39.31,296.68, Ikbkap gene,81260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.88,,,,,,,fee schedule,39.31,296.68,APC Ikbkap gene,81260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.28,,,,,,,fee schedule,39.31,296.68,APC Ikbkap gene,81260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.31,,,,,,,fee schedule,39.31,296.68,APC Igh gene rearrange amp meth,81261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,330.62,,,,,,,fee schedule,197.99,720.18, Igh gene rearrange amp meth,81261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,372.33,,,,,,,fee schedule,197.99,720.18, Igh gene rearrange amp meth,81261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,630.16,,,,,,,fee schedule,197.99,720.18, Igh gene rearrange amp meth,81261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,720.18,,,,,,,fee schedule,197.99,720.18, Igh gene rearrange amp meth,81261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,205.91,,,,,,,fee schedule,197.99,720.18,APC Igh gene rearrange amp meth,81261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,207.89,,,,,,,fee schedule,197.99,720.18,APC Igh gene rearrange amp meth,81261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,197.99,,,,,,,fee schedule,197.99,720.18,APC Igh gene rearrang dir probe,81262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,233.19,,,,,,,fee schedule,68.55,262.61, Igh gene rearrang dir probe,81262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,262.61,,,,,,,fee schedule,68.55,262.61, Igh gene rearrang dir probe,81262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,217.69,,,,,,,fee schedule,68.55,262.61, Igh gene rearrang dir probe,81262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,248.79,,,,,,,fee schedule,68.55,262.61, Igh gene rearrang dir probe,81262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,71.29,,,,,,,fee schedule,68.55,262.61,APC Igh gene rearrang dir probe,81262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,71.98,,,,,,,fee schedule,68.55,262.61,APC Igh gene rearrang dir probe,81262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,68.55,,,,,,,fee schedule,68.55,262.61,APC Igh vari regional mutation,81263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,730.7,,,,,,,fee schedule,294.52,1070.13, Igh vari regional mutation,81263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,822.88,,,,,,,fee schedule,294.52,1070.13, Igh vari regional mutation,81263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,936.36,,,,,,,fee schedule,294.52,1070.13, Igh vari regional mutation,81263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1070.13,,,,,,,fee schedule,294.52,1070.13, Igh vari regional mutation,81263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,306.3,,,,,,,fee schedule,294.52,1070.13,APC Igh vari regional mutation,81263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,309.25,,,,,,,fee schedule,294.52,1070.13,APC Igh vari regional mutation,81263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,294.52,,,,,,,fee schedule,294.52,1070.13,APC Igk rearrangeabn clonal pop,81264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1219.5,,,,,,,fee schedule,172.73,1373.34, Igk rearrangeabn clonal pop,81264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1373.34,,,,,,,fee schedule,172.73,1373.34, Igk rearrangeabn clonal pop,81264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,549.94,,,,,,,fee schedule,172.73,1373.34, Igk rearrangeabn clonal pop,81264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,628.5,,,,,,,fee schedule,172.73,1373.34, Igk rearrangeabn clonal pop,81264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,179.64,,,,,,,fee schedule,172.73,1373.34,APC Igk rearrangeabn clonal pop,81264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,181.37,,,,,,,fee schedule,172.73,1373.34,APC Igk rearrangeabn clonal pop,81264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,172.73,,,,,,,fee schedule,172.73,1373.34,APC Str markers specimen anal,81265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,651.46,,,,,,,fee schedule,233.07,847.53, Str markers specimen anal,81265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,733.65,,,,,,,fee schedule,233.07,847.53, Str markers specimen anal,81265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,741.59,,,,,,,fee schedule,233.07,847.53, Str markers specimen anal,81265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,847.53,,,,,,,fee schedule,233.07,847.53, Str markers specimen anal,81265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,242.39,,,,,,,fee schedule,233.07,847.53,APC Str markers specimen anal,81265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,244.72,,,,,,,fee schedule,233.07,847.53,APC Str markers specimen anal,81265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,233.07,,,,,,,fee schedule,233.07,847.53,APC Str markers spec anal addl,81266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,969.7,,,,,,,fee schedule,304.81,1108.23, Str markers spec anal addl,81266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1108.23,,,,,,,fee schedule,304.81,1108.23, Str markers spec anal addl,81266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,317,,,,,,,fee schedule,304.81,1108.23,APC Str markers spec anal addl,81266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,320.05,,,,,,,fee schedule,304.81,1108.23,APC Str markers spec anal addl,81266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,304.81,,,,,,,fee schedule,304.81,1108.23,APC Chimerism anal no cell selec,81267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2619.57,,,,,,,fee schedule,207.46,2950.03, Chimerism anal no cell selec,81267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2950.03,,,,,,,fee schedule,207.46,2950.03, Chimerism anal no cell selec,81267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,660.35,,,,,,,fee schedule,207.46,2950.03, Chimerism anal no cell selec,81267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,754.68,,,,,,,fee schedule,207.46,2950.03, Chimerism anal no cell selec,81267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.76,,,,,,,fee schedule,207.46,2950.03,APC Chimerism anal no cell selec,81267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.83,,,,,,,fee schedule,207.46,2950.03,APC Chimerism anal no cell selec,81267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.46,,,,,,,fee schedule,207.46,2950.03,APC Chimerism anal w/cell select,81268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1048.65,,,,,,,fee schedule,260.79,1180.94, Chimerism anal w/cell select,81268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1180.94,,,,,,,fee schedule,260.79,1180.94, Chimerism anal w/cell select,81268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,829.08,,,,,,,fee schedule,260.79,1180.94, Chimerism anal w/cell select,81268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,947.52,,,,,,,fee schedule,260.79,1180.94, Chimerism anal w/cell select,81268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,271.22,,,,,,,fee schedule,260.79,1180.94,APC Chimerism anal w/cell select,81268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.83,,,,,,,fee schedule,260.79,1180.94,APC Chimerism anal w/cell select,81268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.79,,,,,,,fee schedule,260.79,1180.94,APC Hba1/hba2 gene dup/del vrnts,81269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,643.68,,,,,,,fee schedule,202.4,735.63, Hba1/hba2 gene dup/del vrnts,81269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,735.63,,,,,,,fee schedule,202.4,735.63, Hba1/hba2 gene dup/del vrnts,81269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,210.5,,,,,,,fee schedule,202.4,735.63,APC Hba1/hba2 gene dup/del vrnts,81269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,212.52,,,,,,,fee schedule,202.4,735.63,APC Hba1/hba2 gene dup/del vrnts,81269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,202.4,,,,,,,fee schedule,202.4,735.63,APC Jak2 gene,81270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.67,,,,,,,fee schedule,91.66,333.3, Jak2 gene,81270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,209.1,,,,,,,fee schedule,91.66,333.3, Jak2 gene,81270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,291.64,,,,,,,fee schedule,91.66,333.3, Jak2 gene,81270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,333.3,,,,,,,fee schedule,91.66,333.3, Jak2 gene,81270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.33,,,,,,,fee schedule,91.66,333.3,APC Jak2 gene,81270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.24,,,,,,,fee schedule,91.66,333.3,APC Jak2 gene,81270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.66,,,,,,,fee schedule,91.66,333.3,APC Htt gene detc abnor alleles,81271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Htt gene detc abnor alleles,81271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Htt gene detc abnor alleles,81271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Htt gene detc abnor alleles,81271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Htt gene detc abnor alleles,81271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Kit gene targeted seq analys,81272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1070.91,,,,,,,fee schedule,329.51,1206.01, Kit gene targeted seq analys,81272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1206.01,,,,,,,fee schedule,329.51,1206.01, Kit gene targeted seq analys,81272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1047.82,,,,,,,fee schedule,329.51,1206.01, Kit gene targeted seq analys,81272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1197.51,,,,,,,fee schedule,329.51,1206.01, Kit gene targeted seq analys,81272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,342.69,,,,,,,fee schedule,329.51,1206.01,APC Kit gene targeted seq analys,81272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,345.99,,,,,,,fee schedule,329.51,1206.01,APC Kit gene targeted seq analys,81272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,329.51,,,,,,,fee schedule,329.51,1206.01,APC Kit gene analys d816 variant,81273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,405.83,,,,,,,fee schedule,124.87,457.02, Kit gene analys d816 variant,81273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,457.02,,,,,,,fee schedule,124.87,457.02, Kit gene analys d816 variant,81273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,396.85,,,,,,,fee schedule,124.87,457.02, Kit gene analys d816 variant,81273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,453.54,,,,,,,fee schedule,124.87,457.02, Kit gene analys d816 variant,81273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,129.86,,,,,,,fee schedule,124.87,457.02,APC Kit gene analys d816 variant,81273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,131.11,,,,,,,fee schedule,124.87,457.02,APC Kit gene analys d816 variant,81273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,124.87,,,,,,,fee schedule,124.87,457.02,APC Htt gene charac alleles,81274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Htt gene charac alleles,81274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Htt gene charac alleles,81274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Htt gene charac alleles,81274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Htt gene charac alleles,81274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Kras gene variants exon 2,81275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,522.47,,,,,,,fee schedule,193.25,702.3, Kras gene variants exon 2,81275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,588.38,,,,,,,fee schedule,193.25,702.3, Kras gene variants exon 2,81275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,614.51,,,,,,,fee schedule,193.25,702.3, Kras gene variants exon 2,81275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,702.3,,,,,,,fee schedule,193.25,702.3, Kras gene variants exon 2,81275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.98,,,,,,,fee schedule,193.25,702.3,APC Kras gene variants exon 2,81275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,202.91,,,,,,,fee schedule,193.25,702.3,APC Kras gene variants exon 2,81275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.25,,,,,,,fee schedule,193.25,702.3,APC Kras gene addl variants,81276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,640.87,,,,,,,fee schedule,193.25,721.72, Kras gene addl variants,81276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,721.72,,,,,,,fee schedule,193.25,721.72, Kras gene addl variants,81276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,614.51,,,,,,,fee schedule,193.25,721.72, Kras gene addl variants,81276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,702.3,,,,,,,fee schedule,193.25,721.72, Kras gene addl variants,81276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.98,,,,,,,fee schedule,193.25,721.72,APC Kras gene addl variants,81276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,202.91,,,,,,,fee schedule,193.25,721.72,APC Kras gene addl variants,81276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.25,,,,,,,fee schedule,193.25,721.72,APC Cytogenomic neo microra alys,81277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3690.28,,,,,,,fee schedule,1160,4217.46, Cytogenomic neo microra alys,81277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4217.46,,,,,,,fee schedule,1160,4217.46, Cytogenomic neo microra alys,81277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1206.4,,,,,,,fee schedule,1160,4217.46,APC Cytogenomic neo microra alys,81277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1218,,,,,,,fee schedule,1160,4217.46,APC Cytogenomic neo microra alys,81277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1160,,,,,,,fee schedule,1160,4217.46,APC Igh@/bcl2 translocation alys,81278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,673.76,,,,,,,fee schedule,207.31,758.75, Igh@/bcl2 translocation alys,81278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,758.75,,,,,,,fee schedule,207.31,758.75, Igh@/bcl2 translocation alys,81278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,659.32,,,,,,,fee schedule,207.31,758.75, Igh@/bcl2 translocation alys,81278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,753.51,,,,,,,fee schedule,207.31,758.75, Igh@/bcl2 translocation alys,81278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.6,,,,,,,fee schedule,207.31,758.75,APC Igh@/bcl2 translocation alys,81278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.68,,,,,,,fee schedule,207.31,758.75,APC Igh@/bcl2 translocation alys,81278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,207.31,758.75,APC Jak2 gene trgt sequence alys,81279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Jak2 gene trgt sequence alys,81279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Jak2 gene trgt sequence alys,81279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Jak2 gene trgt sequence alys,81279,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Jak2 gene trgt sequence alys,81279,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Ifnl3 gene,81283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,233.31,,,,,,,fee schedule,73.37,266.64, Ifnl3 gene,81283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,266.64,,,,,,,fee schedule,73.37,266.64, Ifnl3 gene,81283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.3,,,,,,,fee schedule,73.37,266.64,APC Ifnl3 gene,81283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77.04,,,,,,,fee schedule,73.37,266.64,APC Ifnl3 gene,81283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.37,,,,,,,fee schedule,73.37,266.64,APC Fxn gene detc abnor alleles,81284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Fxn gene detc abnor alleles,81284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Fxn gene detc abnor alleles,81284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Fxn gene detc abnor alleles,81284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Fxn gene detc abnor alleles,81284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Fxn gene charac alleles,81285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Fxn gene charac alleles,81285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Fxn gene charac alleles,81285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Fxn gene charac alleles,81285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Fxn gene charac alleles,81285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Fxn gene full gene sequence,81286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Fxn gene full gene sequence,81286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Fxn gene full gene sequence,81286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Fxn gene full gene sequence,81286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Fxn gene full gene sequence,81286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Mgmt gene methylation anal,81287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,270.04,,,,,,,fee schedule,124.64,453.54, Mgmt gene methylation anal,81287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,304.11,,,,,,,fee schedule,124.64,453.54, Mgmt gene methylation anal,81287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,396.85,,,,,,,fee schedule,124.64,453.54, Mgmt gene methylation anal,81287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,453.54,,,,,,,fee schedule,124.64,453.54, Mgmt gene methylation anal,81287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,129.63,,,,,,,fee schedule,124.64,453.54,APC Mgmt gene methylation anal,81287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,130.87,,,,,,,fee schedule,124.64,453.54,APC Mgmt gene methylation anal,81287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,124.64,,,,,,,fee schedule,124.64,453.54,APC Mlh1 gene,81288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,518.83,,,,,,,fee schedule,192.32,698.73, Mlh1 gene,81288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,584.28,,,,,,,fee schedule,192.32,698.73, Mlh1 gene,81288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,611.39,,,,,,,fee schedule,192.32,698.73, Mlh1 gene,81288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,698.73,,,,,,,fee schedule,192.32,698.73, Mlh1 gene,81288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.01,,,,,,,fee schedule,192.32,698.73,APC Mlh1 gene,81288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.94,,,,,,,fee schedule,192.32,698.73,APC Mlh1 gene,81288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,192.32,,,,,,,fee schedule,192.32,698.73,APC Fxn gene known famil variant,81289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Fxn gene known famil variant,81289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Fxn gene known famil variant,81289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Fxn gene known famil variant,81289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Fxn gene known famil variant,81289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Mcoln1 gene,81290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,263.45,,,,,,,fee schedule,39.31,296.68, Mcoln1 gene,81290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.68,,,,,,,fee schedule,39.31,296.68, Mcoln1 gene,81290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,124.98,,,,,,,fee schedule,39.31,296.68, Mcoln1 gene,81290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.83,,,,,,,fee schedule,39.31,296.68, Mcoln1 gene,81290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.88,,,,,,,fee schedule,39.31,296.68,APC Mcoln1 gene,81290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.28,,,,,,,fee schedule,39.31,296.68,APC Mcoln1 gene,81290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.31,,,,,,,fee schedule,39.31,296.68,APC Mthfr gene,81291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,238.03,,,,,,,fee schedule,65.34,268.06, Mthfr gene,81291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.06,,,,,,,fee schedule,65.34,268.06, Mthfr gene,81291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,208.32,,,,,,,fee schedule,65.34,268.06, Mthfr gene,81291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,238.08,,,,,,,fee schedule,65.34,268.06, Mthfr gene,81291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,67.95,,,,,,,fee schedule,65.34,268.06,APC Mthfr gene,81291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.61,,,,,,,fee schedule,65.34,268.06,APC Mthfr gene,81291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,65.34,,,,,,,fee schedule,65.34,268.06,APC Mlh1 gene full seq,81292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2415.99,,,,,,,fee schedule,675.4,2720.77, Mlh1 gene full seq,81292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2720.77,,,,,,,fee schedule,675.4,2720.77, Mlh1 gene full seq,81292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2148.75,,,,,,,fee schedule,675.4,2720.77, Mlh1 gene full seq,81292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2455.71,,,,,,,fee schedule,675.4,2720.77, Mlh1 gene full seq,81292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,702.42,,,,,,,fee schedule,675.4,2720.77,APC Mlh1 gene full seq,81292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,709.17,,,,,,,fee schedule,675.4,2720.77,APC Mlh1 gene full seq,81292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,675.4,,,,,,,fee schedule,675.4,2720.77,APC Mlh1 gene known variants,81293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,230.75,,,,,,,fee schedule,230.75,1203.45, Mlh1 gene known variants,81293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,259.86,,,,,,,fee schedule,230.75,1203.45, Mlh1 gene known variants,81293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1053.02,,,,,,,fee schedule,230.75,1203.45, Mlh1 gene known variants,81293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1203.45,,,,,,,fee schedule,230.75,1203.45, Mlh1 gene known variants,81293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,344.24,,,,,,,fee schedule,230.75,1203.45,APC Mlh1 gene known variants,81293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,347.55,,,,,,,fee schedule,230.75,1203.45,APC Mlh1 gene known variants,81293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,331,,,,,,,fee schedule,230.75,1203.45,APC Mlh1 gene dup/delete variant,81294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1297.73,,,,,,,fee schedule,202.4,1461.44, Mlh1 gene dup/delete variant,81294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1461.44,,,,,,,fee schedule,202.4,1461.44, Mlh1 gene dup/delete variant,81294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,643.68,,,,,,,fee schedule,202.4,1461.44, Mlh1 gene dup/delete variant,81294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,735.63,,,,,,,fee schedule,202.4,1461.44, Mlh1 gene dup/delete variant,81294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,210.5,,,,,,,fee schedule,202.4,1461.44,APC Mlh1 gene dup/delete variant,81294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,212.52,,,,,,,fee schedule,202.4,1461.44,APC Mlh1 gene dup/delete variant,81294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,202.4,,,,,,,fee schedule,202.4,1461.44,APC Msh2 gene full seq,81295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2165.87,,,,,,,fee schedule,381.7,2439.1, Msh2 gene full seq,81295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2439.1,,,,,,,fee schedule,381.7,2439.1, Msh2 gene full seq,81295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1214.46,,,,,,,fee schedule,381.7,2439.1, Msh2 gene full seq,81295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1387.95,,,,,,,fee schedule,381.7,2439.1, Msh2 gene full seq,81295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,396.97,,,,,,,fee schedule,381.7,2439.1,APC Msh2 gene full seq,81295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,400.78,,,,,,,fee schedule,381.7,2439.1,APC Msh2 gene full seq,81295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,381.7,,,,,,,fee schedule,381.7,2439.1,APC Msh2 gene known variants,81296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,230.75,,,,,,,fee schedule,230.75,1227.27, Msh2 gene known variants,81296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,259.86,,,,,,,fee schedule,230.75,1227.27, Msh2 gene known variants,81296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1073.86,,,,,,,fee schedule,230.75,1227.27, Msh2 gene known variants,81296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1227.27,,,,,,,fee schedule,230.75,1227.27, Msh2 gene known variants,81296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,351.24,,,,,,,fee schedule,230.75,1227.27,APC Msh2 gene known variants,81296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,354.62,,,,,,,fee schedule,230.75,1227.27,APC Msh2 gene known variants,81296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,337.73,,,,,,,fee schedule,230.75,1227.27,APC Msh2 gene dup/delete variant,81297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1150.79,,,,,,,fee schedule,213.3,1295.97, Msh2 gene dup/delete variant,81297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1295.97,,,,,,,fee schedule,213.3,1295.97, Msh2 gene dup/delete variant,81297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,678.06,,,,,,,fee schedule,213.3,1295.97, Msh2 gene dup/delete variant,81297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,774.93,,,,,,,fee schedule,213.3,1295.97, Msh2 gene dup/delete variant,81297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,221.83,,,,,,,fee schedule,213.3,1295.97,APC Msh2 gene dup/delete variant,81297,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,223.97,,,,,,,fee schedule,213.3,1295.97,APC Msh2 gene dup/delete variant,81297,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,213.3,,,,,,,fee schedule,213.3,1295.97,APC Msh6 gene full seq,81298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3247.4,,,,,,,fee schedule,641.85,3657.07, Msh6 gene full seq,81298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3657.07,,,,,,,fee schedule,641.85,3657.07, Msh6 gene full seq,81298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2041.46,,,,,,,fee schedule,641.85,3657.07, Msh6 gene full seq,81298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2333.1,,,,,,,fee schedule,641.85,3657.07, Msh6 gene full seq,81298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.52,,,,,,,fee schedule,641.85,3657.07,APC Msh6 gene full seq,81298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.94,,,,,,,fee schedule,641.85,3657.07,APC Msh6 gene full seq,81298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.85,,,,,,,fee schedule,641.85,3657.07,APC Msh6 gene known variants,81299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,230.75,,,,,,,fee schedule,230.75,1120.14, Msh6 gene known variants,81299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,259.86,,,,,,,fee schedule,230.75,1120.14, Msh6 gene known variants,81299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,980.12,,,,,,,fee schedule,230.75,1120.14, Msh6 gene known variants,81299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1120.14,,,,,,,fee schedule,230.75,1120.14, Msh6 gene known variants,81299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,320.32,,,,,,,fee schedule,230.75,1120.14,APC Msh6 gene known variants,81299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,323.4,,,,,,,fee schedule,230.75,1120.14,APC Msh6 gene known variants,81299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,308,,,,,,,fee schedule,230.75,1120.14,APC Msh6 gene dup/delete variant,81300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,781.63,,,,,,,fee schedule,238,880.23, Msh6 gene dup/delete variant,81300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,880.23,,,,,,,fee schedule,238,880.23, Msh6 gene dup/delete variant,81300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,757.21,,,,,,,fee schedule,238,880.23, Msh6 gene dup/delete variant,81300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,865.38,,,,,,,fee schedule,238,880.23, Msh6 gene dup/delete variant,81300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,247.52,,,,,,,fee schedule,238,880.23,APC Msh6 gene dup/delete variant,81300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,249.9,,,,,,,fee schedule,238,880.23,APC Msh6 gene dup/delete variant,81300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238,,,,,,,fee schedule,238,880.23,APC Microsatellite instability,81301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,778.18,,,,,,,fee schedule,348.56,1266.54, Microsatellite instability,81301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,876.35,,,,,,,fee schedule,348.56,1266.54, Microsatellite instability,81301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1108.22,,,,,,,fee schedule,348.56,1266.54, Microsatellite instability,81301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1266.54,,,,,,,fee schedule,348.56,1266.54, Microsatellite instability,81301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,362.5,,,,,,,fee schedule,348.56,1266.54,APC Microsatellite instability,81301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,365.99,,,,,,,fee schedule,348.56,1266.54,APC Microsatellite instability,81301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,348.56,,,,,,,fee schedule,348.56,1266.54,APC Mecp2 gene full seq,81302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1131.33,,,,,,,fee schedule,527.87,1918.86, Mecp2 gene full seq,81302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1274.05,,,,,,,fee schedule,527.87,1918.86, Mecp2 gene full seq,81302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1679,,,,,,,fee schedule,527.87,1918.86, Mecp2 gene full seq,81302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1918.86,,,,,,,fee schedule,527.87,1918.86, Mecp2 gene full seq,81302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.98,,,,,,,fee schedule,527.87,1918.86,APC Mecp2 gene full seq,81302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.26,,,,,,,fee schedule,527.87,1918.86,APC Mecp2 gene full seq,81302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.87,,,,,,,fee schedule,527.87,1918.86,APC Mecp2 gene known variant,81303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.77,,,,,,,fee schedule,29.77,435.66, Mecp2 gene known variant,81303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.53,,,,,,,fee schedule,29.77,435.66, Mecp2 gene known variant,81303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,381.2,,,,,,,fee schedule,29.77,435.66, Mecp2 gene known variant,81303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,435.66,,,,,,,fee schedule,29.77,435.66, Mecp2 gene known variant,81303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,124.8,,,,,,,fee schedule,29.77,435.66,APC Mecp2 gene known variant,81303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126,,,,,,,fee schedule,29.77,435.66,APC Mecp2 gene known variant,81303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120,,,,,,,fee schedule,29.77,435.66,APC Mecp2 gene dup/delet variant,81304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.9,,,,,,,fee schedule,150,545.19, Mecp2 gene dup/delet variant,81304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,180.07,,,,,,,fee schedule,150,545.19, Mecp2 gene dup/delet variant,81304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,477.04,,,,,,,fee schedule,150,545.19, Mecp2 gene dup/delet variant,81304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,545.19,,,,,,,fee schedule,150,545.19, Mecp2 gene dup/delet variant,81304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,156,,,,,,,fee schedule,150,545.19,APC Mecp2 gene dup/delet variant,81304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.5,,,,,,,fee schedule,150,545.19,APC Mecp2 gene dup/delet variant,81304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,150,,,,,,,fee schedule,150,545.19,APC Myd88 gene p.leu265pro vrnt,81305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,558.29,,,,,,,fee schedule,175.4,638.04, Myd88 gene p.leu265pro vrnt,81305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,638.04,,,,,,,fee schedule,175.4,638.04, Myd88 gene p.leu265pro vrnt,81305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.42,,,,,,,fee schedule,175.4,638.04,APC Myd88 gene p.leu265pro vrnt,81305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.17,,,,,,,fee schedule,175.4,638.04,APC Myd88 gene p.leu265pro vrnt,81305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.4,,,,,,,fee schedule,175.4,638.04,APC Nudt15 gene common variants,81306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,926.99,,,,,,,fee schedule,291.36,1059.42, Nudt15 gene common variants,81306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1059.42,,,,,,,fee schedule,291.36,1059.42, Nudt15 gene common variants,81306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.01,,,,,,,fee schedule,291.36,1059.42,APC Nudt15 gene common variants,81306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.93,,,,,,,fee schedule,291.36,1059.42,APC Nudt15 gene common variants,81306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.36,,,,,,,fee schedule,291.36,1059.42,APC Palb2 gene full gene seq,81307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2151.87,,,,,,,fee schedule,676.5,2459.28, Palb2 gene full gene seq,81307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2459.28,,,,,,,fee schedule,676.5,2459.28, Palb2 gene full gene seq,81307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,703.56,,,,,,,fee schedule,676.5,2459.28,APC Palb2 gene full gene seq,81307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,710.32,,,,,,,fee schedule,676.5,2459.28,APC Palb2 gene full gene seq,81307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,676.5,,,,,,,fee schedule,676.5,2459.28,APC Palb2 gene known famil vrnt,81308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,958.23,,,,,,,fee schedule,301.35,1095.12, Palb2 gene known famil vrnt,81308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1095.12,,,,,,,fee schedule,301.35,1095.12, Palb2 gene known famil vrnt,81308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.4,,,,,,,fee schedule,301.35,1095.12,APC Palb2 gene known famil vrnt,81308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.42,,,,,,,fee schedule,301.35,1095.12,APC Palb2 gene known famil vrnt,81308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.35,,,,,,,fee schedule,301.35,1095.12,APC Pik3ca gene trgt seq alys,81309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,998.7, Pik3ca gene trgt seq alys,81309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,998.7, Pik3ca gene trgt seq alys,81309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,998.7,APC Pik3ca gene trgt seq alys,81309,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,998.7,APC Pik3ca gene trgt seq alys,81309,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,998.7,APC Npm1 gene,81310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,148.23,,,,,,,fee schedule,148.23,896.34, Npm1 gene,81310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,166.93,,,,,,,fee schedule,148.23,896.34, Npm1 gene,81310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,784.3,,,,,,,fee schedule,148.23,896.34, Npm1 gene,81310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,896.34,,,,,,,fee schedule,148.23,896.34, Npm1 gene,81310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.38,,,,,,,fee schedule,148.23,896.34,APC Npm1 gene,81310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,258.85,,,,,,,fee schedule,148.23,896.34,APC Npm1 gene,81310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.52,,,,,,,fee schedule,148.23,896.34,APC Nras gene variants exon 2&3,81311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,961.32,,,,,,,fee schedule,295.79,1082.59, Nras gene variants exon 2&3,81311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1082.59,,,,,,,fee schedule,295.79,1082.59, Nras gene variants exon 2&3,81311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,940.54,,,,,,,fee schedule,295.79,1082.59, Nras gene variants exon 2&3,81311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1074.9,,,,,,,fee schedule,295.79,1082.59, Nras gene variants exon 2&3,81311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,307.62,,,,,,,fee schedule,295.79,1082.59,APC Nras gene variants exon 2&3,81311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,310.58,,,,,,,fee schedule,295.79,1082.59,APC Nras gene variants exon 2&3,81311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.79,,,,,,,fee schedule,295.79,1082.59,APC Pabpn1 gene detc abnor allel,81312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Pabpn1 gene detc abnor allel,81312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Pabpn1 gene detc abnor allel,81312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Pabpn1 gene detc abnor allel,81312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Pabpn1 gene detc abnor allel,81312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Pca3/klk3 antigen,81313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,845.85,,,,,,,fee schedule,255.05,952.55, Pca3/klk3 antigen,81313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,952.55,,,,,,,fee schedule,255.05,952.55, Pca3/klk3 antigen,81313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,811.39,,,,,,,fee schedule,255.05,952.55, Pca3/klk3 antigen,81313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,927.3,,,,,,,fee schedule,255.05,952.55, Pca3/klk3 antigen,81313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.25,,,,,,,fee schedule,255.05,952.55,APC Pca3/klk3 antigen,81313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.8,,,,,,,fee schedule,255.05,952.55,APC Pca3/klk3 antigen,81313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.05,,,,,,,fee schedule,255.05,952.55,APC Pdgfra gene,81314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1070.91,,,,,,,fee schedule,329.51,1206.01, Pdgfra gene,81314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1206.01,,,,,,,fee schedule,329.51,1206.01, Pdgfra gene,81314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1047.82,,,,,,,fee schedule,329.51,1206.01, Pdgfra gene,81314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1197.51,,,,,,,fee schedule,329.51,1206.01, Pdgfra gene,81314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,342.69,,,,,,,fee schedule,329.51,1206.01,APC Pdgfra gene,81314,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,345.99,,,,,,,fee schedule,329.51,1206.01,APC Pdgfra gene,81314,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,329.51,,,,,,,fee schedule,329.51,1206.01,APC Pml/raralpha com breakpoints,81315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.67,,,,,,,fee schedule,185.67,753.51, Pml/raralpha com breakpoints,81315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,209.1,,,,,,,fee schedule,185.67,753.51, Pml/raralpha com breakpoints,81315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,659.32,,,,,,,fee schedule,185.67,753.51, Pml/raralpha com breakpoints,81315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,753.51,,,,,,,fee schedule,185.67,753.51, Pml/raralpha com breakpoints,81315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.6,,,,,,,fee schedule,185.67,753.51,APC Pml/raralpha com breakpoints,81315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.68,,,,,,,fee schedule,185.67,753.51,APC Pml/raralpha com breakpoints,81315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,185.67,753.51,APC Pml/raralpha 1 breakpoint,81316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1402.02,,,,,,,fee schedule,207.31,1578.89, Pml/raralpha 1 breakpoint,81316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1578.89,,,,,,,fee schedule,207.31,1578.89, Pml/raralpha 1 breakpoint,81316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,659.32,,,,,,,fee schedule,207.31,1578.89, Pml/raralpha 1 breakpoint,81316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,753.51,,,,,,,fee schedule,207.31,1578.89, Pml/raralpha 1 breakpoint,81316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.6,,,,,,,fee schedule,207.31,1578.89,APC Pml/raralpha 1 breakpoint,81316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.68,,,,,,,fee schedule,207.31,1578.89,APC Pml/raralpha 1 breakpoint,81316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,207.31,1578.89,APC Pms2 gene full seq analysis,81317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4035.75,,,,,,,fee schedule,676.5,4544.88, Pms2 gene full seq analysis,81317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4544.88,,,,,,,fee schedule,676.5,4544.88, Pms2 gene full seq analysis,81317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2151.87,,,,,,,fee schedule,676.5,4544.88, Pms2 gene full seq analysis,81317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2459.28,,,,,,,fee schedule,676.5,4544.88, Pms2 gene full seq analysis,81317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,703.56,,,,,,,fee schedule,676.5,4544.88,APC Pms2 gene full seq analysis,81317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,710.32,,,,,,,fee schedule,676.5,4544.88,APC Pms2 gene full seq analysis,81317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,676.5,,,,,,,fee schedule,676.5,4544.88,APC Pms2 known familial variants,81318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325.68,,,,,,,fee schedule,325.68,1203.45, Pms2 known familial variants,81318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,366.77,,,,,,,fee schedule,325.68,1203.45, Pms2 known familial variants,81318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1053.02,,,,,,,fee schedule,325.68,1203.45, Pms2 known familial variants,81318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1203.45,,,,,,,fee schedule,325.68,1203.45, Pms2 known familial variants,81318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,344.24,,,,,,,fee schedule,325.68,1203.45,APC Pms2 known familial variants,81318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,347.55,,,,,,,fee schedule,325.68,1203.45,APC Pms2 known familial variants,81318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,331,,,,,,,fee schedule,325.68,1203.45,APC Pms2 gene dup/delet variants,81319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,720.4,,,,,,,fee schedule,203.5,811.28, Pms2 gene dup/delet variants,81319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,811.28,,,,,,,fee schedule,203.5,811.28, Pms2 gene dup/delet variants,81319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,646.8,,,,,,,fee schedule,203.5,811.28, Pms2 gene dup/delet variants,81319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,739.2,,,,,,,fee schedule,203.5,811.28, Pms2 gene dup/delet variants,81319,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,211.64,,,,,,,fee schedule,203.5,811.28,APC Pms2 gene dup/delet variants,81319,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,213.68,,,,,,,fee schedule,203.5,811.28,APC Pms2 gene dup/delet variants,81319,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,203.5,,,,,,,fee schedule,203.5,811.28,APC Plcg2 gene common variants,81320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,926.99,,,,,,,fee schedule,291.36,1059.42, Plcg2 gene common variants,81320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1059.42,,,,,,,fee schedule,291.36,1059.42, Plcg2 gene common variants,81320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.01,,,,,,,fee schedule,291.36,1059.42,APC Plcg2 gene common variants,81320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,305.93,,,,,,,fee schedule,291.36,1059.42,APC Plcg2 gene common variants,81320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,291.36,,,,,,,fee schedule,291.36,1059.42,APC Pten gene full sequence,81321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1523.15,,,,,,,fee schedule,600,2180.73, Pten gene full sequence,81321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1715.3,,,,,,,fee schedule,600,2180.73, Pten gene full sequence,81321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1908.14,,,,,,,fee schedule,600,2180.73, Pten gene full sequence,81321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2180.73,,,,,,,fee schedule,600,2180.73, Pten gene full sequence,81321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,624,,,,,,,fee schedule,600,2180.73,APC Pten gene full sequence,81321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,630,,,,,,,fee schedule,600,2180.73,APC Pten gene full sequence,81321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,600,,,,,,,fee schedule,600,2180.73,APC Pten gene known fam variant,81322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,189.8,,,,,,,fee schedule,46.6,213.74, Pten gene known fam variant,81322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,213.74,,,,,,,fee schedule,46.6,213.74, Pten gene known fam variant,81322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,147.89,,,,,,,fee schedule,46.6,213.74, Pten gene known fam variant,81322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,169.02,,,,,,,fee schedule,46.6,213.74, Pten gene known fam variant,81322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.46,,,,,,,fee schedule,46.6,213.74,APC Pten gene known fam variant,81322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48.93,,,,,,,fee schedule,46.6,213.74,APC Pten gene known fam variant,81322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.6,,,,,,,fee schedule,46.6,213.74,APC Pten gene dup/delet variant,81323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,232.57,,,,,,,fee schedule,232.57,1090.38, Pten gene dup/delet variant,81323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,261.91,,,,,,,fee schedule,232.57,1090.38, Pten gene dup/delet variant,81323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,954.08,,,,,,,fee schedule,232.57,1090.38, Pten gene dup/delet variant,81323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1090.38,,,,,,,fee schedule,232.57,1090.38, Pten gene dup/delet variant,81323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,312,,,,,,,fee schedule,232.57,1090.38,APC Pten gene dup/delet variant,81323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,315,,,,,,,fee schedule,232.57,1090.38,APC Pten gene dup/delet variant,81323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,300,,,,,,,fee schedule,232.57,1090.38,APC Pmp22 gene dup/delet,81324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2997.28,,,,,,,fee schedule,758.36,3375.4, Pmp22 gene dup/delet,81324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3375.4,,,,,,,fee schedule,758.36,3375.4, Pmp22 gene dup/delet,81324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2412.27,,,,,,,fee schedule,758.36,3375.4, Pmp22 gene dup/delet,81324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2756.88,,,,,,,fee schedule,758.36,3375.4, Pmp22 gene dup/delet,81324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,788.69,,,,,,,fee schedule,758.36,3375.4,APC Pmp22 gene dup/delet,81324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,796.28,,,,,,,fee schedule,758.36,3375.4,APC Pmp22 gene dup/delet,81324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,758.36,,,,,,,fee schedule,758.36,3375.4,APC Pmp22 gene full sequence,81325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2447.68,,,,,,,fee schedule,769.58,2797.35, Pmp22 gene full sequence,81325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2797.35,,,,,,,fee schedule,769.58,2797.35, Pmp22 gene full sequence,81325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,800.36,,,,,,,fee schedule,769.58,2797.35,APC Pmp22 gene full sequence,81325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,808.06,,,,,,,fee schedule,769.58,2797.35,APC Pmp22 gene full sequence,81325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,769.58,,,,,,,fee schedule,769.58,2797.35,APC Pmp22 gene known fam variant,81326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,147.89,,,,,,,fee schedule,46.6,169.02, Pmp22 gene known fam variant,81326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,169.02,,,,,,,fee schedule,46.6,169.02, Pmp22 gene known fam variant,81326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.46,,,,,,,fee schedule,46.6,169.02,APC Pmp22 gene known fam variant,81326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48.93,,,,,,,fee schedule,46.6,169.02,APC Pmp22 gene known fam variant,81326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.6,,,,,,,fee schedule,46.6,169.02,APC Sept9 methylation analysis,81327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,610.37,,,,,,,fee schedule,192,697.56, Sept9 methylation analysis,81327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,697.56,,,,,,,fee schedule,192,697.56, Sept9 methylation analysis,81327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.68,,,,,,,fee schedule,192,697.56,APC Sept9 methylation analysis,81327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.6,,,,,,,fee schedule,192,697.56,APC Sept9 methylation analysis,81327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,192,,,,,,,fee schedule,192,697.56,APC Slco1b1 gene com variants,81328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Slco1b1 gene com variants,81328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Slco1b1 gene com variants,81328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Slco1b1 gene com variants,81328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Slco1b1 gene com variants,81328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Smn1 gene dos/deletion alys,81329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Smn1 gene dos/deletion alys,81329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Smn1 gene dos/deletion alys,81329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Smn1 gene dos/deletion alys,81329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Smn1 gene dos/deletion alys,81329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Smpd1 gene common variants,81330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,454.22,,,,,,,fee schedule,47,511.52, Smpd1 gene common variants,81330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,511.52,,,,,,,fee schedule,47,511.52, Smpd1 gene common variants,81330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,149.99,,,,,,,fee schedule,47,511.52, Smpd1 gene common variants,81330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,171.42,,,,,,,fee schedule,47,511.52, Smpd1 gene common variants,81330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.88,,,,,,,fee schedule,47,511.52,APC Smpd1 gene common variants,81330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.35,,,,,,,fee schedule,47,511.52,APC Smpd1 gene common variants,81330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47,,,,,,,fee schedule,47,511.52,APC Snrpn/ube3a gene,81331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,151.71,,,,,,,fee schedule,51.07,185.7, Snrpn/ube3a gene,81331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,170.85,,,,,,,fee schedule,51.07,185.7, Snrpn/ube3a gene,81331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,162.49,,,,,,,fee schedule,51.07,185.7, Snrpn/ube3a gene,81331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,185.7,,,,,,,fee schedule,51.07,185.7, Snrpn/ube3a gene,81331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.11,,,,,,,fee schedule,51.07,185.7,APC Snrpn/ube3a gene,81331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.62,,,,,,,fee schedule,51.07,185.7,APC Snrpn/ube3a gene,81331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.07,,,,,,,fee schedule,51.07,185.7,APC Serpina1 gene,81332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,230.75,,,,,,,fee schedule,43.65,259.86, Serpina1 gene,81332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,259.86,,,,,,,fee schedule,43.65,259.86, Serpina1 gene,81332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,138.52,,,,,,,fee schedule,43.65,259.86, Serpina1 gene,81332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,158.31,,,,,,,fee schedule,43.65,259.86, Serpina1 gene,81332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.4,,,,,,,fee schedule,43.65,259.86,APC Serpina1 gene,81332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,45.83,,,,,,,fee schedule,43.65,259.86,APC Serpina1 gene,81332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,43.65,,,,,,,fee schedule,43.65,259.86,APC Tgfbi gene common variants,81333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Tgfbi gene common variants,81333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Tgfbi gene common variants,81333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Tgfbi gene common variants,81333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Tgfbi gene common variants,81333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Runx1 gene targeted seq alys,81334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1047.82,,,,,,,fee schedule,329.51,1197.51, Runx1 gene targeted seq alys,81334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1197.51,,,,,,,fee schedule,329.51,1197.51, Runx1 gene targeted seq alys,81334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,342.69,,,,,,,fee schedule,329.51,1197.51,APC Runx1 gene targeted seq alys,81334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,345.99,,,,,,,fee schedule,329.51,1197.51,APC Runx1 gene targeted seq alys,81334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,329.51,,,,,,,fee schedule,329.51,1197.51,APC Tpmt gene com variants,81335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Tpmt gene com variants,81335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Tpmt gene com variants,81335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Tpmt gene com variants,81335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Tpmt gene com variants,81335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Smn1 gene full gene sequence,81336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,958.23,,,,,,,fee schedule,301.35,1095.12, Smn1 gene full gene sequence,81336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1095.12,,,,,,,fee schedule,301.35,1095.12, Smn1 gene full gene sequence,81336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.4,,,,,,,fee schedule,301.35,1095.12,APC Smn1 gene full gene sequence,81336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.42,,,,,,,fee schedule,301.35,1095.12,APC Smn1 gene full gene sequence,81336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.35,,,,,,,fee schedule,301.35,1095.12,APC Smn1 gen nown famil seq vrnt,81337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Smn1 gen nown famil seq vrnt,81337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Smn1 gen nown famil seq vrnt,81337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Smn1 gen nown famil seq vrnt,81337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Smn1 gen nown famil seq vrnt,81337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Mpl gene common variants,81338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,478.09,,,,,,,fee schedule,150.33,546.39, Mpl gene common variants,81338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,546.39,,,,,,,fee schedule,150.33,546.39, Mpl gene common variants,81338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,156.34,,,,,,,fee schedule,150.33,546.39,APC Mpl gene common variants,81338,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.85,,,,,,,fee schedule,150.33,546.39,APC Mpl gene common variants,81338,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,150.33,,,,,,,fee schedule,150.33,546.39,APC Mpl gene seq alys exon 10,81339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Mpl gene seq alys exon 10,81339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Mpl gene seq alys exon 10,81339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Mpl gene seq alys exon 10,81339,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Mpl gene seq alys exon 10,81339,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Trb@ gene rearrange amplify,81340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1211.21,,,,,,,fee schedule,208.92,1364.01, Trb@ gene rearrange amplify,81340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1364.01,,,,,,,fee schedule,208.92,1364.01, Trb@ gene rearrange amplify,81340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,664.52,,,,,,,fee schedule,208.92,1364.01, Trb@ gene rearrange amplify,81340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,759.45,,,,,,,fee schedule,208.92,1364.01, Trb@ gene rearrange amplify,81340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,217.28,,,,,,,fee schedule,208.92,1364.01,APC Trb@ gene rearrange amplify,81340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,219.37,,,,,,,fee schedule,208.92,1364.01,APC Trb@ gene rearrange amplify,81340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,208.92,,,,,,,fee schedule,208.92,1364.01,APC Trb@ gene rearrange dirprobe,81341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,142.12,,,,,,,fee schedule,49.59,179.73, Trb@ gene rearrange dirprobe,81341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,160.05,,,,,,,fee schedule,49.59,179.73, Trb@ gene rearrange dirprobe,81341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,157.26,,,,,,,fee schedule,49.59,179.73, Trb@ gene rearrange dirprobe,81341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,179.73,,,,,,,fee schedule,49.59,179.73, Trb@ gene rearrange dirprobe,81341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,51.57,,,,,,,fee schedule,49.59,179.73,APC Trb@ gene rearrange dirprobe,81341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.07,,,,,,,fee schedule,49.59,179.73,APC Trb@ gene rearrange dirprobe,81341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.59,,,,,,,fee schedule,49.59,179.73,APC Trg gene rearrangement anal,81342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325.68,,,,,,,fee schedule,201.5,732.06, Trg gene rearrangement anal,81342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,366.77,,,,,,,fee schedule,201.5,732.06, Trg gene rearrangement anal,81342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,640.55,,,,,,,fee schedule,201.5,732.06, Trg gene rearrangement anal,81342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,732.06,,,,,,,fee schedule,201.5,732.06, Trg gene rearrangement anal,81342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.56,,,,,,,fee schedule,201.5,732.06,APC Trg gene rearrangement anal,81342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.58,,,,,,,fee schedule,201.5,732.06,APC Trg gene rearrangement anal,81342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.5,,,,,,,fee schedule,201.5,732.06,APC Ppp2r2b gen detc abnor allel,81343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Ppp2r2b gen detc abnor allel,81343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Ppp2r2b gen detc abnor allel,81343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Ppp2r2b gen detc abnor allel,81343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Ppp2r2b gen detc abnor allel,81343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Tbp gene detc abnor alleles,81344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Tbp gene detc abnor alleles,81344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Tbp gene detc abnor alleles,81344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Tbp gene detc abnor alleles,81344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Tbp gene detc abnor alleles,81344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Tert gene targeted seq alys,81345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Tert gene targeted seq alys,81345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Tert gene targeted seq alys,81345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Tert gene targeted seq alys,81345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Tert gene targeted seq alys,81345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Tyms gene com variants,81346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Tyms gene com variants,81346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Tyms gene com variants,81346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Tyms gene com variants,81346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Tyms gene com variants,81346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Sf3b1 gene common variants,81347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,614.51,,,,,,,fee schedule,193.25,702.3, Sf3b1 gene common variants,81347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,702.3,,,,,,,fee schedule,193.25,702.3, Sf3b1 gene common variants,81347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.98,,,,,,,fee schedule,193.25,702.3,APC Sf3b1 gene common variants,81347,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,202.91,,,,,,,fee schedule,193.25,702.3,APC Sf3b1 gene common variants,81347,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.25,,,,,,,fee schedule,193.25,702.3,APC Srsf2 gene common variants,81348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,558.29,,,,,,,fee schedule,175.4,638.04, Srsf2 gene common variants,81348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,638.04,,,,,,,fee schedule,175.4,638.04, Srsf2 gene common variants,81348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.42,,,,,,,fee schedule,175.4,638.04,APC Srsf2 gene common variants,81348,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.17,,,,,,,fee schedule,175.4,638.04,APC Srsf2 gene common variants,81348,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.4,,,,,,,fee schedule,175.4,638.04,APC Cytog alys chrml abnr lw-ps,81349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3690.28,,,,,,,fee schedule,1197.94,4217.46, Cytog alys chrml abnr lw-ps,81349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4217.46,,,,,,,fee schedule,1197.94,4217.46, Cytog alys chrml abnr lw-ps,81349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1245.86,,,,,,,fee schedule,1197.94,4217.46,APC Cytog alys chrml abnr lw-ps,81349,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1257.84,,,,,,,fee schedule,1197.94,4217.46,APC Cytog alys chrml abnr lw-ps,81349,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1197.94,,,,,,,fee schedule,1197.94,4217.46,APC Ugt1a1 gene,81350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,249.5,,,,,,,fee schedule,234,851.1, Ugt1a1 gene,81350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,280.98,,,,,,,fee schedule,234,851.1, Ugt1a1 gene,81350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,744.71,,,,,,,fee schedule,234,851.1, Ugt1a1 gene,81350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,851.1,,,,,,,fee schedule,234,851.1, Ugt1a1 gene,81350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,243.36,,,,,,,fee schedule,234,851.1,APC Ugt1a1 gene,81350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,245.7,,,,,,,fee schedule,234,851.1,APC Ugt1a1 gene,81350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,234,,,,,,,fee schedule,234,851.1,APC Tp53 gene full gene sequence,81351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2041.46,,,,,,,fee schedule,641.85,2333.1, Tp53 gene full gene sequence,81351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2333.1,,,,,,,fee schedule,641.85,2333.1, Tp53 gene full gene sequence,81351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,667.52,,,,,,,fee schedule,641.85,2333.1,APC Tp53 gene full gene sequence,81351,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,673.94,,,,,,,fee schedule,641.85,2333.1,APC Tp53 gene full gene sequence,81351,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,641.85,,,,,,,fee schedule,641.85,2333.1,APC Tp53 gene trgt sequence alys,81352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1047.82,,,,,,,fee schedule,329.51,1197.51, Tp53 gene trgt sequence alys,81352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1197.51,,,,,,,fee schedule,329.51,1197.51, Tp53 gene trgt sequence alys,81352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,342.69,,,,,,,fee schedule,329.51,1197.51,APC Tp53 gene trgt sequence alys,81352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,345.99,,,,,,,fee schedule,329.51,1197.51,APC Tp53 gene trgt sequence alys,81352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,329.51,,,,,,,fee schedule,329.51,1197.51,APC Tp53 gene known famil vrnt,81353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,980.12,,,,,,,fee schedule,308,1120.14, Tp53 gene known famil vrnt,81353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1120.14,,,,,,,fee schedule,308,1120.14, Tp53 gene known famil vrnt,81353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,320.32,,,,,,,fee schedule,308,1120.14,APC Tp53 gene known famil vrnt,81353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,323.4,,,,,,,fee schedule,308,1120.14,APC Tp53 gene known famil vrnt,81353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,308,,,,,,,fee schedule,308,1120.14,APC Cytog alys chrml abnor ogm,81354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1314.07,,,,,,,fee schedule,1263.53,1326.71,APC Cytog alys chrml abnor ogm,81354,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1326.71,,,,,,,fee schedule,1263.53,1326.71,APC Cytog alys chrml abnor ogm,81354,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1263.53,,,,,,,fee schedule,1263.53,1326.71,APC Vkorc1 gene,81355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,157.07,,,,,,,fee schedule,88.2,320.22, Vkorc1 gene,81355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,176.89,,,,,,,fee schedule,88.2,320.22, Vkorc1 gene,81355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,280.19,,,,,,,fee schedule,88.2,320.22, Vkorc1 gene,81355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,320.22,,,,,,,fee schedule,88.2,320.22, Vkorc1 gene,81355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,91.73,,,,,,,fee schedule,88.2,320.22,APC Vkorc1 gene,81355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92.61,,,,,,,fee schedule,88.2,320.22,APC Vkorc1 gene,81355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,88.2,,,,,,,fee schedule,88.2,320.22,APC U2af1 gene common variants,81357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,614.51,,,,,,,fee schedule,193.25,702.3, U2af1 gene common variants,81357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,702.3,,,,,,,fee schedule,193.25,702.3, U2af1 gene common variants,81357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.98,,,,,,,fee schedule,193.25,702.3,APC U2af1 gene common variants,81357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,202.91,,,,,,,fee schedule,193.25,702.3,APC U2af1 gene common variants,81357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.25,,,,,,,fee schedule,193.25,702.3,APC Zrsr2 gene common variants,81360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,614.51,,,,,,,fee schedule,193.25,702.3, Zrsr2 gene common variants,81360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,702.3,,,,,,,fee schedule,193.25,702.3, Zrsr2 gene common variants,81360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.98,,,,,,,fee schedule,193.25,702.3,APC Zrsr2 gene common variants,81360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,202.91,,,,,,,fee schedule,193.25,702.3,APC Zrsr2 gene common variants,81360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.25,,,,,,,fee schedule,193.25,702.3,APC Hbb gene com variants,81361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.19,,,,,,,fee schedule,174.81,635.64, Hbb gene com variants,81361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,635.64,,,,,,,fee schedule,174.81,635.64, Hbb gene com variants,81361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.8,,,,,,,fee schedule,174.81,635.64,APC Hbb gene com variants,81361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.55,,,,,,,fee schedule,174.81,635.64,APC Hbb gene com variants,81361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.81,,,,,,,fee schedule,174.81,635.64,APC Hbb gene known fam variant,81362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1193.64,,,,,,,fee schedule,375.25,1364.16, Hbb gene known fam variant,81362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1364.16,,,,,,,fee schedule,375.25,1364.16, Hbb gene known fam variant,81362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,390.26,,,,,,,fee schedule,375.25,1364.16,APC Hbb gene known fam variant,81362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,394.01,,,,,,,fee schedule,375.25,1364.16,APC Hbb gene known fam variant,81362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,375.25,,,,,,,fee schedule,375.25,1364.16,APC Hbb gene dup/del variants,81363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,643.68,,,,,,,fee schedule,202.4,735.63, Hbb gene dup/del variants,81363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,735.63,,,,,,,fee schedule,202.4,735.63, Hbb gene dup/del variants,81363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,210.5,,,,,,,fee schedule,202.4,735.63,APC Hbb gene dup/del variants,81363,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,212.52,,,,,,,fee schedule,202.4,735.63,APC Hbb gene dup/del variants,81363,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,202.4,,,,,,,fee schedule,202.4,735.63,APC Hbb full gene sequence,81364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1032.2,,,,,,,fee schedule,324.58,1179.66, Hbb full gene sequence,81364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1179.66,,,,,,,fee schedule,324.58,1179.66, Hbb full gene sequence,81364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,337.56,,,,,,,fee schedule,324.58,1179.66,APC Hbb full gene sequence,81364,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,340.81,,,,,,,fee schedule,324.58,1179.66,APC Hbb full gene sequence,81364,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,324.58,,,,,,,fee schedule,324.58,1179.66,APC Hla i & ii typing lr,81370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,878.51,,,,,,,fee schedule,402.12,1461.75, Hla i & ii typing lr,81370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,989.33,,,,,,,fee schedule,402.12,1461.75, Hla i & ii typing lr,81370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1279.03,,,,,,,fee schedule,402.12,1461.75, Hla i & ii typing lr,81370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1461.75,,,,,,,fee schedule,402.12,1461.75, Hla i & ii typing lr,81370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,418.2,,,,,,,fee schedule,402.12,1461.75,APC Hla i & ii typing lr,81370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,422.23,,,,,,,fee schedule,402.12,1461.75,APC Hla i & ii typing lr,81370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,402.12,,,,,,,fee schedule,402.12,1461.75,APC Hla i & ii type verify lr,81371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1067.17,,,,,,,fee schedule,404.52,1470.09, Hla i & ii type verify lr,81371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1201.8,,,,,,,fee schedule,404.52,1470.09, Hla i & ii type verify lr,81371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1286.33,,,,,,,fee schedule,404.52,1470.09, Hla i & ii type verify lr,81371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1470.09,,,,,,,fee schedule,404.52,1470.09, Hla i & ii type verify lr,81371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,420.7,,,,,,,fee schedule,404.52,1470.09,APC Hla i & ii type verify lr,81371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,424.75,,,,,,,fee schedule,404.52,1470.09,APC Hla i & ii type verify lr,81371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,404.52,,,,,,,fee schedule,404.52,1470.09,APC Hla i typing complete lr,81372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1587.72,,,,,,,fee schedule,403.59,1788.02, Hla i typing complete lr,81372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1788.02,,,,,,,fee schedule,403.59,1788.02, Hla i typing complete lr,81372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1284.26,,,,,,,fee schedule,403.59,1788.02, Hla i typing complete lr,81372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1467.72,,,,,,,fee schedule,403.59,1788.02, Hla i typing complete lr,81372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,419.73,,,,,,,fee schedule,403.59,1788.02,APC Hla i typing complete lr,81372,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,423.77,,,,,,,fee schedule,403.59,1788.02,APC Hla i typing complete lr,81372,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,403.59,,,,,,,fee schedule,403.59,1788.02,APC Hla i typing 1 locus lr,81373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,538.14,,,,,,,fee schedule,127.43,606.02, Hla i typing 1 locus lr,81373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,606.02,,,,,,,fee schedule,127.43,606.02, Hla i typing 1 locus lr,81373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,405.17,,,,,,,fee schedule,127.43,606.02, Hla i typing 1 locus lr,81373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,463.05,,,,,,,fee schedule,127.43,606.02, Hla i typing 1 locus lr,81373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,132.53,,,,,,,fee schedule,127.43,606.02,APC Hla i typing 1 locus lr,81373,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,133.8,,,,,,,fee schedule,127.43,606.02,APC Hla i typing 1 locus lr,81373,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,127.43,,,,,,,fee schedule,127.43,606.02,APC Hla i typing 1 antigen lr,81374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,538.14,,,,,,,fee schedule,74.33,606.02, Hla i typing 1 antigen lr,81374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,606.02,,,,,,,fee schedule,74.33,606.02, Hla i typing 1 antigen lr,81374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,236.43,,,,,,,fee schedule,74.33,606.02, Hla i typing 1 antigen lr,81374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,270.21,,,,,,,fee schedule,74.33,606.02, Hla i typing 1 antigen lr,81374,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.3,,,,,,,fee schedule,74.33,606.02,APC Hla i typing 1 antigen lr,81374,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.05,,,,,,,fee schedule,74.33,606.02,APC Hla i typing 1 antigen lr,81374,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.33,,,,,,,fee schedule,74.33,606.02,APC Hla ii typing ag equiv lr,81375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,594,,,,,,,fee schedule,220.74,802.29, Hla ii typing ag equiv lr,81375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,668.94,,,,,,,fee schedule,220.74,802.29, Hla ii typing ag equiv lr,81375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,702,,,,,,,fee schedule,220.74,802.29, Hla ii typing ag equiv lr,81375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,802.29,,,,,,,fee schedule,220.74,802.29, Hla ii typing ag equiv lr,81375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,229.57,,,,,,,fee schedule,220.74,802.29,APC Hla ii typing ag equiv lr,81375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,231.78,,,,,,,fee schedule,220.74,802.29,APC Hla ii typing ag equiv lr,81375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,220.74,,,,,,,fee schedule,220.74,802.29,APC Hla ii typing 1 locus lr,81376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,327.08,,,,,,,fee schedule,122.22,444, Hla ii typing 1 locus lr,81376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,368.34,,,,,,,fee schedule,122.22,444, Hla ii typing 1 locus lr,81376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,388.5,,,,,,,fee schedule,122.22,444, Hla ii typing 1 locus lr,81376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444,,,,,,,fee schedule,122.22,444, Hla ii typing 1 locus lr,81376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,127.11,,,,,,,fee schedule,122.22,444,APC Hla ii typing 1 locus lr,81376,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,128.33,,,,,,,fee schedule,122.22,444,APC Hla ii typing 1 locus lr,81376,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,122.22,,,,,,,fee schedule,122.22,444,APC Hla ii type 1 ag equiv lr,81377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,255.74,,,,,,,fee schedule,94.74,344.01, Hla ii type 1 ag equiv lr,81377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,288.01,,,,,,,fee schedule,94.74,344.01, Hla ii type 1 ag equiv lr,81377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,301.01,,,,,,,fee schedule,94.74,344.01, Hla ii type 1 ag equiv lr,81377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,344.01,,,,,,,fee schedule,94.74,344.01, Hla ii type 1 ag equiv lr,81377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,98.53,,,,,,,fee schedule,94.74,344.01,APC Hla ii type 1 ag equiv lr,81377,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,99.48,,,,,,,fee schedule,94.74,344.01,APC Hla ii type 1 ag equiv lr,81377,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,94.74,,,,,,,fee schedule,94.74,344.01,APC Hla i & ii typing hr,81378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1532.18,,,,,,,fee schedule,345.57,1725.47, Hla i & ii typing hr,81378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1725.47,,,,,,,fee schedule,345.57,1725.47, Hla i & ii typing hr,81378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1098.85,,,,,,,fee schedule,345.57,1725.47, Hla i & ii typing hr,81378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1255.83,,,,,,,fee schedule,345.57,1725.47, Hla i & ii typing hr,81378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,359.39,,,,,,,fee schedule,345.57,1725.47,APC Hla i & ii typing hr,81378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,362.85,,,,,,,fee schedule,345.57,1725.47,APC Hla i & ii typing hr,81378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,345.57,,,,,,,fee schedule,345.57,1725.47,APC Hla i typing complete hr,81379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,752.08,,,,,,,fee schedule,335.38,1218.93, Hla i typing complete hr,81379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,846.96,,,,,,,fee schedule,335.38,1218.93, Hla i typing complete hr,81379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1066.56,,,,,,,fee schedule,335.38,1218.93, Hla i typing complete hr,81379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1218.93,,,,,,,fee schedule,335.38,1218.93, Hla i typing complete hr,81379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,348.8,,,,,,,fee schedule,335.38,1218.93,APC Hla i typing complete hr,81379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,352.15,,,,,,,fee schedule,335.38,1218.93,APC Hla i typing complete hr,81379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,335.38,,,,,,,fee schedule,335.38,1218.93,APC Hla i typing 1 locus hr,81380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,473.56,,,,,,,fee schedule,177.25,643.98, Hla i typing 1 locus hr,81380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,533.3,,,,,,,fee schedule,177.25,643.98, Hla i typing 1 locus hr,81380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,563.48,,,,,,,fee schedule,177.25,643.98, Hla i typing 1 locus hr,81380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,643.98,,,,,,,fee schedule,177.25,643.98, Hla i typing 1 locus hr,81380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,184.34,,,,,,,fee schedule,177.25,643.98,APC Hla i typing 1 locus hr,81380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,186.11,,,,,,,fee schedule,177.25,643.98,APC Hla i typing 1 locus hr,81380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,177.25,,,,,,,fee schedule,177.25,643.98,APC Hla i typing 1 allele hr,81381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,516.62,,,,,,,fee schedule,169.9,617.79, Hla i typing 1 allele hr,81381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,581.79,,,,,,,fee schedule,169.9,617.79, Hla i typing 1 allele hr,81381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,540.57,,,,,,,fee schedule,169.9,617.79, Hla i typing 1 allele hr,81381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,617.79,,,,,,,fee schedule,169.9,617.79, Hla i typing 1 allele hr,81381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,176.7,,,,,,,fee schedule,169.9,617.79,APC Hla i typing 1 allele hr,81381,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,178.4,,,,,,,fee schedule,169.9,617.79,APC Hla i typing 1 allele hr,81381,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,169.9,,,,,,,fee schedule,169.9,617.79,APC Hla ii typing 1 loc hr,81382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,305.96,,,,,,,fee schedule,123.68,449.97, Hla ii typing 1 loc hr,81382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,344.55,,,,,,,fee schedule,123.68,449.97, Hla ii typing 1 loc hr,81382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,393.72,,,,,,,fee schedule,123.68,449.97, Hla ii typing 1 loc hr,81382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,449.97,,,,,,,fee schedule,123.68,449.97, Hla ii typing 1 loc hr,81382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.63,,,,,,,fee schedule,123.68,449.97,APC Hla ii typing 1 loc hr,81382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.86,,,,,,,fee schedule,123.68,449.97,APC Hla ii typing 1 loc hr,81382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.68,,,,,,,fee schedule,123.68,449.97,APC Hla ii typing 1 allele hr,81383,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,230.36,,,,,,,fee schedule,109.13,396.39, Hla ii typing 1 allele hr,81383,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,259.42,,,,,,,fee schedule,109.13,396.39, Hla ii typing 1 allele hr,81383,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,346.84,,,,,,,fee schedule,109.13,396.39, Hla ii typing 1 allele hr,81383,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,396.39,,,,,,,fee schedule,109.13,396.39, Hla ii typing 1 allele hr,81383,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,113.5,,,,,,,fee schedule,109.13,396.39,APC Hla ii typing 1 allele hr,81383,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,114.59,,,,,,,fee schedule,109.13,396.39,APC Hla ii typing 1 allele hr,81383,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,109.13,,,,,,,fee schedule,109.13,396.39,APC Mopath procedure level 1,81400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,207.74,,,,,,,fee schedule,63.96,233.95, Mopath procedure level 1,81400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,233.95,,,,,,,fee schedule,63.96,233.95, Mopath procedure level 1,81400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,203.1,,,,,,,fee schedule,63.96,233.95, Mopath procedure level 1,81400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,232.11,,,,,,,fee schedule,63.96,233.95, Mopath procedure level 1,81400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.52,,,,,,,fee schedule,63.96,233.95,APC Mopath procedure level 1,81400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.16,,,,,,,fee schedule,63.96,233.95,APC Mopath procedure level 1,81400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,63.96,,,,,,,fee schedule,63.96,233.95,APC Mopath procedure level 2,81401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,357.25,,,,,,,fee schedule,137,497.58, Mopath procedure level 2,81401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,402.32,,,,,,,fee schedule,137,497.58, Mopath procedure level 2,81401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,435.38,,,,,,,fee schedule,137,497.58, Mopath procedure level 2,81401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.58,,,,,,,fee schedule,137,497.58, Mopath procedure level 2,81401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.48,,,,,,,fee schedule,137,497.58,APC Mopath procedure level 2,81401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,137,497.58,APC Mopath procedure level 2,81401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137,,,,,,,fee schedule,137,497.58,APC Mopath procedure level 3,81402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,983.65,,,,,,,fee schedule,150.33,1107.74, Mopath procedure level 3,81402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1107.74,,,,,,,fee schedule,150.33,1107.74, Mopath procedure level 3,81402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,478.09,,,,,,,fee schedule,150.33,1107.74, Mopath procedure level 3,81402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,546.39,,,,,,,fee schedule,150.33,1107.74, Mopath procedure level 3,81402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,156.34,,,,,,,fee schedule,150.33,1107.74,APC Mopath procedure level 3,81402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.85,,,,,,,fee schedule,150.33,1107.74,APC Mopath procedure level 3,81402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,150.33,,,,,,,fee schedule,150.33,1107.74,APC Mopath procedure level 4,81403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,560.3,,,,,,,fee schedule,185.2,673.74, Mopath procedure level 4,81403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,630.98,,,,,,,fee schedule,185.2,673.74, Mopath procedure level 4,81403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,589.52,,,,,,,fee schedule,185.2,673.74, Mopath procedure level 4,81403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,673.74,,,,,,,fee schedule,185.2,673.74, Mopath procedure level 4,81403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.61,,,,,,,fee schedule,185.2,673.74,APC Mopath procedure level 4,81403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.46,,,,,,,fee schedule,185.2,673.74,APC Mopath procedure level 4,81403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.2,,,,,,,fee schedule,185.2,673.74,APC Mopath procedure level 5,81404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1259.83,,,,,,,fee schedule,274.83,1418.76, Mopath procedure level 5,81404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1418.76,,,,,,,fee schedule,274.83,1418.76, Mopath procedure level 5,81404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,873.86,,,,,,,fee schedule,274.83,1418.76, Mopath procedure level 5,81404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,998.7,,,,,,,fee schedule,274.83,1418.76, Mopath procedure level 5,81404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,285.82,,,,,,,fee schedule,274.83,1418.76,APC Mopath procedure level 5,81404,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.57,,,,,,,fee schedule,274.83,1418.76,APC Mopath procedure level 5,81404,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,274.83,,,,,,,fee schedule,274.83,1418.76,APC Mopath procedure level 6,81405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1064.18,,,,,,,fee schedule,301.35,1198.43, Mopath procedure level 6,81405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1198.43,,,,,,,fee schedule,301.35,1198.43, Mopath procedure level 6,81405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,958.23,,,,,,,fee schedule,301.35,1198.43, Mopath procedure level 6,81405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1095.12,,,,,,,fee schedule,301.35,1198.43, Mopath procedure level 6,81405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.4,,,,,,,fee schedule,301.35,1198.43,APC Mopath procedure level 6,81405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.42,,,,,,,fee schedule,301.35,1198.43,APC Mopath procedure level 6,81405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.35,,,,,,,fee schedule,301.35,1198.43,APC Mopath procedure level 7,81406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2309.91,,,,,,,fee schedule,282.88,2601.31, Mopath procedure level 7,81406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2601.31,,,,,,,fee schedule,282.88,2601.31, Mopath procedure level 7,81406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,899.9,,,,,,,fee schedule,282.88,2601.31, Mopath procedure level 7,81406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1028.46,,,,,,,fee schedule,282.88,2601.31, Mopath procedure level 7,81406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,294.2,,,,,,,fee schedule,282.88,2601.31,APC Mopath procedure level 7,81406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,297.02,,,,,,,fee schedule,282.88,2601.31,APC Mopath procedure level 7,81406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,282.88,,,,,,,fee schedule,282.88,2601.31,APC Mopath procedure level 8,81407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3444.22,,,,,,,fee schedule,846.27,3878.72, Mopath procedure level 8,81407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3878.72,,,,,,,fee schedule,846.27,3878.72, Mopath procedure level 8,81407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2691.41,,,,,,,fee schedule,846.27,3878.72, Mopath procedure level 8,81407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3075.9,,,,,,,fee schedule,846.27,3878.72, Mopath procedure level 8,81407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,880.12,,,,,,,fee schedule,846.27,3878.72,APC Mopath procedure level 8,81407,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,888.58,,,,,,,fee schedule,846.27,3878.72,APC Mopath procedure level 8,81407,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,846.27,,,,,,,fee schedule,846.27,3878.72,APC Mopath procedure level 9,81408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8059.16,,,,,,,fee schedule,2000,9075.85, Mopath procedure level 9,81408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9075.85,,,,,,,fee schedule,2000,9075.85, Mopath procedure level 9,81408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6361.87,,,,,,,fee schedule,2000,9075.85, Mopath procedure level 9,81408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7270.71,,,,,,,fee schedule,2000,9075.85, Mopath procedure level 9,81408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2080,,,,,,,fee schedule,2000,9075.85,APC Mopath procedure level 9,81408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2100,,,,,,,fee schedule,2000,9075.85,APC Mopath procedure level 9,81408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2000,,,,,,,fee schedule,2000,9075.85,APC Aortic dysfunction/dilation,81410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1602.98,,,,,,,fee schedule,504,1831.98, Aortic dysfunction/dilation,81410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1831.98,,,,,,,fee schedule,504,1831.98, Aortic dysfunction/dilation,81410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,524.16,,,,,,,fee schedule,504,1831.98,APC Aortic dysfunction/dilation,81410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,529.2,,,,,,,fee schedule,504,1831.98,APC Aortic dysfunction/dilation,81410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,504,,,,,,,fee schedule,504,1831.98,APC Aortic dysfunction/dilation,81411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4294.37,,,,,,,fee schedule,1350.19,4907.85, Aortic dysfunction/dilation,81411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4907.85,,,,,,,fee schedule,1350.19,4907.85, Aortic dysfunction/dilation,81411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1404.2,,,,,,,fee schedule,1350.19,4907.85,APC Aortic dysfunction/dilation,81411,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1417.7,,,,,,,fee schedule,1350.19,4907.85,APC Aortic dysfunction/dilation,81411,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1350.19,,,,,,,fee schedule,1350.19,4907.85,APC Ashkenazi jewish assoc dis,81412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7788.82,,,,,,,fee schedule,2448.56,8901.51, Ashkenazi jewish assoc dis,81412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8901.51,,,,,,,fee schedule,2448.56,8901.51, Ashkenazi jewish assoc dis,81412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2546.5,,,,,,,fee schedule,2448.56,8901.51,APC Ashkenazi jewish assoc dis,81412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2570.99,,,,,,,fee schedule,2448.56,8901.51,APC Ashkenazi jewish assoc dis,81412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2448.56,,,,,,,fee schedule,2448.56,8901.51,APC Car ion chnnlpath inc 10 gns,81413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3900,,,,,,,fee schedule,584.9,4392, Car ion chnnlpath inc 10 gns,81413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4392,,,,,,,fee schedule,584.9,4392, Car ion chnnlpath inc 10 gns,81413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,584.9,4392, Car ion chnnlpath inc 10 gns,81413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,584.9,4392, Car ion chnnlpath inc 10 gns,81413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,608.3,,,,,,,fee schedule,584.9,4392,APC Car ion chnnlpath inc 10 gns,81413,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,614.14,,,,,,,fee schedule,584.9,4392,APC Car ion chnnlpath inc 10 gns,81413,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.9,,,,,,,fee schedule,584.9,4392,APC Car ion chnnlpath inc 2 gns,81414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,584.9,2125.98, Car ion chnnlpath inc 2 gns,81414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,584.9,2125.98, Car ion chnnlpath inc 2 gns,81414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,608.3,,,,,,,fee schedule,584.9,2125.98,APC Car ion chnnlpath inc 2 gns,81414,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,614.14,,,,,,,fee schedule,584.9,2125.98,APC Car ion chnnlpath inc 2 gns,81414,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.9,,,,,,,fee schedule,584.9,2125.98,APC Exome sequence analysis,81415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15204.79,,,,,,,fee schedule,4780,17376.9, Exome sequence analysis,81415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17376.9,,,,,,,fee schedule,4780,17376.9, Exome sequence analysis,81415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4971.2,,,,,,,fee schedule,4780,17376.9,APC Exome sequence analysis,81415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5019,,,,,,,fee schedule,4780,17376.9,APC Exome sequence analysis,81415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4780,,,,,,,fee schedule,4780,17376.9,APC Exome sequence analysis,81416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38171.31,,,,,,,fee schedule,12000,43624.35, Exome sequence analysis,81416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,43624.35,,,,,,,fee schedule,12000,43624.35, Exome sequence analysis,81416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12480,,,,,,,fee schedule,12000,43624.35,APC Exome sequence analysis,81416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12600,,,,,,,fee schedule,12000,43624.35,APC Exome sequence analysis,81416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12000,,,,,,,fee schedule,12000,43624.35,APC Exome re-evaluation,81417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1017.61,,,,,,,fee schedule,320,1162.98, Exome re-evaluation,81417,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1162.98,,,,,,,fee schedule,320,1162.98, Exome re-evaluation,81417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,332.8,,,,,,,fee schedule,320,1162.98,APC Exome re-evaluation,81417,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,336,,,,,,,fee schedule,320,1162.98,APC Exome re-evaluation,81417,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,320,,,,,,,fee schedule,320,1162.98,APC Rx metab gen seq alys pnl 6,81418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2917.43,,,,,,,fee schedule,917.08,3334.2, Rx metab gen seq alys pnl 6,81418,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3334.2,,,,,,,fee schedule,917.08,3334.2, Rx metab gen seq alys pnl 6,81418,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,953.76,,,,,,,fee schedule,917.08,3334.2,APC Rx metab gen seq alys pnl 6,81418,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,962.93,,,,,,,fee schedule,917.08,3334.2,APC Rx metab gen seq alys pnl 6,81418,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,917.08,,,,,,,fee schedule,917.08,3334.2,APC Epilepsy gen seq alys panel,81419,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7788.82,,,,,,,fee schedule,2448.56,8901.51, Epilepsy gen seq alys panel,81419,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8901.51,,,,,,,fee schedule,2448.56,8901.51, Epilepsy gen seq alys panel,81419,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2546.5,,,,,,,fee schedule,2448.56,8901.51,APC Epilepsy gen seq alys panel,81419,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2570.99,,,,,,,fee schedule,2448.56,8901.51,APC Epilepsy gen seq alys panel,81419,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2448.56,,,,,,,fee schedule,2448.56,8901.51,APC Fetal chrmoml aneuploidy,81420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2414.34,,,,,,,fee schedule,759.05,2759.25, Fetal chrmoml aneuploidy,81420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2759.25,,,,,,,fee schedule,759.05,2759.25, Fetal chrmoml aneuploidy,81420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,2759.25,APC Fetal chrmoml aneuploidy,81420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,2759.25,APC Fetal chrmoml aneuploidy,81420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,2759.25,APC Fetal chrmoml microdeltj,81422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2414.34,,,,,,,fee schedule,759.05,2759.25, Fetal chrmoml microdeltj,81422,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2759.25,,,,,,,fee schedule,759.05,2759.25, Fetal chrmoml microdeltj,81422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.41,,,,,,,fee schedule,759.05,2759.25,APC Fetal chrmoml microdeltj,81422,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797,,,,,,,fee schedule,759.05,2759.25,APC Fetal chrmoml microdeltj,81422,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.05,,,,,,,fee schedule,759.05,2759.25,APC Genome sequence analysis,81425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16003.65,,,,,,,fee schedule,5031.2,18289.89, Genome sequence analysis,81425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18289.89,,,,,,,fee schedule,5031.2,18289.89, Genome sequence analysis,81425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5232.45,,,,,,,fee schedule,5031.2,18289.89,APC Genome sequence analysis,81425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5282.76,,,,,,,fee schedule,5031.2,18289.89,APC Genome sequence analysis,81425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5031.2,,,,,,,fee schedule,5031.2,18289.89,APC Genome sequence analysis,81426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8620,,,,,,,fee schedule,2709.95,9851.43, Genome sequence analysis,81426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9851.43,,,,,,,fee schedule,2709.95,9851.43, Genome sequence analysis,81426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2818.35,,,,,,,fee schedule,2709.95,9851.43,APC Genome sequence analysis,81426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2845.45,,,,,,,fee schedule,2709.95,9851.43,APC Genome sequence analysis,81426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2709.95,,,,,,,fee schedule,2709.95,9851.43,APC Genome re-evaluation,81427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7435.73,,,,,,,fee schedule,2337.65,8497.98, Genome re-evaluation,81427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8497.98,,,,,,,fee schedule,2337.65,8497.98, Genome re-evaluation,81427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2431.16,,,,,,,fee schedule,2337.65,8497.98,APC Genome re-evaluation,81427,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2454.53,,,,,,,fee schedule,2337.65,8497.98,APC Genome re-evaluation,81427,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2337.65,,,,,,,fee schedule,2337.65,8497.98,APC Hearing loss sequence analys,81430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5169.28,,,,,,,fee schedule,1625,5907.75, Hearing loss sequence analys,81430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5907.75,,,,,,,fee schedule,1625,5907.75, Hearing loss sequence analys,81430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1690,,,,,,,fee schedule,1625,5907.75,APC Hearing loss sequence analys,81430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1706.25,,,,,,,fee schedule,1625,5907.75,APC Hearing loss sequence analys,81430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1625,,,,,,,fee schedule,1625,5907.75,APC Hearing loss dup/del analys,81431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2161.24,,,,,,,fee schedule,679.57,2469.99, Hearing loss dup/del analys,81431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2469.99,,,,,,,fee schedule,679.57,2469.99, Hearing loss dup/del analys,81431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,706.75,,,,,,,fee schedule,679.57,2469.99,APC Hearing loss dup/del analys,81431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,713.55,,,,,,,fee schedule,679.57,2469.99,APC Hearing loss dup/del analys,81431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,679.57,,,,,,,fee schedule,679.57,2469.99,APC Hrdtry brst ca-rlatd dsordrs,81432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2160.22,,,,,,,fee schedule,1303.95,2468.82, Hrdtry brst ca-rlatd dsordrs,81432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2468.82,,,,,,,fee schedule,1303.95,2468.82, Hrdtry brst ca-rlatd dsordrs,81432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1356.11,,,,,,,fee schedule,1303.95,2468.82,APC Hrdtry brst ca-rlatd dsordrs,81432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1369.15,,,,,,,fee schedule,1303.95,2468.82,APC Hrdtry brst ca-rlatd dsordrs,81432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1303.95,,,,,,,fee schedule,1303.95,2468.82,APC Hrdtry brst ca-rlatd dsordrs,81433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1395.69,,,,,,,fee schedule,1395.69,1595.07, Hrdtry brst ca-rlatd dsordrs,81433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1595.07,,,,,,,fee schedule,1395.69,1595.07, Hereditary retinal disorders,81434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1901.89,,,,,,,fee schedule,597.91,2173.59, Hereditary retinal disorders,81434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2173.59,,,,,,,fee schedule,597.91,2173.59, Hereditary retinal disorders,81434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.83,,,,,,,fee schedule,597.91,2173.59,APC Hereditary retinal disorders,81434,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.81,,,,,,,fee schedule,597.91,2173.59,APC Hereditary retinal disorders,81434,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.91,,,,,,,fee schedule,597.91,2173.59,APC Hereditary colon ca dsordrs,81435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2589.44,,,,,,,fee schedule,1303.95,2916.11, Hereditary colon ca dsordrs,81435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2916.11,,,,,,,fee schedule,1303.95,2916.11, Hereditary colon ca dsordrs,81435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,1303.95,2916.11, Hereditary colon ca dsordrs,81435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,1303.95,2916.11, Hereditary colon ca dsordrs,81435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1356.11,,,,,,,fee schedule,1303.95,2916.11,APC Hereditary colon ca dsordrs,81435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1369.15,,,,,,,fee schedule,1303.95,2916.11,APC Hereditary colon ca dsordrs,81435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1303.95,,,,,,,fee schedule,1303.95,2916.11,APC Hereditary colon ca dsordrs,81436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2589.44,,,,,,,fee schedule,1860.23,2916.11, Hereditary colon ca dsordrs,81436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2916.11,,,,,,,fee schedule,1860.23,2916.11, Hereditary colon ca dsordrs,81436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,1860.23,2916.11, Hereditary colon ca dsordrs,81436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,1860.23,2916.11, Heredtry nurondcrn tum dsrdr,81437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1395.69,,,,,,,fee schedule,1303.95,1595.07, Heredtry nurondcrn tum dsrdr,81437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1595.07,,,,,,,fee schedule,1303.95,1595.07, Heredtry nurondcrn tum dsrdr,81437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1356.11,,,,,,,fee schedule,1303.95,1595.07,APC Heredtry nurondcrn tum dsrdr,81437,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1369.15,,,,,,,fee schedule,1303.95,1595.07,APC Heredtry nurondcrn tum dsrdr,81437,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1303.95,,,,,,,fee schedule,1303.95,1595.07,APC Heredtry nurondcrn tum dsrdr,81438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1395.69,,,,,,,fee schedule,1395.69,1595.07, Heredtry nurondcrn tum dsrdr,81438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1595.07,,,,,,,fee schedule,1395.69,1595.07, Inherited cardmypthy 5 gns,81439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,584.9,2125.98, Inherited cardmypthy 5 gns,81439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,584.9,2125.98, Inherited cardmypthy 5 gns,81439,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,608.3,,,,,,,fee schedule,584.9,2125.98,APC Inherited cardmypthy 5 gns,81439,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,614.14,,,,,,,fee schedule,584.9,2125.98,APC Inherited cardmypthy 5 gns,81439,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.9,,,,,,,fee schedule,584.9,2125.98,APC Mitochondrial gene,81440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10572.92,,,,,,,fee schedule,3324,12083.34, Mitochondrial gene,81440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12083.34,,,,,,,fee schedule,3324,12083.34, Mitochondrial gene,81440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3456.96,,,,,,,fee schedule,3324,12083.34,APC Mitochondrial gene,81440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3490.2,,,,,,,fee schedule,3324,12083.34,APC Mitochondrial gene,81440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3324,,,,,,,fee schedule,3324,12083.34,APC Ibmfs seq alys pnl 30 genes,81441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7788.82,,,,,,,fee schedule,2448.56,8901.51, Ibmfs seq alys pnl 30 genes,81441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8901.51,,,,,,,fee schedule,2448.56,8901.51, Ibmfs seq alys pnl 30 genes,81441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2546.5,,,,,,,fee schedule,2448.56,8901.51,APC Ibmfs seq alys pnl 30 genes,81441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2570.99,,,,,,,fee schedule,2448.56,8901.51,APC Ibmfs seq alys pnl 30 genes,81441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2448.56,,,,,,,fee schedule,2448.56,8901.51,APC Noonan spectrum disorders,81442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6819.12,,,,,,,fee schedule,2143.6,7793.28, Noonan spectrum disorders,81442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7793.28,,,,,,,fee schedule,2143.6,7793.28, Noonan spectrum disorders,81442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2229.34,,,,,,,fee schedule,2143.6,7793.28,APC Noonan spectrum disorders,81442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2250.78,,,,,,,fee schedule,2143.6,7793.28,APC Noonan spectrum disorders,81442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2143.6,,,,,,,fee schedule,2143.6,7793.28,APC Genetic tstg severe inh cond,81443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7788.82,,,,,,,fee schedule,2448.56,8901.51, Genetic tstg severe inh cond,81443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8901.51,,,,,,,fee schedule,2448.56,8901.51, Genetic tstg severe inh cond,81443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2546.5,,,,,,,fee schedule,2448.56,8901.51,APC Genetic tstg severe inh cond,81443,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2570.99,,,,,,,fee schedule,2448.56,8901.51,APC Genetic tstg severe inh cond,81443,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2448.56,,,,,,,fee schedule,2448.56,8901.51,APC Targeted genomic seq analys,81445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1943.21,,,,,,,fee schedule,597.91,2188.35, Targeted genomic seq analys,81445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2188.35,,,,,,,fee schedule,597.91,2188.35, Targeted genomic seq analys,81445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1901.89,,,,,,,fee schedule,597.91,2188.35, Targeted genomic seq analys,81445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2173.59,,,,,,,fee schedule,597.91,2188.35, Targeted genomic seq analys,81445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.83,,,,,,,fee schedule,597.91,2188.35,APC Targeted genomic seq analys,81445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.81,,,,,,,fee schedule,597.91,2188.35,APC Targeted genomic seq analys,81445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.91,,,,,,,fee schedule,597.91,2188.35,APC Hrdtry perph neurphy panel,81448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1860.23,,,,,,,fee schedule,584.9,2125.98, Hrdtry perph neurphy panel,81448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2125.98,,,,,,,fee schedule,584.9,2125.98, Hrdtry perph neurphy panel,81448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,608.3,,,,,,,fee schedule,584.9,2125.98,APC Hrdtry perph neurphy panel,81448,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,614.14,,,,,,,fee schedule,584.9,2125.98,APC Hrdtry perph neurphy panel,81448,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,584.9,,,,,,,fee schedule,584.9,2125.98,APC Tgsap so neo 5-50 rna alys,81449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1901.89,,,,,,,fee schedule,597.91,2173.59, Tgsap so neo 5-50 rna alys,81449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2173.59,,,,,,,fee schedule,597.91,2173.59, Tgsap so neo 5-50 rna alys,81449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.83,,,,,,,fee schedule,597.91,2173.59,APC Tgsap so neo 5-50 rna alys,81449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.81,,,,,,,fee schedule,597.91,2173.59,APC Tgsap so neo 5-50 rna alys,81449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.91,,,,,,,fee schedule,597.91,2173.59,APC Targeted genomic seq analys,81450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2107.3,,,,,,,fee schedule,759.53,2761.65, Targeted genomic seq analys,81450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2373.14,,,,,,,fee schedule,759.53,2761.65, Targeted genomic seq analys,81450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2416.44,,,,,,,fee schedule,759.53,2761.65, Targeted genomic seq analys,81450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2761.65,,,,,,,fee schedule,759.53,2761.65, Targeted genomic seq analys,81450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.91,,,,,,,fee schedule,759.53,2761.65,APC Targeted genomic seq analys,81450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797.51,,,,,,,fee schedule,759.53,2761.65,APC Targeted genomic seq analys,81450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.53,,,,,,,fee schedule,759.53,2761.65,APC Tgsap hl neo 5-50 rna alys,81451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2416.44,,,,,,,fee schedule,759.53,2761.65, Tgsap hl neo 5-50 rna alys,81451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2761.65,,,,,,,fee schedule,759.53,2761.65, Tgsap hl neo 5-50 rna alys,81451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,789.91,,,,,,,fee schedule,759.53,2761.65,APC Tgsap hl neo 5-50 rna alys,81451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,797.51,,,,,,,fee schedule,759.53,2761.65,APC Tgsap hl neo 5-50 rna alys,81451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,759.53,,,,,,,fee schedule,759.53,2761.65,APC Targeted genomic seq analys,81455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,2919.6,10613.25, Targeted genomic seq analys,81455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,2919.6,10613.25, Targeted genomic seq analys,81455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,10613.25,APC Targeted genomic seq analys,81455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,10613.25,APC Targeted genomic seq analys,81455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,10613.25,APC Tgsap so/hl 51/< rna alys,81456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9286.59,,,,,,,fee schedule,2919.6,10613.25, Tgsap so/hl 51/< rna alys,81456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10613.25,,,,,,,fee schedule,2919.6,10613.25, Tgsap so/hl 51/< rna alys,81456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3036.38,,,,,,,fee schedule,2919.6,10613.25,APC Tgsap so/hl 51/< rna alys,81456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3065.58,,,,,,,fee schedule,2919.6,10613.25,APC Tgsap so/hl 51/< rna alys,81456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2919.6,,,,,,,fee schedule,2919.6,10613.25,APC So neo gsap dna mcrstl ins,81457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,932.74,,,,,,,fee schedule,896.87,941.71,APC So neo gsap dna mcrstl ins,81457,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,941.71,,,,,,,fee schedule,896.87,941.71,APC So neo gsap dna mcrstl ins,81457,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,896.87,,,,,,,fee schedule,896.87,941.71,APC So gsap dna cpy nmbr&mcrstl,81458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1088.2,,,,,,,fee schedule,1046.35,1098.67,APC So gsap dna cpy nmbr&mcrstl,81458,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1098.67,,,,,,,fee schedule,1046.35,1098.67,APC So gsap dna cpy nmbr&mcrstl,81458,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1046.35,,,,,,,fee schedule,1046.35,1098.67,APC So neo gsap dna/dna&rna,81459,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3109.13,,,,,,,fee schedule,2989.55,3139.03,APC So neo gsap dna/dna&rna,81459,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3139.03,,,,,,,fee schedule,2989.55,3139.03,APC So neo gsap dna/dna&rna,81459,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2989.55,,,,,,,fee schedule,2989.55,3139.03,APC Whole mitochondrial genome,81460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4093.35,,,,,,,fee schedule,1287,4678.11, Whole mitochondrial genome,81460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4678.11,,,,,,,fee schedule,1287,4678.11, Whole mitochondrial genome,81460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1338.48,,,,,,,fee schedule,1287,4678.11,APC Whole mitochondrial genome,81460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1351.35,,,,,,,fee schedule,1287,4678.11,APC Whole mitochondrial genome,81460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1287,,,,,,,fee schedule,1287,4678.11,APC So gsap cll fr dna/dna&rna,81462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1243.66,,,,,,,fee schedule,1195.83,1255.62,APC So gsap cll fr dna/dna&rna,81462,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1255.62,,,,,,,fee schedule,1195.83,1255.62,APC So gsap cll fr dna/dna&rna,81462,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1195.83,,,,,,,fee schedule,1195.83,1255.62,APC So gsap cl fr cpy nmbr&mcrst,81463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1399.12,,,,,,,fee schedule,1345.31,1412.58,APC So gsap cl fr cpy nmbr&mcrst,81463,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1412.58,,,,,,,fee schedule,1345.31,1412.58,APC So gsap cl fr cpy nmbr&mcrst,81463,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1345.31,,,,,,,fee schedule,1345.31,1412.58,APC So gsap cll fr mcrstl ins,81464,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3420.05,,,,,,,fee schedule,3288.51,3452.94,APC So gsap cll fr mcrstl ins,81464,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3452.94,,,,,,,fee schedule,3288.51,3452.94,APC So gsap cll fr mcrstl ins,81464,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3288.51,,,,,,,fee schedule,3288.51,3452.94,APC Whole mitochondrial genome,81465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2977.83,,,,,,,fee schedule,936,3403.23, Whole mitochondrial genome,81465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3403.23,,,,,,,fee schedule,936,3403.23, Whole mitochondrial genome,81465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,973.44,,,,,,,fee schedule,936,3403.23,APC Whole mitochondrial genome,81465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,982.8,,,,,,,fee schedule,936,3403.23,APC Whole mitochondrial genome,81465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,936,,,,,,,fee schedule,936,3403.23,APC X-linked intellectual dblt,81470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2907,,,,,,,fee schedule,914,3322.29, X-linked intellectual dblt,81470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3322.29,,,,,,,fee schedule,914,3322.29, X-linked intellectual dblt,81470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,950.56,,,,,,,fee schedule,914,3322.29,APC X-linked intellectual dblt,81470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,959.7,,,,,,,fee schedule,914,3322.29,APC X-linked intellectual dblt,81470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,914,,,,,,,fee schedule,914,3322.29,APC X-linked intellectual dblt,81471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2907,,,,,,,fee schedule,914,3322.29, X-linked intellectual dblt,81471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3322.29,,,,,,,fee schedule,914,3322.29, X-linked intellectual dblt,81471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,950.56,,,,,,,fee schedule,914,3322.29,APC X-linked intellectual dblt,81471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,959.7,,,,,,,fee schedule,914,3322.29,APC X-linked intellectual dblt,81471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,914,,,,,,,fee schedule,914,3322.29,APC Unlisted molecular pathology,81479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,186.38,,,,,,,fee schedule,186.38,213, Unlisted molecular pathology,81479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,213,,,,,,,fee schedule,186.38,213, Autoimmune rheumatoid arthr,81490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2673.69,,,,,,,fee schedule,840.65,3055.65, Autoimmune rheumatoid arthr,81490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3055.65,,,,,,,fee schedule,840.65,3055.65, Autoimmune rheumatoid arthr,81490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,874.28,,,,,,,fee schedule,840.65,3055.65,APC Autoimmune rheumatoid arthr,81490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,882.68,,,,,,,fee schedule,840.65,3055.65,APC Autoimmune rheumatoid arthr,81490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,840.65,,,,,,,fee schedule,840.65,3055.65,APC Cor artery disease mrna,81493,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3340.31,,,,,,,fee schedule,1050,3817.5, Cor artery disease mrna,81493,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3817.5,,,,,,,fee schedule,1050,3817.5, Cor artery disease mrna,81493,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1092,,,,,,,fee schedule,1050,3817.5,APC Cor artery disease mrna,81493,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1102.5,,,,,,,fee schedule,1050,3817.5,APC Cor artery disease mrna,81493,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1050,,,,,,,fee schedule,1050,3817.5,APC Onco (ovar) two proteins,81500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,829.08,,,,,,,fee schedule,260.5,947.52, Onco (ovar) two proteins,81500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,947.52,,,,,,,fee schedule,260.5,947.52, Onco (ovar) two proteins,81500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.92,,,,,,,fee schedule,260.5,947.52,APC Onco (ovar) two proteins,81500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,273.53,,,,,,,fee schedule,260.5,947.52,APC Onco (ovar) two proteins,81500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,260.5,,,,,,,fee schedule,260.5,947.52,APC Onco (ovar) five proteins,81503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2852.85,,,,,,,fee schedule,897,3260.4, Onco (ovar) five proteins,81503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3260.4,,,,,,,fee schedule,897,3260.4, Onco (ovar) five proteins,81503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,932.88,,,,,,,fee schedule,897,3260.4,APC Onco (ovar) five proteins,81503,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,941.85,,,,,,,fee schedule,897,3260.4,APC Onco (ovar) five proteins,81503,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,897,,,,,,,fee schedule,897,3260.4,APC Oncology tissue of origin,81504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1654.01,,,,,,,fee schedule,520,1890.3, Oncology tissue of origin,81504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1890.3,,,,,,,fee schedule,520,1890.3, Oncology tissue of origin,81504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,540.8,,,,,,,fee schedule,520,1890.3,APC Oncology tissue of origin,81504,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,546,,,,,,,fee schedule,520,1890.3,APC Oncology tissue of origin,81504,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,520,,,,,,,fee schedule,520,1890.3,APC Endo assay seven anal,81506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,218.74,,,,,,,fee schedule,68.92,249.99, Endo assay seven anal,81506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,249.99,,,,,,,fee schedule,68.92,249.99, Endo assay seven anal,81506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,71.68,,,,,,,fee schedule,68.92,249.99,APC Endo assay seven anal,81506,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,72.37,,,,,,,fee schedule,68.92,249.99,APC Endo assay seven anal,81506,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,68.92,,,,,,,fee schedule,68.92,249.99,APC Fetal aneuploidy trisom risk,81507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2528.93,,,,,,,fee schedule,795,2890.2, Fetal aneuploidy trisom risk,81507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2890.2,,,,,,,fee schedule,795,2890.2, Fetal aneuploidy trisom risk,81507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,826.8,,,,,,,fee schedule,795,2890.2,APC Fetal aneuploidy trisom risk,81507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,834.75,,,,,,,fee schedule,795,2890.2,APC Fetal aneuploidy trisom risk,81507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,795,,,,,,,fee schedule,795,2890.2,APC Ftl cgen abnor two proteins,81508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,172.91,,,,,,,fee schedule,54.3,197.61, Ftl cgen abnor two proteins,81508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.61,,,,,,,fee schedule,54.3,197.61, Ftl cgen abnor two proteins,81508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,56.47,,,,,,,fee schedule,54.3,197.61,APC Ftl cgen abnor two proteins,81508,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,57.02,,,,,,,fee schedule,54.3,197.61,APC Ftl cgen abnor two proteins,81508,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,54.3,,,,,,,fee schedule,54.3,197.61,APC Ftl cgen abnor 3 proteins,81509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4730.8,,,,,,,fee schedule,1487.37,5406.63, Ftl cgen abnor 3 proteins,81509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5406.63,,,,,,,fee schedule,1487.37,5406.63, Ftl cgen abnor 3 proteins,81509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1546.86,,,,,,,fee schedule,1487.37,5406.63,APC Ftl cgen abnor 3 proteins,81509,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1561.74,,,,,,,fee schedule,1487.37,5406.63,APC Ftl cgen abnor 3 proteins,81509,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1487.37,,,,,,,fee schedule,1487.37,5406.63,APC Ftl cgen abnor three anal,81510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,177.06,,,,,,,fee schedule,55.54,202.35, Ftl cgen abnor three anal,81510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,202.35,,,,,,,fee schedule,55.54,202.35, Ftl cgen abnor three anal,81510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.76,,,,,,,fee schedule,55.54,202.35,APC Ftl cgen abnor three anal,81510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.32,,,,,,,fee schedule,55.54,202.35,APC Ftl cgen abnor three anal,81510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.54,,,,,,,fee schedule,55.54,202.35,APC Ftl cgen abnor four anal,81511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,488.49,,,,,,,fee schedule,153.5,558.27, Ftl cgen abnor four anal,81511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,558.27,,,,,,,fee schedule,153.5,558.27, Ftl cgen abnor four anal,81511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,159.64,,,,,,,fee schedule,153.5,558.27,APC Ftl cgen abnor four anal,81511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,161.18,,,,,,,fee schedule,153.5,558.27,APC Ftl cgen abnor four anal,81511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,153.5,,,,,,,fee schedule,153.5,558.27,APC Ftl cgen abnor five anal,81512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,220.82,,,,,,,fee schedule,69.52,252.36, Ftl cgen abnor five anal,81512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,252.36,,,,,,,fee schedule,69.52,252.36, Ftl cgen abnor five anal,81512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.3,,,,,,,fee schedule,69.52,252.36,APC Ftl cgen abnor five anal,81512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73,,,,,,,fee schedule,69.52,252.36,APC Ftl cgen abnor five anal,81512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.52,,,,,,,fee schedule,69.52,252.36,APC Nfct ds bv rna vag flu alg,81513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,142.63,519, Nfct ds bv rna vag flu alg,81513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,142.63,519, Nfct ds bv rna vag flu alg,81513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,519,APC Nfct ds bv rna vag flu alg,81513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,519,APC Nfct ds bv rna vag flu alg,81513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,519,APC Nfct ds bv&vaginitis dna alg,81514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,836.38,,,,,,,fee schedule,262.99,955.86, Nfct ds bv&vaginitis dna alg,81514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,955.86,,,,,,,fee schedule,262.99,955.86, Nfct ds bv&vaginitis dna alg,81514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,273.51,,,,,,,fee schedule,262.99,955.86,APC Nfct ds bv&vaginitis dna alg,81514,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,276.14,,,,,,,fee schedule,262.99,955.86,APC Nfct ds bv&vaginitis dna alg,81514,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,262.99,,,,,,,fee schedule,262.99,955.86,APC Nfct ds bv&vaginitis dna alg,81515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,273.51,,,,,,,fee schedule,262.99,276.14,APC Nfct ds bv&vaginitis dna alg,81515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,276.14,,,,,,,fee schedule,262.99,276.14,APC Nfct ds bv&vaginitis dna alg,81515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,262.99,,,,,,,fee schedule,262.99,276.14,APC Liver ds alys 3 bmrk srm alg,81517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1600.88,,,,,,,fee schedule,176.19,1829.58, Liver ds alys 3 bmrk srm alg,81517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1829.58,,,,,,,fee schedule,176.19,1829.58, Liver ds alys 3 bmrk srm alg,81517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,183.24,,,,,,,fee schedule,176.19,1829.58,APC Liver ds alys 3 bmrk srm alg,81517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,185,,,,,,,fee schedule,176.19,1829.58,APC Liver ds alys 3 bmrk srm alg,81517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,176.19,,,,,,,fee schedule,176.19,1829.58,APC Onc brst mrna 11 genes,81518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc brst mrna 11 genes,81518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc brst mrna 11 genes,81518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc brst mrna 11 genes,81518,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc brst mrna 11 genes,81518,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Oncology breast mrna,81519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11113.12,,,,,,,fee schedule,3873,14079.6, Oncology breast mrna,81519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12515.08,,,,,,,fee schedule,3873,14079.6, Oncology breast mrna,81519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Oncology breast mrna,81519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Oncology breast mrna,81519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Oncology breast mrna,81519,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Oncology breast mrna,81519,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Onc breast mrna 58 genes,81520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7984.65,,,,,,,fee schedule,2510.21,9125.31, Onc breast mrna 58 genes,81520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9125.31,,,,,,,fee schedule,2510.21,9125.31, Onc breast mrna 58 genes,81520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2610.62,,,,,,,fee schedule,2510.21,9125.31,APC Onc breast mrna 58 genes,81520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2635.72,,,,,,,fee schedule,2510.21,9125.31,APC Onc breast mrna 58 genes,81520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2510.21,,,,,,,fee schedule,2510.21,9125.31,APC Onc breast mrna 70 genes,81521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc breast mrna 70 genes,81521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc breast mrna 70 genes,81521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc breast mrna 70 genes,81521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc breast mrna 70 genes,81521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Onc breast mrna 12 genes,81522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc breast mrna 12 genes,81522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc breast mrna 12 genes,81522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc breast mrna 12 genes,81522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc breast mrna 12 genes,81522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Onc brst mrna 70 cnt 31 gene,81523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc brst mrna 70 cnt 31 gene,81523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc brst mrna 70 cnt 31 gene,81523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc brst mrna 70 cnt 31 gene,81523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc brst mrna 70 cnt 31 gene,81523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Oncology colon mrna,81525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9911.55,,,,,,,fee schedule,3116,11327.49, Oncology colon mrna,81525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11327.49,,,,,,,fee schedule,3116,11327.49, Oncology colon mrna,81525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3240.64,,,,,,,fee schedule,3116,11327.49,APC Oncology colon mrna,81525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3271.8,,,,,,,fee schedule,3116,11327.49,APC Oncology colon mrna,81525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3116,,,,,,,fee schedule,3116,11327.49,APC Oncology colorectal scr,81528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1653.83,,,,,,,fee schedule,508.87,1862.46, Oncology colorectal scr,81528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1862.46,,,,,,,fee schedule,508.87,1862.46, Oncology colorectal scr,81528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1618.6,,,,,,,fee schedule,508.87,1862.46, Oncology colorectal scr,81528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1849.83,,,,,,,fee schedule,508.87,1862.46, Oncology colorectal scr,81528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,529.22,,,,,,,fee schedule,508.87,1862.46,APC Oncology colorectal scr,81528,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,534.31,,,,,,,fee schedule,508.87,1862.46,APC Oncology colorectal scr,81528,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,508.87,,,,,,,fee schedule,508.87,1862.46,APC Onc cutan mlnma mrna 31 gene,81529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22880.08,,,,,,,fee schedule,7193,26148.66, Onc cutan mlnma mrna 31 gene,81529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26148.66,,,,,,,fee schedule,7193,26148.66, Onc cutan mlnma mrna 31 gene,81529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7480.72,,,,,,,fee schedule,7193,26148.66,APC Onc cutan mlnma mrna 31 gene,81529,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7552.65,,,,,,,fee schedule,7193,26148.66,APC Onc cutan mlnma mrna 31 gene,81529,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7193,,,,,,,fee schedule,7193,26148.66,APC Oncology gynecologic,81535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2544.95,,,,,,,fee schedule,579.46,2866, Oncology gynecologic,81535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2866,,,,,,,fee schedule,579.46,2866, Oncology gynecologic,81535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1843.56,,,,,,,fee schedule,579.46,2866, Oncology gynecologic,81535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2106.93,,,,,,,fee schedule,579.46,2866, Oncology gynecologic,81535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,602.64,,,,,,,fee schedule,579.46,2866,APC Oncology gynecologic,81535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,608.43,,,,,,,fee schedule,579.46,2866,APC Oncology gynecologic,81535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,579.46,,,,,,,fee schedule,579.46,2866,APC Oncology gynecologic,81536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,779.81,,,,,,,fee schedule,177.56,878.18, Oncology gynecologic,81536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,878.18,,,,,,,fee schedule,177.56,878.18, Oncology gynecologic,81536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,564.53,,,,,,,fee schedule,177.56,878.18, Oncology gynecologic,81536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,645.18,,,,,,,fee schedule,177.56,878.18, Oncology gynecologic,81536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,184.66,,,,,,,fee schedule,177.56,878.18,APC Oncology gynecologic,81536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,186.44,,,,,,,fee schedule,177.56,878.18,APC Oncology gynecologic,81536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,177.56,,,,,,,fee schedule,177.56,878.18,APC Oncology lung,81538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9132.45,,,,,,,fee schedule,2871,10437.09, Oncology lung,81538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10437.09,,,,,,,fee schedule,2871,10437.09, Oncology lung,81538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2985.84,,,,,,,fee schedule,2871,10437.09,APC Oncology lung,81538,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3014.55,,,,,,,fee schedule,2871,10437.09,APC Oncology lung,81538,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2871,,,,,,,fee schedule,2871,10437.09,APC Oncology prostate prob score,81539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2417.47,,,,,,,fee schedule,760,2762.82, Oncology prostate prob score,81539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2762.82,,,,,,,fee schedule,760,2762.82, Oncology prostate prob score,81539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,790.4,,,,,,,fee schedule,760,2762.82,APC Oncology prostate prob score,81539,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,798,,,,,,,fee schedule,760,2762.82,APC Oncology prostate prob score,81539,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,760,,,,,,,fee schedule,760,2762.82,APC Oncology tum unknown origin,81540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11928,,,,,,,fee schedule,3750,13632, Oncology tum unknown origin,81540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13632,,,,,,,fee schedule,3750,13632, Oncology tum unknown origin,81540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3900,,,,,,,fee schedule,3750,13632,APC Oncology tum unknown origin,81540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3937.5,,,,,,,fee schedule,3750,13632,APC Oncology tum unknown origin,81540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3750,,,,,,,fee schedule,3750,13632,APC Onc prostate mrna 46 genes,81541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc prostate mrna 46 genes,81541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc prostate mrna 46 genes,81541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc prostate mrna 46 genes,81541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc prostate mrna 46 genes,81541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC Onc prostate mrna 22 cnt gen,81542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12319.65,,,,,,,fee schedule,3873,14079.6, Onc prostate mrna 22 cnt gen,81542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14079.6,,,,,,,fee schedule,3873,14079.6, Onc prostate mrna 22 cnt gen,81542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4027.92,,,,,,,fee schedule,3873,14079.6,APC Onc prostate mrna 22 cnt gen,81542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4066.65,,,,,,,fee schedule,3873,14079.6,APC Onc prostate mrna 22 cnt gen,81542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3873,,,,,,,fee schedule,3873,14079.6,APC "Onc thyr mrna 10,196 gen alg",81546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11450.99,,,,,,,fee schedule,3600,13086.84, "Onc thyr mrna 10,196 gen alg",81546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13086.84,,,,,,,fee schedule,3600,13086.84, "Onc thyr mrna 10,196 gen alg",81546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3744,,,,,,,fee schedule,3600,13086.84,APC "Onc thyr mrna 10,196 gen alg",81546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3780,,,,,,,fee schedule,3600,13086.84,APC "Onc thyr mrna 10,196 gen alg",81546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3600,,,,,,,fee schedule,3600,13086.84,APC Onc prostate 3 genes,81551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6457.71,,,,,,,fee schedule,2030,7380.24, Onc prostate 3 genes,81551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7380.24,,,,,,,fee schedule,2030,7380.24, Onc prostate 3 genes,81551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2111.2,,,,,,,fee schedule,2030,7380.24,APC Onc prostate 3 genes,81551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2131.5,,,,,,,fee schedule,2030,7380.24,APC Onc prostate 3 genes,81551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2030,,,,,,,fee schedule,2030,7380.24,APC Onc uveal mlnma mrna 15 gene,81552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24735.11,,,,,,,fee schedule,7776,28268.7, Onc uveal mlnma mrna 15 gene,81552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28268.7,,,,,,,fee schedule,7776,28268.7, Onc uveal mlnma mrna 15 gene,81552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8087.04,,,,,,,fee schedule,7776,28268.7,APC Onc uveal mlnma mrna 15 gene,81552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8164.8,,,,,,,fee schedule,7776,28268.7,APC Onc uveal mlnma mrna 15 gene,81552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7776,,,,,,,fee schedule,7776,28268.7,APC Pulm ds ipf mrna 190 gen alg,81554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17495.18,,,,,,,fee schedule,5409.6,19994.49, Pulm ds ipf mrna 190 gen alg,81554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19994.49,,,,,,,fee schedule,5409.6,19994.49, Pulm ds ipf mrna 190 gen alg,81554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5625.98,,,,,,,fee schedule,5409.6,19994.49,APC Pulm ds ipf mrna 190 gen alg,81554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5680.08,,,,,,,fee schedule,5409.6,19994.49,APC Pulm ds ipf mrna 190 gen alg,81554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5409.6,,,,,,,fee schedule,5409.6,19994.49,APC Trnspl rej kdn mrna qpcr 139,81558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3369.6,,,,,,,fee schedule,3240,3402,APC Trnspl rej kdn mrna qpcr 139,81558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3402,,,,,,,fee schedule,3240,3402,APC Trnspl rej kdn mrna qpcr 139,81558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3240,,,,,,,fee schedule,3240,3402,APC Trnsplj pd lvr&bwl cd154+cll,81560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2038.34,,,,,,,fee schedule,640.73,2329.53, Trnsplj pd lvr&bwl cd154+cll,81560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2329.53,,,,,,,fee schedule,640.73,2329.53, Trnsplj pd lvr&bwl cd154+cll,81560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,666.36,,,,,,,fee schedule,640.73,2329.53,APC Trnsplj pd lvr&bwl cd154+cll,81560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,672.77,,,,,,,fee schedule,640.73,2329.53,APC Trnsplj pd lvr&bwl cd154+cll,81560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,640.73,,,,,,,fee schedule,640.73,2329.53,APC Cardiology hrt trnspl mrna,81595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10306.3,,,,,,,fee schedule,3240,11778.63, Cardiology hrt trnspl mrna,81595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11778.63,,,,,,,fee schedule,3240,11778.63, Cardiology hrt trnspl mrna,81595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3369.6,,,,,,,fee schedule,3240,11778.63,APC Cardiology hrt trnspl mrna,81595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3402,,,,,,,fee schedule,3240,11778.63,APC Cardiology hrt trnspl mrna,81595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3240,,,,,,,fee schedule,3240,11778.63,APC Nfct ds chrnc hcv 6 assays,81596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,229.14,,,,,,,fee schedule,72.19,261.87, Nfct ds chrnc hcv 6 assays,81596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,261.87,,,,,,,fee schedule,72.19,261.87, Nfct ds chrnc hcv 6 assays,81596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,75.08,,,,,,,fee schedule,72.19,261.87,APC Nfct ds chrnc hcv 6 assays,81596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75.8,,,,,,,fee schedule,72.19,261.87,APC Nfct ds chrnc hcv 6 assays,81596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,72.19,,,,,,,fee schedule,72.19,261.87,APC Unlisted maaa,81599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,398.16,,,,,,,fee schedule,398.16,455.04, Unlisted maaa,81599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,455.04,,,,,,,fee schedule,398.16,455.04, Test for acetone/ketones,82009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.2,,,,,,,fee schedule,4.52,16.68, Test for acetone/ketones,82009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.86,,,,,,,fee schedule,4.52,16.68, Test for acetone/ketones,82009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.52,16.68, Test for acetone/ketones,82009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.52,16.68, Test for acetone/ketones,82009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.7,,,,,,,fee schedule,4.52,16.68,APC Test for acetone/ketones,82009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.75,,,,,,,fee schedule,4.52,16.68,APC Test for acetone/ketones,82009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.52,,,,,,,fee schedule,4.52,16.68,APC Acetone assay,82010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.12,,,,,,,fee schedule,8.17,41.8, Acetone assay,82010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.8,,,,,,,fee schedule,8.17,41.8, Acetone assay,82010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.17,41.8, Acetone assay,82010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.17,41.8, Acetone assay,82010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.5,,,,,,,fee schedule,8.17,41.8,APC Acetone assay,82010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.58,,,,,,,fee schedule,8.17,41.8,APC Acetone assay,82010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.17,,,,,,,fee schedule,8.17,41.8,APC Acetylcholinesterase assay,82013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.25,,,,,,,fee schedule,12.29,56.58, Acetylcholinesterase assay,82013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.58,,,,,,,fee schedule,12.29,56.58, Acetylcholinesterase assay,82013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.29,56.58, Acetylcholinesterase assay,82013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.29,56.58, Acetylcholinesterase assay,82013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.78,,,,,,,fee schedule,12.29,56.58,APC Acetylcholinesterase assay,82013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.9,,,,,,,fee schedule,12.29,56.58,APC Acetylcholinesterase assay,82013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.29,,,,,,,fee schedule,12.29,56.58,APC Acylcarnitines qual,82016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.95,,,,,,,fee schedule,16.49,70.89, Acylcarnitines qual,82016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.89,,,,,,,fee schedule,16.49,70.89, Acylcarnitines qual,82016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.49,70.89, Acylcarnitines qual,82016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.49,70.89, Acylcarnitines qual,82016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.15,,,,,,,fee schedule,16.49,70.89,APC Acylcarnitines qual,82016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.31,,,,,,,fee schedule,16.49,70.89,APC Acylcarnitines qual,82016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.49,,,,,,,fee schedule,16.49,70.89,APC Acylcarnitines quant,82017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,16.87,86.27, Acylcarnitines quant,82017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,16.87,86.27, Acylcarnitines quant,82017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.87,86.27, Acylcarnitines quant,82017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.87,86.27, Acylcarnitines quant,82017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.54,,,,,,,fee schedule,16.87,86.27,APC Acylcarnitines quant,82017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.71,,,,,,,fee schedule,16.87,86.27,APC Acylcarnitines quant,82017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.87,86.27,APC Assay of acth,82024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.4,,,,,,,fee schedule,38.62,197.53, Assay of acth,82024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,197.53,,,,,,,fee schedule,38.62,197.53, Assay of acth,82024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.62,197.53, Assay of acth,82024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.62,197.53, Assay of acth,82024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.16,,,,,,,fee schedule,38.62,197.53,APC Assay of acth,82024,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.55,,,,,,,fee schedule,38.62,197.53,APC Assay of acth,82024,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.62,,,,,,,fee schedule,38.62,197.53,APC Assay of adp & amp,82030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.16,,,,,,,fee schedule,25.8,131.94, Assay of adp & amp,82030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,131.94,,,,,,,fee schedule,25.8,131.94, Assay of adp & amp,82030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,82.29,,,,,,,fee schedule,25.8,131.94, Assay of adp & amp,82030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.05,,,,,,,fee schedule,25.8,131.94, Assay of adp & amp,82030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.83,,,,,,,fee schedule,25.8,131.94,APC Assay of adp & amp,82030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.09,,,,,,,fee schedule,25.8,131.94,APC Assay of adp & amp,82030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.8,,,,,,,fee schedule,25.8,131.94,APC Assay of serum albumin,82040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.49,,,,,,,fee schedule,4.95,25.33, Assay of serum albumin,82040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.33,,,,,,,fee schedule,4.95,25.33, Assay of serum albumin,82040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.95,25.33, Assay of serum albumin,82040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.95,25.33, Assay of serum albumin,82040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.15,,,,,,,fee schedule,4.95,25.33,APC Assay of serum albumin,82040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.2,,,,,,,fee schedule,4.95,25.33,APC Assay of serum albumin,82040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.95,,,,,,,fee schedule,4.95,25.33,APC Assay of urine albumin,82042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8,,,,,,,fee schedule,7.78,28.56, Assay of urine albumin,82042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9,,,,,,,fee schedule,7.78,28.56, Assay of urine albumin,82042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.78,28.56, Assay of urine albumin,82042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.78,28.56, Assay of urine albumin,82042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.09,,,,,,,fee schedule,7.78,28.56,APC Assay of urine albumin,82042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.17,,,,,,,fee schedule,7.78,28.56,APC Assay of urine albumin,82042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.78,,,,,,,fee schedule,7.78,28.56,APC Microalbumin quantitative,82043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.29,,,,,,,fee schedule,5.78,29.61, Microalbumin quantitative,82043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.61,,,,,,,fee schedule,5.78,29.61, Microalbumin quantitative,82043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.78,29.61, Microalbumin quantitative,82043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.78,29.61, Microalbumin quantitative,82043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.01,,,,,,,fee schedule,5.78,29.61,APC Microalbumin quantitative,82043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.07,,,,,,,fee schedule,5.78,29.61,APC Microalbumin quantitative,82043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.78,,,,,,,fee schedule,5.78,29.61,APC Microalbumin semiquant,82044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.54,,,,,,,fee schedule,6.23,22.62, Microalbumin semiquant,82044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.99,,,,,,,fee schedule,6.23,22.62, Microalbumin semiquant,82044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.79,,,,,,,fee schedule,6.23,22.62, Microalbumin semiquant,82044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.62,,,,,,,fee schedule,6.23,22.62, Microalbumin semiquant,82044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.48,,,,,,,fee schedule,6.23,22.62,APC Microalbumin semiquant,82044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.54,,,,,,,fee schedule,6.23,22.62,APC Microalbumin semiquant,82044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.23,,,,,,,fee schedule,6.23,22.62,APC Albumin ischemia modified,82045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,154.15,,,,,,,fee schedule,33.94,173.59, Albumin ischemia modified,82045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,173.59,,,,,,,fee schedule,33.94,173.59, Albumin ischemia modified,82045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,108.33,,,,,,,fee schedule,33.94,173.59, Albumin ischemia modified,82045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123.81,,,,,,,fee schedule,33.94,173.59, Albumin ischemia modified,82045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.3,,,,,,,fee schedule,33.94,173.59,APC Albumin ischemia modified,82045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.64,,,,,,,fee schedule,33.94,173.59,APC Albumin ischemia modified,82045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.94,,,,,,,fee schedule,33.94,173.59,APC Assay of breath ethanol,82075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.73,,,,,,,fee schedule,30,109.5, Assay of breath ethanol,82075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.63,,,,,,,fee schedule,30,109.5, Assay of breath ethanol,82075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.81,,,,,,,fee schedule,30,109.5, Assay of breath ethanol,82075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.5,,,,,,,fee schedule,30,109.5, Assay of breath ethanol,82075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.2,,,,,,,fee schedule,30,109.5,APC Assay of breath ethanol,82075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.5,,,,,,,fee schedule,30,109.5,APC Assay of breath ethanol,82075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30,,,,,,,fee schedule,30,109.5,APC Assay spec xcp ur&breath ia,82077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.13,,,,,,,fee schedule,17.27,63.21, Assay spec xcp ur&breath ia,82077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.21,,,,,,,fee schedule,17.27,63.21, Assay spec xcp ur&breath ia,82077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.21, Assay spec xcp ur&breath ia,82077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.21, Assay spec xcp ur&breath ia,82077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.21,APC Assay spec xcp ur&breath ia,82077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.21,APC Assay spec xcp ur&breath ia,82077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.21,APC Assay of aldolase,82085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.07,,,,,,,fee schedule,9.71,49.63, Assay of aldolase,82085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.63,,,,,,,fee schedule,9.71,49.63, Assay of aldolase,82085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.71,49.63, Assay of aldolase,82085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.71,49.63, Assay of aldolase,82085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.1,,,,,,,fee schedule,9.71,49.63,APC Assay of aldolase,82085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.2,,,,,,,fee schedule,9.71,49.63,APC Assay of aldolase,82085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.71,,,,,,,fee schedule,9.71,49.63,APC Assay of aldosterone,82088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.06,,,,,,,fee schedule,40.75,208.4, Assay of aldosterone,82088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.4,,,,,,,fee schedule,40.75,208.4, Assay of aldosterone,82088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129.15,,,,,,,fee schedule,40.75,208.4, Assay of aldosterone,82088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.6,,,,,,,fee schedule,40.75,208.4, Assay of aldosterone,82088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42.38,,,,,,,fee schedule,40.75,208.4,APC Assay of aldosterone,82088,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.79,,,,,,,fee schedule,40.75,208.4,APC Assay of aldosterone,82088,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.75,,,,,,,fee schedule,40.75,208.4,APC Alpha-1-antitrypsin total,82103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61,,,,,,,fee schedule,13.44,68.7, Alpha-1-antitrypsin total,82103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.7,,,,,,,fee schedule,13.44,68.7, Alpha-1-antitrypsin total,82103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.44,68.7, Alpha-1-antitrypsin total,82103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.44,68.7, Alpha-1-antitrypsin total,82103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.98,,,,,,,fee schedule,13.44,68.7,APC Alpha-1-antitrypsin total,82103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.11,,,,,,,fee schedule,13.44,68.7,APC Alpha-1-antitrypsin total,82103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.44,,,,,,,fee schedule,13.44,68.7,APC Alpha-1-antitrypsin pheno,82104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.65,,,,,,,fee schedule,14.46,73.93, Alpha-1-antitrypsin pheno,82104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.93,,,,,,,fee schedule,14.46,73.93, Alpha-1-antitrypsin pheno,82104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.46,73.93, Alpha-1-antitrypsin pheno,82104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.46,73.93, Alpha-1-antitrypsin pheno,82104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.04,,,,,,,fee schedule,14.46,73.93,APC Alpha-1-antitrypsin pheno,82104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.18,,,,,,,fee schedule,14.46,73.93,APC Alpha-1-antitrypsin pheno,82104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.46,,,,,,,fee schedule,14.46,73.93,APC Alpha-fetoprotein serum,82105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.18,,,,,,,fee schedule,16.77,85.79, Alpha-fetoprotein serum,82105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.79,,,,,,,fee schedule,16.77,85.79, Alpha-fetoprotein serum,82105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.77,85.79, Alpha-fetoprotein serum,82105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.77,85.79, Alpha-fetoprotein serum,82105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.44,,,,,,,fee schedule,16.77,85.79,APC Alpha-fetoprotein serum,82105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.61,,,,,,,fee schedule,16.77,85.79,APC Alpha-fetoprotein serum,82105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.77,,,,,,,fee schedule,16.77,85.79,APC Alpha-fetoprotein amniotic,82106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.18,,,,,,,fee schedule,17,85.79, Alpha-fetoprotein amniotic,82106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.79,,,,,,,fee schedule,17,85.79, Alpha-fetoprotein amniotic,82106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17,85.79, Alpha-fetoprotein amniotic,82106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17,85.79, Alpha-fetoprotein amniotic,82106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.68,,,,,,,fee schedule,17,85.79,APC Alpha-fetoprotein amniotic,82106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.85,,,,,,,fee schedule,17,85.79,APC Alpha-fetoprotein amniotic,82106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17,,,,,,,fee schedule,17,85.79,APC Alpha-Fetoprotein L3,82107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,296.5,,,,,,,fee schedule,64.41,333.9, Alpha-Fetoprotein L3,82107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333.9,,,,,,,fee schedule,64.41,333.9, Alpha-Fetoprotein L3,82107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,205.2,,,,,,,fee schedule,64.41,333.9, Alpha-Fetoprotein L3,82107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,234.51,,,,,,,fee schedule,64.41,333.9, Alpha-Fetoprotein L3,82107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.99,,,,,,,fee schedule,64.41,333.9,APC Alpha-Fetoprotein L3,82107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.63,,,,,,,fee schedule,64.41,333.9,APC Alpha-Fetoprotein L3,82107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.41,,,,,,,fee schedule,64.41,333.9,APC Assay of aluminum,82108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.7,,,,,,,fee schedule,25.48,130.3, Assay of aluminum,82108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.3,,,,,,,fee schedule,25.48,130.3, Assay of aluminum,82108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.48,130.3, Assay of aluminum,82108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.48,130.3, Assay of aluminum,82108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.5,,,,,,,fee schedule,25.48,130.3,APC Assay of aluminum,82108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.75,,,,,,,fee schedule,25.48,130.3,APC Assay of aluminum,82108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.48,,,,,,,fee schedule,25.48,130.3,APC Amines vaginal fluid qual,82120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.06,,,,,,,fee schedule,5.99,21.42, Amines vaginal fluid qual,82120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.22,,,,,,,fee schedule,5.99,21.42, Amines vaginal fluid qual,82120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.99,21.42, Amines vaginal fluid qual,82120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.99,21.42, Amines vaginal fluid qual,82120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.23,,,,,,,fee schedule,5.99,21.42,APC Amines vaginal fluid qual,82120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.29,,,,,,,fee schedule,5.99,21.42,APC Amines vaginal fluid qual,82120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.99,,,,,,,fee schedule,5.99,21.42,APC Amino acid single qual,82127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.95,,,,,,,fee schedule,14.18,70.89, Amino acid single qual,82127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.89,,,,,,,fee schedule,14.18,70.89, Amino acid single qual,82127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.18,70.89, Amino acid single qual,82127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.18,70.89, Amino acid single qual,82127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.75,,,,,,,fee schedule,14.18,70.89,APC Amino acid single qual,82127,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.89,,,,,,,fee schedule,14.18,70.89,APC Amino acid single qual,82127,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.18,,,,,,,fee schedule,14.18,70.89,APC Amino acids mult qual,82128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.95,,,,,,,fee schedule,13.87,70.89, Amino acids mult qual,82128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.89,,,,,,,fee schedule,13.87,70.89, Amino acids mult qual,82128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.87,70.89, Amino acids mult qual,82128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.87,70.89, Amino acids mult qual,82128,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.42,,,,,,,fee schedule,13.87,70.89,APC Amino acids mult qual,82128,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.56,,,,,,,fee schedule,13.87,70.89,APC Amino acids mult qual,82128,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.87,,,,,,,fee schedule,13.87,70.89,APC Amino acids single quant,82131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,22.98,86.27, Amino acids single quant,82131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,22.98,86.27, Amino acids single quant,82131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,22.98,86.27, Amino acids single quant,82131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,22.98,86.27, Amino acids single quant,82131,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.9,,,,,,,fee schedule,22.98,86.27,APC Amino acids single quant,82131,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.13,,,,,,,fee schedule,22.98,86.27,APC Amino acids single quant,82131,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.98,,,,,,,fee schedule,22.98,86.27,APC Assay aminolevulinic acid,82135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.75,,,,,,,fee schedule,16.45,84.18, Assay aminolevulinic acid,82135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.18,,,,,,,fee schedule,16.45,84.18, Assay aminolevulinic acid,82135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.45,84.18, Assay aminolevulinic acid,82135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.45,84.18, Assay aminolevulinic acid,82135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.11,,,,,,,fee schedule,16.45,84.18,APC Assay aminolevulinic acid,82135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,16.45,84.18,APC Assay aminolevulinic acid,82135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.45,,,,,,,fee schedule,16.45,84.18,APC Amino acids quant 2-5,82136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,19.61,86.27, Amino acids quant 2-5,82136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,19.61,86.27, Amino acids quant 2-5,82136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.61,86.27, Amino acids quant 2-5,82136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.61,86.27, Amino acids quant 2-5,82136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.39,,,,,,,fee schedule,19.61,86.27,APC Amino acids quant 2-5,82136,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.59,,,,,,,fee schedule,19.61,86.27,APC Amino acids quant 2-5,82136,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.61,,,,,,,fee schedule,19.61,86.27,APC Amino acids quan 6 or more,82139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,16.87,86.27, Amino acids quan 6 or more,82139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,16.87,86.27, Amino acids quan 6 or more,82139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.87,86.27, Amino acids quan 6 or more,82139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.87,86.27, Amino acids quan 6 or more,82139,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.54,,,,,,,fee schedule,16.87,86.27,APC Amino acids quan 6 or more,82139,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.71,,,,,,,fee schedule,16.87,86.27,APC Amino acids quan 6 or more,82139,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.87,86.27,APC Assay of ammonia,82140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.17,,,,,,,fee schedule,14.57,74.52, Assay of ammonia,82140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.52,,,,,,,fee schedule,14.57,74.52, Assay of ammonia,82140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.57,74.52, Assay of ammonia,82140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.57,74.52, Assay of ammonia,82140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.15,,,,,,,fee schedule,14.57,74.52,APC Assay of ammonia,82140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.3,,,,,,,fee schedule,14.57,74.52,APC Assay of ammonia,82140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.57,,,,,,,fee schedule,14.57,74.52,APC Amniotic fluid scan,82143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.23,,,,,,,fee schedule,9.35,35.17, Amniotic fluid scan,82143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.17,,,,,,,fee schedule,9.35,35.17, Amniotic fluid scan,82143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.35,35.17, Amniotic fluid scan,82143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.35,35.17, Amniotic fluid scan,82143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.72,,,,,,,fee schedule,9.35,35.17,APC Amniotic fluid scan,82143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.82,,,,,,,fee schedule,9.35,35.17,APC Amniotic fluid scan,82143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.35,,,,,,,fee schedule,9.35,35.17,APC Assay of amylase,82150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.45,,,,,,,fee schedule,6.48,33.16, Assay of amylase,82150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.16,,,,,,,fee schedule,6.48,33.16, Assay of amylase,82150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.48,33.16, Assay of amylase,82150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.48,33.16, Assay of amylase,82150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.74,,,,,,,fee schedule,6.48,33.16,APC Assay of amylase,82150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.8,,,,,,,fee schedule,6.48,33.16,APC Assay of amylase,82150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.48,,,,,,,fee schedule,6.48,33.16,APC Androstanediol glucuronide,82154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,130.94,,,,,,,fee schedule,28.83,147.46, Androstanediol glucuronide,82154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,147.46,,,,,,,fee schedule,28.83,147.46, Androstanediol glucuronide,82154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,91.67,,,,,,,fee schedule,28.83,147.46, Androstanediol glucuronide,82154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,104.76,,,,,,,fee schedule,28.83,147.46, Androstanediol glucuronide,82154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.98,,,,,,,fee schedule,28.83,147.46,APC Androstanediol glucuronide,82154,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.27,,,,,,,fee schedule,28.83,147.46,APC Androstanediol glucuronide,82154,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.83,,,,,,,fee schedule,28.83,147.46,APC Assay of androstenedione,82157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,132.93,,,,,,,fee schedule,29.28,149.69, Assay of androstenedione,82157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.69,,,,,,,fee schedule,29.28,149.69, Assay of androstenedione,82157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.69,,,,,,,fee schedule,29.28,149.69, Assay of androstenedione,82157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.93,,,,,,,fee schedule,29.28,149.69, Assay of androstenedione,82157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.45,,,,,,,fee schedule,29.28,149.69,APC Assay of androstenedione,82157,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.74,,,,,,,fee schedule,29.28,149.69,APC Assay of androstenedione,82157,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.28,,,,,,,fee schedule,29.28,149.69,APC Assay of androsterone,82160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.56,,,,,,,fee schedule,25.55,127.88, Assay of androsterone,82160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.88,,,,,,,fee schedule,25.55,127.88, Assay of androsterone,82160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.55,127.88, Assay of androsterone,82160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.55,127.88, Assay of androsterone,82160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.57,,,,,,,fee schedule,25.55,127.88,APC Assay of androsterone,82160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.83,,,,,,,fee schedule,25.55,127.88,APC Assay of androsterone,82160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.55,,,,,,,fee schedule,25.55,127.88,APC Assay of angiotensin II,82163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.21,,,,,,,fee schedule,20.52,104.97, Assay of angiotensin II,82163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,104.97,,,,,,,fee schedule,20.52,104.97, Assay of angiotensin II,82163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,65.63,,,,,,,fee schedule,20.52,104.97, Assay of angiotensin II,82163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75,,,,,,,fee schedule,20.52,104.97, Assay of angiotensin II,82163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.34,,,,,,,fee schedule,20.52,104.97,APC Assay of angiotensin II,82163,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.55,,,,,,,fee schedule,20.52,104.97,APC Assay of angiotensin II,82163,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.52,,,,,,,fee schedule,20.52,104.97,APC Angiotensin I enzyme test,82164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.27,,,,,,,fee schedule,14.6,74.63, Angiotensin I enzyme test,82164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.63,,,,,,,fee schedule,14.6,74.63, Angiotensin I enzyme test,82164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.6,74.63, Angiotensin I enzyme test,82164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.6,74.63, Angiotensin I enzyme test,82164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.18,,,,,,,fee schedule,14.6,74.63,APC Angiotensin I enzyme test,82164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.33,,,,,,,fee schedule,14.6,74.63,APC Angiotensin I enzyme test,82164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.6,,,,,,,fee schedule,14.6,74.63,APC Assay anti-mullerian horm,82166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.52,,,,,,,fee schedule,38.62,141.35, Assay anti-mullerian horm,82166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.35,,,,,,,fee schedule,38.62,141.35, Assay anti-mullerian horm,82166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.62,141.35, Assay anti-mullerian horm,82166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.62,141.35, Assay anti-mullerian horm,82166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.16,,,,,,,fee schedule,38.62,141.35,APC Assay anti-mullerian horm,82166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.55,,,,,,,fee schedule,38.62,141.35,APC Assay anti-mullerian horm,82166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.62,,,,,,,fee schedule,38.62,141.35,APC Assay of apolipoprotein,82172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.36,,,,,,,fee schedule,21.09,79.24, Assay of apolipoprotein,82172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.24,,,,,,,fee schedule,21.09,79.24, Assay of apolipoprotein,82172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,21.09,79.24, Assay of apolipoprotein,82172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,21.09,79.24, Assay of apolipoprotein,82172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.93,,,,,,,fee schedule,21.09,79.24,APC Assay of apolipoprotein,82172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.14,,,,,,,fee schedule,21.09,79.24,APC Assay of apolipoprotein,82172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.09,,,,,,,fee schedule,21.09,79.24,APC Assay of arsenic,82175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.16,,,,,,,fee schedule,18.97,97.03, Assay of arsenic,82175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,97.03,,,,,,,fee schedule,18.97,97.03, Assay of arsenic,82175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,18.97,97.03, Assay of arsenic,82175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,18.97,97.03, Assay of arsenic,82175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.73,,,,,,,fee schedule,18.97,97.03,APC Assay of arsenic,82175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.92,,,,,,,fee schedule,18.97,97.03,APC Assay of arsenic,82175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.97,,,,,,,fee schedule,18.97,97.03,APC Assay of ascorbic acid,82180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.88,,,,,,,fee schedule,9.89,50.54, Assay of ascorbic acid,82180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.54,,,,,,,fee schedule,9.89,50.54, Assay of ascorbic acid,82180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.89,50.54, Assay of ascorbic acid,82180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.89,50.54, Assay of ascorbic acid,82180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.29,,,,,,,fee schedule,9.89,50.54,APC Assay of ascorbic acid,82180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.38,,,,,,,fee schedule,9.89,50.54,APC Assay of ascorbic acid,82180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.89,,,,,,,fee schedule,9.89,50.54,APC Atomic absorption,82190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.7,,,,,,,fee schedule,15.9,76.24, Atomic absorption,82190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.24,,,,,,,fee schedule,15.9,76.24, Atomic absorption,82190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,15.9,76.24, Atomic absorption,82190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,15.9,76.24, Atomic absorption,82190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.54,,,,,,,fee schedule,15.9,76.24,APC Atomic absorption,82190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.7,,,,,,,fee schedule,15.9,76.24,APC Atomic absorption,82190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.9,,,,,,,fee schedule,15.9,76.24,APC Assay of beta-2 protein,82232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.48,,,,,,,fee schedule,16.18,82.75, Assay of beta-2 protein,82232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.75,,,,,,,fee schedule,16.18,82.75, Assay of beta-2 protein,82232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.18,82.75, Assay of beta-2 protein,82232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.18,82.75, Assay of beta-2 protein,82232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.83,,,,,,,fee schedule,16.18,82.75,APC Assay of beta-2 protein,82232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.99,,,,,,,fee schedule,16.18,82.75,APC Assay of beta-2 protein,82232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.18,,,,,,,fee schedule,16.18,82.75,APC Beta-amyloid 1-40 (abeta 40),82233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,134.08,,,,,,,fee schedule,128.92,135.37,APC Beta-amyloid 1-40 (abeta 40),82233,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.37,,,,,,,fee schedule,128.92,135.37,APC Beta-amyloid 1-40 (abeta 40),82233,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.92,,,,,,,fee schedule,128.92,135.37,APC Beta-amyloid 1-42 (abeta 42),82234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,134.08,,,,,,,fee schedule,128.92,135.37,APC Beta-amyloid 1-42 (abeta 42),82234,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.37,,,,,,,fee schedule,128.92,135.37,APC Beta-amyloid 1-42 (abeta 42),82234,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.92,,,,,,,fee schedule,128.92,135.37,APC Bile acids total,82239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.81,,,,,,,fee schedule,17.12,87.62, Bile acids total,82239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.62,,,,,,,fee schedule,17.12,87.62, Bile acids total,82239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.12,87.62, Bile acids total,82239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.12,87.62, Bile acids total,82239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.8,,,,,,,fee schedule,17.12,87.62,APC Bile acids total,82239,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.98,,,,,,,fee schedule,17.12,87.62,APC Bile acids total,82239,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.12,,,,,,,fee schedule,17.12,87.62,APC Bile acids cholylglycine,82240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,120.67,,,,,,,fee schedule,26.58,135.9, Bile acids cholylglycine,82240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,135.9,,,,,,,fee schedule,26.58,135.9, Bile acids cholylglycine,82240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.37,,,,,,,fee schedule,26.58,135.9, Bile acids cholylglycine,82240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.42,,,,,,,fee schedule,26.58,135.9, Bile acids cholylglycine,82240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.64,,,,,,,fee schedule,26.58,135.9,APC Bile acids cholylglycine,82240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.91,,,,,,,fee schedule,26.58,135.9,APC Bile acids cholylglycine,82240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.58,,,,,,,fee schedule,26.58,135.9,APC Bilirubin total,82247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.82,,,,,,,fee schedule,5.02,25.69, Bilirubin total,82247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.69,,,,,,,fee schedule,5.02,25.69, Bilirubin total,82247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5.02,25.69, Bilirubin total,82247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5.02,25.69, Bilirubin total,82247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.22,,,,,,,fee schedule,5.02,25.69,APC Bilirubin total,82247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.27,,,,,,,fee schedule,5.02,25.69,APC Bilirubin total,82247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.02,,,,,,,fee schedule,5.02,25.69,APC Bilirubin direct,82248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.82,,,,,,,fee schedule,5.02,25.69, Bilirubin direct,82248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.69,,,,,,,fee schedule,5.02,25.69, Bilirubin direct,82248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5.02,25.69, Bilirubin direct,82248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5.02,25.69, Bilirubin direct,82248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.22,,,,,,,fee schedule,5.02,25.69,APC Bilirubin direct,82248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.27,,,,,,,fee schedule,5.02,25.69,APC Bilirubin direct,82248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.02,,,,,,,fee schedule,5.02,25.69,APC Fecal bilirubin test,82252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.64,,,,,,,fee schedule,4.56,23.24, Fecal bilirubin test,82252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.24,,,,,,,fee schedule,4.56,23.24, Fecal bilirubin test,82252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.56,23.24, Fecal bilirubin test,82252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.56,23.24, Fecal bilirubin test,82252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.74,,,,,,,fee schedule,4.56,23.24,APC Fecal bilirubin test,82252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.79,,,,,,,fee schedule,4.56,23.24,APC Fecal bilirubin test,82252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.56,,,,,,,fee schedule,4.56,23.24,APC Assay of biotinidase,82261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,16.87,86.27, Assay of biotinidase,82261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,16.87,86.27, Assay of biotinidase,82261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.87,86.27, Assay of biotinidase,82261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.87,86.27, Assay of biotinidase,82261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.54,,,,,,,fee schedule,16.87,86.27,APC Assay of biotinidase,82261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.71,,,,,,,fee schedule,16.87,86.27,APC Assay of biotinidase,82261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.87,86.27,APC Occult blood feces,82270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.76,,,,,,,fee schedule,4.38,16.62, Occult blood feces,82270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.62,,,,,,,fee schedule,4.38,16.62, Occult blood feces,82270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.38,16.62, Occult blood feces,82270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.38,16.62, Occult blood feces,82270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.56,,,,,,,fee schedule,4.38,16.62,APC Occult blood feces,82270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.6,,,,,,,fee schedule,4.38,16.62,APC Occult blood feces,82270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.38,,,,,,,fee schedule,4.38,16.62,APC Occult blood other sources,82271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.98,,,,,,,fee schedule,5.32,19.05, Occult blood other sources,82271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.87,,,,,,,fee schedule,5.32,19.05, Occult blood other sources,82271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.32,19.05, Occult blood other sources,82271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.32,19.05, Occult blood other sources,82271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.53,,,,,,,fee schedule,5.32,19.05,APC Occult blood other sources,82271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.59,,,,,,,fee schedule,5.32,19.05,APC Occult blood other sources,82271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.32,,,,,,,fee schedule,5.32,19.05,APC Occult bld feces 1-3 tests,82272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.98,,,,,,,fee schedule,4.23,16.87, Occult bld feces 1-3 tests,82272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.87,,,,,,,fee schedule,4.23,16.87, Occult bld feces 1-3 tests,82272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.23,16.87, Occult bld feces 1-3 tests,82272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.23,16.87, Occult bld feces 1-3 tests,82272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.4,,,,,,,fee schedule,4.23,16.87,APC Occult bld feces 1-3 tests,82272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.23,16.87,APC Occult bld feces 1-3 tests,82272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.23,,,,,,,fee schedule,4.23,16.87,APC Assay test for blood fecal,82274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.22,,,,,,,fee schedule,15.92,81.33, Assay test for blood fecal,82274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.33,,,,,,,fee schedule,15.92,81.33, Assay test for blood fecal,82274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,15.92,81.33, Assay test for blood fecal,82274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,15.92,81.33, Assay test for blood fecal,82274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.56,,,,,,,fee schedule,15.92,81.33,APC Assay test for blood fecal,82274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.72,,,,,,,fee schedule,15.92,81.33,APC Assay test for blood fecal,82274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.92,,,,,,,fee schedule,15.92,81.33,APC Assay of bradykinin,82286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.27,,,,,,,fee schedule,5.16,35.21, Assay of bradykinin,82286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.21,,,,,,,fee schedule,5.16,35.21, Assay of bradykinin,82286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.16,35.21, Assay of bradykinin,82286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.16,35.21, Assay of bradykinin,82286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.37,,,,,,,fee schedule,5.16,35.21,APC Assay of bradykinin,82286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.42,,,,,,,fee schedule,5.16,35.21,APC Assay of bradykinin,82286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.16,,,,,,,fee schedule,5.16,35.21,APC Assay of cadmium,82300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,105.07,,,,,,,fee schedule,23.64,118.33, Assay of cadmium,82300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,118.33,,,,,,,fee schedule,23.64,118.33, Assay of cadmium,82300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75,,,,,,,fee schedule,23.64,118.33, Assay of cadmium,82300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,85.71,,,,,,,fee schedule,23.64,118.33, Assay of cadmium,82300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.59,,,,,,,fee schedule,23.64,118.33,APC Assay of cadmium,82300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.82,,,,,,,fee schedule,23.64,118.33,APC Assay of cadmium,82300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.64,,,,,,,fee schedule,23.64,118.33,APC Vitamin d 25 hydroxy,82306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.42,,,,,,,fee schedule,29.6,151.38, Vitamin d 25 hydroxy,82306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,151.38,,,,,,,fee schedule,29.6,151.38, Vitamin d 25 hydroxy,82306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,93.74,,,,,,,fee schedule,29.6,151.38, Vitamin d 25 hydroxy,82306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,107.13,,,,,,,fee schedule,29.6,151.38, Vitamin d 25 hydroxy,82306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.78,,,,,,,fee schedule,29.6,151.38,APC Vitamin d 25 hydroxy,82306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.08,,,,,,,fee schedule,29.6,151.38,APC Vitamin d 25 hydroxy,82306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.6,,,,,,,fee schedule,29.6,151.38,APC Assay of calcitonin,82308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.58,,,,,,,fee schedule,26.79,136.92, Assay of calcitonin,82308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.92,,,,,,,fee schedule,26.79,136.92, Assay of calcitonin,82308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.79,136.92, Assay of calcitonin,82308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.79,136.92, Assay of calcitonin,82308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.86,,,,,,,fee schedule,26.79,136.92,APC Assay of calcitonin,82308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.13,,,,,,,fee schedule,26.79,136.92,APC Assay of calcitonin,82308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.79,,,,,,,fee schedule,26.79,136.92,APC Assay of calcium,82310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.4,,,,,,,fee schedule,5.16,26.35, Assay of calcium,82310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.35,,,,,,,fee schedule,5.16,26.35, Assay of calcium,82310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.16,26.35, Assay of calcium,82310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.16,26.35, Assay of calcium,82310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.37,,,,,,,fee schedule,5.16,26.35,APC Assay of calcium,82310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.42,,,,,,,fee schedule,5.16,26.35,APC Assay of calcium,82310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.16,,,,,,,fee schedule,5.16,26.35,APC Assay of calcium,82330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.04,,,,,,,fee schedule,13.68,69.87, Assay of calcium,82330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.87,,,,,,,fee schedule,13.68,69.87, Assay of calcium,82330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.68,69.87, Assay of calcium,82330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.68,69.87, Assay of calcium,82330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.23,,,,,,,fee schedule,13.68,69.87,APC Assay of calcium,82330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.36,,,,,,,fee schedule,13.68,69.87,APC Assay of calcium,82330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.68,,,,,,,fee schedule,13.68,69.87,APC Calcium infusion test,82331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,13.34,48.81, Calcium infusion test,82331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,13.34,48.81, Calcium infusion test,82331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.34,48.81, Calcium infusion test,82331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.34,48.81, Calcium infusion test,82331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.87,,,,,,,fee schedule,13.34,48.81,APC Calcium infusion test,82331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.01,,,,,,,fee schedule,13.34,48.81,APC Calcium infusion test,82331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.34,,,,,,,fee schedule,13.34,48.81,APC Assay of calcium in urine,82340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.4,,,,,,,fee schedule,6.03,30.85, Assay of calcium in urine,82340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.85,,,,,,,fee schedule,6.03,30.85, Assay of calcium in urine,82340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,6.03,30.85, Assay of calcium in urine,82340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,6.03,30.85, Assay of calcium in urine,82340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.27,,,,,,,fee schedule,6.03,30.85,APC Assay of calcium in urine,82340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.33,,,,,,,fee schedule,6.03,30.85,APC Assay of calcium in urine,82340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.03,,,,,,,fee schedule,6.03,30.85,APC Calculus analysis qual,82355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.55,,,,,,,fee schedule,11.58,59.18, Calculus analysis qual,82355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.18,,,,,,,fee schedule,11.58,59.18, Calculus analysis qual,82355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.58,59.18, Calculus analysis qual,82355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.58,59.18, Calculus analysis qual,82355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.04,,,,,,,fee schedule,11.58,59.18,APC Calculus analysis qual,82355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.16,,,,,,,fee schedule,11.58,59.18,APC Calculus analysis qual,82355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.58,,,,,,,fee schedule,11.58,59.18,APC Calculus assay quant,82360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.47,,,,,,,fee schedule,12.87,65.84, Calculus assay quant,82360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.84,,,,,,,fee schedule,12.87,65.84, Calculus assay quant,82360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.87,65.84, Calculus assay quant,82360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.87,65.84, Calculus assay quant,82360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.38,,,,,,,fee schedule,12.87,65.84,APC Calculus assay quant,82360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.51,,,,,,,fee schedule,12.87,65.84,APC Calculus assay quant,82360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.87,,,,,,,fee schedule,12.87,65.84,APC Calculus spectroscopy,82365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.53,,,,,,,fee schedule,12.9,65.92, Calculus spectroscopy,82365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.92,,,,,,,fee schedule,12.9,65.92, Calculus spectroscopy,82365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.9,65.92, Calculus spectroscopy,82365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.9,65.92, Calculus spectroscopy,82365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,12.9,65.92,APC Calculus spectroscopy,82365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.55,,,,,,,fee schedule,12.9,65.92,APC Calculus spectroscopy,82365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.9,,,,,,,fee schedule,12.9,65.92,APC X-ray assay calculus,82370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.91,,,,,,,fee schedule,12.52,64.09, X-ray assay calculus,82370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.09,,,,,,,fee schedule,12.52,64.09, X-ray assay calculus,82370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.52,64.09, X-ray assay calculus,82370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.52,64.09, X-ray assay calculus,82370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.02,,,,,,,fee schedule,12.52,64.09,APC X-ray assay calculus,82370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.15,,,,,,,fee schedule,12.52,64.09,APC X-ray assay calculus,82370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.52,,,,,,,fee schedule,12.52,64.09,APC Assay c-d transfer measure,82373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,18.06,92.34, Assay c-d transfer measure,82373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,18.06,92.34, Assay c-d transfer measure,82373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.06,92.34, Assay c-d transfer measure,82373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.06,92.34, Assay c-d transfer measure,82373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.78,,,,,,,fee schedule,18.06,92.34,APC Assay c-d transfer measure,82373,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.96,,,,,,,fee schedule,18.06,92.34,APC Assay c-d transfer measure,82373,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.06,,,,,,,fee schedule,18.06,92.34,APC Assay blood carbon dioxide,82374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.2,,,,,,,fee schedule,4.88,25, Assay blood carbon dioxide,82374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25,,,,,,,fee schedule,4.88,25, Assay blood carbon dioxide,82374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.88,25, Assay blood carbon dioxide,82374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.88,25, Assay blood carbon dioxide,82374,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.08,,,,,,,fee schedule,4.88,25,APC Assay blood carbon dioxide,82374,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.12,,,,,,,fee schedule,4.88,25,APC Assay blood carbon dioxide,82374,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.88,,,,,,,fee schedule,4.88,25,APC Assay carboxyhb quant,82375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.97,,,,,,,fee schedule,12.32,63.03, Assay carboxyhb quant,82375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.03,,,,,,,fee schedule,12.32,63.03, Assay carboxyhb quant,82375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.32,63.03, Assay carboxyhb quant,82375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.32,63.03, Assay carboxyhb quant,82375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.81,,,,,,,fee schedule,12.32,63.03,APC Assay carboxyhb quant,82375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.94,,,,,,,fee schedule,12.32,63.03,APC Assay carboxyhb quant,82375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.32,,,,,,,fee schedule,12.32,63.03,APC Assay carboxyhb qual,82376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.2,,,,,,,fee schedule,14.07,51.18, Assay carboxyhb qual,82376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.63,,,,,,,fee schedule,14.07,51.18, Assay carboxyhb qual,82376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.07,51.18, Assay carboxyhb qual,82376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.07,51.18, Assay carboxyhb qual,82376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.63,,,,,,,fee schedule,14.07,51.18,APC Assay carboxyhb qual,82376,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.77,,,,,,,fee schedule,14.07,51.18,APC Assay carboxyhb qual,82376,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.07,,,,,,,fee schedule,14.07,51.18,APC Carcinoembryonic antigen,82378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.16,,,,,,,fee schedule,18.96,97.03, Carcinoembryonic antigen,82378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,97.03,,,,,,,fee schedule,18.96,97.03, Carcinoembryonic antigen,82378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,18.96,97.03, Carcinoembryonic antigen,82378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,18.96,97.03, Carcinoembryonic antigen,82378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.72,,,,,,,fee schedule,18.96,97.03,APC Carcinoembryonic antigen,82378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.91,,,,,,,fee schedule,18.96,97.03,APC Carcinoembryonic antigen,82378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.96,,,,,,,fee schedule,18.96,97.03,APC Assay of carnitine,82379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,16.87,86.27, Assay of carnitine,82379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,16.87,86.27, Assay of carnitine,82379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.87,86.27, Assay of carnitine,82379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.87,86.27, Assay of carnitine,82379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.54,,,,,,,fee schedule,16.87,86.27,APC Assay of carnitine,82379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.71,,,,,,,fee schedule,16.87,86.27,APC Assay of carnitine,82379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.87,86.27,APC Assay of carotene,82380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.89,,,,,,,fee schedule,9.22,47.18, Assay of carotene,82380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.18,,,,,,,fee schedule,9.22,47.18, Assay of carotene,82380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.16,,,,,,,fee schedule,9.22,47.18, Assay of carotene,82380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.33,,,,,,,fee schedule,9.22,47.18, Assay of carotene,82380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.59,,,,,,,fee schedule,9.22,47.18,APC Assay of carotene,82380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.68,,,,,,,fee schedule,9.22,47.18,APC Assay of carotene,82380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.22,,,,,,,fee schedule,9.22,47.18,APC Assay urine catecholamines,82382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.07,,,,,,,fee schedule,27.3,98.79, Assay urine catecholamines,82382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.91,,,,,,,fee schedule,27.3,98.79, Assay urine catecholamines,82382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.3,98.79, Assay urine catecholamines,82382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.3,98.79, Assay urine catecholamines,82382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.39,,,,,,,fee schedule,27.3,98.79,APC Assay urine catecholamines,82382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.67,,,,,,,fee schedule,27.3,98.79,APC Assay urine catecholamines,82382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.3,,,,,,,fee schedule,27.3,98.79,APC Assay blood catecholamines,82383,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.78,,,,,,,fee schedule,29.08,128.14, Assay blood catecholamines,82383,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.14,,,,,,,fee schedule,29.08,128.14, Assay blood catecholamines,82383,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.69,,,,,,,fee schedule,29.08,128.14, Assay blood catecholamines,82383,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.93,,,,,,,fee schedule,29.08,128.14, Assay blood catecholamines,82383,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.24,,,,,,,fee schedule,29.08,128.14,APC Assay blood catecholamines,82383,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.53,,,,,,,fee schedule,29.08,128.14,APC Assay blood catecholamines,82383,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.08,,,,,,,fee schedule,29.08,128.14,APC Assay three catecholamines,82384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.66,,,,,,,fee schedule,25.25,129.12, Assay three catecholamines,82384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.12,,,,,,,fee schedule,25.25,129.12, Assay three catecholamines,82384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.19,,,,,,,fee schedule,25.25,129.12, Assay three catecholamines,82384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.65,,,,,,,fee schedule,25.25,129.12, Assay three catecholamines,82384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.26,,,,,,,fee schedule,25.25,129.12,APC Assay three catecholamines,82384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.51,,,,,,,fee schedule,25.25,129.12,APC Assay three catecholamines,82384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.25,,,,,,,fee schedule,25.25,129.12,APC Assay of cathepsin-d,82387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.48,,,,,,,fee schedule,18.06,106.4, Assay of cathepsin-d,82387,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.4,,,,,,,fee schedule,18.06,106.4, Assay of cathepsin-d,82387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.06,106.4, Assay of cathepsin-d,82387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.06,106.4, Assay of cathepsin-d,82387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.78,,,,,,,fee schedule,18.06,106.4,APC Assay of cathepsin-d,82387,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.96,,,,,,,fee schedule,18.06,106.4,APC Assay of cathepsin-d,82387,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.06,,,,,,,fee schedule,18.06,106.4,APC Assay of ceruloplasmin,82390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.78,,,,,,,fee schedule,10.74,54.94, Assay of ceruloplasmin,82390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.94,,,,,,,fee schedule,10.74,54.94, Assay of ceruloplasmin,82390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.74,54.94, Assay of ceruloplasmin,82390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.74,54.94, Assay of ceruloplasmin,82390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.17,,,,,,,fee schedule,10.74,54.94,APC Assay of ceruloplasmin,82390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.28,,,,,,,fee schedule,10.74,54.94,APC Assay of ceruloplasmin,82390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.74,54.94,APC Chemiluminescent assay,82397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.16,,,,,,,fee schedule,14.12,72.25, Chemiluminescent assay,82397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.25,,,,,,,fee schedule,14.12,72.25, Chemiluminescent assay,82397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.12,72.25, Chemiluminescent assay,82397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.12,72.25, Chemiluminescent assay,82397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.68,,,,,,,fee schedule,14.12,72.25,APC Chemiluminescent assay,82397,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.83,,,,,,,fee schedule,14.12,72.25,APC Chemiluminescent assay,82397,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.12,,,,,,,fee schedule,14.12,72.25,APC Assay of chloramphenicol,82415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.53,,,,,,,fee schedule,12.67,64.78, Assay of chloramphenicol,82415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.78,,,,,,,fee schedule,12.67,64.78, Assay of chloramphenicol,82415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.67,64.78, Assay of chloramphenicol,82415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.67,64.78, Assay of chloramphenicol,82415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.18,,,,,,,fee schedule,12.67,64.78,APC Assay of chloramphenicol,82415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.3,,,,,,,fee schedule,12.67,64.78,APC Assay of chloramphenicol,82415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.67,,,,,,,fee schedule,12.67,64.78,APC Assay of blood chloride,82435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.87,,,,,,,fee schedule,4.6,23.5, Assay of blood chloride,82435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.5,,,,,,,fee schedule,4.6,23.5, Assay of blood chloride,82435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.6,23.5, Assay of blood chloride,82435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.6,23.5, Assay of blood chloride,82435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.78,,,,,,,fee schedule,4.6,23.5,APC Assay of blood chloride,82435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.83,,,,,,,fee schedule,4.6,23.5,APC Assay of blood chloride,82435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.6,,,,,,,fee schedule,4.6,23.5,APC Assay of urine chloride,82436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.82,,,,,,,fee schedule,5.75,25.69, Assay of urine chloride,82436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.69,,,,,,,fee schedule,5.75,25.69, Assay of urine chloride,82436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.75,25.69, Assay of urine chloride,82436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.75,25.69, Assay of urine chloride,82436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.98,,,,,,,fee schedule,5.75,25.69,APC Assay of urine chloride,82436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.04,,,,,,,fee schedule,5.75,25.69,APC Assay of urine chloride,82436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.75,,,,,,,fee schedule,5.75,25.69,APC Assay other fluid chlorides,82438,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.2,,,,,,,fee schedule,5,25, Assay other fluid chlorides,82438,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25,,,,,,,fee schedule,5,25, Assay other fluid chlorides,82438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5,25, Assay other fluid chlorides,82438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5,25, Assay other fluid chlorides,82438,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.2,,,,,,,fee schedule,5,25,APC Assay other fluid chlorides,82438,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.25,,,,,,,fee schedule,5,25,APC Assay other fluid chlorides,82438,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5,,,,,,,fee schedule,5,25,APC Test for chlorohydrocarbons,82441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.24,,,,,,,fee schedule,6.01,30.67, Test for chlorohydrocarbons,82441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.67,,,,,,,fee schedule,6.01,30.67, Test for chlorohydrocarbons,82441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,6.01,30.67, Test for chlorohydrocarbons,82441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,6.01,30.67, Test for chlorohydrocarbons,82441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.25,,,,,,,fee schedule,6.01,30.67,APC Test for chlorohydrocarbons,82441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.31,,,,,,,fee schedule,6.01,30.67,APC Test for chlorohydrocarbons,82441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.01,,,,,,,fee schedule,6.01,30.67,APC Assay bld/serum cholesterol,82465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.76,,,,,,,fee schedule,4.35,22.25, Assay bld/serum cholesterol,82465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.25,,,,,,,fee schedule,4.35,22.25, Assay bld/serum cholesterol,82465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.35,22.25, Assay bld/serum cholesterol,82465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.35,22.25, Assay bld/serum cholesterol,82465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.52,,,,,,,fee schedule,4.35,22.25,APC Assay bld/serum cholesterol,82465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.57,,,,,,,fee schedule,4.35,22.25,APC Assay bld/serum cholesterol,82465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.35,,,,,,,fee schedule,4.35,22.25,APC Assay serum cholinesterase,82480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.74,,,,,,,fee schedule,7.87,37.99, Assay serum cholinesterase,82480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.99,,,,,,,fee schedule,7.87,37.99, Assay serum cholinesterase,82480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.87,37.99, Assay serum cholinesterase,82480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.87,37.99, Assay serum cholinesterase,82480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.18,,,,,,,fee schedule,7.87,37.99,APC Assay serum cholinesterase,82480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.26,,,,,,,fee schedule,7.87,37.99,APC Assay serum cholinesterase,82480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.87,,,,,,,fee schedule,7.87,37.99,APC Assay rbc cholinesterase,82482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.91,,,,,,,fee schedule,9.81,39.31, Assay rbc cholinesterase,82482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.31,,,,,,,fee schedule,9.81,39.31, Assay rbc cholinesterase,82482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.81,39.31, Assay rbc cholinesterase,82482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.81,39.31, Assay rbc cholinesterase,82482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.2,,,,,,,fee schedule,9.81,39.31,APC Assay rbc cholinesterase,82482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.3,,,,,,,fee schedule,9.81,39.31,APC Assay rbc cholinesterase,82482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.81,,,,,,,fee schedule,9.81,39.31,APC Assay chondroitin sulfate,82485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.76,,,,,,,fee schedule,20.65,105.59, Assay chondroitin sulfate,82485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.59,,,,,,,fee schedule,20.65,105.59, Assay chondroitin sulfate,82485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,65.63,,,,,,,fee schedule,20.65,105.59, Assay chondroitin sulfate,82485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75,,,,,,,fee schedule,20.65,105.59, Assay chondroitin sulfate,82485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.48,,,,,,,fee schedule,20.65,105.59,APC Assay chondroitin sulfate,82485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.68,,,,,,,fee schedule,20.65,105.59,APC Assay chondroitin sulfate,82485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.65,,,,,,,fee schedule,20.65,105.59,APC Assay of chromium,82495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.75,,,,,,,fee schedule,20.28,73.8, Assay of chromium,82495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.76,,,,,,,fee schedule,20.28,73.8, Assay of chromium,82495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.28,73.8, Assay of chromium,82495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.28,73.8, Assay of chromium,82495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.09,,,,,,,fee schedule,20.28,73.8,APC Assay of chromium,82495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.29,,,,,,,fee schedule,20.28,73.8,APC Assay of chromium,82495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.28,,,,,,,fee schedule,20.28,73.8,APC Assay of citrate,82507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.26,,,,,,,fee schedule,27.8,142.19, Assay of citrate,82507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,142.19,,,,,,,fee schedule,27.8,142.19, Assay of citrate,82507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.54,,,,,,,fee schedule,27.8,142.19, Assay of citrate,82507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,101.19,,,,,,,fee schedule,27.8,142.19, Assay of citrate,82507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.91,,,,,,,fee schedule,27.8,142.19,APC Assay of citrate,82507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.19,,,,,,,fee schedule,27.8,142.19,APC Assay of citrate,82507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.8,,,,,,,fee schedule,27.8,142.19,APC Collagen crosslinks,82523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.3,,,,,,,fee schedule,18.68,67.86, Collagen crosslinks,82523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.52,,,,,,,fee schedule,18.68,67.86, Collagen crosslinks,82523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.68,67.86, Collagen crosslinks,82523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.68,67.86, Collagen crosslinks,82523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.43,,,,,,,fee schedule,18.68,67.86,APC Collagen crosslinks,82523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.61,,,,,,,fee schedule,18.68,67.86,APC Collagen crosslinks,82523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.68,,,,,,,fee schedule,18.68,67.86,APC Assay of copper,82525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.32,,,,,,,fee schedule,12.41,53.29, Assay of copper,82525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.29,,,,,,,fee schedule,12.41,53.29, Assay of copper,82525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.41,53.29, Assay of copper,82525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.41,53.29, Assay of copper,82525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.91,,,,,,,fee schedule,12.41,53.29,APC Assay of copper,82525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.03,,,,,,,fee schedule,12.41,53.29,APC Assay of copper,82525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.41,,,,,,,fee schedule,12.41,53.29,APC Assay of corticosterone,82528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.21,,,,,,,fee schedule,22.52,115.11, Assay of corticosterone,82528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,115.11,,,,,,,fee schedule,22.52,115.11, Assay of corticosterone,82528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,71.87,,,,,,,fee schedule,22.52,115.11, Assay of corticosterone,82528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.14,,,,,,,fee schedule,22.52,115.11, Assay of corticosterone,82528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.42,,,,,,,fee schedule,22.52,115.11,APC Assay of corticosterone,82528,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.65,,,,,,,fee schedule,22.52,115.11,APC Assay of corticosterone,82528,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.52,,,,,,,fee schedule,22.52,115.11,APC Cortisol free,82530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.89,,,,,,,fee schedule,16.71,85.46, Cortisol free,82530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.46,,,,,,,fee schedule,16.71,85.46, Cortisol free,82530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.71,85.46, Cortisol free,82530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.71,85.46, Cortisol free,82530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.38,,,,,,,fee schedule,16.71,85.46,APC Cortisol free,82530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.55,,,,,,,fee schedule,16.71,85.46,APC Cortisol free,82530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.71,,,,,,,fee schedule,16.71,85.46,APC Total cortisol,82533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.04,,,,,,,fee schedule,16.3,83.37, Total cortisol,82533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.37,,,,,,,fee schedule,16.3,83.37, Total cortisol,82533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.3,83.37, Total cortisol,82533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.3,83.37, Total cortisol,82533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.95,,,,,,,fee schedule,16.3,83.37,APC Total cortisol,82533,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.12,,,,,,,fee schedule,16.3,83.37,APC Total cortisol,82533,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.3,,,,,,,fee schedule,16.3,83.37,APC Assay of creatine,82540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.06,,,,,,,fee schedule,4.64,23.72, Assay of creatine,82540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.72,,,,,,,fee schedule,4.64,23.72, Assay of creatine,82540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.64,23.72, Assay of creatine,82540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.64,23.72, Assay of creatine,82540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.83,,,,,,,fee schedule,4.64,23.72,APC Assay of creatine,82540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.87,,,,,,,fee schedule,4.64,23.72,APC Assay of creatine,82540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.64,,,,,,,fee schedule,4.64,23.72,APC Col chromotography qual/quan,82542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,24.09,92.34, Col chromotography qual/quan,82542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,24.09,92.34, Col chromotography qual/quan,82542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,24.09,92.34, Col chromotography qual/quan,82542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,24.09,92.34, Col chromotography qual/quan,82542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.05,,,,,,,fee schedule,24.09,92.34,APC Col chromotography qual/quan,82542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.29,,,,,,,fee schedule,24.09,92.34,APC Col chromotography qual/quan,82542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.09,,,,,,,fee schedule,24.09,92.34,APC Assay of ck (cpk),82550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.58,,,,,,,fee schedule,6.51,33.31, Assay of ck (cpk),82550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.31,,,,,,,fee schedule,6.51,33.31, Assay of ck (cpk),82550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.51,33.31, Assay of ck (cpk),82550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.51,33.31, Assay of ck (cpk),82550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.77,,,,,,,fee schedule,6.51,33.31,APC Assay of ck (cpk),82550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.84,,,,,,,fee schedule,6.51,33.31,APC Assay of ck (cpk),82550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.51,,,,,,,fee schedule,6.51,33.31,APC Assay of cpk in blood,82552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.81,,,,,,,fee schedule,13.39,68.48, Assay of cpk in blood,82552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.48,,,,,,,fee schedule,13.39,68.48, Assay of cpk in blood,82552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.39,68.48, Assay of cpk in blood,82552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.39,68.48, Assay of cpk in blood,82552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.93,,,,,,,fee schedule,13.39,68.48,APC Assay of cpk in blood,82552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.06,,,,,,,fee schedule,13.39,68.48,APC Assay of cpk in blood,82552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.39,,,,,,,fee schedule,13.39,68.48,APC Creatine mb fraction,82553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.97,,,,,,,fee schedule,11.55,41.67, Creatine mb fraction,82553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.38,,,,,,,fee schedule,11.55,41.67, Creatine mb fraction,82553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.55,41.67, Creatine mb fraction,82553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.55,41.67, Creatine mb fraction,82553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.01,,,,,,,fee schedule,11.55,41.67,APC Creatine mb fraction,82553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.13,,,,,,,fee schedule,11.55,41.67,APC Creatine mb fraction,82553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.55,,,,,,,fee schedule,11.55,41.67,APC Creatine isoforms,82554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.89,,,,,,,fee schedule,11.87,60.68, Creatine isoforms,82554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.68,,,,,,,fee schedule,11.87,60.68, Creatine isoforms,82554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.87,60.68, Creatine isoforms,82554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.87,60.68, Creatine isoforms,82554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.34,,,,,,,fee schedule,11.87,60.68,APC Creatine isoforms,82554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.87,60.68,APC Creatine isoforms,82554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.87,,,,,,,fee schedule,11.87,60.68,APC Assay of creatinine,82565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.27,,,,,,,fee schedule,5.12,26.21, Assay of creatinine,82565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.21,,,,,,,fee schedule,5.12,26.21, Assay of creatinine,82565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.12,26.21, Assay of creatinine,82565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.12,26.21, Assay of creatinine,82565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.32,,,,,,,fee schedule,5.12,26.21,APC Assay of creatinine,82565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.38,,,,,,,fee schedule,5.12,26.21,APC Assay of creatinine,82565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.12,,,,,,,fee schedule,5.12,26.21,APC Assay of urine creatinine,82570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,5.18,26.46, Assay of urine creatinine,82570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,5.18,26.46, Assay of urine creatinine,82570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.18,26.46, Assay of urine creatinine,82570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.18,26.46, Assay of urine creatinine,82570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.18,26.46,APC Assay of urine creatinine,82570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.44,,,,,,,fee schedule,5.18,26.46,APC Assay of urine creatinine,82570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.18,,,,,,,fee schedule,5.18,26.46,APC Creatinine clearance test,82575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.9,,,,,,,fee schedule,9.46,48.31, Creatinine clearance test,82575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.31,,,,,,,fee schedule,9.46,48.31, Creatinine clearance test,82575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.46,48.31, Creatinine clearance test,82575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.46,48.31, Creatinine clearance test,82575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.84,,,,,,,fee schedule,9.46,48.31,APC Creatinine clearance test,82575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.93,,,,,,,fee schedule,9.46,48.31,APC Creatinine clearance test,82575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.46,,,,,,,fee schedule,9.46,48.31,APC Assay of cryofibrinogen,82585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.94,,,,,,,fee schedule,14.14,51.18, Assay of cryofibrinogen,82585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.85,,,,,,,fee schedule,14.14,51.18, Assay of cryofibrinogen,82585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.14,51.18, Assay of cryofibrinogen,82585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.14,51.18, Assay of cryofibrinogen,82585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.71,,,,,,,fee schedule,14.14,51.18,APC Assay of cryofibrinogen,82585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.85,,,,,,,fee schedule,14.14,51.18,APC Assay of cryofibrinogen,82585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.14,,,,,,,fee schedule,14.14,51.18,APC Assay of cryoglobulin,82595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, Assay of cryoglobulin,82595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, Assay of cryoglobulin,82595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, Assay of cryoglobulin,82595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, Assay of cryoglobulin,82595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC Assay of cryoglobulin,82595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC Assay of cryoglobulin,82595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Assay of cyanide,82600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,19.4,99.22, Assay of cyanide,82600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.22,,,,,,,fee schedule,19.4,99.22, Assay of cyanide,82600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.4,99.22, Assay of cyanide,82600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.4,99.22, Assay of cyanide,82600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.18,,,,,,,fee schedule,19.4,99.22,APC Assay of cyanide,82600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.37,,,,,,,fee schedule,19.4,99.22,APC Assay of cyanide,82600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.4,,,,,,,fee schedule,19.4,99.22,APC Vitamin B-12,82607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.45,,,,,,,fee schedule,15.08,77.08, Vitamin B-12,82607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.08,,,,,,,fee schedule,15.08,77.08, Vitamin B-12,82607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.08,77.08, Vitamin B-12,82607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.08,77.08, Vitamin B-12,82607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.68,,,,,,,fee schedule,15.08,77.08,APC Vitamin B-12,82607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.83,,,,,,,fee schedule,15.08,77.08,APC Vitamin B-12,82607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.08,,,,,,,fee schedule,15.08,77.08,APC B-12 binding capacity,82608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.03,,,,,,,fee schedule,14.32,73.24, B-12 binding capacity,82608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.24,,,,,,,fee schedule,14.32,73.24, B-12 binding capacity,82608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.32,73.24, B-12 binding capacity,82608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.32,73.24, B-12 binding capacity,82608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.89,,,,,,,fee schedule,14.32,73.24,APC B-12 binding capacity,82608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.04,,,,,,,fee schedule,14.32,73.24,APC B-12 binding capacity,82608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.32,,,,,,,fee schedule,14.32,73.24,APC Cystatin c,82610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.56,,,,,,,fee schedule,18.52,70.46, Cystatin c,82610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.46,,,,,,,fee schedule,18.52,70.46, Cystatin c,82610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.52,70.46, Cystatin c,82610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.52,70.46, Cystatin c,82610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.26,,,,,,,fee schedule,18.52,70.46,APC Cystatin c,82610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.45,,,,,,,fee schedule,18.52,70.46,APC Cystatin c,82610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.52,,,,,,,fee schedule,18.52,70.46,APC Test for urine cystines,82615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.08,,,,,,,fee schedule,9.55,41.76, Test for urine cystines,82615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.76,,,,,,,fee schedule,9.55,41.76, Test for urine cystines,82615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.55,41.76, Test for urine cystines,82615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.55,41.76, Test for urine cystines,82615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.93,,,,,,,fee schedule,9.55,41.76,APC Test for urine cystines,82615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.03,,,,,,,fee schedule,9.55,41.76,APC Test for urine cystines,82615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.55,,,,,,,fee schedule,9.55,41.76,APC Dehydroepiandrosterone,82626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.76,,,,,,,fee schedule,25.27,129.23, Dehydroepiandrosterone,82626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.23,,,,,,,fee schedule,25.27,129.23, Dehydroepiandrosterone,82626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.19,,,,,,,fee schedule,25.27,129.23, Dehydroepiandrosterone,82626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.65,,,,,,,fee schedule,25.27,129.23, Dehydroepiandrosterone,82626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.28,,,,,,,fee schedule,25.27,129.23,APC Dehydroepiandrosterone,82626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.53,,,,,,,fee schedule,25.27,129.23,APC Dehydroepiandrosterone,82626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.27,,,,,,,fee schedule,25.27,129.23,APC Dehydroepiandrosterone,82627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,100.98,,,,,,,fee schedule,22.23,113.72, Dehydroepiandrosterone,82627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.72,,,,,,,fee schedule,22.23,113.72, Dehydroepiandrosterone,82627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.82,,,,,,,fee schedule,22.23,113.72, Dehydroepiandrosterone,82627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.94,,,,,,,fee schedule,22.23,113.72, Dehydroepiandrosterone,82627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.12,,,,,,,fee schedule,22.23,113.72,APC Dehydroepiandrosterone,82627,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.34,,,,,,,fee schedule,22.23,113.72,APC Dehydroepiandrosterone,82627,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.23,,,,,,,fee schedule,22.23,113.72,APC Desoxycorticosterone,82633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,140.66,,,,,,,fee schedule,30.98,158.4, Desoxycorticosterone,82633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,158.4,,,,,,,fee schedule,30.98,158.4, Desoxycorticosterone,82633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.94,,,,,,,fee schedule,30.98,158.4, Desoxycorticosterone,82633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,113.07,,,,,,,fee schedule,30.98,158.4, Desoxycorticosterone,82633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.22,,,,,,,fee schedule,30.98,158.4,APC Desoxycorticosterone,82633,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.53,,,,,,,fee schedule,30.98,158.4,APC Desoxycorticosterone,82633,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.98,,,,,,,fee schedule,30.98,158.4,APC Deoxycortisol,82634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,132.93,,,,,,,fee schedule,29.28,149.69, Deoxycortisol,82634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.69,,,,,,,fee schedule,29.28,149.69, Deoxycortisol,82634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.69,,,,,,,fee schedule,29.28,149.69, Deoxycortisol,82634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.93,,,,,,,fee schedule,29.28,149.69, Deoxycortisol,82634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.45,,,,,,,fee schedule,29.28,149.69,APC Deoxycortisol,82634,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.74,,,,,,,fee schedule,29.28,149.69,APC Deoxycortisol,82634,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.28,,,,,,,fee schedule,29.28,149.69,APC Assay of dibucaine number,82638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.85,,,,,,,fee schedule,12.25,59.51, Assay of dibucaine number,82638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.51,,,,,,,fee schedule,12.25,59.51, Assay of dibucaine number,82638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.25,59.51, Assay of dibucaine number,82638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.25,59.51, Assay of dibucaine number,82638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.74,,,,,,,fee schedule,12.25,59.51,APC Assay of dibucaine number,82638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.86,,,,,,,fee schedule,12.25,59.51,APC Assay of dibucaine number,82638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.25,,,,,,,fee schedule,12.25,59.51,APC Dihydrotestosterone,82642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,105.72,,,,,,,fee schedule,29.28,119.06, Dihydrotestosterone,82642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,119.06,,,,,,,fee schedule,29.28,119.06, Dihydrotestosterone,82642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.69,,,,,,,fee schedule,29.28,119.06, Dihydrotestosterone,82642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.93,,,,,,,fee schedule,29.28,119.06, Dihydrotestosterone,82642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.45,,,,,,,fee schedule,29.28,119.06,APC Dihydrotestosterone,82642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.74,,,,,,,fee schedule,29.28,119.06,APC Dihydrotestosterone,82642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.28,,,,,,,fee schedule,29.28,119.06,APC Vit d 1 25-dihydroxy,82652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,174.79,,,,,,,fee schedule,38.5,196.83, Vit d 1 25-dihydroxy,82652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,196.83,,,,,,,fee schedule,38.5,196.83, Vit d 1 25-dihydroxy,82652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,38.5,196.83, Vit d 1 25-dihydroxy,82652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,38.5,196.83, Vit d 1 25-dihydroxy,82652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.04,,,,,,,fee schedule,38.5,196.83,APC Vit d 1 25-dihydroxy,82652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.43,,,,,,,fee schedule,38.5,196.83,APC Vit d 1 25-dihydroxy,82652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.5,,,,,,,fee schedule,38.5,196.83,APC El-1 fecal quantitative,82653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.65,,,,,,,fee schedule,22.97,84.07, El-1 fecal quantitative,82653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.07,,,,,,,fee schedule,22.97,84.07, El-1 fecal quantitative,82653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,22.97,84.07, El-1 fecal quantitative,82653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,22.97,84.07, El-1 fecal quantitative,82653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.89,,,,,,,fee schedule,22.97,84.07,APC El-1 fecal quantitative,82653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.12,,,,,,,fee schedule,22.97,84.07,APC El-1 fecal quantitative,82653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.97,,,,,,,fee schedule,22.97,84.07,APC Pancreatic elastase fecal,82656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.53,56.33, Pancreatic elastase fecal,82656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.53,56.33, Pancreatic elastase fecal,82656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,56.33, Pancreatic elastase fecal,82656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,56.33, Pancreatic elastase fecal,82656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,56.33,APC Pancreatic elastase fecal,82656,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,56.33,APC Pancreatic elastase fecal,82656,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,56.33,APC Enzyme cell activity,82657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,22.17,92.34, Enzyme cell activity,82657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,22.17,92.34, Enzyme cell activity,82657,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.82,,,,,,,fee schedule,22.17,92.34, Enzyme cell activity,82657,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.94,,,,,,,fee schedule,22.17,92.34, Enzyme cell activity,82657,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.06,,,,,,,fee schedule,22.17,92.34,APC Enzyme cell activity,82657,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.28,,,,,,,fee schedule,22.17,92.34,APC Enzyme cell activity,82657,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.17,,,,,,,fee schedule,22.17,92.34,APC Enzyme cell activity ra,82658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,44.03,159.51, Enzyme cell activity ra,82658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,44.03,159.51, Enzyme cell activity ra,82658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,139.57,,,,,,,fee schedule,44.03,159.51, Enzyme cell activity ra,82658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,159.51,,,,,,,fee schedule,44.03,159.51, Enzyme cell activity ra,82658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.79,,,,,,,fee schedule,44.03,159.51,APC Enzyme cell activity ra,82658,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.23,,,,,,,fee schedule,44.03,159.51,APC Enzyme cell activity ra,82658,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.03,,,,,,,fee schedule,44.03,159.51,APC Electrophoretic test,82664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156,,,,,,,fee schedule,61.5,223.8, Electrophoretic test,82664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,175.68,,,,,,,fee schedule,61.5,223.8, Electrophoretic test,82664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,195.83,,,,,,,fee schedule,61.5,223.8, Electrophoretic test,82664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,223.8,,,,,,,fee schedule,61.5,223.8, Electrophoretic test,82664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,63.96,,,,,,,fee schedule,61.5,223.8,APC Electrophoretic test,82664,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.58,,,,,,,fee schedule,61.5,223.8,APC Electrophoretic test,82664,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.5,,,,,,,fee schedule,61.5,223.8,APC Assay of erythropoietin,82668,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.01,,,,,,,fee schedule,18.79,88.97, Assay of erythropoietin,82668,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.97,,,,,,,fee schedule,18.79,88.97, Assay of erythropoietin,82668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.79,88.97, Assay of erythropoietin,82668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.79,88.97, Assay of erythropoietin,82668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.54,,,,,,,fee schedule,18.79,88.97,APC Assay of erythropoietin,82668,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.73,,,,,,,fee schedule,18.79,88.97,APC Assay of erythropoietin,82668,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.79,,,,,,,fee schedule,18.79,88.97,APC Assay of estradiol,82670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.88,,,,,,,fee schedule,27.94,142.89, Assay of estradiol,82670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,142.89,,,,,,,fee schedule,27.94,142.89, Assay of estradiol,82670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.54,,,,,,,fee schedule,27.94,142.89, Assay of estradiol,82670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,101.19,,,,,,,fee schedule,27.94,142.89, Assay of estradiol,82670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.06,,,,,,,fee schedule,27.94,142.89,APC Assay of estradiol,82670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.34,,,,,,,fee schedule,27.94,142.89,APC Assay of estradiol,82670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.94,,,,,,,fee schedule,27.94,142.89,APC Assay of estrogens,82671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,146.67,,,,,,,fee schedule,32.3,165.18, Assay of estrogens,82671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,165.18,,,,,,,fee schedule,32.3,165.18, Assay of estrogens,82671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,103.11,,,,,,,fee schedule,32.3,165.18, Assay of estrogens,82671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,117.84,,,,,,,fee schedule,32.3,165.18, Assay of estrogens,82671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.59,,,,,,,fee schedule,32.3,165.18,APC Assay of estrogens,82671,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.92,,,,,,,fee schedule,32.3,165.18,APC Assay of estrogens,82671,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.3,,,,,,,fee schedule,32.3,165.18,APC Assay of estrogen,82672,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.13,,,,,,,fee schedule,21.7,107.13, Assay of estrogen,82672,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,107.13,,,,,,,fee schedule,21.7,107.13, Assay of estrogen,82672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.75,,,,,,,fee schedule,21.7,107.13, Assay of estrogen,82672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,78.57,,,,,,,fee schedule,21.7,107.13, Assay of estrogen,82672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.57,,,,,,,fee schedule,21.7,107.13,APC Assay of estrogen,82672,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.78,,,,,,,fee schedule,21.7,107.13,APC Assay of estrogen,82672,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.7,,,,,,,fee schedule,21.7,107.13,APC Assay of estriol,82677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.82,,,,,,,fee schedule,24.18,123.67, Assay of estriol,82677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.67,,,,,,,fee schedule,24.18,123.67, Assay of estriol,82677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,24.18,123.67, Assay of estriol,82677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,24.18,123.67, Assay of estriol,82677,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.15,,,,,,,fee schedule,24.18,123.67,APC Assay of estriol,82677,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.39,,,,,,,fee schedule,24.18,123.67,APC Assay of estriol,82677,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.18,,,,,,,fee schedule,24.18,123.67,APC Assay of estrone,82679,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.36,,,,,,,fee schedule,24.95,127.66, Assay of estrone,82679,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.66,,,,,,,fee schedule,24.95,127.66, Assay of estrone,82679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.17,,,,,,,fee schedule,24.95,127.66, Assay of estrone,82679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.48,,,,,,,fee schedule,24.95,127.66, Assay of estrone,82679,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.95,,,,,,,fee schedule,24.95,127.66,APC Assay of estrone,82679,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.2,,,,,,,fee schedule,24.95,127.66,APC Assay of estrone,82679,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.95,,,,,,,fee schedule,24.95,127.66,APC Assay dir meas fr estradiol,82681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.81,,,,,,,fee schedule,27.94,102.26, Assay dir meas fr estradiol,82681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.26,,,,,,,fee schedule,27.94,102.26, Assay dir meas fr estradiol,82681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.54,,,,,,,fee schedule,27.94,102.26, Assay dir meas fr estradiol,82681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,101.19,,,,,,,fee schedule,27.94,102.26, Assay dir meas fr estradiol,82681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.06,,,,,,,fee schedule,27.94,102.26,APC Assay dir meas fr estradiol,82681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.34,,,,,,,fee schedule,27.94,102.26,APC Assay dir meas fr estradiol,82681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.94,,,,,,,fee schedule,27.94,102.26,APC Assay of ethylene glycol,82693,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.53,,,,,,,fee schedule,14.9,65.92, Assay of ethylene glycol,82693,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.92,,,,,,,fee schedule,14.9,65.92, Assay of ethylene glycol,82693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,14.9,65.92, Assay of ethylene glycol,82693,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,14.9,65.92, Assay of ethylene glycol,82693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.5,,,,,,,fee schedule,14.9,65.92,APC Assay of ethylene glycol,82693,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.65,,,,,,,fee schedule,14.9,65.92,APC Assay of ethylene glycol,82693,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.9,,,,,,,fee schedule,14.9,65.92,APC Assay of etiocholanolone,82696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,107.09,,,,,,,fee schedule,26.24,120.6, Assay of etiocholanolone,82696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,120.6,,,,,,,fee schedule,26.24,120.6, Assay of etiocholanolone,82696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.32,,,,,,,fee schedule,26.24,120.6, Assay of etiocholanolone,82696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.22,,,,,,,fee schedule,26.24,120.6, Assay of etiocholanolone,82696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.29,,,,,,,fee schedule,26.24,120.6,APC Assay of etiocholanolone,82696,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.55,,,,,,,fee schedule,26.24,120.6,APC Assay of etiocholanolone,82696,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.24,,,,,,,fee schedule,26.24,120.6,APC Fats/lipids feces qual,82705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.11,,,,,,,fee schedule,5.1,26.02, Fats/lipids feces qual,82705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.02,,,,,,,fee schedule,5.1,26.02, Fats/lipids feces qual,82705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.1,26.02, Fats/lipids feces qual,82705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.1,26.02, Fats/lipids feces qual,82705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.3,,,,,,,fee schedule,5.1,26.02,APC Fats/lipids feces qual,82705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.36,,,,,,,fee schedule,5.1,26.02,APC Fats/lipids feces qual,82705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.1,,,,,,,fee schedule,5.1,26.02,APC Fats/lipids feces quant,82710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.28,,,,,,,fee schedule,16.8,85.9, Fats/lipids feces quant,82710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.9,,,,,,,fee schedule,16.8,85.9, Fats/lipids feces quant,82710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.8,85.9, Fats/lipids feces quant,82710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.8,85.9, Fats/lipids feces quant,82710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.47,,,,,,,fee schedule,16.8,85.9,APC Fats/lipids feces quant,82710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.64,,,,,,,fee schedule,16.8,85.9,APC Fats/lipids feces quant,82710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.8,,,,,,,fee schedule,16.8,85.9,APC Assay of fecal fat,82715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.72,,,,,,,fee schedule,22.97,83.34, Assay of fecal fat,82715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.73,,,,,,,fee schedule,22.97,83.34, Assay of fecal fat,82715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,22.97,83.34, Assay of fecal fat,82715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,22.97,83.34, Assay of fecal fat,82715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.89,,,,,,,fee schedule,22.97,83.34,APC Assay of fecal fat,82715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.12,,,,,,,fee schedule,22.97,83.34,APC Assay of fecal fat,82715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.97,,,,,,,fee schedule,22.97,83.34,APC Assay of blood fatty acids,82725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.45,,,,,,,fee schedule,18.77,68.08, Assay of blood fatty acids,82725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.08,,,,,,,fee schedule,18.77,68.08, Assay of blood fatty acids,82725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.77,68.08, Assay of blood fatty acids,82725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.77,68.08, Assay of blood fatty acids,82725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.52,,,,,,,fee schedule,18.77,68.08,APC Assay of blood fatty acids,82725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.71,,,,,,,fee schedule,18.77,68.08,APC Assay of blood fatty acids,82725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.77,,,,,,,fee schedule,18.77,68.08,APC Long chain fatty acids,82726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,19.75,92.34, Long chain fatty acids,82726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,19.75,92.34, Long chain fatty acids,82726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.75,92.34, Long chain fatty acids,82726,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.75,92.34, Long chain fatty acids,82726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.54,,,,,,,fee schedule,19.75,92.34,APC Long chain fatty acids,82726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.74,,,,,,,fee schedule,19.75,92.34,APC Long chain fatty acids,82726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.75,,,,,,,fee schedule,19.75,92.34,APC Assay of ferritin,82728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.85,,,,,,,fee schedule,13.63,69.65, Assay of ferritin,82728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.65,,,,,,,fee schedule,13.63,69.65, Assay of ferritin,82728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.63,69.65, Assay of ferritin,82728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.63,69.65, Assay of ferritin,82728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.18,,,,,,,fee schedule,13.63,69.65,APC Assay of ferritin,82728,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.31,,,,,,,fee schedule,13.63,69.65,APC Assay of ferritin,82728,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.63,,,,,,,fee schedule,13.63,69.65,APC Assay of fetal fibronectin,82731,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,292.47,,,,,,,fee schedule,64.41,329.36, Assay of fetal fibronectin,82731,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,329.36,,,,,,,fee schedule,64.41,329.36, Assay of fetal fibronectin,82731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,205.2,,,,,,,fee schedule,64.41,329.36, Assay of fetal fibronectin,82731,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,234.51,,,,,,,fee schedule,64.41,329.36, Assay of fetal fibronectin,82731,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.99,,,,,,,fee schedule,64.41,329.36,APC Assay of fetal fibronectin,82731,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.63,,,,,,,fee schedule,64.41,329.36,APC Assay of fetal fibronectin,82731,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.41,,,,,,,fee schedule,64.41,329.36,APC Assay of fluoride,82735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.21,,,,,,,fee schedule,18.54,94.83, Assay of fluoride,82735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.83,,,,,,,fee schedule,18.54,94.83, Assay of fluoride,82735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.54,94.83, Assay of fluoride,82735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.54,94.83, Assay of fluoride,82735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,94.83,APC Assay of fluoride,82735,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,94.83,APC Assay of fluoride,82735,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,94.83,APC Assay of folic acid serum,82746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.76,,,,,,,fee schedule,14.7,75.18, Assay of folic acid serum,82746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.18,,,,,,,fee schedule,14.7,75.18, Assay of folic acid serum,82746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.7,75.18, Assay of folic acid serum,82746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.7,75.18, Assay of folic acid serum,82746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.29,,,,,,,fee schedule,14.7,75.18,APC Assay of folic acid serum,82746,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.44,,,,,,,fee schedule,14.7,75.18,APC Assay of folic acid serum,82746,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.7,,,,,,,fee schedule,14.7,75.18,APC Assay of folic acid rbc,82747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.23,,,,,,,fee schedule,17.65,88.1, Assay of folic acid rbc,82747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.1,,,,,,,fee schedule,17.65,88.1, Assay of folic acid rbc,82747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,17.65,88.1, Assay of folic acid rbc,82747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,17.65,88.1, Assay of folic acid rbc,82747,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.36,,,,,,,fee schedule,17.65,88.1,APC Assay of folic acid rbc,82747,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.53,,,,,,,fee schedule,17.65,88.1,APC Assay of folic acid rbc,82747,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.65,,,,,,,fee schedule,17.65,88.1,APC Assay of semen fructose,82757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.78,,,,,,,fee schedule,17.34,88.72, Assay of semen fructose,82757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.72,,,,,,,fee schedule,17.34,88.72, Assay of semen fructose,82757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.34,88.72, Assay of semen fructose,82757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.34,88.72, Assay of semen fructose,82757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.03,,,,,,,fee schedule,17.34,88.72,APC Assay of semen fructose,82757,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.21,,,,,,,fee schedule,17.34,88.72,APC Assay of semen fructose,82757,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.34,,,,,,,fee schedule,17.34,88.72,APC Assay of rbc galactokinase,82759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.53,,,,,,,fee schedule,21.48,109.84, Assay of rbc galactokinase,82759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.84,,,,,,,fee schedule,21.48,109.84, Assay of rbc galactokinase,82759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.75,,,,,,,fee schedule,21.48,109.84, Assay of rbc galactokinase,82759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,78.57,,,,,,,fee schedule,21.48,109.84, Assay of rbc galactokinase,82759,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.34,,,,,,,fee schedule,21.48,109.84,APC Assay of rbc galactokinase,82759,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.55,,,,,,,fee schedule,21.48,109.84,APC Assay of rbc galactokinase,82759,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.48,,,,,,,fee schedule,21.48,109.84,APC Assay of galactose,82760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.83,,,,,,,fee schedule,11.2,57.24, Assay of galactose,82760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.24,,,,,,,fee schedule,11.2,57.24, Assay of galactose,82760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.41,,,,,,,fee schedule,11.2,57.24, Assay of galactose,82760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.47,,,,,,,fee schedule,11.2,57.24, Assay of galactose,82760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.65,,,,,,,fee schedule,11.2,57.24,APC Assay of galactose,82760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.76,,,,,,,fee schedule,11.2,57.24,APC Assay of galactose,82760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.2,,,,,,,fee schedule,11.2,57.24,APC Assay galactose transferase,82775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.65,,,,,,,fee schedule,21.07,107.71, Assay galactose transferase,82775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,107.71,,,,,,,fee schedule,21.07,107.71, Assay galactose transferase,82775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,21.07,107.71, Assay galactose transferase,82775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,21.07,107.71, Assay galactose transferase,82775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.91,,,,,,,fee schedule,21.07,107.71,APC Assay galactose transferase,82775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.12,,,,,,,fee schedule,21.07,107.71,APC Assay galactose transferase,82775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.07,,,,,,,fee schedule,21.07,107.71,APC Galactose transferase test,82776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.06,,,,,,,fee schedule,11.74,42.86, Galactose transferase test,82776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.86,,,,,,,fee schedule,11.74,42.86, Galactose transferase test,82776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.74,42.86, Galactose transferase test,82776,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.74,42.86, Galactose transferase test,82776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.21,,,,,,,fee schedule,11.74,42.86,APC Galactose transferase test,82776,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.33,,,,,,,fee schedule,11.74,42.86,APC Galactose transferase test,82776,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.74,,,,,,,fee schedule,11.74,42.86,APC Galectin-3,82777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.85,,,,,,,fee schedule,44.25,160.71, Galectin-3,82777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.15,,,,,,,fee schedule,44.25,160.71, Galectin-3,82777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,140.62,,,,,,,fee schedule,44.25,160.71, Galectin-3,82777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,160.71,,,,,,,fee schedule,44.25,160.71, Galectin-3,82777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.02,,,,,,,fee schedule,44.25,160.71,APC Galectin-3,82777,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.46,,,,,,,fee schedule,44.25,160.71,APC Galectin-3,82777,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.25,,,,,,,fee schedule,44.25,160.71,APC Assay iga/igd/igg/igm each,82784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.22,,,,,,,fee schedule,9.3,47.54, Assay iga/igd/igg/igm each,82784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.54,,,,,,,fee schedule,9.3,47.54, Assay iga/igd/igg/igm each,82784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.16,,,,,,,fee schedule,9.3,47.54, Assay iga/igd/igg/igm each,82784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.33,,,,,,,fee schedule,9.3,47.54, Assay iga/igd/igg/igm each,82784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.67,,,,,,,fee schedule,9.3,47.54,APC Assay iga/igd/igg/igm each,82784,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.76,,,,,,,fee schedule,9.3,47.54,APC Assay iga/igd/igg/igm each,82784,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.3,,,,,,,fee schedule,9.3,47.54,APC Assay of ige,82785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.78,,,,,,,fee schedule,16.46,84.22, Assay of ige,82785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.22,,,,,,,fee schedule,16.46,84.22, Assay of ige,82785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.46,84.22, Assay of ige,82785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.46,84.22, Assay of ige,82785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.12,,,,,,,fee schedule,16.46,84.22,APC Assay of ige,82785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.28,,,,,,,fee schedule,16.46,84.22,APC Assay of ige,82785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.46,,,,,,,fee schedule,16.46,84.22,APC Igg 1 2 3 or 4 each,82787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.4,,,,,,,fee schedule,8.02,40.99, Igg 1 2 3 or 4 each,82787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.99,,,,,,,fee schedule,8.02,40.99, Igg 1 2 3 or 4 each,82787,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,8.02,40.99, Igg 1 2 3 or 4 each,82787,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,8.02,40.99, Igg 1 2 3 or 4 each,82787,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.34,,,,,,,fee schedule,8.02,40.99,APC Igg 1 2 3 or 4 each,82787,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.42,,,,,,,fee schedule,8.02,40.99,APC Igg 1 2 3 or 4 each,82787,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.02,,,,,,,fee schedule,8.02,40.99,APC Blood pH,82800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.45,,,,,,,fee schedule,11,43.3, Blood pH,82800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.3,,,,,,,fee schedule,11,43.3, Blood pH,82800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.41,,,,,,,fee schedule,11,43.3, Blood pH,82800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.47,,,,,,,fee schedule,11,43.3, Blood pH,82800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.44,,,,,,,fee schedule,11,43.3,APC Blood pH,82800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.55,,,,,,,fee schedule,11,43.3,APC Blood pH,82800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11,,,,,,,fee schedule,11,43.3,APC Blood gases any combination,82803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.88,,,,,,,fee schedule,26.07,98.97, Blood gases any combination,82803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98.97,,,,,,,fee schedule,26.07,98.97, Blood gases any combination,82803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.32,,,,,,,fee schedule,26.07,98.97, Blood gases any combination,82803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.22,,,,,,,fee schedule,26.07,98.97, Blood gases any combination,82803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,26.07,98.97,APC Blood gases any combination,82803,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.37,,,,,,,fee schedule,26.07,98.97,APC Blood gases any combination,82803,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.07,,,,,,,fee schedule,26.07,98.97,APC Blood gases w/o2 saturation,82805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,78.77,286.89, Blood gases w/o2 saturation,82805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,78.77,286.89, Blood gases w/o2 saturation,82805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,251.03,,,,,,,fee schedule,78.77,286.89, Blood gases w/o2 saturation,82805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,286.89,,,,,,,fee schedule,78.77,286.89, Blood gases w/o2 saturation,82805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,81.92,,,,,,,fee schedule,78.77,286.89,APC Blood gases w/o2 saturation,82805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,82.71,,,,,,,fee schedule,78.77,286.89,APC Blood gases w/o2 saturation,82805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,78.77,,,,,,,fee schedule,78.77,286.89,APC Blood gases o2 sat only,82810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.65,,,,,,,fee schedule,9.77,44.65, Blood gases o2 sat only,82810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.65,,,,,,,fee schedule,9.77,44.65, Blood gases o2 sat only,82810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.77,44.65, Blood gases o2 sat only,82810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.77,44.65, Blood gases o2 sat only,82810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.16,,,,,,,fee schedule,9.77,44.65,APC Blood gases o2 sat only,82810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.26,,,,,,,fee schedule,9.77,44.65,APC Blood gases o2 sat only,82810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.77,,,,,,,fee schedule,9.77,44.65,APC Hemoglobin-oxygen affinity,82820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.37,,,,,,,fee schedule,13.34,51.09, Hemoglobin-oxygen affinity,82820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.09,,,,,,,fee schedule,13.34,51.09, Hemoglobin-oxygen affinity,82820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.34,51.09, Hemoglobin-oxygen affinity,82820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.34,51.09, Hemoglobin-oxygen affinity,82820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.87,,,,,,,fee schedule,13.34,51.09,APC Hemoglobin-oxygen affinity,82820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.01,,,,,,,fee schedule,13.34,51.09,APC Hemoglobin-oxygen affinity,82820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.34,,,,,,,fee schedule,13.34,51.09,APC Gastric analy w/ph ea spec,82930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.74,,,,,,,fee schedule,6.71,33.49, Gastric analy w/ph ea spec,82930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.49,,,,,,,fee schedule,6.71,33.49, Gastric analy w/ph ea spec,82930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.71,33.49, Gastric analy w/ph ea spec,82930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.71,33.49, Gastric analy w/ph ea spec,82930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.98,,,,,,,fee schedule,6.71,33.49,APC Gastric analy w/ph ea spec,82930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.05,,,,,,,fee schedule,6.71,33.49,APC Gastric analy w/ph ea spec,82930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.71,,,,,,,fee schedule,6.71,33.49,APC Gastrin test,82938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.34,,,,,,,fee schedule,17.69,90.48, Gastrin test,82938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.48,,,,,,,fee schedule,17.69,90.48, Gastrin test,82938,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,17.69,90.48, Gastrin test,82938,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,17.69,90.48, Gastrin test,82938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.4,,,,,,,fee schedule,17.69,90.48,APC Gastrin test,82938,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.57,,,,,,,fee schedule,17.69,90.48,APC Gastrin test,82938,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.69,,,,,,,fee schedule,17.69,90.48,APC Assay of gastrin,82941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.08,,,,,,,fee schedule,17.63,90.18, Assay of gastrin,82941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.18,,,,,,,fee schedule,17.63,90.18, Assay of gastrin,82941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,17.63,90.18, Assay of gastrin,82941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,17.63,90.18, Assay of gastrin,82941,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.34,,,,,,,fee schedule,17.63,90.18,APC Assay of gastrin,82941,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.51,,,,,,,fee schedule,17.63,90.18,APC Assay of gastrin,82941,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.63,,,,,,,fee schedule,17.63,90.18,APC Assay of glucagon,82943,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.07,,,,,,,fee schedule,13.07,52.38, Assay of glucagon,82943,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.71,,,,,,,fee schedule,13.07,52.38, Assay of glucagon,82943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,13.07,52.38, Assay of glucagon,82943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,13.07,52.38, Assay of glucagon,82943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.86,,,,,,,fee schedule,13.07,52.38,APC Assay of glucagon,82943,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15,,,,,,,fee schedule,13.07,52.38,APC Assay of glucagon,82943,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.29,,,,,,,fee schedule,13.07,52.38,APC Glucose Other Fluid,82945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.81,,,,,,,fee schedule,3.93,20.06, Glucose Other Fluid,82945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.06,,,,,,,fee schedule,3.93,20.06, Glucose Other Fluid,82945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.93,20.06, Glucose Other Fluid,82945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.93,20.06, Glucose Other Fluid,82945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.09,,,,,,,fee schedule,3.93,20.06,APC Glucose Other Fluid,82945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.13,,,,,,,fee schedule,3.93,20.06,APC Glucose Other Fluid,82945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.93,,,,,,,fee schedule,3.93,20.06,APC Glucagon tolerance test,82946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.45,,,,,,,fee schedule,17.77,77.08, Glucagon tolerance test,82946,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.08,,,,,,,fee schedule,17.77,77.08, Glucagon tolerance test,82946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,17.77,77.08, Glucagon tolerance test,82946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,17.77,77.08, Glucagon tolerance test,82946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.48,,,,,,,fee schedule,17.77,77.08,APC Glucagon tolerance test,82946,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.66,,,,,,,fee schedule,17.77,77.08,APC Glucagon tolerance test,82946,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.77,,,,,,,fee schedule,17.77,77.08,APC Assay glucose blood quant,82947,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.81,,,,,,,fee schedule,3.93,20.06, Assay glucose blood quant,82947,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.06,,,,,,,fee schedule,3.93,20.06, Assay glucose blood quant,82947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.93,20.06, Assay glucose blood quant,82947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.93,20.06, Assay glucose blood quant,82947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.09,,,,,,,fee schedule,3.93,20.06,APC Assay glucose blood quant,82947,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.13,,,,,,,fee schedule,3.93,20.06,APC Assay glucose blood quant,82947,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.93,,,,,,,fee schedule,3.93,20.06,APC Reagent strip/blood glucose,82948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.4,,,,,,,fee schedule,5.04,17.85, Reagent strip/blood glucose,82948,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.21,,,,,,,fee schedule,5.04,17.85, Reagent strip/blood glucose,82948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5.04,17.85, Reagent strip/blood glucose,82948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5.04,17.85, Reagent strip/blood glucose,82948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.24,,,,,,,fee schedule,5.04,17.85,APC Reagent strip/blood glucose,82948,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.29,,,,,,,fee schedule,5.04,17.85,APC Reagent strip/blood glucose,82948,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.04,,,,,,,fee schedule,5.04,17.85,APC Glucose test,82950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.58,,,,,,,fee schedule,4.75,24.3, Glucose test,82950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.3,,,,,,,fee schedule,4.75,24.3, Glucose test,82950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.75,24.3, Glucose test,82950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.75,24.3, Glucose test,82950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.94,,,,,,,fee schedule,4.75,24.3,APC Glucose test,82950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.99,,,,,,,fee schedule,4.75,24.3,APC Glucose test,82950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.75,,,,,,,fee schedule,4.75,24.3,APC Glucose tolerance test (GTT),82951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.47,,,,,,,fee schedule,12.87,65.84, Glucose tolerance test (GTT),82951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.84,,,,,,,fee schedule,12.87,65.84, Glucose tolerance test (GTT),82951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.87,65.84, Glucose tolerance test (GTT),82951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.87,65.84, Glucose tolerance test (GTT),82951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.38,,,,,,,fee schedule,12.87,65.84,APC Glucose tolerance test (GTT),82951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.51,,,,,,,fee schedule,12.87,65.84,APC Glucose tolerance test (GTT),82951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.87,,,,,,,fee schedule,12.87,65.84,APC GTT-added samples,82952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.07,,,,,,,fee schedule,3.92,14.71, GTT-added samples,82952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.71,,,,,,,fee schedule,3.92,14.71, GTT-added samples,82952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.92,14.71, GTT-added samples,82952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.92,14.71, GTT-added samples,82952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.08,,,,,,,fee schedule,3.92,14.71,APC GTT-added samples,82952,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.12,,,,,,,fee schedule,3.92,14.71,APC GTT-added samples,82952,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.92,,,,,,,fee schedule,3.92,14.71,APC Assay of g6pd enzyme,82955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.72,,,,,,,fee schedule,9.7,44.73, Assay of g6pd enzyme,82955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.73,,,,,,,fee schedule,9.7,44.73, Assay of g6pd enzyme,82955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.7,44.73, Assay of g6pd enzyme,82955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.7,44.73, Assay of g6pd enzyme,82955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.09,,,,,,,fee schedule,9.7,44.73,APC Assay of g6pd enzyme,82955,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.18,,,,,,,fee schedule,9.7,44.73,APC Assay of g6pd enzyme,82955,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.7,,,,,,,fee schedule,9.7,44.73,APC Test for G6PD enzyme,82960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.53,,,,,,,fee schedule,6.05,31, Test for G6PD enzyme,82960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,31,,,,,,,fee schedule,6.05,31, Test for G6PD enzyme,82960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,6.05,31, Test for G6PD enzyme,82960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,6.05,31, Test for G6PD enzyme,82960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.29,,,,,,,fee schedule,6.05,31,APC Test for G6PD enzyme,82960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.35,,,,,,,fee schedule,6.05,31,APC Test for G6PD enzyme,82960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.05,,,,,,,fee schedule,6.05,31,APC Glucose blood test,82962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.63,,,,,,,fee schedule,3.28,11.97, Glucose blood test,82962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.97,,,,,,,fee schedule,3.28,11.97, Glucose blood test,82962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.42,,,,,,,fee schedule,3.28,11.97, Glucose blood test,82962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.91,,,,,,,fee schedule,3.28,11.97, Glucose blood test,82962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.41,,,,,,,fee schedule,3.28,11.97,APC Glucose blood test,82962,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.44,,,,,,,fee schedule,3.28,11.97,APC Glucose blood test,82962,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.28,,,,,,,fee schedule,3.28,11.97,APC Assay of glucosidase,82963,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.53,,,,,,,fee schedule,21.48,109.84, Assay of glucosidase,82963,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.84,,,,,,,fee schedule,21.48,109.84, Assay of glucosidase,82963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.75,,,,,,,fee schedule,21.48,109.84, Assay of glucosidase,82963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,78.57,,,,,,,fee schedule,21.48,109.84, Assay of glucosidase,82963,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.34,,,,,,,fee schedule,21.48,109.84,APC Assay of glucosidase,82963,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.55,,,,,,,fee schedule,21.48,109.84,APC Assay of glucosidase,82963,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.48,,,,,,,fee schedule,21.48,109.84,APC Assay of gdh enzyme,82965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.1,,,,,,,fee schedule,13.15,47.61, Assay of gdh enzyme,82965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.53,,,,,,,fee schedule,13.15,47.61, Assay of gdh enzyme,82965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.15,47.61, Assay of gdh enzyme,82965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.15,47.61, Assay of gdh enzyme,82965,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.68,,,,,,,fee schedule,13.15,47.61,APC Assay of gdh enzyme,82965,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.81,,,,,,,fee schedule,13.15,47.61,APC Assay of gdh enzyme,82965,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.15,,,,,,,fee schedule,13.15,47.61,APC Assay of GGT,82977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.7,,,,,,,fee schedule,7.2,36.82, Assay of GGT,82977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.82,,,,,,,fee schedule,7.2,36.82, Assay of GGT,82977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.2,36.82, Assay of GGT,82977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.2,36.82, Assay of GGT,82977,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.49,,,,,,,fee schedule,7.2,36.82,APC Assay of GGT,82977,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.56,,,,,,,fee schedule,7.2,36.82,APC Assay of GGT,82977,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.2,,,,,,,fee schedule,7.2,36.82,APC Assay of glutathione,82978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.07,,,,,,,fee schedule,15.45,55.95, Assay of glutathione,82978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.49,,,,,,,fee schedule,15.45,55.95, Assay of glutathione,82978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.45,55.95, Assay of glutathione,82978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.45,55.95, Assay of glutathione,82978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.07,,,,,,,fee schedule,15.45,55.95,APC Assay of glutathione,82978,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.22,,,,,,,fee schedule,15.45,55.95,APC Assay of glutathione,82978,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.45,,,,,,,fee schedule,15.45,55.95,APC Assay rbc glutathione,82979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.27,,,,,,,fee schedule,9.44,35.21, Assay rbc glutathione,82979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.21,,,,,,,fee schedule,9.44,35.21, Assay rbc glutathione,82979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.44,35.21, Assay rbc glutathione,82979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.44,35.21, Assay rbc glutathione,82979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.82,,,,,,,fee schedule,9.44,35.21,APC Assay rbc glutathione,82979,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.91,,,,,,,fee schedule,9.44,35.21,APC Assay rbc glutathione,82979,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.44,,,,,,,fee schedule,9.44,35.21,APC Assay of glycated protein,82985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.45,,,,,,,fee schedule,16.76,77.08, Assay of glycated protein,82985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.08,,,,,,,fee schedule,16.76,77.08, Assay of glycated protein,82985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.76,77.08, Assay of glycated protein,82985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.76,77.08, Assay of glycated protein,82985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.43,,,,,,,fee schedule,16.76,77.08,APC Assay of glycated protein,82985,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.6,,,,,,,fee schedule,16.76,77.08,APC Assay of glycated protein,82985,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.76,,,,,,,fee schedule,16.76,77.08,APC Assay of gonadotropin (fsh),83001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.4,,,,,,,fee schedule,18.58,95.05, Assay of gonadotropin (fsh),83001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,95.05,,,,,,,fee schedule,18.58,95.05, Assay of gonadotropin (fsh),83001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.58,95.05, Assay of gonadotropin (fsh),83001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.58,95.05, Assay of gonadotropin (fsh),83001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.32,,,,,,,fee schedule,18.58,95.05,APC Assay of gonadotropin (fsh),83001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.51,,,,,,,fee schedule,18.58,95.05,APC Assay of gonadotropin (fsh),83001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.58,,,,,,,fee schedule,18.58,95.05,APC Assay of gonadotropin (lh),83002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.11,,,,,,,fee schedule,18.52,94.72, Assay of gonadotropin (lh),83002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.72,,,,,,,fee schedule,18.52,94.72, Assay of gonadotropin (lh),83002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.52,94.72, Assay of gonadotropin (lh),83002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.52,94.72, Assay of gonadotropin (lh),83002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.26,,,,,,,fee schedule,18.52,94.72,APC Assay of gonadotropin (lh),83002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.45,,,,,,,fee schedule,18.52,94.72,APC Assay of gonadotropin (lh),83002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.52,,,,,,,fee schedule,18.52,94.72,APC Assay growth hormone (hgh),83003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.69,,,,,,,fee schedule,16.67,85.24, Assay growth hormone (hgh),83003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.24,,,,,,,fee schedule,16.67,85.24, Assay growth hormone (hgh),83003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.67,85.24, Assay growth hormone (hgh),83003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.67,85.24, Assay growth hormone (hgh),83003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.34,,,,,,,fee schedule,16.67,85.24,APC Assay growth hormone (hgh),83003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.5,,,,,,,fee schedule,16.67,85.24,APC Assay growth hormone (hgh),83003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.67,,,,,,,fee schedule,16.67,85.24,APC Growth stimulation gene 2,83006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.27,,,,,,,fee schedule,75.6,274.98, Growth stimulation gene 2,83006,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.54,,,,,,,fee schedule,75.6,274.98, Growth stimulation gene 2,83006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,240.61,,,,,,,fee schedule,75.6,274.98, Growth stimulation gene 2,83006,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,274.98,,,,,,,fee schedule,75.6,274.98, Growth stimulation gene 2,83006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,78.62,,,,,,,fee schedule,75.6,274.98,APC Growth stimulation gene 2,83006,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,79.38,,,,,,,fee schedule,75.6,274.98,APC Growth stimulation gene 2,83006,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,75.6,,,,,,,fee schedule,75.6,274.98,APC H pylori (c-13) blood,83009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,305.86,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) blood,83009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,344.44,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) blood,83009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,214.57,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) blood,83009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,245.22,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) blood,83009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,70.05,,,,,,,fee schedule,67.36,344.44,APC H pylori (c-13) blood,83009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,70.73,,,,,,,fee schedule,67.36,344.44,APC H pylori (c-13) blood,83009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,67.36,,,,,,,fee schedule,67.36,344.44,APC Assay of haptoglobin quant,83010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.14,,,,,,,fee schedule,12.58,64.34, Assay of haptoglobin quant,83010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.34,,,,,,,fee schedule,12.58,64.34, Assay of haptoglobin quant,83010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.58,64.34, Assay of haptoglobin quant,83010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.58,64.34, Assay of haptoglobin quant,83010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.08,,,,,,,fee schedule,12.58,64.34,APC Assay of haptoglobin quant,83010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.21,,,,,,,fee schedule,12.58,64.34,APC Assay of haptoglobin quant,83010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,12.58,64.34,APC Assay of haptoglobins,83012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.07,,,,,,,fee schedule,26.89,97.62, Assay of haptoglobins,83012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.91,,,,,,,fee schedule,26.89,97.62, Assay of haptoglobins,83012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.89,97.62, Assay of haptoglobins,83012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.89,97.62, Assay of haptoglobins,83012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.97,,,,,,,fee schedule,26.89,97.62,APC Assay of haptoglobins,83012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.23,,,,,,,fee schedule,26.89,97.62,APC Assay of haptoglobins,83012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.89,,,,,,,fee schedule,26.89,97.62,APC H pylori (c-13) breath,83013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,305.86,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) breath,83013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,344.44,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) breath,83013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,214.57,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) breath,83013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,245.22,,,,,,,fee schedule,67.36,344.44, H pylori (c-13) breath,83013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,70.05,,,,,,,fee schedule,67.36,344.44,APC H pylori (c-13) breath,83013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,70.73,,,,,,,fee schedule,67.36,344.44,APC H pylori (c-13) breath,83013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,67.36,,,,,,,fee schedule,67.36,344.44,APC H pylori drug admin,83014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.69,,,,,,,fee schedule,7.86,40.19, H pylori drug admin,83014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.19,,,,,,,fee schedule,7.86,40.19, H pylori drug admin,83014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.86,40.19, H pylori drug admin,83014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.86,40.19, H pylori drug admin,83014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.17,,,,,,,fee schedule,7.86,40.19,APC H pylori drug admin,83014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.25,,,,,,,fee schedule,7.86,40.19,APC H pylori drug admin,83014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.86,,,,,,,fee schedule,7.86,40.19,APC Heavy metal qual any anal,83015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.01,,,,,,,fee schedule,20.94,88.97, Heavy metal qual any anal,83015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.97,,,,,,,fee schedule,20.94,88.97, Heavy metal qual any anal,83015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.94,88.97, Heavy metal qual any anal,83015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.94,88.97, Heavy metal qual any anal,83015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.78,,,,,,,fee schedule,20.94,88.97,APC Heavy metal qual any anal,83015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.99,,,,,,,fee schedule,20.94,88.97,APC Heavy metal qual any anal,83015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.94,,,,,,,fee schedule,20.94,88.97,APC Heavy metal quant each nes,83018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.71,,,,,,,fee schedule,21.96,112.29, Heavy metal quant each nes,83018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,112.29,,,,,,,fee schedule,21.96,112.29, Heavy metal quant each nes,83018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,21.96,112.29, Heavy metal quant each nes,83018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,21.96,112.29, Heavy metal quant each nes,83018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.84,,,,,,,fee schedule,21.96,112.29,APC Heavy metal quant each nes,83018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.06,,,,,,,fee schedule,21.96,112.29,APC Heavy metal quant each nes,83018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.96,,,,,,,fee schedule,21.96,112.29,APC Hemoglobin electrophoresis,83020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.47,,,,,,,fee schedule,12.87,65.84, Hemoglobin electrophoresis,83020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.84,,,,,,,fee schedule,12.87,65.84, Hemoglobin electrophoresis,83020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.87,65.84, Hemoglobin electrophoresis,83020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.87,65.84, Hemoglobin electrophoresis,83020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.38,,,,,,,fee schedule,12.87,65.84,APC Hemoglobin electrophoresis,83020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.51,,,,,,,fee schedule,12.87,65.84,APC Hemoglobin electrophoresis,83020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.87,,,,,,,fee schedule,12.87,65.84,APC Hemoglobin chromotography,83021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,18.06,92.34, Hemoglobin chromotography,83021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,18.06,92.34, Hemoglobin chromotography,83021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.06,92.34, Hemoglobin chromotography,83021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.06,92.34, Hemoglobin chromotography,83021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.78,,,,,,,fee schedule,18.06,92.34,APC Hemoglobin chromotography,83021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.96,,,,,,,fee schedule,18.06,92.34,APC Hemoglobin chromotography,83021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.06,,,,,,,fee schedule,18.06,92.34,APC Hemoglobin copper sulfate,83026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.73,,,,,,,fee schedule,4.01,14.28, Hemoglobin copper sulfate,83026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.08,,,,,,,fee schedule,4.01,14.28, Hemoglobin copper sulfate,83026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,4.01,14.28, Hemoglobin copper sulfate,83026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,4.01,14.28, Hemoglobin copper sulfate,83026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.17,,,,,,,fee schedule,4.01,14.28,APC Hemoglobin copper sulfate,83026,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.21,,,,,,,fee schedule,4.01,14.28,APC Hemoglobin copper sulfate,83026,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.01,,,,,,,fee schedule,4.01,14.28,APC Fetal hemoglobin chemical,83030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.57,,,,,,,fee schedule,10.74,42.31, Fetal hemoglobin chemical,83030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.31,,,,,,,fee schedule,10.74,42.31, Fetal hemoglobin chemical,83030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.74,42.31, Fetal hemoglobin chemical,83030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.74,42.31, Fetal hemoglobin chemical,83030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.17,,,,,,,fee schedule,10.74,42.31,APC Fetal hemoglobin chemical,83030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.28,,,,,,,fee schedule,10.74,42.31,APC Fetal hemoglobin chemical,83030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.74,42.31,APC Fetal hemoglobin assay qual,83033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.2,,,,,,,fee schedule,8,29.5, Fetal hemoglobin assay qual,83033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.5,,,,,,,fee schedule,8,29.5, Fetal hemoglobin assay qual,83033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,8,29.5, Fetal hemoglobin assay qual,83033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,8,29.5, Fetal hemoglobin assay qual,83033,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.32,,,,,,,fee schedule,8,29.5,APC Fetal hemoglobin assay qual,83033,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.4,,,,,,,fee schedule,8,29.5,APC Fetal hemoglobin assay qual,83033,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8,,,,,,,fee schedule,8,29.5,APC Glycosylated hemoglobin test,83036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.07,,,,,,,fee schedule,9.71,49.63, Glycosylated hemoglobin test,83036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.63,,,,,,,fee schedule,9.71,49.63, Glycosylated hemoglobin test,83036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.71,49.63, Glycosylated hemoglobin test,83036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.71,49.63, Glycosylated hemoglobin test,83036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.1,,,,,,,fee schedule,9.71,49.63,APC Glycosylated hemoglobin test,83036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.2,,,,,,,fee schedule,9.71,49.63,APC Glycosylated hemoglobin test,83036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.71,,,,,,,fee schedule,9.71,49.63,APC Glycosylated hb home device,83037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.69,,,,,,,fee schedule,9.71,50.33, Glycosylated hb home device,83037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.33,,,,,,,fee schedule,9.71,50.33, Glycosylated hb home device,83037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.71,50.33, Glycosylated hb home device,83037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.71,50.33, Glycosylated hb home device,83037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.1,,,,,,,fee schedule,9.71,50.33,APC Glycosylated hb home device,83037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.2,,,,,,,fee schedule,9.71,50.33,APC Glycosylated hb home device,83037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.71,,,,,,,fee schedule,9.71,50.33,APC Blood methemoglobin test,83045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.52,,,,,,,fee schedule,6.49,25.36, Blood methemoglobin test,83045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.36,,,,,,,fee schedule,6.49,25.36, Blood methemoglobin test,83045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.49,25.36, Blood methemoglobin test,83045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.49,25.36, Blood methemoglobin test,83045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.75,,,,,,,fee schedule,6.49,25.36,APC Blood methemoglobin test,83045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.81,,,,,,,fee schedule,6.49,25.36,APC Blood methemoglobin test,83045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.49,,,,,,,fee schedule,6.49,25.36,APC Blood methemoglobin assay,83050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.79,,,,,,,fee schedule,8.2,29.76, Blood methemoglobin assay,83050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.79,,,,,,,fee schedule,8.2,29.76, Blood methemoglobin assay,83050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.2,29.76, Blood methemoglobin assay,83050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.2,29.76, Blood methemoglobin assay,83050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.53,,,,,,,fee schedule,8.2,29.76,APC Blood methemoglobin assay,83050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.61,,,,,,,fee schedule,8.2,29.76,APC Blood methemoglobin assay,83050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.2,,,,,,,fee schedule,8.2,29.76,APC Assay of plasma hemoglobin,83051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.18,,,,,,,fee schedule,7.31,37.37, Assay of plasma hemoglobin,83051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.37,,,,,,,fee schedule,7.31,37.37, Assay of plasma hemoglobin,83051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.31,37.37, Assay of plasma hemoglobin,83051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.31,37.37, Assay of plasma hemoglobin,83051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.6,,,,,,,fee schedule,7.31,37.37,APC Assay of plasma hemoglobin,83051,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.68,,,,,,,fee schedule,7.31,37.37,APC Assay of plasma hemoglobin,83051,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.31,,,,,,,fee schedule,7.31,37.37,APC Blood sulfhemoglobin assay,83060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.57,,,,,,,fee schedule,8.8,42.31, Blood sulfhemoglobin assay,83060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.31,,,,,,,fee schedule,8.8,42.31, Blood sulfhemoglobin assay,83060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.8,42.31, Blood sulfhemoglobin assay,83060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.8,42.31, Blood sulfhemoglobin assay,83060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.15,,,,,,,fee schedule,8.8,42.31,APC Blood sulfhemoglobin assay,83060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.24,,,,,,,fee schedule,8.8,42.31,APC Blood sulfhemoglobin assay,83060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.8,,,,,,,fee schedule,8.8,42.31,APC Assay of hemoglobin heat,83065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.27,,,,,,,fee schedule,9,35.21, Assay of hemoglobin heat,83065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.21,,,,,,,fee schedule,9,35.21, Assay of hemoglobin heat,83065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,9,35.21, Assay of hemoglobin heat,83065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,9,35.21, Assay of hemoglobin heat,83065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.36,,,,,,,fee schedule,9,35.21,APC Assay of hemoglobin heat,83065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.45,,,,,,,fee schedule,9,35.21,APC Assay of hemoglobin heat,83065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9,,,,,,,fee schedule,9,35.21,APC Hemoglobin stability screen,83068,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.66,,,,,,,fee schedule,9.47,34.53, Hemoglobin stability screen,83068,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12,,,,,,,fee schedule,9.47,34.53, Hemoglobin stability screen,83068,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.47,34.53, Hemoglobin stability screen,83068,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.47,34.53, Hemoglobin stability screen,83068,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.85,,,,,,,fee schedule,9.47,34.53,APC Hemoglobin stability screen,83068,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.94,,,,,,,fee schedule,9.47,34.53,APC Hemoglobin stability screen,83068,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.47,,,,,,,fee schedule,9.47,34.53,APC Assay of urine hemoglobin,83069,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.91,,,,,,,fee schedule,3.95,20.17, Assay of urine hemoglobin,83069,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.17,,,,,,,fee schedule,3.95,20.17, Assay of urine hemoglobin,83069,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.95,20.17, Assay of urine hemoglobin,83069,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.95,20.17, Assay of urine hemoglobin,83069,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.11,,,,,,,fee schedule,3.95,20.17,APC Assay of urine hemoglobin,83069,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.15,,,,,,,fee schedule,3.95,20.17,APC Assay of urine hemoglobin,83069,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.95,,,,,,,fee schedule,3.95,20.17,APC Assay of hemosiderin qual,83070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.58,,,,,,,fee schedule,4.75,24.3, Assay of hemosiderin qual,83070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.3,,,,,,,fee schedule,4.75,24.3, Assay of hemosiderin qual,83070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.75,24.3, Assay of hemosiderin qual,83070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.75,24.3, Assay of hemosiderin qual,83070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.94,,,,,,,fee schedule,4.75,24.3,APC Assay of hemosiderin qual,83070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.99,,,,,,,fee schedule,4.75,24.3,APC Assay of hemosiderin qual,83070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.75,,,,,,,fee schedule,4.75,24.3,APC Assay of b hexosaminidase,83080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,16.87,86.27, Assay of b hexosaminidase,83080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,16.87,86.27, Assay of b hexosaminidase,83080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.87,86.27, Assay of b hexosaminidase,83080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.87,86.27, Assay of b hexosaminidase,83080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.54,,,,,,,fee schedule,16.87,86.27,APC Assay of b hexosaminidase,83080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.71,,,,,,,fee schedule,16.87,86.27,APC Assay of b hexosaminidase,83080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.87,86.27,APC Assay of histamine,83088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.1,,,,,,,fee schedule,29.53,151.01, Assay of histamine,83088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,151.01,,,,,,,fee schedule,29.53,151.01, Assay of histamine,83088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,93.74,,,,,,,fee schedule,29.53,151.01, Assay of histamine,83088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,107.13,,,,,,,fee schedule,29.53,151.01, Assay of histamine,83088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.71,,,,,,,fee schedule,29.53,151.01,APC Assay of histamine,83088,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.01,,,,,,,fee schedule,29.53,151.01,APC Assay of histamine,83088,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.53,,,,,,,fee schedule,29.53,151.01,APC Assay Of Homocystine,83090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.6,,,,,,,fee schedule,17.92,86.27, Assay Of Homocystine,83090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.27,,,,,,,fee schedule,17.92,86.27, Assay Of Homocystine,83090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.92,86.27, Assay Of Homocystine,83090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.92,86.27, Assay Of Homocystine,83090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,17.92,86.27,APC Assay Of Homocystine,83090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.82,,,,,,,fee schedule,17.92,86.27,APC Assay Of Homocystine,83090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.92,,,,,,,fee schedule,17.92,86.27,APC Assay of homovanillic acid,83150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.88,,,,,,,fee schedule,22.41,98.97, Assay of homovanillic acid,83150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98.97,,,,,,,fee schedule,22.41,98.97, Assay of homovanillic acid,83150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.82,,,,,,,fee schedule,22.41,98.97, Assay of homovanillic acid,83150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.94,,,,,,,fee schedule,22.41,98.97, Assay of homovanillic acid,83150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.31,,,,,,,fee schedule,22.41,98.97,APC Assay of homovanillic acid,83150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.53,,,,,,,fee schedule,22.41,98.97,APC Assay of homovanillic acid,83150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.41,,,,,,,fee schedule,22.41,98.97,APC Assay of corticosteroids 17,83491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.53,,,,,,,fee schedule,17.9,89.56, Assay of corticosteroids 17,83491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.56,,,,,,,fee schedule,17.9,89.56, Assay of corticosteroids 17,83491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.9,89.56, Assay of corticosteroids 17,83491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.9,89.56, Assay of corticosteroids 17,83491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.62,,,,,,,fee schedule,17.9,89.56,APC Assay of corticosteroids 17,83491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.79,,,,,,,fee schedule,17.9,89.56,APC Assay of corticosteroids 17,83491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.9,89.56,APC Assay of 5-hiaa,83497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.53,,,,,,,fee schedule,12.9,65.92, Assay of 5-hiaa,83497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.92,,,,,,,fee schedule,12.9,65.92, Assay of 5-hiaa,83497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.9,65.92, Assay of 5-hiaa,83497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.9,65.92, Assay of 5-hiaa,83497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,12.9,65.92,APC Assay of 5-hiaa,83497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.55,,,,,,,fee schedule,12.9,65.92,APC Assay of 5-hiaa,83497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.9,,,,,,,fee schedule,12.9,65.92,APC Assay of progesterone 17-d,83498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.34,,,,,,,fee schedule,27.17,138.9, Assay of progesterone 17-d,83498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.9,,,,,,,fee schedule,27.17,138.9, Assay of progesterone 17-d,83498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.17,138.9, Assay of progesterone 17-d,83498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.17,138.9, Assay of progesterone 17-d,83498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.26,,,,,,,fee schedule,27.17,138.9,APC Assay of progesterone 17-d,83498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.53,,,,,,,fee schedule,27.17,138.9,APC Assay of progesterone 17-d,83498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.17,,,,,,,fee schedule,27.17,138.9,APC Assay free hydroxyproline,83500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.86,,,,,,,fee schedule,22.65,115.84, Assay free hydroxyproline,83500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,115.84,,,,,,,fee schedule,22.65,115.84, Assay free hydroxyproline,83500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,71.87,,,,,,,fee schedule,22.65,115.84, Assay free hydroxyproline,83500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.14,,,,,,,fee schedule,22.65,115.84, Assay free hydroxyproline,83500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.56,,,,,,,fee schedule,22.65,115.84,APC Assay free hydroxyproline,83500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.78,,,,,,,fee schedule,22.65,115.84,APC Assay free hydroxyproline,83500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.65,,,,,,,fee schedule,22.65,115.84,APC Assay total hydroxyproline,83505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,110.37,,,,,,,fee schedule,24.3,124.29, Assay total hydroxyproline,83505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,124.29,,,,,,,fee schedule,24.3,124.29, Assay total hydroxyproline,83505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,24.3,124.29, Assay total hydroxyproline,83505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,24.3,124.29, Assay total hydroxyproline,83505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.27,,,,,,,fee schedule,24.3,124.29,APC Assay total hydroxyproline,83505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.52,,,,,,,fee schedule,24.3,124.29,APC Assay total hydroxyproline,83505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.3,,,,,,,fee schedule,24.3,124.29,APC Immunoassay nonantibody,83516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.53,56.33, Immunoassay nonantibody,83516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.53,56.33, Immunoassay nonantibody,83516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,56.33, Immunoassay nonantibody,83516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,56.33, Immunoassay nonantibody,83516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,56.33,APC Immunoassay nonantibody,83516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,56.33,APC Immunoassay nonantibody,83516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,56.33,APC Immunoassay dipstick,83518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.51,,,,,,,fee schedule,9.64,43.37, Immunoassay dipstick,83518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.37,,,,,,,fee schedule,9.64,43.37, Immunoassay dipstick,83518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.64,43.37, Immunoassay dipstick,83518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.64,43.37, Immunoassay dipstick,83518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.03,,,,,,,fee schedule,9.64,43.37,APC Immunoassay dipstick,83518,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.12,,,,,,,fee schedule,9.64,43.37,APC Immunoassay dipstick,83518,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.64,,,,,,,fee schedule,9.64,43.37,APC Ria nonantibody,83519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.36,,,,,,,fee schedule,18.4,69.1, Ria nonantibody,83519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.1,,,,,,,fee schedule,18.4,69.1, Ria nonantibody,83519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.4,69.1, Ria nonantibody,83519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.4,69.1, Ria nonantibody,83519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.14,,,,,,,fee schedule,18.4,69.1,APC Ria nonantibody,83519,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.32,,,,,,,fee schedule,18.4,69.1,APC Ria nonantibody,83519,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.4,,,,,,,fee schedule,18.4,69.1,APC Immunoassay quant nos nonab,83520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,17.27,66.21, Immunoassay quant nos nonab,83520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,17.27,66.21, Immunoassay quant nos nonab,83520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,66.21, Immunoassay quant nos nonab,83520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,66.21, Immunoassay quant nos nonab,83520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,66.21,APC Immunoassay quant nos nonab,83520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,66.21,APC Immunoassay quant nos nonab,83520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,66.21,APC Ig light chains free each,83521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.13,,,,,,,fee schedule,17.27,63.21, Ig light chains free each,83521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.21,,,,,,,fee schedule,17.27,63.21, Ig light chains free each,83521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.21, Ig light chains free each,83521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.21, Ig light chains free each,83521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.21,APC Ig light chains free each,83521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.21,APC Ig light chains free each,83521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.21,APC Assay of insulin,83525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.94,,,,,,,fee schedule,11.43,58.49, Assay of insulin,83525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.49,,,,,,,fee schedule,11.43,58.49, Assay of insulin,83525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.43,58.49, Assay of insulin,83525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.43,58.49, Assay of insulin,83525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.89,,,,,,,fee schedule,11.43,58.49,APC Assay of insulin,83525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12,,,,,,,fee schedule,11.43,58.49,APC Assay of insulin,83525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.43,,,,,,,fee schedule,11.43,58.49,APC Assay of insulin,83527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,12.95,66.21, Assay of insulin,83527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,12.95,66.21, Assay of insulin,83527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,12.95,66.21, Assay of insulin,83527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,12.95,66.21, Assay of insulin,83527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.47,,,,,,,fee schedule,12.95,66.21,APC Assay of insulin,83527,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.6,,,,,,,fee schedule,12.95,66.21,APC Assay of insulin,83527,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.95,,,,,,,fee schedule,12.95,66.21,APC Assay of intrinsic factor,83528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.22,,,,,,,fee schedule,19.82,81.33, Assay of intrinsic factor,83528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.33,,,,,,,fee schedule,19.82,81.33, Assay of intrinsic factor,83528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,19.82,81.33, Assay of intrinsic factor,83528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,19.82,81.33, Assay of intrinsic factor,83528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.61,,,,,,,fee schedule,19.82,81.33,APC Assay of intrinsic factor,83528,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,19.82,81.33,APC Assay of intrinsic factor,83528,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.82,,,,,,,fee schedule,19.82,81.33,APC Asay of interleukin-6 (il-6),83529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.13,,,,,,,fee schedule,17.27,63.21, Asay of interleukin-6 (il-6),83529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.21,,,,,,,fee schedule,17.27,63.21, Asay of interleukin-6 (il-6),83529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.21, Asay of interleukin-6 (il-6),83529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.21, Asay of interleukin-6 (il-6),83529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.21,APC Asay of interleukin-6 (il-6),83529,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.21,APC Asay of interleukin-6 (il-6),83529,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.21,APC Assay of iron,83540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.41,,,,,,,fee schedule,6.47,33.12, Assay of iron,83540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.12,,,,,,,fee schedule,6.47,33.12, Assay of iron,83540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.12, Assay of iron,83540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.12, Assay of iron,83540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.12,APC Assay of iron,83540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.12,APC Assay of iron,83540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.12,APC Iron binding test,83550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.68,,,,,,,fee schedule,8.74,44.69, Iron binding test,83550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.69,,,,,,,fee schedule,8.74,44.69, Iron binding test,83550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.74,44.69, Iron binding test,83550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.74,44.69, Iron binding test,83550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.09,,,,,,,fee schedule,8.74,44.69,APC Iron binding test,83550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.18,,,,,,,fee schedule,8.74,44.69,APC Iron binding test,83550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.74,,,,,,,fee schedule,8.74,44.69,APC Assay of idh enzyme,83570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.17,,,,,,,fee schedule,8.85,45.24, Assay of idh enzyme,83570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,45.24,,,,,,,fee schedule,8.85,45.24, Assay of idh enzyme,83570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.85,45.24, Assay of idh enzyme,83570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.85,45.24, Assay of idh enzyme,83570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.2,,,,,,,fee schedule,8.85,45.24,APC Assay of idh enzyme,83570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.29,,,,,,,fee schedule,8.85,45.24,APC Assay of idh enzyme,83570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.85,,,,,,,fee schedule,8.85,45.24,APC Assay of ketogenic steroids,83582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.35,,,,,,,fee schedule,15.47,72.47, Assay of ketogenic steroids,83582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.47,,,,,,,fee schedule,15.47,72.47, Assay of ketogenic steroids,83582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.47,72.47, Assay of ketogenic steroids,83582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.47,72.47, Assay of ketogenic steroids,83582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.09,,,,,,,fee schedule,15.47,72.47,APC Assay of ketogenic steroids,83582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.24,,,,,,,fee schedule,15.47,72.47,APC Assay of ketogenic steroids,83582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.47,,,,,,,fee schedule,15.47,72.47,APC Assay 17- ketosteroids,83586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.14,,,,,,,fee schedule,12.8,65.48, Assay 17- ketosteroids,83586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.48,,,,,,,fee schedule,12.8,65.48, Assay 17- ketosteroids,83586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.8,65.48, Assay 17- ketosteroids,83586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.8,65.48, Assay 17- ketosteroids,83586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.31,,,,,,,fee schedule,12.8,65.48,APC Assay 17- ketosteroids,83586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.44,,,,,,,fee schedule,12.8,65.48,APC Assay 17- ketosteroids,83586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.8,,,,,,,fee schedule,12.8,65.48,APC Fractionation ketosteroids,83593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.44,,,,,,,fee schedule,28.5,134.51, Fractionation ketosteroids,83593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,134.51,,,,,,,fee schedule,28.5,134.51, Fractionation ketosteroids,83593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,90.62,,,,,,,fee schedule,28.5,134.51, Fractionation ketosteroids,83593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,103.56,,,,,,,fee schedule,28.5,134.51, Fractionation ketosteroids,83593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.64,,,,,,,fee schedule,28.5,134.51,APC Fractionation ketosteroids,83593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.92,,,,,,,fee schedule,28.5,134.51,APC Fractionation ketosteroids,83593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.5,,,,,,,fee schedule,28.5,134.51,APC Assay of lactic acid,83605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.49,,,,,,,fee schedule,11.57,54.61, Assay of lactic acid,83605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.61,,,,,,,fee schedule,11.57,54.61, Assay of lactic acid,83605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.57,54.61, Assay of lactic acid,83605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.57,54.61, Assay of lactic acid,83605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.03,,,,,,,fee schedule,11.57,54.61,APC Assay of lactic acid,83605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.15,,,,,,,fee schedule,11.57,54.61,APC Assay of lactic acid,83605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.57,,,,,,,fee schedule,11.57,54.61,APC Lactate (LD) (LDH) enzyme,83615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.43,,,,,,,fee schedule,6.04,30.89, Lactate (LD) (LDH) enzyme,83615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.89,,,,,,,fee schedule,6.04,30.89, Lactate (LD) (LDH) enzyme,83615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,6.04,30.89, Lactate (LD) (LDH) enzyme,83615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,6.04,30.89, Lactate (LD) (LDH) enzyme,83615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.28,,,,,,,fee schedule,6.04,30.89,APC Lactate (LD) (LDH) enzyme,83615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.34,,,,,,,fee schedule,6.04,30.89,APC Lactate (LD) (LDH) enzyme,83615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.04,,,,,,,fee schedule,6.04,30.89,APC Assay of ldh enzymes,83625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.11,,,,,,,fee schedule,12.79,65.44, Assay of ldh enzymes,83625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.44,,,,,,,fee schedule,12.79,65.44, Assay of ldh enzymes,83625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.79,65.44, Assay of ldh enzymes,83625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.79,65.44, Assay of ldh enzymes,83625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.3,,,,,,,fee schedule,12.79,65.44,APC Assay of ldh enzymes,83625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.43,,,,,,,fee schedule,12.79,65.44,APC Assay of ldh enzymes,83625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.79,,,,,,,fee schedule,12.79,65.44,APC Lactoferrin fecal (qual),83630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,19.7,71.43, Lactoferrin fecal (qual),83630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,19.7,71.43, Lactoferrin fecal (qual),83630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.7,71.43, Lactoferrin fecal (qual),83630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.7,71.43, Lactoferrin fecal (qual),83630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.49,,,,,,,fee schedule,19.7,71.43,APC Lactoferrin fecal (qual),83630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.68,,,,,,,fee schedule,19.7,71.43,APC Lactoferrin fecal (qual),83630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.7,,,,,,,fee schedule,19.7,71.43,APC Lactoferrin fecal (quant),83631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.35,,,,,,,fee schedule,19.63,101.75, Lactoferrin fecal (quant),83631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.75,,,,,,,fee schedule,19.63,101.75, Lactoferrin fecal (quant),83631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.63,101.75, Lactoferrin fecal (quant),83631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.63,101.75, Lactoferrin fecal (quant),83631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.42,,,,,,,fee schedule,19.63,101.75,APC Lactoferrin fecal (quant),83631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.61,,,,,,,fee schedule,19.63,101.75,APC Lactoferrin fecal (quant),83631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.63,,,,,,,fee schedule,19.63,101.75,APC Placental lactogen,83632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.78,,,,,,,fee schedule,20.22,103.36, Placental lactogen,83632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.36,,,,,,,fee schedule,20.22,103.36, Placental lactogen,83632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.22,103.36, Placental lactogen,83632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.22,103.36, Placental lactogen,83632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.03,,,,,,,fee schedule,20.22,103.36,APC Placental lactogen,83632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.23,,,,,,,fee schedule,20.22,103.36,APC Placental lactogen,83632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.22,,,,,,,fee schedule,20.22,103.36,APC Test urine for lactose,83633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.99,,,,,,,fee schedule,11.25,40.47, Test urine for lactose,83633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.15,,,,,,,fee schedule,11.25,40.47, Test urine for lactose,83633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.41,,,,,,,fee schedule,11.25,40.47, Test urine for lactose,83633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.47,,,,,,,fee schedule,11.25,40.47, Test urine for lactose,83633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.7,,,,,,,fee schedule,11.25,40.47,APC Test urine for lactose,83633,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.81,,,,,,,fee schedule,11.25,40.47,APC Test urine for lactose,83633,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.25,,,,,,,fee schedule,11.25,40.47,APC Assay of lead,83655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.96,,,,,,,fee schedule,12.11,61.89, Assay of lead,83655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.89,,,,,,,fee schedule,12.11,61.89, Assay of lead,83655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.11,61.89, Assay of lead,83655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.11,61.89, Assay of lead,83655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.59,,,,,,,fee schedule,12.11,61.89,APC Assay of lead,83655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.72,,,,,,,fee schedule,12.11,61.89,APC Assay of lead,83655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,12.11,61.89,APC L/s ratio fetal lung,83661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.81,,,,,,,fee schedule,21.99,112.4, L/s ratio fetal lung,83661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,112.4,,,,,,,fee schedule,21.99,112.4, L/s ratio fetal lung,83661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,21.99,112.4, L/s ratio fetal lung,83661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,21.99,112.4, L/s ratio fetal lung,83661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.87,,,,,,,fee schedule,21.99,112.4,APC L/s ratio fetal lung,83661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.09,,,,,,,fee schedule,21.99,112.4,APC L/s ratio fetal lung,83661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.99,,,,,,,fee schedule,21.99,112.4,APC Foam stability fetal lung,83662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,85.9,,,,,,,fee schedule,18.91,96.73, Foam stability fetal lung,83662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.73,,,,,,,fee schedule,18.91,96.73, Foam stability fetal lung,83662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,18.91,96.73, Foam stability fetal lung,83662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,18.91,96.73, Foam stability fetal lung,83662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.67,,,,,,,fee schedule,18.91,96.73,APC Foam stability fetal lung,83662,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.86,,,,,,,fee schedule,18.91,96.73,APC Foam stability fetal lung,83662,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.91,,,,,,,fee schedule,18.91,96.73,APC Fluoro polarize fetal lung,83663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,85.9,,,,,,,fee schedule,18.91,96.73, Fluoro polarize fetal lung,83663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.73,,,,,,,fee schedule,18.91,96.73, Fluoro polarize fetal lung,83663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,18.91,96.73, Fluoro polarize fetal lung,83663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,18.91,96.73, Fluoro polarize fetal lung,83663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.67,,,,,,,fee schedule,18.91,96.73,APC Fluoro polarize fetal lung,83663,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.86,,,,,,,fee schedule,18.91,96.73,APC Fluoro polarize fetal lung,83663,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.91,,,,,,,fee schedule,18.91,96.73,APC Lamellar bdy fetal lung,83664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,85.9,,,,,,,fee schedule,19.32,96.73, Lamellar bdy fetal lung,83664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.73,,,,,,,fee schedule,19.32,96.73, Lamellar bdy fetal lung,83664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.32,96.73, Lamellar bdy fetal lung,83664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.32,96.73, Lamellar bdy fetal lung,83664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.09,,,,,,,fee schedule,19.32,96.73,APC Lamellar bdy fetal lung,83664,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.29,,,,,,,fee schedule,19.32,96.73,APC Lamellar bdy fetal lung,83664,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.32,,,,,,,fee schedule,19.32,96.73,APC Assay of lap enzyme,83670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.6,,,,,,,fee schedule,9.81,46.85, Assay of lap enzyme,83670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.85,,,,,,,fee schedule,9.81,46.85, Assay of lap enzyme,83670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.81,46.85, Assay of lap enzyme,83670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.81,46.85, Assay of lap enzyme,83670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.2,,,,,,,fee schedule,9.81,46.85,APC Assay of lap enzyme,83670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.3,,,,,,,fee schedule,9.81,46.85,APC Assay of lap enzyme,83670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.81,,,,,,,fee schedule,9.81,46.85,APC Assay of lipase,83690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.27,,,,,,,fee schedule,6.89,35.21, Assay of lipase,83690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.21,,,,,,,fee schedule,6.89,35.21, Assay of lipase,83690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.89,35.21, Assay of lipase,83690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.89,35.21, Assay of lipase,83690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.17,,,,,,,fee schedule,6.89,35.21,APC Assay of lipase,83690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.23,,,,,,,fee schedule,6.89,35.21,APC Assay of lipase,83690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.89,,,,,,,fee schedule,6.89,35.21,APC Assay of lipoprotein(a),83695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.61,,,,,,,fee schedule,14.32,67.12, Assay of lipoprotein(a),83695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.12,,,,,,,fee schedule,14.32,67.12, Assay of lipoprotein(a),83695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.32,67.12, Assay of lipoprotein(a),83695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.32,67.12, Assay of lipoprotein(a),83695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.89,,,,,,,fee schedule,14.32,67.12,APC Assay of lipoprotein(a),83695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.04,,,,,,,fee schedule,14.32,67.12,APC Assay of lipoprotein(a),83695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.32,,,,,,,fee schedule,14.32,67.12,APC Assay Lipoprotein Pla2,83698,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.26,,,,,,,fee schedule,46.31,175.97, Assay Lipoprotein Pla2,83698,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,175.97,,,,,,,fee schedule,46.31,175.97, Assay Lipoprotein Pla2,83698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.87,,,,,,,fee schedule,46.31,175.97, Assay Lipoprotein Pla2,83698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,167.85,,,,,,,fee schedule,46.31,175.97, Assay Lipoprotein Pla2,83698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.16,,,,,,,fee schedule,46.31,175.97,APC Assay Lipoprotein Pla2,83698,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48.63,,,,,,,fee schedule,46.31,175.97,APC Assay Lipoprotein Pla2,83698,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.31,,,,,,,fee schedule,46.31,175.97,APC Lipopro bld electrophoretic,83700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.84,,,,,,,fee schedule,11.26,58.38, Lipopro bld electrophoretic,83700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.38,,,,,,,fee schedule,11.26,58.38, Lipopro bld electrophoretic,83700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.41,,,,,,,fee schedule,11.26,58.38, Lipopro bld electrophoretic,83700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.47,,,,,,,fee schedule,11.26,58.38, Lipopro bld electrophoretic,83700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.71,,,,,,,fee schedule,11.26,58.38,APC Lipopro bld electrophoretic,83700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.82,,,,,,,fee schedule,11.26,58.38,APC Lipopro bld electrophoretic,83700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.26,,,,,,,fee schedule,11.26,58.38,APC Lipoprotein bld hr fraction,83701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,103.87,,,,,,,fee schedule,33.86,122.61, Lipoprotein bld hr fraction,83701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.97,,,,,,,fee schedule,33.86,122.61, Lipoprotein bld hr fraction,83701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,107.28,,,,,,,fee schedule,33.86,122.61, Lipoprotein bld hr fraction,83701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,122.61,,,,,,,fee schedule,33.86,122.61, Lipoprotein bld hr fraction,83701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.21,,,,,,,fee schedule,33.86,122.61,APC Lipoprotein bld hr fraction,83701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.55,,,,,,,fee schedule,33.86,122.61,APC Lipoprotein bld hr fraction,83701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.86,,,,,,,fee schedule,33.86,122.61,APC Lipoprotein bld quan part,83704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,145.24,,,,,,,fee schedule,34.19,163.57, Lipoprotein bld quan part,83704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,163.57,,,,,,,fee schedule,34.19,163.57, Lipoprotein bld quan part,83704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,108.33,,,,,,,fee schedule,34.19,163.57, Lipoprotein bld quan part,83704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123.81,,,,,,,fee schedule,34.19,163.57, Lipoprotein bld quan part,83704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.56,,,,,,,fee schedule,34.19,163.57,APC Lipoprotein bld quan part,83704,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.9,,,,,,,fee schedule,34.19,163.57,APC Lipoprotein bld quan part,83704,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.19,,,,,,,fee schedule,34.19,163.57,APC Assay of lipoprotein,83718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.18,,,,,,,fee schedule,8.19,41.87, Assay of lipoprotein,83718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.87,,,,,,,fee schedule,8.19,41.87, Assay of lipoprotein,83718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.19,41.87, Assay of lipoprotein,83718,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.19,41.87, Assay of lipoprotein,83718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.52,,,,,,,fee schedule,8.19,41.87,APC Assay of lipoprotein,83718,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.6,,,,,,,fee schedule,8.19,41.87,APC Assay of lipoprotein,83718,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.19,,,,,,,fee schedule,8.19,41.87,APC Assay of blood lipoprotein,83719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.85,,,,,,,fee schedule,12.75,59.51, Assay of blood lipoprotein,83719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.51,,,,,,,fee schedule,12.75,59.51, Assay of blood lipoprotein,83719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.75,59.51, Assay of blood lipoprotein,83719,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.75,59.51, Assay of blood lipoprotein,83719,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.26,,,,,,,fee schedule,12.75,59.51,APC Assay of blood lipoprotein,83719,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.39,,,,,,,fee schedule,12.75,59.51,APC Assay of blood lipoprotein,83719,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.75,,,,,,,fee schedule,12.75,59.51,APC Assay of blood lipoprotein,83721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.32,,,,,,,fee schedule,10.5,48.79, Assay of blood lipoprotein,83721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.79,,,,,,,fee schedule,10.5,48.79, Assay of blood lipoprotein,83721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.5,48.79, Assay of blood lipoprotein,83721,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.5,48.79, Assay of blood lipoprotein,83721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.92,,,,,,,fee schedule,10.5,48.79,APC Assay of blood lipoprotein,83721,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.02,,,,,,,fee schedule,10.5,48.79,APC Assay of blood lipoprotein,83721,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.5,,,,,,,fee schedule,10.5,48.79,APC Lipoprtn dir meas sd ldl chl,83722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.95,,,,,,,fee schedule,34.19,128.32, Lipoprtn dir meas sd ldl chl,83722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.32,,,,,,,fee schedule,34.19,128.32, Lipoprtn dir meas sd ldl chl,83722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,108.33,,,,,,,fee schedule,34.19,128.32, Lipoprtn dir meas sd ldl chl,83722,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123.81,,,,,,,fee schedule,34.19,128.32, Lipoprtn dir meas sd ldl chl,83722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.56,,,,,,,fee schedule,34.19,128.32,APC Lipoprtn dir meas sd ldl chl,83722,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.9,,,,,,,fee schedule,34.19,128.32,APC Lipoprtn dir meas sd ldl chl,83722,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.19,,,,,,,fee schedule,34.19,128.32,APC Assay of lrh hormone,83727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.07,,,,,,,fee schedule,17.19,87.91, Assay of lrh hormone,83727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.91,,,,,,,fee schedule,17.19,87.91, Assay of lrh hormone,83727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.19,87.91, Assay of lrh hormone,83727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.19,87.91, Assay of lrh hormone,83727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.88,,,,,,,fee schedule,17.19,87.91,APC Assay of lrh hormone,83727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.05,,,,,,,fee schedule,17.19,87.91,APC Assay of lrh hormone,83727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.19,,,,,,,fee schedule,17.19,87.91,APC Assay of magnesium,83735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.42,,,,,,,fee schedule,6.7,34.26, Assay of magnesium,83735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.26,,,,,,,fee schedule,6.7,34.26, Assay of magnesium,83735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.7,34.26, Assay of magnesium,83735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.7,34.26, Assay of magnesium,83735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.97,,,,,,,fee schedule,6.7,34.26,APC Assay of magnesium,83735,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.04,,,,,,,fee schedule,6.7,34.26,APC Assay of magnesium,83735,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.7,,,,,,,fee schedule,6.7,34.26,APC Assay malate dehydrogenase,83775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.48,,,,,,,fee schedule,7.37,37.7, Assay malate dehydrogenase,83775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.7,,,,,,,fee schedule,7.37,37.7, Assay malate dehydrogenase,83775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.97,,,,,,,fee schedule,7.37,37.7, Assay malate dehydrogenase,83775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.39,,,,,,,fee schedule,7.37,37.7, Assay malate dehydrogenase,83775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.66,,,,,,,fee schedule,7.37,37.7,APC Assay malate dehydrogenase,83775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.74,,,,,,,fee schedule,7.37,37.7,APC Assay malate dehydrogenase,83775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.37,,,,,,,fee schedule,7.37,37.7,APC Assay of manganese,83785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.91,,,,,,,fee schedule,26.65,108.01, Assay of manganese,83785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,108.01,,,,,,,fee schedule,26.65,108.01, Assay of manganese,83785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.37,,,,,,,fee schedule,26.65,108.01, Assay of manganese,83785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.42,,,,,,,fee schedule,26.65,108.01, Assay of manganese,83785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.72,,,,,,,fee schedule,26.65,108.01,APC Assay of manganese,83785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.98,,,,,,,fee schedule,26.65,108.01,APC Assay of manganese,83785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.65,,,,,,,fee schedule,26.65,108.01,APC Mass spectrometry qual/quan,83789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82,,,,,,,fee schedule,24.11,92.34, Mass spectrometry qual/quan,83789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.34,,,,,,,fee schedule,24.11,92.34, Mass spectrometry qual/quan,83789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,24.11,92.34, Mass spectrometry qual/quan,83789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,24.11,92.34, Mass spectrometry qual/quan,83789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.07,,,,,,,fee schedule,24.11,92.34,APC Mass spectrometry qual/quan,83789,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.32,,,,,,,fee schedule,24.11,92.34,APC Mass spectrometry qual/quan,83789,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.11,,,,,,,fee schedule,24.11,92.34,APC Assay of mercury,83825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.84,,,,,,,fee schedule,16.26,83.16, Assay of mercury,83825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.16,,,,,,,fee schedule,16.26,83.16, Assay of mercury,83825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.26,83.16, Assay of mercury,83825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.26,83.16, Assay of mercury,83825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.91,,,,,,,fee schedule,16.26,83.16,APC Assay of mercury,83825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.07,,,,,,,fee schedule,16.26,83.16,APC Assay of mercury,83825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.26,,,,,,,fee schedule,16.26,83.16,APC Assay of metanephrines,83835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.93,,,,,,,fee schedule,16.94,86.63, Assay of metanephrines,83835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.63,,,,,,,fee schedule,16.94,86.63, Assay of metanephrines,83835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.94,86.63, Assay of metanephrines,83835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.94,86.63, Assay of metanephrines,83835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.62,,,,,,,fee schedule,16.94,86.63,APC Assay of metanephrines,83835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.79,,,,,,,fee schedule,16.94,86.63,APC Assay of metanephrines,83835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.94,,,,,,,fee schedule,16.94,86.63,APC Assay of methemalbumin,83857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.78,,,,,,,fee schedule,10.74,54.94, Assay of methemalbumin,83857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.94,,,,,,,fee schedule,10.74,54.94, Assay of methemalbumin,83857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.74,54.94, Assay of methemalbumin,83857,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.74,54.94, Assay of methemalbumin,83857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.17,,,,,,,fee schedule,10.74,54.94,APC Assay of methemalbumin,83857,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.28,,,,,,,fee schedule,10.74,54.94,APC Assay of methemalbumin,83857,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.74,54.94,APC Microfluid analy tears,83861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.05,,,,,,,fee schedule,22.48,85.64, Microfluid analy tears,83861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.64,,,,,,,fee schedule,22.48,85.64, Microfluid analy tears,83861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,71.87,,,,,,,fee schedule,22.48,85.64, Microfluid analy tears,83861,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.14,,,,,,,fee schedule,22.48,85.64, Microfluid analy tears,83861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.38,,,,,,,fee schedule,22.48,85.64,APC Microfluid analy tears,83861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.6,,,,,,,fee schedule,22.48,85.64,APC Microfluid analy tears,83861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.48,,,,,,,fee schedule,22.48,85.64,APC Mucopolysaccharides,83864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.42,,,,,,,fee schedule,28.5,103.56, Mucopolysaccharides,83864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.82,,,,,,,fee schedule,28.5,103.56, Mucopolysaccharides,83864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,90.62,,,,,,,fee schedule,28.5,103.56, Mucopolysaccharides,83864,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,103.56,,,,,,,fee schedule,28.5,103.56, Mucopolysaccharides,83864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.64,,,,,,,fee schedule,28.5,103.56,APC Mucopolysaccharides,83864,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.92,,,,,,,fee schedule,28.5,103.56,APC Mucopolysaccharides,83864,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.5,,,,,,,fee schedule,28.5,103.56,APC Assay synovial fluid mucin,83872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.62,,,,,,,fee schedule,5.86,29.98, Assay synovial fluid mucin,83872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.98,,,,,,,fee schedule,5.86,29.98, Assay synovial fluid mucin,83872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.86,29.98, Assay synovial fluid mucin,83872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.86,29.98, Assay synovial fluid mucin,83872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.09,,,,,,,fee schedule,5.86,29.98,APC Assay synovial fluid mucin,83872,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.15,,,,,,,fee schedule,5.86,29.98,APC Assay synovial fluid mucin,83872,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.86,,,,,,,fee schedule,5.86,29.98,APC Assay of csf protein,83873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.13,,,,,,,fee schedule,17.2,87.99, Assay of csf protein,83873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.99,,,,,,,fee schedule,17.2,87.99, Assay of csf protein,83873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.2,87.99, Assay of csf protein,83873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.2,87.99, Assay of csf protein,83873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.89,,,,,,,fee schedule,17.2,87.99,APC Assay of csf protein,83873,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.06,,,,,,,fee schedule,17.2,87.99,APC Assay of csf protein,83873,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.2,,,,,,,fee schedule,17.2,87.99,APC Assay of myoglobin,83874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.63,,,,,,,fee schedule,12.92,66.03, Assay of myoglobin,83874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.03,,,,,,,fee schedule,12.92,66.03, Assay of myoglobin,83874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.92,66.03, Assay of myoglobin,83874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.92,66.03, Assay of myoglobin,83874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.44,,,,,,,fee schedule,12.92,66.03,APC Assay of myoglobin,83874,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.57,,,,,,,fee schedule,12.92,66.03,APC Assay of myoglobin,83874,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.92,,,,,,,fee schedule,12.92,66.03,APC Assay myeloperoxidase,83876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.26,,,,,,,fee schedule,50.86,184.5, Assay myeloperoxidase,83876,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,175.97,,,,,,,fee schedule,50.86,184.5, Assay myeloperoxidase,83876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,161.44,,,,,,,fee schedule,50.86,184.5, Assay myeloperoxidase,83876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,184.5,,,,,,,fee schedule,50.86,184.5, Assay myeloperoxidase,83876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.89,,,,,,,fee schedule,50.86,184.5,APC Assay myeloperoxidase,83876,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.4,,,,,,,fee schedule,50.86,184.5,APC Assay myeloperoxidase,83876,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.86,,,,,,,fee schedule,50.86,184.5,APC Assay of natriuretic peptide,83880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,154.15,,,,,,,fee schedule,39.26,173.59, Assay of natriuretic peptide,83880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,173.59,,,,,,,fee schedule,39.26,173.59, Assay of natriuretic peptide,83880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,124.98,,,,,,,fee schedule,39.26,173.59, Assay of natriuretic peptide,83880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.83,,,,,,,fee schedule,39.26,173.59, Assay of natriuretic peptide,83880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.83,,,,,,,fee schedule,39.26,173.59,APC Assay of natriuretic peptide,83880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.22,,,,,,,fee schedule,39.26,173.59,APC Assay of natriuretic peptide,83880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.26,,,,,,,fee schedule,39.26,173.59,APC Assay nephelometry not spec,83883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.75,,,,,,,fee schedule,13.6,69.54, Assay nephelometry not spec,83883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.54,,,,,,,fee schedule,13.6,69.54, Assay nephelometry not spec,83883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.6,69.54, Assay nephelometry not spec,83883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.6,69.54, Assay nephelometry not spec,83883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.14,,,,,,,fee schedule,13.6,69.54,APC Assay nephelometry not spec,83883,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.28,,,,,,,fee schedule,13.6,69.54,APC Assay nephelometry not spec,83883,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.6,,,,,,,fee schedule,13.6,69.54,APC Assay neurflmnt light chain,83884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,120.88,,,,,,,fee schedule,116.23,122.04,APC Assay neurflmnt light chain,83884,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,122.04,,,,,,,fee schedule,116.23,122.04,APC Assay neurflmnt light chain,83884,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,116.23,,,,,,,fee schedule,116.23,122.04,APC Assay of nickel,83885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.25,,,,,,,fee schedule,24.51,125.28, Assay of nickel,83885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.28,,,,,,,fee schedule,24.51,125.28, Assay of nickel,83885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.12,,,,,,,fee schedule,24.51,125.28, Assay of nickel,83885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.28,,,,,,,fee schedule,24.51,125.28, Assay of nickel,83885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.49,,,,,,,fee schedule,24.51,125.28,APC Assay of nickel,83885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.74,,,,,,,fee schedule,24.51,125.28,APC Assay of nickel,83885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.51,,,,,,,fee schedule,24.51,125.28,APC Assay of nucleotidase,83915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.64,,,,,,,fee schedule,11.15,57.02, Assay of nucleotidase,83915,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.02,,,,,,,fee schedule,11.15,57.02, Assay of nucleotidase,83915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.41,,,,,,,fee schedule,11.15,57.02, Assay of nucleotidase,83915,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.47,,,,,,,fee schedule,11.15,57.02, Assay of nucleotidase,83915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.6,,,,,,,fee schedule,11.15,57.02,APC Assay of nucleotidase,83915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.71,,,,,,,fee schedule,11.15,57.02,APC Assay of nucleotidase,83915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.15,,,,,,,fee schedule,11.15,57.02,APC Oligoclonal bands,83916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.29,,,,,,,fee schedule,27.39,102.81, Oligoclonal bands,83916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.81,,,,,,,fee schedule,27.39,102.81, Oligoclonal bands,83916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.49,,,,,,,fee schedule,27.39,102.81, Oligoclonal bands,83916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,99.99,,,,,,,fee schedule,27.39,102.81, Oligoclonal bands,83916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.49,,,,,,,fee schedule,27.39,102.81,APC Oligoclonal bands,83916,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.76,,,,,,,fee schedule,27.39,102.81,APC Oligoclonal bands,83916,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.39,,,,,,,fee schedule,27.39,102.81,APC Organic acids total quant,83918,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.75,,,,,,,fee schedule,23.6,85.71, Organic acids total quant,83918,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.18,,,,,,,fee schedule,23.6,85.71, Organic acids total quant,83918,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75,,,,,,,fee schedule,23.6,85.71, Organic acids total quant,83918,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,85.71,,,,,,,fee schedule,23.6,85.71, Organic acids total quant,83918,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.54,,,,,,,fee schedule,23.6,85.71,APC Organic acids total quant,83918,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.78,,,,,,,fee schedule,23.6,85.71,APC Organic acids total quant,83918,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.6,,,,,,,fee schedule,23.6,85.71,APC Organic acids qual each,83919,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.75,,,,,,,fee schedule,16.45,84.18, Organic acids qual each,83919,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.18,,,,,,,fee schedule,16.45,84.18, Organic acids qual each,83919,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.45,84.18, Organic acids qual each,83919,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.45,84.18, Organic acids qual each,83919,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.11,,,,,,,fee schedule,16.45,84.18,APC Organic acids qual each,83919,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,16.45,84.18,APC Organic acids qual each,83919,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.45,,,,,,,fee schedule,16.45,84.18,APC Organic acid single quant,83921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.75,,,,,,,fee schedule,21.21,84.18, Organic acid single quant,83921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.18,,,,,,,fee schedule,21.21,84.18, Organic acid single quant,83921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.7,,,,,,,fee schedule,21.21,84.18, Organic acid single quant,83921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,77.37,,,,,,,fee schedule,21.21,84.18, Organic acid single quant,83921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.06,,,,,,,fee schedule,21.21,84.18,APC Organic acid single quant,83921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.27,,,,,,,fee schedule,21.21,84.18,APC Organic acid single quant,83921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.21,,,,,,,fee schedule,21.21,84.18,APC Assay of blood osmolality,83930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.15,,,,,,,fee schedule,6.61,32.83, Assay of blood osmolality,83930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.83,,,,,,,fee schedule,6.61,32.83, Assay of blood osmolality,83930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.61,32.83, Assay of blood osmolality,83930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.61,32.83, Assay of blood osmolality,83930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.87,,,,,,,fee schedule,6.61,32.83,APC Assay of blood osmolality,83930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.94,,,,,,,fee schedule,6.61,32.83,APC Assay of blood osmolality,83930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.61,,,,,,,fee schedule,6.61,32.83,APC Assay of urine osmolality,83935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.94,,,,,,,fee schedule,6.82,34.84, Assay of urine osmolality,83935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.84,,,,,,,fee schedule,6.82,34.84, Assay of urine osmolality,83935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.82,34.84, Assay of urine osmolality,83935,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.82,34.84, Assay of urine osmolality,83935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.09,,,,,,,fee schedule,6.82,34.84,APC Assay of urine osmolality,83935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.16,,,,,,,fee schedule,6.82,34.84,APC Assay of urine osmolality,83935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.82,,,,,,,fee schedule,6.82,34.84,APC Assay of osteocalcin,83937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,135.56,,,,,,,fee schedule,29.85,152.66, Assay of osteocalcin,83937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,152.66,,,,,,,fee schedule,29.85,152.66, Assay of osteocalcin,83937,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,29.85,152.66, Assay of osteocalcin,83937,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,29.85,152.66, Assay of osteocalcin,83937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.04,,,,,,,fee schedule,29.85,152.66,APC Assay of osteocalcin,83937,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.34,,,,,,,fee schedule,29.85,152.66,APC Assay of osteocalcin,83937,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.85,,,,,,,fee schedule,29.85,152.66,APC Assay of oxalate,83945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.47,,,,,,,fee schedule,14.45,65.84, Assay of oxalate,83945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.84,,,,,,,fee schedule,14.45,65.84, Assay of oxalate,83945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.45,65.84, Assay of oxalate,83945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.45,65.84, Assay of oxalate,83945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.03,,,,,,,fee schedule,14.45,65.84,APC Assay of oxalate,83945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.17,,,,,,,fee schedule,14.45,65.84,APC Assay of oxalate,83945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.45,,,,,,,fee schedule,14.45,65.84,APC Oncoprotein her-2/neu,83950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,292.47,,,,,,,fee schedule,64.41,329.36, Oncoprotein her-2/neu,83950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,329.36,,,,,,,fee schedule,64.41,329.36, Oncoprotein her-2/neu,83950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,205.2,,,,,,,fee schedule,64.41,329.36, Oncoprotein her-2/neu,83950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,234.51,,,,,,,fee schedule,64.41,329.36, Oncoprotein her-2/neu,83950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.99,,,,,,,fee schedule,64.41,329.36,APC Oncoprotein her-2/neu,83950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.63,,,,,,,fee schedule,64.41,329.36,APC Oncoprotein her-2/neu,83950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.41,,,,,,,fee schedule,64.41,329.36,APC Oncoprotein dcp,83951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,296.5,,,,,,,fee schedule,64.41,333.9, Oncoprotein dcp,83951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333.9,,,,,,,fee schedule,64.41,333.9, Oncoprotein dcp,83951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,205.2,,,,,,,fee schedule,64.41,333.9, Oncoprotein dcp,83951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,234.51,,,,,,,fee schedule,64.41,333.9, Oncoprotein dcp,83951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.99,,,,,,,fee schedule,64.41,333.9,APC Oncoprotein dcp,83951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.63,,,,,,,fee schedule,64.41,333.9,APC Oncoprotein dcp,83951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.41,,,,,,,fee schedule,64.41,333.9,APC Assay of parathormone,83970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,187.43,,,,,,,fee schedule,41.28,211.07, Assay of parathormone,83970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,211.07,,,,,,,fee schedule,41.28,211.07, Assay of parathormone,83970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,131.25,,,,,,,fee schedule,41.28,211.07, Assay of parathormone,83970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,150,,,,,,,fee schedule,41.28,211.07, Assay of parathormone,83970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42.93,,,,,,,fee schedule,41.28,211.07,APC Assay of parathormone,83970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.34,,,,,,,fee schedule,41.28,211.07,APC Assay of parathormone,83970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.28,,,,,,,fee schedule,41.28,211.07,APC Assay ph body fluid nos,83986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.49,,,,,,,fee schedule,3.58,15.19, Assay ph body fluid nos,83986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.19,,,,,,,fee schedule,3.58,15.19, Assay ph body fluid nos,83986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.45,,,,,,,fee schedule,3.58,15.19, Assay ph body fluid nos,83986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.08,,,,,,,fee schedule,3.58,15.19, Assay ph body fluid nos,83986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.72,,,,,,,fee schedule,3.58,15.19,APC Assay ph body fluid nos,83986,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.76,,,,,,,fee schedule,3.58,15.19,APC Assay ph body fluid nos,83986,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.58,,,,,,,fee schedule,3.58,15.19,APC Exhaled breath condensate,83987,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.09,,,,,,,fee schedule,3.58,82.31, Exhaled breath condensate,83987,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.31,,,,,,,fee schedule,3.58,82.31, Exhaled breath condensate,83987,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.45,,,,,,,fee schedule,3.58,82.31, Exhaled breath condensate,83987,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.08,,,,,,,fee schedule,3.58,82.31, Exhaled breath condensate,83987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.72,,,,,,,fee schedule,3.58,82.31,APC Exhaled breath condensate,83987,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.76,,,,,,,fee schedule,3.58,82.31,APC Exhaled breath condensate,83987,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.58,,,,,,,fee schedule,3.58,82.31,APC Assay for phencyclidine,83992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.76,,,,,,,fee schedule,66.76,130.95, Assay for phencyclidine,83992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.18,,,,,,,fee schedule,66.76,130.95, Assay for phencyclidine,83992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,114.58,,,,,,,fee schedule,66.76,130.95, Assay for phencyclidine,83992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,130.95,,,,,,,fee schedule,66.76,130.95, Assay for calprotectin fecal,83993,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.35,,,,,,,fee schedule,19.63,101.75, Assay for calprotectin fecal,83993,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.75,,,,,,,fee schedule,19.63,101.75, Assay for calprotectin fecal,83993,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.63,101.75, Assay for calprotectin fecal,83993,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.63,101.75, Assay for calprotectin fecal,83993,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.42,,,,,,,fee schedule,19.63,101.75,APC Assay for calprotectin fecal,83993,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.61,,,,,,,fee schedule,19.63,101.75,APC Assay for calprotectin fecal,83993,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.63,,,,,,,fee schedule,19.63,101.75,APC Assay of blood pku,84030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.99,,,,,,,fee schedule,5.5,28.15, Assay of blood pku,84030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.15,,,,,,,fee schedule,5.5,28.15, Assay of blood pku,84030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.5,28.15, Assay of blood pku,84030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.5,28.15, Assay of blood pku,84030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.72,,,,,,,fee schedule,5.5,28.15,APC Assay of blood pku,84030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.78,,,,,,,fee schedule,5.5,28.15,APC Assay of blood pku,84030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.5,,,,,,,fee schedule,5.5,28.15,APC Assay of phenylketones,84035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.61,,,,,,,fee schedule,3.98,18.7, Assay of phenylketones,84035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.7,,,,,,,fee schedule,3.98,18.7, Assay of phenylketones,84035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.98,18.7, Assay of phenylketones,84035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.98,18.7, Assay of phenylketones,84035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.14,,,,,,,fee schedule,3.98,18.7,APC Assay of phenylketones,84035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.18,,,,,,,fee schedule,3.98,18.7,APC Assay of phenylketones,84035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.98,,,,,,,fee schedule,3.98,18.7,APC Assay acid phosphatase,84060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.54,,,,,,,fee schedule,7.64,37.77, Assay acid phosphatase,84060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.77,,,,,,,fee schedule,7.64,37.77, Assay acid phosphatase,84060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.97,,,,,,,fee schedule,7.64,37.77, Assay acid phosphatase,84060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.39,,,,,,,fee schedule,7.64,37.77, Assay acid phosphatase,84060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.95,,,,,,,fee schedule,7.64,37.77,APC Assay acid phosphatase,84060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.02,,,,,,,fee schedule,7.64,37.77,APC Assay acid phosphatase,84060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.64,,,,,,,fee schedule,7.64,37.77,APC Assay prostate phosphatase,84066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.88,,,,,,,fee schedule,9.66,49.41, Assay prostate phosphatase,84066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.41,,,,,,,fee schedule,9.66,49.41, Assay prostate phosphatase,84066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.66,49.41, Assay prostate phosphatase,84066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.66,49.41, Assay prostate phosphatase,84066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.05,,,,,,,fee schedule,9.66,49.41,APC Assay prostate phosphatase,84066,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.14,,,,,,,fee schedule,9.66,49.41,APC Assay prostate phosphatase,84066,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.66,,,,,,,fee schedule,9.66,49.41,APC Assay alkaline phosphatase,84075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,5.18,26.46, Assay alkaline phosphatase,84075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,5.18,26.46, Assay alkaline phosphatase,84075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.18,26.46, Assay alkaline phosphatase,84075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.18,26.46, Assay alkaline phosphatase,84075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.18,26.46,APC Assay alkaline phosphatase,84075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.44,,,,,,,fee schedule,5.18,26.46,APC Assay alkaline phosphatase,84075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.18,,,,,,,fee schedule,5.18,26.46,APC Assay alkaline phosphatase,84078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.15,,,,,,,fee schedule,8.26,37.33, Assay alkaline phosphatase,84078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.33,,,,,,,fee schedule,8.26,37.33, Assay alkaline phosphatase,84078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.26,37.33, Assay alkaline phosphatase,84078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.26,37.33, Assay alkaline phosphatase,84078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.59,,,,,,,fee schedule,8.26,37.33,APC Assay alkaline phosphatase,84078,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.67,,,,,,,fee schedule,8.26,37.33,APC Assay alkaline phosphatase,84078,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.26,,,,,,,fee schedule,8.26,37.33,APC Assay alkaline phosphatases,84080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.15,,,,,,,fee schedule,14.78,75.62, Assay alkaline phosphatases,84080,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.62,,,,,,,fee schedule,14.78,75.62, Assay alkaline phosphatases,84080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.78,75.62, Assay alkaline phosphatases,84080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.78,75.62, Assay alkaline phosphatases,84080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.37,,,,,,,fee schedule,14.78,75.62,APC Assay alkaline phosphatases,84080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.52,,,,,,,fee schedule,14.78,75.62,APC Assay alkaline phosphatases,84080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.78,,,,,,,fee schedule,14.78,75.62,APC Assay phosphatidylglycerol,84081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.04,,,,,,,fee schedule,16.52,84.51, Assay phosphatidylglycerol,84081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,84.51,,,,,,,fee schedule,16.52,84.51, Assay phosphatidylglycerol,84081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.52,84.51, Assay phosphatidylglycerol,84081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.52,84.51, Assay phosphatidylglycerol,84081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.18,,,,,,,fee schedule,16.52,84.51,APC Assay phosphatidylglycerol,84081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.35,,,,,,,fee schedule,16.52,84.51,APC Assay phosphatidylglycerol,84081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.52,,,,,,,fee schedule,16.52,84.51,APC Assay of rbc pg6d enzyme,84085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.62,,,,,,,fee schedule,9.44,34.53, Assay of rbc pg6d enzyme,84085,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.48,,,,,,,fee schedule,9.44,34.53, Assay of rbc pg6d enzyme,84085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.44,34.53, Assay of rbc pg6d enzyme,84085,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.44,34.53, Assay of rbc pg6d enzyme,84085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.82,,,,,,,fee schedule,9.44,34.53,APC Assay of rbc pg6d enzyme,84085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.91,,,,,,,fee schedule,9.44,34.53,APC Assay of rbc pg6d enzyme,84085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.44,,,,,,,fee schedule,9.44,34.53,APC Assay phosphohexose enzymes,84087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.87,,,,,,,fee schedule,10.73,52.78, Assay phosphohexose enzymes,84087,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.78,,,,,,,fee schedule,10.73,52.78, Assay phosphohexose enzymes,84087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.73,52.78, Assay phosphohexose enzymes,84087,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.73,52.78, Assay phosphohexose enzymes,84087,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.16,,,,,,,fee schedule,10.73,52.78,APC Assay phosphohexose enzymes,84087,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.27,,,,,,,fee schedule,10.73,52.78,APC Assay phosphohexose enzymes,84087,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.73,,,,,,,fee schedule,10.73,52.78,APC Assay of phosphorus,84100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.55,,,,,,,fee schedule,4.74,24.27, Assay of phosphorus,84100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.27,,,,,,,fee schedule,4.74,24.27, Assay of phosphorus,84100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.74,24.27, Assay of phosphorus,84100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.74,24.27, Assay of phosphorus,84100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.93,,,,,,,fee schedule,4.74,24.27,APC Assay of phosphorus,84100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.98,,,,,,,fee schedule,4.74,24.27,APC Assay of phosphorus,84100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.74,,,,,,,fee schedule,4.74,24.27,APC Assay of urine phosphorus,84105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,5.78,26.46, Assay of urine phosphorus,84105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,5.78,26.46, Assay of urine phosphorus,84105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.78,26.46, Assay of urine phosphorus,84105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.78,26.46, Assay of urine phosphorus,84105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.01,,,,,,,fee schedule,5.78,26.46,APC Assay of urine phosphorus,84105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.07,,,,,,,fee schedule,5.78,26.46,APC Assay of urine phosphorus,84105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.78,,,,,,,fee schedule,5.78,26.46,APC Test for porphobilinogen,84106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.47,,,,,,,fee schedule,5.82,21.92, Test for porphobilinogen,84106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.92,,,,,,,fee schedule,5.82,21.92, Test for porphobilinogen,84106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.82,21.92, Test for porphobilinogen,84106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.82,21.92, Test for porphobilinogen,84106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.05,,,,,,,fee schedule,5.82,21.92,APC Test for porphobilinogen,84106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.11,,,,,,,fee schedule,5.82,21.92,APC Test for porphobilinogen,84106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.82,,,,,,,fee schedule,5.82,21.92,APC Assay of porphobilinogen,84110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.35,,,,,,,fee schedule,8.44,43.19, Assay of porphobilinogen,84110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.19,,,,,,,fee schedule,8.44,43.19, Assay of porphobilinogen,84110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.44,43.19, Assay of porphobilinogen,84110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.44,43.19, Assay of porphobilinogen,84110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.78,,,,,,,fee schedule,8.44,43.19,APC Assay of porphobilinogen,84110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.86,,,,,,,fee schedule,8.44,43.19,APC Assay of porphobilinogen,84110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.44,,,,,,,fee schedule,8.44,43.19,APC Eval amniotic fluid protein,84112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,296.5,,,,,,,fee schedule,98.11,357.12, Eval amniotic fluid protein,84112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333.9,,,,,,,fee schedule,98.11,357.12, Eval amniotic fluid protein,84112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,312.48,,,,,,,fee schedule,98.11,357.12, Eval amniotic fluid protein,84112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,357.12,,,,,,,fee schedule,98.11,357.12, Eval amniotic fluid protein,84112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,102.03,,,,,,,fee schedule,98.11,357.12,APC Eval amniotic fluid protein,84112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,103.02,,,,,,,fee schedule,98.11,357.12,APC Eval amniotic fluid protein,84112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,98.11,,,,,,,fee schedule,98.11,357.12,APC Test urine for porphyrins,84119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.1,,,,,,,fee schedule,13.36,48.81, Test urine for porphyrins,84119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.03,,,,,,,fee schedule,13.36,48.81, Test urine for porphyrins,84119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.36,48.81, Test urine for porphyrins,84119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.36,48.81, Test urine for porphyrins,84119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.89,,,,,,,fee schedule,13.36,48.81,APC Test urine for porphyrins,84119,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.03,,,,,,,fee schedule,13.36,48.81,APC Test urine for porphyrins,84119,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.36,,,,,,,fee schedule,13.36,48.81,APC Assay of urine porphyrins,84120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.79,,,,,,,fee schedule,14.71,75.21, Assay of urine porphyrins,84120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.21,,,,,,,fee schedule,14.71,75.21, Assay of urine porphyrins,84120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.71,75.21, Assay of urine porphyrins,84120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.71,75.21, Assay of urine porphyrins,84120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.3,,,,,,,fee schedule,14.71,75.21,APC Assay of urine porphyrins,84120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.45,,,,,,,fee schedule,14.71,75.21,APC Assay of urine porphyrins,84120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.71,,,,,,,fee schedule,14.71,75.21,APC Assay of feces porphyrins,84126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.67,,,,,,,fee schedule,39.11,141.66, Assay of feces porphyrins,84126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.26,,,,,,,fee schedule,39.11,141.66, Assay of feces porphyrins,84126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,123.95,,,,,,,fee schedule,39.11,141.66, Assay of feces porphyrins,84126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,141.66,,,,,,,fee schedule,39.11,141.66, Assay of feces porphyrins,84126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.67,,,,,,,fee schedule,39.11,141.66,APC Assay of feces porphyrins,84126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.07,,,,,,,fee schedule,39.11,141.66,APC Assay of feces porphyrins,84126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.11,,,,,,,fee schedule,39.11,141.66,APC Assay of serum potassium,84132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.87,,,,,,,fee schedule,4.76,23.5, Assay of serum potassium,84132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.5,,,,,,,fee schedule,4.76,23.5, Assay of serum potassium,84132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.76,23.5, Assay of serum potassium,84132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.76,23.5, Assay of serum potassium,84132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.95,,,,,,,fee schedule,4.76,23.5,APC Assay of serum potassium,84132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5,,,,,,,fee schedule,4.76,23.5,APC Assay of serum potassium,84132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.76,,,,,,,fee schedule,4.76,23.5,APC Assay of urine potassium,84133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.53,,,,,,,fee schedule,4.73,22, Assay of urine potassium,84133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22,,,,,,,fee schedule,4.73,22, Assay of urine potassium,84133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.73,22, Assay of urine potassium,84133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.73,22, Assay of urine potassium,84133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.92,,,,,,,fee schedule,4.73,22,APC Assay of urine potassium,84133,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.97,,,,,,,fee schedule,4.73,22,APC Assay of urine potassium,84133,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.73,,,,,,,fee schedule,4.73,22,APC Assay of prealbumin,84134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.24,,,,,,,fee schedule,14.59,74.59, Assay of prealbumin,84134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.59,,,,,,,fee schedule,14.59,74.59, Assay of prealbumin,84134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.59,74.59, Assay of prealbumin,84134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.59,74.59, Assay of prealbumin,84134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.17,,,,,,,fee schedule,14.59,74.59,APC Assay of prealbumin,84134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.32,,,,,,,fee schedule,14.59,74.59,APC Assay of prealbumin,84134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.59,,,,,,,fee schedule,14.59,74.59,APC Assay of pregnanediol,84135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.87,,,,,,,fee schedule,21.27,97.83, Assay of pregnanediol,84135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,97.83,,,,,,,fee schedule,21.27,97.83, Assay of pregnanediol,84135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.7,,,,,,,fee schedule,21.27,97.83, Assay of pregnanediol,84135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,77.37,,,,,,,fee schedule,21.27,97.83, Assay of pregnanediol,84135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.12,,,,,,,fee schedule,21.27,97.83,APC Assay of pregnanediol,84135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.33,,,,,,,fee schedule,21.27,97.83,APC Assay of pregnanediol,84135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.27,,,,,,,fee schedule,21.27,97.83,APC Assay of pregnanetriol,84138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86,,,,,,,fee schedule,21.05,96.84, Assay of pregnanetriol,84138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.84,,,,,,,fee schedule,21.05,96.84, Assay of pregnanetriol,84138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,21.05,96.84, Assay of pregnanetriol,84138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,21.05,96.84, Assay of pregnanetriol,84138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.89,,,,,,,fee schedule,21.05,96.84,APC Assay of pregnanetriol,84138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.1,,,,,,,fee schedule,21.05,96.84,APC Assay of pregnanetriol,84138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,21.05,96.84,APC Assay of pregnenolone,84140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.89,,,,,,,fee schedule,20.67,105.74, Assay of pregnenolone,84140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.74,,,,,,,fee schedule,20.67,105.74, Assay of pregnenolone,84140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,65.63,,,,,,,fee schedule,20.67,105.74, Assay of pregnenolone,84140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75,,,,,,,fee schedule,20.67,105.74, Assay of pregnenolone,84140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.5,,,,,,,fee schedule,20.67,105.74,APC Assay of pregnenolone,84140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.7,,,,,,,fee schedule,20.67,105.74,APC Assay of pregnenolone,84140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.67,,,,,,,fee schedule,20.67,105.74,APC Assay of 17-hydroxypregneno,84143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,103.64,,,,,,,fee schedule,22.81,116.72, Assay of 17-hydroxypregneno,84143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.72,,,,,,,fee schedule,22.81,116.72, Assay of 17-hydroxypregneno,84143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,22.81,116.72, Assay of 17-hydroxypregneno,84143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,22.81,116.72, Assay of 17-hydroxypregneno,84143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.72,,,,,,,fee schedule,22.81,116.72,APC Assay of 17-hydroxypregneno,84143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.95,,,,,,,fee schedule,22.81,116.72,APC Assay of 17-hydroxypregneno,84143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.81,,,,,,,fee schedule,22.81,116.72,APC Assay of progesterone,84144,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.74,,,,,,,fee schedule,20.86,106.69, Assay of progesterone,84144,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.69,,,,,,,fee schedule,20.86,106.69, Assay of progesterone,84144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.86,106.69, Assay of progesterone,84144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.86,106.69, Assay of progesterone,84144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.69,,,,,,,fee schedule,20.86,106.69,APC Assay of progesterone,84144,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.9,,,,,,,fee schedule,20.86,106.69,APC Assay of progesterone,84144,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.86,,,,,,,fee schedule,20.86,106.69,APC Procalcitonin (PCT),84145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.27,,,,,,,fee schedule,27.22,138.82, Procalcitonin (PCT),84145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.82,,,,,,,fee schedule,27.22,138.82, Procalcitonin (PCT),84145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.22,138.82, Procalcitonin (PCT),84145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.22,138.82, Procalcitonin (PCT),84145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.31,,,,,,,fee schedule,27.22,138.82,APC Procalcitonin (PCT),84145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.58,,,,,,,fee schedule,27.22,138.82,APC Procalcitonin (PCT),84145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.22,,,,,,,fee schedule,27.22,138.82,APC Assay of prolactin,84146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.01,,,,,,,fee schedule,19.38,99.11, Assay of prolactin,84146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.11,,,,,,,fee schedule,19.38,99.11, Assay of prolactin,84146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.38,99.11, Assay of prolactin,84146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.38,99.11, Assay of prolactin,84146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.16,,,,,,,fee schedule,19.38,99.11,APC Assay of prolactin,84146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.35,,,,,,,fee schedule,19.38,99.11,APC Assay of prolactin,84146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.38,,,,,,,fee schedule,19.38,99.11,APC Assay of prostaglandin,84150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.36,,,,,,,fee schedule,41.77,152.37, Assay of prostaglandin,84150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.66,,,,,,,fee schedule,41.77,152.37, Assay of prostaglandin,84150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.32,,,,,,,fee schedule,41.77,152.37, Assay of prostaglandin,84150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.37,,,,,,,fee schedule,41.77,152.37, Assay of prostaglandin,84150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.44,,,,,,,fee schedule,41.77,152.37,APC Assay of prostaglandin,84150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.86,,,,,,,fee schedule,41.77,152.37,APC Assay of prostaglandin,84150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.77,,,,,,,fee schedule,41.77,152.37,APC Assay of psa complexed,84152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.53,,,,,,,fee schedule,18.39,94.06, Assay of psa complexed,84152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.06,,,,,,,fee schedule,18.39,94.06, Assay of psa complexed,84152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.39,94.06, Assay of psa complexed,84152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.39,94.06, Assay of psa complexed,84152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.13,,,,,,,fee schedule,18.39,94.06,APC Assay of psa complexed,84152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.31,,,,,,,fee schedule,18.39,94.06,APC Assay of psa complexed,84152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.39,,,,,,,fee schedule,18.39,94.06,APC Assay of psa total,84153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.53,,,,,,,fee schedule,18.39,94.06, Assay of psa total,84153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.06,,,,,,,fee schedule,18.39,94.06, Assay of psa total,84153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.39,94.06, Assay of psa total,84153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.39,94.06, Assay of psa total,84153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.13,,,,,,,fee schedule,18.39,94.06,APC Assay of psa total,84153,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.31,,,,,,,fee schedule,18.39,94.06,APC Assay of psa total,84153,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.39,,,,,,,fee schedule,18.39,94.06,APC Assay of psa free,84154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.53,,,,,,,fee schedule,18.39,94.06, Assay of psa free,84154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.06,,,,,,,fee schedule,18.39,94.06, Assay of psa free,84154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.39,94.06, Assay of psa free,84154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.39,94.06, Assay of psa free,84154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.13,,,,,,,fee schedule,18.39,94.06,APC Assay of psa free,84154,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.31,,,,,,,fee schedule,18.39,94.06,APC Assay of psa free,84154,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.39,,,,,,,fee schedule,18.39,94.06,APC Assay of protein serum,84155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.64,,,,,,,fee schedule,3.67,18.74, Assay of protein serum,84155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.74,,,,,,,fee schedule,3.67,18.74, Assay of protein serum,84155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.45,,,,,,,fee schedule,3.67,18.74, Assay of protein serum,84155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.08,,,,,,,fee schedule,3.67,18.74, Assay of protein serum,84155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.82,,,,,,,fee schedule,3.67,18.74,APC Assay of protein serum,84155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.85,,,,,,,fee schedule,3.67,18.74,APC Assay of protein serum,84155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.67,,,,,,,fee schedule,3.67,18.74,APC Assay of protein urine,84156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.64,,,,,,,fee schedule,3.67,18.74, Assay of protein urine,84156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.74,,,,,,,fee schedule,3.67,18.74, Assay of protein urine,84156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.45,,,,,,,fee schedule,3.67,18.74, Assay of protein urine,84156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.08,,,,,,,fee schedule,3.67,18.74, Assay of protein urine,84156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.82,,,,,,,fee schedule,3.67,18.74,APC Assay of protein urine,84156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.85,,,,,,,fee schedule,3.67,18.74,APC Assay of protein urine,84156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.67,,,,,,,fee schedule,3.67,18.74,APC Assay of protein other,84157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.64,,,,,,,fee schedule,4,18.74, Assay of protein other,84157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.74,,,,,,,fee schedule,4,18.74, Assay of protein other,84157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,4,18.74, Assay of protein other,84157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,4,18.74, Assay of protein other,84157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.16,,,,,,,fee schedule,4,18.74,APC Assay of protein other,84157,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.2,,,,,,,fee schedule,4,18.74,APC Assay of protein other,84157,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4,,,,,,,fee schedule,4,18.74,APC Assay of protein any source,84160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,5.61,26.46, Assay of protein any source,84160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,5.61,26.46, Assay of protein any source,84160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.61,26.46, Assay of protein any source,84160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.61,26.46, Assay of protein any source,84160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.83,,,,,,,fee schedule,5.61,26.46,APC Assay of protein any source,84160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.89,,,,,,,fee schedule,5.61,26.46,APC Assay of protein any source,84160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.61,,,,,,,fee schedule,5.61,26.46,APC Pappa serum,84163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.88,,,,,,,fee schedule,15.05,74.19, Pappa serum,84163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.19,,,,,,,fee schedule,15.05,74.19, Pappa serum,84163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.05,74.19, Pappa serum,84163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.05,74.19, Pappa serum,84163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.65,,,,,,,fee schedule,15.05,74.19,APC Pappa serum,84163,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.8,,,,,,,fee schedule,15.05,74.19,APC Pappa serum,84163,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.05,,,,,,,fee schedule,15.05,74.19,APC Protein e-phoresis serum,84165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.78,,,,,,,fee schedule,10.74,54.94, Protein e-phoresis serum,84165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.94,,,,,,,fee schedule,10.74,54.94, Protein e-phoresis serum,84165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.74,54.94, Protein e-phoresis serum,84165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.74,54.94, Protein e-phoresis serum,84165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.17,,,,,,,fee schedule,10.74,54.94,APC Protein e-phoresis serum,84165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.28,,,,,,,fee schedule,10.74,54.94,APC Protein e-phoresis serum,84165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.74,54.94,APC Protein e-phoresis/urine/csf,84166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.99,,,,,,,fee schedule,17.83,91.21, Protein e-phoresis/urine/csf,84166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.21,,,,,,,fee schedule,17.83,91.21, Protein e-phoresis/urine/csf,84166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,17.83,91.21, Protein e-phoresis/urine/csf,84166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,17.83,91.21, Protein e-phoresis/urine/csf,84166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,17.83,91.21,APC Protein e-phoresis/urine/csf,84166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.72,,,,,,,fee schedule,17.83,91.21,APC Protein e-phoresis/urine/csf,84166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.83,,,,,,,fee schedule,17.83,91.21,APC Western blot test,84181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.35,,,,,,,fee schedule,17.03,87.11, Western blot test,84181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.11,,,,,,,fee schedule,17.03,87.11, Western blot test,84181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.03,87.11, Western blot test,84181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.03,87.11, Western blot test,84181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.71,,,,,,,fee schedule,17.03,87.11,APC Western blot test,84181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.88,,,,,,,fee schedule,17.03,87.11,APC Western blot test,84181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.03,,,,,,,fee schedule,17.03,87.11,APC Protein western blot test,84182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.74,,,,,,,fee schedule,29.21,105.93, Protein western blot test,84182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.05,,,,,,,fee schedule,29.21,105.93, Protein western blot test,84182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.69,,,,,,,fee schedule,29.21,105.93, Protein western blot test,84182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.93,,,,,,,fee schedule,29.21,105.93, Protein western blot test,84182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.38,,,,,,,fee schedule,29.21,105.93,APC Protein western blot test,84182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.67,,,,,,,fee schedule,29.21,105.93,APC Protein western blot test,84182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.21,,,,,,,fee schedule,29.21,105.93,APC Assay RBC protoporphyrin,84202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.16,,,,,,,fee schedule,14.35,73.38, Assay RBC protoporphyrin,84202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.38,,,,,,,fee schedule,14.35,73.38, Assay RBC protoporphyrin,84202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.35,73.38, Assay RBC protoporphyrin,84202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.35,73.38, Assay RBC protoporphyrin,84202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.92,,,,,,,fee schedule,14.35,73.38,APC Assay RBC protoporphyrin,84202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.07,,,,,,,fee schedule,14.35,73.38,APC Assay RBC protoporphyrin,84202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.35,,,,,,,fee schedule,14.35,73.38,APC Test RBC protoporphyrin,84203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.1,,,,,,,fee schedule,9.74,44.03, Test RBC protoporphyrin,84203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.03,,,,,,,fee schedule,9.74,44.03, Test RBC protoporphyrin,84203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.74,44.03, Test RBC protoporphyrin,84203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.74,44.03, Test RBC protoporphyrin,84203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.13,,,,,,,fee schedule,9.74,44.03,APC Test RBC protoporphyrin,84203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.23,,,,,,,fee schedule,9.74,44.03,APC Test RBC protoporphyrin,84203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.74,,,,,,,fee schedule,9.74,44.03,APC Assay of proinsulin,84206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.66,,,,,,,fee schedule,26.69,97.62, Assay of proinsulin,84206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.42,,,,,,,fee schedule,26.69,97.62, Assay of proinsulin,84206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.69,97.62, Assay of proinsulin,84206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.69,97.62, Assay of proinsulin,84206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.76,,,,,,,fee schedule,26.69,97.62,APC Assay of proinsulin,84206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.02,,,,,,,fee schedule,26.69,97.62,APC Assay of proinsulin,84206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.69,,,,,,,fee schedule,26.69,97.62,APC Assay of vitamin b-6,84207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,127.56,,,,,,,fee schedule,28.1,143.66, Assay of vitamin b-6,84207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,143.66,,,,,,,fee schedule,28.1,143.66, Assay of vitamin b-6,84207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,89.57,,,,,,,fee schedule,28.1,143.66, Assay of vitamin b-6,84207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,102.36,,,,,,,fee schedule,28.1,143.66, Assay of vitamin b-6,84207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.22,,,,,,,fee schedule,28.1,143.66,APC Assay of vitamin b-6,84207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.51,,,,,,,fee schedule,28.1,143.66,APC Assay of vitamin b-6,84207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.1,,,,,,,fee schedule,28.1,143.66,APC Assay of pyruvate,84210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.3,,,,,,,fee schedule,14.48,55.52, Assay of pyruvate,84210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.52,,,,,,,fee schedule,14.48,55.52, Assay of pyruvate,84210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.48,55.52, Assay of pyruvate,84210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.48,55.52, Assay of pyruvate,84210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.06,,,,,,,fee schedule,14.48,55.52,APC Assay of pyruvate,84210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.2,,,,,,,fee schedule,14.48,55.52,APC Assay of pyruvate,84210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.48,,,,,,,fee schedule,14.48,55.52,APC Assay of pyruvate kinase,84220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.84,,,,,,,fee schedule,9.44,48.24, Assay of pyruvate kinase,84220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.24,,,,,,,fee schedule,9.44,48.24, Assay of pyruvate kinase,84220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.44,48.24, Assay of pyruvate kinase,84220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.44,48.24, Assay of pyruvate kinase,84220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.82,,,,,,,fee schedule,9.44,48.24,APC Assay of pyruvate kinase,84220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.91,,,,,,,fee schedule,9.44,48.24,APC Assay of pyruvate kinase,84220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.44,,,,,,,fee schedule,9.44,48.24,APC Assay of quinine,84228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.85,,,,,,,fee schedule,11.63,59.51, Assay of quinine,84228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.51,,,,,,,fee schedule,11.63,59.51, Assay of quinine,84228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.63,59.51, Assay of quinine,84228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.63,59.51, Assay of quinine,84228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.1,,,,,,,fee schedule,11.63,59.51,APC Assay of quinine,84228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.21,,,,,,,fee schedule,11.63,59.51,APC Assay of quinine,84228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.63,,,,,,,fee schedule,11.63,59.51,APC Assay of estrogen,84233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,292.47,,,,,,,fee schedule,87.88,329.36, Assay of estrogen,84233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,329.36,,,,,,,fee schedule,87.88,329.36, Assay of estrogen,84233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,279.14,,,,,,,fee schedule,87.88,329.36, Assay of estrogen,84233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,319.02,,,,,,,fee schedule,87.88,329.36, Assay of estrogen,84233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,91.4,,,,,,,fee schedule,87.88,329.36,APC Assay of estrogen,84233,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92.27,,,,,,,fee schedule,87.88,329.36,APC Assay of estrogen,84233,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,87.88,,,,,,,fee schedule,87.88,329.36,APC Assay of progesterone,84234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,294.58,,,,,,,fee schedule,64.88,331.74, Assay of progesterone,84234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,331.74,,,,,,,fee schedule,64.88,331.74, Assay of progesterone,84234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,206.22,,,,,,,fee schedule,64.88,331.74, Assay of progesterone,84234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,235.68,,,,,,,fee schedule,64.88,331.74, Assay of progesterone,84234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,67.48,,,,,,,fee schedule,64.88,331.74,APC Assay of progesterone,84234,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.12,,,,,,,fee schedule,64.88,331.74,APC Assay of progesterone,84234,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.88,,,,,,,fee schedule,64.88,331.74,APC Assay of endocrine hormone,84235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,237.64,,,,,,,fee schedule,71.23,267.62, Assay of endocrine hormone,84235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,267.62,,,,,,,fee schedule,71.23,267.62, Assay of endocrine hormone,84235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,227.06,,,,,,,fee schedule,71.23,267.62, Assay of endocrine hormone,84235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,259.5,,,,,,,fee schedule,71.23,267.62, Assay of endocrine hormone,84235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,74.08,,,,,,,fee schedule,71.23,267.62,APC Assay of endocrine hormone,84235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,74.79,,,,,,,fee schedule,71.23,267.62,APC Assay of endocrine hormone,84235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,71.23,,,,,,,fee schedule,71.23,267.62,APC Assay nonendocrine receptor,84238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,166.04,,,,,,,fee schedule,36.57,186.99, Assay nonendocrine receptor,84238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,186.99,,,,,,,fee schedule,36.57,186.99, Assay nonendocrine receptor,84238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.66,,,,,,,fee schedule,36.57,186.99, Assay nonendocrine receptor,84238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,133.32,,,,,,,fee schedule,36.57,186.99, Assay nonendocrine receptor,84238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.03,,,,,,,fee schedule,36.57,186.99,APC Assay nonendocrine receptor,84238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.4,,,,,,,fee schedule,36.57,186.99,APC Assay nonendocrine receptor,84238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.57,,,,,,,fee schedule,36.57,186.99,APC Assay of renin,84244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.87,,,,,,,fee schedule,21.99,112.47, Assay of renin,84244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,112.47,,,,,,,fee schedule,21.99,112.47, Assay of renin,84244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,21.99,112.47, Assay of renin,84244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,21.99,112.47, Assay of renin,84244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.87,,,,,,,fee schedule,21.99,112.47,APC Assay of renin,84244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.09,,,,,,,fee schedule,21.99,112.47,APC Assay of renin,84244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.99,,,,,,,fee schedule,21.99,112.47,APC Assay of vitamin b-2,84252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.57,,,,,,,fee schedule,20.24,100.87, Assay of vitamin b-2,84252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.87,,,,,,,fee schedule,20.24,100.87, Assay of vitamin b-2,84252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.24,100.87, Assay of vitamin b-2,84252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.24,100.87, Assay of vitamin b-2,84252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.24,100.87,APC Assay of vitamin b-2,84252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.25,,,,,,,fee schedule,20.24,100.87,APC Assay of vitamin b-2,84252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.24,,,,,,,fee schedule,20.24,100.87,APC Assay of selenium,84255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.93,,,,,,,fee schedule,25.53,130.55, Assay of selenium,84255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.55,,,,,,,fee schedule,25.53,130.55, Assay of selenium,84255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.53,130.55, Assay of selenium,84255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.53,130.55, Assay of selenium,84255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.55,,,,,,,fee schedule,25.53,130.55,APC Assay of selenium,84255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.81,,,,,,,fee schedule,25.53,130.55,APC Assay of selenium,84255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.53,,,,,,,fee schedule,25.53,130.55,APC Assay of serotonin,84260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,140.66,,,,,,,fee schedule,30.98,158.4, Assay of serotonin,84260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,158.4,,,,,,,fee schedule,30.98,158.4, Assay of serotonin,84260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.94,,,,,,,fee schedule,30.98,158.4, Assay of serotonin,84260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,113.07,,,,,,,fee schedule,30.98,158.4, Assay of serotonin,84260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.22,,,,,,,fee schedule,30.98,158.4,APC Assay of serotonin,84260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.53,,,,,,,fee schedule,30.98,158.4,APC Assay of serotonin,84260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.98,,,,,,,fee schedule,30.98,158.4,APC Assay of sex hormone globul,84270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.57,,,,,,,fee schedule,21.73,100.87, Assay of sex hormone globul,84270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.87,,,,,,,fee schedule,21.73,100.87, Assay of sex hormone globul,84270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.75,,,,,,,fee schedule,21.73,100.87, Assay of sex hormone globul,84270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,78.57,,,,,,,fee schedule,21.73,100.87, Assay of sex hormone globul,84270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.6,,,,,,,fee schedule,21.73,100.87,APC Assay of sex hormone globul,84270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.82,,,,,,,fee schedule,21.73,100.87,APC Assay of sex hormone globul,84270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.73,,,,,,,fee schedule,21.73,100.87,APC Assay of sialic acid,84275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61,,,,,,,fee schedule,13.44,68.7, Assay of sialic acid,84275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.7,,,,,,,fee schedule,13.44,68.7, Assay of sialic acid,84275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.44,68.7, Assay of sialic acid,84275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.44,68.7, Assay of sialic acid,84275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.98,,,,,,,fee schedule,13.44,68.7,APC Assay of sialic acid,84275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.11,,,,,,,fee schedule,13.44,68.7,APC Assay of sialic acid,84275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.44,,,,,,,fee schedule,13.44,68.7,APC Assay of silica,84285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.4,,,,,,,fee schedule,25.21,91.65, Assay of silica,84285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.41,,,,,,,fee schedule,25.21,91.65, Assay of silica,84285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.19,,,,,,,fee schedule,25.21,91.65, Assay of silica,84285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.65,,,,,,,fee schedule,25.21,91.65, Assay of silica,84285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.22,,,,,,,fee schedule,25.21,91.65,APC Assay of silica,84285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.47,,,,,,,fee schedule,25.21,91.65,APC Assay of silica,84285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.21,,,,,,,fee schedule,25.21,91.65,APC Assay of serum sodium,84295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.84,,,,,,,fee schedule,4.81,24.6, Assay of serum sodium,84295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.6,,,,,,,fee schedule,4.81,24.6, Assay of serum sodium,84295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.81,24.6, Assay of serum sodium,84295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.81,24.6, Assay of serum sodium,84295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5,,,,,,,fee schedule,4.81,24.6,APC Assay of serum sodium,84295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.05,,,,,,,fee schedule,4.81,24.6,APC Assay of serum sodium,84295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.81,,,,,,,fee schedule,4.81,24.6,APC Assay of urine sodium,84300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.13,,,,,,,fee schedule,5.06,23.79, Assay of urine sodium,84300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.79,,,,,,,fee schedule,5.06,23.79, Assay of urine sodium,84300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5.06,23.79, Assay of urine sodium,84300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5.06,23.79, Assay of urine sodium,84300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.26,,,,,,,fee schedule,5.06,23.79,APC Assay of urine sodium,84300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.31,,,,,,,fee schedule,5.06,23.79,APC Assay of urine sodium,84300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.06,,,,,,,fee schedule,5.06,23.79,APC Assay of sweat sodium,84302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.13,,,,,,,fee schedule,4.86,23.79, Assay of sweat sodium,84302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.79,,,,,,,fee schedule,4.86,23.79, Assay of sweat sodium,84302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.86,23.79, Assay of sweat sodium,84302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.86,23.79, Assay of sweat sodium,84302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.05,,,,,,,fee schedule,4.86,23.79,APC Assay of sweat sodium,84302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.1,,,,,,,fee schedule,4.86,23.79,APC Assay of sweat sodium,84302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.86,,,,,,,fee schedule,4.86,23.79,APC Assay of somatomedin,84305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.98,,,,,,,fee schedule,21.26,88.94, Assay of somatomedin,84305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.94,,,,,,,fee schedule,21.26,88.94, Assay of somatomedin,84305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.7,,,,,,,fee schedule,21.26,88.94, Assay of somatomedin,84305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,77.37,,,,,,,fee schedule,21.26,88.94, Assay of somatomedin,84305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.11,,,,,,,fee schedule,21.26,88.94,APC Assay of somatomedin,84305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.32,,,,,,,fee schedule,21.26,88.94,APC Assay of somatomedin,84305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.26,,,,,,,fee schedule,21.26,88.94,APC Assay of somatostatin,84307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.98,,,,,,,fee schedule,18.28,88.94, Assay of somatostatin,84307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.94,,,,,,,fee schedule,18.28,88.94, Assay of somatostatin,84307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.28,88.94, Assay of somatostatin,84307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.28,88.94, Assay of somatostatin,84307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.01,,,,,,,fee schedule,18.28,88.94,APC Assay of somatostatin,84307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.19,,,,,,,fee schedule,18.28,88.94,APC Assay of somatostatin,84307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.28,,,,,,,fee schedule,18.28,88.94,APC Spectrophotometry,84311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.75,,,,,,,fee schedule,8.1,35.76, Spectrophotometry,84311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.76,,,,,,,fee schedule,8.1,35.76, Spectrophotometry,84311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.1,35.76, Spectrophotometry,84311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.1,35.76, Spectrophotometry,84311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.42,,,,,,,fee schedule,8.1,35.76,APC Spectrophotometry,84311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.51,,,,,,,fee schedule,8.1,35.76,APC Spectrophotometry,84311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.1,,,,,,,fee schedule,8.1,35.76,APC Body fluid specific gravity,84315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.38,,,,,,,fee schedule,3.28,12.81, Body fluid specific gravity,84315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.81,,,,,,,fee schedule,3.28,12.81, Body fluid specific gravity,84315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.42,,,,,,,fee schedule,3.28,12.81, Body fluid specific gravity,84315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.91,,,,,,,fee schedule,3.28,12.81, Body fluid specific gravity,84315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.41,,,,,,,fee schedule,3.28,12.81,APC Body fluid specific gravity,84315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.44,,,,,,,fee schedule,3.28,12.81,APC Body fluid specific gravity,84315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.28,,,,,,,fee schedule,3.28,12.81,APC Chromatogram assay sugars,84375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.02,,,,,,,fee schedule,39,141.66, Chromatogram assay sugars,84375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.25,,,,,,,fee schedule,39,141.66, Chromatogram assay sugars,84375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,123.95,,,,,,,fee schedule,39,141.66, Chromatogram assay sugars,84375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,141.66,,,,,,,fee schedule,39,141.66, Chromatogram assay sugars,84375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.56,,,,,,,fee schedule,39,141.66,APC Chromatogram assay sugars,84375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.95,,,,,,,fee schedule,39,141.66,APC Chromatogram assay sugars,84375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39,,,,,,,fee schedule,39,141.66,APC Sugars single qual,84376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.99,,,,,,,fee schedule,5.5,28.15, Sugars single qual,84376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.15,,,,,,,fee schedule,5.5,28.15, Sugars single qual,84376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.5,28.15, Sugars single qual,84376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.5,28.15, Sugars single qual,84376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.72,,,,,,,fee schedule,5.5,28.15,APC Sugars single qual,84376,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.78,,,,,,,fee schedule,5.5,28.15,APC Sugars single qual,84376,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.5,,,,,,,fee schedule,5.5,28.15,APC Sugars multiple qual,84377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.99,,,,,,,fee schedule,5.5,28.15, Sugars multiple qual,84377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.15,,,,,,,fee schedule,5.5,28.15, Sugars multiple qual,84377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.5,28.15, Sugars multiple qual,84377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.5,28.15, Sugars multiple qual,84377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.72,,,,,,,fee schedule,5.5,28.15,APC Sugars multiple qual,84377,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.78,,,,,,,fee schedule,5.5,28.15,APC Sugars multiple qual,84377,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.5,,,,,,,fee schedule,5.5,28.15,APC Sugars single quant,84378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.33,,,,,,,fee schedule,11.53,58.93, Sugars single quant,84378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.93,,,,,,,fee schedule,11.53,58.93, Sugars single quant,84378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,58.93, Sugars single quant,84378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,58.93, Sugars single quant,84378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,58.93,APC Sugars single quant,84378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,58.93,APC Sugars single quant,84378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,58.93,APC Sugars multiple quant,84379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.33,,,,,,,fee schedule,11.53,58.93, Sugars multiple quant,84379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.93,,,,,,,fee schedule,11.53,58.93, Sugars multiple quant,84379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,58.93, Sugars multiple quant,84379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,58.93, Sugars multiple quant,84379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,58.93,APC Sugars multiple quant,84379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,58.93,APC Sugars multiple quant,84379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,58.93,APC Assay of urine sulfate,84392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.58,,,,,,,fee schedule,5.49,24.3, Assay of urine sulfate,84392,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.3,,,,,,,fee schedule,5.49,24.3, Assay of urine sulfate,84392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.49,24.3, Assay of urine sulfate,84392,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.49,24.3, Assay of urine sulfate,84392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.71,,,,,,,fee schedule,5.49,24.3,APC Assay of urine sulfate,84392,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.76,,,,,,,fee schedule,5.49,24.3,APC Assay of urine sulfate,84392,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.49,,,,,,,fee schedule,5.49,24.3,APC Tau phosphorylated ea,84393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,134.08,,,,,,,fee schedule,128.92,135.37,APC Tau phosphorylated ea,84393,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.37,,,,,,,fee schedule,128.92,135.37,APC Tau phosphorylated ea,84393,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.92,,,,,,,fee schedule,128.92,135.37,APC Total tau,84394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,134.08,,,,,,,fee schedule,128.92,135.37,APC Total tau,84394,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.37,,,,,,,fee schedule,128.92,135.37,APC Total tau,84394,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.92,,,,,,,fee schedule,128.92,135.37,APC Assay of free testosterone,84402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.6,,,,,,,fee schedule,25.47,130.19, Assay of free testosterone,84402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.19,,,,,,,fee schedule,25.47,130.19, Assay of free testosterone,84402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.47,130.19, Assay of free testosterone,84402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.47,130.19, Assay of free testosterone,84402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.49,,,,,,,fee schedule,25.47,130.19,APC Assay of free testosterone,84402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.74,,,,,,,fee schedule,25.47,130.19,APC Assay of free testosterone,84402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.47,,,,,,,fee schedule,25.47,130.19,APC Assay of total testosterone,84403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.26,,,,,,,fee schedule,25.81,132.05, Assay of total testosterone,84403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,132.05,,,,,,,fee schedule,25.81,132.05, Assay of total testosterone,84403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,82.29,,,,,,,fee schedule,25.81,132.05, Assay of total testosterone,84403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.05,,,,,,,fee schedule,25.81,132.05, Assay of total testosterone,84403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.84,,,,,,,fee schedule,25.81,132.05,APC Assay of total testosterone,84403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.1,,,,,,,fee schedule,25.81,132.05,APC Assay of total testosterone,84403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.81,,,,,,,fee schedule,25.81,132.05,APC Testosterone bioavailable,84410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.54,,,,,,,fee schedule,51.28,186.9, Testosterone bioavailable,84410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,51.28,186.9, Testosterone bioavailable,84410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.33,,,,,,,fee schedule,51.28,186.9,APC Testosterone bioavailable,84410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.84,,,,,,,fee schedule,51.28,186.9,APC Testosterone bioavailable,84410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.28,,,,,,,fee schedule,51.28,186.9,APC Assay of vitamin b-1,84425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96.43,,,,,,,fee schedule,21.23,108.59, Assay of vitamin b-1,84425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,108.59,,,,,,,fee schedule,21.23,108.59, Assay of vitamin b-1,84425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.7,,,,,,,fee schedule,21.23,108.59, Assay of vitamin b-1,84425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,77.37,,,,,,,fee schedule,21.23,108.59, Assay of vitamin b-1,84425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.08,,,,,,,fee schedule,21.23,108.59,APC Assay of vitamin b-1,84425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.29,,,,,,,fee schedule,21.23,108.59,APC Assay of vitamin b-1,84425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.23,,,,,,,fee schedule,21.23,108.59,APC Assay of thiocyanate,84430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.13,,,,,,,fee schedule,11.63,42.84, Assay of thiocyanate,84430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.79,,,,,,,fee schedule,11.63,42.84, Assay of thiocyanate,84430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.63,42.84, Assay of thiocyanate,84430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.63,42.84, Assay of thiocyanate,84430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.1,,,,,,,fee schedule,11.63,42.84,APC Assay of thiocyanate,84430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.21,,,,,,,fee schedule,11.63,42.84,APC Assay of thiocyanate,84430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.63,,,,,,,fee schedule,11.63,42.84,APC Thromboxane urine,84431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.35,,,,,,,fee schedule,35.11,127.38, Thromboxane urine,84431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.11,,,,,,,fee schedule,35.11,127.38, Thromboxane urine,84431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.11,127.38, Thromboxane urine,84431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.11,127.38, Thromboxane urine,84431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.51,,,,,,,fee schedule,35.11,127.38,APC Thromboxane urine,84431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.87,,,,,,,fee schedule,35.11,127.38,APC Thromboxane urine,84431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.11,,,,,,,fee schedule,35.11,127.38,APC Assay of thyroglobulin,84432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.93,,,,,,,fee schedule,16.06,82.13, Assay of thyroglobulin,84432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.13,,,,,,,fee schedule,16.06,82.13, Assay of thyroglobulin,84432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.06,82.13, Assay of thyroglobulin,84432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.06,82.13, Assay of thyroglobulin,84432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.7,,,,,,,fee schedule,16.06,82.13,APC Assay of thyroglobulin,84432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.86,,,,,,,fee schedule,16.06,82.13,APC Assay of thyroglobulin,84432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.06,,,,,,,fee schedule,16.06,82.13,APC Asy thiopurin s-mthyltrnsfrs,84433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.05,,,,,,,fee schedule,22.17,81.14, Asy thiopurin s-mthyltrnsfrs,84433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.14,,,,,,,fee schedule,22.17,81.14, Asy thiopurin s-mthyltrnsfrs,84433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.82,,,,,,,fee schedule,22.17,81.14, Asy thiopurin s-mthyltrnsfrs,84433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.94,,,,,,,fee schedule,22.17,81.14, Asy thiopurin s-mthyltrnsfrs,84433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.06,,,,,,,fee schedule,22.17,81.14,APC Asy thiopurin s-mthyltrnsfrs,84433,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.28,,,,,,,fee schedule,22.17,81.14,APC Asy thiopurin s-mthyltrnsfrs,84433,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.17,,,,,,,fee schedule,22.17,81.14,APC Assay of total thyroxine,84436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.23,,,,,,,fee schedule,6.87,35.17, Assay of total thyroxine,84436,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.17,,,,,,,fee schedule,6.87,35.17, Assay of total thyroxine,84436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.87,35.17, Assay of total thyroxine,84436,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.87,35.17, Assay of total thyroxine,84436,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.14,,,,,,,fee schedule,6.87,35.17,APC Assay of total thyroxine,84436,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.21,,,,,,,fee schedule,6.87,35.17,APC Assay of total thyroxine,84436,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.87,,,,,,,fee schedule,6.87,35.17,APC Assay of neonatal thyroxine,84437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, Assay of neonatal thyroxine,84437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, Assay of neonatal thyroxine,84437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, Assay of neonatal thyroxine,84437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, Assay of neonatal thyroxine,84437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC Assay of neonatal thyroxine,84437,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC Assay of neonatal thyroxine,84437,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Assay of free thyroxine,84439,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.95,,,,,,,fee schedule,9.02,46.12, Assay of free thyroxine,84439,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.12,,,,,,,fee schedule,9.02,46.12, Assay of free thyroxine,84439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.16,,,,,,,fee schedule,9.02,46.12, Assay of free thyroxine,84439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.33,,,,,,,fee schedule,9.02,46.12, Assay of free thyroxine,84439,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.38,,,,,,,fee schedule,9.02,46.12,APC Assay of free thyroxine,84439,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.47,,,,,,,fee schedule,9.02,46.12,APC Assay of free thyroxine,84439,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.02,,,,,,,fee schedule,9.02,46.12,APC Assay of thyroid activity,84442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.15,,,,,,,fee schedule,14.78,75.62, Assay of thyroid activity,84442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.62,,,,,,,fee schedule,14.78,75.62, Assay of thyroid activity,84442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.78,75.62, Assay of thyroid activity,84442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.78,75.62, Assay of thyroid activity,84442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.37,,,,,,,fee schedule,14.78,75.62,APC Assay of thyroid activity,84442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.52,,,,,,,fee schedule,14.78,75.62,APC Assay of thyroid activity,84442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.78,,,,,,,fee schedule,14.78,75.62,APC Assay thyroid stim hormone,84443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.28,,,,,,,fee schedule,16.8,85.9, Assay thyroid stim hormone,84443,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.9,,,,,,,fee schedule,16.8,85.9, Assay thyroid stim hormone,84443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.8,85.9, Assay thyroid stim hormone,84443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.8,85.9, Assay thyroid stim hormone,84443,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.47,,,,,,,fee schedule,16.8,85.9,APC Assay thyroid stim hormone,84443,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.64,,,,,,,fee schedule,16.8,85.9,APC Assay thyroid stim hormone,84443,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.8,,,,,,,fee schedule,16.8,85.9,APC Assay of tsi globulin,84445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,230.91,,,,,,,fee schedule,50.86,260.04, Assay of tsi globulin,84445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,260.04,,,,,,,fee schedule,50.86,260.04, Assay of tsi globulin,84445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,161.44,,,,,,,fee schedule,50.86,260.04, Assay of tsi globulin,84445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,184.5,,,,,,,fee schedule,50.86,260.04, Assay of tsi globulin,84445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.89,,,,,,,fee schedule,50.86,260.04,APC Assay of tsi globulin,84445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.4,,,,,,,fee schedule,50.86,260.04,APC Assay of tsi globulin,84445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.86,,,,,,,fee schedule,50.86,260.04,APC Assay of vitamin e,84446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.38,,,,,,,fee schedule,14.18,72.5, Assay of vitamin e,84446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.5,,,,,,,fee schedule,14.18,72.5, Assay of vitamin e,84446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.18,72.5, Assay of vitamin e,84446,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.18,72.5, Assay of vitamin e,84446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.75,,,,,,,fee schedule,14.18,72.5,APC Assay of vitamin e,84446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.89,,,,,,,fee schedule,14.18,72.5,APC Assay of vitamin e,84446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.18,,,,,,,fee schedule,14.18,72.5,APC Assay of transcortin,84449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.74,,,,,,,fee schedule,18,92.05, Assay of transcortin,84449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.05,,,,,,,fee schedule,18,92.05, Assay of transcortin,84449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18,92.05, Assay of transcortin,84449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18,92.05, Assay of transcortin,84449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.72,,,,,,,fee schedule,18,92.05,APC Assay of transcortin,84449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.9,,,,,,,fee schedule,18,92.05,APC Assay of transcortin,84449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18,,,,,,,fee schedule,18,92.05,APC Transferase (AST) (SGOT),84450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.47,,,,,,,fee schedule,5.18,26.43, Transferase (AST) (SGOT),84450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.43,,,,,,,fee schedule,5.18,26.43, Transferase (AST) (SGOT),84450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.18,26.43, Transferase (AST) (SGOT),84450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.18,26.43, Transferase (AST) (SGOT),84450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.18,26.43,APC Transferase (AST) (SGOT),84450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.44,,,,,,,fee schedule,5.18,26.43,APC Transferase (AST) (SGOT),84450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.18,,,,,,,fee schedule,5.18,26.43,APC Alanine amino (ALT) (SGPT),84460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.05,,,,,,,fee schedule,5.3,27.08, Alanine amino (ALT) (SGPT),84460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.08,,,,,,,fee schedule,5.3,27.08, Alanine amino (ALT) (SGPT),84460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.3,27.08, Alanine amino (ALT) (SGPT),84460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.3,27.08, Alanine amino (ALT) (SGPT),84460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.51,,,,,,,fee schedule,5.3,27.08,APC Alanine amino (ALT) (SGPT),84460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.56,,,,,,,fee schedule,5.3,27.08,APC Alanine amino (ALT) (SGPT),84460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.3,,,,,,,fee schedule,5.3,27.08,APC Assay of transferrin,84466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.52,,,,,,,fee schedule,12.76,54.64, Assay of transferrin,84466,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.64,,,,,,,fee schedule,12.76,54.64, Assay of transferrin,84466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.76,54.64, Assay of transferrin,84466,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.76,54.64, Assay of transferrin,84466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.27,,,,,,,fee schedule,12.76,54.64,APC Assay of transferrin,84466,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.4,,,,,,,fee schedule,12.76,54.64,APC Assay of transferrin,84466,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.76,,,,,,,fee schedule,12.76,54.64,APC Assay of triglycerides,84478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.13,,,,,,,fee schedule,5.74,29.43, Assay of triglycerides,84478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.43,,,,,,,fee schedule,5.74,29.43, Assay of triglycerides,84478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.74,29.43, Assay of triglycerides,84478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.74,29.43, Assay of triglycerides,84478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.97,,,,,,,fee schedule,5.74,29.43,APC Assay of triglycerides,84478,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.03,,,,,,,fee schedule,5.74,29.43,APC Assay of triglycerides,84478,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.74,,,,,,,fee schedule,5.74,29.43,APC Assay of thyroid (t3 or t4),84479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, Assay of thyroid (t3 or t4),84479,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, Assay of thyroid (t3 or t4),84479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, Assay of thyroid (t3 or t4),84479,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, Assay of thyroid (t3 or t4),84479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC Assay of thyroid (t3 or t4),84479,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC Assay of thyroid (t3 or t4),84479,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Assay triiodothyronine (t3),84480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.38,,,,,,,fee schedule,14.18,72.5, Assay triiodothyronine (t3),84480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.5,,,,,,,fee schedule,14.18,72.5, Assay triiodothyronine (t3),84480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.18,72.5, Assay triiodothyronine (t3),84480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.18,72.5, Assay triiodothyronine (t3),84480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.75,,,,,,,fee schedule,14.18,72.5,APC Assay triiodothyronine (t3),84480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.89,,,,,,,fee schedule,14.18,72.5,APC Assay triiodothyronine (t3),84480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.18,,,,,,,fee schedule,14.18,72.5,APC Free assay (FT-3),84481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.93,,,,,,,fee schedule,16.94,86.63, Free assay (FT-3),84481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.63,,,,,,,fee schedule,16.94,86.63, Free assay (FT-3),84481,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.94,86.63, Free assay (FT-3),84481,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.94,86.63, Free assay (FT-3),84481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.62,,,,,,,fee schedule,16.94,86.63,APC Free assay (FT-3),84481,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.79,,,,,,,fee schedule,16.94,86.63,APC Free assay (FT-3),84481,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.94,,,,,,,fee schedule,16.94,86.63,APC T3 reverse,84482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.57,,,,,,,fee schedule,15.76,80.59, T3 reverse,84482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.59,,,,,,,fee schedule,15.76,80.59, T3 reverse,84482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.01,,,,,,,fee schedule,15.76,80.59, T3 reverse,84482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.15,,,,,,,fee schedule,15.76,80.59, T3 reverse,84482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.39,,,,,,,fee schedule,15.76,80.59,APC T3 reverse,84482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.55,,,,,,,fee schedule,15.76,80.59,APC T3 reverse,84482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.76,,,,,,,fee schedule,15.76,80.59,APC Assay of troponin quant,84484,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.55,,,,,,,fee schedule,12.47,45.24, Assay of troponin quant,84484,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.54,,,,,,,fee schedule,12.47,45.24, Assay of troponin quant,84484,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.47,45.24, Assay of troponin quant,84484,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.47,45.24, Assay of troponin quant,84484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.97,,,,,,,fee schedule,12.47,45.24,APC Assay of troponin quant,84484,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.09,,,,,,,fee schedule,12.47,45.24,APC Assay of troponin quant,84484,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.47,,,,,,,fee schedule,12.47,45.24,APC Assay duodenal fluid trypsin,84485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.09,,,,,,,fee schedule,7.2,38.39, Assay duodenal fluid trypsin,84485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,38.39,,,,,,,fee schedule,7.2,38.39, Assay duodenal fluid trypsin,84485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.2,38.39, Assay duodenal fluid trypsin,84485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.2,38.39, Assay duodenal fluid trypsin,84485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.49,,,,,,,fee schedule,7.2,38.39,APC Assay duodenal fluid trypsin,84485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.56,,,,,,,fee schedule,7.2,38.39,APC Assay duodenal fluid trypsin,84485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.2,,,,,,,fee schedule,7.2,38.39,APC Test feces for trypsin,84488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.15,,,,,,,fee schedule,7.3,37.33, Test feces for trypsin,84488,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.33,,,,,,,fee schedule,7.3,37.33, Test feces for trypsin,84488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.3,37.33, Test feces for trypsin,84488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.3,37.33, Test feces for trypsin,84488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.59,,,,,,,fee schedule,7.3,37.33,APC Test feces for trypsin,84488,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.66,,,,,,,fee schedule,7.3,37.33,APC Test feces for trypsin,84488,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.3,,,,,,,fee schedule,7.3,37.33,APC Assay of feces for trypsin,84490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.55,,,,,,,fee schedule,9.93,38.91, Assay of feces for trypsin,84490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,38.91,,,,,,,fee schedule,9.93,38.91, Assay of feces for trypsin,84490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.93,38.91, Assay of feces for trypsin,84490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.93,38.91, Assay of feces for trypsin,84490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.33,,,,,,,fee schedule,9.93,38.91,APC Assay of feces for trypsin,84490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.43,,,,,,,fee schedule,9.93,38.91,APC Assay of feces for trypsin,84490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.93,,,,,,,fee schedule,9.93,38.91,APC Assay of tyrosine,84510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.22,,,,,,,fee schedule,10.63,53.18, Assay of tyrosine,84510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.18,,,,,,,fee schedule,10.63,53.18, Assay of tyrosine,84510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.63,53.18, Assay of tyrosine,84510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.63,53.18, Assay of tyrosine,84510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.06,,,,,,,fee schedule,10.63,53.18,APC Assay of tyrosine,84510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.16,,,,,,,fee schedule,10.63,53.18,APC Assay of tyrosine,84510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.63,,,,,,,fee schedule,10.63,53.18,APC Assay of troponin qual,84512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.51,,,,,,,fee schedule,10.09,37.73, Assay of troponin qual,84512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.73,,,,,,,fee schedule,10.09,37.73, Assay of troponin qual,84512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.09,37.73, Assay of troponin qual,84512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.09,37.73, Assay of troponin qual,84512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.49,,,,,,,fee schedule,10.09,37.73,APC Assay of troponin qual,84512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.59,,,,,,,fee schedule,10.09,37.73,APC Assay of troponin qual,84512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.09,,,,,,,fee schedule,10.09,37.73,APC Assay of urea nitrogen,84520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.91,,,,,,,fee schedule,3.95,20.17, Assay of urea nitrogen,84520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.17,,,,,,,fee schedule,3.95,20.17, Assay of urea nitrogen,84520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.95,20.17, Assay of urea nitrogen,84520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.95,20.17, Assay of urea nitrogen,84520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.11,,,,,,,fee schedule,3.95,20.17,APC Assay of urea nitrogen,84520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.15,,,,,,,fee schedule,3.95,20.17,APC Assay of urea nitrogen,84520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.95,,,,,,,fee schedule,3.95,20.17,APC Urea nitrogen semi-quant,84525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.06,,,,,,,fee schedule,5.13,19.22, Urea nitrogen semi-quant,84525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.22,,,,,,,fee schedule,5.13,19.22, Urea nitrogen semi-quant,84525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.13,19.22, Urea nitrogen semi-quant,84525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.13,19.22, Urea nitrogen semi-quant,84525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.34,,,,,,,fee schedule,5.13,19.22,APC Urea nitrogen semi-quant,84525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.13,19.22,APC Urea nitrogen semi-quant,84525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.13,,,,,,,fee schedule,5.13,19.22,APC Assay of urine/urea-n,84540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.58,,,,,,,fee schedule,5.56,24.3, Assay of urine/urea-n,84540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.3,,,,,,,fee schedule,5.56,24.3, Assay of urine/urea-n,84540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.56,24.3, Assay of urine/urea-n,84540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.56,24.3, Assay of urine/urea-n,84540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.78,,,,,,,fee schedule,5.56,24.3,APC Assay of urine/urea-n,84540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.84,,,,,,,fee schedule,5.56,24.3,APC Assay of urine/urea-n,84540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.56,,,,,,,fee schedule,5.56,24.3,APC Urea-N clearance test,84545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30,,,,,,,fee schedule,7.2,33.78, Urea-N clearance test,84545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.78,,,,,,,fee schedule,7.2,33.78, Urea-N clearance test,84545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.2,33.78, Urea-N clearance test,84545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.2,33.78, Urea-N clearance test,84545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.49,,,,,,,fee schedule,7.2,33.78,APC Urea-N clearance test,84545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.56,,,,,,,fee schedule,7.2,33.78,APC Urea-N clearance test,84545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.2,,,,,,,fee schedule,7.2,33.78,APC Assay of blood/uric acid,84550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.51,,,,,,,fee schedule,4.52,23.09, Assay of blood/uric acid,84550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.09,,,,,,,fee schedule,4.52,23.09, Assay of blood/uric acid,84550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.52,23.09, Assay of blood/uric acid,84550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.52,23.09, Assay of blood/uric acid,84550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.7,,,,,,,fee schedule,4.52,23.09,APC Assay of blood/uric acid,84550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.75,,,,,,,fee schedule,4.52,23.09,APC Assay of blood/uric acid,84550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.52,,,,,,,fee schedule,4.52,23.09,APC Assay of urine/uric acid,84560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.7,,,,,,,fee schedule,5.08,19.05, Assay of urine/uric acid,84560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.68,,,,,,,fee schedule,5.08,19.05, Assay of urine/uric acid,84560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.08,19.05, Assay of urine/uric acid,84560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.08,19.05, Assay of urine/uric acid,84560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.28,,,,,,,fee schedule,5.08,19.05,APC Assay of urine/uric acid,84560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.33,,,,,,,fee schedule,5.08,19.05,APC Assay of urine/uric acid,84560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.08,,,,,,,fee schedule,5.08,19.05,APC Assay of feces/urobilinogen,84577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.65,,,,,,,fee schedule,16.8,63.79, Assay of feces/urobilinogen,84577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.79,,,,,,,fee schedule,16.8,63.79, Assay of feces/urobilinogen,84577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.8,63.79, Assay of feces/urobilinogen,84577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.8,63.79, Assay of feces/urobilinogen,84577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.47,,,,,,,fee schedule,16.8,63.79,APC Assay of feces/urobilinogen,84577,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.64,,,,,,,fee schedule,16.8,63.79,APC Assay of feces/urobilinogen,84577,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.8,,,,,,,fee schedule,16.8,63.79,APC Test urine urobilinogen,84578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.07,,,,,,,fee schedule,4.47,16.68, Test urine urobilinogen,84578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.71,,,,,,,fee schedule,4.47,16.68, Test urine urobilinogen,84578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.47,16.68, Test urine urobilinogen,84578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.47,16.68, Test urine urobilinogen,84578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.65,,,,,,,fee schedule,4.47,16.68,APC Test urine urobilinogen,84578,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.69,,,,,,,fee schedule,4.47,16.68,APC Test urine urobilinogen,84578,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.47,,,,,,,fee schedule,4.47,16.68,APC Assay of urine urobilinogen,84580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.24,,,,,,,fee schedule,9.55,36.31, Assay of urine urobilinogen,84580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.31,,,,,,,fee schedule,9.55,36.31, Assay of urine urobilinogen,84580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.55,36.31, Assay of urine urobilinogen,84580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.55,36.31, Assay of urine urobilinogen,84580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.93,,,,,,,fee schedule,9.55,36.31,APC Assay of urine urobilinogen,84580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.03,,,,,,,fee schedule,9.55,36.31,APC Assay of urine urobilinogen,84580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.55,,,,,,,fee schedule,9.55,36.31,APC Assay of urine urobilinogen,84583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.82,,,,,,,fee schedule,6.05,25.69, Assay of urine urobilinogen,84583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.69,,,,,,,fee schedule,6.05,25.69, Assay of urine urobilinogen,84583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,6.05,25.69, Assay of urine urobilinogen,84583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,6.05,25.69, Assay of urine urobilinogen,84583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.29,,,,,,,fee schedule,6.05,25.69,APC Assay of urine urobilinogen,84583,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.35,,,,,,,fee schedule,6.05,25.69,APC Assay of urine urobilinogen,84583,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.05,,,,,,,fee schedule,6.05,25.69,APC Assay of urine vma,84585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.4,,,,,,,fee schedule,15.5,79.28, Assay of urine vma,84585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.28,,,,,,,fee schedule,15.5,79.28, Assay of urine vma,84585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.5,79.28, Assay of urine vma,84585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.5,79.28, Assay of urine vma,84585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.12,,,,,,,fee schedule,15.5,79.28,APC Assay of urine vma,84585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.28,,,,,,,fee schedule,15.5,79.28,APC Assay of urine vma,84585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.5,,,,,,,fee schedule,15.5,79.28,APC Assay of vip,84586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,160.45,,,,,,,fee schedule,35.33,180.69, Assay of vip,84586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,180.69,,,,,,,fee schedule,35.33,180.69, Assay of vip,84586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,112.48,,,,,,,fee schedule,35.33,180.69, Assay of vip,84586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,128.55,,,,,,,fee schedule,35.33,180.69, Assay of vip,84586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.74,,,,,,,fee schedule,35.33,180.69,APC Assay of vip,84586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.1,,,,,,,fee schedule,35.33,180.69,APC Assay of vip,84586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.33,,,,,,,fee schedule,35.33,180.69,APC Assay of vasopressin,84588,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,154.15,,,,,,,fee schedule,33.94,173.59, Assay of vasopressin,84588,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,173.59,,,,,,,fee schedule,33.94,173.59, Assay of vasopressin,84588,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,108.33,,,,,,,fee schedule,33.94,173.59, Assay of vasopressin,84588,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123.81,,,,,,,fee schedule,33.94,173.59, Assay of vasopressin,84588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.3,,,,,,,fee schedule,33.94,173.59,APC Assay of vasopressin,84588,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.64,,,,,,,fee schedule,33.94,173.59,APC Assay of vasopressin,84588,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.94,,,,,,,fee schedule,33.94,173.59,APC Assay of vitamin a,84590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.65,,,,,,,fee schedule,11.61,59.29, Assay of vitamin a,84590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.29,,,,,,,fee schedule,11.61,59.29, Assay of vitamin a,84590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.61,59.29, Assay of vitamin a,84590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.61,59.29, Assay of vitamin a,84590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.07,,,,,,,fee schedule,11.61,59.29,APC Assay of vitamin a,84590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.19,,,,,,,fee schedule,11.61,59.29,APC Assay of vitamin a,84590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.61,,,,,,,fee schedule,11.61,59.29,APC Assay Of Nos Vitamin,84591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.65,,,,,,,fee schedule,17.06,61.89, Assay Of Nos Vitamin,84591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.29,,,,,,,fee schedule,17.06,61.89, Assay Of Nos Vitamin,84591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.06,61.89, Assay Of Nos Vitamin,84591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.06,61.89, Assay Of Nos Vitamin,84591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.74,,,,,,,fee schedule,17.06,61.89,APC Assay Of Nos Vitamin,84591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.91,,,,,,,fee schedule,17.06,61.89,APC Assay Of Nos Vitamin,84591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.06,,,,,,,fee schedule,17.06,61.89,APC Assay of vitamin k,84597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.24,,,,,,,fee schedule,13.72,70.09, Assay of vitamin k,84597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.09,,,,,,,fee schedule,13.72,70.09, Assay of vitamin k,84597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.72,70.09, Assay of vitamin k,84597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.72,70.09, Assay of vitamin k,84597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.27,,,,,,,fee schedule,13.72,70.09,APC Assay of vitamin k,84597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.41,,,,,,,fee schedule,13.72,70.09,APC Assay of vitamin k,84597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.72,70.09,APC Assay of volatiles,84600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.96,,,,,,,fee schedule,17.11,82.17, Assay of volatiles,84600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.17,,,,,,,fee schedule,17.11,82.17, Assay of volatiles,84600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.11,82.17, Assay of volatiles,84600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.11,82.17, Assay of volatiles,84600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.79,,,,,,,fee schedule,17.11,82.17,APC Assay of volatiles,84600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.97,,,,,,,fee schedule,17.11,82.17,APC Assay of volatiles,84600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.11,,,,,,,fee schedule,17.11,82.17,APC Xylose tolerance test,84620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.79,,,,,,,fee schedule,12.91,60.57, Xylose tolerance test,84620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.57,,,,,,,fee schedule,12.91,60.57, Xylose tolerance test,84620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.91,60.57, Xylose tolerance test,84620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.91,60.57, Xylose tolerance test,84620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.43,,,,,,,fee schedule,12.91,60.57,APC Xylose tolerance test,84620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.56,,,,,,,fee schedule,12.91,60.57,APC Xylose tolerance test,84620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.91,,,,,,,fee schedule,12.91,60.57,APC Assay of zinc,84630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.32,,,,,,,fee schedule,11.39,53.29, Assay of zinc,84630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.29,,,,,,,fee schedule,11.39,53.29, Assay of zinc,84630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.39,53.29, Assay of zinc,84630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.39,53.29, Assay of zinc,84630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.85,,,,,,,fee schedule,11.39,53.29,APC Assay of zinc,84630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.96,,,,,,,fee schedule,11.39,53.29,APC Assay of zinc,84630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.39,,,,,,,fee schedule,11.39,53.29,APC Assay of c-peptide,84681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.48,,,,,,,fee schedule,20.81,106.4, Assay of c-peptide,84681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.4,,,,,,,fee schedule,20.81,106.4, Assay of c-peptide,84681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.81,106.4, Assay of c-peptide,84681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.81,106.4, Assay of c-peptide,84681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,106.4,APC Assay of c-peptide,84681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,106.4,APC Assay of c-peptide,84681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,106.4,APC Chorionic gonadotropin test,84702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.88,,,,,,,fee schedule,15.05,74.19, Chorionic gonadotropin test,84702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.19,,,,,,,fee schedule,15.05,74.19, Chorionic gonadotropin test,84702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.05,74.19, Chorionic gonadotropin test,84702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.05,74.19, Chorionic gonadotropin test,84702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.65,,,,,,,fee schedule,15.05,74.19,APC Chorionic gonadotropin test,84702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.8,,,,,,,fee schedule,15.05,74.19,APC Chorionic gonadotropin test,84702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.05,,,,,,,fee schedule,15.05,74.19,APC Chorionic gonadotropin assay,84703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.09,,,,,,,fee schedule,7.52,38.39, Chorionic gonadotropin assay,84703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,38.39,,,,,,,fee schedule,7.52,38.39, Chorionic gonadotropin assay,84703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.97,,,,,,,fee schedule,7.52,38.39, Chorionic gonadotropin assay,84703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.39,,,,,,,fee schedule,7.52,38.39, Chorionic gonadotropin assay,84703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.82,,,,,,,fee schedule,7.52,38.39,APC Chorionic gonadotropin assay,84703,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.9,,,,,,,fee schedule,7.52,38.39,APC Chorionic gonadotropin assay,84703,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.52,,,,,,,fee schedule,7.52,38.39,APC Hcg free betachain test,84704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.79,,,,,,,fee schedule,15.29,75.21, Hcg free betachain test,84704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.21,,,,,,,fee schedule,15.29,75.21, Hcg free betachain test,84704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.29,75.21, Hcg free betachain test,84704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.29,75.21, Hcg free betachain test,84704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.9,,,,,,,fee schedule,15.29,75.21,APC Hcg free betachain test,84704,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.05,,,,,,,fee schedule,15.29,75.21,APC Hcg free betachain test,84704,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.29,,,,,,,fee schedule,15.29,75.21,APC Ovulation tests,84830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.57,,,,,,,fee schedule,12.7,51.31, Ovulation tests,84830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.31,,,,,,,fee schedule,12.7,51.31, Ovulation tests,84830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.7,51.31, Ovulation tests,84830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.7,51.31, Ovulation tests,84830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.21,,,,,,,fee schedule,12.7,51.31,APC Ovulation tests,84830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.34,,,,,,,fee schedule,12.7,51.31,APC Ovulation tests,84830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.7,,,,,,,fee schedule,12.7,51.31,APC Clinical chemistry test,84999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.3,,,,,,,fee schedule,36.3,44.82, Clinical chemistry test,84999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.88,,,,,,,fee schedule,36.3,44.82, Clinical chemistry test,84999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.22,,,,,,,fee schedule,36.3,44.82, Clinical chemistry test,84999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.82,,,,,,,fee schedule,36.3,44.82, Bleeding time test,85002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.44,,,,,,,fee schedule,4.82,23.02, Bleeding time test,85002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.02,,,,,,,fee schedule,4.82,23.02, Bleeding time test,85002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.82,23.02, Bleeding time test,85002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.82,23.02, Bleeding time test,85002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.01,,,,,,,fee schedule,4.82,23.02,APC Bleeding time test,85002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.06,,,,,,,fee schedule,4.82,23.02,APC Bleeding time test,85002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.82,,,,,,,fee schedule,4.82,23.02,APC Automated diff wbc count,85004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, Automated diff wbc count,85004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, Automated diff wbc count,85004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, Automated diff wbc count,85004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, Automated diff wbc count,85004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC Automated diff wbc count,85004,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC Automated diff wbc count,85004,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Bl smear w/diff wbc count,85007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.63,,,,,,,fee schedule,3.8,17.6, Bl smear w/diff wbc count,85007,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.6,,,,,,,fee schedule,3.8,17.6, Bl smear w/diff wbc count,85007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.8,17.6, Bl smear w/diff wbc count,85007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.8,17.6, Bl smear w/diff wbc count,85007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.95,,,,,,,fee schedule,3.8,17.6,APC Bl smear w/diff wbc count,85007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.99,,,,,,,fee schedule,3.8,17.6,APC Bl smear w/diff wbc count,85007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.8,,,,,,,fee schedule,3.8,17.6,APC Bl smear w/o diff wbc count,85008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.63,,,,,,,fee schedule,3.43,17.6, Bl smear w/o diff wbc count,85008,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.6,,,,,,,fee schedule,3.43,17.6, Bl smear w/o diff wbc count,85008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.42,,,,,,,fee schedule,3.43,17.6, Bl smear w/o diff wbc count,85008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.91,,,,,,,fee schedule,3.43,17.6, Bl smear w/o diff wbc count,85008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.57,,,,,,,fee schedule,3.43,17.6,APC Bl smear w/o diff wbc count,85008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.6,,,,,,,fee schedule,3.43,17.6,APC Bl smear w/o diff wbc count,85008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.43,,,,,,,fee schedule,3.43,17.6,APC Manual diff wbc count b-coat,85009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.87,,,,,,,fee schedule,5.07,19, Manual diff wbc count b-coat,85009,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19,,,,,,,fee schedule,5.07,19, Manual diff wbc count b-coat,85009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5.07,19, Manual diff wbc count b-coat,85009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5.07,19, Manual diff wbc count b-coat,85009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.27,,,,,,,fee schedule,5.07,19,APC Manual diff wbc count b-coat,85009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.32,,,,,,,fee schedule,5.07,19,APC Manual diff wbc count b-coat,85009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.07,,,,,,,fee schedule,5.07,19,APC Spun microhematocrit,85013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.76,,,,,,,fee schedule,7,24.99, Spun microhematocrit,85013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.11,,,,,,,fee schedule,7,24.99, Spun microhematocrit,85013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,7,24.99, Spun microhematocrit,85013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,7,24.99, Spun microhematocrit,85013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.28,,,,,,,fee schedule,7,24.99,APC Spun microhematocrit,85013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.35,,,,,,,fee schedule,7,24.99,APC Spun microhematocrit,85013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7,,,,,,,fee schedule,7,24.99,APC Hematocrit,85014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.76,,,,,,,fee schedule,2.37,12.11, Hematocrit,85014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.11,,,,,,,fee schedule,2.37,12.11, Hematocrit,85014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.3,,,,,,,fee schedule,2.37,12.11, Hematocrit,85014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.34,,,,,,,fee schedule,2.37,12.11, Hematocrit,85014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.46,,,,,,,fee schedule,2.37,12.11,APC Hematocrit,85014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.49,,,,,,,fee schedule,2.37,12.11,APC Hematocrit,85014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.37,,,,,,,fee schedule,2.37,12.11,APC Hemoglobin,85018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.76,,,,,,,fee schedule,2.37,12.11, Hemoglobin,85018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.11,,,,,,,fee schedule,2.37,12.11, Hemoglobin,85018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.3,,,,,,,fee schedule,2.37,12.11, Hemoglobin,85018,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.34,,,,,,,fee schedule,2.37,12.11, Hemoglobin,85018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.46,,,,,,,fee schedule,2.37,12.11,APC Hemoglobin,85018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.49,,,,,,,fee schedule,2.37,12.11,APC Hemoglobin,85018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.37,,,,,,,fee schedule,2.37,12.11,APC Complete cbc w/auto diff wbc,85025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.3,,,,,,,fee schedule,7.77,39.75, Complete cbc w/auto diff wbc,85025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.75,,,,,,,fee schedule,7.77,39.75, Complete cbc w/auto diff wbc,85025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.77,39.75, Complete cbc w/auto diff wbc,85025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.77,39.75, Complete cbc w/auto diff wbc,85025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.08,,,,,,,fee schedule,7.77,39.75,APC Complete cbc w/auto diff wbc,85025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.16,,,,,,,fee schedule,7.77,39.75,APC Complete cbc w/auto diff wbc,85025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.77,,,,,,,fee schedule,7.77,39.75,APC Complete cbc automated,85027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, Complete cbc automated,85027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, Complete cbc automated,85027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, Complete cbc automated,85027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, Complete cbc automated,85027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC Complete cbc automated,85027,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC Complete cbc automated,85027,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Manual cell count each,85032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.53,,,,,,,fee schedule,4.31,22, Manual cell count each,85032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22,,,,,,,fee schedule,4.31,22, Manual cell count each,85032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.31,22, Manual cell count each,85032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.31,22, Manual cell count each,85032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.31,22,APC Manual cell count each,85032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.53,,,,,,,fee schedule,4.31,22,APC Manual cell count each,85032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.31,,,,,,,fee schedule,4.31,22,APC Automated rbc count,85041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.07,,,,,,,fee schedule,3.02,14.71, Automated rbc count,85041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.71,,,,,,,fee schedule,3.02,14.71, Automated rbc count,85041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.37,,,,,,,fee schedule,3.02,14.71, Automated rbc count,85041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.71,,,,,,,fee schedule,3.02,14.71, Automated rbc count,85041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.14,,,,,,,fee schedule,3.02,14.71,APC Automated rbc count,85041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.17,,,,,,,fee schedule,3.02,14.71,APC Automated rbc count,85041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.02,,,,,,,fee schedule,3.02,14.71,APC Manual reticulocyte count,85044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.53,,,,,,,fee schedule,4.31,22, Manual reticulocyte count,85044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22,,,,,,,fee schedule,4.31,22, Manual reticulocyte count,85044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.31,22, Manual reticulocyte count,85044,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.31,22, Manual reticulocyte count,85044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.31,22,APC Manual reticulocyte count,85044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.53,,,,,,,fee schedule,4.31,22,APC Manual reticulocyte count,85044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.31,,,,,,,fee schedule,4.31,22,APC Automated reticulocyte count,85045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,18.17,,,,,,,fee schedule,3.99,20.46, Automated reticulocyte count,85045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.46,,,,,,,fee schedule,3.99,20.46, Automated reticulocyte count,85045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.99,20.46, Automated reticulocyte count,85045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.99,20.46, Automated reticulocyte count,85045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.15,,,,,,,fee schedule,3.99,20.46,APC Automated reticulocyte count,85045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.19,,,,,,,fee schedule,3.99,20.46,APC Automated reticulocyte count,85045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.99,,,,,,,fee schedule,3.99,20.46,APC Reticyte/hgb concentrate,85046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.35,,,,,,,fee schedule,5.57,28.55, Reticyte/hgb concentrate,85046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.55,,,,,,,fee schedule,5.57,28.55, Reticyte/hgb concentrate,85046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.57,28.55, Reticyte/hgb concentrate,85046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.57,28.55, Reticyte/hgb concentrate,85046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.79,,,,,,,fee schedule,5.57,28.55,APC Reticyte/hgb concentrate,85046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.85,,,,,,,fee schedule,5.57,28.55,APC Reticyte/hgb concentrate,85046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.57,,,,,,,fee schedule,5.57,28.55,APC Automated leukocyte count,85048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.54,,,,,,,fee schedule,2.54,12.99, Automated leukocyte count,85048,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.99,,,,,,,fee schedule,2.54,12.99, Automated leukocyte count,85048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.32,,,,,,,fee schedule,2.54,12.99, Automated leukocyte count,85048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.51,,,,,,,fee schedule,2.54,12.99, Automated leukocyte count,85048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.64,,,,,,,fee schedule,2.54,12.99,APC Automated leukocyte count,85048,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.67,,,,,,,fee schedule,2.54,12.99,APC Automated leukocyte count,85048,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.54,,,,,,,fee schedule,2.54,12.99,APC Automated platelet count,85049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.31,,,,,,,fee schedule,4.48,22.88, Automated platelet count,85049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.88,,,,,,,fee schedule,4.48,22.88, Automated platelet count,85049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.48,22.88, Automated platelet count,85049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.48,22.88, Automated platelet count,85049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.66,,,,,,,fee schedule,4.48,22.88,APC Automated platelet count,85049,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.7,,,,,,,fee schedule,4.48,22.88,APC Automated platelet count,85049,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.48,22.88,APC Reticulated platelet assay,85055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.58,,,,,,,fee schedule,35.74,136.92, Reticulated platelet assay,85055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.92,,,,,,,fee schedule,35.74,136.92, Reticulated platelet assay,85055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,113.53,,,,,,,fee schedule,35.74,136.92, Reticulated platelet assay,85055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,129.75,,,,,,,fee schedule,35.74,136.92, Reticulated platelet assay,85055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.17,,,,,,,fee schedule,35.74,136.92,APC Reticulated platelet assay,85055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.53,,,,,,,fee schedule,35.74,136.92,APC Reticulated platelet assay,85055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.74,,,,,,,fee schedule,35.74,136.92,APC Blood smear interpretation,85060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.2,,,,,,,fee schedule,39.11,98.2, Blood smear interpretation,85060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98.2,,,,,,,fee schedule,39.11,98.2, Blood smear interpretation,85060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.11,,,,,,,fee schedule,39.11,98.2, Blood smear interpretation,85060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.7,,,,,,,fee schedule,39.11,98.2, Bone marrow interpretation,85097,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,98.05,,,,,,,fee schedule,78.78,999.37, Bone marrow interpretation,85097,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,110.42,,,,,,,fee schedule,78.78,999.37, Bone marrow interpretation,85097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.78,,,,,,,fee schedule,78.78,999.37, Bone marrow interpretation,85097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.03,,,,,,,fee schedule,78.78,999.37, Bone marrow interpretation,85097,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,78.78,999.37,APC Bone marrow interpretation,85097,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,78.78,999.37,APC Bone marrow interpretation,85097,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,78.78,999.37,APC Chromogenic substrate assay,85130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.02,,,,,,,fee schedule,11.89,60.83, Chromogenic substrate assay,85130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.83,,,,,,,fee schedule,11.89,60.83, Chromogenic substrate assay,85130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.89,60.83, Chromogenic substrate assay,85130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.89,60.83, Chromogenic substrate assay,85130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.37,,,,,,,fee schedule,11.89,60.83,APC Chromogenic substrate assay,85130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.48,,,,,,,fee schedule,11.89,60.83,APC Chromogenic substrate assay,85130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.89,,,,,,,fee schedule,11.89,60.83,APC Blood clot retraction,85170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.23,,,,,,,fee schedule,9.23,59.52, Blood clot retraction,85170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.39,,,,,,,fee schedule,9.23,59.52, Blood clot retraction,85170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,9.23,59.52, Blood clot retraction,85170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,9.23,59.52, Blood clot retraction,85170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.95,,,,,,,fee schedule,9.23,59.52,APC Blood clot retraction,85170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.12,,,,,,,fee schedule,9.23,59.52,APC Blood clot retraction,85170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.3,,,,,,,fee schedule,9.23,59.52,APC Blood clot lysis time,85175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.64,,,,,,,fee schedule,20.37,73.8, Blood clot lysis time,85175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.24,,,,,,,fee schedule,20.37,73.8, Blood clot lysis time,85175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.37,73.8, Blood clot lysis time,85175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.37,73.8, Blood clot lysis time,85175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.18,,,,,,,fee schedule,20.37,73.8,APC Blood clot lysis time,85175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.39,,,,,,,fee schedule,20.37,73.8,APC Blood clot lysis time,85175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.37,,,,,,,fee schedule,20.37,73.8,APC Clot factor ii prothrom spec,85210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.75,,,,,,,fee schedule,12.98,47.61, Clot factor ii prothrom spec,85210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.76,,,,,,,fee schedule,12.98,47.61, Clot factor ii prothrom spec,85210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,12.98,47.61, Clot factor ii prothrom spec,85210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,12.98,47.61, Clot factor ii prothrom spec,85210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.5,,,,,,,fee schedule,12.98,47.61,APC Clot factor ii prothrom spec,85210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.63,,,,,,,fee schedule,12.98,47.61,APC Clot factor ii prothrom spec,85210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.98,,,,,,,fee schedule,12.98,47.61,APC Blooc clot factor v test,85220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.15,,,,,,,fee schedule,17.65,90.26, Blooc clot factor v test,85220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.26,,,,,,,fee schedule,17.65,90.26, Blooc clot factor v test,85220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,17.65,90.26, Blooc clot factor v test,85220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,17.65,90.26, Blooc clot factor v test,85220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.36,,,,,,,fee schedule,17.65,90.26,APC Blooc clot factor v test,85220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.53,,,,,,,fee schedule,17.65,90.26,APC Blooc clot factor v test,85220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.65,,,,,,,fee schedule,17.65,90.26,APC Clot factor vii proconvertin,85230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.32,,,,,,,fee schedule,17.9,91.57, Clot factor vii proconvertin,85230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.57,,,,,,,fee schedule,17.9,91.57, Clot factor vii proconvertin,85230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.9,91.57, Clot factor vii proconvertin,85230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.9,91.57, Clot factor vii proconvertin,85230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.62,,,,,,,fee schedule,17.9,91.57,APC Clot factor vii proconvertin,85230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.79,,,,,,,fee schedule,17.9,91.57,APC Clot factor vii proconvertin,85230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.9,91.57,APC Clot factor viii ahg 1 stage,85240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.32,,,,,,,fee schedule,17.9,91.57, Clot factor viii ahg 1 stage,85240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.57,,,,,,,fee schedule,17.9,91.57, Clot factor viii ahg 1 stage,85240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.9,91.57, Clot factor viii ahg 1 stage,85240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.9,91.57, Clot factor viii ahg 1 stage,85240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.62,,,,,,,fee schedule,17.9,91.57,APC Clot factor viii ahg 1 stage,85240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.79,,,,,,,fee schedule,17.9,91.57,APC Clot factor viii ahg 1 stage,85240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.9,91.57,APC Clot factor viii reltd antgn,85244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.72,,,,,,,fee schedule,20.42,104.42, Clot factor viii reltd antgn,85244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,104.42,,,,,,,fee schedule,20.42,104.42, Clot factor viii reltd antgn,85244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.42,104.42, Clot factor viii reltd antgn,85244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.42,104.42, Clot factor viii reltd antgn,85244,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.24,,,,,,,fee schedule,20.42,104.42,APC Clot factor viii reltd antgn,85244,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.44,,,,,,,fee schedule,20.42,104.42,APC Clot factor viii reltd antgn,85244,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.42,,,,,,,fee schedule,20.42,104.42,APC Clot factor viii vw ristoctn,85245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,104.2,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw ristoctn,85245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.34,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw ristoctn,85245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw ristoctn,85245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw ristoctn,85245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.86,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii vw ristoctn,85245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.09,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii vw ristoctn,85245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.94,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii vw antigen,85246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,104.2,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw antigen,85246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.34,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw antigen,85246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw antigen,85246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,22.94,117.34, Clot factor viii vw antigen,85246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.86,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii vw antigen,85246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.09,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii vw antigen,85246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.94,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii multimetric,85247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,104.2,,,,,,,fee schedule,22.94,117.34, Clot factor viii multimetric,85247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.34,,,,,,,fee schedule,22.94,117.34, Clot factor viii multimetric,85247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,22.94,117.34, Clot factor viii multimetric,85247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,22.94,117.34, Clot factor viii multimetric,85247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.86,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii multimetric,85247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.09,,,,,,,fee schedule,22.94,117.34,APC Clot factor viii multimetric,85247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.94,,,,,,,fee schedule,22.94,117.34,APC Clot factor ix ptc/chrstmas,85250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.45,,,,,,,fee schedule,19.04,97.36, Clot factor ix ptc/chrstmas,85250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,97.36,,,,,,,fee schedule,19.04,97.36, Clot factor ix ptc/chrstmas,85250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,19.04,97.36, Clot factor ix ptc/chrstmas,85250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,19.04,97.36, Clot factor ix ptc/chrstmas,85250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.8,,,,,,,fee schedule,19.04,97.36,APC Clot factor ix ptc/chrstmas,85250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.99,,,,,,,fee schedule,19.04,97.36,APC Clot factor ix ptc/chrstmas,85250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.04,,,,,,,fee schedule,19.04,97.36,APC Clot factor x stuart-power,85260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.32,,,,,,,fee schedule,17.9,91.57, Clot factor x stuart-power,85260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.57,,,,,,,fee schedule,17.9,91.57, Clot factor x stuart-power,85260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.9,91.57, Clot factor x stuart-power,85260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.9,91.57, Clot factor x stuart-power,85260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.62,,,,,,,fee schedule,17.9,91.57,APC Clot factor x stuart-power,85260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.79,,,,,,,fee schedule,17.9,91.57,APC Clot factor x stuart-power,85260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.9,91.57,APC Clot factor xi pta,85270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.32,,,,,,,fee schedule,17.9,91.57, Clot factor xi pta,85270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.57,,,,,,,fee schedule,17.9,91.57, Clot factor xi pta,85270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.9,91.57, Clot factor xi pta,85270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.9,91.57, Clot factor xi pta,85270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.62,,,,,,,fee schedule,17.9,91.57,APC Clot factor xi pta,85270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.79,,,,,,,fee schedule,17.9,91.57,APC Clot factor xi pta,85270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.9,,,,,,,fee schedule,17.9,91.57,APC Clot factor xii hageman,85280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.88,,,,,,,fee schedule,19.35,98.97, Clot factor xii hageman,85280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98.97,,,,,,,fee schedule,19.35,98.97, Clot factor xii hageman,85280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.35,98.97, Clot factor xii hageman,85280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.35,98.97, Clot factor xii hageman,85280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.12,,,,,,,fee schedule,19.35,98.97,APC Clot factor xii hageman,85280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.32,,,,,,,fee schedule,19.35,98.97,APC Clot factor xii hageman,85280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.35,,,,,,,fee schedule,19.35,98.97,APC Clot factor xiii fibrin stab,85290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.76,,,,,,,fee schedule,16.34,59.52, Clot factor xiii fibrin stab,85290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.39,,,,,,,fee schedule,16.34,59.52, Clot factor xiii fibrin stab,85290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.34,59.52, Clot factor xiii fibrin stab,85290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.34,59.52, Clot factor xiii fibrin stab,85290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.99,,,,,,,fee schedule,16.34,59.52,APC Clot factor xiii fibrin stab,85290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.16,,,,,,,fee schedule,16.34,59.52,APC Clot factor xiii fibrin stab,85290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.34,,,,,,,fee schedule,16.34,59.52,APC Clot factor xiii fibrin scrn,85291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.76,,,,,,,fee schedule,9.11,41.39, Clot factor xiii fibrin scrn,85291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.39,,,,,,,fee schedule,9.11,41.39, Clot factor xiii fibrin scrn,85291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.16,,,,,,,fee schedule,9.11,41.39, Clot factor xiii fibrin scrn,85291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.33,,,,,,,fee schedule,9.11,41.39, Clot factor xiii fibrin scrn,85291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.47,,,,,,,fee schedule,9.11,41.39,APC Clot factor xiii fibrin scrn,85291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.57,,,,,,,fee schedule,9.11,41.39,APC Clot factor xiii fibrin scrn,85291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.11,,,,,,,fee schedule,9.11,41.39,APC Clot factor fletcher fact,85292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86,,,,,,,fee schedule,18.93,96.84, Clot factor fletcher fact,85292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.84,,,,,,,fee schedule,18.93,96.84, Clot factor fletcher fact,85292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,18.93,96.84, Clot factor fletcher fact,85292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,18.93,96.84, Clot factor fletcher fact,85292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.69,,,,,,,fee schedule,18.93,96.84,APC Clot factor fletcher fact,85292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.88,,,,,,,fee schedule,18.93,96.84,APC Clot factor fletcher fact,85292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.93,,,,,,,fee schedule,18.93,96.84,APC Clot factor wght kininogen,85293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86,,,,,,,fee schedule,18.93,96.84, Clot factor wght kininogen,85293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.84,,,,,,,fee schedule,18.93,96.84, Clot factor wght kininogen,85293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,18.93,96.84, Clot factor wght kininogen,85293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,18.93,96.84, Clot factor wght kininogen,85293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.69,,,,,,,fee schedule,18.93,96.84,APC Clot factor wght kininogen,85293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.88,,,,,,,fee schedule,18.93,96.84,APC Clot factor wght kininogen,85293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.93,,,,,,,fee schedule,18.93,96.84,APC Antithrombin iii activity,85300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.94,,,,,,,fee schedule,11.85,49.48, Antithrombin iii activity,85300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.48,,,,,,,fee schedule,11.85,49.48, Antithrombin iii activity,85300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.85,49.48, Antithrombin iii activity,85300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.85,49.48, Antithrombin iii activity,85300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.32,,,,,,,fee schedule,11.85,49.48,APC Antithrombin iii activity,85300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.44,,,,,,,fee schedule,11.85,49.48,APC Antithrombin iii activity,85300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.85,,,,,,,fee schedule,11.85,49.48,APC Antithrombin iii antigen,85301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.11,,,,,,,fee schedule,10.81,55.3, Antithrombin iii antigen,85301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.3,,,,,,,fee schedule,10.81,55.3, Antithrombin iii antigen,85301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.81,55.3, Antithrombin iii antigen,85301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.81,55.3, Antithrombin iii antigen,85301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.24,,,,,,,fee schedule,10.81,55.3,APC Antithrombin iii antigen,85301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.35,,,,,,,fee schedule,10.81,55.3,APC Antithrombin iii antigen,85301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.81,,,,,,,fee schedule,10.81,55.3,APC Clot inhibit prot c antigen,85302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.6,,,,,,,fee schedule,12.01,61.49, Clot inhibit prot c antigen,85302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.49,,,,,,,fee schedule,12.01,61.49, Clot inhibit prot c antigen,85302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.01,61.49, Clot inhibit prot c antigen,85302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.01,61.49, Clot inhibit prot c antigen,85302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.49,,,,,,,fee schedule,12.01,61.49,APC Clot inhibit prot c antigen,85302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.61,,,,,,,fee schedule,12.01,61.49,APC Clot inhibit prot c antigen,85302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.01,,,,,,,fee schedule,12.01,61.49,APC Clot inhibit prot c activity,85303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.79,,,,,,,fee schedule,13.84,70.71, Clot inhibit prot c activity,85303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.71,,,,,,,fee schedule,13.84,70.71, Clot inhibit prot c activity,85303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.84,70.71, Clot inhibit prot c activity,85303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.84,70.71, Clot inhibit prot c activity,85303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.39,,,,,,,fee schedule,13.84,70.71,APC Clot inhibit prot c activity,85303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.53,,,,,,,fee schedule,13.84,70.71,APC Clot inhibit prot c activity,85303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.84,,,,,,,fee schedule,13.84,70.71,APC Clot inhibit prot s total,85305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.65,,,,,,,fee schedule,11.61,59.29, Clot inhibit prot s total,85305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.29,,,,,,,fee schedule,11.61,59.29, Clot inhibit prot s total,85305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.61,59.29, Clot inhibit prot s total,85305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.61,59.29, Clot inhibit prot s total,85305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.07,,,,,,,fee schedule,11.61,59.29,APC Clot inhibit prot s total,85305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.19,,,,,,,fee schedule,11.61,59.29,APC Clot inhibit prot s total,85305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.61,,,,,,,fee schedule,11.61,59.29,APC Clot inhibit prot s free,85306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.58,,,,,,,fee schedule,15.32,78.36, Clot inhibit prot s free,85306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.36,,,,,,,fee schedule,15.32,78.36, Clot inhibit prot s free,85306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.32,78.36, Clot inhibit prot s free,85306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.32,78.36, Clot inhibit prot s free,85306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.93,,,,,,,fee schedule,15.32,78.36,APC Clot inhibit prot s free,85306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.09,,,,,,,fee schedule,15.32,78.36,APC Clot inhibit prot s free,85306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.32,,,,,,,fee schedule,15.32,78.36,APC Assay Activated Protein C,85307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.58,,,,,,,fee schedule,15.32,78.36, Assay Activated Protein C,85307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.36,,,,,,,fee schedule,15.32,78.36, Assay Activated Protein C,85307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.32,78.36, Assay Activated Protein C,85307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.32,78.36, Assay Activated Protein C,85307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.93,,,,,,,fee schedule,15.32,78.36,APC Assay Activated Protein C,85307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.09,,,,,,,fee schedule,15.32,78.36,APC Assay Activated Protein C,85307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.32,,,,,,,fee schedule,15.32,78.36,APC Factor inhibitor test,85335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.66,,,,,,,fee schedule,12.87,46.41, Factor inhibitor test,85335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.64,,,,,,,fee schedule,12.87,46.41, Factor inhibitor test,85335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.87,46.41, Factor inhibitor test,85335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.87,46.41, Factor inhibitor test,85335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.38,,,,,,,fee schedule,12.87,46.41,APC Factor inhibitor test,85335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.51,,,,,,,fee schedule,12.87,46.41,APC Factor inhibitor test,85335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.87,,,,,,,fee schedule,12.87,46.41,APC Thrombomodulin,85337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.32,,,,,,,fee schedule,17.27,63.09, Thrombomodulin,85337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.29,,,,,,,fee schedule,17.27,63.09, Thrombomodulin,85337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.27,63.09, Thrombomodulin,85337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.27,63.09, Thrombomodulin,85337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.96,,,,,,,fee schedule,17.27,63.09,APC Thrombomodulin,85337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,17.27,63.09,APC Thrombomodulin,85337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.27,,,,,,,fee schedule,17.27,63.09,APC Coagulation time lee & white,85345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.53,,,,,,,fee schedule,4.69,22, Coagulation time lee & white,85345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22,,,,,,,fee schedule,4.69,22, Coagulation time lee & white,85345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.69,22, Coagulation time lee & white,85345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.69,22, Coagulation time lee & white,85345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.88,,,,,,,fee schedule,4.69,22,APC Coagulation time lee & white,85345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.92,,,,,,,fee schedule,4.69,22,APC Coagulation time lee & white,85345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.69,,,,,,,fee schedule,4.69,22,APC Coagulation time activated,85347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.34,,,,,,,fee schedule,4.28,21.78, Coagulation time activated,85347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.78,,,,,,,fee schedule,4.28,21.78, Coagulation time activated,85347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.28,21.78, Coagulation time activated,85347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.28,21.78, Coagulation time activated,85347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.45,,,,,,,fee schedule,4.28,21.78,APC Coagulation time activated,85347,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.49,,,,,,,fee schedule,4.28,21.78,APC Coagulation time activated,85347,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.28,,,,,,,fee schedule,4.28,21.78,APC Coagulation time otr method,85348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.9,,,,,,,fee schedule,4.49,19.03, Coagulation time otr method,85348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.03,,,,,,,fee schedule,4.49,19.03, Coagulation time otr method,85348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.49,19.03, Coagulation time otr method,85348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.49,19.03, Coagulation time otr method,85348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.67,,,,,,,fee schedule,4.49,19.03,APC Coagulation time otr method,85348,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.71,,,,,,,fee schedule,4.49,19.03,APC Coagulation time otr method,85348,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.49,,,,,,,fee schedule,4.49,19.03,APC Euglobulin lysis,85360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.16,,,,,,,fee schedule,8.41,42.97, Euglobulin lysis,85360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.97,,,,,,,fee schedule,8.41,42.97, Euglobulin lysis,85360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.41,42.97, Euglobulin lysis,85360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.41,42.97, Euglobulin lysis,85360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.75,,,,,,,fee schedule,8.41,42.97,APC Euglobulin lysis,85360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.83,,,,,,,fee schedule,8.41,42.97,APC Euglobulin lysis,85360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.41,,,,,,,fee schedule,8.41,42.97,APC Fibrin degradation products,85362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.27,,,,,,,fee schedule,6.89,35.21, Fibrin degradation products,85362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.21,,,,,,,fee schedule,6.89,35.21, Fibrin degradation products,85362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.89,35.21, Fibrin degradation products,85362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.89,35.21, Fibrin degradation products,85362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.17,,,,,,,fee schedule,6.89,35.21,APC Fibrin degradation products,85362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.23,,,,,,,fee schedule,6.89,35.21,APC Fibrin degradation products,85362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.89,,,,,,,fee schedule,6.89,35.21,APC Fibrinogen test,85366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.1,,,,,,,fee schedule,39.1,292.83, Fibrinogen test,85366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.03,,,,,,,fee schedule,39.1,292.83, Fibrinogen test,85366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,256.23,,,,,,,fee schedule,39.1,292.83, Fibrinogen test,85366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,292.83,,,,,,,fee schedule,39.1,292.83, Fibrinogen test,85366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,83.68,,,,,,,fee schedule,39.1,292.83,APC Fibrinogen test,85366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,84.48,,,,,,,fee schedule,39.1,292.83,APC Fibrinogen test,85366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,80.46,,,,,,,fee schedule,39.1,292.83,APC Fibrinogen test,85370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.76,,,,,,,fee schedule,12.43,45.24, Fibrinogen test,85370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.39,,,,,,,fee schedule,12.43,45.24, Fibrinogen test,85370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.43,45.24, Fibrinogen test,85370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.43,45.24, Fibrinogen test,85370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.93,,,,,,,fee schedule,12.43,45.24,APC Fibrinogen test,85370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.05,,,,,,,fee schedule,12.43,45.24,APC Fibrinogen test,85370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.43,,,,,,,fee schedule,12.43,45.24,APC Fibrin degrade semiquant,85378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.4,,,,,,,fee schedule,9.72,36.49, Fibrin degrade semiquant,85378,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.49,,,,,,,fee schedule,9.72,36.49, Fibrin degrade semiquant,85378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.72,36.49, Fibrin degrade semiquant,85378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.72,36.49, Fibrin degrade semiquant,85378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.11,,,,,,,fee schedule,9.72,36.49,APC Fibrin degrade semiquant,85378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.21,,,,,,,fee schedule,9.72,36.49,APC Fibrin degrade semiquant,85378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.72,,,,,,,fee schedule,9.72,36.49,APC Fibrin degradation quant,85379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.76,,,,,,,fee schedule,10.18,41.39, Fibrin degradation quant,85379,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.39,,,,,,,fee schedule,10.18,41.39, Fibrin degradation quant,85379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.18,41.39, Fibrin degradation quant,85379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.18,41.39, Fibrin degradation quant,85379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.59,,,,,,,fee schedule,10.18,41.39,APC Fibrin degradation quant,85379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.69,,,,,,,fee schedule,10.18,41.39,APC Fibrin degradation quant,85379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.18,,,,,,,fee schedule,10.18,41.39,APC Fibrin degradj d-dimer,85380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.76,,,,,,,fee schedule,10.18,41.39, Fibrin degradj d-dimer,85380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.39,,,,,,,fee schedule,10.18,41.39, Fibrin degradj d-dimer,85380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.18,41.39, Fibrin degradj d-dimer,85380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.18,41.39, Fibrin degradj d-dimer,85380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.59,,,,,,,fee schedule,10.18,41.39,APC Fibrin degradj d-dimer,85380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.69,,,,,,,fee schedule,10.18,41.39,APC Fibrin degradj d-dimer,85380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.18,,,,,,,fee schedule,10.18,41.39,APC Fibrinogen activity,85384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.58,,,,,,,fee schedule,9.72,43.44, Fibrinogen activity,85384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.44,,,,,,,fee schedule,9.72,43.44, Fibrinogen activity,85384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.72,43.44, Fibrinogen activity,85384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.72,43.44, Fibrinogen activity,85384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.11,,,,,,,fee schedule,9.72,43.44,APC Fibrinogen activity,85384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.21,,,,,,,fee schedule,9.72,43.44,APC Fibrinogen activity,85384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.72,,,,,,,fee schedule,9.72,43.44,APC Fibrinogen antigen,85385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.58,,,,,,,fee schedule,14.46,52.38, Fibrinogen antigen,85385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.44,,,,,,,fee schedule,14.46,52.38, Fibrinogen antigen,85385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.46,52.38, Fibrinogen antigen,85385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.46,52.38, Fibrinogen antigen,85385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.04,,,,,,,fee schedule,14.46,52.38,APC Fibrinogen antigen,85385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.18,,,,,,,fee schedule,14.46,52.38,APC Fibrinogen antigen,85385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.46,,,,,,,fee schedule,14.46,52.38,APC Fibrinolysins screen i&r,85390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.47,,,,,,,fee schedule,15.48,55.95, Fibrinolysins screen i&r,85390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.43,,,,,,,fee schedule,15.48,55.95, Fibrinolysins screen i&r,85390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.48,55.95, Fibrinolysins screen i&r,85390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.48,55.95, Fibrinolysins screen i&r,85390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.1,,,,,,,fee schedule,15.48,55.95,APC Fibrinolysins screen i&r,85390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.25,,,,,,,fee schedule,15.48,55.95,APC Fibrinolysins screen i&r,85390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.48,,,,,,,fee schedule,15.48,55.95,APC Clotting assay whole blood,85396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.84,,,,,,,fee schedule,31.84,36.39, Clotting assay whole blood,85396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.39,,,,,,,fee schedule,31.84,36.39, Clotting funct activity,85397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,105.63,,,,,,,fee schedule,30.86,118.95, Clotting funct activity,85397,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,118.95,,,,,,,fee schedule,30.86,118.95, Clotting funct activity,85397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,97.91,,,,,,,fee schedule,30.86,118.95, Clotting funct activity,85397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,111.9,,,,,,,fee schedule,30.86,118.95, Clotting funct activity,85397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.09,,,,,,,fee schedule,30.86,118.95,APC Clotting funct activity,85397,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.4,,,,,,,fee schedule,30.86,118.95,APC Clotting funct activity,85397,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.86,,,,,,,fee schedule,30.86,118.95,APC Fibrinolytic plasmin,85400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.17,,,,,,,fee schedule,7.71,45.24, Fibrinolytic plasmin,85400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,45.24,,,,,,,fee schedule,7.71,45.24, Fibrinolytic plasmin,85400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.71,45.24, Fibrinolytic plasmin,85400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.71,45.24, Fibrinolytic plasmin,85400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.02,,,,,,,fee schedule,7.71,45.24,APC Fibrinolytic plasmin,85400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.1,,,,,,,fee schedule,7.71,45.24,APC Fibrinolytic plasmin,85400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.71,,,,,,,fee schedule,7.71,45.24,APC Fibrinolytic antiplasmin,85410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35,,,,,,,fee schedule,7.71,39.42, Fibrinolytic antiplasmin,85410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.42,,,,,,,fee schedule,7.71,39.42, Fibrinolytic antiplasmin,85410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.71,39.42, Fibrinolytic antiplasmin,85410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.71,39.42, Fibrinolytic antiplasmin,85410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.02,,,,,,,fee schedule,7.71,39.42,APC Fibrinolytic antiplasmin,85410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.1,,,,,,,fee schedule,7.71,39.42,APC Fibrinolytic antiplasmin,85410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.71,,,,,,,fee schedule,7.71,39.42,APC Fibrinolytic plasminogen,85415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.98,,,,,,,fee schedule,17.19,74.3, Fibrinolytic plasminogen,85415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.3,,,,,,,fee schedule,17.19,74.3, Fibrinolytic plasminogen,85415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.19,74.3, Fibrinolytic plasminogen,85415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.19,74.3, Fibrinolytic plasminogen,85415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.88,,,,,,,fee schedule,17.19,74.3,APC Fibrinolytic plasminogen,85415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.05,,,,,,,fee schedule,17.19,74.3,APC Fibrinolytic plasminogen,85415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.19,,,,,,,fee schedule,17.19,74.3,APC Fibrinolytic plasminogen,85420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.67,,,,,,,fee schedule,6.53,33.42, Fibrinolytic plasminogen,85420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.42,,,,,,,fee schedule,6.53,33.42, Fibrinolytic plasminogen,85420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.53,33.42, Fibrinolytic plasminogen,85420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.53,33.42, Fibrinolytic plasminogen,85420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.53,33.42,APC Fibrinolytic plasminogen,85420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.86,,,,,,,fee schedule,6.53,33.42,APC Fibrinolytic plasminogen,85420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.53,,,,,,,fee schedule,6.53,33.42,APC Fibrinolytic plasminogen,85421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.25,,,,,,,fee schedule,10.18,52.08, Fibrinolytic plasminogen,85421,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.08,,,,,,,fee schedule,10.18,52.08, Fibrinolytic plasminogen,85421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.18,52.08, Fibrinolytic plasminogen,85421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.18,52.08, Fibrinolytic plasminogen,85421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.59,,,,,,,fee schedule,10.18,52.08,APC Fibrinolytic plasminogen,85421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.69,,,,,,,fee schedule,10.18,52.08,APC Fibrinolytic plasminogen,85421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.18,,,,,,,fee schedule,10.18,52.08,APC Heinz bodies direct,85441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.11,,,,,,,fee schedule,4.2,21.52, Heinz bodies direct,85441,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.52,,,,,,,fee schedule,4.2,21.52, Heinz bodies direct,85441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.2,21.52, Heinz bodies direct,85441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.2,21.52, Heinz bodies direct,85441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.37,,,,,,,fee schedule,4.2,21.52,APC Heinz bodies direct,85441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.41,,,,,,,fee schedule,4.2,21.52,APC Heinz bodies direct,85441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.2,,,,,,,fee schedule,4.2,21.52,APC Heinz bodies induced,85445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.2,,,,,,,fee schedule,6.82,29.5, Heinz bodies induced,85445,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.5,,,,,,,fee schedule,6.82,29.5, Heinz bodies induced,85445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.82,29.5, Heinz bodies induced,85445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.82,29.5, Heinz bodies induced,85445,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.09,,,,,,,fee schedule,6.82,29.5,APC Heinz bodies induced,85445,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.16,,,,,,,fee schedule,6.82,29.5,APC Heinz bodies induced,85445,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.82,,,,,,,fee schedule,6.82,29.5,APC Hemoglobin fetal,85460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.13,,,,,,,fee schedule,7.73,39.56, Hemoglobin fetal,85460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.56,,,,,,,fee schedule,7.73,39.56, Hemoglobin fetal,85460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.73,39.56, Hemoglobin fetal,85460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.73,39.56, Hemoglobin fetal,85460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.04,,,,,,,fee schedule,7.73,39.56,APC Hemoglobin fetal,85460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.12,,,,,,,fee schedule,7.73,39.56,APC Hemoglobin fetal,85460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.73,,,,,,,fee schedule,7.73,39.56,APC Hemoglobin fetal,85461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.1,,,,,,,fee schedule,9.36,34.53, Hemoglobin fetal,85461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.89,,,,,,,fee schedule,9.36,34.53, Hemoglobin fetal,85461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.36,34.53, Hemoglobin fetal,85461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.36,34.53, Hemoglobin fetal,85461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.73,,,,,,,fee schedule,9.36,34.53,APC Hemoglobin fetal,85461,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.83,,,,,,,fee schedule,9.36,34.53,APC Hemoglobin fetal,85461,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.36,,,,,,,fee schedule,9.36,34.53,APC Hemolysin acid,85475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.3,,,,,,,fee schedule,8.87,45.38, Hemolysin acid,85475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,45.38,,,,,,,fee schedule,8.87,45.38, Hemolysin acid,85475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.87,45.38, Hemolysin acid,85475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.87,45.38, Hemolysin acid,85475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.22,,,,,,,fee schedule,8.87,45.38,APC Hemolysin acid,85475,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.31,,,,,,,fee schedule,8.87,45.38,APC Hemolysin acid,85475,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.87,,,,,,,fee schedule,8.87,45.38,APC Heparin assay,85520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.44,,,,,,,fee schedule,13.09,66.94, Heparin assay,85520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.94,,,,,,,fee schedule,13.09,66.94, Heparin assay,85520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.09,66.94, Heparin assay,85520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.09,66.94, Heparin assay,85520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.61,,,,,,,fee schedule,13.09,66.94,APC Heparin assay,85520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.74,,,,,,,fee schedule,13.09,66.94,APC Heparin assay,85520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.09,,,,,,,fee schedule,13.09,66.94,APC Heparin neutralization,85525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.79,,,,,,,fee schedule,11.84,60.57, Heparin neutralization,85525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.57,,,,,,,fee schedule,11.84,60.57, Heparin neutralization,85525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.84,60.57, Heparin neutralization,85525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.84,60.57, Heparin neutralization,85525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.31,,,,,,,fee schedule,11.84,60.57,APC Heparin neutralization,85525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.43,,,,,,,fee schedule,11.84,60.57,APC Heparin neutralization,85525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.84,,,,,,,fee schedule,11.84,60.57,APC Heparin-protamine tolerance,85530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.38,,,,,,,fee schedule,13.09,72.5, Heparin-protamine tolerance,85530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.5,,,,,,,fee schedule,13.09,72.5, Heparin-protamine tolerance,85530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.09,72.5, Heparin-protamine tolerance,85530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.09,72.5, Heparin-protamine tolerance,85530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.61,,,,,,,fee schedule,13.09,72.5,APC Heparin-protamine tolerance,85530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.74,,,,,,,fee schedule,13.09,72.5,APC Heparin-protamine tolerance,85530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.09,,,,,,,fee schedule,13.09,72.5,APC Iron Stain Peripheral Blood,85536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.88,33.09, Iron Stain Peripheral Blood,85536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.88,33.09, Iron Stain Peripheral Blood,85536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.88,33.09, Iron Stain Peripheral Blood,85536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.88,33.09, Iron Stain Peripheral Blood,85536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.16,,,,,,,fee schedule,6.88,33.09,APC Iron Stain Peripheral Blood,85536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.22,,,,,,,fee schedule,6.88,33.09,APC Iron Stain Peripheral Blood,85536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.88,,,,,,,fee schedule,6.88,33.09,APC Wbc alkaline phosphatase,85540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.07,,,,,,,fee schedule,8.6,43.99, Wbc alkaline phosphatase,85540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.99,,,,,,,fee schedule,8.6,43.99, Wbc alkaline phosphatase,85540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.6,43.99, Wbc alkaline phosphatase,85540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.6,43.99, Wbc alkaline phosphatase,85540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.94,,,,,,,fee schedule,8.6,43.99,APC Wbc alkaline phosphatase,85540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.03,,,,,,,fee schedule,8.6,43.99,APC Wbc alkaline phosphatase,85540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.6,,,,,,,fee schedule,8.6,43.99,APC RBC mechanical fragility,85547,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.07,,,,,,,fee schedule,8.6,43.99, RBC mechanical fragility,85547,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.99,,,,,,,fee schedule,8.6,43.99, RBC mechanical fragility,85547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.6,43.99, RBC mechanical fragility,85547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.6,43.99, RBC mechanical fragility,85547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.94,,,,,,,fee schedule,8.6,43.99,APC RBC mechanical fragility,85547,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.03,,,,,,,fee schedule,8.6,43.99,APC RBC mechanical fragility,85547,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.6,,,,,,,fee schedule,8.6,43.99,APC Muramidase,85549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.91,,,,,,,fee schedule,18.75,74.22, Muramidase,85549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.22,,,,,,,fee schedule,18.75,74.22, Muramidase,85549,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,18.75,74.22, Muramidase,85549,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,18.75,74.22, Muramidase,85549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.5,,,,,,,fee schedule,18.75,74.22,APC Muramidase,85549,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.69,,,,,,,fee schedule,18.75,74.22,APC Muramidase,85549,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.75,,,,,,,fee schedule,18.75,74.22,APC RBC osmotic fragility,85555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.15,,,,,,,fee schedule,7.47,32.83, RBC osmotic fragility,85555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.83,,,,,,,fee schedule,7.47,32.83, RBC osmotic fragility,85555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.97,,,,,,,fee schedule,7.47,32.83, RBC osmotic fragility,85555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.39,,,,,,,fee schedule,7.47,32.83, RBC osmotic fragility,85555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.77,,,,,,,fee schedule,7.47,32.83,APC RBC osmotic fragility,85555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.84,,,,,,,fee schedule,7.47,32.83,APC RBC osmotic fragility,85555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.47,,,,,,,fee schedule,7.47,32.83,APC RBC osmotic fragility,85557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.65,,,,,,,fee schedule,13.36,68.3, RBC osmotic fragility,85557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.3,,,,,,,fee schedule,13.36,68.3, RBC osmotic fragility,85557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.36,68.3, RBC osmotic fragility,85557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.36,68.3, RBC osmotic fragility,85557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.89,,,,,,,fee schedule,13.36,68.3,APC RBC osmotic fragility,85557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.03,,,,,,,fee schedule,13.36,68.3,APC RBC osmotic fragility,85557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.36,,,,,,,fee schedule,13.36,68.3,APC Blood platelet aggregation,85576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.53,,,,,,,fee schedule,24.91,109.84, Blood platelet aggregation,85576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.84,,,,,,,fee schedule,24.91,109.84, Blood platelet aggregation,85576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.17,,,,,,,fee schedule,24.91,109.84, Blood platelet aggregation,85576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.48,,,,,,,fee schedule,24.91,109.84, Blood platelet aggregation,85576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.91,,,,,,,fee schedule,24.91,109.84,APC Blood platelet aggregation,85576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.16,,,,,,,fee schedule,24.91,109.84,APC Blood platelet aggregation,85576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.91,,,,,,,fee schedule,24.91,109.84,APC Phospholipid pltlt neutraliz,85597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.64,,,,,,,fee schedule,17.98,91.94, Phospholipid pltlt neutraliz,85597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.94,,,,,,,fee schedule,17.98,91.94, Phospholipid pltlt neutraliz,85597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.98,91.94, Phospholipid pltlt neutraliz,85597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.98,91.94, Phospholipid pltlt neutraliz,85597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.7,,,,,,,fee schedule,17.98,91.94,APC Phospholipid pltlt neutraliz,85597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.88,,,,,,,fee schedule,17.98,91.94,APC Phospholipid pltlt neutraliz,85597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.98,,,,,,,fee schedule,17.98,91.94,APC Hexagnal phosph pltlt neutrl,85598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.74,,,,,,,fee schedule,17.98,93.18, Hexagnal phosph pltlt neutrl,85598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,93.18,,,,,,,fee schedule,17.98,93.18, Hexagnal phosph pltlt neutrl,85598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.98,93.18, Hexagnal phosph pltlt neutrl,85598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.98,93.18, Hexagnal phosph pltlt neutrl,85598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.7,,,,,,,fee schedule,17.98,93.18,APC Hexagnal phosph pltlt neutrl,85598,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.88,,,,,,,fee schedule,17.98,93.18,APC Hexagnal phosph pltlt neutrl,85598,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.98,,,,,,,fee schedule,17.98,93.18,APC Prothrombin time,85610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.84,,,,,,,fee schedule,4.29,20.09, Prothrombin time,85610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.09,,,,,,,fee schedule,4.29,20.09, Prothrombin time,85610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.29,20.09, Prothrombin time,85610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.29,20.09, Prothrombin time,85610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.46,,,,,,,fee schedule,4.29,20.09,APC Prothrombin time,85610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.5,,,,,,,fee schedule,4.29,20.09,APC Prothrombin time,85610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.29,,,,,,,fee schedule,4.29,20.09,APC Prothrombin test,85611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.91,,,,,,,fee schedule,3.94,20.17, Prothrombin test,85611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.17,,,,,,,fee schedule,3.94,20.17, Prothrombin test,85611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,3.94,20.17, Prothrombin test,85611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,3.94,20.17, Prothrombin test,85611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.1,,,,,,,fee schedule,3.94,20.17,APC Prothrombin test,85611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.14,,,,,,,fee schedule,3.94,20.17,APC Prothrombin test,85611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.94,,,,,,,fee schedule,3.94,20.17,APC Viper venom prothrombin time,85612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.45,,,,,,,fee schedule,17.49,63.09, Viper venom prothrombin time,85612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.93,,,,,,,fee schedule,17.49,63.09, Viper venom prothrombin time,85612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.2,,,,,,,fee schedule,17.49,63.09, Viper venom prothrombin time,85612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.09,,,,,,,fee schedule,17.49,63.09, Viper venom prothrombin time,85612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.19,,,,,,,fee schedule,17.49,63.09,APC Viper venom prothrombin time,85612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.36,,,,,,,fee schedule,17.49,63.09,APC Viper venom prothrombin time,85612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.49,,,,,,,fee schedule,17.49,63.09,APC Russell viper venom diluted,85613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.45,,,,,,,fee schedule,9.58,48.93, Russell viper venom diluted,85613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.93,,,,,,,fee schedule,9.58,48.93, Russell viper venom diluted,85613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.58,48.93, Russell viper venom diluted,85613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.58,48.93, Russell viper venom diluted,85613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.96,,,,,,,fee schedule,9.58,48.93,APC Russell viper venom diluted,85613,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.06,,,,,,,fee schedule,9.58,48.93,APC Russell viper venom diluted,85613,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.58,,,,,,,fee schedule,9.58,48.93,APC Reptilase test,85635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.75,,,,,,,fee schedule,9.85,35.76, Reptilase test,85635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.76,,,,,,,fee schedule,9.85,35.76, Reptilase test,85635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.85,35.76, Reptilase test,85635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.85,35.76, Reptilase test,85635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.24,,,,,,,fee schedule,9.85,35.76,APC Reptilase test,85635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.34,,,,,,,fee schedule,9.85,35.76,APC Reptilase test,85635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.85,,,,,,,fee schedule,9.85,35.76,APC Rbc sed rate nonautomated,85651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.12,,,,,,,fee schedule,4.27,18.15, Rbc sed rate nonautomated,85651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.15,,,,,,,fee schedule,4.27,18.15, Rbc sed rate nonautomated,85651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,18.15, Rbc sed rate nonautomated,85651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,18.15, Rbc sed rate nonautomated,85651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,18.15,APC Rbc sed rate nonautomated,85651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,18.15,APC Rbc sed rate nonautomated,85651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,18.15,APC Rbc sed rate automated,85652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.25,,,,,,,fee schedule,2.7,13.8, Rbc sed rate automated,85652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13.8,,,,,,,fee schedule,2.7,13.8, Rbc sed rate automated,85652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.32,,,,,,,fee schedule,2.7,13.8, Rbc sed rate automated,85652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.51,,,,,,,fee schedule,2.7,13.8, Rbc sed rate automated,85652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.81,,,,,,,fee schedule,2.7,13.8,APC Rbc sed rate automated,85652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.84,,,,,,,fee schedule,2.7,13.8,APC Rbc sed rate automated,85652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.7,,,,,,,fee schedule,2.7,13.8,APC RBC sickle cell test,85660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.7,,,,,,,fee schedule,5.51,27.82, RBC sickle cell test,85660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.82,,,,,,,fee schedule,5.51,27.82, RBC sickle cell test,85660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.51,27.82, RBC sickle cell test,85660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.51,27.82, RBC sickle cell test,85660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.73,,,,,,,fee schedule,5.51,27.82,APC RBC sickle cell test,85660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.79,,,,,,,fee schedule,5.51,27.82,APC RBC sickle cell test,85660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.51,,,,,,,fee schedule,5.51,27.82,APC Thrombin time plasma,85670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.27,,,,,,,fee schedule,5.77,26.21, Thrombin time plasma,85670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.21,,,,,,,fee schedule,5.77,26.21, Thrombin time plasma,85670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.77,26.21, Thrombin time plasma,85670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.77,26.21, Thrombin time plasma,85670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6,,,,,,,fee schedule,5.77,26.21,APC Thrombin time plasma,85670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.06,,,,,,,fee schedule,5.77,26.21,APC Thrombin time plasma,85670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.77,,,,,,,fee schedule,5.77,26.21,APC Thrombin time titer,85675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.27,,,,,,,fee schedule,6.85,26.21, Thrombin time titer,85675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.21,,,,,,,fee schedule,6.85,26.21, Thrombin time titer,85675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.85,26.21, Thrombin time titer,85675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.85,26.21, Thrombin time titer,85675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.12,,,,,,,fee schedule,6.85,26.21,APC Thrombin time titer,85675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.19,,,,,,,fee schedule,6.85,26.21,APC Thrombin time titer,85675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.85,,,,,,,fee schedule,6.85,26.21,APC Thromboplastin inhibition,85705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.64,,,,,,,fee schedule,9.63,43.52, Thromboplastin inhibition,85705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.52,,,,,,,fee schedule,9.63,43.52, Thromboplastin inhibition,85705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.63,43.52, Thromboplastin inhibition,85705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.63,43.52, Thromboplastin inhibition,85705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.02,,,,,,,fee schedule,9.63,43.52,APC Thromboplastin inhibition,85705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.11,,,,,,,fee schedule,9.63,43.52,APC Thromboplastin inhibition,85705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.63,,,,,,,fee schedule,9.63,43.52,APC Thromboplastin time partial,85730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.24,,,,,,,fee schedule,6.01,30.67, Thromboplastin time partial,85730,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.67,,,,,,,fee schedule,6.01,30.67, Thromboplastin time partial,85730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,6.01,30.67, Thromboplastin time partial,85730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,6.01,30.67, Thromboplastin time partial,85730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.25,,,,,,,fee schedule,6.01,30.67,APC Thromboplastin time partial,85730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.31,,,,,,,fee schedule,6.01,30.67,APC Thromboplastin time partial,85730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.01,,,,,,,fee schedule,6.01,30.67,APC Thromboplastin time partial,85732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, Thromboplastin time partial,85732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, Thromboplastin time partial,85732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, Thromboplastin time partial,85732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, Thromboplastin time partial,85732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC Thromboplastin time partial,85732,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC Thromboplastin time partial,85732,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Blood viscosity examination,85810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.04,,,,,,,fee schedule,11.67,59.73, Blood viscosity examination,85810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.73,,,,,,,fee schedule,11.67,59.73, Blood viscosity examination,85810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.67,59.73, Blood viscosity examination,85810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.67,59.73, Blood viscosity examination,85810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.14,,,,,,,fee schedule,11.67,59.73,APC Blood viscosity examination,85810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.25,,,,,,,fee schedule,11.67,59.73,APC Blood viscosity examination,85810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.67,,,,,,,fee schedule,11.67,59.73,APC Hematology procedure,85999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.23,,,,,,,fee schedule,13.23,44.82, Hematology procedure,85999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.9,,,,,,,fee schedule,13.23,44.82, Hematology procedure,85999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.22,,,,,,,fee schedule,13.23,44.82, Hematology procedure,85999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.82,,,,,,,fee schedule,13.23,44.82, Agglutinins febrile antigen,86000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.69,,,,,,,fee schedule,6.98,35.69, Agglutinins febrile antigen,86000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.69,,,,,,,fee schedule,6.98,35.69, Agglutinins febrile antigen,86000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.87,,,,,,,fee schedule,6.98,35.69, Agglutinins febrile antigen,86000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.99,,,,,,,fee schedule,6.98,35.69, Agglutinins febrile antigen,86000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.26,,,,,,,fee schedule,6.98,35.69,APC Agglutinins febrile antigen,86000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.33,,,,,,,fee schedule,6.98,35.69,APC Agglutinins febrile antigen,86000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.98,,,,,,,fee schedule,6.98,35.69,APC Allergen Specific Igg,86001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.73,,,,,,,fee schedule,7.82,28.56, Allergen Specific Igg,86001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.72,,,,,,,fee schedule,7.82,28.56, Allergen Specific Igg,86001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.82,28.56, Allergen Specific Igg,86001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.82,28.56, Allergen Specific Igg,86001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.13,,,,,,,fee schedule,7.82,28.56,APC Allergen Specific Igg,86001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.21,,,,,,,fee schedule,7.82,28.56,APC Allergen Specific Igg,86001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.82,,,,,,,fee schedule,7.82,28.56,APC Allergen specific IgE,86003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.73,,,,,,,fee schedule,5.22,26.72, Allergen specific IgE,86003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.72,,,,,,,fee schedule,5.22,26.72, Allergen specific IgE,86003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.22,26.72, Allergen specific IgE,86003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.22,26.72, Allergen specific IgE,86003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.43,,,,,,,fee schedule,5.22,26.72,APC Allergen specific IgE,86003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.48,,,,,,,fee schedule,5.22,26.72,APC Allergen specific IgE,86003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.22,,,,,,,fee schedule,5.22,26.72,APC Allergen specific IgE,86005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.16,,,,,,,fee schedule,7.97,28.56, Allergen specific IgE,86005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.82,,,,,,,fee schedule,7.97,28.56, Allergen specific IgE,86005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.97,28.56, Allergen specific IgE,86005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.97,28.56, Allergen specific IgE,86005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.29,,,,,,,fee schedule,7.97,28.56,APC Allergen specific IgE,86005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.37,,,,,,,fee schedule,7.97,28.56,APC Allergen specific IgE,86005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.97,,,,,,,fee schedule,7.97,28.56,APC Allg spec ige recomb ea,86008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.93,65.46, Allg spec ige recomb ea,86008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.93,65.46, Allg spec ige recomb ea,86008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.65,,,,,,,fee schedule,17.93,65.46,APC Allg spec ige recomb ea,86008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.83,,,,,,,fee schedule,17.93,65.46,APC Allg spec ige recomb ea,86008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.93,,,,,,,fee schedule,17.93,65.46,APC Actin antibody each,86015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.47,,,,,,,fee schedule,12.05,44.04, Actin antibody each,86015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.2,,,,,,,fee schedule,12.05,44.04, Actin antibody each,86015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.04, Actin antibody each,86015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.04, Actin antibody each,86015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.04,APC Actin antibody each,86015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.04,APC Actin antibody each,86015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.04,APC WBC antibody identification,86021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.32,,,,,,,fee schedule,15.05,54.75, WBC antibody identification,86021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.29,,,,,,,fee schedule,15.05,54.75, WBC antibody identification,86021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.05,54.75, WBC antibody identification,86021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.05,54.75, WBC antibody identification,86021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.65,,,,,,,fee schedule,15.05,54.75,APC WBC antibody identification,86021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.8,,,,,,,fee schedule,15.05,54.75,APC WBC antibody identification,86021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.05,,,,,,,fee schedule,15.05,54.75,APC Platelet antibodies,86022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.32,,,,,,,fee schedule,18.37,66.66, Platelet antibodies,86022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.29,,,,,,,fee schedule,18.37,66.66, Platelet antibodies,86022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.37,66.66, Platelet antibodies,86022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.37,66.66, Platelet antibodies,86022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.1,,,,,,,fee schedule,18.37,66.66,APC Platelet antibodies,86022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.29,,,,,,,fee schedule,18.37,66.66,APC Platelet antibodies,86022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.37,,,,,,,fee schedule,18.37,66.66,APC Immunoglobulin assay,86023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.55,,,,,,,fee schedule,12.46,63.68, Immunoglobulin assay,86023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.68,,,,,,,fee schedule,12.46,63.68, Immunoglobulin assay,86023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.46,63.68, Immunoglobulin assay,86023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.46,63.68, Immunoglobulin assay,86023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.96,,,,,,,fee schedule,12.46,63.68,APC Immunoglobulin assay,86023,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.08,,,,,,,fee schedule,12.46,63.68,APC Immunoglobulin assay,86023,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,12.46,63.68,APC Anca screen each antibody,86036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.16,,,,,,,fee schedule,12.05,44.1, Anca screen each antibody,86036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.1,,,,,,,fee schedule,12.05,44.1, Anca screen each antibody,86036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.1, Anca screen each antibody,86036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.1, Anca screen each antibody,86036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.1,APC Anca screen each antibody,86036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.1,APC Anca screen each antibody,86036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.1,APC Anca titer each antibody,86037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.16,,,,,,,fee schedule,12.05,44.1, Anca titer each antibody,86037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.1,,,,,,,fee schedule,12.05,44.1, Anca titer each antibody,86037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.1, Anca titer each antibody,86037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.1, Anca titer each antibody,86037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.1,APC Anca titer each antibody,86037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.1,APC Anca titer each antibody,86037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.1,APC Antinuclear antibodies,86038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.89,,,,,,,fee schedule,12.09,61.82, Antinuclear antibodies,86038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.82,,,,,,,fee schedule,12.09,61.82, Antinuclear antibodies,86038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.09,61.82, Antinuclear antibodies,86038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.09,61.82, Antinuclear antibodies,86038,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.57,,,,,,,fee schedule,12.09,61.82,APC Antinuclear antibodies,86038,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.69,,,,,,,fee schedule,12.09,61.82,APC Antinuclear antibodies,86038,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.09,,,,,,,fee schedule,12.09,61.82,APC Antinuclear antibodies (ANA),86039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.7,,,,,,,fee schedule,11.16,57.1, Antinuclear antibodies (ANA),86039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.1,,,,,,,fee schedule,11.16,57.1, Antinuclear antibodies (ANA),86039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.41,,,,,,,fee schedule,11.16,57.1, Antinuclear antibodies (ANA),86039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.47,,,,,,,fee schedule,11.16,57.1, Antinuclear antibodies (ANA),86039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.61,,,,,,,fee schedule,11.16,57.1,APC Antinuclear antibodies (ANA),86039,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.72,,,,,,,fee schedule,11.16,57.1,APC Antinuclear antibodies (ANA),86039,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.16,,,,,,,fee schedule,11.16,57.1,APC Acetylcholn rcptr bndng antb,86041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.8,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr bndng antb,86041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.34,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr bndng antb,86041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr bndng antb,86041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr bndng antb,86041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.14,,,,,,,fee schedule,18.4,67.34,APC Acetylcholn rcptr bndng antb,86041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.32,,,,,,,fee schedule,18.4,67.34,APC Acetylcholn rcptr bndng antb,86041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.4,,,,,,,fee schedule,18.4,67.34,APC Acetylcholn rcptr blckg antb,86042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.8,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr blckg antb,86042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.34,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr blckg antb,86042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr blckg antb,86042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.4,67.34, Acetylcholn rcptr blckg antb,86042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.14,,,,,,,fee schedule,18.4,67.34,APC Acetylcholn rcptr blckg antb,86042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.32,,,,,,,fee schedule,18.4,67.34,APC Acetylcholn rcptr blckg antb,86042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.4,,,,,,,fee schedule,18.4,67.34,APC Acetylcholn rcptr modlg antb,86043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.16,,,,,,,fee schedule,12.05,44.1, Acetylcholn rcptr modlg antb,86043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.1,,,,,,,fee schedule,12.05,44.1, Acetylcholn rcptr modlg antb,86043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.1, Acetylcholn rcptr modlg antb,86043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.1, Acetylcholn rcptr modlg antb,86043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.1,APC Acetylcholn rcptr modlg antb,86043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.1,APC Acetylcholn rcptr modlg antb,86043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.1,APC Aquaporin-4 antb elisa,86051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.47,,,,,,,fee schedule,11.53,42.2, Aquaporin-4 antb elisa,86051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.2,,,,,,,fee schedule,11.53,42.2, Aquaporin-4 antb elisa,86051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,42.2, Aquaporin-4 antb elisa,86051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,42.2, Aquaporin-4 antb elisa,86051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,42.2,APC Aquaporin-4 antb elisa,86051,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,42.2,APC Aquaporin-4 antb elisa,86051,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,42.2,APC Aquaporin-4 antb cba each,86052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.16,,,,,,,fee schedule,12.05,44.1, Aquaporin-4 antb cba each,86052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.1,,,,,,,fee schedule,12.05,44.1, Aquaporin-4 antb cba each,86052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.1, Aquaporin-4 antb cba each,86052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.1, Aquaporin-4 antb cba each,86052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.1,APC Aquaporin-4 antb cba each,86052,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.1,APC Aquaporin-4 antb cba each,86052,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.1,APC Aqaprn-4 antb flo cytmtry ea,86053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.16,,,,,,,fee schedule,37.73,136.89, Aqaprn-4 antb flo cytmtry ea,86053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.1,,,,,,,fee schedule,37.73,136.89, Aqaprn-4 antb flo cytmtry ea,86053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.78,,,,,,,fee schedule,37.73,136.89, Aqaprn-4 antb flo cytmtry ea,86053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,136.89,,,,,,,fee schedule,37.73,136.89, Aqaprn-4 antb flo cytmtry ea,86053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.24,,,,,,,fee schedule,37.73,136.89,APC Aqaprn-4 antb flo cytmtry ea,86053,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.62,,,,,,,fee schedule,37.73,136.89,APC Aqaprn-4 antb flo cytmtry ea,86053,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,37.73,136.89,APC Antistreptolysin o titer,86060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.15,,,,,,,fee schedule,7.3,37.33, Antistreptolysin o titer,86060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.33,,,,,,,fee schedule,7.3,37.33, Antistreptolysin o titer,86060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.3,37.33, Antistreptolysin o titer,86060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.3,37.33, Antistreptolysin o titer,86060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.59,,,,,,,fee schedule,7.3,37.33,APC Antistreptolysin o titer,86060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.66,,,,,,,fee schedule,7.3,37.33,APC Antistreptolysin o titer,86060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.3,,,,,,,fee schedule,7.3,37.33,APC Antistreptolysin o screen,86063,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.23,,,,,,,fee schedule,5.77,29.54, Antistreptolysin o screen,86063,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.54,,,,,,,fee schedule,5.77,29.54, Antistreptolysin o screen,86063,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.77,29.54, Antistreptolysin o screen,86063,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.77,29.54, Antistreptolysin o screen,86063,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6,,,,,,,fee schedule,5.77,29.54,APC Antistreptolysin o screen,86063,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.06,,,,,,,fee schedule,5.77,29.54,APC Antistreptolysin o screen,86063,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.77,,,,,,,fee schedule,5.77,29.54,APC Phys blood bank serv xmatch,86077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.39,,,,,,,fee schedule,34.17,91.95, Phys blood bank serv xmatch,86077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.14,,,,,,,fee schedule,34.17,91.95, Phys blood bank serv xmatch,86077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.46,,,,,,,fee schedule,34.17,91.95, Phys blood bank serv xmatch,86077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.95,,,,,,,fee schedule,34.17,91.95, Phys blood bank serv xmatch,86077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,91.95,APC Phys blood bank serv xmatch,86077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,91.95,APC Phys blood bank serv xmatch,86077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,91.95,APC Phys blood bank serv reactj,86078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.15,,,,,,,fee schedule,80.46,211.33, Phys blood bank serv reactj,86078,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,115.03,,,,,,,fee schedule,80.46,211.33, Phys blood bank serv reactj,86078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.46,,,,,,,fee schedule,80.46,211.33, Phys blood bank serv reactj,86078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.95,,,,,,,fee schedule,80.46,211.33, Phys blood bank serv reactj,86078,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,80.46,211.33,APC Phys blood bank serv reactj,86078,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,80.46,211.33,APC Phys blood bank serv reactj,86078,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,80.46,211.33,APC Phys blood bank serv authrj,86079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.63,,,,,,,fee schedule,58.63,91.95, Phys blood bank serv authrj,86079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.03,,,,,,,fee schedule,58.63,91.95, Phys blood bank serv authrj,86079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.46,,,,,,,fee schedule,58.63,91.95, Phys blood bank serv authrj,86079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.95,,,,,,,fee schedule,58.63,91.95, Phys blood bank serv authrj,86079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,58.63,91.95,APC Phys blood bank serv authrj,86079,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,58.63,91.95,APC Phys blood bank serv authrj,86079,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,58.63,91.95,APC C-reactive protein,86140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,5.18,26.46, C-reactive protein,86140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,5.18,26.46, C-reactive protein,86140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.18,26.46, C-reactive protein,86140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.18,26.46, C-reactive protein,86140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.18,26.46,APC C-reactive protein,86140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.44,,,,,,,fee schedule,5.18,26.46,APC C-reactive protein,86140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.18,,,,,,,fee schedule,5.18,26.46,APC C-reactive protein hs,86141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,12.95,66.21, C-reactive protein hs,86141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,12.95,66.21, C-reactive protein hs,86141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,12.95,66.21, C-reactive protein hs,86141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,12.95,66.21, C-reactive protein hs,86141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.47,,,,,,,fee schedule,12.95,66.21,APC C-reactive protein hs,86141,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.6,,,,,,,fee schedule,12.95,66.21,APC C-reactive protein hs,86141,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.95,,,,,,,fee schedule,12.95,66.21,APC Beta-2 glycoprotein antibody,86146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.51,,,,,,,fee schedule,25.45,130.08, Beta-2 glycoprotein antibody,86146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.08,,,,,,,fee schedule,25.45,130.08, Beta-2 glycoprotein antibody,86146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.45,130.08, Beta-2 glycoprotein antibody,86146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.45,130.08, Beta-2 glycoprotein antibody,86146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.47,,,,,,,fee schedule,25.45,130.08,APC Beta-2 glycoprotein antibody,86146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.72,,,,,,,fee schedule,25.45,130.08,APC Beta-2 glycoprotein antibody,86146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.45,,,,,,,fee schedule,25.45,130.08,APC Cardiolipin antibody ea ig,86147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.51,,,,,,,fee schedule,25.45,130.08, Cardiolipin antibody ea ig,86147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.08,,,,,,,fee schedule,25.45,130.08, Cardiolipin antibody ea ig,86147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.45,130.08, Cardiolipin antibody ea ig,86147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.45,130.08, Cardiolipin antibody ea ig,86147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.47,,,,,,,fee schedule,25.45,130.08,APC Cardiolipin antibody ea ig,86147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.72,,,,,,,fee schedule,25.45,130.08,APC Cardiolipin antibody ea ig,86147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.45,,,,,,,fee schedule,25.45,130.08,APC Anti-phospholipid antibody,86148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.08,,,,,,,fee schedule,16.07,58.32, Anti-phospholipid antibody,86148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.76,,,,,,,fee schedule,16.07,58.32, Anti-phospholipid antibody,86148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.07,58.32, Anti-phospholipid antibody,86148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.07,58.32, Anti-phospholipid antibody,86148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.71,,,,,,,fee schedule,16.07,58.32,APC Anti-phospholipid antibody,86148,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.07,58.32,APC Anti-phospholipid antibody,86148,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.07,,,,,,,fee schedule,16.07,58.32,APC Cell enumeration & id,86152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,690.11,,,,,,,fee schedule,250.78,911.82, Cell enumeration & id,86152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,777.16,,,,,,,fee schedule,250.78,911.82, Cell enumeration & id,86152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,797.84,,,,,,,fee schedule,250.78,911.82, Cell enumeration & id,86152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,911.82,,,,,,,fee schedule,250.78,911.82, Cell enumeration & id,86152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,260.81,,,,,,,fee schedule,250.78,911.82,APC Cell enumeration & id,86152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.32,,,,,,,fee schedule,250.78,911.82,APC Cell enumeration & id,86152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,250.78,911.82,APC Chemotaxis assay,86155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.57,,,,,,,fee schedule,15.99,81.73, Chemotaxis assay,86155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.73,,,,,,,fee schedule,15.99,81.73, Chemotaxis assay,86155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,15.99,81.73, Chemotaxis assay,86155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,15.99,81.73, Chemotaxis assay,86155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.63,,,,,,,fee schedule,15.99,81.73,APC Chemotaxis assay,86155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.79,,,,,,,fee schedule,15.99,81.73,APC Chemotaxis assay,86155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.99,,,,,,,fee schedule,15.99,81.73,APC Cold agglutinin screen,86156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.99,,,,,,,fee schedule,8.07,32.65, Cold agglutinin screen,86156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.65,,,,,,,fee schedule,8.07,32.65, Cold agglutinin screen,86156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.07,32.65, Cold agglutinin screen,86156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.07,32.65, Cold agglutinin screen,86156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.39,,,,,,,fee schedule,8.07,32.65,APC Cold agglutinin screen,86156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.47,,,,,,,fee schedule,8.07,32.65,APC Cold agglutinin screen,86156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.07,,,,,,,fee schedule,8.07,32.65,APC Cold agglutinin titer,86157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.63,,,,,,,fee schedule,8.06,41.25, Cold agglutinin titer,86157,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.25,,,,,,,fee schedule,8.06,41.25, Cold agglutinin titer,86157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.06,41.25, Cold agglutinin titer,86157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.06,41.25, Cold agglutinin titer,86157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.38,,,,,,,fee schedule,8.06,41.25,APC Cold agglutinin titer,86157,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.46,,,,,,,fee schedule,8.06,41.25,APC Cold agglutinin titer,86157,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.06,,,,,,,fee schedule,8.06,41.25,APC Complement antigen,86160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.54,,,,,,,fee schedule,12,61.41, Complement antigen,86160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.41,,,,,,,fee schedule,12,61.41, Complement antigen,86160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12,61.41, Complement antigen,86160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12,61.41, Complement antigen,86160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.48,,,,,,,fee schedule,12,61.41,APC Complement antigen,86160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.6,,,,,,,fee schedule,12,61.41,APC Complement antigen,86160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12,,,,,,,fee schedule,12,61.41,APC Complement/function activity,86161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.54,,,,,,,fee schedule,12,61.41, Complement/function activity,86161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.41,,,,,,,fee schedule,12,61.41, Complement/function activity,86161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12,61.41, Complement/function activity,86161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12,61.41, Complement/function activity,86161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.48,,,,,,,fee schedule,12,61.41,APC Complement/function activity,86161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.6,,,,,,,fee schedule,12,61.41,APC Complement/function activity,86161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12,,,,,,,fee schedule,12,61.41,APC Complement total (ch50),86162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.27,,,,,,,fee schedule,20.32,103.91, Complement total (ch50),86162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.91,,,,,,,fee schedule,20.32,103.91, Complement total (ch50),86162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.32,103.91, Complement total (ch50),86162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.32,103.91, Complement total (ch50),86162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.13,,,,,,,fee schedule,20.32,103.91,APC Complement total (ch50),86162,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.34,,,,,,,fee schedule,20.32,103.91,APC Complement total (ch50),86162,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.32,,,,,,,fee schedule,20.32,103.91,APC Complement fixation each,86171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.94,,,,,,,fee schedule,10.01,49.48, Complement fixation each,86171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.48,,,,,,,fee schedule,10.01,49.48, Complement fixation each,86171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.01,49.48, Complement fixation each,86171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.01,49.48, Complement fixation each,86171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.41,,,,,,,fee schedule,10.01,49.48,APC Complement fixation each,86171,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.51,,,,,,,fee schedule,10.01,49.48,APC Complement fixation each,86171,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.01,,,,,,,fee schedule,10.01,49.48,APC Ccp antibody,86200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.61,,,,,,,fee schedule,12.95,67.12, Ccp antibody,86200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.12,,,,,,,fee schedule,12.95,67.12, Ccp antibody,86200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,12.95,67.12, Ccp antibody,86200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,12.95,67.12, Ccp antibody,86200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.47,,,,,,,fee schedule,12.95,67.12,APC Ccp antibody,86200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.6,,,,,,,fee schedule,12.95,67.12,APC Ccp antibody,86200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.95,,,,,,,fee schedule,12.95,67.12,APC Deoxyribonuclease antibody,86215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.16,,,,,,,fee schedule,13.25,67.75, Deoxyribonuclease antibody,86215,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.75,,,,,,,fee schedule,13.25,67.75, Deoxyribonuclease antibody,86215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,67.75, Deoxyribonuclease antibody,86215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,67.75, Deoxyribonuclease antibody,86215,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,67.75,APC Deoxyribonuclease antibody,86215,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,67.75,APC Deoxyribonuclease antibody,86215,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,67.75,APC Dna antibody native,86225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.4,,,,,,,fee schedule,13.74,70.27, Dna antibody native,86225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.27,,,,,,,fee schedule,13.74,70.27, Dna antibody native,86225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.74,70.27, Dna antibody native,86225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.74,70.27, Dna antibody native,86225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.29,,,,,,,fee schedule,13.74,70.27,APC Dna antibody native,86225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.43,,,,,,,fee schedule,13.74,70.27,APC Dna antibody native,86225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.74,,,,,,,fee schedule,13.74,70.27,APC Dna antibody single strand,86226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.99,,,,,,,fee schedule,12.11,61.93, Dna antibody single strand,86226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.93,,,,,,,fee schedule,12.11,61.93, Dna antibody single strand,86226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.11,61.93, Dna antibody single strand,86226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.11,61.93, Dna antibody single strand,86226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.59,,,,,,,fee schedule,12.11,61.93,APC Dna antibody single strand,86226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.72,,,,,,,fee schedule,12.11,61.93,APC Dna antibody single strand,86226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,12.11,61.93,APC Ema each ig class,86231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.29,,,,,,,fee schedule,12.09,44.25, Ema each ig class,86231,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.25,,,,,,,fee schedule,12.09,44.25, Ema each ig class,86231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.09,44.25, Ema each ig class,86231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.09,44.25, Ema each ig class,86231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.57,,,,,,,fee schedule,12.09,44.25,APC Ema each ig class,86231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.69,,,,,,,fee schedule,12.09,44.25,APC Ema each ig class,86231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.09,,,,,,,fee schedule,12.09,44.25,APC Nuclear antigen antibody,86235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.45,,,,,,,fee schedule,17.93,91.72, Nuclear antigen antibody,86235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.72,,,,,,,fee schedule,17.93,91.72, Nuclear antigen antibody,86235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.93,91.72, Nuclear antigen antibody,86235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.93,91.72, Nuclear antigen antibody,86235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.65,,,,,,,fee schedule,17.93,91.72,APC Nuclear antigen antibody,86235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.83,,,,,,,fee schedule,17.93,91.72,APC Nuclear antigen antibody,86235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.93,,,,,,,fee schedule,17.93,91.72,APC Fluorescent antibody screen,86255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.73,,,,,,,fee schedule,12.05,61.63, Fluorescent antibody screen,86255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.63,,,,,,,fee schedule,12.05,61.63, Fluorescent antibody screen,86255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,61.63, Fluorescent antibody screen,86255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,61.63, Fluorescent antibody screen,86255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,61.63,APC Fluorescent antibody screen,86255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,61.63,APC Fluorescent antibody screen,86255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,61.63,APC Fluorescent antibody titer,86256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.72,,,,,,,fee schedule,12.05,44.73, Fluorescent antibody titer,86256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.73,,,,,,,fee schedule,12.05,44.73, Fluorescent antibody titer,86256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.73, Fluorescent antibody titer,86256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.73, Fluorescent antibody titer,86256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.73,APC Fluorescent antibody titer,86256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.73,APC Fluorescent antibody titer,86256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.73,APC Dgp antibody each ig class,86258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.47,,,,,,,fee schedule,12.05,44.04, Dgp antibody each ig class,86258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.2,,,,,,,fee schedule,12.05,44.04, Dgp antibody each ig class,86258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.04, Dgp antibody each ig class,86258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.04, Dgp antibody each ig class,86258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.04,APC Dgp antibody each ig class,86258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.04,APC Dgp antibody each ig class,86258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.04,APC Growth hormone antibody,86277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.47,,,,,,,fee schedule,15.74,80.48, Growth hormone antibody,86277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.48,,,,,,,fee schedule,15.74,80.48, Growth hormone antibody,86277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.01,,,,,,,fee schedule,15.74,80.48, Growth hormone antibody,86277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.15,,,,,,,fee schedule,15.74,80.48, Growth hormone antibody,86277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.37,,,,,,,fee schedule,15.74,80.48,APC Growth hormone antibody,86277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.53,,,,,,,fee schedule,15.74,80.48,APC Growth hormone antibody,86277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.74,,,,,,,fee schedule,15.74,80.48,APC Hemagglutination inhibition,86280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.18,,,,,,,fee schedule,8.19,41.87, Hemagglutination inhibition,86280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.87,,,,,,,fee schedule,8.19,41.87, Hemagglutination inhibition,86280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.19,41.87, Hemagglutination inhibition,86280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.19,41.87, Hemagglutination inhibition,86280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.52,,,,,,,fee schedule,8.19,41.87,APC Hemagglutination inhibition,86280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.6,,,,,,,fee schedule,8.19,41.87,APC Hemagglutination inhibition,86280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.19,,,,,,,fee schedule,8.19,41.87,APC Immunoassay tumor qual,86294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.46,,,,,,,fee schedule,25.57,92.85, Immunoassay tumor qual,86294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.49,,,,,,,fee schedule,25.57,92.85, Immunoassay tumor qual,86294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.57,92.85, Immunoassay tumor qual,86294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.57,92.85, Immunoassay tumor qual,86294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.59,,,,,,,fee schedule,25.57,92.85,APC Immunoassay tumor qual,86294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.85,,,,,,,fee schedule,25.57,92.85,APC Immunoassay tumor qual,86294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.57,,,,,,,fee schedule,25.57,92.85,APC Immunoassay tumor ca 15-3,86300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.48,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 15-3,86300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.4,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 15-3,86300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 15-3,86300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 15-3,86300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 15-3,86300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 15-3,86300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 19-9,86301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.48,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 19-9,86301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.4,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 19-9,86301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 19-9,86301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 19-9,86301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 19-9,86301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 19-9,86301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 125,86304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.48,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 125,86304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.4,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 125,86304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 125,86304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor ca 125,86304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 125,86304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor ca 125,86304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,106.4,APC Human epididymis protein 4,86305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.81,,,,,,,fee schedule,20.81,107.9, Human epididymis protein 4,86305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,107.9,,,,,,,fee schedule,20.81,107.9, Human epididymis protein 4,86305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.81,107.9, Human epididymis protein 4,86305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.81,107.9, Human epididymis protein 4,86305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,107.9,APC Human epididymis protein 4,86305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,107.9,APC Human epididymis protein 4,86305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,107.9,APC Heterophile antibody screen,86308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,5.18,26.46, Heterophile antibody screen,86308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,5.18,26.46, Heterophile antibody screen,86308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.18,26.46, Heterophile antibody screen,86308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.18,26.46, Heterophile antibody screen,86308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.18,26.46,APC Heterophile antibody screen,86308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.44,,,,,,,fee schedule,5.18,26.46,APC Heterophile antibody screen,86308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.18,,,,,,,fee schedule,5.18,26.46,APC Heterophile antibody titer,86309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, Heterophile antibody titer,86309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, Heterophile antibody titer,86309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, Heterophile antibody titer,86309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, Heterophile antibody titer,86309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC Heterophile antibody titer,86309,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC Heterophile antibody titer,86309,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Heterophile antibody absrbj,86310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.48,,,,,,,fee schedule,7.37,37.7, Heterophile antibody absrbj,86310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.7,,,,,,,fee schedule,7.37,37.7, Heterophile antibody absrbj,86310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.97,,,,,,,fee schedule,7.37,37.7, Heterophile antibody absrbj,86310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.39,,,,,,,fee schedule,7.37,37.7, Heterophile antibody absrbj,86310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.66,,,,,,,fee schedule,7.37,37.7,APC Heterophile antibody absrbj,86310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.74,,,,,,,fee schedule,7.37,37.7,APC Heterophile antibody absrbj,86310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.37,,,,,,,fee schedule,7.37,37.7,APC Immunoassay tumor other,86316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.48,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor other,86316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.4,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor other,86316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor other,86316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,20.81,106.4, Immunoassay tumor other,86316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.64,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor other,86316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.85,,,,,,,fee schedule,20.81,106.4,APC Immunoassay tumor other,86316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.81,,,,,,,fee schedule,20.81,106.4,APC Immunoassay infectious agent,86317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.09,,,,,,,fee schedule,14.99,76.68, Immunoassay infectious agent,86317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.68,,,,,,,fee schedule,14.99,76.68, Immunoassay infectious agent,86317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,14.99,76.68, Immunoassay infectious agent,86317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,14.99,76.68, Immunoassay infectious agent,86317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.59,,,,,,,fee schedule,14.99,76.68,APC Immunoassay infectious agent,86317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.74,,,,,,,fee schedule,14.99,76.68,APC Immunoassay infectious agent,86317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.99,,,,,,,fee schedule,14.99,76.68,APC Immunoassay infectious agent,86318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.79,,,,,,,fee schedule,18.09,66.21, Immunoassay infectious agent,86318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.21,,,,,,,fee schedule,18.09,66.21, Immunoassay infectious agent,86318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.09,66.21, Immunoassay infectious agent,86318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.09,66.21, Immunoassay infectious agent,86318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.81,,,,,,,fee schedule,18.09,66.21,APC Immunoassay infectious agent,86318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.99,,,,,,,fee schedule,18.09,66.21,APC Immunoassay infectious agent,86318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.09,,,,,,,fee schedule,18.09,66.21,APC Serum immunoelectrophoresis,86320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.79,,,,,,,fee schedule,29.92,114.63, Serum immunoelectrophoresis,86320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.63,,,,,,,fee schedule,29.92,114.63, Serum immunoelectrophoresis,86320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,29.92,114.63, Serum immunoelectrophoresis,86320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,29.92,114.63, Serum immunoelectrophoresis,86320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.12,,,,,,,fee schedule,29.92,114.63,APC Serum immunoelectrophoresis,86320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.42,,,,,,,fee schedule,29.92,114.63,APC Serum immunoelectrophoresis,86320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.92,,,,,,,fee schedule,29.92,114.63,APC Other immunoelectrophoresis,86325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.53,,,,,,,fee schedule,23.13,114.34, Other immunoelectrophoresis,86325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.34,,,,,,,fee schedule,23.13,114.34, Other immunoelectrophoresis,86325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,73.95,,,,,,,fee schedule,23.13,114.34, Other immunoelectrophoresis,86325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,84.51,,,,,,,fee schedule,23.13,114.34, Other immunoelectrophoresis,86325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.06,,,,,,,fee schedule,23.13,114.34,APC Other immunoelectrophoresis,86325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.29,,,,,,,fee schedule,23.13,114.34,APC Other immunoelectrophoresis,86325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.13,,,,,,,fee schedule,23.13,114.34,APC Immunoelectrophoresis assay,86327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,103.03,,,,,,,fee schedule,94.79,116.02, Immunoelectrophoresis assay,86327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.02,,,,,,,fee schedule,94.79,116.02, Immunoelectrophoresis assay,86327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,94.79,116.02, Immunoelectrophoresis assay,86327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,94.79,116.02, Ia nfct ab sarscov2 covid19,86328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,147,,,,,,,fee schedule,45.28,165.54, Ia nfct ab sarscov2 covid19,86328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,165.54,,,,,,,fee schedule,45.28,165.54, Ia nfct ab sarscov2 covid19,86328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,143.75,,,,,,,fee schedule,45.28,165.54, Ia nfct ab sarscov2 covid19,86328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,164.28,,,,,,,fee schedule,45.28,165.54, Ia nfct ab sarscov2 covid19,86328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,47.09,,,,,,,fee schedule,45.28,165.54,APC Ia nfct ab sarscov2 covid19,86328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,47.54,,,,,,,fee schedule,45.28,165.54,APC Ia nfct ab sarscov2 covid19,86328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,45.28,,,,,,,fee schedule,45.28,165.54,APC Immunodiffusion nes,86329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.52,,,,,,,fee schedule,14.05,54.64, Immunodiffusion nes,86329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.64,,,,,,,fee schedule,14.05,54.64, Immunodiffusion nes,86329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.05,54.64, Immunodiffusion nes,86329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.05,54.64, Immunodiffusion nes,86329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.61,,,,,,,fee schedule,14.05,54.64,APC Immunodiffusion nes,86329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.75,,,,,,,fee schedule,14.05,54.64,APC Immunodiffusion nes,86329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.05,,,,,,,fee schedule,14.05,54.64,APC Immunodiffusion ouchterlony,86331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.44,,,,,,,fee schedule,11.98,61.31, Immunodiffusion ouchterlony,86331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.31,,,,,,,fee schedule,11.98,61.31, Immunodiffusion ouchterlony,86331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,61.31, Immunodiffusion ouchterlony,86331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,61.31, Immunodiffusion ouchterlony,86331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,61.31,APC Immunodiffusion ouchterlony,86331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,61.31,APC Immunodiffusion ouchterlony,86331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,61.31,APC Immune complex assay,86332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,110.66,,,,,,,fee schedule,24.37,124.62, Immune complex assay,86332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,124.62,,,,,,,fee schedule,24.37,124.62, Immune complex assay,86332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,24.37,124.62, Immune complex assay,86332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,24.37,124.62, Immune complex assay,86332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.34,,,,,,,fee schedule,24.37,124.62,APC Immune complex assay,86332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.59,,,,,,,fee schedule,24.37,124.62,APC Immune complex assay,86332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.37,,,,,,,fee schedule,24.37,124.62,APC Immunofix e-phoresis serum,86334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.43,,,,,,,fee schedule,22.34,114.23, Immunofix e-phoresis serum,86334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.23,,,,,,,fee schedule,22.34,114.23, Immunofix e-phoresis serum,86334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.82,,,,,,,fee schedule,22.34,114.23, Immunofix e-phoresis serum,86334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.94,,,,,,,fee schedule,22.34,114.23, Immunofix e-phoresis serum,86334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.23,,,,,,,fee schedule,22.34,114.23,APC Immunofix e-phoresis serum,86334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.46,,,,,,,fee schedule,22.34,114.23,APC Immunofix e-phoresis serum,86334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.34,,,,,,,fee schedule,22.34,114.23,APC Immunfix e-phorsis/urine/csf,86335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,133.25,,,,,,,fee schedule,29.35,150.06, Immunfix e-phorsis/urine/csf,86335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,150.06,,,,,,,fee schedule,29.35,150.06, Immunfix e-phorsis/urine/csf,86335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,93.74,,,,,,,fee schedule,29.35,150.06, Immunfix e-phorsis/urine/csf,86335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,107.13,,,,,,,fee schedule,29.35,150.06, Immunfix e-phorsis/urine/csf,86335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.52,,,,,,,fee schedule,29.35,150.06,APC Immunfix e-phorsis/urine/csf,86335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.82,,,,,,,fee schedule,29.35,150.06,APC Immunfix e-phorsis/urine/csf,86335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.35,,,,,,,fee schedule,29.35,150.06,APC Inhibin A,86336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.75,,,,,,,fee schedule,15.59,79.68, Inhibin A,86336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.68,,,,,,,fee schedule,15.59,79.68, Inhibin A,86336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.01,,,,,,,fee schedule,15.59,79.68, Inhibin A,86336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.15,,,,,,,fee schedule,15.59,79.68, Inhibin A,86336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.21,,,,,,,fee schedule,15.59,79.68,APC Inhibin A,86336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.37,,,,,,,fee schedule,15.59,79.68,APC Inhibin A,86336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.59,,,,,,,fee schedule,15.59,79.68,APC Insulin antibodies,86337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.01,,,,,,,fee schedule,21.41,88.97, Insulin antibodies,86337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.97,,,,,,,fee schedule,21.41,88.97, Insulin antibodies,86337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.7,,,,,,,fee schedule,21.41,88.97, Insulin antibodies,86337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,77.37,,,,,,,fee schedule,21.41,88.97, Insulin antibodies,86337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.27,,,,,,,fee schedule,21.41,88.97,APC Insulin antibodies,86337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.48,,,,,,,fee schedule,21.41,88.97,APC Insulin antibodies,86337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.41,,,,,,,fee schedule,21.41,88.97,APC Intrinsic factor antibody,86340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.45,,,,,,,fee schedule,15.08,77.08, Intrinsic factor antibody,86340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.08,,,,,,,fee schedule,15.08,77.08, Intrinsic factor antibody,86340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.08,77.08, Intrinsic factor antibody,86340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.08,77.08, Intrinsic factor antibody,86340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.68,,,,,,,fee schedule,15.08,77.08,APC Intrinsic factor antibody,86340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.83,,,,,,,fee schedule,15.08,77.08,APC Intrinsic factor antibody,86340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.08,,,,,,,fee schedule,15.08,77.08,APC Islet cell antibody,86341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.86,,,,,,,fee schedule,23.57,101.2, Islet cell antibody,86341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.2,,,,,,,fee schedule,23.57,101.2, Islet cell antibody,86341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75,,,,,,,fee schedule,23.57,101.2, Islet cell antibody,86341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,85.71,,,,,,,fee schedule,23.57,101.2, Islet cell antibody,86341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.51,,,,,,,fee schedule,23.57,101.2,APC Islet cell antibody,86341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.75,,,,,,,fee schedule,23.57,101.2,APC Islet cell antibody,86341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.57,,,,,,,fee schedule,23.57,101.2,APC Leukocyte histamine release,86343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.58,,,,,,,fee schedule,12.46,63.72, Leukocyte histamine release,86343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.72,,,,,,,fee schedule,12.46,63.72, Leukocyte histamine release,86343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.46,63.72, Leukocyte histamine release,86343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.46,63.72, Leukocyte histamine release,86343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.96,,,,,,,fee schedule,12.46,63.72,APC Leukocyte histamine release,86343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.08,,,,,,,fee schedule,12.46,63.72,APC Leukocyte histamine release,86343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,12.46,63.72,APC Leukocyte phagocytosis,86344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.27,,,,,,,fee schedule,10.39,40.85, Leukocyte phagocytosis,86344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.85,,,,,,,fee schedule,10.39,40.85, Leukocyte phagocytosis,86344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.39,40.85, Leukocyte phagocytosis,86344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.39,40.85, Leukocyte phagocytosis,86344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.81,,,,,,,fee schedule,10.39,40.85,APC Leukocyte phagocytosis,86344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.91,,,,,,,fee schedule,10.39,40.85,APC Leukocyte phagocytosis,86344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.39,,,,,,,fee schedule,10.39,40.85,APC Cell function assay w/stim,86352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,625.4,,,,,,,fee schedule,135.86,704.29, Cell function assay w/stim,86352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,704.29,,,,,,,fee schedule,135.86,704.29, Cell function assay w/stim,86352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,432.26,,,,,,,fee schedule,135.86,704.29, Cell function assay w/stim,86352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,494.01,,,,,,,fee schedule,135.86,704.29, Cell function assay w/stim,86352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,141.29,,,,,,,fee schedule,135.86,704.29,APC Cell function assay w/stim,86352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,142.65,,,,,,,fee schedule,135.86,704.29,APC Cell function assay w/stim,86352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,135.86,,,,,,,fee schedule,135.86,704.29,APC Lymphocyte transformation,86353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,222.59,,,,,,,fee schedule,49.03,250.67, Lymphocyte transformation,86353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,250.67,,,,,,,fee schedule,49.03,250.67, Lymphocyte transformation,86353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,156.24,,,,,,,fee schedule,49.03,250.67, Lymphocyte transformation,86353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,178.56,,,,,,,fee schedule,49.03,250.67, Lymphocyte transformation,86353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.99,,,,,,,fee schedule,49.03,250.67,APC Lymphocyte transformation,86353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.48,,,,,,,fee schedule,49.03,250.67,APC Lymphocyte transformation,86353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.03,,,,,,,fee schedule,49.03,250.67,APC B cells total count,86355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,173.65,,,,,,,fee schedule,37.73,195.55, B cells total count,86355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,195.55,,,,,,,fee schedule,37.73,195.55, B cells total count,86355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.78,,,,,,,fee schedule,37.73,195.55, B cells total count,86355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,136.89,,,,,,,fee schedule,37.73,195.55, B cells total count,86355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.24,,,,,,,fee schedule,37.73,195.55,APC B cells total count,86355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.62,,,,,,,fee schedule,37.73,195.55,APC B cells total count,86355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,37.73,195.55,APC Mononuclear cell antigen,86356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.24,,,,,,,fee schedule,26.78,138.79, Mononuclear cell antigen,86356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.79,,,,,,,fee schedule,26.78,138.79, Mononuclear cell antigen,86356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.78,138.79, Mononuclear cell antigen,86356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.78,138.79, Mononuclear cell antigen,86356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.85,,,,,,,fee schedule,26.78,138.79,APC Mononuclear cell antigen,86356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.12,,,,,,,fee schedule,26.78,138.79,APC Mononuclear cell antigen,86356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.78,,,,,,,fee schedule,26.78,138.79,APC Nk cells total count,86357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,173.65,,,,,,,fee schedule,37.73,195.55, Nk cells total count,86357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,195.55,,,,,,,fee schedule,37.73,195.55, Nk cells total count,86357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.78,,,,,,,fee schedule,37.73,195.55, Nk cells total count,86357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,136.89,,,,,,,fee schedule,37.73,195.55, Nk cells total count,86357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.24,,,,,,,fee schedule,37.73,195.55,APC Nk cells total count,86357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.62,,,,,,,fee schedule,37.73,195.55,APC Nk cells total count,86357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,37.73,195.55,APC T cells total count,86359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,171.28,,,,,,,fee schedule,37.73,192.88, T cells total count,86359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,192.88,,,,,,,fee schedule,37.73,192.88, T cells total count,86359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.78,,,,,,,fee schedule,37.73,192.88, T cells total count,86359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,136.89,,,,,,,fee schedule,37.73,192.88, T cells total count,86359,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.24,,,,,,,fee schedule,37.73,192.88,APC T cells total count,86359,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.62,,,,,,,fee schedule,37.73,192.88,APC T cells total count,86359,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,37.73,192.88,APC T cell absolute count/ratio,86360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,213.36,,,,,,,fee schedule,46.98,240.28, T cell absolute count/ratio,86360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,240.28,,,,,,,fee schedule,46.98,240.28, T cell absolute count/ratio,86360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,148.94,,,,,,,fee schedule,46.98,240.28, T cell absolute count/ratio,86360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.22,,,,,,,fee schedule,46.98,240.28, T cell absolute count/ratio,86360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.86,,,,,,,fee schedule,46.98,240.28,APC T cell absolute count/ratio,86360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.33,,,,,,,fee schedule,46.98,240.28,APC T cell absolute count/ratio,86360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.98,,,,,,,fee schedule,46.98,240.28,APC T cell absolute count,86361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.58,,,,,,,fee schedule,26.78,136.92, T cell absolute count,86361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.92,,,,,,,fee schedule,26.78,136.92, T cell absolute count,86361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.78,136.92, T cell absolute count,86361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.78,136.92, T cell absolute count,86361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.85,,,,,,,fee schedule,26.78,136.92,APC T cell absolute count,86361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.12,,,,,,,fee schedule,26.78,136.92,APC T cell absolute count,86361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.78,,,,,,,fee schedule,26.78,136.92,APC Mog-igg1 antb cba each,86362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.16,,,,,,,fee schedule,12.05,44.1, Mog-igg1 antb cba each,86362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.1,,,,,,,fee schedule,12.05,44.1, Mog-igg1 antb cba each,86362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,44.1, Mog-igg1 antb cba each,86362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,44.1, Mog-igg1 antb cba each,86362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,44.1,APC Mog-igg1 antb cba each,86362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,44.1,APC Mog-igg1 antb cba each,86362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,44.1,APC Mog-igg1 antb flo cytmtry ea,86363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.16,,,,,,,fee schedule,37.73,136.89, Mog-igg1 antb flo cytmtry ea,86363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.1,,,,,,,fee schedule,37.73,136.89, Mog-igg1 antb flo cytmtry ea,86363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.78,,,,,,,fee schedule,37.73,136.89, Mog-igg1 antb flo cytmtry ea,86363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,136.89,,,,,,,fee schedule,37.73,136.89, Mog-igg1 antb flo cytmtry ea,86363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.24,,,,,,,fee schedule,37.73,136.89,APC Mog-igg1 antb flo cytmtry ea,86363,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.62,,,,,,,fee schedule,37.73,136.89,APC Mog-igg1 antb flo cytmtry ea,86363,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,37.73,136.89,APC Tiss trnsgltmnase ea ig clas,86364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.47,,,,,,,fee schedule,11.53,42.2, Tiss trnsgltmnase ea ig clas,86364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.2,,,,,,,fee schedule,11.53,42.2, Tiss trnsgltmnase ea ig clas,86364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,42.2, Tiss trnsgltmnase ea ig clas,86364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,42.2, Tiss trnsgltmnase ea ig clas,86364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,42.2,APC Tiss trnsgltmnase ea ig clas,86364,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,42.2,APC Tiss trnsgltmnase ea ig clas,86364,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,42.2,APC Muscle-specific kinase antb,86366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.8,,,,,,,fee schedule,18.4,67.34, Muscle-specific kinase antb,86366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.34,,,,,,,fee schedule,18.4,67.34, Muscle-specific kinase antb,86366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.4,67.34, Muscle-specific kinase antb,86366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.4,67.34, Muscle-specific kinase antb,86366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.14,,,,,,,fee schedule,18.4,67.34,APC Muscle-specific kinase antb,86366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.32,,,,,,,fee schedule,18.4,67.34,APC Muscle-specific kinase antb,86366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.4,,,,,,,fee schedule,18.4,67.34,APC Stem cells total count,86367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,173.65,,,,,,,fee schedule,77.78,283.32, Stem cells total count,86367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,195.55,,,,,,,fee schedule,77.78,283.32, Stem cells total count,86367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,247.91,,,,,,,fee schedule,77.78,283.32, Stem cells total count,86367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,283.32,,,,,,,fee schedule,77.78,283.32, Stem cells total count,86367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.89,,,,,,,fee schedule,77.78,283.32,APC Stem cells total count,86367,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,81.67,,,,,,,fee schedule,77.78,283.32,APC Stem cells total count,86367,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.78,,,,,,,fee schedule,77.78,283.32,APC Microsomal antibody each,86376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.07,,,,,,,fee schedule,14.55,74.41, Microsomal antibody each,86376,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.41,,,,,,,fee schedule,14.55,74.41, Microsomal antibody each,86376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.55,74.41, Microsomal antibody each,86376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.55,74.41, Microsomal antibody each,86376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.13,,,,,,,fee schedule,14.55,74.41,APC Microsomal antibody each,86376,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.28,,,,,,,fee schedule,14.55,74.41,APC Microsomal antibody each,86376,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.55,,,,,,,fee schedule,14.55,74.41,APC Mitochondrial antibody each,86381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.71,,,,,,,fee schedule,25.45,93.15, Mitochondrial antibody each,86381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,93.15,,,,,,,fee schedule,25.45,93.15, Mitochondrial antibody each,86381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.24,,,,,,,fee schedule,25.45,93.15, Mitochondrial antibody each,86381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.85,,,,,,,fee schedule,25.45,93.15, Mitochondrial antibody each,86381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.47,,,,,,,fee schedule,25.45,93.15,APC Mitochondrial antibody each,86381,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.72,,,,,,,fee schedule,25.45,93.15,APC Mitochondrial antibody each,86381,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.45,,,,,,,fee schedule,25.45,93.15,APC Neutralization test viral,86382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.77,,,,,,,fee schedule,16.91,86.45, Neutralization test viral,86382,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.45,,,,,,,fee schedule,16.91,86.45, Neutralization test viral,86382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.91,86.45, Neutralization test viral,86382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.91,86.45, Neutralization test viral,86382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.59,,,,,,,fee schedule,16.91,86.45,APC Neutralization test viral,86382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.76,,,,,,,fee schedule,16.91,86.45,APC Neutralization test viral,86382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.91,,,,,,,fee schedule,16.91,86.45,APC Nitroblue tetrazolium dye,86384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.71,,,,,,,fee schedule,13.61,58.23, Nitroblue tetrazolium dye,86384,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.23,,,,,,,fee schedule,13.61,58.23, Nitroblue tetrazolium dye,86384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.61,58.23, Nitroblue tetrazolium dye,86384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.61,58.23, Nitroblue tetrazolium dye,86384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.15,,,,,,,fee schedule,13.61,58.23,APC Nitroblue tetrazolium dye,86384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.29,,,,,,,fee schedule,13.61,58.23,APC Nitroblue tetrazolium dye,86384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.61,,,,,,,fee schedule,13.61,58.23,APC Nuclear matrix protein 22,86386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.48,,,,,,,fee schedule,21.78,82.75, Nuclear matrix protein 22,86386,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.75,,,,,,,fee schedule,21.78,82.75, Nuclear matrix protein 22,86386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,21.78,82.75, Nuclear matrix protein 22,86386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,21.78,82.75, Nuclear matrix protein 22,86386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.65,,,,,,,fee schedule,21.78,82.75,APC Nuclear matrix protein 22,86386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.87,,,,,,,fee schedule,21.78,82.75,APC Nuclear matrix protein 22,86386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.78,,,,,,,fee schedule,21.78,82.75,APC Particle agglut antbdy scrn,86403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.28,,,,,,,fee schedule,11.54,52.12, Particle agglut antbdy scrn,86403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.12,,,,,,,fee schedule,11.54,52.12, Particle agglut antbdy scrn,86403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.54,52.12, Particle agglut antbdy scrn,86403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.54,52.12, Particle agglut antbdy scrn,86403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12,,,,,,,fee schedule,11.54,52.12,APC Particle agglut antbdy scrn,86403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.12,,,,,,,fee schedule,11.54,52.12,APC Particle agglut antbdy scrn,86403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.54,,,,,,,fee schedule,11.54,52.12,APC Particle agglut antbdy titr,86406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.33,,,,,,,fee schedule,10.64,54.42, Particle agglut antbdy titr,86406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.42,,,,,,,fee schedule,10.64,54.42, Particle agglut antbdy titr,86406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.64,54.42, Particle agglut antbdy titr,86406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.64,54.42, Particle agglut antbdy titr,86406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.07,,,,,,,fee schedule,10.64,54.42,APC Particle agglut antbdy titr,86406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.17,,,,,,,fee schedule,10.64,54.42,APC Particle agglut antbdy titr,86406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.64,,,,,,,fee schedule,10.64,54.42,APC Neutrlzg antb sarscov2 scr,86408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.92,,,,,,,fee schedule,42.13,154.2, Neutrlzg antb sarscov2 scr,86408,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,154.2,,,,,,,fee schedule,42.13,154.2, Neutrlzg antb sarscov2 scr,86408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,134.37,,,,,,,fee schedule,42.13,154.2, Neutrlzg antb sarscov2 scr,86408,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,153.57,,,,,,,fee schedule,42.13,154.2, Neutrlzg antb sarscov2 scr,86408,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.82,,,,,,,fee schedule,42.13,154.2,APC Neutrlzg antb sarscov2 scr,86408,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.24,,,,,,,fee schedule,42.13,154.2,APC Neutrlzg antb sarscov2 scr,86408,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.13,,,,,,,fee schedule,42.13,154.2,APC Neutrlzg antb sarscov2 titer,86409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,342.32,,,,,,,fee schedule,79.61,385.51, Neutrlzg antb sarscov2 titer,86409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,385.51,,,,,,,fee schedule,79.61,385.51, Neutrlzg antb sarscov2 titer,86409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.79,,,,,,,fee schedule,79.61,385.51,APC Neutrlzg antb sarscov2 titer,86409,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,83.59,,,,,,,fee schedule,79.61,385.51,APC Neutrlzg antb sarscov2 titer,86409,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79.61,,,,,,,fee schedule,79.61,385.51,APC Sars-cov-2 antb quantitative,86413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.92,,,,,,,fee schedule,51.43,154.2, Sars-cov-2 antb quantitative,86413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,154.2,,,,,,,fee schedule,51.43,154.2, Sars-cov-2 antb quantitative,86413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.49,,,,,,,fee schedule,51.43,154.2,APC Sars-cov-2 antb quantitative,86413,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54,,,,,,,fee schedule,51.43,154.2,APC Sars-cov-2 antb quantitative,86413,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.43,,,,,,,fee schedule,51.43,154.2,APC Rheumatoid factor test qual,86430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.77,,,,,,,fee schedule,6.14,29.02, Rheumatoid factor test qual,86430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.02,,,,,,,fee schedule,6.14,29.02, Rheumatoid factor test qual,86430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.79,,,,,,,fee schedule,6.14,29.02, Rheumatoid factor test qual,86430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.62,,,,,,,fee schedule,6.14,29.02, Rheumatoid factor test qual,86430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.39,,,,,,,fee schedule,6.14,29.02,APC Rheumatoid factor test qual,86430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.45,,,,,,,fee schedule,6.14,29.02,APC Rheumatoid factor test qual,86430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.14,,,,,,,fee schedule,6.14,29.02,APC Rheumatoid factor quant,86431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.77,,,,,,,fee schedule,5.67,29.02, Rheumatoid factor quant,86431,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.02,,,,,,,fee schedule,5.67,29.02, Rheumatoid factor quant,86431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.67,29.02, Rheumatoid factor quant,86431,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.67,29.02, Rheumatoid factor quant,86431,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.9,,,,,,,fee schedule,5.67,29.02,APC Rheumatoid factor quant,86431,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.95,,,,,,,fee schedule,5.67,29.02,APC Rheumatoid factor quant,86431,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.67,,,,,,,fee schedule,5.67,29.02,APC Tb test cell immun measure,86480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,285.32,,,,,,,fee schedule,61.98,321.31, Tb test cell immun measure,86480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,321.31,,,,,,,fee schedule,61.98,321.31, Tb test cell immun measure,86480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,196.85,,,,,,,fee schedule,61.98,321.31, Tb test cell immun measure,86480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,224.97,,,,,,,fee schedule,61.98,321.31, Tb test cell immun measure,86480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.46,,,,,,,fee schedule,61.98,321.31,APC Tb test cell immun measure,86480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.08,,,,,,,fee schedule,61.98,321.31,APC Tb test cell immun measure,86480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.98,,,,,,,fee schedule,61.98,321.31,APC Tb ag response t-cell susp,86481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,344.89,,,,,,,fee schedule,100,388.4, Tb ag response t-cell susp,86481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,388.4,,,,,,,fee schedule,100,388.4, Tb ag response t-cell susp,86481,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,317.68,,,,,,,fee schedule,100,388.4, Tb ag response t-cell susp,86481,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,363.06,,,,,,,fee schedule,100,388.4, Tb ag response t-cell susp,86481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,104,,,,,,,fee schedule,100,388.4,APC Tb ag response t-cell susp,86481,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,105,,,,,,,fee schedule,100,388.4,APC Tb ag response t-cell susp,86481,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,100,,,,,,,fee schedule,100,388.4,APC Skin test candida,86485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.67,,,,,,,fee schedule,24.67,67.86, Skin test candida,86485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.78,,,,,,,fee schedule,24.67,67.86, Skin test candida,86485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,24.67,67.86, Skin test candida,86485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,24.67,67.86, Skin test candida,86485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,24.67,67.86,APC Skin test candida,86485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,24.67,67.86,APC Skin test candida,86485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,24.67,67.86,APC Skin test nos antigen,86486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.65,,,,,,,fee schedule,19.77,35.88, Skin test nos antigen,86486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.38,,,,,,,fee schedule,19.77,35.88, Skin test nos antigen,86486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.77,,,,,,,fee schedule,19.77,35.88, Skin test nos antigen,86486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.59,,,,,,,fee schedule,19.77,35.88, Skin test nos antigen,86486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,19.77,35.88,APC Skin test nos antigen,86486,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,19.77,35.88,APC Skin test nos antigen,86486,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,19.77,35.88,APC Coccidioidomycosis skin test,86490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,238.51,,,,,,,fee schedule,238.51,272.58, Coccidioidomycosis skin test,86490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,272.58,,,,,,,fee schedule,238.51,272.58, Histoplasmosis skin test,86510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.35,,,,,,,fee schedule,23.94,46.33, Histoplasmosis skin test,86510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.55,,,,,,,fee schedule,23.94,46.33, Histoplasmosis skin test,86510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.94,,,,,,,fee schedule,23.94,46.33, Histoplasmosis skin test,86510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.36,,,,,,,fee schedule,23.94,46.33, Histoplasmosis skin test,86510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,23.94,46.33,APC Histoplasmosis skin test,86510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,23.94,46.33,APC Histoplasmosis skin test,86510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,23.94,46.33,APC TB intradermal test,86580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.29,,,,,,,fee schedule,17.29,36.87, TB intradermal test,86580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.47,,,,,,,fee schedule,17.29,36.87, TB intradermal test,86580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.26,,,,,,,fee schedule,17.29,36.87, TB intradermal test,86580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.87,,,,,,,fee schedule,17.29,36.87, TB intradermal test,86580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,17.29,36.87,APC TB intradermal test,86580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,17.29,36.87,APC TB intradermal test,86580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,17.29,36.87,APC Strptcs pneum antb serot ia,86581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.71,,,,,,,fee schedule,92.03,96.63,APC Strptcs pneum antb serot ia,86581,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.63,,,,,,,fee schedule,92.03,96.63,APC Strptcs pneum antb serot ia,86581,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,92.03,,,,,,,fee schedule,92.03,96.63,APC Streptokinase antibody,86590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.08,,,,,,,fee schedule,12.66,56.4, Streptokinase antibody,86590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.4,,,,,,,fee schedule,12.66,56.4, Streptokinase antibody,86590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.66,56.4, Streptokinase antibody,86590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.66,56.4, Streptokinase antibody,86590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.17,,,,,,,fee schedule,12.66,56.4,APC Streptokinase antibody,86590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.29,,,,,,,fee schedule,12.66,56.4,APC Streptokinase antibody,86590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.66,,,,,,,fee schedule,12.66,56.4,APC Syphilis test non-trep qual,86592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,4.27,21.81, Syphilis test non-trep qual,86592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,4.27,21.81, Syphilis test non-trep qual,86592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,21.81, Syphilis test non-trep qual,86592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,21.81, Syphilis test non-trep qual,86592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,21.81,APC Syphilis test non-trep qual,86592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,21.81,APC Syphilis test non-trep qual,86592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,21.81,APC Syphilis test non-trep quant,86593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.02,,,,,,,fee schedule,4.4,22.55, Syphilis test non-trep quant,86593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.55,,,,,,,fee schedule,4.4,22.55, Syphilis test non-trep quant,86593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.4,22.55, Syphilis test non-trep quant,86593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.4,22.55, Syphilis test non-trep quant,86593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.58,,,,,,,fee schedule,4.4,22.55,APC Syphilis test non-trep quant,86593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.62,,,,,,,fee schedule,4.4,22.55,APC Syphilis test non-trep quant,86593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.4,,,,,,,fee schedule,4.4,22.55,APC Voltage-gtd ca chnl antb ea,86596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.8,,,,,,,fee schedule,12.05,67.34, Voltage-gtd ca chnl antb ea,86596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.34,,,,,,,fee schedule,12.05,67.34, Voltage-gtd ca chnl antb ea,86596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,67.34, Voltage-gtd ca chnl antb ea,86596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,67.34, Voltage-gtd ca chnl antb ea,86596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,67.34,APC Voltage-gtd ca chnl antb ea,86596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,67.34,APC Voltage-gtd ca chnl antb ea,86596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,67.34,APC Antinomyces antibody,86602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.22,,,,,,,fee schedule,10.18,52.05, Antinomyces antibody,86602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.05,,,,,,,fee schedule,10.18,52.05, Antinomyces antibody,86602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.18,52.05, Antinomyces antibody,86602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.18,52.05, Antinomyces antibody,86602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.59,,,,,,,fee schedule,10.18,52.05,APC Antinomyces antibody,86602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.69,,,,,,,fee schedule,10.18,52.05,APC Antinomyces antibody,86602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.18,,,,,,,fee schedule,10.18,52.05,APC Adenovirus antibody,86603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.44,,,,,,,fee schedule,12.87,65.81, Adenovirus antibody,86603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.81,,,,,,,fee schedule,12.87,65.81, Adenovirus antibody,86603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.87,65.81, Adenovirus antibody,86603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.87,65.81, Adenovirus antibody,86603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.38,,,,,,,fee schedule,12.87,65.81,APC Adenovirus antibody,86603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.51,,,,,,,fee schedule,12.87,65.81,APC Adenovirus antibody,86603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.87,,,,,,,fee schedule,12.87,65.81,APC Aspergillus antibody,86606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.35,,,,,,,fee schedule,15.05,76.97, Aspergillus antibody,86606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.97,,,,,,,fee schedule,15.05,76.97, Aspergillus antibody,86606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.05,76.97, Aspergillus antibody,86606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.05,76.97, Aspergillus antibody,86606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.65,,,,,,,fee schedule,15.05,76.97,APC Aspergillus antibody,86606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.8,,,,,,,fee schedule,15.05,76.97,APC Aspergillus antibody,86606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.05,,,,,,,fee schedule,15.05,76.97,APC Bacterium antibody,86609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.5,,,,,,,fee schedule,12.88,65.88, Bacterium antibody,86609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.88,,,,,,,fee schedule,12.88,65.88, Bacterium antibody,86609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.88,65.88, Bacterium antibody,86609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.88,65.88, Bacterium antibody,86609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.4,,,,,,,fee schedule,12.88,65.88,APC Bacterium antibody,86609,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.52,,,,,,,fee schedule,12.88,65.88,APC Bacterium antibody,86609,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.88,,,,,,,fee schedule,12.88,65.88,APC Bartonella Antibody,86611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.22,,,,,,,fee schedule,10.18,52.05, Bartonella Antibody,86611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.05,,,,,,,fee schedule,10.18,52.05, Bartonella Antibody,86611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.18,52.05, Bartonella Antibody,86611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.18,52.05, Bartonella Antibody,86611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.59,,,,,,,fee schedule,10.18,52.05,APC Bartonella Antibody,86611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.69,,,,,,,fee schedule,10.18,52.05,APC Bartonella Antibody,86611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.18,,,,,,,fee schedule,10.18,52.05,APC Blastomyces antibody,86612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.6,,,,,,,fee schedule,12.9,65.99, Blastomyces antibody,86612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.99,,,,,,,fee schedule,12.9,65.99, Blastomyces antibody,86612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.9,65.99, Blastomyces antibody,86612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.9,65.99, Blastomyces antibody,86612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,12.9,65.99,APC Blastomyces antibody,86612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.55,,,,,,,fee schedule,12.9,65.99,APC Blastomyces antibody,86612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.9,,,,,,,fee schedule,12.9,65.99,APC Bordetella antibody,86615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Bordetella antibody,86615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Bordetella antibody,86615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Bordetella antibody,86615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Bordetella antibody,86615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Bordetella antibody,86615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Bordetella antibody,86615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Lyme disease antibody,86617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.33,,,,,,,fee schedule,15.49,79.2, Lyme disease antibody,86617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.2,,,,,,,fee schedule,15.49,79.2, Lyme disease antibody,86617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.49,79.2, Lyme disease antibody,86617,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.49,79.2, Lyme disease antibody,86617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.11,,,,,,,fee schedule,15.49,79.2,APC Lyme disease antibody,86617,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.26,,,,,,,fee schedule,15.49,79.2,APC Lyme disease antibody,86617,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.49,,,,,,,fee schedule,15.49,79.2,APC Lyme disease antibody,86618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.35,,,,,,,fee schedule,17.03,87.11, Lyme disease antibody,86618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.11,,,,,,,fee schedule,17.03,87.11, Lyme disease antibody,86618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.03,87.11, Lyme disease antibody,86618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.03,87.11, Lyme disease antibody,86618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.71,,,,,,,fee schedule,17.03,87.11,APC Lyme disease antibody,86618,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.88,,,,,,,fee schedule,17.03,87.11,APC Lyme disease antibody,86618,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.03,,,,,,,fee schedule,17.03,87.11,APC Borrelia antibody,86619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.74,,,,,,,fee schedule,13.38,68.41, Borrelia antibody,86619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.41,,,,,,,fee schedule,13.38,68.41, Borrelia antibody,86619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.38,68.41, Borrelia antibody,86619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.38,68.41, Borrelia antibody,86619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.92,,,,,,,fee schedule,13.38,68.41,APC Borrelia antibody,86619,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.05,,,,,,,fee schedule,13.38,68.41,APC Borrelia antibody,86619,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.38,,,,,,,fee schedule,13.38,68.41,APC Brucella antibody,86622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.15,,,,,,,fee schedule,8.93,41.83, Brucella antibody,86622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.83,,,,,,,fee schedule,8.93,41.83, Brucella antibody,86622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.93,41.83, Brucella antibody,86622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.93,41.83, Brucella antibody,86622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.29,,,,,,,fee schedule,8.93,41.83,APC Brucella antibody,86622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.38,,,,,,,fee schedule,8.93,41.83,APC Brucella antibody,86622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.93,,,,,,,fee schedule,8.93,41.83,APC Campylobacter antibody,86625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.57,,,,,,,fee schedule,13.12,67.09, Campylobacter antibody,86625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.09,,,,,,,fee schedule,13.12,67.09, Campylobacter antibody,86625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.12,67.09, Campylobacter antibody,86625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.12,67.09, Campylobacter antibody,86625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.64,,,,,,,fee schedule,13.12,67.09,APC Campylobacter antibody,86625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.12,67.09,APC Campylobacter antibody,86625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.12,,,,,,,fee schedule,13.12,67.09,APC Candida antibody,86628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.52,,,,,,,fee schedule,12.01,54.64, Candida antibody,86628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.64,,,,,,,fee schedule,12.01,54.64, Candida antibody,86628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.01,54.64, Candida antibody,86628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.01,54.64, Candida antibody,86628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.49,,,,,,,fee schedule,12.01,54.64,APC Candida antibody,86628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.61,,,,,,,fee schedule,12.01,54.64,APC Candida antibody,86628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.01,,,,,,,fee schedule,12.01,54.64,APC Chlamydia antibody,86631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.91,,,,,,,fee schedule,11.82,49.45, Chlamydia antibody,86631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.45,,,,,,,fee schedule,11.82,49.45, Chlamydia antibody,86631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.82,49.45, Chlamydia antibody,86631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.82,49.45, Chlamydia antibody,86631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.29,,,,,,,fee schedule,11.82,49.45,APC Chlamydia antibody,86631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.41,,,,,,,fee schedule,11.82,49.45,APC Chlamydia antibody,86631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.82,,,,,,,fee schedule,11.82,49.45,APC Chlamydia igm antibody,86632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.52,,,,,,,fee schedule,12.68,54.64, Chlamydia igm antibody,86632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.64,,,,,,,fee schedule,12.68,54.64, Chlamydia igm antibody,86632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.68,54.64, Chlamydia igm antibody,86632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.68,54.64, Chlamydia igm antibody,86632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,12.68,54.64,APC Chlamydia igm antibody,86632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.31,,,,,,,fee schedule,12.68,54.64,APC Chlamydia igm antibody,86632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.68,,,,,,,fee schedule,12.68,54.64,APC Coccidioides antibody,86635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.52,,,,,,,fee schedule,11.47,54.64, Coccidioides antibody,86635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.64,,,,,,,fee schedule,11.47,54.64, Coccidioides antibody,86635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.47,54.64, Coccidioides antibody,86635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.47,54.64, Coccidioides antibody,86635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.93,,,,,,,fee schedule,11.47,54.64,APC Coccidioides antibody,86635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.04,,,,,,,fee schedule,11.47,54.64,APC Coccidioides antibody,86635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.47,,,,,,,fee schedule,11.47,54.64,APC Q fever antibody,86638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.06,,,,,,,fee schedule,12.12,62, Q fever antibody,86638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62,,,,,,,fee schedule,12.12,62, Q fever antibody,86638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.12,62, Q fever antibody,86638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.12,62, Q fever antibody,86638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.6,,,,,,,fee schedule,12.12,62,APC Q fever antibody,86638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.73,,,,,,,fee schedule,12.12,62,APC Q fever antibody,86638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.12,,,,,,,fee schedule,12.12,62,APC Cryptococcus antibody,86641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.46,,,,,,,fee schedule,14.41,73.71, Cryptococcus antibody,86641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.71,,,,,,,fee schedule,14.41,73.71, Cryptococcus antibody,86641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.41,73.71, Cryptococcus antibody,86641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.41,73.71, Cryptococcus antibody,86641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.99,,,,,,,fee schedule,14.41,73.71,APC Cryptococcus antibody,86641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.13,,,,,,,fee schedule,14.41,73.71,APC Cryptococcus antibody,86641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.41,,,,,,,fee schedule,14.41,73.71,APC CMV antibody,86644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.36,,,,,,,fee schedule,14.39,73.6, CMV antibody,86644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.6,,,,,,,fee schedule,14.39,73.6, CMV antibody,86644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.39,73.6, CMV antibody,86644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.39,73.6, CMV antibody,86644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.97,,,,,,,fee schedule,14.39,73.6,APC CMV antibody,86644,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.11,,,,,,,fee schedule,14.39,73.6,APC CMV antibody,86644,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.39,,,,,,,fee schedule,14.39,73.6,APC Cmv antibody igm,86645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.51,,,,,,,fee schedule,16.85,86.16, Cmv antibody igm,86645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.16,,,,,,,fee schedule,16.85,86.16, Cmv antibody igm,86645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.85,86.16, Cmv antibody igm,86645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.85,86.16, Cmv antibody igm,86645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.52,,,,,,,fee schedule,16.85,86.16,APC Cmv antibody igm,86645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.69,,,,,,,fee schedule,16.85,86.16,APC Cmv antibody igm,86645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.85,,,,,,,fee schedule,16.85,86.16,APC Diphtheria antibody,86648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.06,,,,,,,fee schedule,15.21,77.78, Diphtheria antibody,86648,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.78,,,,,,,fee schedule,15.21,77.78, Diphtheria antibody,86648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.21,77.78, Diphtheria antibody,86648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.21,77.78, Diphtheria antibody,86648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.82,,,,,,,fee schedule,15.21,77.78,APC Diphtheria antibody,86648,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.97,,,,,,,fee schedule,15.21,77.78,APC Diphtheria antibody,86648,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.21,,,,,,,fee schedule,15.21,77.78,APC Encephalitis californ antbdy,86651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Encephalitis californ antbdy,86651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Encephalitis californ antbdy,86651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Encephalitis californ antbdy,86651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Encephalitis californ antbdy,86651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Encephalitis californ antbdy,86651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Encephalitis californ antbdy,86651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Encephaltis east eqne anbdy,86652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Encephaltis east eqne anbdy,86652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Encephaltis east eqne anbdy,86652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Encephaltis east eqne anbdy,86652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Encephaltis east eqne anbdy,86652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Encephaltis east eqne anbdy,86652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Encephaltis east eqne anbdy,86652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Encephaltis st louis antbody,86653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Encephaltis st louis antbody,86653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Encephaltis st louis antbody,86653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Encephaltis st louis antbody,86653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Encephaltis st louis antbody,86653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Encephaltis st louis antbody,86653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Encephaltis st louis antbody,86653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Encephaltis west eqne antbdy,86654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Encephaltis west eqne antbdy,86654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Encephaltis west eqne antbdy,86654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Encephaltis west eqne antbdy,86654,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Encephaltis west eqne antbdy,86654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Encephaltis west eqne antbdy,86654,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Encephaltis west eqne antbdy,86654,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Enterovirus antibody,86658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.15,,,,,,,fee schedule,13.03,66.61, Enterovirus antibody,86658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.61,,,,,,,fee schedule,13.03,66.61, Enterovirus antibody,86658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.03,66.61, Enterovirus antibody,86658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.03,66.61, Enterovirus antibody,86658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.55,,,,,,,fee schedule,13.03,66.61,APC Enterovirus antibody,86658,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.68,,,,,,,fee schedule,13.03,66.61,APC Enterovirus antibody,86658,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.03,,,,,,,fee schedule,13.03,66.61,APC Epstein-barr antibody,86663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.57,,,,,,,fee schedule,13.12,67.09, Epstein-barr antibody,86663,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.09,,,,,,,fee schedule,13.12,67.09, Epstein-barr antibody,86663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.12,67.09, Epstein-barr antibody,86663,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.12,67.09, Epstein-barr antibody,86663,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.64,,,,,,,fee schedule,13.12,67.09,APC Epstein-barr antibody,86663,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.12,67.09,APC Epstein-barr antibody,86663,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.12,,,,,,,fee schedule,13.12,67.09,APC Epstein-barr nuclear antigen,86664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.49,,,,,,,fee schedule,15.29,78.25, Epstein-barr nuclear antigen,86664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.25,,,,,,,fee schedule,15.29,78.25, Epstein-barr nuclear antigen,86664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.29,78.25, Epstein-barr nuclear antigen,86664,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.29,78.25, Epstein-barr nuclear antigen,86664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.9,,,,,,,fee schedule,15.29,78.25,APC Epstein-barr nuclear antigen,86664,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.05,,,,,,,fee schedule,15.29,78.25,APC Epstein-barr nuclear antigen,86664,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.29,,,,,,,fee schedule,15.29,78.25,APC Epstein-barr capsid vca,86665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.39,,,,,,,fee schedule,18.14,92.78, Epstein-barr capsid vca,86665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.78,,,,,,,fee schedule,18.14,92.78, Epstein-barr capsid vca,86665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.14,92.78, Epstein-barr capsid vca,86665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.14,92.78, Epstein-barr capsid vca,86665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.87,,,,,,,fee schedule,18.14,92.78,APC Epstein-barr capsid vca,86665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.05,,,,,,,fee schedule,18.14,92.78,APC Epstein-barr capsid vca,86665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.14,,,,,,,fee schedule,18.14,92.78,APC Ehrlichia Antibody,86666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.22,,,,,,,fee schedule,10.18,52.05, Ehrlichia Antibody,86666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.05,,,,,,,fee schedule,10.18,52.05, Ehrlichia Antibody,86666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.29,,,,,,,fee schedule,10.18,52.05, Ehrlichia Antibody,86666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.9,,,,,,,fee schedule,10.18,52.05, Ehrlichia Antibody,86666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.59,,,,,,,fee schedule,10.18,52.05,APC Ehrlichia Antibody,86666,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.69,,,,,,,fee schedule,10.18,52.05,APC Ehrlichia Antibody,86666,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.18,,,,,,,fee schedule,10.18,52.05,APC Francisella tularensis,86668,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.22,,,,,,,fee schedule,14.16,53.18, Francisella tularensis,86668,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.18,,,,,,,fee schedule,14.16,53.18, Francisella tularensis,86668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.16,53.18, Francisella tularensis,86668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.16,53.18, Francisella tularensis,86668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.73,,,,,,,fee schedule,14.16,53.18,APC Francisella tularensis,86668,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.87,,,,,,,fee schedule,14.16,53.18,APC Francisella tularensis,86668,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.16,,,,,,,fee schedule,14.16,53.18,APC Fungus nes antibody,86671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.67,,,,,,,fee schedule,12.25,62.7, Fungus nes antibody,86671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.7,,,,,,,fee schedule,12.25,62.7, Fungus nes antibody,86671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.25,62.7, Fungus nes antibody,86671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.25,62.7, Fungus nes antibody,86671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.74,,,,,,,fee schedule,12.25,62.7,APC Fungus nes antibody,86671,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.86,,,,,,,fee schedule,12.25,62.7,APC Fungus nes antibody,86671,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.25,,,,,,,fee schedule,12.25,62.7,APC Giardia lamblia antibody,86674,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.82,,,,,,,fee schedule,14.72,75.25, Giardia lamblia antibody,86674,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.25,,,,,,,fee schedule,14.72,75.25, Giardia lamblia antibody,86674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.72,75.25, Giardia lamblia antibody,86674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.72,75.25, Giardia lamblia antibody,86674,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.31,,,,,,,fee schedule,14.72,75.25,APC Giardia lamblia antibody,86674,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.46,,,,,,,fee schedule,14.72,75.25,APC Giardia lamblia antibody,86674,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.72,,,,,,,fee schedule,14.72,75.25,APC Helicobacter pylori antibody,86677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.91,,,,,,,fee schedule,16.85,74.22, Helicobacter pylori antibody,86677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.22,,,,,,,fee schedule,16.85,74.22, Helicobacter pylori antibody,86677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.85,74.22, Helicobacter pylori antibody,86677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.85,74.22, Helicobacter pylori antibody,86677,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.52,,,,,,,fee schedule,16.85,74.22,APC Helicobacter pylori antibody,86677,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.69,,,,,,,fee schedule,16.85,74.22,APC Helicobacter pylori antibody,86677,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.85,,,,,,,fee schedule,16.85,74.22,APC Helminth antibody,86682,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.05,,,,,,,fee schedule,13.01,66.5, Helminth antibody,86682,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.5,,,,,,,fee schedule,13.01,66.5, Helminth antibody,86682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.01,66.5, Helminth antibody,86682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.01,66.5, Helminth antibody,86682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.53,,,,,,,fee schedule,13.01,66.5,APC Helminth antibody,86682,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.66,,,,,,,fee schedule,13.01,66.5,APC Helminth antibody,86682,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.01,,,,,,,fee schedule,13.01,66.5,APC Hemophilus influenza antibdy,86684,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.96,,,,,,,fee schedule,15.84,81.03, Hemophilus influenza antibdy,86684,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.03,,,,,,,fee schedule,15.84,81.03, Hemophilus influenza antibdy,86684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.01,,,,,,,fee schedule,15.84,81.03, Hemophilus influenza antibdy,86684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.15,,,,,,,fee schedule,15.84,81.03, Hemophilus influenza antibdy,86684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.47,,,,,,,fee schedule,15.84,81.03,APC Hemophilus influenza antibdy,86684,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.63,,,,,,,fee schedule,15.84,81.03,APC Hemophilus influenza antibdy,86684,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.84,,,,,,,fee schedule,15.84,81.03,APC Htlv-i antibody,86687,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.09,,,,,,,fee schedule,9.09,42.9, Htlv-i antibody,86687,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.9,,,,,,,fee schedule,9.09,42.9, Htlv-i antibody,86687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.16,,,,,,,fee schedule,9.09,42.9, Htlv-i antibody,86687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.33,,,,,,,fee schedule,9.09,42.9, Htlv-i antibody,86687,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.45,,,,,,,fee schedule,9.09,42.9,APC Htlv-i antibody,86687,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.54,,,,,,,fee schedule,9.09,42.9,APC Htlv-i antibody,86687,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.09,,,,,,,fee schedule,9.09,42.9,APC Htlv-ii antibody,86688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,14,54.02, Htlv-ii antibody,86688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,14,54.02, Htlv-ii antibody,86688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14,54.02, Htlv-ii antibody,86688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14,54.02, Htlv-ii antibody,86688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.56,,,,,,,fee schedule,14,54.02,APC Htlv-ii antibody,86688,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.7,,,,,,,fee schedule,14,54.02,APC Htlv-ii antibody,86688,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14,,,,,,,fee schedule,14,54.02,APC Htlv/hiv confirmj antibody,86689,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.91,,,,,,,fee schedule,19.35,99, Htlv/hiv confirmj antibody,86689,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99,,,,,,,fee schedule,19.35,99, Htlv/hiv confirmj antibody,86689,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.35,99, Htlv/hiv confirmj antibody,86689,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.35,99, Htlv/hiv confirmj antibody,86689,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.12,,,,,,,fee schedule,19.35,99,APC Htlv/hiv confirmj antibody,86689,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.32,,,,,,,fee schedule,19.35,99,APC Htlv/hiv confirmj antibody,86689,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.35,,,,,,,fee schedule,19.35,99,APC Hepatitis delta agent antbdy,86692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.94,,,,,,,fee schedule,17.16,87.77, Hepatitis delta agent antbdy,86692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.77,,,,,,,fee schedule,17.16,87.77, Hepatitis delta agent antbdy,86692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,17.16,87.77, Hepatitis delta agent antbdy,86692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,17.16,87.77, Hepatitis delta agent antbdy,86692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.85,,,,,,,fee schedule,17.16,87.77,APC Hepatitis delta agent antbdy,86692,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.02,,,,,,,fee schedule,17.16,87.77,APC Hepatitis delta agent antbdy,86692,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.16,,,,,,,fee schedule,17.16,87.77,APC Herpes simplex nes antbdy,86694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.36,,,,,,,fee schedule,14.39,73.6, Herpes simplex nes antbdy,86694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.6,,,,,,,fee schedule,14.39,73.6, Herpes simplex nes antbdy,86694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.39,73.6, Herpes simplex nes antbdy,86694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.39,73.6, Herpes simplex nes antbdy,86694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.97,,,,,,,fee schedule,14.39,73.6,APC Herpes simplex nes antbdy,86694,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.11,,,,,,,fee schedule,14.39,73.6,APC Herpes simplex nes antbdy,86694,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.39,,,,,,,fee schedule,14.39,73.6,APC Herpes simplex type 1 test,86695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Herpes simplex type 1 test,86695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Herpes simplex type 1 test,86695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Herpes simplex type 1 test,86695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Herpes simplex type 1 test,86695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Herpes simplex type 1 test,86695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Herpes simplex type 1 test,86695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Herpes simplex type 2 test,86696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.91,,,,,,,fee schedule,19.35,99, Herpes simplex type 2 test,86696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99,,,,,,,fee schedule,19.35,99, Herpes simplex type 2 test,86696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.35,99, Herpes simplex type 2 test,86696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.35,99, Herpes simplex type 2 test,86696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.12,,,,,,,fee schedule,19.35,99,APC Herpes simplex type 2 test,86696,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.32,,,,,,,fee schedule,19.35,99,APC Herpes simplex type 2 test,86696,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.35,,,,,,,fee schedule,19.35,99,APC Histoplasma antibody,86698,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.52,,,,,,,fee schedule,13.79,54.64, Histoplasma antibody,86698,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.64,,,,,,,fee schedule,13.79,54.64, Histoplasma antibody,86698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.79,54.64, Histoplasma antibody,86698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.79,54.64, Histoplasma antibody,86698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.34,,,,,,,fee schedule,13.79,54.64,APC Histoplasma antibody,86698,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.48,,,,,,,fee schedule,13.79,54.64,APC Histoplasma antibody,86698,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.79,,,,,,,fee schedule,13.79,54.64,APC Hiv-1antibody,86701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.33,,,,,,,fee schedule,8.89,45.42, Hiv-1antibody,86701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,45.42,,,,,,,fee schedule,8.89,45.42, Hiv-1antibody,86701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.89,45.42, Hiv-1antibody,86701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.89,45.42, Hiv-1antibody,86701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.25,,,,,,,fee schedule,8.89,45.42,APC Hiv-1antibody,86701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.33,,,,,,,fee schedule,8.89,45.42,APC Hiv-1antibody,86701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.89,,,,,,,fee schedule,8.89,45.42,APC Hiv-2 antibody,86702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,13.52,54.02, Hiv-2 antibody,86702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,13.52,54.02, Hiv-2 antibody,86702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.52,54.02, Hiv-2 antibody,86702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.52,54.02, Hiv-2 antibody,86702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.06,,,,,,,fee schedule,13.52,54.02,APC Hiv-2 antibody,86702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.2,,,,,,,fee schedule,13.52,54.02,APC Hiv-2 antibody,86702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.52,,,,,,,fee schedule,13.52,54.02,APC Hiv-1/hiv-2 1 result antbdy,86703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.3,,,,,,,fee schedule,13.71,70.16, Hiv-1/hiv-2 1 result antbdy,86703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.16,,,,,,,fee schedule,13.71,70.16, Hiv-1/hiv-2 1 result antbdy,86703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.71,70.16, Hiv-1/hiv-2 1 result antbdy,86703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.71,70.16, Hiv-1/hiv-2 1 result antbdy,86703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.26,,,,,,,fee schedule,13.71,70.16,APC Hiv-1/hiv-2 1 result antbdy,86703,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.4,,,,,,,fee schedule,13.71,70.16,APC Hiv-1/hiv-2 1 result antbdy,86703,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.71,,,,,,,fee schedule,13.71,70.16,APC Hep b core antibody total,86704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.73,,,,,,,fee schedule,12.05,61.63, Hep b core antibody total,86704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.63,,,,,,,fee schedule,12.05,61.63, Hep b core antibody total,86704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,61.63, Hep b core antibody total,86704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,61.63, Hep b core antibody total,86704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,61.63,APC Hep b core antibody total,86704,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,61.63,APC Hep b core antibody total,86704,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,61.63,APC Hep b core antibody igm,86705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.43,,,,,,,fee schedule,11.77,60.17, Hep b core antibody igm,86705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.17,,,,,,,fee schedule,11.77,60.17, Hep b core antibody igm,86705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,11.77,60.17, Hep b core antibody igm,86705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,11.77,60.17, Hep b core antibody igm,86705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.24,,,,,,,fee schedule,11.77,60.17,APC Hep b core antibody igm,86705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.36,,,,,,,fee schedule,11.77,60.17,APC Hep b core antibody igm,86705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.77,,,,,,,fee schedule,11.77,60.17,APC Hep b surface antibody,86706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.78,,,,,,,fee schedule,10.74,54.94, Hep b surface antibody,86706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.94,,,,,,,fee schedule,10.74,54.94, Hep b surface antibody,86706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.74,54.94, Hep b surface antibody,86706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.74,54.94, Hep b surface antibody,86706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.17,,,,,,,fee schedule,10.74,54.94,APC Hep b surface antibody,86706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.28,,,,,,,fee schedule,10.74,54.94,APC Hep b surface antibody,86706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.74,54.94,APC Hepatitis be antibody,86707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.52,,,,,,,fee schedule,11.57,59.15, Hepatitis be antibody,86707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.15,,,,,,,fee schedule,11.57,59.15, Hepatitis be antibody,86707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.57,59.15, Hepatitis be antibody,86707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.57,59.15, Hepatitis be antibody,86707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.03,,,,,,,fee schedule,11.57,59.15,APC Hepatitis be antibody,86707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.15,,,,,,,fee schedule,11.57,59.15,APC Hepatitis be antibody,86707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.57,,,,,,,fee schedule,11.57,59.15,APC Hepatitis a antibody,86708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.26,,,,,,,fee schedule,12.39,63.35, Hepatitis a antibody,86708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.35,,,,,,,fee schedule,12.39,63.35, Hepatitis a antibody,86708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.39,63.35, Hepatitis a antibody,86708,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.39,63.35, Hepatitis a antibody,86708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.89,,,,,,,fee schedule,12.39,63.35,APC Hepatitis a antibody,86708,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.01,,,,,,,fee schedule,12.39,63.35,APC Hepatitis a antibody,86708,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.39,,,,,,,fee schedule,12.39,63.35,APC Hepatitis a igm antibody,86709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.12,,,,,,,fee schedule,11.26,57.57, Hepatitis a igm antibody,86709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.57,,,,,,,fee schedule,11.26,57.57, Hepatitis a igm antibody,86709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.41,,,,,,,fee schedule,11.26,57.57, Hepatitis a igm antibody,86709,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.47,,,,,,,fee schedule,11.26,57.57, Hepatitis a igm antibody,86709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.71,,,,,,,fee schedule,11.26,57.57,APC Hepatitis a igm antibody,86709,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.82,,,,,,,fee schedule,11.26,57.57,APC Hepatitis a igm antibody,86709,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.26,,,,,,,fee schedule,11.26,57.57,APC Influenza virus antibody,86710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.56,,,,,,,fee schedule,13.55,69.32, Influenza virus antibody,86710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.32,,,,,,,fee schedule,13.55,69.32, Influenza virus antibody,86710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.55,69.32, Influenza virus antibody,86710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.55,69.32, Influenza virus antibody,86710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.09,,,,,,,fee schedule,13.55,69.32,APC Influenza virus antibody,86710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.23,,,,,,,fee schedule,13.55,69.32,APC Influenza virus antibody,86710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.55,,,,,,,fee schedule,13.55,69.32,APC John cunningham antibody,86711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.32,,,,,,,fee schedule,16.89,72.43, John cunningham antibody,86711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.43,,,,,,,fee schedule,16.89,72.43, John cunningham antibody,86711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.15,,,,,,,fee schedule,16.89,72.43, John cunningham antibody,86711,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.89,,,,,,,fee schedule,16.89,72.43, John cunningham antibody,86711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.57,,,,,,,fee schedule,16.89,72.43,APC John cunningham antibody,86711,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.73,,,,,,,fee schedule,16.89,72.43,APC John cunningham antibody,86711,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.89,,,,,,,fee schedule,16.89,72.43,APC Legionella antibody,86713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.52,,,,,,,fee schedule,15.3,78.29, Legionella antibody,86713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.29,,,,,,,fee schedule,15.3,78.29, Legionella antibody,86713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.3,78.29, Legionella antibody,86713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.3,78.29, Legionella antibody,86713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.91,,,,,,,fee schedule,15.3,78.29,APC Legionella antibody,86713,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.07,,,,,,,fee schedule,15.3,78.29,APC Legionella antibody,86713,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.3,,,,,,,fee schedule,15.3,78.29,APC Leishmania antibody,86717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.64,,,,,,,fee schedule,12.25,62.66, Leishmania antibody,86717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.66,,,,,,,fee schedule,12.25,62.66, Leishmania antibody,86717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.25,62.66, Leishmania antibody,86717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.25,62.66, Leishmania antibody,86717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.74,,,,,,,fee schedule,12.25,62.66,APC Leishmania antibody,86717,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.86,,,,,,,fee schedule,12.25,62.66,APC Leishmania antibody,86717,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.25,,,,,,,fee schedule,12.25,62.66,APC Leptospira antibody,86720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,16.2,67.45, Leptospira antibody,86720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,16.2,67.45, Leptospira antibody,86720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.2,67.45, Leptospira antibody,86720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.2,67.45, Leptospira antibody,86720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.85,,,,,,,fee schedule,16.2,67.45,APC Leptospira antibody,86720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.01,,,,,,,fee schedule,16.2,67.45,APC Leptospira antibody,86720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.2,,,,,,,fee schedule,16.2,67.45,APC Listeria monocytogenes,86723,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Listeria monocytogenes,86723,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Listeria monocytogenes,86723,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Listeria monocytogenes,86723,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Listeria monocytogenes,86723,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Listeria monocytogenes,86723,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Listeria monocytogenes,86723,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Lymph choriomeningitis ab,86727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.44,,,,,,,fee schedule,12.87,65.81, Lymph choriomeningitis ab,86727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.81,,,,,,,fee schedule,12.87,65.81, Lymph choriomeningitis ab,86727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.87,65.81, Lymph choriomeningitis ab,86727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.87,65.81, Lymph choriomeningitis ab,86727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.38,,,,,,,fee schedule,12.87,65.81,APC Lymph choriomeningitis ab,86727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.51,,,,,,,fee schedule,12.87,65.81,APC Lymph choriomeningitis ab,86727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.87,,,,,,,fee schedule,12.87,65.81,APC Mucormycosis antibody,86732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,15,67.45, Mucormycosis antibody,86732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,15,67.45, Mucormycosis antibody,86732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15,67.45, Mucormycosis antibody,86732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15,67.45, Mucormycosis antibody,86732,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.6,,,,,,,fee schedule,15,67.45,APC Mucormycosis antibody,86732,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.75,,,,,,,fee schedule,15,67.45,APC Mucormycosis antibody,86732,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15,,,,,,,fee schedule,15,67.45,APC Mumps antibody,86735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.25,,,,,,,fee schedule,13.05,66.72, Mumps antibody,86735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.72,,,,,,,fee schedule,13.05,66.72, Mumps antibody,86735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.05,66.72, Mumps antibody,86735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.05,66.72, Mumps antibody,86735,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.57,,,,,,,fee schedule,13.05,66.72,APC Mumps antibody,86735,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.7,,,,,,,fee schedule,13.05,66.72,APC Mumps antibody,86735,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.05,,,,,,,fee schedule,13.05,66.72,APC Mycoplasma antibody,86738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.16,,,,,,,fee schedule,13.24,67.75, Mycoplasma antibody,86738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.75,,,,,,,fee schedule,13.24,67.75, Mycoplasma antibody,86738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.24,67.75, Mycoplasma antibody,86738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.24,67.75, Mycoplasma antibody,86738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.77,,,,,,,fee schedule,13.24,67.75,APC Mycoplasma antibody,86738,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.9,,,,,,,fee schedule,13.24,67.75,APC Mycoplasma antibody,86738,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.24,,,,,,,fee schedule,13.24,67.75,APC Neisseria meningitidis,86741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Neisseria meningitidis,86741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Neisseria meningitidis,86741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Neisseria meningitidis,86741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Neisseria meningitidis,86741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Neisseria meningitidis,86741,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Neisseria meningitidis,86741,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Nocardia antibody,86744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,15.99,67.45, Nocardia antibody,86744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,15.99,67.45, Nocardia antibody,86744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,15.99,67.45, Nocardia antibody,86744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,15.99,67.45, Nocardia antibody,86744,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.63,,,,,,,fee schedule,15.99,67.45,APC Nocardia antibody,86744,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.79,,,,,,,fee schedule,15.99,67.45,APC Nocardia antibody,86744,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.99,,,,,,,fee schedule,15.99,67.45,APC Parvovirus antibody,86747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.25,,,,,,,fee schedule,15.03,76.86, Parvovirus antibody,86747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.86,,,,,,,fee schedule,15.03,76.86, Parvovirus antibody,86747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.03,76.86, Parvovirus antibody,86747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.03,76.86, Parvovirus antibody,86747,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.63,,,,,,,fee schedule,15.03,76.86,APC Parvovirus antibody,86747,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.78,,,,,,,fee schedule,15.03,76.86,APC Parvovirus antibody,86747,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.03,,,,,,,fee schedule,15.03,76.86,APC Malaria antibody,86750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Malaria antibody,86750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Malaria antibody,86750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Malaria antibody,86750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Malaria antibody,86750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Malaria antibody,86750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Malaria antibody,86750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Protozoa antibody nos,86753,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.29,,,,,,,fee schedule,12.39,63.39, Protozoa antibody nos,86753,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.39,,,,,,,fee schedule,12.39,63.39, Protozoa antibody nos,86753,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.39,63.39, Protozoa antibody nos,86753,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.39,63.39, Protozoa antibody nos,86753,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.89,,,,,,,fee schedule,12.39,63.39,APC Protozoa antibody nos,86753,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.01,,,,,,,fee schedule,12.39,63.39,APC Protozoa antibody nos,86753,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.39,,,,,,,fee schedule,12.39,63.39,APC Respiratory virus antibody,86756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.53,,,,,,,fee schedule,15.89,65.92, Respiratory virus antibody,86756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.92,,,,,,,fee schedule,15.89,65.92, Respiratory virus antibody,86756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,15.89,65.92, Respiratory virus antibody,86756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,15.89,65.92, Respiratory virus antibody,86756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.53,,,,,,,fee schedule,15.89,65.92,APC Respiratory virus antibody,86756,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.68,,,,,,,fee schedule,15.89,65.92,APC Respiratory virus antibody,86756,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.89,,,,,,,fee schedule,15.89,65.92,APC Rickettsia Antibody,86757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.91,,,,,,,fee schedule,19.35,99, Rickettsia Antibody,86757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99,,,,,,,fee schedule,19.35,99, Rickettsia Antibody,86757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.35,99, Rickettsia Antibody,86757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.35,99, Rickettsia Antibody,86757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.12,,,,,,,fee schedule,19.35,99,APC Rickettsia Antibody,86757,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.32,,,,,,,fee schedule,19.35,99,APC Rickettsia Antibody,86757,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.35,,,,,,,fee schedule,19.35,99,APC Rotavirus antibody,86759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,18.23,67.45, Rotavirus antibody,86759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,18.23,67.45, Rotavirus antibody,86759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.23,67.45, Rotavirus antibody,86759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.23,67.45, Rotavirus antibody,86759,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.96,,,,,,,fee schedule,18.23,67.45,APC Rotavirus antibody,86759,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.14,,,,,,,fee schedule,18.23,67.45,APC Rotavirus antibody,86759,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.23,,,,,,,fee schedule,18.23,67.45,APC Rubella antibody,86762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.36,,,,,,,fee schedule,14.39,73.6, Rubella antibody,86762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.6,,,,,,,fee schedule,14.39,73.6, Rubella antibody,86762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.39,73.6, Rubella antibody,86762,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.39,73.6, Rubella antibody,86762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.97,,,,,,,fee schedule,14.39,73.6,APC Rubella antibody,86762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.11,,,,,,,fee schedule,14.39,73.6,APC Rubella antibody,86762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.39,,,,,,,fee schedule,14.39,73.6,APC Rubeola antibody,86765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.46,,,,,,,fee schedule,12.88,50.07, Rubeola antibody,86765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.07,,,,,,,fee schedule,12.88,50.07, Rubeola antibody,86765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.88,50.07, Rubeola antibody,86765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.88,50.07, Rubeola antibody,86765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.4,,,,,,,fee schedule,12.88,50.07,APC Rubeola antibody,86765,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.52,,,,,,,fee schedule,12.88,50.07,APC Rubeola antibody,86765,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.88,,,,,,,fee schedule,12.88,50.07,APC Salmonella antibody,86768,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,13.19,67.45, Salmonella antibody,86768,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,13.19,67.45, Salmonella antibody,86768,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,67.45, Salmonella antibody,86768,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,67.45, Salmonella antibody,86768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,67.45,APC Salmonella antibody,86768,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,67.45,APC Salmonella antibody,86768,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,67.45,APC Sars-cov-2 covid-19 antibody,86769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.92,,,,,,,fee schedule,42.13,154.2, Sars-cov-2 covid-19 antibody,86769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,154.2,,,,,,,fee schedule,42.13,154.2, Sars-cov-2 covid-19 antibody,86769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,134.37,,,,,,,fee schedule,42.13,154.2, Sars-cov-2 covid-19 antibody,86769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,153.57,,,,,,,fee schedule,42.13,154.2, Sars-cov-2 covid-19 antibody,86769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.82,,,,,,,fee schedule,42.13,154.2,APC Sars-cov-2 covid-19 antibody,86769,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.24,,,,,,,fee schedule,42.13,154.2,APC Sars-cov-2 covid-19 antibody,86769,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.13,,,,,,,fee schedule,42.13,154.2,APC Shigella antibody,86771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.9,,,,,,,fee schedule,24.48,89.28, Shigella antibody,86771,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.45,,,,,,,fee schedule,24.48,89.28, Shigella antibody,86771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.12,,,,,,,fee schedule,24.48,89.28, Shigella antibody,86771,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.28,,,,,,,fee schedule,24.48,89.28, Shigella antibody,86771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.46,,,,,,,fee schedule,24.48,89.28,APC Shigella antibody,86771,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.7,,,,,,,fee schedule,24.48,89.28,APC Shigella antibody,86771,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.48,,,,,,,fee schedule,24.48,89.28,APC Tetanus antibody,86774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.21,,,,,,,fee schedule,14.8,75.69, Tetanus antibody,86774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.69,,,,,,,fee schedule,14.8,75.69, Tetanus antibody,86774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.8,75.69, Tetanus antibody,86774,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.8,75.69, Tetanus antibody,86774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.39,,,,,,,fee schedule,14.8,75.69,APC Tetanus antibody,86774,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.54,,,,,,,fee schedule,14.8,75.69,APC Tetanus antibody,86774,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.8,,,,,,,fee schedule,14.8,75.69,APC Toxoplasma antibody,86777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.36,,,,,,,fee schedule,14.39,73.6, Toxoplasma antibody,86777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.6,,,,,,,fee schedule,14.39,73.6, Toxoplasma antibody,86777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.39,73.6, Toxoplasma antibody,86777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.39,73.6, Toxoplasma antibody,86777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.97,,,,,,,fee schedule,14.39,73.6,APC Toxoplasma antibody,86777,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.11,,,,,,,fee schedule,14.39,73.6,APC Toxoplasma antibody,86777,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.39,,,,,,,fee schedule,14.39,73.6,APC Toxoplasma antibody igm,86778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.39,,,,,,,fee schedule,14.41,73.64, Toxoplasma antibody igm,86778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.64,,,,,,,fee schedule,14.41,73.64, Toxoplasma antibody igm,86778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.41,73.64, Toxoplasma antibody igm,86778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.41,73.64, Toxoplasma antibody igm,86778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.99,,,,,,,fee schedule,14.41,73.64,APC Toxoplasma antibody igm,86778,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.13,,,,,,,fee schedule,14.41,73.64,APC Toxoplasma antibody igm,86778,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.41,,,,,,,fee schedule,14.41,73.64,APC Treponema pallidum,86780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.94,,,,,,,fee schedule,13.24,68.63, Treponema pallidum,86780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.63,,,,,,,fee schedule,13.24,68.63, Treponema pallidum,86780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.24,68.63, Treponema pallidum,86780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.24,68.63, Treponema pallidum,86780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.77,,,,,,,fee schedule,13.24,68.63,APC Treponema pallidum,86780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.9,,,,,,,fee schedule,13.24,68.63,APC Treponema pallidum,86780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.24,,,,,,,fee schedule,13.24,68.63,APC Trichinella antibody,86784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.04,,,,,,,fee schedule,12.56,64.23, Trichinella antibody,86784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.23,,,,,,,fee schedule,12.56,64.23, Trichinella antibody,86784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.56,64.23, Trichinella antibody,86784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.56,64.23, Trichinella antibody,86784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.06,,,,,,,fee schedule,12.56,64.23,APC Trichinella antibody,86784,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,12.56,64.23,APC Trichinella antibody,86784,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.56,,,,,,,fee schedule,12.56,64.23,APC Varicella-zoster antibody,86787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.5,,,,,,,fee schedule,12.88,65.88, Varicella-zoster antibody,86787,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.88,,,,,,,fee schedule,12.88,65.88, Varicella-zoster antibody,86787,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.88,65.88, Varicella-zoster antibody,86787,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.88,65.88, Varicella-zoster antibody,86787,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.4,,,,,,,fee schedule,12.88,65.88,APC Varicella-zoster antibody,86787,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.52,,,,,,,fee schedule,12.88,65.88,APC Varicella-zoster antibody,86787,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.88,,,,,,,fee schedule,12.88,65.88,APC West nile virus ab igm,86788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.55,,,,,,,fee schedule,16.85,87.33, West nile virus ab igm,86788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.33,,,,,,,fee schedule,16.85,87.33, West nile virus ab igm,86788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.85,87.33, West nile virus ab igm,86788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.85,87.33, West nile virus ab igm,86788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.52,,,,,,,fee schedule,16.85,87.33,APC West nile virus ab igm,86788,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.69,,,,,,,fee schedule,16.85,87.33,APC West nile virus ab igm,86788,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.85,,,,,,,fee schedule,16.85,87.33,APC West Nile Virus Antibody,86789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.27,,,,,,,fee schedule,14.39,74.63, West Nile Virus Antibody,86789,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.63,,,,,,,fee schedule,14.39,74.63, West Nile Virus Antibody,86789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.39,74.63, West Nile Virus Antibody,86789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.39,74.63, West Nile Virus Antibody,86789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.97,,,,,,,fee schedule,14.39,74.63,APC West Nile Virus Antibody,86789,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.11,,,,,,,fee schedule,14.39,74.63,APC West Nile Virus Antibody,86789,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.39,,,,,,,fee schedule,14.39,74.63,APC Virus antibody nos,86790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.5,,,,,,,fee schedule,12.88,65.88, Virus antibody nos,86790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.88,,,,,,,fee schedule,12.88,65.88, Virus antibody nos,86790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.88,65.88, Virus antibody nos,86790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.88,65.88, Virus antibody nos,86790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.4,,,,,,,fee schedule,12.88,65.88,APC Virus antibody nos,86790,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.52,,,,,,,fee schedule,12.88,65.88,APC Virus antibody nos,86790,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.88,,,,,,,fee schedule,12.88,65.88,APC Yersinia antibody,86793,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.39,,,,,,,fee schedule,13.19,47.61, Yersinia antibody,86793,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.36,,,,,,,fee schedule,13.19,47.61, Yersinia antibody,86793,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.19,47.61, Yersinia antibody,86793,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.19,47.61, Yersinia antibody,86793,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.19,47.61,APC Yersinia antibody,86793,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.85,,,,,,,fee schedule,13.19,47.61,APC Yersinia antibody,86793,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.19,,,,,,,fee schedule,13.19,47.61,APC Zika virus igm antibody,86794,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.6,,,,,,,fee schedule,16.85,76.13, Zika virus igm antibody,86794,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.13,,,,,,,fee schedule,16.85,76.13, Zika virus igm antibody,86794,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.85,76.13, Zika virus igm antibody,86794,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.85,76.13, Zika virus igm antibody,86794,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.52,,,,,,,fee schedule,16.85,76.13,APC Zika virus igm antibody,86794,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.69,,,,,,,fee schedule,16.85,76.13,APC Zika virus igm antibody,86794,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.85,,,,,,,fee schedule,16.85,76.13,APC Thyroglobulin antibody,86800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.22,,,,,,,fee schedule,15.91,81.33, Thyroglobulin antibody,86800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.33,,,,,,,fee schedule,15.91,81.33, Thyroglobulin antibody,86800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,15.91,81.33, Thyroglobulin antibody,86800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,15.91,81.33, Thyroglobulin antibody,86800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.55,,,,,,,fee schedule,15.91,81.33,APC Thyroglobulin antibody,86800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.71,,,,,,,fee schedule,15.91,81.33,APC Thyroglobulin antibody,86800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.91,,,,,,,fee schedule,15.91,81.33,APC Hepatitis c ab test,86803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.81,,,,,,,fee schedule,14.27,72.98, Hepatitis c ab test,86803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.98,,,,,,,fee schedule,14.27,72.98, Hepatitis c ab test,86803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.27,72.98, Hepatitis c ab test,86803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.27,72.98, Hepatitis c ab test,86803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.84,,,,,,,fee schedule,14.27,72.98,APC Hepatitis c ab test,86803,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.98,,,,,,,fee schedule,14.27,72.98,APC Hepatitis c ab test,86803,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.27,,,,,,,fee schedule,14.27,72.98,APC Hep c ab test confirm,86804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.33,,,,,,,fee schedule,15.49,79.2, Hep c ab test confirm,86804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.2,,,,,,,fee schedule,15.49,79.2, Hep c ab test confirm,86804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.49,79.2, Hep c ab test confirm,86804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.49,79.2, Hep c ab test confirm,86804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.11,,,,,,,fee schedule,15.49,79.2,APC Hep c ab test confirm,86804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.26,,,,,,,fee schedule,15.49,79.2,APC Hep c ab test confirm,86804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.49,,,,,,,fee schedule,15.49,79.2,APC Lymphocytotoxicity assay,86805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,152.85,,,,,,,fee schedule,152.85,689.22, Lymphocytotoxicity assay,86805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,172.13,,,,,,,fee schedule,152.85,689.22, Lymphocytotoxicity assay,86805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,603.07,,,,,,,fee schedule,152.85,689.22, Lymphocytotoxicity assay,86805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,689.22,,,,,,,fee schedule,152.85,689.22, Lymphocytotoxicity assay,86805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,197.09,,,,,,,fee schedule,152.85,689.22,APC Lymphocytotoxicity assay,86805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,198.99,,,,,,,fee schedule,152.85,689.22,APC Lymphocytotoxicity assay,86805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,189.51,,,,,,,fee schedule,152.85,689.22,APC Lymphocytotoxicity assay,86806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,152.85,,,,,,,fee schedule,47.59,172.59, Lymphocytotoxicity assay,86806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,172.13,,,,,,,fee schedule,47.59,172.59, Lymphocytotoxicity assay,86806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,151.02,,,,,,,fee schedule,47.59,172.59, Lymphocytotoxicity assay,86806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,172.59,,,,,,,fee schedule,47.59,172.59, Lymphocytotoxicity assay,86806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.49,,,,,,,fee schedule,47.59,172.59,APC Lymphocytotoxicity assay,86806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.97,,,,,,,fee schedule,47.59,172.59,APC Lymphocytotoxicity assay,86806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.59,,,,,,,fee schedule,47.59,172.59,APC Cytotoxic antibody screening,86807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,179.69,,,,,,,fee schedule,78.65,285.69, Cytotoxic antibody screening,86807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,202.36,,,,,,,fee schedule,78.65,285.69, Cytotoxic antibody screening,86807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,249.98,,,,,,,fee schedule,78.65,285.69, Cytotoxic antibody screening,86807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,285.69,,,,,,,fee schedule,78.65,285.69, Cytotoxic antibody screening,86807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,81.8,,,,,,,fee schedule,78.65,285.69,APC Cytotoxic antibody screening,86807,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,82.58,,,,,,,fee schedule,78.65,285.69,APC Cytotoxic antibody screening,86807,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,78.65,,,,,,,fee schedule,78.65,285.69,APC Cytotoxic antibody screening,86808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.78,,,,,,,fee schedule,29.68,151.78, Cytotoxic antibody screening,86808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,151.78,,,,,,,fee schedule,29.68,151.78, Cytotoxic antibody screening,86808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,29.68,151.78, Cytotoxic antibody screening,86808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,29.68,151.78, Cytotoxic antibody screening,86808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.87,,,,,,,fee schedule,29.68,151.78,APC Cytotoxic antibody screening,86808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.16,,,,,,,fee schedule,29.68,151.78,APC Cytotoxic antibody screening,86808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.68,,,,,,,fee schedule,29.68,151.78,APC Hla typing a b or c,86812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.2,,,,,,,fee schedule,25.81,131.98, Hla typing a b or c,86812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,131.98,,,,,,,fee schedule,25.81,131.98, Hla typing a b or c,86812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,82.29,,,,,,,fee schedule,25.81,131.98, Hla typing a b or c,86812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.05,,,,,,,fee schedule,25.81,131.98, Hla typing a b or c,86812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.84,,,,,,,fee schedule,25.81,131.98,APC Hla typing a b or c,86812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.1,,,,,,,fee schedule,25.81,131.98,APC Hla typing a b or c,86812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.81,,,,,,,fee schedule,25.81,131.98,APC Hla typing a b or c,86813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,263.32,,,,,,,fee schedule,58,296.53, Hla typing a b or c,86813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.53,,,,,,,fee schedule,58,296.53, Hla typing a b or c,86813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,184.35,,,,,,,fee schedule,58,296.53, Hla typing a b or c,86813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,210.69,,,,,,,fee schedule,58,296.53, Hla typing a b or c,86813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.32,,,,,,,fee schedule,58,296.53,APC Hla typing a b or c,86813,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,60.9,,,,,,,fee schedule,58,296.53,APC Hla typing a b or c,86813,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58,,,,,,,fee schedule,58,296.53,APC Hla typing dr/dq,86816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.49,,,,,,,fee schedule,30.17,142.45, Hla typing dr/dq,86816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,142.45,,,,,,,fee schedule,30.17,142.45, Hla typing dr/dq,86816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.81,,,,,,,fee schedule,30.17,142.45, Hla typing dr/dq,86816,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.5,,,,,,,fee schedule,30.17,142.45, Hla typing dr/dq,86816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.38,,,,,,,fee schedule,30.17,142.45,APC Hla typing dr/dq,86816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.68,,,,,,,fee schedule,30.17,142.45,APC Hla typing dr/dq,86816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.17,,,,,,,fee schedule,30.17,142.45,APC Hla typing dr/dq,86817,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,292.34,,,,,,,fee schedule,106.14,385.68, Hla typing dr/dq,86817,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,329.22,,,,,,,fee schedule,106.14,385.68, Hla typing dr/dq,86817,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,337.47,,,,,,,fee schedule,106.14,385.68, Hla typing dr/dq,86817,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,385.68,,,,,,,fee schedule,106.14,385.68, Hla typing dr/dq,86817,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,110.39,,,,,,,fee schedule,106.14,385.68,APC Hla typing dr/dq,86817,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,111.45,,,,,,,fee schedule,106.14,385.68,APC Hla typing dr/dq,86817,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,106.14,,,,,,,fee schedule,106.14,385.68,APC Lymphocyte culture mixed,86821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,256.36,,,,,,,fee schedule,36.56,288.7, Lymphocyte culture mixed,86821,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,288.7,,,,,,,fee schedule,36.56,288.7, Lymphocyte culture mixed,86821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.66,,,,,,,fee schedule,36.56,288.7, Lymphocyte culture mixed,86821,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,133.32,,,,,,,fee schedule,36.56,288.7, Lymphocyte culture mixed,86821,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.02,,,,,,,fee schedule,36.56,288.7,APC Lymphocyte culture mixed,86821,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.39,,,,,,,fee schedule,36.56,288.7,APC Lymphocyte culture mixed,86821,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.56,,,,,,,fee schedule,36.56,288.7,APC Hla x-math non-cytotoxic,86825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,369.72,,,,,,,fee schedule,109.49,416.36, Hla x-math non-cytotoxic,86825,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,416.36,,,,,,,fee schedule,109.49,416.36, Hla x-math non-cytotoxic,86825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,347.89,,,,,,,fee schedule,109.49,416.36, Hla x-math non-cytotoxic,86825,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,397.59,,,,,,,fee schedule,109.49,416.36, Hla x-math non-cytotoxic,86825,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,113.87,,,,,,,fee schedule,109.49,416.36,APC Hla x-math non-cytotoxic,86825,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,114.96,,,,,,,fee schedule,109.49,416.36,APC Hla x-math non-cytotoxic,86825,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,109.49,,,,,,,fee schedule,109.49,416.36,APC Hla x-match noncytotoxc addl,86826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.24,,,,,,,fee schedule,36.53,138.79, Hla x-match noncytotoxc addl,86826,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.79,,,,,,,fee schedule,36.53,138.79, Hla x-match noncytotoxc addl,86826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.66,,,,,,,fee schedule,36.53,138.79, Hla x-match noncytotoxc addl,86826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,133.32,,,,,,,fee schedule,36.53,138.79, Hla x-match noncytotoxc addl,86826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.99,,,,,,,fee schedule,36.53,138.79,APC Hla x-match noncytotoxc addl,86826,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.36,,,,,,,fee schedule,36.53,138.79,APC Hla x-match noncytotoxc addl,86826,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.53,,,,,,,fee schedule,36.53,138.79,APC Hla class i&ii antibody qual,86828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,176.8,,,,,,,fee schedule,64.19,233.31, Hla class i&ii antibody qual,86828,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,199.1,,,,,,,fee schedule,64.19,233.31, Hla class i&ii antibody qual,86828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,204.15,,,,,,,fee schedule,64.19,233.31, Hla class i&ii antibody qual,86828,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,233.31,,,,,,,fee schedule,64.19,233.31, Hla class i&ii antibody qual,86828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.76,,,,,,,fee schedule,64.19,233.31,APC Hla class i&ii antibody qual,86828,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.4,,,,,,,fee schedule,64.19,233.31,APC Hla class i&ii antibody qual,86828,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.19,,,,,,,fee schedule,64.19,233.31,APC Hla class i/ii antibody qual,86829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,132.6,,,,,,,fee schedule,64.19,233.31, Hla class i/ii antibody qual,86829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.33,,,,,,,fee schedule,64.19,233.31, Hla class i/ii antibody qual,86829,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,204.15,,,,,,,fee schedule,64.19,233.31, Hla class i/ii antibody qual,86829,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,233.31,,,,,,,fee schedule,64.19,233.31, Hla class i/ii antibody qual,86829,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.76,,,,,,,fee schedule,64.19,233.31,APC Hla class i/ii antibody qual,86829,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.4,,,,,,,fee schedule,64.19,233.31,APC Hla class i/ii antibody qual,86829,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.19,,,,,,,fee schedule,64.19,233.31,APC Hla class i phenotype qual,86830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,344.21,,,,,,,fee schedule,95.52,387.63, Hla class i phenotype qual,86830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,387.63,,,,,,,fee schedule,95.52,387.63, Hla class i phenotype qual,86830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,304.13,,,,,,,fee schedule,95.52,387.63, Hla class i phenotype qual,86830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,347.58,,,,,,,fee schedule,95.52,387.63, Hla class i phenotype qual,86830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,99.34,,,,,,,fee schedule,95.52,387.63,APC Hla class i phenotype qual,86830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,100.3,,,,,,,fee schedule,95.52,387.63,APC Hla class i phenotype qual,86830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,95.52,,,,,,,fee schedule,95.52,387.63,APC Hla class ii phenotype qual,86831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,295.04,,,,,,,fee schedule,81.88,332.25, Hla class ii phenotype qual,86831,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,332.25,,,,,,,fee schedule,81.88,332.25, Hla class ii phenotype qual,86831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,260.4,,,,,,,fee schedule,81.88,332.25, Hla class ii phenotype qual,86831,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,297.6,,,,,,,fee schedule,81.88,332.25, Hla class ii phenotype qual,86831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,85.16,,,,,,,fee schedule,81.88,332.25,APC Hla class ii phenotype qual,86831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,85.97,,,,,,,fee schedule,81.88,332.25,APC Hla class ii phenotype qual,86831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,81.88,,,,,,,fee schedule,81.88,332.25,APC Hla class i high defin qual,86832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,540.9,,,,,,,fee schedule,323.75,1177.26, Hla class i high defin qual,86832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,609.13,,,,,,,fee schedule,323.75,1177.26, Hla class i high defin qual,86832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1030.1,,,,,,,fee schedule,323.75,1177.26, Hla class i high defin qual,86832,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1177.26,,,,,,,fee schedule,323.75,1177.26, Hla class i high defin qual,86832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,336.7,,,,,,,fee schedule,323.75,1177.26,APC Hla class i high defin qual,86832,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,339.94,,,,,,,fee schedule,323.75,1177.26,APC Hla class i high defin qual,86832,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,323.75,,,,,,,fee schedule,323.75,1177.26,APC Hla class ii high defin qual,86833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,491.73,,,,,,,fee schedule,325.8,1184.4, Hla class ii high defin qual,86833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,553.76,,,,,,,fee schedule,325.8,1184.4, Hla class ii high defin qual,86833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1036.35,,,,,,,fee schedule,325.8,1184.4, Hla class ii high defin qual,86833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1184.4,,,,,,,fee schedule,325.8,1184.4, Hla class ii high defin qual,86833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,338.83,,,,,,,fee schedule,325.8,1184.4,APC Hla class ii high defin qual,86833,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,342.09,,,,,,,fee schedule,325.8,1184.4,APC Hla class ii high defin qual,86833,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,325.8,,,,,,,fee schedule,325.8,1184.4,APC Hla class i semiquant panel,86834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1524.35,,,,,,,fee schedule,357.56,1716.65, Hla class i semiquant panel,86834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1716.65,,,,,,,fee schedule,357.56,1716.65, Hla class i semiquant panel,86834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1137.39,,,,,,,fee schedule,357.56,1716.65, Hla class i semiquant panel,86834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1299.87,,,,,,,fee schedule,357.56,1716.65, Hla class i semiquant panel,86834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,371.86,,,,,,,fee schedule,357.56,1716.65,APC Hla class i semiquant panel,86834,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,375.44,,,,,,,fee schedule,357.56,1716.65,APC Hla class i semiquant panel,86834,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,357.56,,,,,,,fee schedule,357.56,1716.65,APC Hla class ii semiquant panel,86835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1376.83,,,,,,,fee schedule,322.96,1550.52, Hla class ii semiquant panel,86835,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1550.52,,,,,,,fee schedule,322.96,1550.52, Hla class ii semiquant panel,86835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1026.98,,,,,,,fee schedule,322.96,1550.52, Hla class ii semiquant panel,86835,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1173.69,,,,,,,fee schedule,322.96,1550.52, Hla class ii semiquant panel,86835,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,335.88,,,,,,,fee schedule,322.96,1550.52,APC Hla class ii semiquant panel,86835,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,339.11,,,,,,,fee schedule,322.96,1550.52,APC Hla class ii semiquant panel,86835,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,322.96,,,,,,,fee schedule,322.96,1550.52,APC Immunology procedure,86849,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,158.63,,,,,,,fee schedule,39.22,178.64, Immunology procedure,86849,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,178.64,,,,,,,fee schedule,39.22,178.64, Immunology procedure,86849,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.22,,,,,,,fee schedule,39.22,178.64, Immunology procedure,86849,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.82,,,,,,,fee schedule,39.22,178.64, RBC antibody screen,86850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.85,,,,,,,fee schedule,31.24,64.64, RBC antibody screen,86850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.01,,,,,,,fee schedule,31.24,64.64, RBC antibody screen,86850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,31.24,64.64, RBC antibody screen,86850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,31.24,64.64, RBC antibody screen,86850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,31.24,64.64,APC RBC antibody screen,86850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,31.24,64.64,APC RBC antibody screen,86850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,31.24,64.64,APC RBC antibody elution,86860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.87,,,,,,,fee schedule,68.87,211.33, RBC antibody elution,86860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.56,,,,,,,fee schedule,68.87,211.33, RBC antibody elution,86860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,68.87,211.33, RBC antibody elution,86860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,68.87,211.33, RBC antibody elution,86860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,68.87,211.33,APC RBC antibody elution,86860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,68.87,211.33,APC RBC antibody elution,86860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,68.87,211.33,APC RBC antibody identification,86870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.14,,,,,,,fee schedule,92.14,444.62, RBC antibody identification,86870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.76,,,,,,,fee schedule,92.14,444.62, RBC antibody identification,86870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,130.2,,,,,,,fee schedule,92.14,444.62, RBC antibody identification,86870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,148.8,,,,,,,fee schedule,92.14,444.62, RBC antibody identification,86870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,92.14,444.62,APC RBC antibody identification,86870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,92.14,444.62,APC RBC antibody identification,86870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,92.14,444.62,APC Coombs test direct,86880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.38,,,,,,,fee schedule,16.67,73.17, Coombs test direct,86880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.45,,,,,,,fee schedule,16.67,73.17, Coombs test direct,86880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,16.67,73.17, Coombs test direct,86880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,16.67,73.17, Coombs test direct,86880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,16.67,73.17,APC Coombs test direct,86880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,16.67,73.17,APC Coombs test direct,86880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,16.67,73.17,APC Coombs test indirect qual,86885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.97,,,,,,,fee schedule,17.72,211.33, Coombs test indirect qual,86885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.24,,,,,,,fee schedule,17.72,211.33, Coombs test indirect qual,86885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,17.72,211.33, Coombs test indirect qual,86885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,17.72,211.33, Coombs test indirect qual,86885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,17.72,211.33,APC Coombs test indirect qual,86885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,17.72,211.33,APC Coombs test indirect qual,86885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,17.72,211.33,APC Coombs test indirect titer,86886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,16.67,211.33, Coombs test indirect titer,86886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,16.67,211.33, Coombs test indirect titer,86886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,16.67,211.33, Coombs test indirect titer,86886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,16.67,211.33, Coombs test indirect titer,86886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,16.67,211.33,APC Coombs test indirect titer,86886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,16.67,211.33,APC Coombs test indirect titer,86886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,16.67,211.33,APC Autologous blood process,86890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,166.53,,,,,,,fee schedule,166.53,340.44, Autologous blood process,86890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,187.54,,,,,,,fee schedule,166.53,340.44, Autologous blood process,86890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,297.89,,,,,,,fee schedule,166.53,340.44, Autologous blood process,86890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,340.44,,,,,,,fee schedule,166.53,340.44, Autologous blood process,86890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,166.53,340.44,APC Autologous blood process,86890,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,166.53,340.44,APC Autologous blood process,86890,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,166.53,340.44,APC Autologous blood op salvage,86891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.82,,,,,,,fee schedule,66.82,999.37, Autologous blood op salvage,86891,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.25,,,,,,,fee schedule,66.82,999.37, Autologous blood op salvage,86891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,420.79,,,,,,,fee schedule,66.82,999.37, Autologous blood op salvage,86891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,480.9,,,,,,,fee schedule,66.82,999.37, Autologous blood op salvage,86891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,66.82,999.37,APC Autologous blood op salvage,86891,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,66.82,999.37,APC Autologous blood op salvage,86891,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,66.82,999.37,APC Blood typing serologic abo,86900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.55,,,,,,,fee schedule,9.37,165.03, Blood typing serologic abo,86900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.26,,,,,,,fee schedule,9.37,165.03, Blood typing serologic abo,86900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.37,,,,,,,fee schedule,9.37,165.03, Blood typing serologic abo,86900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.71,,,,,,,fee schedule,9.37,165.03, Blood typing serologic abo,86900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,9.37,165.03,APC Blood typing serologic abo,86900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,9.37,165.03,APC Blood typing serologic abo,86900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,9.37,165.03,APC Blood typing serologic rh(d),86901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.75,,,,,,,fee schedule,9.37,46.33, Blood typing serologic rh(d),86901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.48,,,,,,,fee schedule,9.37,46.33, Blood typing serologic rh(d),86901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.37,,,,,,,fee schedule,9.37,46.33, Blood typing serologic rh(d),86901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.71,,,,,,,fee schedule,9.37,46.33, Blood typing serologic rh(d),86901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,9.37,46.33,APC Blood typing serologic rh(d),86901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,9.37,46.33,APC Blood typing serologic rh(d),86901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,9.37,46.33,APC Blood type antigen donor ea,86902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.87,,,,,,,fee schedule,19.79,444.62, Blood type antigen donor ea,86902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.28,,,,,,,fee schedule,19.79,444.62, Blood type antigen donor ea,86902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.79,,,,,,,fee schedule,19.79,444.62, Blood type antigen donor ea,86902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.62,,,,,,,fee schedule,19.79,444.62, Blood type antigen donor ea,86902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,19.79,444.62,APC Blood type antigen donor ea,86902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,19.79,444.62,APC Blood type antigen donor ea,86902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,19.79,444.62,APC Blood typing patient serum,86904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.16,,,,,,,fee schedule,43.16,73.17, Blood typing patient serum,86904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.6,,,,,,,fee schedule,43.16,73.17, Blood typing patient serum,86904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,43.16,73.17, Blood typing patient serum,86904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,43.16,73.17, Blood typing patient serum,86904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,43.16,73.17,APC Blood typing patient serum,86904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,43.16,73.17,APC Blood typing patient serum,86904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,43.16,73.17,APC Blood typing rbc antigens,86905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.36,,,,,,,fee schedule,12.5,444.62, Blood typing rbc antigens,86905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.54,,,,,,,fee schedule,12.5,444.62, Blood typing rbc antigens,86905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.5,,,,,,,fee schedule,12.5,444.62, Blood typing rbc antigens,86905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.28,,,,,,,fee schedule,12.5,444.62, Blood typing rbc antigens,86905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,12.5,444.62,APC Blood typing rbc antigens,86905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,12.5,444.62,APC Blood typing rbc antigens,86905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,12.5,444.62,APC Bld typing serologic rh phnt,86906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.2,,,,,,,fee schedule,24.99,46.33, Bld typing serologic rh phnt,86906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.64,,,,,,,fee schedule,24.99,46.33, Bld typing serologic rh phnt,86906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,24.99,46.33, Bld typing serologic rh phnt,86906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,24.99,46.33, Bld typing serologic rh phnt,86906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,24.99,46.33,APC Bld typing serologic rh phnt,86906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,24.99,46.33,APC Bld typing serologic rh phnt,86906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,24.99,46.33,APC Blood typing paternity test,86910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,77.07,88.08, Blood typing paternity test,86910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,77.07,88.08, Blood typing antigen system,86911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.65,,,,,,,fee schedule,66.65,76.17, Blood typing antigen system,86911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.17,,,,,,,fee schedule,66.65,76.17, Compatibility test spin,86920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.25,,,,,,,fee schedule,64.25,211.33, Compatibility test spin,86920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.36,,,,,,,fee schedule,64.25,211.33, Compatibility test spin,86920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,105.21,,,,,,,fee schedule,64.25,211.33, Compatibility test spin,86920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,120.24,,,,,,,fee schedule,64.25,211.33, Compatibility test spin,86920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,64.25,211.33,APC Compatibility test spin,86920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,64.25,211.33,APC Compatibility test spin,86920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,64.25,211.33,APC Compatibility test incubate,86921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.34,,,,,,,fee schedule,36.34,211.33, Compatibility test incubate,86921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.92,,,,,,,fee schedule,36.34,211.33, Compatibility test incubate,86921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,36.34,211.33, Compatibility test incubate,86921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,36.34,211.33, Compatibility test incubate,86921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,36.34,211.33,APC Compatibility test incubate,86921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,36.34,211.33,APC Compatibility test incubate,86921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,36.34,211.33,APC Compatibility test antiglob,86922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.24,,,,,,,fee schedule,71.24,211.33, Compatibility test antiglob,86922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.23,,,,,,,fee schedule,71.24,211.33, Compatibility test antiglob,86922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,112.48,,,,,,,fee schedule,71.24,211.33, Compatibility test antiglob,86922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,128.55,,,,,,,fee schedule,71.24,211.33, Compatibility test antiglob,86922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,71.24,211.33,APC Compatibility test antiglob,86922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,71.24,211.33,APC Compatibility test antiglob,86922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,71.24,211.33,APC Compatibility test electric,86923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.34,,,,,,,fee schedule,41.34,211.33, Compatibility test electric,86923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.56,,,,,,,fee schedule,41.34,211.33, Compatibility test electric,86923,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.37,,,,,,,fee schedule,41.34,211.33, Compatibility test electric,86923,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.42,,,,,,,fee schedule,41.34,211.33, Compatibility test electric,86923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,41.34,211.33,APC Compatibility test electric,86923,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,41.34,211.33,APC Compatibility test electric,86923,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,41.34,211.33,APC Plasma fresh frozen,86927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.02,,,,,,,fee schedule,37.02,211.33, Plasma fresh frozen,86927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.69,,,,,,,fee schedule,37.02,211.33, Plasma fresh frozen,86927,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.38,,,,,,,fee schedule,37.02,211.33, Plasma fresh frozen,86927,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.86,,,,,,,fee schedule,37.02,211.33, Plasma fresh frozen,86927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,37.02,211.33,APC Plasma fresh frozen,86927,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,37.02,211.33,APC Plasma fresh frozen,86927,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,37.02,211.33,APC Frozen blood prep,86930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.37,,,,,,,fee schedule,67.37,401.16, Frozen blood prep,86930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.87,,,,,,,fee schedule,67.37,401.16, Frozen blood prep,86930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,351.02,,,,,,,fee schedule,67.37,401.16, Frozen blood prep,86930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,401.16,,,,,,,fee schedule,67.37,401.16, Frozen blood prep,86930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,67.37,401.16,APC Frozen blood prep,86930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,67.37,401.16,APC Frozen blood prep,86930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,67.37,401.16,APC Frozen blood thaw,86931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.97,,,,,,,fee schedule,134.97,301.17, Frozen blood thaw,86931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,152,,,,,,,fee schedule,134.97,301.17, Frozen blood thaw,86931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,263.52,,,,,,,fee schedule,134.97,301.17, Frozen blood thaw,86931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,301.17,,,,,,,fee schedule,134.97,301.17, Frozen blood thaw,86931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,134.97,301.17,APC Frozen blood thaw,86931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,134.97,301.17,APC Frozen blood thaw,86931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,134.97,301.17,APC Frozen blood freeze/thaw,86932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.23,,,,,,,fee schedule,17.23,340.44, Frozen blood freeze/thaw,86932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.4,,,,,,,fee schedule,17.23,340.44, Frozen blood freeze/thaw,86932,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,297.89,,,,,,,fee schedule,17.23,340.44, Frozen blood freeze/thaw,86932,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,340.44,,,,,,,fee schedule,17.23,340.44, Frozen blood freeze/thaw,86932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,17.23,340.44,APC Frozen blood freeze/thaw,86932,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,17.23,340.44,APC Frozen blood freeze/thaw,86932,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,17.23,340.44,APC Hemolysins/agglutinins auto,86940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.95,,,,,,,fee schedule,8.77,32.13, Hemolysins/agglutinins auto,86940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,31.48,,,,,,,fee schedule,8.77,32.13, Hemolysins/agglutinins auto,86940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.77,32.13, Hemolysins/agglutinins auto,86940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.77,32.13, Hemolysins/agglutinins auto,86940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.12,,,,,,,fee schedule,8.77,32.13,APC Hemolysins/agglutinins auto,86940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.21,,,,,,,fee schedule,8.77,32.13,APC Hemolysins/agglutinins auto,86940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.77,,,,,,,fee schedule,8.77,32.13,APC Hemolysins/agglutinins,86941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.99,,,,,,,fee schedule,12.11,61.93, Hemolysins/agglutinins,86941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.93,,,,,,,fee schedule,12.11,61.93, Hemolysins/agglutinins,86941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.11,61.93, Hemolysins/agglutinins,86941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.11,61.93, Hemolysins/agglutinins,86941,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.59,,,,,,,fee schedule,12.11,61.93,APC Hemolysins/agglutinins,86941,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.72,,,,,,,fee schedule,12.11,61.93,APC Hemolysins/agglutinins,86941,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,12.11,61.93,APC Blood product/irradiation,86945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.91,,,,,,,fee schedule,44.12,99.99, Blood product/irradiation,86945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.95,,,,,,,fee schedule,44.12,99.99, Blood product/irradiation,86945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.49,,,,,,,fee schedule,44.12,99.99, Blood product/irradiation,86945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,99.99,,,,,,,fee schedule,44.12,99.99, Blood product/irradiation,86945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,99.99,APC Blood product/irradiation,86945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,99.99,APC Blood product/irradiation,86945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,99.99,APC Leukacyte transfusion,86950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.1,,,,,,,fee schedule,134.1,260.7, Leukacyte transfusion,86950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,151.01,,,,,,,fee schedule,134.1,260.7, Leukacyte transfusion,86950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,228.11,,,,,,,fee schedule,134.1,260.7, Leukacyte transfusion,86950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,260.7,,,,,,,fee schedule,134.1,260.7, Leukacyte transfusion,86950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,134.1,260.7,APC Leukacyte transfusion,86950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,134.1,260.7,APC Leukacyte transfusion,86950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,134.1,260.7,APC Vol reduction of blood/prod,86960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.15,,,,,,,fee schedule,72.15,211.33, Vol reduction of blood/prod,86960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.25,,,,,,,fee schedule,72.15,211.33, Vol reduction of blood/prod,86960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,97.91,,,,,,,fee schedule,72.15,211.33, Vol reduction of blood/prod,86960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,111.9,,,,,,,fee schedule,72.15,211.33, Vol reduction of blood/prod,86960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,72.15,211.33,APC Vol reduction of blood/prod,86960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,72.15,211.33,APC Vol reduction of blood/prod,86960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,72.15,211.33,APC Pooling blood platelets,86965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.78,,,,,,,fee schedule,56.78,211.33, Pooling blood platelets,86965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.94,,,,,,,fee schedule,56.78,211.33, Pooling blood platelets,86965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,97.91,,,,,,,fee schedule,56.78,211.33, Pooling blood platelets,86965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,111.9,,,,,,,fee schedule,56.78,211.33, Pooling blood platelets,86965,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,56.78,211.33,APC Pooling blood platelets,86965,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,56.78,211.33,APC Pooling blood platelets,86965,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,56.78,211.33,APC Rbc pretx incubatj w/chemicl,86970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.44,,,,,,,fee schedule,54.44,99.99, Rbc pretx incubatj w/chemicl,86970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.31,,,,,,,fee schedule,54.44,99.99, Rbc pretx incubatj w/chemicl,86970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.49,,,,,,,fee schedule,54.44,99.99, Rbc pretx incubatj w/chemicl,86970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,99.99,,,,,,,fee schedule,54.44,99.99, Rbc pretx incubatj w/chemicl,86970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,54.44,99.99,APC Rbc pretx incubatj w/chemicl,86970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,54.44,99.99,APC Rbc pretx incubatj w/chemicl,86970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,54.44,99.99,APC Rbc pretx incubatj w/enzymes,86971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.19,,,,,,,fee schedule,55.19,211.33, Rbc pretx incubatj w/enzymes,86971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.15,,,,,,,fee schedule,55.19,211.33, Rbc pretx incubatj w/enzymes,86971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,55.19,211.33, Rbc pretx incubatj w/enzymes,86971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,55.19,211.33, Rbc pretx incubatj w/enzymes,86971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,55.19,211.33,APC Rbc pretx incubatj w/enzymes,86971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,55.19,211.33,APC Rbc pretx incubatj w/enzymes,86971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,55.19,211.33,APC Rbc pretx incubatj w/density,86972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.8,,,,,,,fee schedule,72.8,211.33, Rbc pretx incubatj w/density,86972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.98,,,,,,,fee schedule,72.8,211.33, Rbc pretx incubatj w/density,86972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.9,,,,,,,fee schedule,72.8,211.33, Rbc pretx incubatj w/density,86972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,140.46,,,,,,,fee schedule,72.8,211.33, Rbc pretx incubatj w/density,86972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,72.8,211.33,APC Rbc pretx incubatj w/density,86972,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,72.8,211.33,APC Rbc pretx incubatj w/density,86972,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,72.8,211.33,APC Rbc serum pretx incubj drugs,86975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.91,,,,,,,fee schedule,91.91,554.12, Rbc serum pretx incubj drugs,86975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.5,,,,,,,fee schedule,91.91,554.12, Rbc serum pretx incubj drugs,86975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,91.91,554.12, Rbc serum pretx incubj drugs,86975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,91.91,554.12, Rbc serum pretx incubj drugs,86975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,91.91,554.12,APC Rbc serum pretx incubj drugs,86975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,91.91,554.12,APC Rbc serum pretx incubj drugs,86975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,91.91,554.12,APC Rbc serum pretx id dilution,86976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.73,,,,,,,fee schedule,34.17,120.24, Rbc serum pretx id dilution,86976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.49,,,,,,,fee schedule,34.17,120.24, Rbc serum pretx id dilution,86976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,105.21,,,,,,,fee schedule,34.17,120.24, Rbc serum pretx id dilution,86976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,120.24,,,,,,,fee schedule,34.17,120.24, Rbc serum pretx id dilution,86976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,120.24,APC Rbc serum pretx id dilution,86976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,120.24,APC Rbc serum pretx id dilution,86976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,120.24,APC Rbc serum pretx incubj/inhib,86977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,152.85,,,,,,,fee schedule,105.21,211.33, Rbc serum pretx incubj/inhib,86977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,172.13,,,,,,,fee schedule,105.21,211.33, Rbc serum pretx incubj/inhib,86977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,105.21,,,,,,,fee schedule,105.21,211.33, Rbc serum pretx incubj/inhib,86977,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,120.24,,,,,,,fee schedule,105.21,211.33, Rbc serum pretx incubj/inhib,86977,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,105.21,211.33,APC Rbc serum pretx incubj/inhib,86977,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,105.21,211.33,APC Rbc serum pretx incubj/inhib,86977,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,105.21,211.33,APC Rbc pretreatment serum,86978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.24,,,,,,,fee schedule,69.69,120.24, Rbc pretreatment serum,86978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.23,,,,,,,fee schedule,69.69,120.24, Rbc pretreatment serum,86978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,105.21,,,,,,,fee schedule,69.69,120.24, Rbc pretreatment serum,86978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,120.24,,,,,,,fee schedule,69.69,120.24, Rbc pretreatment serum,86978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,120.24,APC Rbc pretreatment serum,86978,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,120.24,APC Rbc pretreatment serum,86978,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,120.24,APC Split blood or products,86985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.29,,,,,,,fee schedule,77.07,211.33, Split blood or products,86985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.67,,,,,,,fee schedule,77.07,211.33, Split blood or products,86985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,77.07,211.33, Split blood or products,86985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,77.07,211.33, Split blood or products,86985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,77.07,211.33,APC Split blood or products,86985,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,77.07,211.33,APC Split blood or products,86985,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,77.07,211.33,APC Transfusion procedure,86999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.51,,,,,,,fee schedule,27.98,72.65, Transfusion procedure,86999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.65,,,,,,,fee schedule,27.98,72.65, Transfusion procedure,86999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.98,,,,,,,fee schedule,27.98,72.65, Transfusion procedure,86999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,31.98,,,,,,,fee schedule,27.98,72.65, Transfusion procedure,86999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,27.98,72.65,APC Transfusion procedure,86999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,27.98,72.65,APC Transfusion procedure,86999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,27.98,72.65,APC Small animal inoculation,87003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.44,,,,,,,fee schedule,16.84,86.08, Small animal inoculation,87003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.08,,,,,,,fee schedule,16.84,86.08, Small animal inoculation,87003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.84,86.08, Small animal inoculation,87003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.84,86.08, Small animal inoculation,87003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.51,,,,,,,fee schedule,16.84,86.08,APC Small animal inoculation,87003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.68,,,,,,,fee schedule,16.84,86.08,APC Small animal inoculation,87003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.84,,,,,,,fee schedule,16.84,86.08,APC Specimen infect agnt concntj,87015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.89,,,,,,,fee schedule,6.68,31.4, Specimen infect agnt concntj,87015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,31.4,,,,,,,fee schedule,6.68,31.4, Specimen infect agnt concntj,87015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.68,31.4, Specimen infect agnt concntj,87015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.68,31.4, Specimen infect agnt concntj,87015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.95,,,,,,,fee schedule,6.68,31.4,APC Specimen infect agnt concntj,87015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.01,,,,,,,fee schedule,6.68,31.4,APC Specimen infect agnt concntj,87015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.68,,,,,,,fee schedule,6.68,31.4,APC Blood culture for bacteria,87040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.87,,,,,,,fee schedule,10.32,52.78, Blood culture for bacteria,87040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.78,,,,,,,fee schedule,10.32,52.78, Blood culture for bacteria,87040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.32,52.78, Blood culture for bacteria,87040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.32,52.78, Blood culture for bacteria,87040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.73,,,,,,,fee schedule,10.32,52.78,APC Blood culture for bacteria,87040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.84,,,,,,,fee schedule,10.32,52.78,APC Blood culture for bacteria,87040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.32,,,,,,,fee schedule,10.32,52.78,APC Feces culture aerobic bact,87045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.84,,,,,,,fee schedule,9.44,48.24, Feces culture aerobic bact,87045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.24,,,,,,,fee schedule,9.44,48.24, Feces culture aerobic bact,87045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.44,48.24, Feces culture aerobic bact,87045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.44,48.24, Feces culture aerobic bact,87045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.82,,,,,,,fee schedule,9.44,48.24,APC Feces culture aerobic bact,87045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.91,,,,,,,fee schedule,9.44,48.24,APC Feces culture aerobic bact,87045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.44,,,,,,,fee schedule,9.44,48.24,APC Stool cultr aerobic bact ea,87046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.84,,,,,,,fee schedule,9.44,48.24, Stool cultr aerobic bact ea,87046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.24,,,,,,,fee schedule,9.44,48.24, Stool cultr aerobic bact ea,87046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.44,48.24, Stool cultr aerobic bact ea,87046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.44,48.24, Stool cultr aerobic bact ea,87046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.82,,,,,,,fee schedule,9.44,48.24,APC Stool cultr aerobic bact ea,87046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.91,,,,,,,fee schedule,9.44,48.24,APC Stool cultr aerobic bact ea,87046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.44,,,,,,,fee schedule,9.44,48.24,APC Culture othr specimn aerobic,87070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.1,,,,,,,fee schedule,8.62,44.03, Culture othr specimn aerobic,87070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.03,,,,,,,fee schedule,8.62,44.03, Culture othr specimn aerobic,87070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.62,44.03, Culture othr specimn aerobic,87070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.62,44.03, Culture othr specimn aerobic,87070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.96,,,,,,,fee schedule,8.62,44.03,APC Culture othr specimn aerobic,87070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.05,,,,,,,fee schedule,8.62,44.03,APC Culture othr specimn aerobic,87070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.62,,,,,,,fee schedule,8.62,44.03,APC Culture aerobic quant other,87071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.84,,,,,,,fee schedule,9.89,48.24, Culture aerobic quant other,87071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.24,,,,,,,fee schedule,9.89,48.24, Culture aerobic quant other,87071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.89,48.24, Culture aerobic quant other,87071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.89,48.24, Culture aerobic quant other,87071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.29,,,,,,,fee schedule,9.89,48.24,APC Culture aerobic quant other,87071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.38,,,,,,,fee schedule,9.89,48.24,APC Culture aerobic quant other,87071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.89,,,,,,,fee schedule,9.89,48.24,APC Culture Bacteria Anaerobic,87073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.84,,,,,,,fee schedule,9.66,48.24, Culture Bacteria Anaerobic,87073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.24,,,,,,,fee schedule,9.66,48.24, Culture Bacteria Anaerobic,87073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.66,48.24, Culture Bacteria Anaerobic,87073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.66,48.24, Culture Bacteria Anaerobic,87073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.05,,,,,,,fee schedule,9.66,48.24,APC Culture Bacteria Anaerobic,87073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.14,,,,,,,fee schedule,9.66,48.24,APC Culture Bacteria Anaerobic,87073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.66,,,,,,,fee schedule,9.66,48.24,APC Cultr bacteria except blood,87075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.97,,,,,,,fee schedule,9.47,48.39, Cultr bacteria except blood,87075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.39,,,,,,,fee schedule,9.47,48.39, Cultr bacteria except blood,87075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.47,48.39, Cultr bacteria except blood,87075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.47,48.39, Cultr bacteria except blood,87075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.85,,,,,,,fee schedule,9.47,48.39,APC Cultr bacteria except blood,87075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.94,,,,,,,fee schedule,9.47,48.39,APC Cultr bacteria except blood,87075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.47,,,,,,,fee schedule,9.47,48.39,APC Culture anaerobe ident each,87076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.69,,,,,,,fee schedule,8.08,41.32, Culture anaerobe ident each,87076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.32,,,,,,,fee schedule,8.08,41.32, Culture anaerobe ident each,87076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.08,41.32, Culture anaerobe ident each,87076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.08,41.32, Culture anaerobe ident each,87076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.4,,,,,,,fee schedule,8.08,41.32,APC Culture anaerobe ident each,87076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.48,,,,,,,fee schedule,8.08,41.32,APC Culture anaerobe ident each,87076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.08,,,,,,,fee schedule,8.08,41.32,APC Culture Aerobic Identify,87077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.69,,,,,,,fee schedule,8.08,41.32, Culture Aerobic Identify,87077,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.32,,,,,,,fee schedule,8.08,41.32, Culture Aerobic Identify,87077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.08,41.32, Culture Aerobic Identify,87077,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.08,41.32, Culture Aerobic Identify,87077,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.4,,,,,,,fee schedule,8.08,41.32,APC Culture Aerobic Identify,87077,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.48,,,,,,,fee schedule,8.08,41.32,APC Culture Aerobic Identify,87077,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.08,,,,,,,fee schedule,8.08,41.32,APC Culture screen only,87081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.1,,,,,,,fee schedule,6.63,33.89, Culture screen only,87081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.89,,,,,,,fee schedule,6.63,33.89, Culture screen only,87081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.63,33.89, Culture screen only,87081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.63,33.89, Culture screen only,87081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.9,,,,,,,fee schedule,6.63,33.89,APC Culture screen only,87081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.96,,,,,,,fee schedule,6.63,33.89,APC Culture screen only,87081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.63,,,,,,,fee schedule,6.63,33.89,APC Culture of specimen by kit,87084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.1,,,,,,,fee schedule,27.07,98.79, Culture of specimen by kit,87084,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.03,,,,,,,fee schedule,27.07,98.79, Culture of specimen by kit,87084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.07,98.79, Culture of specimen by kit,87084,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.07,98.79, Culture of specimen by kit,87084,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.15,,,,,,,fee schedule,27.07,98.79,APC Culture of specimen by kit,87084,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.42,,,,,,,fee schedule,27.07,98.79,APC Culture of specimen by kit,87084,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.07,,,,,,,fee schedule,27.07,98.79,APC Urine culture/colony count,87086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.66,,,,,,,fee schedule,8.07,41.28, Urine culture/colony count,87086,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.28,,,,,,,fee schedule,8.07,41.28, Urine culture/colony count,87086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.07,41.28, Urine culture/colony count,87086,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.07,41.28, Urine culture/colony count,87086,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.39,,,,,,,fee schedule,8.07,41.28,APC Urine culture/colony count,87086,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.47,,,,,,,fee schedule,8.07,41.28,APC Urine culture/colony count,87086,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.07,,,,,,,fee schedule,8.07,41.28,APC Urine bacteria culture,87088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.76,,,,,,,fee schedule,8.09,41.39, Urine bacteria culture,87088,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.39,,,,,,,fee schedule,8.09,41.39, Urine bacteria culture,87088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,8.09,41.39, Urine bacteria culture,87088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,8.09,41.39, Urine bacteria culture,87088,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.41,,,,,,,fee schedule,8.09,41.39,APC Urine bacteria culture,87088,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.49,,,,,,,fee schedule,8.09,41.39,APC Urine bacteria culture,87088,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.09,,,,,,,fee schedule,8.09,41.39,APC Skin fungi culture,87101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35,,,,,,,fee schedule,7.71,39.42, Skin fungi culture,87101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.42,,,,,,,fee schedule,7.71,39.42, Skin fungi culture,87101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.71,39.42, Skin fungi culture,87101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.71,39.42, Skin fungi culture,87101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.02,,,,,,,fee schedule,7.71,39.42,APC Skin fungi culture,87101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.1,,,,,,,fee schedule,7.71,39.42,APC Skin fungi culture,87101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.71,,,,,,,fee schedule,7.71,39.42,APC Fungus isolation culture,87102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.16,,,,,,,fee schedule,8.41,42.97, Fungus isolation culture,87102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.97,,,,,,,fee schedule,8.41,42.97, Fungus isolation culture,87102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.41,42.97, Fungus isolation culture,87102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.41,42.97, Fungus isolation culture,87102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.75,,,,,,,fee schedule,8.41,42.97,APC Fungus isolation culture,87102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.83,,,,,,,fee schedule,8.41,42.97,APC Fungus isolation culture,87102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.41,,,,,,,fee schedule,8.41,42.97,APC Blood fungus culture,87103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.95,,,,,,,fee schedule,20.46,73.8, Blood fungus culture,87103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.12,,,,,,,fee schedule,20.46,73.8, Blood fungus culture,87103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.46,73.8, Blood fungus culture,87103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.46,73.8, Blood fungus culture,87103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.28,,,,,,,fee schedule,20.46,73.8,APC Blood fungus culture,87103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.48,,,,,,,fee schedule,20.46,73.8,APC Blood fungus culture,87103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.46,,,,,,,fee schedule,20.46,73.8,APC Fungi identification yeast,87106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.87,,,,,,,fee schedule,10.32,52.78, Fungi identification yeast,87106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.78,,,,,,,fee schedule,10.32,52.78, Fungi identification yeast,87106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.32,52.78, Fungi identification yeast,87106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.32,52.78, Fungi identification yeast,87106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.73,,,,,,,fee schedule,10.32,52.78,APC Fungi identification yeast,87106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.84,,,,,,,fee schedule,10.32,52.78,APC Fungi identification yeast,87106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.32,,,,,,,fee schedule,10.32,52.78,APC Fungi identification mold,87107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.87,,,,,,,fee schedule,10.32,52.78, Fungi identification mold,87107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.78,,,,,,,fee schedule,10.32,52.78, Fungi identification mold,87107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.32,52.78, Fungi identification mold,87107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.32,52.78, Fungi identification mold,87107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.73,,,,,,,fee schedule,10.32,52.78,APC Fungi identification mold,87107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.84,,,,,,,fee schedule,10.32,52.78,APC Fungi identification mold,87107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.32,,,,,,,fee schedule,10.32,52.78,APC Mycoplasma,87109,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.88,,,,,,,fee schedule,15.39,78.69, Mycoplasma,87109,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.69,,,,,,,fee schedule,15.39,78.69, Mycoplasma,87109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.39,78.69, Mycoplasma,87109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.39,78.69, Mycoplasma,87109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.01,,,,,,,fee schedule,15.39,78.69,APC Mycoplasma,87109,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.16,,,,,,,fee schedule,15.39,78.69,APC Mycoplasma,87109,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.39,,,,,,,fee schedule,15.39,78.69,APC Chlamydia culture,87110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.95,,,,,,,fee schedule,19.6,100.17, Chlamydia culture,87110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.17,,,,,,,fee schedule,19.6,100.17, Chlamydia culture,87110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.6,100.17, Chlamydia culture,87110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.6,100.17, Chlamydia culture,87110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.38,,,,,,,fee schedule,19.6,100.17,APC Chlamydia culture,87110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.58,,,,,,,fee schedule,19.6,100.17,APC Chlamydia culture,87110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.6,,,,,,,fee schedule,19.6,100.17,APC Mycobacteria culture,87116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.89,,,,,,,fee schedule,10.8,39.27, Mycobacteria culture,87116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,31.4,,,,,,,fee schedule,10.8,39.27, Mycobacteria culture,87116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.8,39.27, Mycobacteria culture,87116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.8,39.27, Mycobacteria culture,87116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.23,,,,,,,fee schedule,10.8,39.27,APC Mycobacteria culture,87116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.34,,,,,,,fee schedule,10.8,39.27,APC Mycobacteria culture,87116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.8,,,,,,,fee schedule,10.8,39.27,APC Mycobacteric identification,87118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.69,,,,,,,fee schedule,14.61,55.96, Mycobacteric identification,87118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.96,,,,,,,fee schedule,14.61,55.96, Mycobacteric identification,87118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.61,55.96, Mycobacteric identification,87118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.61,55.96, Mycobacteric identification,87118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.19,,,,,,,fee schedule,14.61,55.96,APC Mycobacteric identification,87118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.34,,,,,,,fee schedule,14.61,55.96,APC Mycobacteric identification,87118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.61,,,,,,,fee schedule,14.61,55.96,APC Culture type immunofluoresc,87140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.32,,,,,,,fee schedule,5.57,28.51, Culture type immunofluoresc,87140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.51,,,,,,,fee schedule,5.57,28.51, Culture type immunofluoresc,87140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.57,28.51, Culture type immunofluoresc,87140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.57,28.51, Culture type immunofluoresc,87140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.79,,,,,,,fee schedule,5.57,28.51,APC Culture type immunofluoresc,87140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.85,,,,,,,fee schedule,5.57,28.51,APC Culture type immunofluoresc,87140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.57,,,,,,,fee schedule,5.57,28.51,APC Culture typing glc/hplc,87143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.91,,,,,,,fee schedule,12.52,64.09, Culture typing glc/hplc,87143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.09,,,,,,,fee schedule,12.52,64.09, Culture typing glc/hplc,87143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.52,64.09, Culture typing glc/hplc,87143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.52,64.09, Culture typing glc/hplc,87143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.02,,,,,,,fee schedule,12.52,64.09,APC Culture typing glc/hplc,87143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.15,,,,,,,fee schedule,12.52,64.09,APC Culture typing glc/hplc,87143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.52,,,,,,,fee schedule,12.52,64.09,APC Culture type immunologic,87147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.5,,,,,,,fee schedule,5.18,26.46, Culture type immunologic,87147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.46,,,,,,,fee schedule,5.18,26.46, Culture type immunologic,87147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.18,26.46, Culture type immunologic,87147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.18,26.46, Culture type immunologic,87147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.18,26.46,APC Culture type immunologic,87147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.44,,,,,,,fee schedule,5.18,26.46,APC Culture type immunologic,87147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.18,,,,,,,fee schedule,5.18,26.46,APC Dna/rna direct probe,87149,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Dna/rna direct probe,87149,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Dna/rna direct probe,87149,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Dna/rna direct probe,87149,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Dna/rna direct probe,87149,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Dna/rna direct probe,87149,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Dna/rna direct probe,87149,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Dna/rna amplified probe,87150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.56,,,,,,,fee schedule,35.09,181.94, Dna/rna amplified probe,87150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.94,,,,,,,fee schedule,35.09,181.94, Dna/rna amplified probe,87150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,181.94, Dna/rna amplified probe,87150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,181.94, Dna/rna amplified probe,87150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,181.94,APC Dna/rna amplified probe,87150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,181.94,APC Dna/rna amplified probe,87150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,181.94,APC Culture Type Pulse Field Gel,87152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.76,,,,,,,fee schedule,7.74,28.56, Culture Type Pulse Field Gel,87152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.75,,,,,,,fee schedule,7.74,28.56, Culture Type Pulse Field Gel,87152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.74,28.56, Culture Type Pulse Field Gel,87152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.74,28.56, Culture Type Pulse Field Gel,87152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.05,,,,,,,fee schedule,7.74,28.56,APC Culture Type Pulse Field Gel,87152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.13,,,,,,,fee schedule,7.74,28.56,APC Culture Type Pulse Field Gel,87152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.74,,,,,,,fee schedule,7.74,28.56,APC Dna/rna sequencing,87153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,531.02,,,,,,,fee schedule,115.36,598.01, Dna/rna sequencing,87153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,598.01,,,,,,,fee schedule,115.36,598.01, Dna/rna sequencing,87153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,366.63,,,,,,,fee schedule,115.36,598.01, Dna/rna sequencing,87153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,419.01,,,,,,,fee schedule,115.36,598.01, Dna/rna sequencing,87153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.97,,,,,,,fee schedule,115.36,598.01,APC Dna/rna sequencing,87153,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,121.13,,,,,,,fee schedule,115.36,598.01,APC Dna/rna sequencing,87153,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,115.36,,,,,,,fee schedule,115.36,598.01,APC Cul typ id bld pthgn 6+ trgt,87154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,708.7,,,,,,,fee schedule,218.06,798.1, Cul typ id bld pthgn 6+ trgt,87154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,798.1,,,,,,,fee schedule,218.06,798.1, Cul typ id bld pthgn 6+ trgt,87154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,693.68,,,,,,,fee schedule,218.06,798.1, Cul typ id bld pthgn 6+ trgt,87154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,792.78,,,,,,,fee schedule,218.06,798.1, Cul typ id bld pthgn 6+ trgt,87154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,226.78,,,,,,,fee schedule,218.06,798.1,APC Cul typ id bld pthgn 6+ trgt,87154,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,228.96,,,,,,,fee schedule,218.06,798.1,APC Cul typ id bld pthgn 6+ trgt,87154,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,218.06,,,,,,,fee schedule,218.06,798.1,APC Culture typing added method,87158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.76,,,,,,,fee schedule,7.74,28.56, Culture typing added method,87158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.75,,,,,,,fee schedule,7.74,28.56, Culture typing added method,87158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.74,28.56, Culture typing added method,87158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.74,28.56, Culture typing added method,87158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.05,,,,,,,fee schedule,7.74,28.56,APC Culture typing added method,87158,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.13,,,,,,,fee schedule,7.74,28.56,APC Culture typing added method,87158,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.74,,,,,,,fee schedule,7.74,28.56,APC Dark field examination,87164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.78,,,,,,,fee schedule,10.74,54.94, Dark field examination,87164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.94,,,,,,,fee schedule,10.74,54.94, Dark field examination,87164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.74,54.94, Dark field examination,87164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.74,54.94, Dark field examination,87164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.17,,,,,,,fee schedule,10.74,54.94,APC Dark field examination,87164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.28,,,,,,,fee schedule,10.74,54.94,APC Dark field examination,87164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.74,54.94,APC Dark field examination,87166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.29,,,,,,,fee schedule,11.3,57.75, Dark field examination,87166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.75,,,,,,,fee schedule,11.3,57.75, Dark field examination,87166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.3,57.75, Dark field examination,87166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.3,57.75, Dark field examination,87166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.75,,,,,,,fee schedule,11.3,57.75,APC Dark field examination,87166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.87,,,,,,,fee schedule,11.3,57.75,APC Dark field examination,87166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.3,,,,,,,fee schedule,11.3,57.75,APC Macroscopic Exam Arthropod,87168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,4.27,21.81, Macroscopic Exam Arthropod,87168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,4.27,21.81, Macroscopic Exam Arthropod,87168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,21.81, Macroscopic Exam Arthropod,87168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,21.81, Macroscopic Exam Arthropod,87168,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,21.81,APC Macroscopic Exam Arthropod,87168,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,21.81,APC Macroscopic Exam Arthropod,87168,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,21.81,APC Macroscopic exam parasite,87169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,4.31,21.81, Macroscopic exam parasite,87169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,4.31,21.81, Macroscopic exam parasite,87169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.31,21.81, Macroscopic exam parasite,87169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.31,21.81, Macroscopic exam parasite,87169,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.31,21.81,APC Macroscopic exam parasite,87169,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.53,,,,,,,fee schedule,4.31,21.81,APC Macroscopic exam parasite,87169,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.31,,,,,,,fee schedule,4.31,21.81,APC Pinworm Exam,87172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,4.27,21.81, Pinworm Exam,87172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,4.27,21.81, Pinworm Exam,87172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,21.81, Pinworm Exam,87172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,21.81, Pinworm Exam,87172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,21.81,APC Pinworm Exam,87172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,21.81,APC Pinworm Exam,87172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,21.81,APC Tissue homogenization cultr,87176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.72,,,,,,,fee schedule,5.88,30.09, Tissue homogenization cultr,87176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.09,,,,,,,fee schedule,5.88,30.09, Tissue homogenization cultr,87176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.88,30.09, Tissue homogenization cultr,87176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.88,30.09, Tissue homogenization cultr,87176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.12,,,,,,,fee schedule,5.88,30.09,APC Tissue homogenization cultr,87176,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.17,,,,,,,fee schedule,5.88,30.09,APC Tissue homogenization cultr,87176,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.88,,,,,,,fee schedule,5.88,30.09,APC Ova and parasites smears,87177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.89,,,,,,,fee schedule,8.9,32.13, Ova and parasites smears,87177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,31.4,,,,,,,fee schedule,8.9,32.13, Ova and parasites smears,87177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,8.9,32.13, Ova and parasites smears,87177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,8.9,32.13, Ova and parasites smears,87177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.26,,,,,,,fee schedule,8.9,32.13,APC Ova and parasites smears,87177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.35,,,,,,,fee schedule,8.9,32.13,APC Ova and parasites smears,87177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.9,,,,,,,fee schedule,8.9,32.13,APC Microbe susceptible diffuse,87181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.58,,,,,,,fee schedule,4.75,24.3, Microbe susceptible diffuse,87181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.3,,,,,,,fee schedule,4.75,24.3, Microbe susceptible diffuse,87181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.75,24.3, Microbe susceptible diffuse,87181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.75,24.3, Microbe susceptible diffuse,87181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.94,,,,,,,fee schedule,4.75,24.3,APC Microbe susceptible diffuse,87181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.99,,,,,,,fee schedule,4.75,24.3,APC Microbe susceptible diffuse,87181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.75,,,,,,,fee schedule,4.75,24.3,APC Sc std carbapenem resist gen,87183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Sc std carbapenem resist gen,87183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Sc std carbapenem resist gen,87183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Microbe susceptible disk,87184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.3,,,,,,,fee schedule,7.48,35.25, Microbe susceptible disk,87184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.25,,,,,,,fee schedule,7.48,35.25, Microbe susceptible disk,87184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.97,,,,,,,fee schedule,7.48,35.25, Microbe susceptible disk,87184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.39,,,,,,,fee schedule,7.48,35.25, Microbe susceptible disk,87184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.78,,,,,,,fee schedule,7.48,35.25,APC Microbe susceptible disk,87184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.85,,,,,,,fee schedule,7.48,35.25,APC Microbe susceptible disk,87184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.48,,,,,,,fee schedule,7.48,35.25,APC Microbe susceptible enzyme,87185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.58,,,,,,,fee schedule,4.75,24.3, Microbe susceptible enzyme,87185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.3,,,,,,,fee schedule,4.75,24.3, Microbe susceptible enzyme,87185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.75,24.3, Microbe susceptible enzyme,87185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.75,24.3, Microbe susceptible enzyme,87185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.94,,,,,,,fee schedule,4.75,24.3,APC Microbe susceptible enzyme,87185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.99,,,,,,,fee schedule,4.75,24.3,APC Microbe susceptible enzyme,87185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.75,,,,,,,fee schedule,4.75,24.3,APC Microbe susceptible mic,87186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.26,,,,,,,fee schedule,8.65,44.21, Microbe susceptible mic,87186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.21,,,,,,,fee schedule,8.65,44.21, Microbe susceptible mic,87186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.65,44.21, Microbe susceptible mic,87186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.65,44.21, Microbe susceptible mic,87186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9,,,,,,,fee schedule,8.65,44.21,APC Microbe susceptible mic,87186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.08,,,,,,,fee schedule,8.65,44.21,APC Microbe susceptible mic,87186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.65,,,,,,,fee schedule,8.65,44.21,APC Microbe susceptible mlc,87187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.06,,,,,,,fee schedule,40.17,146.4, Microbe susceptible mlc,87187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53,,,,,,,fee schedule,40.17,146.4, Microbe susceptible mlc,87187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,128.1,,,,,,,fee schedule,40.17,146.4, Microbe susceptible mlc,87187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,146.4,,,,,,,fee schedule,40.17,146.4, Microbe susceptible mlc,87187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.78,,,,,,,fee schedule,40.17,146.4,APC Microbe susceptible mlc,87187,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.18,,,,,,,fee schedule,40.17,146.4,APC Microbe susceptible mlc,87187,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.17,,,,,,,fee schedule,40.17,146.4,APC Microbe suscept macrobroth,87188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.81,,,,,,,fee schedule,6.64,29.06, Microbe suscept macrobroth,87188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.06,,,,,,,fee schedule,6.64,29.06, Microbe suscept macrobroth,87188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.64,29.06, Microbe suscept macrobroth,87188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.64,29.06, Microbe suscept macrobroth,87188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.91,,,,,,,fee schedule,6.64,29.06,APC Microbe suscept macrobroth,87188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.97,,,,,,,fee schedule,6.64,29.06,APC Microbe suscept macrobroth,87188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.64,,,,,,,fee schedule,6.64,29.06,APC Microbe suscept mycobacteri,87190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.68,,,,,,,fee schedule,7.31,28.91, Microbe suscept mycobacteri,87190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.91,,,,,,,fee schedule,7.31,28.91, Microbe suscept mycobacteri,87190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.31,28.91, Microbe suscept mycobacteri,87190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.31,28.91, Microbe suscept mycobacteri,87190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.6,,,,,,,fee schedule,7.31,28.91,APC Microbe suscept mycobacteri,87190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.68,,,,,,,fee schedule,7.31,28.91,APC Microbe suscept mycobacteri,87190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.31,,,,,,,fee schedule,7.31,28.91,APC Bactericidal level serum,87197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.78,,,,,,,fee schedule,15.02,59.44, Bactericidal level serum,87197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.44,,,,,,,fee schedule,15.02,59.44, Bactericidal level serum,87197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15.02,59.44, Bactericidal level serum,87197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15.02,59.44, Bactericidal level serum,87197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.62,,,,,,,fee schedule,15.02,59.44,APC Bactericidal level serum,87197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.77,,,,,,,fee schedule,15.02,59.44,APC Bactericidal level serum,87197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.02,,,,,,,fee schedule,15.02,59.44,APC Smear gram stain,87205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,4.27,21.81, Smear gram stain,87205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,4.27,21.81, Smear gram stain,87205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,21.81, Smear gram stain,87205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,21.81, Smear gram stain,87205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,21.81,APC Smear gram stain,87205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,21.81,APC Smear gram stain,87205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,21.81,APC Smear fluorescent/acid stai,87206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.38,,,,,,,fee schedule,5.39,27.45, Smear fluorescent/acid stai,87206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.45,,,,,,,fee schedule,5.39,27.45, Smear fluorescent/acid stai,87206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.67,,,,,,,fee schedule,5.39,27.45, Smear fluorescent/acid stai,87206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.05,,,,,,,fee schedule,5.39,27.45, Smear fluorescent/acid stai,87206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.61,,,,,,,fee schedule,5.39,27.45,APC Smear fluorescent/acid stai,87206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.66,,,,,,,fee schedule,5.39,27.45,APC Smear fluorescent/acid stai,87206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.39,,,,,,,fee schedule,5.39,27.45,APC Smear special stain,87207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.2,,,,,,,fee schedule,5.99,30.63, Smear special stain,87207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.63,,,,,,,fee schedule,5.99,30.63, Smear special stain,87207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.99,30.63, Smear special stain,87207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.99,30.63, Smear special stain,87207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.23,,,,,,,fee schedule,5.99,30.63,APC Smear special stain,87207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.29,,,,,,,fee schedule,5.99,30.63,APC Smear special stain,87207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.99,,,,,,,fee schedule,5.99,30.63,APC Smear complex stain,87209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.74,,,,,,,fee schedule,17.98,93.18, Smear complex stain,87209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,93.18,,,,,,,fee schedule,17.98,93.18, Smear complex stain,87209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.98,93.18, Smear complex stain,87209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.98,93.18, Smear complex stain,87209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.7,,,,,,,fee schedule,17.98,93.18,APC Smear complex stain,87209,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.88,,,,,,,fee schedule,17.98,93.18,APC Smear complex stain,87209,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.98,,,,,,,fee schedule,17.98,93.18,APC Smear wet mount saline/ink,87210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,5.82,21.81, Smear wet mount saline/ink,87210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,5.82,21.81, Smear wet mount saline/ink,87210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.82,21.81, Smear wet mount saline/ink,87210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.82,21.81, Smear wet mount saline/ink,87210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.05,,,,,,,fee schedule,5.82,21.81,APC Smear wet mount saline/ink,87210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.11,,,,,,,fee schedule,5.82,21.81,APC Smear wet mount saline/ink,87210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.82,,,,,,,fee schedule,5.82,21.81,APC Tissue exam for fungi,87220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.7,,,,,,,fee schedule,4.27,17.68, Tissue exam for fungi,87220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.68,,,,,,,fee schedule,4.27,17.68, Tissue exam for fungi,87220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,17.68, Tissue exam for fungi,87220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,17.68, Tissue exam for fungi,87220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,17.68,APC Tissue exam for fungi,87220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,17.68,APC Tissue exam for fungi,87220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,17.68,APC Assay toxin or antitoxin,87230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.2,,,,,,,fee schedule,19.74,89.19, Assay toxin or antitoxin,87230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.19,,,,,,,fee schedule,19.74,89.19, Assay toxin or antitoxin,87230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.74,89.19, Assay toxin or antitoxin,87230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.74,89.19, Assay toxin or antitoxin,87230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.53,,,,,,,fee schedule,19.74,89.19,APC Assay toxin or antitoxin,87230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.73,,,,,,,fee schedule,19.74,89.19,APC Assay toxin or antitoxin,87230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.74,,,,,,,fee schedule,19.74,89.19,APC Virus inoculate eggs/animal,87250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.79,,,,,,,fee schedule,19.56,99.99, Virus inoculate eggs/animal,87250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.99,,,,,,,fee schedule,19.56,99.99, Virus inoculate eggs/animal,87250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.56,99.99, Virus inoculate eggs/animal,87250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.56,99.99, Virus inoculate eggs/animal,87250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.34,,,,,,,fee schedule,19.56,99.99,APC Virus inoculate eggs/animal,87250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.54,,,,,,,fee schedule,19.56,99.99,APC Virus inoculate eggs/animal,87250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.56,,,,,,,fee schedule,19.56,99.99,APC Virus inoculation tissue,87252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,118.37,,,,,,,fee schedule,26.07,133.3, Virus inoculation tissue,87252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,133.3,,,,,,,fee schedule,26.07,133.3, Virus inoculation tissue,87252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.32,,,,,,,fee schedule,26.07,133.3, Virus inoculation tissue,87252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.22,,,,,,,fee schedule,26.07,133.3, Virus inoculation tissue,87252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,26.07,133.3,APC Virus inoculation tissue,87252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.37,,,,,,,fee schedule,26.07,133.3,APC Virus inoculation tissue,87252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.07,,,,,,,fee schedule,26.07,133.3,APC Virus inoculate tissue addl,87253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.72,,,,,,,fee schedule,20.2,103.29, Virus inoculate tissue addl,87253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.29,,,,,,,fee schedule,20.2,103.29, Virus inoculate tissue addl,87253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.2,103.29, Virus inoculate tissue addl,87253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.2,103.29, Virus inoculate tissue addl,87253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.01,,,,,,,fee schedule,20.2,103.29,APC Virus inoculate tissue addl,87253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.21,,,,,,,fee schedule,20.2,103.29,APC Virus inoculate tissue addl,87253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.2,,,,,,,fee schedule,20.2,103.29,APC Virus inoculation shell via,87254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.79,,,,,,,fee schedule,19.56,99.99, Virus inoculation shell via,87254,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.99,,,,,,,fee schedule,19.56,99.99, Virus inoculation shell via,87254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.56,99.99, Virus inoculation shell via,87254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.56,99.99, Virus inoculation shell via,87254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.34,,,,,,,fee schedule,19.56,99.99,APC Virus inoculation shell via,87254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.54,,,,,,,fee schedule,19.56,99.99,APC Virus inoculation shell via,87254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.56,,,,,,,fee schedule,19.56,99.99,APC Genet virus isolate hsv,87255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.76,,,,,,,fee schedule,33.86,173.15, Genet virus isolate hsv,87255,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,173.15,,,,,,,fee schedule,33.86,173.15, Genet virus isolate hsv,87255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,107.28,,,,,,,fee schedule,33.86,173.15, Genet virus isolate hsv,87255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,122.61,,,,,,,fee schedule,33.86,173.15, Genet virus isolate hsv,87255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.21,,,,,,,fee schedule,33.86,173.15,APC Genet virus isolate hsv,87255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.55,,,,,,,fee schedule,33.86,173.15,APC Genet virus isolate hsv,87255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.86,,,,,,,fee schedule,33.86,173.15,APC Adenovirus ag if,87260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,14.43,56.33, Adenovirus ag if,87260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,14.43,56.33, Adenovirus ag if,87260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.43,56.33, Adenovirus ag if,87260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.43,56.33, Adenovirus ag if,87260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.01,,,,,,,fee schedule,14.43,56.33,APC Adenovirus ag if,87260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.15,,,,,,,fee schedule,14.43,56.33,APC Adenovirus ag if,87260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.43,,,,,,,fee schedule,14.43,56.33,APC Pertussis ag if,87265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Pertussis ag if,87265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Pertussis ag if,87265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Pertussis ag if,87265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Pertussis ag if,87265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Pertussis ag if,87265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Pertussis ag if,87265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Enterovirus antibody dfa,87267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.42,56.33, Enterovirus antibody dfa,87267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.42,56.33, Enterovirus antibody dfa,87267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.42,56.33, Enterovirus antibody dfa,87267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.42,56.33, Enterovirus antibody dfa,87267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.96,,,,,,,fee schedule,13.42,56.33,APC Enterovirus antibody dfa,87267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.09,,,,,,,fee schedule,13.42,56.33,APC Enterovirus antibody dfa,87267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,13.42,56.33,APC Giardia ag if,87269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.61,56.33, Giardia ag if,87269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.61,56.33, Giardia ag if,87269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.61,56.33, Giardia ag if,87269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.61,56.33, Giardia ag if,87269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.15,,,,,,,fee schedule,13.61,56.33,APC Giardia ag if,87269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.29,,,,,,,fee schedule,13.61,56.33,APC Giardia ag if,87269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.61,,,,,,,fee schedule,13.61,56.33,APC Chlamydia trachomatis ag if,87270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Chlamydia trachomatis ag if,87270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Chlamydia trachomatis ag if,87270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Chlamydia trachomatis ag if,87270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Chlamydia trachomatis ag if,87270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Chlamydia trachomatis ag if,87270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Chlamydia trachomatis ag if,87270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Cytomegalovirus dfa,87271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.42,56.33, Cytomegalovirus dfa,87271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.42,56.33, Cytomegalovirus dfa,87271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.42,56.33, Cytomegalovirus dfa,87271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.42,56.33, Cytomegalovirus dfa,87271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.96,,,,,,,fee schedule,13.42,56.33,APC Cytomegalovirus dfa,87271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.09,,,,,,,fee schedule,13.42,56.33,APC Cytomegalovirus dfa,87271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,13.42,56.33,APC Cryptosporidium ag if,87272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Cryptosporidium ag if,87272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Cryptosporidium ag if,87272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Cryptosporidium ag if,87272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Cryptosporidium ag if,87272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Cryptosporidium ag if,87272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Cryptosporidium ag if,87272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Herpes simplex 2 ag if,87273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Herpes simplex 2 ag if,87273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Herpes simplex 2 ag if,87273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Herpes simplex 2 ag if,87273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Herpes simplex 2 ag if,87273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Herpes simplex 2 ag if,87273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Herpes simplex 2 ag if,87273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Herpes simplex 1 ag if,87274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Herpes simplex 1 ag if,87274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Herpes simplex 1 ag if,87274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Herpes simplex 1 ag if,87274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Herpes simplex 1 ag if,87274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Herpes simplex 1 ag if,87274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Herpes simplex 1 ag if,87274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Influenza b ag if,87275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,12.25,56.33, Influenza b ag if,87275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,12.25,56.33, Influenza b ag if,87275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.25,56.33, Influenza b ag if,87275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.25,56.33, Influenza b ag if,87275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.74,,,,,,,fee schedule,12.25,56.33,APC Influenza b ag if,87275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.86,,,,,,,fee schedule,12.25,56.33,APC Influenza b ag if,87275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.25,,,,,,,fee schedule,12.25,56.33,APC Influenza a ag if,87276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16.07,58.32, Influenza a ag if,87276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16.07,58.32, Influenza a ag if,87276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.07,58.32, Influenza a ag if,87276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.07,58.32, Influenza a ag if,87276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.71,,,,,,,fee schedule,16.07,58.32,APC Influenza a ag if,87276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.07,58.32,APC Influenza a ag if,87276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.07,,,,,,,fee schedule,16.07,58.32,APC Legion pneumophilia ag if,87278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,15.6,57.15, Legion pneumophilia ag if,87278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,15.6,57.15, Legion pneumophilia ag if,87278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.01,,,,,,,fee schedule,15.6,57.15, Legion pneumophilia ag if,87278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.15,,,,,,,fee schedule,15.6,57.15, Legion pneumophilia ag if,87278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.22,,,,,,,fee schedule,15.6,57.15,APC Legion pneumophilia ag if,87278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.38,,,,,,,fee schedule,15.6,57.15,APC Legion pneumophilia ag if,87278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.6,,,,,,,fee schedule,15.6,57.15,APC Parainfluenza ag if,87279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16.43,59.52, Parainfluenza ag if,87279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16.43,59.52, Parainfluenza ag if,87279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.43,59.52, Parainfluenza ag if,87279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.43,59.52, Parainfluenza ag if,87279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.09,,,,,,,fee schedule,16.43,59.52,APC Parainfluenza ag if,87279,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.25,,,,,,,fee schedule,16.43,59.52,APC Parainfluenza ag if,87279,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.43,,,,,,,fee schedule,16.43,59.52,APC Respiratory syncytial ag if,87280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.42,56.33, Respiratory syncytial ag if,87280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.42,56.33, Respiratory syncytial ag if,87280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.42,56.33, Respiratory syncytial ag if,87280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.42,56.33, Respiratory syncytial ag if,87280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.96,,,,,,,fee schedule,13.42,56.33,APC Respiratory syncytial ag if,87280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.09,,,,,,,fee schedule,13.42,56.33,APC Respiratory syncytial ag if,87280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,13.42,56.33,APC Pneumocystis carinii ag if,87281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Pneumocystis carinii ag if,87281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Pneumocystis carinii ag if,87281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Pneumocystis carinii ag if,87281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Pneumocystis carinii ag if,87281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Pneumocystis carinii ag if,87281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Pneumocystis carinii ag if,87281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Rubeola ag if,87283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,50.02,221.4, Rubeola ag if,87283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,50.02,221.4, Rubeola ag if,87283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,193.73,,,,,,,fee schedule,50.02,221.4, Rubeola ag if,87283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,221.4,,,,,,,fee schedule,50.02,221.4, Rubeola ag if,87283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,63.23,,,,,,,fee schedule,50.02,221.4,APC Rubeola ag if,87283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,63.84,,,,,,,fee schedule,50.02,221.4,APC Rubeola ag if,87283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,60.8,,,,,,,fee schedule,50.02,221.4,APC Treponema pallidum ag if,87285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,12.18,56.33, Treponema pallidum ag if,87285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,12.18,56.33, Treponema pallidum ag if,87285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.18,56.33, Treponema pallidum ag if,87285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.18,56.33, Treponema pallidum ag if,87285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.67,,,,,,,fee schedule,12.18,56.33,APC Treponema pallidum ag if,87285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.79,,,,,,,fee schedule,12.18,56.33,APC Treponema pallidum ag if,87285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.18,,,,,,,fee schedule,12.18,56.33,APC Varicella zoster ag if,87290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.42,56.33, Varicella zoster ag if,87290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.42,56.33, Varicella zoster ag if,87290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.42,56.33, Varicella zoster ag if,87290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.42,56.33, Varicella zoster ag if,87290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.96,,,,,,,fee schedule,13.42,56.33,APC Varicella zoster ag if,87290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.09,,,,,,,fee schedule,13.42,56.33,APC Varicella zoster ag if,87290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,13.42,56.33,APC Antibody detection nos if,87299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16.1,58.32, Antibody detection nos if,87299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16.1,58.32, Antibody detection nos if,87299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.1,58.32, Antibody detection nos if,87299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.1,58.32, Antibody detection nos if,87299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.74,,,,,,,fee schedule,16.1,58.32,APC Antibody detection nos if,87299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.9,,,,,,,fee schedule,16.1,58.32,APC Antibody detection nos if,87299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.1,,,,,,,fee schedule,16.1,58.32,APC Ag detection polyval if,87300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Ag detection polyval if,87300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Ag detection polyval if,87300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Ag detection polyval if,87300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Ag detection polyval if,87300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Ag detection polyval if,87300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Ag detection polyval if,87300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Adenovirus ag ia,87301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Adenovirus ag ia,87301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Adenovirus ag ia,87301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Adenovirus ag ia,87301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Adenovirus ag ia,87301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Adenovirus ag ia,87301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Adenovirus ag ia,87301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Aspergillus ag ia,87305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.67,,,,,,,fee schedule,11.98,57.06, Aspergillus ag ia,87305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.06,,,,,,,fee schedule,11.98,57.06, Aspergillus ag ia,87305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,57.06, Aspergillus ag ia,87305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,57.06, Aspergillus ag ia,87305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,57.06,APC Aspergillus ag ia,87305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,57.06,APC Aspergillus ag ia,87305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,57.06,APC Chylmd trach ag ia,87320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,15,56.33, Chylmd trach ag ia,87320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,15,56.33, Chylmd trach ag ia,87320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.91,,,,,,,fee schedule,15,56.33, Chylmd trach ag ia,87320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.75,,,,,,,fee schedule,15,56.33, Chylmd trach ag ia,87320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.6,,,,,,,fee schedule,15,56.33,APC Chylmd trach ag ia,87320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.75,,,,,,,fee schedule,15,56.33,APC Chylmd trach ag ia,87320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15,,,,,,,fee schedule,15,56.33,APC Clostridium ag ia,87324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Clostridium ag ia,87324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Clostridium ag ia,87324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Clostridium ag ia,87324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Clostridium ag ia,87324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Clostridium ag ia,87324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Clostridium ag ia,87324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Cryptococcus neoform ag ia,87327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.42,56.33, Cryptococcus neoform ag ia,87327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.42,56.33, Cryptococcus neoform ag ia,87327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.71,,,,,,,fee schedule,13.42,56.33, Cryptococcus neoform ag ia,87327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.81,,,,,,,fee schedule,13.42,56.33, Cryptococcus neoform ag ia,87327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.96,,,,,,,fee schedule,13.42,56.33,APC Cryptococcus neoform ag ia,87327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.09,,,,,,,fee schedule,13.42,56.33,APC Cryptococcus neoform ag ia,87327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,13.42,56.33,APC Cryptosporidium ag ia,87328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.82,56.33, Cryptosporidium ag ia,87328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.82,56.33, Cryptosporidium ag ia,87328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.82,56.33, Cryptosporidium ag ia,87328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.82,56.33, Cryptosporidium ag ia,87328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.37,,,,,,,fee schedule,13.82,56.33,APC Cryptosporidium ag ia,87328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.51,,,,,,,fee schedule,13.82,56.33,APC Cryptosporidium ag ia,87328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.82,,,,,,,fee schedule,13.82,56.33,APC Giardia ag ia,87329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Giardia ag ia,87329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Giardia ag ia,87329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Giardia ag ia,87329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Giardia ag ia,87329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Giardia ag ia,87329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Giardia ag ia,87329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Cytomegalovirus ag ia,87332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Cytomegalovirus ag ia,87332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Cytomegalovirus ag ia,87332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Cytomegalovirus ag ia,87332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Cytomegalovirus ag ia,87332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Cytomegalovirus ag ia,87332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Cytomegalovirus ag ia,87332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC E coli 0157 ag ia,87335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,12.66,56.33, E coli 0157 ag ia,87335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,12.66,56.33, E coli 0157 ag ia,87335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.66,56.33, E coli 0157 ag ia,87335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.66,56.33, E coli 0157 ag ia,87335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.17,,,,,,,fee schedule,12.66,56.33,APC E coli 0157 ag ia,87335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.29,,,,,,,fee schedule,12.66,56.33,APC E coli 0157 ag ia,87335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.66,,,,,,,fee schedule,12.66,56.33,APC Entamoeb hist dispr ag ia,87336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16,58.32, Entamoeb hist dispr ag ia,87336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16,58.32, Entamoeb hist dispr ag ia,87336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16,58.32, Entamoeb hist dispr ag ia,87336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16,58.32, Entamoeb hist dispr ag ia,87336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.64,,,,,,,fee schedule,16,58.32,APC Entamoeb hist dispr ag ia,87336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.8,,,,,,,fee schedule,16,58.32,APC Entamoeb hist dispr ag ia,87336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16,,,,,,,fee schedule,16,58.32,APC Entamoeb hist group ag ia,87337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Entamoeb hist group ag ia,87337,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Entamoeb hist group ag ia,87337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Entamoeb hist group ag ia,87337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Entamoeb hist group ag ia,87337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Entamoeb hist group ag ia,87337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Entamoeb hist group ag ia,87337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Hpylori stool ia,87338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,14.38,56.33, Hpylori stool ia,87338,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,14.38,56.33, Hpylori stool ia,87338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.83,,,,,,,fee schedule,14.38,56.33, Hpylori stool ia,87338,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.38,,,,,,,fee schedule,14.38,56.33, Hpylori stool ia,87338,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.96,,,,,,,fee schedule,14.38,56.33,APC Hpylori stool ia,87338,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.1,,,,,,,fee schedule,14.38,56.33,APC Hpylori stool ia,87338,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.38,,,,,,,fee schedule,14.38,56.33,APC H pylori ag ia,87339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16,58.32, H pylori ag ia,87339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16,58.32, H pylori ag ia,87339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16,58.32, H pylori ag ia,87339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16,58.32, H pylori ag ia,87339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.64,,,,,,,fee schedule,16,58.32,APC H pylori ag ia,87339,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.8,,,,,,,fee schedule,16,58.32,APC H pylori ag ia,87339,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16,,,,,,,fee schedule,16,58.32,APC Hepatitis b surface ag ia,87340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.9,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.81,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.33,52.81,APC Hepatitis b surface ag ia,87340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.85,,,,,,,fee schedule,10.33,52.81,APC Hepatitis b surface ag ia,87340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.33,,,,,,,fee schedule,10.33,52.81,APC Hepatitis b surface ag ia,87341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.9,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.81,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.33,52.81, Hepatitis b surface ag ia,87341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.74,,,,,,,fee schedule,10.33,52.81,APC Hepatitis b surface ag ia,87341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.85,,,,,,,fee schedule,10.33,52.81,APC Hepatitis b surface ag ia,87341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.33,,,,,,,fee schedule,10.33,52.81,APC Hepatitis be ag ia,87350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.33,,,,,,,fee schedule,11.53,58.93, Hepatitis be ag ia,87350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.93,,,,,,,fee schedule,11.53,58.93, Hepatitis be ag ia,87350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.46,,,,,,,fee schedule,11.53,58.93, Hepatitis be ag ia,87350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.67,,,,,,,fee schedule,11.53,58.93, Hepatitis be ag ia,87350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,58.93,APC Hepatitis be ag ia,87350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,58.93,APC Hepatitis be ag ia,87350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,58.93,APC Hepatitis delta ag ia,87380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.56,,,,,,,fee schedule,18.36,83.96, Hepatitis delta ag ia,87380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.96,,,,,,,fee schedule,18.36,83.96, Hepatitis delta ag ia,87380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.36,83.96, Hepatitis delta ag ia,87380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.36,83.96, Hepatitis delta ag ia,87380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.09,,,,,,,fee schedule,18.36,83.96,APC Hepatitis delta ag ia,87380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.36,83.96,APC Hepatitis delta ag ia,87380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.36,,,,,,,fee schedule,18.36,83.96,APC Histoplasma capsul ag ia,87385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.25,56.33, Histoplasma capsul ag ia,87385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.25,56.33, Histoplasma capsul ag ia,87385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.25,56.33, Histoplasma capsul ag ia,87385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.25,56.33, Histoplasma capsul ag ia,87385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.78,,,,,,,fee schedule,13.25,56.33,APC Histoplasma capsul ag ia,87385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.25,56.33,APC Histoplasma capsul ag ia,87385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.25,,,,,,,fee schedule,13.25,56.33,APC Hiv-1 ag w/hiv-1 & hiv-2 ab,87389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,110.89,,,,,,,fee schedule,24.08,124.88, Hiv-1 ag w/hiv-1 & hiv-2 ab,87389,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,124.88,,,,,,,fee schedule,24.08,124.88, Hiv-1 ag w/hiv-1 & hiv-2 ab,87389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,24.08,124.88, Hiv-1 ag w/hiv-1 & hiv-2 ab,87389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,24.08,124.88, Hiv-1 ag w/hiv-1 & hiv-2 ab,87389,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.04,,,,,,,fee schedule,24.08,124.88,APC Hiv-1 ag w/hiv-1 & hiv-2 ab,87389,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.28,,,,,,,fee schedule,24.08,124.88,APC Hiv-1 ag w/hiv-1 & hiv-2 ab,87389,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.08,,,,,,,fee schedule,24.08,124.88,APC Hiv-1 ag ia,87390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.11,,,,,,,fee schedule,24.06,90.22, Hiv-1 ag ia,87390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.22,,,,,,,fee schedule,24.06,90.22, Hiv-1 ag ia,87390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,76.05,,,,,,,fee schedule,24.06,90.22, Hiv-1 ag ia,87390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,86.91,,,,,,,fee schedule,24.06,90.22, Hiv-1 ag ia,87390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.02,,,,,,,fee schedule,24.06,90.22,APC Hiv-1 ag ia,87390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.26,,,,,,,fee schedule,24.06,90.22,APC Hiv-1 ag ia,87390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.06,,,,,,,fee schedule,24.06,90.22,APC Hiv-2 ag ia,87391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.11,,,,,,,fee schedule,21.9,90.22, Hiv-2 ag ia,87391,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.22,,,,,,,fee schedule,21.9,90.22, Hiv-2 ag ia,87391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,21.9,90.22, Hiv-2 ag ia,87391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,21.9,90.22, Hiv-2 ag ia,87391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.78,,,,,,,fee schedule,21.9,90.22,APC Hiv-2 ag ia,87391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23,,,,,,,fee schedule,21.9,90.22,APC Hiv-2 ag ia,87391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.9,,,,,,,fee schedule,21.9,90.22,APC Influenza a/b ag ia,87400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,14.13,56.33, Influenza a/b ag ia,87400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,14.13,56.33, Influenza a/b ag ia,87400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.78,,,,,,,fee schedule,14.13,56.33, Influenza a/b ag ia,87400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.18,,,,,,,fee schedule,14.13,56.33, Influenza a/b ag ia,87400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.7,,,,,,,fee schedule,14.13,56.33,APC Influenza a/b ag ia,87400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.84,,,,,,,fee schedule,14.13,56.33,APC Influenza a/b ag ia,87400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.13,,,,,,,fee schedule,14.13,56.33,APC Resp syncytial ag ia,87420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.91,56.33, Resp syncytial ag ia,87420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.91,56.33, Resp syncytial ag ia,87420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.76,,,,,,,fee schedule,13.91,56.33, Resp syncytial ag ia,87420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.01,,,,,,,fee schedule,13.91,56.33, Resp syncytial ag ia,87420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.47,,,,,,,fee schedule,13.91,56.33,APC Resp syncytial ag ia,87420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.61,,,,,,,fee schedule,13.91,56.33,APC Resp syncytial ag ia,87420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.91,,,,,,,fee schedule,13.91,56.33,APC Rotavirus ag ia,87425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Rotavirus ag ia,87425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Rotavirus ag ia,87425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Rotavirus ag ia,87425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Rotavirus ag ia,87425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Rotavirus ag ia,87425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Rotavirus ag ia,87425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Coronavirus ag ia,87426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,147,,,,,,,fee schedule,35.33,165.54, Coronavirus ag ia,87426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,165.54,,,,,,,fee schedule,35.33,165.54, Coronavirus ag ia,87426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,112.48,,,,,,,fee schedule,35.33,165.54, Coronavirus ag ia,87426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,128.55,,,,,,,fee schedule,35.33,165.54, Coronavirus ag ia,87426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.74,,,,,,,fee schedule,35.33,165.54,APC Coronavirus ag ia,87426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.1,,,,,,,fee schedule,35.33,165.54,APC Coronavirus ag ia,87426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.33,,,,,,,fee schedule,35.33,165.54,APC Shiga-like toxin ag ia,87427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Shiga-like toxin ag ia,87427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Shiga-like toxin ag ia,87427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Shiga-like toxin ag ia,87427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Shiga-like toxin ag ia,87427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Shiga-like toxin ag ia,87427,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Shiga-like toxin ag ia,87427,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Sarscov & inf vir a&b ag ia,87428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,238.84,,,,,,,fee schedule,70.29,268.97, Sarscov & inf vir a&b ag ia,87428,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.97,,,,,,,fee schedule,70.29,268.97, Sarscov & inf vir a&b ag ia,87428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.94,,,,,,,fee schedule,70.29,268.97, Sarscov & inf vir a&b ag ia,87428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,137.07,,,,,,,fee schedule,70.29,268.97, Sarscov & inf vir a&b ag ia,87428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.1,,,,,,,fee schedule,70.29,268.97,APC Sarscov & inf vir a&b ag ia,87428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.8,,,,,,,fee schedule,70.29,268.97,APC Sarscov & inf vir a&b ag ia,87428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.29,,,,,,,fee schedule,70.29,268.97,APC Strep a ag ia,87430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16.81,60.72, Strep a ag ia,87430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16.81,60.72, Strep a ag ia,87430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.81,60.72, Strep a ag ia,87430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.81,60.72, Strep a ag ia,87430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.48,,,,,,,fee schedule,16.81,60.72,APC Strep a ag ia,87430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.65,,,,,,,fee schedule,16.81,60.72,APC Strep a ag ia,87430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.81,,,,,,,fee schedule,16.81,60.72,APC Ag detect nos ia mult,87449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,11.98,56.33, Ag detect nos ia mult,87449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,11.98,56.33, Ag detect nos ia mult,87449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,56.33, Ag detect nos ia mult,87449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,56.33, Ag detect nos ia mult,87449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,56.33,APC Ag detect nos ia mult,87449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,56.33,APC Ag detect nos ia mult,87449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,56.33,APC Ag detect polyval ia mult,87451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.52,,,,,,,fee schedule,10.51,49.01, Ag detect polyval ia mult,87451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.01,,,,,,,fee schedule,10.51,49.01, Ag detect polyval ia mult,87451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.51,49.01, Ag detect polyval ia mult,87451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.51,49.01, Ag detect polyval ia mult,87451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.93,,,,,,,fee schedule,10.51,49.01,APC Ag detect polyval ia mult,87451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.04,,,,,,,fee schedule,10.51,49.01,APC Ag detect polyval ia mult,87451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.51,,,,,,,fee schedule,10.51,49.01,APC Hepatitis b surface ag quan,87467,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.91,,,,,,,fee schedule,25.32,55.08, Hepatitis b surface ag quan,87467,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.08,,,,,,,fee schedule,25.32,55.08, Hepatitis b surface ag quan,87467,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.33,,,,,,,fee schedule,25.32,55.08,APC Hepatitis b surface ag quan,87467,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.59,,,,,,,fee schedule,25.32,55.08,APC Hepatitis b surface ag quan,87467,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.32,,,,,,,fee schedule,25.32,55.08,APC Anaplsma phgcytophlm amp prb,87468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.04,,,,,,,fee schedule,35.09,128.43, Anaplsma phgcytophlm amp prb,87468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.43,,,,,,,fee schedule,35.09,128.43, Anaplsma phgcytophlm amp prb,87468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,128.43, Anaplsma phgcytophlm amp prb,87468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,128.43, Anaplsma phgcytophlm amp prb,87468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,128.43,APC Anaplsma phgcytophlm amp prb,87468,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,128.43,APC Anaplsma phgcytophlm amp prb,87468,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,128.43,APC Babesia microti amp prb,87469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.04,,,,,,,fee schedule,35.09,128.43, Babesia microti amp prb,87469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.43,,,,,,,fee schedule,35.09,128.43, Babesia microti amp prb,87469,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,128.43, Babesia microti amp prb,87469,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,128.43, Babesia microti amp prb,87469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,128.43,APC Babesia microti amp prb,87469,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,128.43,APC Babesia microti amp prb,87469,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,128.43,APC Bartonella dna amp probe,87471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Bartonella dna amp probe,87471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Bartonella dna amp probe,87471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Bartonella dna amp probe,87471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Bartonella dna amp probe,87471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Bartonella dna amp probe,87471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Bartonella dna amp probe,87471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Bartonella dna quant,87472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, Bartonella dna quant,87472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, Bartonella dna quant,87472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, Bartonella dna quant,87472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, Bartonella dna quant,87472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC Bartonella dna quant,87472,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC Bartonella dna quant,87472,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC Lyme dis dna dir probe,87475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Lyme dis dna dir probe,87475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Lyme dis dna dir probe,87475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Lyme dis dna dir probe,87475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Lyme dis dna dir probe,87475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Lyme dis dna dir probe,87475,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Lyme dis dna dir probe,87475,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Lyme dis dna amp probe,87476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Lyme dis dna amp probe,87476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Lyme dis dna amp probe,87476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Lyme dis dna amp probe,87476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Lyme dis dna amp probe,87476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Lyme dis dna amp probe,87476,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Lyme dis dna amp probe,87476,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Borrelia miyamotoi amp prb,87478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.04,,,,,,,fee schedule,35.09,128.43, Borrelia miyamotoi amp prb,87478,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.43,,,,,,,fee schedule,35.09,128.43, Borrelia miyamotoi amp prb,87478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,128.43, Borrelia miyamotoi amp prb,87478,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,128.43, Borrelia miyamotoi amp prb,87478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,128.43,APC Borrelia miyamotoi amp prb,87478,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,128.43,APC Borrelia miyamotoi amp prb,87478,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,128.43,APC Candida dna dir probe,87480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Candida dna dir probe,87480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Candida dna dir probe,87480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Candida dna dir probe,87480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Candida dna dir probe,87480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Candida dna dir probe,87480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Candida dna dir probe,87480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Candida dna amp probe,87481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Candida dna amp probe,87481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Candida dna amp probe,87481,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Candida dna amp probe,87481,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Candida dna amp probe,87481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Candida dna amp probe,87481,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Candida dna amp probe,87481,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Candida dna quant,87482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,55.74,202.35, Candida dna quant,87482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,55.74,202.35, Candida dna quant,87482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,177.06,,,,,,,fee schedule,55.74,202.35, Candida dna quant,87482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,202.35,,,,,,,fee schedule,55.74,202.35, Candida dna quant,87482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.97,,,,,,,fee schedule,55.74,202.35,APC Candida dna quant,87482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.53,,,,,,,fee schedule,55.74,202.35,APC Candida dna quant,87482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.74,,,,,,,fee schedule,55.74,202.35,APC Cns dna amp probe type 12-25,87483,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,1515.33, Cns dna amp probe type 12-25,87483,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,1515.33, Cns dna amp probe type 12-25,87483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,1515.33,APC Cns dna amp probe type 12-25,87483,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,1515.33,APC Cns dna amp probe type 12-25,87483,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,1515.33,APC Ehrlicha chaffeensis amp prb,87484,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.04,,,,,,,fee schedule,35.09,128.43, Ehrlicha chaffeensis amp prb,87484,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.43,,,,,,,fee schedule,35.09,128.43, Ehrlicha chaffeensis amp prb,87484,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,128.43, Ehrlicha chaffeensis amp prb,87484,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,128.43, Ehrlicha chaffeensis amp prb,87484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,128.43,APC Ehrlicha chaffeensis amp prb,87484,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,128.43,APC Ehrlicha chaffeensis amp prb,87484,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,128.43,APC Chylmd pneum dna dir probe,87485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Chylmd pneum dna dir probe,87485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Chylmd pneum dna dir probe,87485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Chylmd pneum dna dir probe,87485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Chylmd pneum dna dir probe,87485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Chylmd pneum dna dir probe,87485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Chylmd pneum dna dir probe,87485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Chylmd pneum dna amp probe,87486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Chylmd pneum dna amp probe,87486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Chylmd pneum dna amp probe,87486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Chylmd pneum dna amp probe,87486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Chylmd pneum dna amp probe,87486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Chylmd pneum dna amp probe,87486,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Chylmd pneum dna amp probe,87486,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Chylmd pneum dna quant,87487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, Chylmd pneum dna quant,87487,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, Chylmd pneum dna quant,87487,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, Chylmd pneum dna quant,87487,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, Chylmd pneum dna quant,87487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC Chylmd pneum dna quant,87487,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC Chylmd pneum dna quant,87487,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC Chylmd trach dna dir probe,87490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,22.75,102.55, Chylmd trach dna dir probe,87490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,22.75,102.55, Chylmd trach dna dir probe,87490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,71.87,,,,,,,fee schedule,22.75,102.55, Chylmd trach dna dir probe,87490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.14,,,,,,,fee schedule,22.75,102.55, Chylmd trach dna dir probe,87490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.66,,,,,,,fee schedule,22.75,102.55,APC Chylmd trach dna dir probe,87490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.89,,,,,,,fee schedule,22.75,102.55,APC Chylmd trach dna dir probe,87490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.75,,,,,,,fee schedule,22.75,102.55,APC Chylmd trach dna amp probe,87491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Chylmd trach dna amp probe,87491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Chylmd trach dna amp probe,87491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Chylmd trach dna amp probe,87491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Chylmd trach dna amp probe,87491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Chylmd trach dna amp probe,87491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Chylmd trach dna amp probe,87491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Chylmd trach dna quant,87492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,53.47,194.04, Chylmd trach dna quant,87492,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,53.47,194.04, Chylmd trach dna quant,87492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,169.79,,,,,,,fee schedule,53.47,194.04, Chylmd trach dna quant,87492,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,194.04,,,,,,,fee schedule,53.47,194.04, Chylmd trach dna quant,87492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,55.61,,,,,,,fee schedule,53.47,194.04,APC Chylmd trach dna quant,87492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,56.14,,,,,,,fee schedule,53.47,194.04,APC Chylmd trach dna quant,87492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,53.47,,,,,,,fee schedule,53.47,194.04,APC C diff amplified probe,87493,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.56,,,,,,,fee schedule,37.27,181.94, C diff amplified probe,87493,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.94,,,,,,,fee schedule,37.27,181.94, C diff amplified probe,87493,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,118.73,,,,,,,fee schedule,37.27,181.94, C diff amplified probe,87493,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,135.69,,,,,,,fee schedule,37.27,181.94, C diff amplified probe,87493,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.76,,,,,,,fee schedule,37.27,181.94,APC C diff amplified probe,87493,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.13,,,,,,,fee schedule,37.27,181.94,APC C diff amplified probe,87493,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.27,,,,,,,fee schedule,37.27,181.94,APC Chlmy trch&neisra gonor mult,87494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.99,,,,,,,fee schedule,70.18,73.69,APC Chlmy trch&neisra gonor mult,87494,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.69,,,,,,,fee schedule,70.18,73.69,APC Chlmy trch&neisra gonor mult,87494,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.18,,,,,,,fee schedule,70.18,73.69,APC Cytomeg dna dir probe,87495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,30.03,109.5, Cytomeg dna dir probe,87495,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,30.03,109.5, Cytomeg dna dir probe,87495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.81,,,,,,,fee schedule,30.03,109.5, Cytomeg dna dir probe,87495,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.5,,,,,,,fee schedule,30.03,109.5, Cytomeg dna dir probe,87495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.23,,,,,,,fee schedule,30.03,109.5,APC Cytomeg dna dir probe,87495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.53,,,,,,,fee schedule,30.03,109.5,APC Cytomeg dna dir probe,87495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.03,,,,,,,fee schedule,30.03,109.5,APC Cytomeg dna amp probe,87496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Cytomeg dna amp probe,87496,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Cytomeg dna amp probe,87496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Cytomeg dna amp probe,87496,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Cytomeg dna amp probe,87496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Cytomeg dna amp probe,87496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Cytomeg dna amp probe,87496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Cytomeg dna quant,87497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, Cytomeg dna quant,87497,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, Cytomeg dna quant,87497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, Cytomeg dna quant,87497,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, Cytomeg dna quant,87497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC Cytomeg dna quant,87497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC Cytomeg dna quant,87497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC Enterovirus probe&revrs trns,87498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.56,,,,,,,fee schedule,35.09,181.94, Enterovirus probe&revrs trns,87498,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.94,,,,,,,fee schedule,35.09,181.94, Enterovirus probe&revrs trns,87498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,181.94, Enterovirus probe&revrs trns,87498,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,181.94, Enterovirus probe&revrs trns,87498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,181.94,APC Enterovirus probe&revrs trns,87498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,181.94,APC Enterovirus probe&revrs trns,87498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,181.94,APC Vanomycin dna amp probe,87500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.56,,,,,,,fee schedule,35.09,181.94, Vanomycin dna amp probe,87500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.94,,,,,,,fee schedule,35.09,181.94, Vanomycin dna amp probe,87500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,181.94, Vanomycin dna amp probe,87500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,181.94, Vanomycin dna amp probe,87500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,181.94,APC Vanomycin dna amp probe,87500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,181.94,APC Vanomycin dna amp probe,87500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,181.94,APC Influenza dna amp prob 1+,87501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,236.21,,,,,,,fee schedule,51.31,266.01, Influenza dna amp prob 1+,87501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,266.01,,,,,,,fee schedule,51.31,266.01, Influenza dna amp prob 1+,87501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.54,,,,,,,fee schedule,51.31,266.01, Influenza dna amp prob 1+,87501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,51.31,266.01, Influenza dna amp prob 1+,87501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.36,,,,,,,fee schedule,51.31,266.01,APC Influenza dna amp prob 1+,87501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.88,,,,,,,fee schedule,51.31,266.01,APC Influenza dna amp prob 1+,87501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.31,,,,,,,fee schedule,51.31,266.01,APC Influenza dna amp probe,87502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,391.69,,,,,,,fee schedule,95.8,441.1, Influenza dna amp probe,87502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,441.1,,,,,,,fee schedule,95.8,441.1, Influenza dna amp probe,87502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,305.18,,,,,,,fee schedule,95.8,441.1, Influenza dna amp probe,87502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,348.78,,,,,,,fee schedule,95.8,441.1, Influenza dna amp probe,87502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,99.63,,,,,,,fee schedule,95.8,441.1,APC Influenza dna amp probe,87502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,100.59,,,,,,,fee schedule,95.8,441.1,APC Influenza dna amp probe,87502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,95.8,,,,,,,fee schedule,95.8,441.1,APC Influenza dna amp prob addl,87503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.62,,,,,,,fee schedule,29.22,107.68, Influenza dna amp prob addl,87503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,107.68,,,,,,,fee schedule,29.22,107.68, Influenza dna amp prob addl,87503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.69,,,,,,,fee schedule,29.22,107.68, Influenza dna amp prob addl,87503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.93,,,,,,,fee schedule,29.22,107.68, Influenza dna amp prob addl,87503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.39,,,,,,,fee schedule,29.22,107.68,APC Influenza dna amp prob addl,87503,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.68,,,,,,,fee schedule,29.22,107.68,APC Influenza dna amp prob addl,87503,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.22,,,,,,,fee schedule,29.22,107.68,APC Nfct agent detection gi,87505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,567.39,,,,,,,fee schedule,128.29,638.96, Nfct agent detection gi,87505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,638.96,,,,,,,fee schedule,128.29,638.96, Nfct agent detection gi,87505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,408.29,,,,,,,fee schedule,128.29,638.96, Nfct agent detection gi,87505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,466.62,,,,,,,fee schedule,128.29,638.96, Nfct agent detection gi,87505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,133.42,,,,,,,fee schedule,128.29,638.96,APC Nfct agent detection gi,87505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,134.7,,,,,,,fee schedule,128.29,638.96,APC Nfct agent detection gi,87505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.29,,,,,,,fee schedule,128.29,638.96,APC Iadna-dna/rna probe tq 6-11,87506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,943.96,,,,,,,fee schedule,262.99,1063.05, Iadna-dna/rna probe tq 6-11,87506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1063.05,,,,,,,fee schedule,262.99,1063.05, Iadna-dna/rna probe tq 6-11,87506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,836.38,,,,,,,fee schedule,262.99,1063.05, Iadna-dna/rna probe tq 6-11,87506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,955.86,,,,,,,fee schedule,262.99,1063.05, Iadna-dna/rna probe tq 6-11,87506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,273.51,,,,,,,fee schedule,262.99,1063.05,APC Iadna-dna/rna probe tq 6-11,87506,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,276.14,,,,,,,fee schedule,262.99,1063.05,APC Iadna-dna/rna probe tq 6-11,87506,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,262.99,,,,,,,fee schedule,262.99,1063.05,APC Iadna-dna/rna probe tq 12-25,87507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1843.34,,,,,,,fee schedule,416.78,2075.88, Iadna-dna/rna probe tq 12-25,87507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2075.88,,,,,,,fee schedule,416.78,2075.88, Iadna-dna/rna probe tq 12-25,87507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,2075.88, Iadna-dna/rna probe tq 12-25,87507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,2075.88, Iadna-dna/rna probe tq 12-25,87507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,2075.88,APC Iadna-dna/rna probe tq 12-25,87507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,2075.88,APC Iadna-dna/rna probe tq 12-25,87507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,2075.88,APC Gardner vag dna dir probe,87510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Gardner vag dna dir probe,87510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Gardner vag dna dir probe,87510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Gardner vag dna dir probe,87510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Gardner vag dna dir probe,87510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Gardner vag dna dir probe,87510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Gardner vag dna dir probe,87510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Gardner vag dna amp probe,87511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Gardner vag dna amp probe,87511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Gardner vag dna amp probe,87511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Gardner vag dna amp probe,87511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Gardner vag dna amp probe,87511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Gardner vag dna amp probe,87511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Gardner vag dna amp probe,87511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Gardner vag dna quant,87512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,41.76,152.37, Gardner vag dna quant,87512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,41.76,152.37, Gardner vag dna quant,87512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.32,,,,,,,fee schedule,41.76,152.37, Gardner vag dna quant,87512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.37,,,,,,,fee schedule,41.76,152.37, Gardner vag dna quant,87512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.43,,,,,,,fee schedule,41.76,152.37,APC Gardner vag dna quant,87512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.85,,,,,,,fee schedule,41.76,152.37,APC Gardner vag dna quant,87512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.76,,,,,,,fee schedule,41.76,152.37,APC H pylri clrthmcn rst amp prb,87513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC H pylri clrthmcn rst amp prb,87513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC H pylri clrthmcn rst amp prb,87513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Hepatitis b dna amp probe,87516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hepatitis b dna amp probe,87516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hepatitis b dna amp probe,87516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hepatitis b dna amp probe,87516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hepatitis b dna amp probe,87516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hepatitis b dna amp probe,87516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hepatitis b dna amp probe,87516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hepatitis b dna quant,87517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, Hepatitis b dna quant,87517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, Hepatitis b dna quant,87517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, Hepatitis b dna quant,87517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, Hepatitis b dna quant,87517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC Hepatitis b dna quant,87517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC Hepatitis b dna quant,87517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC Hepatitis c rna dir probe,87520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,31.22,113.07, Hepatitis c rna dir probe,87520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,31.22,113.07, Hepatitis c rna dir probe,87520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.94,,,,,,,fee schedule,31.22,113.07, Hepatitis c rna dir probe,87520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,113.07,,,,,,,fee schedule,31.22,113.07, Hepatitis c rna dir probe,87520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.47,,,,,,,fee schedule,31.22,113.07,APC Hepatitis c rna dir probe,87520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.78,,,,,,,fee schedule,31.22,113.07,APC Hepatitis c rna dir probe,87520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.22,,,,,,,fee schedule,31.22,113.07,APC Hepatitis c probe&rvrs trnsc,87521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hepatitis c probe&rvrs trnsc,87521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hepatitis c probe&rvrs trnsc,87521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hepatitis c probe&rvrs trnsc,87521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hepatitis c probe&rvrs trnsc,87521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hepatitis c probe&rvrs trnsc,87521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hepatitis c probe&rvrs trnsc,87521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hepatitis c revrs trnscrpj,87522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, Hepatitis c revrs trnscrpj,87522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, Hepatitis c revrs trnscrpj,87522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, Hepatitis c revrs trnscrpj,87522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, Hepatitis c revrs trnscrpj,87522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC Hepatitis c revrs trnscrpj,87522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC Hepatitis c revrs trnscrpj,87522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC Hepatitis d quantification,87523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,139.23,,,,,,,fee schedule,42.84,156.79, Hepatitis d quantification,87523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,156.79,,,,,,,fee schedule,42.84,156.79, Hepatitis d quantification,87523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,156.79, Hepatitis d quantification,87523,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,156.79, Hepatitis d quantification,87523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,156.79,APC Hepatitis d quantification,87523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,156.79,APC Hepatitis d quantification,87523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,156.79,APC Hepatitis g dna dir probe,87525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,29.8,108.33, Hepatitis g dna dir probe,87525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,29.8,108.33, Hepatitis g dna dir probe,87525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.79,,,,,,,fee schedule,29.8,108.33, Hepatitis g dna dir probe,87525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.33,,,,,,,fee schedule,29.8,108.33, Hepatitis g dna dir probe,87525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.99,,,,,,,fee schedule,29.8,108.33,APC Hepatitis g dna dir probe,87525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.29,,,,,,,fee schedule,29.8,108.33,APC Hepatitis g dna dir probe,87525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.8,,,,,,,fee schedule,29.8,108.33,APC Hepatitis g dna amp probe,87526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,39.26,179.49, Hepatitis g dna amp probe,87526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,39.26,179.49, Hepatitis g dna amp probe,87526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,124.98,,,,,,,fee schedule,39.26,179.49, Hepatitis g dna amp probe,87526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.83,,,,,,,fee schedule,39.26,179.49, Hepatitis g dna amp probe,87526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.83,,,,,,,fee schedule,39.26,179.49,APC Hepatitis g dna amp probe,87526,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.22,,,,,,,fee schedule,39.26,179.49,APC Hepatitis g dna amp probe,87526,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.26,,,,,,,fee schedule,39.26,179.49,APC Hepatitis g dna quant,87527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,41.76,152.37, Hepatitis g dna quant,87527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,41.76,152.37, Hepatitis g dna quant,87527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.32,,,,,,,fee schedule,41.76,152.37, Hepatitis g dna quant,87527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.37,,,,,,,fee schedule,41.76,152.37, Hepatitis g dna quant,87527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.43,,,,,,,fee schedule,41.76,152.37,APC Hepatitis g dna quant,87527,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.85,,,,,,,fee schedule,41.76,152.37,APC Hepatitis g dna quant,87527,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.76,,,,,,,fee schedule,41.76,152.37,APC Hsv dna dir probe,87528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Hsv dna dir probe,87528,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Hsv dna dir probe,87528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Hsv dna dir probe,87528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Hsv dna dir probe,87528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Hsv dna dir probe,87528,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Hsv dna dir probe,87528,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Hsv dna amp probe,87529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hsv dna amp probe,87529,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hsv dna amp probe,87529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hsv dna amp probe,87529,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hsv dna amp probe,87529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hsv dna amp probe,87529,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hsv dna amp probe,87529,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hsv dna quant,87530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, Hsv dna quant,87530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, Hsv dna quant,87530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, Hsv dna quant,87530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, Hsv dna quant,87530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC Hsv dna quant,87530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC Hsv dna quant,87530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC Hhv-6 dna dir probe,87531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,58,210.69, Hhv-6 dna dir probe,87531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,58,210.69, Hhv-6 dna dir probe,87531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,184.35,,,,,,,fee schedule,58,210.69, Hhv-6 dna dir probe,87531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,210.69,,,,,,,fee schedule,58,210.69, Hhv-6 dna dir probe,87531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.32,,,,,,,fee schedule,58,210.69,APC Hhv-6 dna dir probe,87531,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,60.9,,,,,,,fee schedule,58,210.69,APC Hhv-6 dna dir probe,87531,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58,,,,,,,fee schedule,58,210.69,APC Hhv-6 dna amp probe,87532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hhv-6 dna amp probe,87532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hhv-6 dna amp probe,87532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hhv-6 dna amp probe,87532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hhv-6 dna amp probe,87532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hhv-6 dna amp probe,87532,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hhv-6 dna amp probe,87532,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hhv-6 dna quant,87533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,41.76,152.37, Hhv-6 dna quant,87533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,41.76,152.37, Hhv-6 dna quant,87533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.32,,,,,,,fee schedule,41.76,152.37, Hhv-6 dna quant,87533,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.37,,,,,,,fee schedule,41.76,152.37, Hhv-6 dna quant,87533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.43,,,,,,,fee schedule,41.76,152.37,APC Hhv-6 dna quant,87533,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.85,,,,,,,fee schedule,41.76,152.37,APC Hhv-6 dna quant,87533,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.76,,,,,,,fee schedule,41.76,152.37,APC Hiv-1 dna dir probe,87534,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,21.92,102.55, Hiv-1 dna dir probe,87534,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,21.92,102.55, Hiv-1 dna dir probe,87534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,21.92,102.55, Hiv-1 dna dir probe,87534,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,21.92,102.55, Hiv-1 dna dir probe,87534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.8,,,,,,,fee schedule,21.92,102.55,APC Hiv-1 dna dir probe,87534,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.02,,,,,,,fee schedule,21.92,102.55,APC Hiv-1 dna dir probe,87534,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.92,,,,,,,fee schedule,21.92,102.55,APC Hiv-1 probe&reverse trnscrpj,87535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hiv-1 probe&reverse trnscrpj,87535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hiv-1 probe&reverse trnscrpj,87535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hiv-1 probe&reverse trnscrpj,87535,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hiv-1 probe&reverse trnscrpj,87535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hiv-1 probe&reverse trnscrpj,87535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hiv-1 probe&reverse trnscrpj,87535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hiv-1 quant&revrse trnscrpj,87536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,386.39,,,,,,,fee schedule,85.1,435.14, Hiv-1 quant&revrse trnscrpj,87536,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,435.14,,,,,,,fee schedule,85.1,435.14, Hiv-1 quant&revrse trnscrpj,87536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,270.8,,,,,,,fee schedule,85.1,435.14, Hiv-1 quant&revrse trnscrpj,87536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,309.48,,,,,,,fee schedule,85.1,435.14, Hiv-1 quant&revrse trnscrpj,87536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.5,,,,,,,fee schedule,85.1,435.14,APC Hiv-1 quant&revrse trnscrpj,87536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.36,,,,,,,fee schedule,85.1,435.14,APC Hiv-1 quant&revrse trnscrpj,87536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.1,,,,,,,fee schedule,85.1,435.14,APC Hiv-2 dna dir probe,87537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,21.92,102.55, Hiv-2 dna dir probe,87537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,21.92,102.55, Hiv-2 dna dir probe,87537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,69.77,,,,,,,fee schedule,21.92,102.55, Hiv-2 dna dir probe,87537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,21.92,102.55, Hiv-2 dna dir probe,87537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.8,,,,,,,fee schedule,21.92,102.55,APC Hiv-2 dna dir probe,87537,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.02,,,,,,,fee schedule,21.92,102.55,APC Hiv-2 dna dir probe,87537,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.92,,,,,,,fee schedule,21.92,102.55,APC Hiv-2 probe&revrse trnscripj,87538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hiv-2 probe&revrse trnscripj,87538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hiv-2 probe&revrse trnscripj,87538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hiv-2 probe&revrse trnscripj,87538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hiv-2 probe&revrse trnscripj,87538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hiv-2 probe&revrse trnscripj,87538,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hiv-2 probe&revrse trnscripj,87538,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hiv-2 quant&revrse trnscripj,87539,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,58.62,213.06, Hiv-2 quant&revrse trnscripj,87539,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,58.62,213.06, Hiv-2 quant&revrse trnscripj,87539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,186.43,,,,,,,fee schedule,58.62,213.06, Hiv-2 quant&revrse trnscripj,87539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,213.06,,,,,,,fee schedule,58.62,213.06, Hiv-2 quant&revrse trnscripj,87539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.96,,,,,,,fee schedule,58.62,213.06,APC Hiv-2 quant&revrse trnscripj,87539,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61.55,,,,,,,fee schedule,58.62,213.06,APC Hiv-2 quant&revrse trnscripj,87539,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58.62,,,,,,,fee schedule,58.62,213.06,APC Legion pneumo dna dir prob,87540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Legion pneumo dna dir prob,87540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Legion pneumo dna dir prob,87540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Legion pneumo dna dir prob,87540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Legion pneumo dna dir prob,87540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Legion pneumo dna dir prob,87540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Legion pneumo dna dir prob,87540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Legion pneumo dna amp prob,87541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Legion pneumo dna amp prob,87541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Legion pneumo dna amp prob,87541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Legion pneumo dna amp prob,87541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Legion pneumo dna amp prob,87541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Legion pneumo dna amp prob,87541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Legion pneumo dna amp prob,87541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Legion pneumo dna quant,87542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,41.76,152.37, Legion pneumo dna quant,87542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,41.76,152.37, Legion pneumo dna quant,87542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.32,,,,,,,fee schedule,41.76,152.37, Legion pneumo dna quant,87542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.37,,,,,,,fee schedule,41.76,152.37, Legion pneumo dna quant,87542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.43,,,,,,,fee schedule,41.76,152.37,APC Legion pneumo dna quant,87542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.85,,,,,,,fee schedule,41.76,152.37,APC Legion pneumo dna quant,87542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.76,,,,,,,fee schedule,41.76,152.37,APC Mycobacteria dna dir probe,87550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Mycobacteria dna dir probe,87550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Mycobacteria dna dir probe,87550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Mycobacteria dna dir probe,87550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Mycobacteria dna dir probe,87550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Mycobacteria dna dir probe,87550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Mycobacteria dna dir probe,87550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Mycobacteria dna amp probe,87551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,48.24,179.49, Mycobacteria dna amp probe,87551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,48.24,179.49, Mycobacteria dna amp probe,87551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,153.12,,,,,,,fee schedule,48.24,179.49, Mycobacteria dna amp probe,87551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,174.99,,,,,,,fee schedule,48.24,179.49, Mycobacteria dna amp probe,87551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.17,,,,,,,fee schedule,48.24,179.49,APC Mycobacteria dna amp probe,87551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50.65,,,,,,,fee schedule,48.24,179.49,APC Mycobacteria dna amp probe,87551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.24,,,,,,,fee schedule,48.24,179.49,APC Mycobacteria dna quant,87552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, Mycobacteria dna quant,87552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, Mycobacteria dna quant,87552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, Mycobacteria dna quant,87552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, Mycobacteria dna quant,87552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC Mycobacteria dna quant,87552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC Mycobacteria dna quant,87552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC M.tuberculo dna dir probe,87555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,26.88,102.55, M.tuberculo dna dir probe,87555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,26.88,102.55, M.tuberculo dna dir probe,87555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.88,102.55, M.tuberculo dna dir probe,87555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.88,102.55, M.tuberculo dna dir probe,87555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.96,,,,,,,fee schedule,26.88,102.55,APC M.tuberculo dna dir probe,87555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.22,,,,,,,fee schedule,26.88,102.55,APC M.tuberculo dna dir probe,87555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.88,,,,,,,fee schedule,26.88,102.55,APC M.tuberculo dna amp probe,87556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,41.68,179.49, M.tuberculo dna amp probe,87556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,41.68,179.49, M.tuberculo dna amp probe,87556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,132.27,,,,,,,fee schedule,41.68,179.49, M.tuberculo dna amp probe,87556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,151.17,,,,,,,fee schedule,41.68,179.49, M.tuberculo dna amp probe,87556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.35,,,,,,,fee schedule,41.68,179.49,APC M.tuberculo dna amp probe,87556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.76,,,,,,,fee schedule,41.68,179.49,APC M.tuberculo dna amp probe,87556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.68,,,,,,,fee schedule,41.68,179.49,APC M.tuberculo dna quant,87557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, M.tuberculo dna quant,87557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, M.tuberculo dna quant,87557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, M.tuberculo dna quant,87557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, M.tuberculo dna quant,87557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC M.tuberculo dna quant,87557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC M.tuberculo dna quant,87557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC M.avium-intra dna dir prob,87560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,27.29,102.55, M.avium-intra dna dir prob,87560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,27.29,102.55, M.avium-intra dna dir prob,87560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.29,102.55, M.avium-intra dna dir prob,87560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.29,102.55, M.avium-intra dna dir prob,87560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.38,,,,,,,fee schedule,27.29,102.55,APC M.avium-intra dna dir prob,87560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.65,,,,,,,fee schedule,27.29,102.55,APC M.avium-intra dna dir prob,87560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.29,,,,,,,fee schedule,27.29,102.55,APC M.avium-intra dna amp prob,87561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, M.avium-intra dna amp prob,87561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, M.avium-intra dna amp prob,87561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, M.avium-intra dna amp prob,87561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, M.avium-intra dna amp prob,87561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC M.avium-intra dna amp prob,87561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC M.avium-intra dna amp prob,87561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC M.avium-intra dna quant,87562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, M.avium-intra dna quant,87562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, M.avium-intra dna quant,87562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, M.avium-intra dna quant,87562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, M.avium-intra dna quant,87562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC M.avium-intra dna quant,87562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC M.avium-intra dna quant,87562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC M. genitalium amp probe,87563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.04,,,,,,,fee schedule,35.09,128.43, M. genitalium amp probe,87563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.43,,,,,,,fee schedule,35.09,128.43, M. genitalium amp probe,87563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,128.43, M. genitalium amp probe,87563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,128.43, M. genitalium amp probe,87563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,128.43,APC M. genitalium amp probe,87563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,128.43,APC M. genitalium amp probe,87563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,128.43,APC Mtb rifampin rst amp prb tq,87564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79.84,,,,,,,fee schedule,76.77,80.61,APC Mtb rifampin rst amp prb tq,87564,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80.61,,,,,,,fee schedule,76.77,80.61,APC Mtb rifampin rst amp prb tq,87564,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,76.77,,,,,,,fee schedule,76.77,80.61,APC M.pneumon dna dir probe,87580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, M.pneumon dna dir probe,87580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, M.pneumon dna dir probe,87580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, M.pneumon dna dir probe,87580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, M.pneumon dna dir probe,87580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC M.pneumon dna dir probe,87580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC M.pneumon dna dir probe,87580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC M.pneumon dna amp probe,87581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, M.pneumon dna amp probe,87581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, M.pneumon dna amp probe,87581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, M.pneumon dna amp probe,87581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, M.pneumon dna amp probe,87581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC M.pneumon dna amp probe,87581,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC M.pneumon dna amp probe,87581,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC M.pneumon dna quant,87582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,128.86,1099.89, M.pneumon dna quant,87582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,128.86,1099.89, M.pneumon dna quant,87582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,962.4,,,,,,,fee schedule,128.86,1099.89, M.pneumon dna quant,87582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1099.89,,,,,,,fee schedule,128.86,1099.89, M.pneumon dna quant,87582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,314.72,,,,,,,fee schedule,128.86,1099.89,APC M.pneumon dna quant,87582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,317.75,,,,,,,fee schedule,128.86,1099.89,APC M.pneumon dna quant,87582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,302.62,,,,,,,fee schedule,128.86,1099.89,APC N.gonorrhoeae dna dir prob,87590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,26.88,102.55, N.gonorrhoeae dna dir prob,87590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,26.88,102.55, N.gonorrhoeae dna dir prob,87590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.88,102.55, N.gonorrhoeae dna dir prob,87590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.88,102.55, N.gonorrhoeae dna dir prob,87590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.96,,,,,,,fee schedule,26.88,102.55,APC N.gonorrhoeae dna dir prob,87590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.22,,,,,,,fee schedule,26.88,102.55,APC N.gonorrhoeae dna dir prob,87590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.88,,,,,,,fee schedule,26.88,102.55,APC N.gonorrhoeae dna amp prob,87591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, N.gonorrhoeae dna amp prob,87591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, N.gonorrhoeae dna amp prob,87591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, N.gonorrhoeae dna amp prob,87591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, N.gonorrhoeae dna amp prob,87591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC N.gonorrhoeae dna amp prob,87591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC N.gonorrhoeae dna amp prob,87591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC N.gonorrhoeae dna quant,87592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,42.84,155.94, N.gonorrhoeae dna quant,87592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,42.84,155.94, N.gonorrhoeae dna quant,87592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,155.94, N.gonorrhoeae dna quant,87592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,155.94, N.gonorrhoeae dna quant,87592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,155.94,APC N.gonorrhoeae dna quant,87592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,155.94,APC N.gonorrhoeae dna quant,87592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,155.94,APC Orthopoxvirus amp prb each,87593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.36,,,,,,,fee schedule,51.31,53.88,APC Orthopoxvirus amp prb each,87593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.88,,,,,,,fee schedule,51.31,53.88,APC Orthopoxvirus amp prb each,87593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.31,,,,,,,fee schedule,51.31,53.88,APC Pneumcysts jirovecii amp prb,87594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Pneumcysts jirovecii amp prb,87594,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Pneumcysts jirovecii amp prb,87594,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Hpv low-risk types,87623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hpv low-risk types,87623,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hpv low-risk types,87623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hpv low-risk types,87623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hpv low-risk types,87623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hpv low-risk types,87623,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hpv low-risk types,87623,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hpv high-risk types,87624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Hpv high-risk types,87624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Hpv high-risk types,87624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Hpv high-risk types,87624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Hpv high-risk types,87624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Hpv high-risk types,87624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Hpv high-risk types,87624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Hpv types 16 & 18 only,87625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,40.55,179.49, Hpv types 16 & 18 only,87625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,40.55,179.49, Hpv types 16 & 18 only,87625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129.15,,,,,,,fee schedule,40.55,179.49, Hpv types 16 & 18 only,87625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.6,,,,,,,fee schedule,40.55,179.49, Hpv types 16 & 18 only,87625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42.17,,,,,,,fee schedule,40.55,179.49,APC Hpv types 16 & 18 only,87625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.58,,,,,,,fee schedule,40.55,179.49,APC Hpv types 16 & 18 only,87625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.55,,,,,,,fee schedule,40.55,179.49,APC Hpv sep hi-rsk typ&pool rslt,87626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.01,,,,,,,fee schedule,70.2,73.71,APC Hpv sep hi-rsk typ&pool rslt,87626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.71,,,,,,,fee schedule,70.2,73.71,APC Hpv sep hi-rsk typ&pool rslt,87626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.2,,,,,,,fee schedule,70.2,73.71,APC Jt spc pthgn&rx rsist gen26+,87627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,706.96,,,,,,,fee schedule,679.77,713.76,APC Jt spc pthgn&rx rsist gen26+,87627,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,713.76,,,,,,,fee schedule,679.77,713.76,APC Jt spc pthgn&rx rsist gen26+,87627,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,679.77,,,,,,,fee schedule,679.77,713.76,APC Resp virus 3-5 targets,87631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,573.11,,,,,,,fee schedule,142.63,645.4, Resp virus 3-5 targets,87631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,645.4,,,,,,,fee schedule,142.63,645.4, Resp virus 3-5 targets,87631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,142.63,645.4, Resp virus 3-5 targets,87631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,142.63,645.4, Resp virus 3-5 targets,87631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,645.4,APC Resp virus 3-5 targets,87631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,645.4,APC Resp virus 3-5 targets,87631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,645.4,APC Resp virus 6-11 targets,87632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,953.45,,,,,,,fee schedule,218.06,1073.73, Resp virus 6-11 targets,87632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1073.73,,,,,,,fee schedule,218.06,1073.73, Resp virus 6-11 targets,87632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,693.68,,,,,,,fee schedule,218.06,1073.73, Resp virus 6-11 targets,87632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,792.78,,,,,,,fee schedule,218.06,1073.73, Resp virus 6-11 targets,87632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,226.78,,,,,,,fee schedule,218.06,1073.73,APC Resp virus 6-11 targets,87632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,228.96,,,,,,,fee schedule,218.06,1073.73,APC Resp virus 6-11 targets,87632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,218.06,,,,,,,fee schedule,218.06,1073.73,APC Resp virus 12-25 targets,87633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1861.96,,,,,,,fee schedule,416.78,2096.85, Resp virus 12-25 targets,87633,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2096.85,,,,,,,fee schedule,416.78,2096.85, Resp virus 12-25 targets,87633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1325.91,,,,,,,fee schedule,416.78,2096.85, Resp virus 12-25 targets,87633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1515.33,,,,,,,fee schedule,416.78,2096.85, Resp virus 12-25 targets,87633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.45,,,,,,,fee schedule,416.78,2096.85,APC Resp virus 12-25 targets,87633,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.62,,,,,,,fee schedule,416.78,2096.85,APC Resp virus 12-25 targets,87633,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.78,,,,,,,fee schedule,416.78,2096.85,APC Rsv dna/rna amp probe,87634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,281.65,,,,,,,fee schedule,70.2,317.18, Rsv dna/rna amp probe,87634,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,317.18,,,,,,,fee schedule,70.2,317.18, Rsv dna/rna amp probe,87634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,222.89,,,,,,,fee schedule,70.2,317.18, Rsv dna/rna amp probe,87634,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,254.73,,,,,,,fee schedule,70.2,317.18, Rsv dna/rna amp probe,87634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.01,,,,,,,fee schedule,70.2,317.18,APC Rsv dna/rna amp probe,87634,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.71,,,,,,,fee schedule,70.2,317.18,APC Rsv dna/rna amp probe,87634,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.2,,,,,,,fee schedule,70.2,317.18,APC Sars-cov-2 covid-19 amp prb,87635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,166.82,,,,,,,fee schedule,51.31,187.87, Sars-cov-2 covid-19 amp prb,87635,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,187.87,,,,,,,fee schedule,51.31,187.87, Sars-cov-2 covid-19 amp prb,87635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.54,,,,,,,fee schedule,51.31,187.87, Sars-cov-2 covid-19 amp prb,87635,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,51.31,187.87, Sars-cov-2 covid-19 amp prb,87635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.36,,,,,,,fee schedule,51.31,187.87,APC Sars-cov-2 covid-19 amp prb,87635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.88,,,,,,,fee schedule,51.31,187.87,APC Sars-cov-2 covid-19 amp prb,87635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.31,,,,,,,fee schedule,51.31,187.87,APC Sarscov2 & inf a&b amp prb,87636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,463.55,,,,,,,fee schedule,142.63,522.03, Sarscov2 & inf a&b amp prb,87636,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,522.03,,,,,,,fee schedule,142.63,522.03, Sarscov2 & inf a&b amp prb,87636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,142.63,522.03, Sarscov2 & inf a&b amp prb,87636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,142.63,522.03, Sarscov2 & inf a&b amp prb,87636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,522.03,APC Sarscov2 & inf a&b amp prb,87636,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,522.03,APC Sarscov2 & inf a&b amp prb,87636,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,522.03,APC Sarscov2&inf a&b&rsv amp prb,87637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,463.55,,,,,,,fee schedule,142.63,522.03, Sarscov2&inf a&b&rsv amp prb,87637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,522.03,,,,,,,fee schedule,142.63,522.03, Sarscov2&inf a&b&rsv amp prb,87637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,454.13,,,,,,,fee schedule,142.63,522.03, Sarscov2&inf a&b&rsv amp prb,87637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,519,,,,,,,fee schedule,142.63,522.03, Sarscov2&inf a&b&rsv amp prb,87637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.34,,,,,,,fee schedule,142.63,522.03,APC Sarscov2&inf a&b&rsv amp prb,87637,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,149.76,,,,,,,fee schedule,142.63,522.03,APC Sarscov2&inf a&b&rsv amp prb,87637,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,142.63,,,,,,,fee schedule,142.63,522.03,APC Staph a dna amp probe,87640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.56,,,,,,,fee schedule,35.09,181.94, Staph a dna amp probe,87640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.94,,,,,,,fee schedule,35.09,181.94, Staph a dna amp probe,87640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,181.94, Staph a dna amp probe,87640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,181.94, Staph a dna amp probe,87640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,181.94,APC Staph a dna amp probe,87640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,181.94,APC Staph a dna amp probe,87640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,181.94,APC Mr-staph dna amp probe,87641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.56,,,,,,,fee schedule,35.09,181.94, Mr-staph dna amp probe,87641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.94,,,,,,,fee schedule,35.09,181.94, Mr-staph dna amp probe,87641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,181.94, Mr-staph dna amp probe,87641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,181.94, Mr-staph dna amp probe,87641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,181.94,APC Mr-staph dna amp probe,87641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,181.94,APC Mr-staph dna amp probe,87641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,181.94,APC Strep a dna dir probe,87650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Strep a dna dir probe,87650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Strep a dna dir probe,87650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Strep a dna dir probe,87650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Strep a dna dir probe,87650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Strep a dna dir probe,87650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Strep a dna dir probe,87650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Strep a dna amp probe,87651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Strep a dna amp probe,87651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Strep a dna amp probe,87651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Strep a dna amp probe,87651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Strep a dna amp probe,87651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Strep a dna amp probe,87651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Strep a dna amp probe,87651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Strep a dna quant,87652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.86,,,,,,,fee schedule,41.76,152.37, Strep a dna quant,87652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.12,,,,,,,fee schedule,41.76,152.37, Strep a dna quant,87652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.32,,,,,,,fee schedule,41.76,152.37, Strep a dna quant,87652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.37,,,,,,,fee schedule,41.76,152.37, Strep a dna quant,87652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.43,,,,,,,fee schedule,41.76,152.37,APC Strep a dna quant,87652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.85,,,,,,,fee schedule,41.76,152.37,APC Strep a dna quant,87652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.76,,,,,,,fee schedule,41.76,152.37,APC Strep b dna amp probe,87653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.56,,,,,,,fee schedule,35.09,181.94, Strep b dna amp probe,87653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.94,,,,,,,fee schedule,35.09,181.94, Strep b dna amp probe,87653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,181.94, Strep b dna amp probe,87653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,181.94, Strep b dna amp probe,87653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,181.94,APC Strep b dna amp probe,87653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,181.94,APC Strep b dna amp probe,87653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,181.94,APC Trichomonas vagin dir probe,87660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,20.05,102.55, Trichomonas vagin dir probe,87660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,20.05,102.55, Trichomonas vagin dir probe,87660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.53,,,,,,,fee schedule,20.05,102.55, Trichomonas vagin dir probe,87660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.6,,,,,,,fee schedule,20.05,102.55, Trichomonas vagin dir probe,87660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.85,,,,,,,fee schedule,20.05,102.55,APC Trichomonas vagin dir probe,87660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.05,,,,,,,fee schedule,20.05,102.55,APC Trichomonas vagin dir probe,87660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.05,,,,,,,fee schedule,20.05,102.55,APC Trichomonas vaginalis amplif,87661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,155.58,,,,,,,fee schedule,35.09,175.2, Trichomonas vaginalis amplif,87661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,175.2,,,,,,,fee schedule,35.09,175.2, Trichomonas vaginalis amplif,87661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,175.2, Trichomonas vaginalis amplif,87661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,175.2, Trichomonas vaginalis amplif,87661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,175.2,APC Trichomonas vaginalis amplif,87661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,175.2,APC Trichomonas vaginalis amplif,87661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,175.2,APC Zika virus dna/rna amp probe,87662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,205.89,,,,,,,fee schedule,51.31,231.86, Zika virus dna/rna amp probe,87662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,231.86,,,,,,,fee schedule,51.31,231.86, Zika virus dna/rna amp probe,87662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.54,,,,,,,fee schedule,51.31,231.86, Zika virus dna/rna amp probe,87662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,51.31,231.86, Zika virus dna/rna amp probe,87662,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.36,,,,,,,fee schedule,51.31,231.86,APC Zika virus dna/rna amp probe,87662,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.88,,,,,,,fee schedule,51.31,231.86,APC Zika virus dna/rna amp probe,87662,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.31,,,,,,,fee schedule,51.31,231.86,APC Detect agent nos dna dir,87797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.07,,,,,,,fee schedule,30.03,109.5, Detect agent nos dna dir,87797,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.55,,,,,,,fee schedule,30.03,109.5, Detect agent nos dna dir,87797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.81,,,,,,,fee schedule,30.03,109.5, Detect agent nos dna dir,87797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.5,,,,,,,fee schedule,30.03,109.5, Detect agent nos dna dir,87797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.23,,,,,,,fee schedule,30.03,109.5,APC Detect agent nos dna dir,87797,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.53,,,,,,,fee schedule,30.03,109.5,APC Detect agent nos dna dir,87797,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.03,,,,,,,fee schedule,30.03,109.5,APC Detect agent nos dna amp,87798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.38,,,,,,,fee schedule,35.09,179.49, Detect agent nos dna amp,87798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,179.49,,,,,,,fee schedule,35.09,179.49, Detect agent nos dna amp,87798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,179.49, Detect agent nos dna amp,87798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,179.49, Detect agent nos dna amp,87798,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,179.49,APC Detect agent nos dna amp,87798,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,179.49,APC Detect agent nos dna amp,87798,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,179.49,APC Detect agent nos dna quant,87799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,194.51,,,,,,,fee schedule,42.84,219.05, Detect agent nos dna quant,87799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,219.05,,,,,,,fee schedule,42.84,219.05, Detect agent nos dna quant,87799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.45,,,,,,,fee schedule,42.84,219.05, Detect agent nos dna quant,87799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.94,,,,,,,fee schedule,42.84,219.05, Detect agent nos dna quant,87799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.55,,,,,,,fee schedule,42.84,219.05,APC Detect agent nos dna quant,87799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.98,,,,,,,fee schedule,42.84,219.05,APC Detect agent nos dna quant,87799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.84,,,,,,,fee schedule,42.84,219.05,APC Detect agnt mult dna direc,87800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,182.1,,,,,,,fee schedule,43.67,205.07, Detect agnt mult dna direc,87800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,205.07,,,,,,,fee schedule,43.67,205.07, Detect agnt mult dna direc,87800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,138.52,,,,,,,fee schedule,43.67,205.07, Detect agnt mult dna direc,87800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,158.31,,,,,,,fee schedule,43.67,205.07, Detect agnt mult dna direc,87800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.42,,,,,,,fee schedule,43.67,205.07,APC Detect agnt mult dna direc,87800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,43.67,205.07,APC Detect agnt mult dna direc,87800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,43.67,,,,,,,fee schedule,43.67,205.07,APC Detect agnt mult dna ampli,87801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,318.73,,,,,,,fee schedule,70.2,358.94, Detect agnt mult dna ampli,87801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,358.94,,,,,,,fee schedule,70.2,358.94, Detect agnt mult dna ampli,87801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,222.89,,,,,,,fee schedule,70.2,358.94, Detect agnt mult dna ampli,87801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,254.73,,,,,,,fee schedule,70.2,358.94, Detect agnt mult dna ampli,87801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.01,,,,,,,fee schedule,70.2,358.94,APC Detect agnt mult dna ampli,87801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.71,,,,,,,fee schedule,70.2,358.94,APC Detect agnt mult dna ampli,87801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.2,,,,,,,fee schedule,70.2,358.94,APC Strep b assay w/optic,87802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,12.73,56.33, Strep b assay w/optic,87802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,12.73,56.33, Strep b assay w/optic,87802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.61,,,,,,,fee schedule,12.73,56.33, Strep b assay w/optic,87802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.41,,,,,,,fee schedule,12.73,56.33, Strep b assay w/optic,87802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.24,,,,,,,fee schedule,12.73,56.33,APC Strep b assay w/optic,87802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.37,,,,,,,fee schedule,12.73,56.33,APC Strep b assay w/optic,87802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.73,,,,,,,fee schedule,12.73,56.33,APC Clostridium toxin a w/optic,87803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16,58.32, Clostridium toxin a w/optic,87803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16,58.32, Clostridium toxin a w/optic,87803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16,58.32, Clostridium toxin a w/optic,87803,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16,58.32, Clostridium toxin a w/optic,87803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.64,,,,,,,fee schedule,16,58.32,APC Clostridium toxin a w/optic,87803,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.8,,,,,,,fee schedule,16,58.32,APC Clostridium toxin a w/optic,87803,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16,,,,,,,fee schedule,16,58.32,APC Influenza assay w/optic,87804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16.55,60.72, Influenza assay w/optic,87804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16.55,60.72, Influenza assay w/optic,87804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.13,,,,,,,fee schedule,16.55,60.72, Influenza assay w/optic,87804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.72,,,,,,,fee schedule,16.55,60.72, Influenza assay w/optic,87804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.21,,,,,,,fee schedule,16.55,60.72,APC Influenza assay w/optic,87804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.38,,,,,,,fee schedule,16.55,60.72,APC Influenza assay w/optic,87804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.55,,,,,,,fee schedule,16.55,60.72,APC Hiv antigen w/hiv antibodies,87806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.5,,,,,,,fee schedule,32.77,119.94, Hiv antigen w/hiv antibodies,87806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,119.94,,,,,,,fee schedule,32.77,119.94, Hiv antigen w/hiv antibodies,87806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,104.16,,,,,,,fee schedule,32.77,119.94, Hiv antigen w/hiv antibodies,87806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,119.04,,,,,,,fee schedule,32.77,119.94, Hiv antigen w/hiv antibodies,87806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.08,,,,,,,fee schedule,32.77,119.94,APC Hiv antigen w/hiv antibodies,87806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34.41,,,,,,,fee schedule,32.77,119.94,APC Hiv antigen w/hiv antibodies,87806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.77,,,,,,,fee schedule,32.77,119.94,APC Rsv assay w/optic,87807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,13.1,56.33, Rsv assay w/optic,87807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,13.1,56.33, Rsv assay w/optic,87807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.1,56.33, Rsv assay w/optic,87807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.1,56.33, Rsv assay w/optic,87807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.62,,,,,,,fee schedule,13.1,56.33,APC Rsv assay w/optic,87807,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.76,,,,,,,fee schedule,13.1,56.33,APC Rsv assay w/optic,87807,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.1,,,,,,,fee schedule,13.1,56.33,APC Trichomonas assay w/optic,87808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.67,,,,,,,fee schedule,15.29,57.06, Trichomonas assay w/optic,87808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.06,,,,,,,fee schedule,15.29,57.06, Trichomonas assay w/optic,87808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.29,57.06, Trichomonas assay w/optic,87808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.29,57.06, Trichomonas assay w/optic,87808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.9,,,,,,,fee schedule,15.29,57.06,APC Trichomonas assay w/optic,87808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.05,,,,,,,fee schedule,15.29,57.06,APC Trichomonas assay w/optic,87808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.29,,,,,,,fee schedule,15.29,57.06,APC Adenovirus assay w/optic,87809,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.67,,,,,,,fee schedule,21.76,78.57, Adenovirus assay w/optic,87809,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.06,,,,,,,fee schedule,21.76,78.57, Adenovirus assay w/optic,87809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.75,,,,,,,fee schedule,21.76,78.57, Adenovirus assay w/optic,87809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,78.57,,,,,,,fee schedule,21.76,78.57, Adenovirus assay w/optic,87809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.63,,,,,,,fee schedule,21.76,78.57,APC Adenovirus assay w/optic,87809,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.85,,,,,,,fee schedule,21.76,78.57,APC Adenovirus assay w/optic,87809,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.76,,,,,,,fee schedule,21.76,78.57,APC Chylmd trach assay w/optic,87810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,35.29,128.55, Chylmd trach assay w/optic,87810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,35.29,128.55, Chylmd trach assay w/optic,87810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,112.48,,,,,,,fee schedule,35.29,128.55, Chylmd trach assay w/optic,87810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,128.55,,,,,,,fee schedule,35.29,128.55, Chylmd trach assay w/optic,87810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.7,,,,,,,fee schedule,35.29,128.55,APC Chylmd trach assay w/optic,87810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.05,,,,,,,fee schedule,35.29,128.55,APC Chylmd trach assay w/optic,87810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.29,,,,,,,fee schedule,35.29,128.55,APC Sars-cov-2 covid19 w/optic,87811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.47,,,,,,,fee schedule,41.38,150, Sars-cov-2 covid19 w/optic,87811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.2,,,,,,,fee schedule,41.38,150, Sars-cov-2 covid19 w/optic,87811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,131.25,,,,,,,fee schedule,41.38,150, Sars-cov-2 covid19 w/optic,87811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,150,,,,,,,fee schedule,41.38,150, Sars-cov-2 covid19 w/optic,87811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.04,,,,,,,fee schedule,41.38,150,APC Sars-cov-2 covid19 w/optic,87811,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.45,,,,,,,fee schedule,41.38,150,APC Sars-cov-2 covid19 w/optic,87811,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.38,,,,,,,fee schedule,41.38,150,APC Sarscov2&inf typ a&b w/optic,87812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.46,,,,,,,fee schedule,74.48,78.2,APC Sarscov2&inf typ a&b w/optic,87812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.2,,,,,,,fee schedule,74.48,78.2,APC Sarscov2&inf typ a&b w/optic,87812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.48,,,,,,,fee schedule,74.48,78.2,APC N. gonorrhoeae assay w/optic,87850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,24.56,89.28, N. gonorrhoeae assay w/optic,87850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,24.56,89.28, N. gonorrhoeae assay w/optic,87850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.12,,,,,,,fee schedule,24.56,89.28, N. gonorrhoeae assay w/optic,87850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.28,,,,,,,fee schedule,24.56,89.28, N. gonorrhoeae assay w/optic,87850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.54,,,,,,,fee schedule,24.56,89.28,APC N. gonorrhoeae assay w/optic,87850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.79,,,,,,,fee schedule,24.56,89.28,APC N. gonorrhoeae assay w/optic,87850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.56,,,,,,,fee schedule,24.56,89.28,APC Strep a assay w/optic,87880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16.53,59.52, Strep a assay w/optic,87880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16.53,59.52, Strep a assay w/optic,87880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.08,,,,,,,fee schedule,16.53,59.52, Strep a assay w/optic,87880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.52,,,,,,,fee schedule,16.53,59.52, Strep a assay w/optic,87880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.19,,,,,,,fee schedule,16.53,59.52,APC Strep a assay w/optic,87880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.36,,,,,,,fee schedule,16.53,59.52,APC Strep a assay w/optic,87880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.53,,,,,,,fee schedule,16.53,59.52,APC Agent nos assay w/optic,87899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,16.07,58.32, Agent nos assay w/optic,87899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.33,,,,,,,fee schedule,16.07,58.32, Agent nos assay w/optic,87899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.03,,,,,,,fee schedule,16.07,58.32, Agent nos assay w/optic,87899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.32,,,,,,,fee schedule,16.07,58.32, Agent nos assay w/optic,87899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.71,,,,,,,fee schedule,16.07,58.32,APC Agent nos assay w/optic,87899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.87,,,,,,,fee schedule,16.07,58.32,APC Agent nos assay w/optic,87899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.07,,,,,,,fee schedule,16.07,58.32,APC Phenotype infect agent drug,87900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,600.01,,,,,,,fee schedule,130.35,675.71, Phenotype infect agent drug,87900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,675.71,,,,,,,fee schedule,130.35,675.71, Phenotype infect agent drug,87900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,414.54,,,,,,,fee schedule,130.35,675.71, Phenotype infect agent drug,87900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,473.76,,,,,,,fee schedule,130.35,675.71, Phenotype infect agent drug,87900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,135.56,,,,,,,fee schedule,130.35,675.71,APC Phenotype infect agent drug,87900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,136.87,,,,,,,fee schedule,130.35,675.71,APC Phenotype infect agent drug,87900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,130.35,,,,,,,fee schedule,130.35,675.71,APC Genotype dna hiv reverse t,87901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1168.99,,,,,,,fee schedule,257.45,1316.47, Genotype dna hiv reverse t,87901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1316.47,,,,,,,fee schedule,257.45,1316.47, Genotype dna hiv reverse t,87901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,818.66,,,,,,,fee schedule,257.45,1316.47, Genotype dna hiv reverse t,87901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,935.61,,,,,,,fee schedule,257.45,1316.47, Genotype dna hiv reverse t,87901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,267.75,,,,,,,fee schedule,257.45,1316.47,APC Genotype dna hiv reverse t,87901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,270.32,,,,,,,fee schedule,257.45,1316.47,APC Genotype dna hiv reverse t,87901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,257.45,,,,,,,fee schedule,257.45,1316.47,APC Genotype dna/rna hep c,87902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1168.99,,,,,,,fee schedule,257.45,1316.47, Genotype dna/rna hep c,87902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1316.47,,,,,,,fee schedule,257.45,1316.47, Genotype dna/rna hep c,87902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,818.66,,,,,,,fee schedule,257.45,1316.47, Genotype dna/rna hep c,87902,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,935.61,,,,,,,fee schedule,257.45,1316.47, Genotype dna/rna hep c,87902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,267.75,,,,,,,fee schedule,257.45,1316.47,APC Genotype dna/rna hep c,87902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,270.32,,,,,,,fee schedule,257.45,1316.47,APC Genotype dna/rna hep c,87902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,257.45,,,,,,,fee schedule,257.45,1316.47,APC Phenotype dna hiv w/culture,87903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2218.84,,,,,,,fee schedule,488.66,2498.76, Phenotype dna hiv w/culture,87903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2498.76,,,,,,,fee schedule,488.66,2498.76, Phenotype dna hiv w/culture,87903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1554.03,,,,,,,fee schedule,488.66,2498.76, Phenotype dna hiv w/culture,87903,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1776.03,,,,,,,fee schedule,488.66,2498.76, Phenotype dna hiv w/culture,87903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,508.21,,,,,,,fee schedule,488.66,2498.76,APC Phenotype dna hiv w/culture,87903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,513.09,,,,,,,fee schedule,488.66,2498.76,APC Phenotype dna hiv w/culture,87903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,488.66,,,,,,,fee schedule,488.66,2498.76,APC Phenotype dna hiv w/clt add,87904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,591.86,,,,,,,fee schedule,26.07,666.52, Phenotype dna hiv w/clt add,87904,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,666.52,,,,,,,fee schedule,26.07,666.52, Phenotype dna hiv w/clt add,87904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.32,,,,,,,fee schedule,26.07,666.52, Phenotype dna hiv w/clt add,87904,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.22,,,,,,,fee schedule,26.07,666.52, Phenotype dna hiv w/clt add,87904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,26.07,666.52,APC Phenotype dna hiv w/clt add,87904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.37,,,,,,,fee schedule,26.07,666.52,APC Phenotype dna hiv w/clt add,87904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.07,,,,,,,fee schedule,26.07,666.52,APC Sialidase enzyme assay,87905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.26,,,,,,,fee schedule,12.22,63.35, Sialidase enzyme assay,87905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.35,,,,,,,fee schedule,12.22,63.35, Sialidase enzyme assay,87905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.22,63.35, Sialidase enzyme assay,87905,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.22,63.35, Sialidase enzyme assay,87905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.71,,,,,,,fee schedule,12.22,63.35,APC Sialidase enzyme assay,87905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.83,,,,,,,fee schedule,12.22,63.35,APC Sialidase enzyme assay,87905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.22,,,,,,,fee schedule,12.22,63.35,APC Genotype dna/rna hiv,87906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,592.54,,,,,,,fee schedule,128.73,667.29, Genotype dna/rna hiv,87906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,667.29,,,,,,,fee schedule,128.73,667.29, Genotype dna/rna hiv,87906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,409.34,,,,,,,fee schedule,128.73,667.29, Genotype dna/rna hiv,87906,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,467.82,,,,,,,fee schedule,128.73,667.29, Genotype dna/rna hiv,87906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,133.88,,,,,,,fee schedule,128.73,667.29,APC Genotype dna/rna hiv,87906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.17,,,,,,,fee schedule,128.73,667.29,APC Genotype dna/rna hiv,87906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.73,,,,,,,fee schedule,128.73,667.29,APC Genotype cytomegalovirus,87910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1150.11,,,,,,,fee schedule,257.45,1295.2, Genotype cytomegalovirus,87910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1295.2,,,,,,,fee schedule,257.45,1295.2, Genotype cytomegalovirus,87910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,818.66,,,,,,,fee schedule,257.45,1295.2, Genotype cytomegalovirus,87910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,935.61,,,,,,,fee schedule,257.45,1295.2, Genotype cytomegalovirus,87910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,267.75,,,,,,,fee schedule,257.45,1295.2,APC Genotype cytomegalovirus,87910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,270.32,,,,,,,fee schedule,257.45,1295.2,APC Genotype cytomegalovirus,87910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,257.45,,,,,,,fee schedule,257.45,1295.2,APC Genotype dna hepatitis b,87912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1150.11,,,,,,,fee schedule,257.45,1295.2, Genotype dna hepatitis b,87912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1295.2,,,,,,,fee schedule,257.45,1295.2, Genotype dna hepatitis b,87912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,818.66,,,,,,,fee schedule,257.45,1295.2, Genotype dna hepatitis b,87912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,935.61,,,,,,,fee schedule,257.45,1295.2, Genotype dna hepatitis b,87912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,267.75,,,,,,,fee schedule,257.45,1295.2,APC Genotype dna hepatitis b,87912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,270.32,,,,,,,fee schedule,257.45,1295.2,APC Genotype dna hepatitis b,87912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,257.45,,,,,,,fee schedule,257.45,1295.2,APC Nfct agt gntyp alys sarscov2,87913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,836.71,,,,,,,fee schedule,257.45,942.27, Nfct agt gntyp alys sarscov2,87913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,942.27,,,,,,,fee schedule,257.45,942.27, Nfct agt gntyp alys sarscov2,87913,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,818.66,,,,,,,fee schedule,257.45,942.27, Nfct agt gntyp alys sarscov2,87913,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,935.61,,,,,,,fee schedule,257.45,942.27, Nfct agt gntyp alys sarscov2,87913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,267.75,,,,,,,fee schedule,257.45,942.27,APC Nfct agt gntyp alys sarscov2,87913,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,270.32,,,,,,,fee schedule,257.45,942.27,APC Nfct agt gntyp alys sarscov2,87913,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,257.45,,,,,,,fee schedule,257.45,942.27,APC Microbiology procedure,87999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1345.18,,,,,,,fee schedule,39.22,1514.87, Microbiology procedure,87999,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1514.87,,,,,,,fee schedule,39.22,1514.87, Microbiology procedure,87999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.22,,,,,,,fee schedule,39.22,1514.87, Microbiology procedure,87999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.82,,,,,,,fee schedule,39.22,1514.87, Autopsy (necropsy) gross,88000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.82,,,,,,,fee schedule,10.82,12.36, Autopsy (necropsy) gross,88000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.36,,,,,,,fee schedule,10.82,12.36, Autopsy (necropsy) gross,88005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.6,,,,,,,fee schedule,12.6,14.4, Autopsy (necropsy) gross,88005,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.4,,,,,,,fee schedule,12.6,14.4, Autopsy (necropsy) gross,88007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.2,,,,,,,fee schedule,13.2,15.09, Autopsy (necropsy) gross,88007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.09,,,,,,,fee schedule,13.2,15.09, Autopsy (necropsy) gross,88012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.82,,,,,,,fee schedule,10.82,12.36, Autopsy (necropsy) gross,88012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.36,,,,,,,fee schedule,10.82,12.36, Autopsy (necropsy) gross,88014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.92,,,,,,,fee schedule,9.92,11.34, Autopsy (necropsy) gross,88014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.34,,,,,,,fee schedule,9.92,11.34, Autopsy (necropsy) gross,88016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.83,,,,,,,fee schedule,13.83,15.81, Autopsy (necropsy) gross,88016,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.81,,,,,,,fee schedule,13.83,15.81, Autopsy (necropsy) complete,88020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.61,,,,,,,fee schedule,18.61,21.27, Autopsy (necropsy) complete,88020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.27,,,,,,,fee schedule,18.61,21.27, Autopsy (necropsy) complete,88025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.01,,,,,,,fee schedule,18.01,20.58, Autopsy (necropsy) complete,88025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.58,,,,,,,fee schedule,18.01,20.58, Autopsy (necropsy) complete,88027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.22,,,,,,,fee schedule,19.22,21.96, Autopsy (necropsy) complete,88027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.96,,,,,,,fee schedule,19.22,21.96, Autopsy (necropsy) complete,88028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.82,,,,,,,fee schedule,10.82,12.36, Autopsy (necropsy) complete,88028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.36,,,,,,,fee schedule,10.82,12.36, Autopsy (necropsy) complete,88029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.82,,,,,,,fee schedule,10.82,12.36, Autopsy (necropsy) complete,88029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.36,,,,,,,fee schedule,10.82,12.36, Limited autopsy,88036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.41,,,,,,,fee schedule,5.41,6.18, Limited autopsy,88036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.18,,,,,,,fee schedule,5.41,6.18, Limited autopsy,88037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.8,,,,,,,fee schedule,4.8,5.49, Limited autopsy,88037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.49,,,,,,,fee schedule,4.8,5.49, Forensic autopsy (necropsy),88040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.03,,,,,,,fee schedule,30.03,34.32, Forensic autopsy (necropsy),88040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.32,,,,,,,fee schedule,30.03,34.32, Coroners autopsy (necropsy),88045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.99,,,,,,,fee schedule,2.99,3.42, Coroners autopsy (necropsy),88045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.42,,,,,,,fee schedule,2.99,3.42, Necropsy (autopsy) procedure,88099,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.22,,,,,,,fee schedule,39.22,44.82, Necropsy (autopsy) procedure,88099,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.82,,,,,,,fee schedule,39.22,44.82, Cytopath fl nongyn smears,88104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,60.71,,,,,,,fee schedule,44.12,174.93, Cytopath fl nongyn smears,88104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.37,,,,,,,fee schedule,44.12,174.93, Cytopath fl nongyn smears,88104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,153.06,,,,,,,fee schedule,44.12,174.93, Cytopath fl nongyn smears,88104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,174.93,,,,,,,fee schedule,44.12,174.93, Cytopath fl nongyn smears,88104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,174.93,APC Cytopath fl nongyn smears,88104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,174.93,APC Cytopath fl nongyn smears,88104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,174.93,APC Cytopath fl nongyn filter,88106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.17,,,,,,,fee schedule,34.17,189.21, Cytopath fl nongyn filter,88106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.88,,,,,,,fee schedule,34.17,189.21, Cytopath fl nongyn filter,88106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,165.56,,,,,,,fee schedule,34.17,189.21, Cytopath fl nongyn filter,88106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,189.21,,,,,,,fee schedule,34.17,189.21, Cytopath fl nongyn filter,88106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,189.21,APC Cytopath fl nongyn filter,88106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,189.21,APC Cytopath fl nongyn filter,88106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,189.21,APC Cytopath concentrate tech,88108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.8,,,,,,,fee schedule,44.12,167.82, Cytopath concentrate tech,88108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.35,,,,,,,fee schedule,44.12,167.82, Cytopath concentrate tech,88108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.84,,,,,,,fee schedule,44.12,167.82, Cytopath concentrate tech,88108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,167.82,,,,,,,fee schedule,44.12,167.82, Cytopath concentrate tech,88108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,167.82,APC Cytopath concentrate tech,88108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,167.82,APC Cytopath concentrate tech,88108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,167.82,APC Cytopath cell enhance tech,88112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.31,,,,,,,fee schedule,61.56,147.57, Cytopath cell enhance tech,88112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.58,,,,,,,fee schedule,61.56,147.57, Cytopath cell enhance tech,88112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129.12,,,,,,,fee schedule,61.56,147.57, Cytopath cell enhance tech,88112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.57,,,,,,,fee schedule,61.56,147.57, Cytopath cell enhance tech,88112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,147.57,APC Cytopath cell enhance tech,88112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,147.57,APC Cytopath cell enhance tech,88112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,147.57,APC Cytp urne 3-5 probes ea spec,88120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1845.29,,,,,,,fee schedule,201.27,2078.07, Cytp urne 3-5 probes ea spec,88120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2078.07,,,,,,,fee schedule,201.27,2078.07, Cytp urne 3-5 probes ea spec,88120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1636.24,,,,,,,fee schedule,201.27,2078.07, Cytp urne 3-5 probes ea spec,88120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1869.99,,,,,,,fee schedule,201.27,2078.07, Cytp urne 3-5 probes ea spec,88120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,2078.07,APC Cytp urne 3-5 probes ea spec,88120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,2078.07,APC Cytp urne 3-5 probes ea spec,88120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,2078.07,APC Cytp urine 3-5 probes cmptr,88121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1533.94,,,,,,,fee schedule,201.27,1727.45, Cytp urine 3-5 probes cmptr,88121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1727.45,,,,,,,fee schedule,201.27,1727.45, Cytp urine 3-5 probes cmptr,88121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1164.42,,,,,,,fee schedule,201.27,1727.45, Cytp urine 3-5 probes cmptr,88121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1330.77,,,,,,,fee schedule,201.27,1727.45, Cytp urine 3-5 probes cmptr,88121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,1727.45,APC Cytp urine 3-5 probes cmptr,88121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,1727.45,APC Cytp urine 3-5 probes cmptr,88121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,1727.45,APC Forensic cytopathology,88125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.15,,,,,,,fee schedule,47.88,64.64, Forensic cytopathology,88125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.11,,,,,,,fee schedule,47.88,64.64, Forensic cytopathology,88125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.88,,,,,,,fee schedule,47.88,64.64, Forensic cytopathology,88125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.72,,,,,,,fee schedule,47.88,64.64, Forensic cytopathology,88125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,47.88,64.64,APC Forensic cytopathology,88125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,47.88,64.64,APC Forensic cytopathology,88125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,47.88,64.64,APC Sex chromatin identification,88130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.32,,,,,,,fee schedule,17.98,76.93, Sex chromatin identification,88130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.93,,,,,,,fee schedule,17.98,76.93, Sex chromatin identification,88130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,17.98,76.93, Sex chromatin identification,88130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,17.98,76.93, Sex chromatin identification,88130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.7,,,,,,,fee schedule,17.98,76.93,APC Sex chromatin identification,88130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.88,,,,,,,fee schedule,17.98,76.93,APC Sex chromatin identification,88130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.98,,,,,,,fee schedule,17.98,76.93,APC Sex chromatin identification,88140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.3,,,,,,,fee schedule,7.99,40.88, Sex chromatin identification,88140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.88,,,,,,,fee schedule,7.99,40.88, Sex chromatin identification,88140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.99,40.88, Sex chromatin identification,88140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.99,40.88, Sex chromatin identification,88140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.31,,,,,,,fee schedule,7.99,40.88,APC Sex chromatin identification,88140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.39,,,,,,,fee schedule,7.99,40.88,APC Sex chromatin identification,88140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.99,,,,,,,fee schedule,7.99,40.88,APC Cytopath c/v interpret,88141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.88,,,,,,,fee schedule,40.22,88.83, Cytopath c/v interpret,88141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.83,,,,,,,fee schedule,40.22,88.83, Cytopath c/v interpret,88141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.22,,,,,,,fee schedule,40.22,88.83, Cytopath c/v interpret,88141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.96,,,,,,,fee schedule,40.22,88.83, Cytopath c/v thin layer,88142,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.01,,,,,,,fee schedule,20.26,103.61, Cytopath c/v thin layer,88142,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.61,,,,,,,fee schedule,20.26,103.61, Cytopath c/v thin layer,88142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.26,103.61, Cytopath c/v thin layer,88142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.26,103.61, Cytopath c/v thin layer,88142,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.07,,,,,,,fee schedule,20.26,103.61,APC Cytopath c/v thin layer,88142,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.27,,,,,,,fee schedule,20.26,103.61,APC Cytopath c/v thin layer,88142,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.26,,,,,,,fee schedule,20.26,103.61,APC Cytopath c/v thin layer redo,88143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.01,,,,,,,fee schedule,23.04,103.61, Cytopath c/v thin layer redo,88143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.61,,,,,,,fee schedule,23.04,103.61, Cytopath c/v thin layer redo,88143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.92,,,,,,,fee schedule,23.04,103.61, Cytopath c/v thin layer redo,88143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,83.34,,,,,,,fee schedule,23.04,103.61, Cytopath c/v thin layer redo,88143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.96,,,,,,,fee schedule,23.04,103.61,APC Cytopath c/v thin layer redo,88143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.19,,,,,,,fee schedule,23.04,103.61,APC Cytopath c/v thin layer redo,88143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.04,,,,,,,fee schedule,23.04,103.61,APC Cytopath c/v automated,88147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.68,,,,,,,fee schedule,50.56,183.33, Cytopath c/v automated,88147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.19,,,,,,,fee schedule,50.56,183.33, Cytopath c/v automated,88147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,160.41,,,,,,,fee schedule,50.56,183.33, Cytopath c/v automated,88147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,183.33,,,,,,,fee schedule,50.56,183.33, Cytopath c/v automated,88147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.58,,,,,,,fee schedule,50.56,183.33,APC Cytopath c/v automated,88147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.09,,,,,,,fee schedule,50.56,183.33,APC Cytopath c/v automated,88147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.56,,,,,,,fee schedule,50.56,183.33,APC Cytopath c/v auto rescreen,88148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69,,,,,,,fee schedule,18.54,77.7, Cytopath c/v auto rescreen,88148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.7,,,,,,,fee schedule,18.54,77.7, Cytopath c/v auto rescreen,88148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,77.7, Cytopath c/v auto rescreen,88148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,77.7, Cytopath c/v auto rescreen,88148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,77.7,APC Cytopath c/v auto rescreen,88148,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,77.7,APC Cytopath c/v auto rescreen,88148,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,77.7,APC Cytopath c/v manual,88150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,18.54,64.29, Cytopath c/v manual,88150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,18.54,64.29, Cytopath c/v manual,88150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,64.29, Cytopath c/v manual,88150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,64.29, Cytopath c/v manual,88150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,64.29,APC Cytopath c/v manual,88150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,64.29,APC Cytopath c/v manual,88150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,64.29,APC Cytopath c/v auto redo,88152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,27.64,99.99, Cytopath c/v auto redo,88152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,27.64,99.99, Cytopath c/v auto redo,88152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.49,,,,,,,fee schedule,27.64,99.99, Cytopath c/v auto redo,88152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,99.99,,,,,,,fee schedule,27.64,99.99, Cytopath c/v auto redo,88152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.75,,,,,,,fee schedule,27.64,99.99,APC Cytopath c/v auto redo,88152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.02,,,,,,,fee schedule,27.64,99.99,APC Cytopath c/v auto redo,88152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.64,,,,,,,fee schedule,27.64,99.99,APC Cytopath c/v redo,88153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,24.03,86.91, Cytopath c/v redo,88153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,24.03,86.91, Cytopath c/v redo,88153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,76.05,,,,,,,fee schedule,24.03,86.91, Cytopath c/v redo,88153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,86.91,,,,,,,fee schedule,24.03,86.91, Cytopath c/v redo,88153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.99,,,,,,,fee schedule,24.03,86.91,APC Cytopath c/v redo,88153,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.23,,,,,,,fee schedule,24.03,86.91,APC Cytopath c/v redo,88153,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.03,,,,,,,fee schedule,24.03,86.91,APC Cytopath c/v index add-on,88155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.2,,,,,,,fee schedule,14.65,53.58, Cytopath c/v index add-on,88155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.63,,,,,,,fee schedule,14.65,53.58, Cytopath c/v index add-on,88155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.88,,,,,,,fee schedule,14.65,53.58, Cytopath c/v index add-on,88155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.58,,,,,,,fee schedule,14.65,53.58, Cytopath c/v index add-on,88155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.24,,,,,,,fee schedule,14.65,53.58,APC Cytopath c/v index add-on,88155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.38,,,,,,,fee schedule,14.65,53.58,APC Cytopath c/v index add-on,88155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.65,,,,,,,fee schedule,14.65,53.58,APC Cytopath smear other source,88160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.69,,,,,,,fee schedule,34.17,196.35, Cytopath smear other source,88160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.96,,,,,,,fee schedule,34.17,196.35, Cytopath smear other source,88160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,171.81,,,,,,,fee schedule,34.17,196.35, Cytopath smear other source,88160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,196.35,,,,,,,fee schedule,34.17,196.35, Cytopath smear other source,88160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,196.35,APC Cytopath smear other source,88160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,196.35,APC Cytopath smear other source,88160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,196.35,APC Cytopath smear other source,88161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.36,,,,,,,fee schedule,34.17,203.49, Cytopath smear other source,88161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.46,,,,,,,fee schedule,34.17,203.49, Cytopath smear other source,88161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,178.05,,,,,,,fee schedule,34.17,203.49, Cytopath smear other source,88161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,203.49,,,,,,,fee schedule,34.17,203.49, Cytopath smear other source,88161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,203.49,APC Cytopath smear other source,88161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,203.49,APC Cytopath smear other source,88161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,203.49,APC Cytopath smear other source,88162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.76,,,,,,,fee schedule,61.56,323.7, Cytopath smear other source,88162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.95,,,,,,,fee schedule,61.56,323.7, Cytopath smear other source,88162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,283.24,,,,,,,fee schedule,61.56,323.7, Cytopath smear other source,88162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,323.7,,,,,,,fee schedule,61.56,323.7, Cytopath smear other source,88162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,323.7,APC Cytopath smear other source,88162,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,323.7,APC Cytopath smear other source,88162,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,323.7,APC Cytopath tbs c/v manual,88164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v manual,88164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v manual,88164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v manual,88164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v manual,88164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v manual,88164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v manual,88164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v redo,88165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,42.22,153.57, Cytopath tbs c/v redo,88165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,42.22,153.57, Cytopath tbs c/v redo,88165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,134.37,,,,,,,fee schedule,42.22,153.57, Cytopath tbs c/v redo,88165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,153.57,,,,,,,fee schedule,42.22,153.57, Cytopath tbs c/v redo,88165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.91,,,,,,,fee schedule,42.22,153.57,APC Cytopath tbs c/v redo,88165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.33,,,,,,,fee schedule,42.22,153.57,APC Cytopath tbs c/v redo,88165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.22,,,,,,,fee schedule,42.22,153.57,APC Cytopath tbs c/v auto redo,88166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v auto redo,88166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v auto redo,88166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v auto redo,88166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v auto redo,88166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v auto redo,88166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v auto redo,88166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v select,88167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v select,88167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v select,88167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v select,88167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,64.29, Cytopath tbs c/v select,88167,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v select,88167,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,64.29,APC Cytopath tbs c/v select,88167,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,64.29,APC Cytp dx eval fna 1st ea site,88172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.17,,,,,,,fee schedule,67.67,211.33, Cytp dx eval fna 1st ea site,88172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.16,,,,,,,fee schedule,67.67,211.33, Cytp dx eval fna 1st ea site,88172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.67,,,,,,,fee schedule,67.67,211.33, Cytp dx eval fna 1st ea site,88172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,77.34,,,,,,,fee schedule,67.67,211.33, Cytp dx eval fna 1st ea site,88172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,67.67,211.33,APC Cytp dx eval fna 1st ea site,88172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,67.67,211.33,APC Cytp dx eval fna 1st ea site,88172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,67.67,211.33,APC Cytopath eval fna report,88173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.53,,,,,,,fee schedule,61.56,357.03, Cytopath eval fna report,88173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.34,,,,,,,fee schedule,61.56,357.03, Cytopath eval fna report,88173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,312.4,,,,,,,fee schedule,61.56,357.03, Cytopath eval fna report,88173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,357.03,,,,,,,fee schedule,61.56,357.03, Cytopath eval fna report,88173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,357.03,APC Cytopath eval fna report,88173,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,357.03,APC Cytopath eval fna report,88173,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,357.03,APC Cytopath c/v auto in fluid,88174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.01,,,,,,,fee schedule,25.37,109.25, Cytopath c/v auto in fluid,88174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.25,,,,,,,fee schedule,25.37,109.25, Cytopath c/v auto in fluid,88174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.19,,,,,,,fee schedule,25.37,109.25, Cytopath c/v auto in fluid,88174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.65,,,,,,,fee schedule,25.37,109.25, Cytopath c/v auto in fluid,88174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.38,,,,,,,fee schedule,25.37,109.25,APC Cytopath c/v auto in fluid,88174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.64,,,,,,,fee schedule,25.37,109.25,APC Cytopath c/v auto in fluid,88174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.37,,,,,,,fee schedule,25.37,109.25,APC Cytopath c/v auto fluid redo,88175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,120.28,,,,,,,fee schedule,26.61,135.46, Cytopath c/v auto fluid redo,88175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,135.46,,,,,,,fee schedule,26.61,135.46, Cytopath c/v auto fluid redo,88175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.37,,,,,,,fee schedule,26.61,135.46, Cytopath c/v auto fluid redo,88175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.42,,,,,,,fee schedule,26.61,135.46, Cytopath c/v auto fluid redo,88175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.67,,,,,,,fee schedule,26.61,135.46,APC Cytopath c/v auto fluid redo,88175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.94,,,,,,,fee schedule,26.61,135.46,APC Cytopath c/v auto fluid redo,88175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.61,,,,,,,fee schedule,26.61,135.46,APC Cytp fna eval ea addl,88177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.04,,,,,,,fee schedule,26.04,29.76, Cytp fna eval ea addl,88177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.76,,,,,,,fee schedule,26.04,29.76, Cell marker study,88182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,105.14,,,,,,,fee schedule,61.56,464.13, Cell marker study,88182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,118.4,,,,,,,fee schedule,61.56,464.13, Cell marker study,88182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,406.11,,,,,,,fee schedule,61.56,464.13, Cell marker study,88182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,464.13,,,,,,,fee schedule,61.56,464.13, Cell marker study,88182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,464.13,APC Cell marker study,88182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,464.13,APC Cell marker study,88182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,464.13,APC Flowcytometry/ tc 1 marker,88184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.33,,,,,,,fee schedule,70.33,444.62, Flowcytometry/ tc 1 marker,88184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.2,,,,,,,fee schedule,70.33,444.62, Flowcytometry/ tc 1 marker,88184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,243.68,,,,,,,fee schedule,70.33,444.62, Flowcytometry/ tc 1 marker,88184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,278.49,,,,,,,fee schedule,70.33,444.62, Flowcytometry/ tc 1 marker,88184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,70.33,444.62,APC Flowcytometry/ tc 1 marker,88184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,70.33,444.62,APC Flowcytometry/ tc 1 marker,88184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,70.33,444.62,APC Flowcytometry/tc add-on,88185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.99,,,,,,,fee schedule,49.99,84.51, Flowcytometry/tc add-on,88185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.29,,,,,,,fee schedule,49.99,84.51, Flowcytometry/tc add-on,88185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,73.95,,,,,,,fee schedule,49.99,84.51, Flowcytometry/tc add-on,88185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,84.51,,,,,,,fee schedule,49.99,84.51, Flowcytometry/read 2-8,88187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.64,,,,,,,fee schedule,29.64,67.05, Flowcytometry/read 2-8,88187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.38,,,,,,,fee schedule,29.64,67.05, Flowcytometry/read 2-8,88187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.67,,,,,,,fee schedule,29.64,67.05, Flowcytometry/read 2-8,88187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.05,,,,,,,fee schedule,29.64,67.05, Flowcytometry/read 9-15,88188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.93,,,,,,,fee schedule,93.93,115.56, Flowcytometry/read 9-15,88188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.77,,,,,,,fee schedule,93.93,115.56, Flowcytometry/read 9-15,88188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,101.12,,,,,,,fee schedule,93.93,115.56, Flowcytometry/read 9-15,88188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,115.56,,,,,,,fee schedule,93.93,115.56, Flowcytometry/read 16 & >,88189,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.94,,,,,,,fee schedule,91.94,156.45, Flowcytometry/read 16 & >,88189,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.54,,,,,,,fee schedule,91.94,156.45, Flowcytometry/read 16 & >,88189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.89,,,,,,,fee schedule,91.94,156.45, Flowcytometry/read 16 & >,88189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,156.45,,,,,,,fee schedule,91.94,156.45, Cytopathology procedure,88199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,324.74,,,,,,,fee schedule,56.28,365.71, Cytopathology procedure,88199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,365.71,,,,,,,fee schedule,56.28,365.71, Cytopathology procedure,88199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.28,,,,,,,fee schedule,56.28,365.71, Cytopathology procedure,88199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.32,,,,,,,fee schedule,56.28,365.71, Cytopathology procedure,88199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,56.28,365.71,APC Cytopathology procedure,88199,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,56.28,365.71,APC Cytopathology procedure,88199,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,56.28,365.71,APC Tissue culture lymphocyte,88230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,529,,,,,,,fee schedule,116.49,595.74, Tissue culture lymphocyte,88230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,595.74,,,,,,,fee schedule,116.49,595.74, Tissue culture lymphocyte,88230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,370.81,,,,,,,fee schedule,116.49,595.74, Tissue culture lymphocyte,88230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,423.78,,,,,,,fee schedule,116.49,595.74, Tissue culture lymphocyte,88230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,121.15,,,,,,,fee schedule,116.49,595.74,APC Tissue culture lymphocyte,88230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,122.31,,,,,,,fee schedule,116.49,595.74,APC Tissue culture lymphocyte,88230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,116.49,,,,,,,fee schedule,116.49,595.74,APC Tissue culture skin/biopsy,88233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,639.05,,,,,,,fee schedule,140.73,719.67, Tissue culture skin/biopsy,88233,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,719.67,,,,,,,fee schedule,140.73,719.67, Tissue culture skin/biopsy,88233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,447.88,,,,,,,fee schedule,140.73,719.67, Tissue culture skin/biopsy,88233,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,511.86,,,,,,,fee schedule,140.73,719.67, Tissue culture skin/biopsy,88233,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,146.36,,,,,,,fee schedule,140.73,719.67,APC Tissue culture skin/biopsy,88233,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,147.77,,,,,,,fee schedule,140.73,719.67,APC Tissue culture skin/biopsy,88233,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,140.73,,,,,,,fee schedule,140.73,719.67,APC Tissue culture placenta,88235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,668.66,,,,,,,fee schedule,150.3,753.01, Tissue culture placenta,88235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,753.01,,,,,,,fee schedule,150.3,753.01, Tissue culture placenta,88235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,478.09,,,,,,,fee schedule,150.3,753.01, Tissue culture placenta,88235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,546.39,,,,,,,fee schedule,150.3,753.01, Tissue culture placenta,88235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,156.31,,,,,,,fee schedule,150.3,753.01,APC Tissue culture placenta,88235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.82,,,,,,,fee schedule,150.3,753.01,APC Tissue culture placenta,88235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,150.3,,,,,,,fee schedule,150.3,753.01,APC Tissue culture bone marrow,88237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,573.53,,,,,,,fee schedule,143.75,645.88, Tissue culture bone marrow,88237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,645.88,,,,,,,fee schedule,143.75,645.88, Tissue culture bone marrow,88237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,457.25,,,,,,,fee schedule,143.75,645.88, Tissue culture bone marrow,88237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,522.57,,,,,,,fee schedule,143.75,645.88, Tissue culture bone marrow,88237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,149.5,,,,,,,fee schedule,143.75,645.88,APC Tissue culture bone marrow,88237,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,150.94,,,,,,,fee schedule,143.75,645.88,APC Tissue culture bone marrow,88237,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,143.75,,,,,,,fee schedule,143.75,645.88,APC Tissue culture tumor,88239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,669.89,,,,,,,fee schedule,147.52,754.4, Tissue culture tumor,88239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,754.4,,,,,,,fee schedule,147.52,754.4, Tissue culture tumor,88239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,469.74,,,,,,,fee schedule,147.52,754.4, Tissue culture tumor,88239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,536.85,,,,,,,fee schedule,147.52,754.4, Tissue culture tumor,88239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,153.42,,,,,,,fee schedule,147.52,754.4,APC Tissue culture tumor,88239,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.9,,,,,,,fee schedule,147.52,754.4,APC Tissue culture tumor,88239,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.52,,,,,,,fee schedule,147.52,754.4,APC Cell cryopreserve/storage,88240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.86,,,,,,,fee schedule,13.07,51.64, Cell cryopreserve/storage,88240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.64,,,,,,,fee schedule,13.07,51.64, Cell cryopreserve/storage,88240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.66,,,,,,,fee schedule,13.07,51.64, Cell cryopreserve/storage,88240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.61,,,,,,,fee schedule,13.07,51.64, Cell cryopreserve/storage,88240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.59,,,,,,,fee schedule,13.07,51.64,APC Cell cryopreserve/storage,88240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.72,,,,,,,fee schedule,13.07,51.64,APC Cell cryopreserve/storage,88240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.07,,,,,,,fee schedule,13.07,51.64,APC Frozen cell preparation,88241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.86,,,,,,,fee schedule,12.09,51.64, Frozen cell preparation,88241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.64,,,,,,,fee schedule,12.09,51.64, Frozen cell preparation,88241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.09,51.64, Frozen cell preparation,88241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.09,51.64, Frozen cell preparation,88241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.57,,,,,,,fee schedule,12.09,51.64,APC Frozen cell preparation,88241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.69,,,,,,,fee schedule,12.09,51.64,APC Frozen cell preparation,88241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.09,,,,,,,fee schedule,12.09,51.64,APC Chromosome analysis 20-25,88245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,675.94,,,,,,,fee schedule,173.17,761.21, Chromosome analysis 20-25,88245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,761.21,,,,,,,fee schedule,173.17,761.21, Chromosome analysis 20-25,88245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,550.99,,,,,,,fee schedule,173.17,761.21, Chromosome analysis 20-25,88245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,629.7,,,,,,,fee schedule,173.17,761.21, Chromosome analysis 20-25,88245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,180.1,,,,,,,fee schedule,173.17,761.21,APC Chromosome analysis 20-25,88245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,181.83,,,,,,,fee schedule,173.17,761.21,APC Chromosome analysis 20-25,88245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,173.17,,,,,,,fee schedule,173.17,761.21,APC Chromosome analysis 50-100,88248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,786.37,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 50-100,88248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,885.57,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 50-100,88248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,550.99,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 50-100,88248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,629.7,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 50-100,88248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,180.1,,,,,,,fee schedule,173.17,885.57,APC Chromosome analysis 50-100,88248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,181.83,,,,,,,fee schedule,173.17,885.57,APC Chromosome analysis 50-100,88248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,173.17,,,,,,,fee schedule,173.17,885.57,APC Chromosome analysis 100,88249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,786.37,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 100,88249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,885.57,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 100,88249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,550.99,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 100,88249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,629.7,,,,,,,fee schedule,173.17,885.57, Chromosome analysis 100,88249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,180.1,,,,,,,fee schedule,173.17,885.57,APC Chromosome analysis 100,88249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,181.83,,,,,,,fee schedule,173.17,885.57,APC Chromosome analysis 100,88249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,173.17,,,,,,,fee schedule,173.17,885.57,APC Chromosome analysis 5,88261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,802.52,,,,,,,fee schedule,264.34,960.63, Chromosome analysis 5,88261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,903.76,,,,,,,fee schedule,264.34,960.63, Chromosome analysis 5,88261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,840.55,,,,,,,fee schedule,264.34,960.63, Chromosome analysis 5,88261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,960.63,,,,,,,fee schedule,264.34,960.63, Chromosome analysis 5,88261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,274.91,,,,,,,fee schedule,264.34,960.63,APC Chromosome analysis 5,88261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,277.56,,,,,,,fee schedule,264.34,960.63,APC Chromosome analysis 5,88261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,264.34,,,,,,,fee schedule,264.34,960.63,APC Chromosome analysis 15-20,88262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,565.96,,,,,,,fee schedule,125.49,637.35, Chromosome analysis 15-20,88262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,637.35,,,,,,,fee schedule,125.49,637.35, Chromosome analysis 15-20,88262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,398.92,,,,,,,fee schedule,125.49,637.35, Chromosome analysis 15-20,88262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,455.91,,,,,,,fee schedule,125.49,637.35, Chromosome analysis 15-20,88262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,130.51,,,,,,,fee schedule,125.49,637.35,APC Chromosome analysis 15-20,88262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,131.76,,,,,,,fee schedule,125.49,637.35,APC Chromosome analysis 15-20,88262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,125.49,,,,,,,fee schedule,125.49,637.35,APC Chromosome analysis 45,88263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,682.4,,,,,,,fee schedule,150.29,768.49, Chromosome analysis 45,88263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,768.49,,,,,,,fee schedule,150.29,768.49, Chromosome analysis 45,88263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,478.09,,,,,,,fee schedule,150.29,768.49, Chromosome analysis 45,88263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,546.39,,,,,,,fee schedule,150.29,768.49, Chromosome analysis 45,88263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,156.3,,,,,,,fee schedule,150.29,768.49,APC Chromosome analysis 45,88263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.8,,,,,,,fee schedule,150.29,768.49,APC Chromosome analysis 45,88263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,150.29,,,,,,,fee schedule,150.29,768.49,APC Chromosome analysis 20-25,88264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,565.96,,,,,,,fee schedule,144.61,637.35, Chromosome analysis 20-25,88264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,637.35,,,,,,,fee schedule,144.61,637.35, Chromosome analysis 20-25,88264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,460.37,,,,,,,fee schedule,144.61,637.35, Chromosome analysis 20-25,88264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,526.14,,,,,,,fee schedule,144.61,637.35, Chromosome analysis 20-25,88264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,150.39,,,,,,,fee schedule,144.61,637.35,APC Chromosome analysis 20-25,88264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,151.84,,,,,,,fee schedule,144.61,637.35,APC Chromosome analysis 20-25,88264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,144.61,,,,,,,fee schedule,144.61,637.35,APC Chromosome analys placenta,88267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,816.3,,,,,,,fee schedule,188.57,919.28, Chromosome analys placenta,88267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,919.28,,,,,,,fee schedule,188.57,919.28, Chromosome analys placenta,88267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,599.94,,,,,,,fee schedule,188.57,919.28, Chromosome analys placenta,88267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,685.65,,,,,,,fee schedule,188.57,919.28, Chromosome analys placenta,88267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,196.11,,,,,,,fee schedule,188.57,919.28,APC Chromosome analys placenta,88267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,198,,,,,,,fee schedule,188.57,919.28,APC Chromosome analys placenta,88267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,188.57,,,,,,,fee schedule,188.57,919.28,APC Chromosome analys amniotic,88269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,755.24,,,,,,,fee schedule,173.66,850.51, Chromosome analys amniotic,88269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,850.51,,,,,,,fee schedule,173.66,850.51, Chromosome analys amniotic,88269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,552.04,,,,,,,fee schedule,173.66,850.51, Chromosome analys amniotic,88269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,630.9,,,,,,,fee schedule,173.66,850.51, Chromosome analys amniotic,88269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,180.61,,,,,,,fee schedule,173.66,850.51,APC Chromosome analys amniotic,88269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,182.34,,,,,,,fee schedule,173.66,850.51,APC Chromosome analys amniotic,88269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,173.66,,,,,,,fee schedule,173.66,850.51,APC Cytogenetics dna probe,88271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.27,,,,,,,fee schedule,21.42,109.54, Cytogenetics dna probe,88271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.54,,,,,,,fee schedule,21.42,109.54, Cytogenetics dna probe,88271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.7,,,,,,,fee schedule,21.42,109.54, Cytogenetics dna probe,88271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,77.37,,,,,,,fee schedule,21.42,109.54, Cytogenetics dna probe,88271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.28,,,,,,,fee schedule,21.42,109.54,APC Cytogenetics dna probe,88271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.49,,,,,,,fee schedule,21.42,109.54,APC Cytogenetics dna probe,88271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.42,,,,,,,fee schedule,21.42,109.54,APC Cytogenetics 3-5,88272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.58,,,,,,,fee schedule,40.7,147.6, Cytogenetics 3-5,88272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.92,,,,,,,fee schedule,40.7,147.6, Cytogenetics 3-5,88272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129.15,,,,,,,fee schedule,40.7,147.6, Cytogenetics 3-5,88272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.6,,,,,,,fee schedule,40.7,147.6, Cytogenetics 3-5,88272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42.33,,,,,,,fee schedule,40.7,147.6,APC Cytogenetics 3-5,88272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.74,,,,,,,fee schedule,40.7,147.6,APC Cytogenetics 3-5,88272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.7,,,,,,,fee schedule,40.7,147.6,APC Cytogenetics 10-30,88273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,145.89,,,,,,,fee schedule,34.81,164.3, Cytogenetics 10-30,88273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,164.3,,,,,,,fee schedule,34.81,164.3, Cytogenetics 10-30,88273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,110.41,,,,,,,fee schedule,34.81,164.3, Cytogenetics 10-30,88273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,126.18,,,,,,,fee schedule,34.81,164.3, Cytogenetics 10-30,88273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.2,,,,,,,fee schedule,34.81,164.3,APC Cytogenetics 10-30,88273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.55,,,,,,,fee schedule,34.81,164.3,APC Cytogenetics 10-30,88273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.81,,,,,,,fee schedule,34.81,164.3,APC Cytogenetics 25-99,88274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,158.05,,,,,,,fee schedule,42.38,177.99, Cytogenetics 25-99,88274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,177.99,,,,,,,fee schedule,42.38,177.99, Cytogenetics 25-99,88274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,134.37,,,,,,,fee schedule,42.38,177.99, Cytogenetics 25-99,88274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,153.57,,,,,,,fee schedule,42.38,177.99, Cytogenetics 25-99,88274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.08,,,,,,,fee schedule,42.38,177.99,APC Cytogenetics 25-99,88274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.5,,,,,,,fee schedule,42.38,177.99,APC Cytogenetics 25-99,88274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.38,,,,,,,fee schedule,42.38,177.99,APC Cytogenetics 100-300,88275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,182.36,,,,,,,fee schedule,51.19,205.36, Cytogenetics 100-300,88275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,205.36,,,,,,,fee schedule,51.19,205.36, Cytogenetics 100-300,88275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,162.49,,,,,,,fee schedule,51.19,205.36, Cytogenetics 100-300,88275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,185.7,,,,,,,fee schedule,51.19,205.36, Cytogenetics 100-300,88275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.24,,,,,,,fee schedule,51.19,205.36,APC Cytogenetics 100-300,88275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.75,,,,,,,fee schedule,51.19,205.36,APC Cytogenetics 100-300,88275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.19,,,,,,,fee schedule,51.19,205.36,APC Chromosome karyotype study,88280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.98,,,,,,,fee schedule,33.47,128.36, Chromosome karyotype study,88280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.36,,,,,,,fee schedule,33.47,128.36, Chromosome karyotype study,88280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,106.23,,,,,,,fee schedule,33.47,128.36, Chromosome karyotype study,88280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,121.41,,,,,,,fee schedule,33.47,128.36, Chromosome karyotype study,88280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.81,,,,,,,fee schedule,33.47,128.36,APC Chromosome karyotype study,88280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.14,,,,,,,fee schedule,33.47,128.36,APC Chromosome karyotype study,88280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.47,,,,,,,fee schedule,33.47,128.36,APC Chromosome banding study,88283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,311.48,,,,,,,fee schedule,68.6,350.77, Chromosome banding study,88283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,350.77,,,,,,,fee schedule,68.6,350.77, Chromosome banding study,88283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,218.74,,,,,,,fee schedule,68.6,350.77, Chromosome banding study,88283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,249.99,,,,,,,fee schedule,68.6,350.77, Chromosome banding study,88283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,71.34,,,,,,,fee schedule,68.6,350.77,APC Chromosome banding study,88283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,72.03,,,,,,,fee schedule,68.6,350.77,APC Chromosome banding study,88283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,68.6,,,,,,,fee schedule,68.6,350.77,APC Chromosome count additional,88285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.26,,,,,,,fee schedule,26.91,97.62, Chromosome count additional,88285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,97.14,,,,,,,fee schedule,26.91,97.62, Chromosome count additional,88285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.42,,,,,,,fee schedule,26.91,97.62, Chromosome count additional,88285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.62,,,,,,,fee schedule,26.91,97.62, Chromosome count additional,88285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.99,,,,,,,fee schedule,26.91,97.62,APC Chromosome count additional,88285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.26,,,,,,,fee schedule,26.91,97.62,APC Chromosome count additional,88285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.91,,,,,,,fee schedule,26.91,97.62,APC Chromosome study additional,88289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.36,,,,,,,fee schedule,34.43,176.08, Chromosome study additional,88289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,176.08,,,,,,,fee schedule,34.43,176.08, Chromosome study additional,88289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,109.36,,,,,,,fee schedule,34.43,176.08, Chromosome study additional,88289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,124.98,,,,,,,fee schedule,34.43,176.08, Chromosome study additional,88289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.81,,,,,,,fee schedule,34.43,176.08,APC Chromosome study additional,88289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.15,,,,,,,fee schedule,34.43,176.08,APC Chromosome study additional,88289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.43,,,,,,,fee schedule,34.43,176.08,APC Cyto/molecular report,88291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.86,,,,,,,fee schedule,55.86,63.84, Cyto/molecular report,88291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.84,,,,,,,fee schedule,55.86,63.84, Cytogenetic study,88299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.6,,,,,,,fee schedule,56.28,76.13, Cytogenetic study,88299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.13,,,,,,,fee schedule,56.28,76.13, Cytogenetic study,88299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.28,,,,,,,fee schedule,56.28,76.13, Cytogenetic study,88299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.32,,,,,,,fee schedule,56.28,76.13, Cytogenetic study,88299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,56.28,76.13,APC Cytogenetic study,88299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,56.28,76.13,APC Cytogenetic study,88299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,56.28,76.13,APC Surgical path gross,88300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.71,,,,,,,fee schedule,34.17,43.59, Surgical path gross,88300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.59,,,,,,,fee schedule,34.17,43.59, Surgical path gross,88300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.49,,,,,,,fee schedule,34.17,43.59, Surgical path gross,88300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.84,,,,,,,fee schedule,34.17,43.59, Surgical path gross,88300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,43.59,APC Surgical path gross,88300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,43.59,APC Surgical path gross,88300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,43.59,APC Tissue exam by pathologist,88302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,68.25,,,,,,,fee schedule,44.12,95.19, Tissue exam by pathologist,88302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.86,,,,,,,fee schedule,44.12,95.19, Tissue exam by pathologist,88302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.29,,,,,,,fee schedule,44.12,95.19, Tissue exam by pathologist,88302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.19,,,,,,,fee schedule,44.12,95.19, Tissue exam by pathologist,88302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,95.19,APC Tissue exam by pathologist,88302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,95.19,APC Tissue exam by pathologist,88302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,95.19,APC Tissue exam by pathologist,88304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.87,,,,,,,fee schedule,61.56,114.24, Tissue exam by pathologist,88304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.33,,,,,,,fee schedule,61.56,114.24, Tissue exam by pathologist,88304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,99.96,,,,,,,fee schedule,61.56,114.24, Tissue exam by pathologist,88304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,114.24,,,,,,,fee schedule,61.56,114.24, Tissue exam by pathologist,88304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,114.24,APC Tissue exam by pathologist,88304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,114.24,APC Tissue exam by pathologist,88304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,114.24,APC Tissue exam by pathologist,88305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.86,,,,,,,fee schedule,61.56,139.48, Tissue exam by pathologist,88305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,139.48,,,,,,,fee schedule,61.56,139.48, Tissue exam by pathologist,88305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.43,,,,,,,fee schedule,61.56,139.48, Tissue exam by pathologist,88305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.35,,,,,,,fee schedule,61.56,139.48, Tissue exam by pathologist,88305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,139.48,APC Tissue exam by pathologist,88305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,139.48,APC Tissue exam by pathologist,88305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,139.48,APC Tissue exam by pathologist,88307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,186.62,,,,,,,fee schedule,186.62,746.25, Tissue exam by pathologist,88307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,210.16,,,,,,,fee schedule,186.62,746.25, Tissue exam by pathologist,88307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,652.97,,,,,,,fee schedule,186.62,746.25, Tissue exam by pathologist,88307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,746.25,,,,,,,fee schedule,186.62,746.25, Tissue exam by pathologist,88307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,186.62,746.25,APC Tissue exam by pathologist,88307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,186.62,746.25,APC Tissue exam by pathologist,88307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,186.62,746.25,APC Tissue exam by pathologist,88309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,244.6,,,,,,,fee schedule,244.6,1047.42, Tissue exam by pathologist,88309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,275.45,,,,,,,fee schedule,244.6,1047.42, Tissue exam by pathologist,88309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,916.49,,,,,,,fee schedule,244.6,1047.42, Tissue exam by pathologist,88309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1047.42,,,,,,,fee schedule,244.6,1047.42, Tissue exam by pathologist,88309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,244.6,1047.42,APC Tissue exam by pathologist,88309,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,244.6,1047.42,APC Tissue exam by pathologist,88309,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,244.6,1047.42,APC Decalcify tissue,88311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.17,,,,,,,fee schedule,27.06,39.6, Decalcify tissue,88311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.6,,,,,,,fee schedule,27.06,39.6, Decalcify tissue,88311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.06,,,,,,,fee schedule,27.06,39.6, Decalcify tissue,88311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.93,,,,,,,fee schedule,27.06,39.6, Special stains group 1,88312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.57,,,,,,,fee schedule,59.57,310.65, Special stains group 1,88312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.09,,,,,,,fee schedule,59.57,310.65, Special stains group 1,88312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,271.82,,,,,,,fee schedule,59.57,310.65, Special stains group 1,88312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,310.65,,,,,,,fee schedule,59.57,310.65, Special stains group 1,88312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,59.57,310.65,APC Special stains group 1,88312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,59.57,310.65,APC Special stains group 1,88312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,59.57,310.65,APC Special stains group 2,88313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.57,,,,,,,fee schedule,59.57,254.7, Special stains group 2,88313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.09,,,,,,,fee schedule,59.57,254.7, Special stains group 2,88313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,222.86,,,,,,,fee schedule,59.57,254.7, Special stains group 2,88313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,254.7,,,,,,,fee schedule,59.57,254.7, Special stains group 2,88313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,59.57,254.7,APC Special stains group 2,88313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,59.57,254.7,APC Special stains group 2,88313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,59.57,254.7,APC Histochemical stains add-on,88314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.15,,,,,,,fee schedule,72.15,246.36, Histochemical stains add-on,88314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.25,,,,,,,fee schedule,72.15,246.36, Histochemical stains add-on,88314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,215.57,,,,,,,fee schedule,72.15,246.36, Histochemical stains add-on,88314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,246.36,,,,,,,fee schedule,72.15,246.36, Enzyme histochemistry,88319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,163.61,,,,,,,fee schedule,163.61,999.37, Enzyme histochemistry,88319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,184.24,,,,,,,fee schedule,163.61,999.37, Enzyme histochemistry,88319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,345.77,,,,,,,fee schedule,163.61,999.37, Enzyme histochemistry,88319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,395.16,,,,,,,fee schedule,163.61,999.37, Enzyme histochemistry,88319,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,163.61,999.37,APC Enzyme histochemistry,88319,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,163.61,999.37,APC Enzyme histochemistry,88319,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,163.61,999.37,APC Microslide consultation,88321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.23,,,,,,,fee schedule,44.12,155.79, Microslide consultation,88321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.82,,,,,,,fee schedule,44.12,155.79, Microslide consultation,88321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.32,,,,,,,fee schedule,44.12,155.79, Microslide consultation,88321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.79,,,,,,,fee schedule,44.12,155.79, Microslide consultation,88321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,155.79,APC Microslide consultation,88321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,155.79,APC Microslide consultation,88321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,155.79,APC Microslide consultation,88323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.4,,,,,,,fee schedule,61.56,114.19, Microslide consultation,88323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.19,,,,,,,fee schedule,61.56,114.19, Microslide consultation,88323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.69,,,,,,,fee schedule,61.56,114.19, Microslide consultation,88323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.93,,,,,,,fee schedule,61.56,114.19, Microslide consultation,88323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,114.19,APC Microslide consultation,88323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,114.19,APC Microslide consultation,88323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,114.19,APC Comprehensive review of data,88325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,183.46,,,,,,,fee schedule,183.46,250.29, Comprehensive review of data,88325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,206.61,,,,,,,fee schedule,183.46,250.29, Comprehensive review of data,88325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,219,,,,,,,fee schedule,183.46,250.29, Comprehensive review of data,88325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,250.29,,,,,,,fee schedule,183.46,250.29, Comprehensive review of data,88325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,183.46,250.29,APC Comprehensive review of data,88325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,183.46,250.29,APC Comprehensive review of data,88325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,183.46,250.29,APC Path consult introp,88329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.24,,,,,,,fee schedule,49.24,73.17, Path consult introp,88329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.45,,,,,,,fee schedule,49.24,73.17, Path consult introp,88329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.54,,,,,,,fee schedule,49.24,73.17, Path consult introp,88329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.76,,,,,,,fee schedule,49.24,73.17, Path consult introp,88329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,49.24,73.17,APC Path consult introp,88329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,49.24,73.17,APC Path consult introp,88329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,49.24,73.17,APC Path consult intraop 1 bloc,88331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96.53,,,,,,,fee schedule,96.53,211.33, Path consult intraop 1 bloc,88331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,108.7,,,,,,,fee schedule,96.53,211.33, Path consult intraop 1 bloc,88331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129.12,,,,,,,fee schedule,96.53,211.33, Path consult intraop 1 bloc,88331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.57,,,,,,,fee schedule,96.53,211.33, Path consult intraop 1 bloc,88331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,96.53,211.33,APC Path consult intraop 1 bloc,88331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,96.53,211.33,APC Path consult intraop 1 bloc,88331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,96.53,211.33,APC Path consult intraop addl,88332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.96,,,,,,,fee schedule,41.96,89.25, Path consult intraop addl,88332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.25,,,,,,,fee schedule,41.96,89.25, Path consult intraop addl,88332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.09,,,,,,,fee schedule,41.96,89.25, Path consult intraop addl,88332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.25,,,,,,,fee schedule,41.96,89.25, Intraop cyto path consult 1,88333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.12,,,,,,,fee schedule,63.12,999.37, Intraop cyto path consult 1,88333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.08,,,,,,,fee schedule,63.12,999.37, Intraop cyto path consult 1,88333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,99.96,,,,,,,fee schedule,63.12,999.37, Intraop cyto path consult 1,88333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,114.24,,,,,,,fee schedule,63.12,999.37, Intraop cyto path consult 1,88333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,63.12,999.37,APC Intraop cyto path consult 1,88333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,63.12,999.37,APC Intraop cyto path consult 1,88333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,63.12,999.37,APC Intraop cyto path consult 2,88334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.53,,,,,,,fee schedule,58.53,69.03, Intraop cyto path consult 2,88334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.92,,,,,,,fee schedule,58.53,69.03, Intraop cyto path consult 2,88334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,58.53,69.03, Intraop cyto path consult 2,88334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,58.53,69.03, Immunohisto antb addl slide,88341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,198.95,,,,,,,fee schedule,198.95,227.37, Immunohisto antb addl slide,88341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,227.37,,,,,,,fee schedule,198.95,227.37, Immunohisto antb 1st stain,88342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.62,,,,,,,fee schedule,109.62,258.27, Immunohisto antb 1st stain,88342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.45,,,,,,,fee schedule,109.62,258.27, Immunohisto antb 1st stain,88342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,225.99,,,,,,,fee schedule,109.62,258.27, Immunohisto antb 1st stain,88342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,258.27,,,,,,,fee schedule,109.62,258.27, Immunohisto antb 1st stain,88342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,109.62,258.27,APC Immunohisto antb 1st stain,88342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,109.62,258.27,APC Immunohisto antb 1st stain,88342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,109.62,258.27,APC Immunohisto antibody slide,88344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,403.98,,,,,,,fee schedule,403.98,485.64, Immunohisto antibody slide,88344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,454.94,,,,,,,fee schedule,403.98,485.64, Immunohisto antibody slide,88344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,424.94,,,,,,,fee schedule,403.98,485.64, Immunohisto antibody slide,88344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,485.64,,,,,,,fee schedule,403.98,485.64, Immunohisto antibody slide,88344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,403.98,485.64,APC Immunohisto antibody slide,88344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,403.98,485.64,APC Immunohisto antibody slide,88344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,403.98,485.64,APC Immunofluor antb 1st stain,88346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96.43,,,,,,,fee schedule,96.43,411.81, Immunofluor antb 1st stain,88346,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,108.59,,,,,,,fee schedule,96.43,411.81, Immunofluor antb 1st stain,88346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,360.33,,,,,,,fee schedule,96.43,411.81, Immunofluor antb 1st stain,88346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,411.81,,,,,,,fee schedule,96.43,411.81, Immunofluor antb 1st stain,88346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,96.43,411.81,APC Immunofluor antb 1st stain,88346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,96.43,411.81,APC Immunofluor antb 1st stain,88346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,96.43,411.81,APC Electron microscopy,88348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,547.4,,,,,,,fee schedule,547.4,1463.94, Electron microscopy,88348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,616.45,,,,,,,fee schedule,547.4,1463.94, Electron microscopy,88348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1280.95,,,,,,,fee schedule,547.4,1463.94, Electron microscopy,88348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1463.94,,,,,,,fee schedule,547.4,1463.94, Electron microscopy,88348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,547.4,1463.94,APC Electron microscopy,88348,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,547.4,1463.94,APC Electron microscopy,88348,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,547.4,1463.94,APC Immunofluor antb addl stain,88350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96.85,,,,,,,fee schedule,96.85,307.08, Immunofluor antb addl stain,88350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.07,,,,,,,fee schedule,96.85,307.08, Immunofluor antb addl stain,88350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,268.7,,,,,,,fee schedule,96.85,307.08, Immunofluor antb addl stain,88350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,307.08,,,,,,,fee schedule,96.85,307.08, Analysis skeletal muscle,88355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,206.93,,,,,,,fee schedule,164.54,233.03, Analysis skeletal muscle,88355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,233.03,,,,,,,fee schedule,164.54,233.03, Analysis skeletal muscle,88355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.54,,,,,,,fee schedule,164.54,233.03, Analysis skeletal muscle,88355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,188.04,,,,,,,fee schedule,164.54,233.03, Analysis skeletal muscle,88355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,164.54,233.03,APC Analysis skeletal muscle,88355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,164.54,233.03,APC Analysis skeletal muscle,88355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,164.54,233.03,APC Analysis nerve,88356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,338.16,,,,,,,fee schedule,61.56,417.66, Analysis nerve,88356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,380.82,,,,,,,fee schedule,61.56,417.66, Analysis nerve,88356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,365.45,,,,,,,fee schedule,61.56,417.66, Analysis nerve,88356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,417.66,,,,,,,fee schedule,61.56,417.66, Analysis nerve,88356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,417.66,APC Analysis nerve,88356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,417.66,APC Analysis nerve,88356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,417.66,APC Analysis tumor,88358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,133.15,,,,,,,fee schedule,133.15,317.79, Analysis tumor,88358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.95,,,,,,,fee schedule,133.15,317.79, Analysis tumor,88358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,278.07,,,,,,,fee schedule,133.15,317.79, Analysis tumor,88358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.79,,,,,,,fee schedule,133.15,317.79, Analysis tumor,88358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,133.15,317.79,APC Analysis tumor,88358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,133.15,317.79,APC Analysis tumor,88358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,133.15,317.79,APC Tumor immunohistochem/manual,88360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.9,,,,,,,fee schedule,128.9,286.86, Tumor immunohistochem/manual,88360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,145.16,,,,,,,fee schedule,128.9,286.86, Tumor immunohistochem/manual,88360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,251,,,,,,,fee schedule,128.9,286.86, Tumor immunohistochem/manual,88360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,286.86,,,,,,,fee schedule,128.9,286.86, Tumor immunohistochem/manual,88360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,128.9,286.86,APC Tumor immunohistochem/manual,88360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,128.9,286.86,APC Tumor immunohistochem/manual,88360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,128.9,286.86,APC Tumor immunohistochem/comput,88361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.91,,,,,,,fee schedule,138.91,444.62, Tumor immunohistochem/comput,88361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,156.43,,,,,,,fee schedule,138.91,444.62, Tumor immunohistochem/comput,88361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,241.63,,,,,,,fee schedule,138.91,444.62, Tumor immunohistochem/comput,88361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,276.15,,,,,,,fee schedule,138.91,444.62, Tumor immunohistochem/comput,88361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,138.91,444.62,APC Tumor immunohistochem/comput,88361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,138.91,444.62,APC Tumor immunohistochem/comput,88361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,138.91,444.62,APC Nerve teasing preparations,88362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,261.85,,,,,,,fee schedule,261.85,999.37, Nerve teasing preparations,88362,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,294.89,,,,,,,fee schedule,261.85,999.37, Nerve teasing preparations,88362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,380.1,,,,,,,fee schedule,261.85,999.37, Nerve teasing preparations,88362,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,434.4,,,,,,,fee schedule,261.85,999.37, Nerve teasing preparations,88362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,261.85,999.37,APC Nerve teasing preparations,88362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,261.85,999.37,APC Nerve teasing preparations,88362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,261.85,999.37,APC Xm archive tissue molec anal,88363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.73,,,,,,,fee schedule,31.29,71.77, Xm archive tissue molec anal,88363,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.77,,,,,,,fee schedule,31.29,71.77, Xm archive tissue molec anal,88363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.29,,,,,,,fee schedule,31.29,71.77, Xm archive tissue molec anal,88363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.76,,,,,,,fee schedule,31.29,71.77, Xm archive tissue molec anal,88363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,31.29,71.77,APC Xm archive tissue molec anal,88363,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,31.29,71.77,APC Xm archive tissue molec anal,88363,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,31.29,71.77,APC Insitu hybridization (fish),88364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,314.53,,,,,,,fee schedule,314.53,359.46, Insitu hybridization (fish),88364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,359.46,,,,,,,fee schedule,314.53,359.46, Insitu hybridization (fish),88365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.88,,,,,,,fee schedule,156.88,485.61, Insitu hybridization (fish),88365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,176.67,,,,,,,fee schedule,156.88,485.61, Insitu hybridization (fish),88365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,424.91,,,,,,,fee schedule,156.88,485.61, Insitu hybridization (fish),88365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,485.61,,,,,,,fee schedule,156.88,485.61, Insitu hybridization (fish),88365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,156.88,485.61,APC Insitu hybridization (fish),88365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,156.88,485.61,APC Insitu hybridization (fish),88365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,156.88,485.61,APC Insitu hybridization (fish),88366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,595.37,,,,,,,fee schedule,201.27,758.22, Insitu hybridization (fish),88366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,670.48,,,,,,,fee schedule,201.27,758.22, Insitu hybridization (fish),88366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,663.44,,,,,,,fee schedule,201.27,758.22, Insitu hybridization (fish),88366,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,758.22,,,,,,,fee schedule,201.27,758.22, Insitu hybridization (fish),88366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,758.22,APC Insitu hybridization (fish),88366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,758.22,APC Insitu hybridization (fish),88366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,758.22,APC Insitu hybridization auto,88367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,188.79,,,,,,,fee schedule,188.79,444.62, Insitu hybridization auto,88367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.61,,,,,,,fee schedule,188.79,444.62, Insitu hybridization auto,88367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,248.9,,,,,,,fee schedule,188.79,444.62, Insitu hybridization auto,88367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,284.46,,,,,,,fee schedule,188.79,444.62, Insitu hybridization auto,88367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,188.79,444.62,APC Insitu hybridization auto,88367,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,188.79,444.62,APC Insitu hybridization auto,88367,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,188.79,444.62,APC Insitu hybridization manual,88368,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.69,,,,,,,fee schedule,161.69,444.62, Insitu hybridization manual,88368,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,182.09,,,,,,,fee schedule,161.69,444.62, Insitu hybridization manual,88368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,335.34,,,,,,,fee schedule,161.69,444.62, Insitu hybridization manual,88368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,383.25,,,,,,,fee schedule,161.69,444.62, Insitu hybridization manual,88368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,161.69,444.62,APC Insitu hybridization manual,88368,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,161.69,444.62,APC Insitu hybridization manual,88368,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,161.69,444.62,APC M/phmtrc alysishquant/semiq,88369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,299.96,,,,,,,fee schedule,299.96,342.81, M/phmtrc alysishquant/semiq,88369,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,342.81,,,,,,,fee schedule,299.96,342.81, Protein western blot tissue,88371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,100.91,,,,,,,fee schedule,70.82,113.64, Protein western blot tissue,88371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.64,,,,,,,fee schedule,70.82,113.64, Protein western blot tissue,88371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.82,,,,,,,fee schedule,70.82,113.64, Protein western blot tissue,88371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.94,,,,,,,fee schedule,70.82,113.64, Protein analysis w/probe,88372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,103.32,,,,,,,fee schedule,83.32,116.35, Protein analysis w/probe,88372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.35,,,,,,,fee schedule,83.32,116.35, Protein analysis w/probe,88372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.32,,,,,,,fee schedule,83.32,116.35, Protein analysis w/probe,88372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.22,,,,,,,fee schedule,83.32,116.35, M/phmtrc alys ishquant/semiq,88373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,135.37,,,,,,,fee schedule,135.37,154.71, M/phmtrc alys ishquant/semiq,88373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,154.71,,,,,,,fee schedule,135.37,154.71, M/phmtrc alys ishquant/semiq,88374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,896.71,,,,,,,fee schedule,201.27,1009.83, M/phmtrc alys ishquant/semiq,88374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1009.83,,,,,,,fee schedule,201.27,1009.83, M/phmtrc alys ishquant/semiq,88374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,771.78,,,,,,,fee schedule,201.27,1009.83, M/phmtrc alys ishquant/semiq,88374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,882.03,,,,,,,fee schedule,201.27,1009.83, M/phmtrc alys ishquant/semiq,88374,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,1009.83,APC M/phmtrc alys ishquant/semiq,88374,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,1009.83,APC M/phmtrc alys ishquant/semiq,88374,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,1009.83,APC Optical endomicroscpy interp,88375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.23,,,,,,,fee schedule,78.23,89.4, Optical endomicroscpy interp,88375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.4,,,,,,,fee schedule,78.23,89.4, M/phmtrc alys ishquant/semiq,88377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1029.99,,,,,,,fee schedule,201.27,1191.48, M/phmtrc alys ishquant/semiq,88377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1159.93,,,,,,,fee schedule,201.27,1191.48, M/phmtrc alys ishquant/semiq,88377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1042.55,,,,,,,fee schedule,201.27,1191.48, M/phmtrc alys ishquant/semiq,88377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1191.48,,,,,,,fee schedule,201.27,1191.48, M/phmtrc alys ishquant/semiq,88377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,1191.48,APC M/phmtrc alys ishquant/semiq,88377,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,1191.48,APC M/phmtrc alys ishquant/semiq,88377,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,1191.48,APC Microdissection laser,88380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,230.13,,,,,,,fee schedule,230.13,263.01, Microdissection laser,88380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,263.01,,,,,,,fee schedule,230.13,263.01, Microdissection manual,88381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,558.21,,,,,,,fee schedule,558.21,637.95, Microdissection manual,88381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,637.95,,,,,,,fee schedule,558.21,637.95, Tiss exam molecular study,88387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.89,,,,,,,fee schedule,22.89,26.16, Tiss exam molecular study,88387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.16,,,,,,,fee schedule,22.89,26.16, Tiss ex molecul study add-on,88388,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.63,,,,,,,fee schedule,41.63,47.58, Tiss ex molecul study add-on,88388,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.58,,,,,,,fee schedule,41.63,47.58, Surgical pathology procedure,88399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.37,,,,,,,fee schedule,45.37,100.68, Surgical pathology procedure,88399,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.09,,,,,,,fee schedule,45.37,100.68, Surgical pathology procedure,88399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,45.37,100.68, Surgical pathology procedure,88399,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,45.37,100.68, Surgical pathology procedure,88399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,45.37,100.68,APC Surgical pathology procedure,88399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,45.37,100.68,APC Surgical pathology procedure,88399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,45.37,100.68,APC Bilirubin total transcut,88720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.82,,,,,,,fee schedule,5.02,25.69, Bilirubin total transcut,88720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.69,,,,,,,fee schedule,5.02,25.69, Bilirubin total transcut,88720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5.02,25.69, Bilirubin total transcut,88720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5.02,25.69, Bilirubin total transcut,88720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.22,,,,,,,fee schedule,5.02,25.69,APC Bilirubin total transcut,88720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.27,,,,,,,fee schedule,5.02,25.69,APC Bilirubin total transcut,88720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.02,,,,,,,fee schedule,5.02,25.69,APC Hgb quant transcutaneous,88738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.07,,,,,,,fee schedule,5.02,25.99, Hgb quant transcutaneous,88738,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.99,,,,,,,fee schedule,5.02,25.99, Hgb quant transcutaneous,88738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,5.02,25.99, Hgb quant transcutaneous,88738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,5.02,25.99, Hgb quant transcutaneous,88738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.22,,,,,,,fee schedule,5.02,25.99,APC Hgb quant transcutaneous,88738,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.27,,,,,,,fee schedule,5.02,25.99,APC Hgb quant transcutaneous,88738,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.02,,,,,,,fee schedule,5.02,25.99,APC Transcutaneous carboxyhb,88740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.07,,,,,,,fee schedule,9.37,34.53, Transcutaneous carboxyhb,88740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.99,,,,,,,fee schedule,9.37,34.53, Transcutaneous carboxyhb,88740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.37,34.53, Transcutaneous carboxyhb,88740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.37,34.53, Transcutaneous carboxyhb,88740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.74,,,,,,,fee schedule,9.37,34.53,APC Transcutaneous carboxyhb,88740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.84,,,,,,,fee schedule,9.37,34.53,APC Transcutaneous carboxyhb,88740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.37,,,,,,,fee schedule,9.37,34.53,APC Transcutaneous methb,88741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.07,,,,,,,fee schedule,9.37,34.53, Transcutaneous methb,88741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.99,,,,,,,fee schedule,9.37,34.53, Transcutaneous methb,88741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.21,,,,,,,fee schedule,9.37,34.53, Transcutaneous methb,88741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.53,,,,,,,fee schedule,9.37,34.53, Transcutaneous methb,88741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.74,,,,,,,fee schedule,9.37,34.53,APC Transcutaneous methb,88741,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.84,,,,,,,fee schedule,9.37,34.53,APC Transcutaneous methb,88741,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.37,,,,,,,fee schedule,9.37,34.53,APC In vivo lab service,88749,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.22,,,,,,,fee schedule,39.22,44.82, In vivo lab service,88749,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.82,,,,,,,fee schedule,39.22,44.82, Chct for mal hyperthermia,89049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,101.69,,,,,,,fee schedule,101.69,211.33, Chct for mal hyperthermia,89049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,116.22,,,,,,,fee schedule,101.69,211.33, Chct for mal hyperthermia,89049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,101.69,211.33,APC Chct for mal hyperthermia,89049,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,101.69,211.33,APC Chct for mal hyperthermia,89049,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,101.69,211.33,APC Body fluid cell count,89050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.48,,,,,,,fee schedule,4.72,24.19, Body fluid cell count,89050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.19,,,,,,,fee schedule,4.72,24.19, Body fluid cell count,89050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.6,,,,,,,fee schedule,4.72,24.19, Body fluid cell count,89050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.68,,,,,,,fee schedule,4.72,24.19, Body fluid cell count,89050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.91,,,,,,,fee schedule,4.72,24.19,APC Body fluid cell count,89050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.96,,,,,,,fee schedule,4.72,24.19,APC Body fluid cell count,89050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.72,,,,,,,fee schedule,4.72,24.19,APC Body fluid cell count,89051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.03,,,,,,,fee schedule,5.6,28.18, Body fluid cell count,89051,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.18,,,,,,,fee schedule,5.6,28.18, Body fluid cell count,89051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.72,,,,,,,fee schedule,5.6,28.18, Body fluid cell count,89051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.25,,,,,,,fee schedule,5.6,28.18, Body fluid cell count,89051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.82,,,,,,,fee schedule,5.6,28.18,APC Body fluid cell count,89051,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.88,,,,,,,fee schedule,5.6,28.18,APC Body fluid cell count,89051,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.6,,,,,,,fee schedule,5.6,28.18,APC Leukocyte assessment fecal,89055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,4.27,21.81, Leukocyte assessment fecal,89055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,4.27,21.81, Leukocyte assessment fecal,89055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,21.81, Leukocyte assessment fecal,89055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,21.81, Leukocyte assessment fecal,89055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,21.81,APC Leukocyte assessment fecal,89055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,21.81,APC Leukocyte assessment fecal,89055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,21.81,APC Exam synovial fluid crystals,89060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.47,,,,,,,fee schedule,7.33,36.56, Exam synovial fluid crystals,89060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.56,,,,,,,fee schedule,7.33,36.56, Exam synovial fluid crystals,89060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.92,,,,,,,fee schedule,7.33,36.56, Exam synovial fluid crystals,89060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.19,,,,,,,fee schedule,7.33,36.56, Exam synovial fluid crystals,89060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.62,,,,,,,fee schedule,7.33,36.56,APC Exam synovial fluid crystals,89060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.7,,,,,,,fee schedule,7.33,36.56,APC Exam synovial fluid crystals,89060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.33,,,,,,,fee schedule,7.33,36.56,APC Specimen fat stain,89125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.6,,,,,,,fee schedule,5.88,22.07, Specimen fat stain,89125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.07,,,,,,,fee schedule,5.88,22.07, Specimen fat stain,89125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.88,22.07, Specimen fat stain,89125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.88,22.07, Specimen fat stain,89125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.12,,,,,,,fee schedule,5.88,22.07,APC Specimen fat stain,89125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.17,,,,,,,fee schedule,5.88,22.07,APC Specimen fat stain,89125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.88,,,,,,,fee schedule,5.88,22.07,APC Exam feces for meat fibers,89160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.74,,,,,,,fee schedule,4.85,18.85, Exam feces for meat fibers,89160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.85,,,,,,,fee schedule,4.85,18.85, Exam feces for meat fibers,89160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.85,18.85, Exam feces for meat fibers,89160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.85,18.85, Exam feces for meat fibers,89160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.04,,,,,,,fee schedule,4.85,18.85,APC Exam feces for meat fibers,89160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.09,,,,,,,fee schedule,4.85,18.85,APC Exam feces for meat fibers,89160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.85,,,,,,,fee schedule,4.85,18.85,APC Nasal smear for eosinophils,89190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.58,,,,,,,fee schedule,5.79,24.3, Nasal smear for eosinophils,89190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.3,,,,,,,fee schedule,5.79,24.3, Nasal smear for eosinophils,89190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.79,24.3, Nasal smear for eosinophils,89190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.79,24.3, Nasal smear for eosinophils,89190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.02,,,,,,,fee schedule,5.79,24.3,APC Nasal smear for eosinophils,89190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.08,,,,,,,fee schedule,5.79,24.3,APC Nasal smear for eosinophils,89190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.79,,,,,,,fee schedule,5.79,24.3,APC Sputum specimen collection,89220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96.72,,,,,,,fee schedule,60.4,211.33, Sputum specimen collection,89220,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,108.92,,,,,,,fee schedule,60.4,211.33, Sputum specimen collection,89220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.4,,,,,,,fee schedule,60.4,211.33, Sputum specimen collection,89220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.03,,,,,,,fee schedule,60.4,211.33, Sputum specimen collection,89220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,60.4,211.33,APC Sputum specimen collection,89220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,60.4,211.33,APC Sputum specimen collection,89220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,60.4,211.33,APC Collect sweat for test,89230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.12,,,,,,,fee schedule,9.35,130.77, Collect sweat for test,89230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.77,,,,,,,fee schedule,9.35,130.77, Collect sweat for test,89230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.35,,,,,,,fee schedule,9.35,130.77, Collect sweat for test,89230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.68,,,,,,,fee schedule,9.35,130.77, Collect sweat for test,89230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,9.35,130.77,APC Collect sweat for test,89230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,9.35,130.77,APC Collect sweat for test,89230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,9.35,130.77,APC Pathology lab procedure,89240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.99,,,,,,,fee schedule,24.99,100.68, Pathology lab procedure,89240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.15,,,,,,,fee schedule,24.99,100.68, Pathology lab procedure,89240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,24.99,100.68, Pathology lab procedure,89240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,24.99,100.68, Pathology lab procedure,89240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,24.99,100.68,APC Pathology lab procedure,89240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,24.99,100.68,APC Pathology lab procedure,89240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,24.99,100.68,APC Cultr oocyte/embryo <4 days,89250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3441.32,,,,,,,fee schedule,201.27,3932.94, Cultr oocyte/embryo <4 days,89250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3932.94,,,,,,,fee schedule,201.27,3932.94, Cultr oocyte/embryo <4 days,89250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,3932.94,APC Cultr oocyte/embryo <4 days,89250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,3932.94,APC Cultr oocyte/embryo <4 days,89250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,3932.94,APC Cultr oocyte/embryo <4 days,89251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3579.87,,,,,,,fee schedule,201.27,4091.28, Cultr oocyte/embryo <4 days,89251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4091.28,,,,,,,fee schedule,201.27,4091.28, Cultr oocyte/embryo <4 days,89251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,4091.28,APC Cultr oocyte/embryo <4 days,89251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,4091.28,APC Cultr oocyte/embryo <4 days,89251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,4091.28,APC Embryo hatching,89253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Embryo hatching,89253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Embryo hatching,89253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Embryo hatching,89253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Embryo hatching,89253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Oocyte identification,89254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Oocyte identification,89254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Oocyte identification,89254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Oocyte identification,89254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Oocyte identification,89254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Prepare embryo for transfer,89255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,61.56,100.68, Prepare embryo for transfer,89255,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,61.56,100.68, Prepare embryo for transfer,89255,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,100.68,APC Prepare embryo for transfer,89255,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,100.68,APC Prepare embryo for transfer,89255,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,100.68,APC Sperm identification,89257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,61.56,100.68, Sperm identification,89257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,61.56,100.68, Sperm identification,89257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,100.68,APC Sperm identification,89257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,100.68,APC Sperm identification,89257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,100.68,APC Cryopreservation embryo(s),89258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1397.92,,,,,,,fee schedule,951.79,1597.62, Cryopreservation embryo(s),89258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1597.62,,,,,,,fee schedule,951.79,1597.62, Cryopreservation embryo(s),89258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,951.79,1597.62,APC Cryopreservation embryo(s),89258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,951.79,1597.62,APC Cryopreservation embryo(s),89258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,951.79,1597.62,APC Cryopreservation sperm,89259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.31,,,,,,,fee schedule,106.31,317.34, Cryopreservation sperm,89259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,119.72,,,,,,,fee schedule,106.31,317.34, Cryopreservation sperm,89259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,106.31,317.34, Cryopreservation sperm,89259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,106.31,317.34, Cryopreservation sperm,89259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,106.31,317.34,APC Cryopreservation sperm,89259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,106.31,317.34,APC Cryopreservation sperm,89259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,106.31,317.34,APC Sperm isolation simple,89260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.72,,,,,,,fee schedule,48.72,100.68, Sperm isolation simple,89260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.86,,,,,,,fee schedule,48.72,100.68, Sperm isolation simple,89260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,48.72,100.68, Sperm isolation simple,89260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,48.72,100.68, Sperm isolation simple,89260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,48.72,100.68,APC Sperm isolation simple,89260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,48.72,100.68,APC Sperm isolation simple,89260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,48.72,100.68,APC Sperm isolation complex,89261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,199.06,,,,,,,fee schedule,61.56,224.18, Sperm isolation complex,89261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,224.18,,,,,,,fee schedule,61.56,224.18, Sperm isolation complex,89261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,61.56,224.18, Sperm isolation complex,89261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,61.56,224.18, Sperm isolation complex,89261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,224.18,APC Sperm isolation complex,89261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,224.18,APC Sperm isolation complex,89261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,224.18,APC Identify sperm tissue,89264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,309.37,,,,,,,fee schedule,61.56,348.4, Identify sperm tissue,89264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,348.4,,,,,,,fee schedule,61.56,348.4, Identify sperm tissue,89264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,61.56,348.4, Identify sperm tissue,89264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,61.56,348.4, Identify sperm tissue,89264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,348.4,APC Identify sperm tissue,89264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,348.4,APC Identify sperm tissue,89264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,348.4,APC Insemination of oocytes,89268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Insemination of oocytes,89268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Insemination of oocytes,89268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Insemination of oocytes,89268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Insemination of oocytes,89268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Extended culture of oocytes,89272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1397.92,,,,,,,fee schedule,951.79,1597.62, Extended culture of oocytes,89272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1597.62,,,,,,,fee schedule,951.79,1597.62, Extended culture of oocytes,89272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,951.79,1597.62,APC Extended culture of oocytes,89272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,951.79,1597.62,APC Extended culture of oocytes,89272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,951.79,1597.62,APC Assist oocyte fertilization,89280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1397.92,,,,,,,fee schedule,951.79,1597.62, Assist oocyte fertilization,89280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1597.62,,,,,,,fee schedule,951.79,1597.62, Assist oocyte fertilization,89280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,989.86,,,,,,,fee schedule,951.79,1597.62,APC Assist oocyte fertilization,89280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,999.37,,,,,,,fee schedule,951.79,1597.62,APC Assist oocyte fertilization,89280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,951.79,,,,,,,fee schedule,951.79,1597.62,APC Assist oocyte fertilization,89281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Assist oocyte fertilization,89281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Assist oocyte fertilization,89281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Assist oocyte fertilization,89281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Assist oocyte fertilization,89281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Biopsy oocyte polar body,89290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Biopsy oocyte polar body,89290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Biopsy oocyte polar body,89290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Biopsy oocyte polar body,89290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Biopsy oocyte polar body,89290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Biopsy oocyte polar body,89291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Biopsy oocyte polar body,89291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Biopsy oocyte polar body,89291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Biopsy oocyte polar body,89291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Biopsy oocyte polar body,89291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Semen analysis w/huhner,89300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.46,,,,,,,fee schedule,9.84,45.57, Semen analysis w/huhner,89300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,45.57,,,,,,,fee schedule,9.84,45.57, Semen analysis w/huhner,89300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.84,45.57, Semen analysis w/huhner,89300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.84,45.57, Semen analysis w/huhner,89300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.23,,,,,,,fee schedule,9.84,45.57,APC Semen analysis w/huhner,89300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.33,,,,,,,fee schedule,9.84,45.57,APC Semen analysis w/huhner,89300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.84,,,,,,,fee schedule,9.84,45.57,APC Semen analysis w/count,89310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.1,,,,,,,fee schedule,8.61,44.03, Semen analysis w/count,89310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.03,,,,,,,fee schedule,8.61,44.03, Semen analysis w/count,89310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.09,,,,,,,fee schedule,8.61,44.03, Semen analysis w/count,89310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.96,,,,,,,fee schedule,8.61,44.03, Semen analysis w/count,89310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.95,,,,,,,fee schedule,8.61,44.03,APC Semen analysis w/count,89310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.04,,,,,,,fee schedule,8.61,44.03,APC Semen analysis w/count,89310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.61,,,,,,,fee schedule,8.61,44.03,APC Semen anal vol/count/mot,89320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.73,,,,,,,fee schedule,12.31,61.63, Semen anal vol/count/mot,89320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.63,,,,,,,fee schedule,12.31,61.63, Semen anal vol/count/mot,89320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.59,,,,,,,fee schedule,12.31,61.63, Semen anal vol/count/mot,89320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.24,,,,,,,fee schedule,12.31,61.63, Semen anal vol/count/mot,89320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.8,,,,,,,fee schedule,12.31,61.63,APC Semen anal vol/count/mot,89320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.93,,,,,,,fee schedule,12.31,61.63,APC Semen anal vol/count/mot,89320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.31,,,,,,,fee schedule,12.31,61.63,APC Semen anal sperm detection,89321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.73,,,,,,,fee schedule,12.05,61.63, Semen anal sperm detection,89321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.63,,,,,,,fee schedule,12.05,61.63, Semen anal sperm detection,89321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,12.05,61.63, Semen anal sperm detection,89321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,12.05,61.63, Semen anal sperm detection,89321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.53,,,,,,,fee schedule,12.05,61.63,APC Semen anal sperm detection,89321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.65,,,,,,,fee schedule,12.05,61.63,APC Semen anal sperm detection,89321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.05,,,,,,,fee schedule,12.05,61.63,APC Semen anal strict criteria,89322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,71.37,,,,,,,fee schedule,15.5,80.37, Semen anal strict criteria,89322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.37,,,,,,,fee schedule,15.5,80.37, Semen anal strict criteria,89322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.96,,,,,,,fee schedule,15.5,80.37, Semen anal strict criteria,89322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.95,,,,,,,fee schedule,15.5,80.37, Semen anal strict criteria,89322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.12,,,,,,,fee schedule,15.5,80.37,APC Semen anal strict criteria,89322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.28,,,,,,,fee schedule,15.5,80.37,APC Semen anal strict criteria,89322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.5,,,,,,,fee schedule,15.5,80.37,APC Sperm antibody test,89325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.46,,,,,,,fee schedule,10.67,54.57, Sperm antibody test,89325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.57,,,,,,,fee schedule,10.67,54.57, Sperm antibody test,89325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,10.67,54.57, Sperm antibody test,89325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,10.67,54.57, Sperm antibody test,89325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.1,,,,,,,fee schedule,10.67,54.57,APC Sperm antibody test,89325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.2,,,,,,,fee schedule,10.67,54.57,APC Sperm antibody test,89325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.67,,,,,,,fee schedule,10.67,54.57,APC Sperm evaluation test,89329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.23,,,,,,,fee schedule,19.59,107.24, Sperm evaluation test,89329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,107.24,,,,,,,fee schedule,19.59,107.24, Sperm evaluation test,89329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.59,107.24, Sperm evaluation test,89329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.59,107.24, Sperm evaluation test,89329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.37,,,,,,,fee schedule,19.59,107.24,APC Sperm evaluation test,89329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.57,,,,,,,fee schedule,19.59,107.24,APC Sperm evaluation test,89329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.59,,,,,,,fee schedule,19.59,107.24,APC Evaluation cervical mucus,89330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.95,,,,,,,fee schedule,10.38,50.62, Evaluation cervical mucus,89330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.62,,,,,,,fee schedule,10.38,50.62, Evaluation cervical mucus,89330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,10.38,50.62, Evaluation cervical mucus,89330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.1,,,,,,,fee schedule,10.38,50.62, Evaluation cervical mucus,89330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.8,,,,,,,fee schedule,10.38,50.62,APC Evaluation cervical mucus,89330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.9,,,,,,,fee schedule,10.38,50.62,APC Evaluation cervical mucus,89330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.38,,,,,,,fee schedule,10.38,50.62,APC Retrograde ejaculation anal,89331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.15,,,,,,,fee schedule,19.59,101.53, Retrograde ejaculation anal,89331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.53,,,,,,,fee schedule,19.59,101.53, Retrograde ejaculation anal,89331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.59,101.53, Retrograde ejaculation anal,89331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.59,101.53, Retrograde ejaculation anal,89331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.37,,,,,,,fee schedule,19.59,101.53,APC Retrograde ejaculation anal,89331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.57,,,,,,,fee schedule,19.59,101.53,APC Retrograde ejaculation anal,89331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.59,,,,,,,fee schedule,19.59,101.53,APC Cryopreserve testicular tiss,89335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,178.75,,,,,,,fee schedule,61.56,201.3, Cryopreserve testicular tiss,89335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,201.3,,,,,,,fee schedule,61.56,201.3, Cryopreserve testicular tiss,89335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,61.56,201.3, Cryopreserve testicular tiss,89335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,61.56,201.3, Cryopreserve testicular tiss,89335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,201.3,APC Cryopreserve testicular tiss,89335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,201.3,APC Cryopreserve testicular tiss,89335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,201.3,APC Cryopreservation oocyte(s),89337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Cryopreservation oocyte(s),89337,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Cryopreservation oocyte(s),89337,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Cryopreservation oocyte(s),89337,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Cryopreservation oocyte(s),89337,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Storage/year embryo(s),89342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Storage/year embryo(s),89342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Storage/year embryo(s),89342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Storage/year embryo(s),89342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Storage/year embryo(s),89342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Storage/year sperm/semen,89343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,261.11,,,,,,,fee schedule,201.27,317.34, Storage/year sperm/semen,89343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,294.04,,,,,,,fee schedule,201.27,317.34, Storage/year sperm/semen,89343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Storage/year sperm/semen,89343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Storage/year sperm/semen,89343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Storage/year sperm/semen,89343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Storage/year sperm/semen,89343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Storage/year reprod tissue,89344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Storage/year reprod tissue,89344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Storage/year reprod tissue,89344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Storage/year reprod tissue,89344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Storage/year reprod tissue,89344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Storage/year oocyte(s),89346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Storage/year oocyte(s),89346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Storage/year oocyte(s),89346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Storage/year oocyte(s),89346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Storage/year oocyte(s),89346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Thawing cryopresrved embryo,89352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.57,,,,,,,fee schedule,119.57,317.34, Thawing cryopresrved embryo,89352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,134.65,,,,,,,fee schedule,119.57,317.34, Thawing cryopresrved embryo,89352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,119.57,317.34, Thawing cryopresrved embryo,89352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,119.57,317.34, Thawing cryopresrved embryo,89352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,119.57,317.34,APC Thawing cryopresrved embryo,89352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,119.57,317.34,APC Thawing cryopresrved embryo,89352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,119.57,317.34,APC Thawing cryopresrved sperm,89353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,61.56,100.68, Thawing cryopresrved sperm,89353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,61.56,100.68, Thawing cryopresrved sperm,89353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,100.68,APC Thawing cryopresrved sperm,89353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,100.68,APC Thawing cryopresrved sperm,89353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,100.68,APC Thaw cryoprsvrd reprod tiss,89354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Thaw cryoprsvrd reprod tiss,89354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Thaw cryoprsvrd reprod tiss,89354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Thaw cryoprsvrd reprod tiss,89354,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Thaw cryoprsvrd reprod tiss,89354,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Thawing cryopresrved oocyte,89356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.67,,,,,,,fee schedule,201.27,317.34, Thawing cryopresrved oocyte,89356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.34,,,,,,,fee schedule,201.27,317.34, Thawing cryopresrved oocyte,89356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.32,,,,,,,fee schedule,201.27,317.34,APC Thawing cryopresrved oocyte,89356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.33,,,,,,,fee schedule,201.27,317.34,APC Thawing cryopresrved oocyte,89356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.27,,,,,,,fee schedule,201.27,317.34,APC Unlisted reprod med lab proc,89398,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.1,,,,,,,fee schedule,61.56,100.68, Unlisted reprod med lab proc,89398,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.68,,,,,,,fee schedule,61.56,100.68, Unlisted reprod med lab proc,89398,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.02,,,,,,,fee schedule,61.56,100.68,APC Unlisted reprod med lab proc,89398,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.64,,,,,,,fee schedule,61.56,100.68,APC Unlisted reprod med lab proc,89398,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.56,,,,,,,fee schedule,61.56,100.68,APC Human ig im,90281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,199.03,,,,,,,fee schedule,199.03,238.86, Human ig im,90281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,238.86,,,,,,,fee schedule,199.03,238.86, Human ig iv,90283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,155.67,,,,,,,fee schedule,155.67,186.82, Human ig iv,90283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.82,,,,,,,fee schedule,155.67,186.82, Human ig sc,90284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.12,,,,,,,fee schedule,31.12,37.35, Human ig sc,90284,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,37.35,,,,,,,fee schedule,31.12,37.35, Botulism ig iv,90288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,91029.65,,,,,,,fee schedule,91029.65,109245.32, Botulism ig iv,90288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109245.32,,,,,,,fee schedule,91029.65,109245.32, Cmv ig iv,90291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3677.58,,,,,,,fee schedule,3677.58,4413.48, Cmv ig iv,90291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4413.48,,,,,,,fee schedule,3677.58,4413.48, Hep b ig im,90371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,203.4,,,,,,,fee schedule,140.21,397.1, Hep b ig im,90371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,203.4,,,,,,,fee schedule,140.21,397.1, Hep b ig im,90371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,330.89,,,,,,,fee schedule,140.21,397.1, Hep b ig im,90371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,397.1,,,,,,,fee schedule,140.21,397.1, Hep b ig im,90371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,145.82,,,,,,,fee schedule,140.21,397.1,APC Hep b ig im,90371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,147.22,,,,,,,fee schedule,140.21,397.1,APC Hep b ig im,90371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,140.21,,,,,,,fee schedule,140.21,397.1,APC Rabies ig im/sc,90375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,414.73,,,,,,,fee schedule,275.18,842.13, Rabies ig im/sc,90375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,414.73,,,,,,,fee schedule,275.18,842.13, Rabies ig im/sc,90375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,701.72,,,,,,,fee schedule,275.18,842.13, Rabies ig im/sc,90375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,842.13,,,,,,,fee schedule,275.18,842.13, Rabies ig im/sc,90375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,286.19,,,,,,,fee schedule,275.18,842.13,APC Rabies ig im/sc,90375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,288.94,,,,,,,fee schedule,275.18,842.13,APC Rabies ig im/sc,90375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,275.18,,,,,,,fee schedule,275.18,842.13,APC Rabies ig heat treated,90376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,947.36,,,,,,,fee schedule,352.44,1136.93, Rabies ig heat treated,90376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1136.93,,,,,,,fee schedule,352.44,1136.93, Rabies ig heat treated,90376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,366.54,,,,,,,fee schedule,352.44,1136.93,APC Rabies ig heat treated,90376,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,370.06,,,,,,,fee schedule,352.44,1136.93,APC Rabies ig heat treated,90376,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,352.44,,,,,,,fee schedule,352.44,1136.93,APC Rabies ig ht&sol human im/sc,90377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,369.07,,,,,,,fee schedule,242.18,895.76, Rabies ig ht&sol human im/sc,90377,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,369.07,,,,,,,fee schedule,242.18,895.76, Rabies ig ht&sol human im/sc,90377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,746.4,,,,,,,fee schedule,242.18,895.76, Rabies ig ht&sol human im/sc,90377,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,895.76,,,,,,,fee schedule,242.18,895.76, Rabies ig ht&sol human im/sc,90377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,251.86,,,,,,,fee schedule,242.18,895.76,APC Rabies ig ht&sol human im/sc,90377,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,254.29,,,,,,,fee schedule,242.18,895.76,APC Rabies ig ht&sol human im/sc,90377,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,242.18,,,,,,,fee schedule,242.18,895.76,APC Rsv mab im 50mg,90378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3811.15,,,,,,,fee schedule,436.75,4573.79, Rsv mab im 50mg,90378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4573.79,,,,,,,fee schedule,436.75,4573.79, Rsv mab im 50mg,90378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,454.22,,,,,,,fee schedule,436.75,4573.79,APC Rsv mab im 50mg,90378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,458.59,,,,,,,fee schedule,436.75,4573.79,APC Rsv mab im 50mg,90378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,436.75,,,,,,,fee schedule,436.75,4573.79,APC Rsv monoc antb seasn .5ml im,90380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1164.14,,,,,,,fee schedule,1164.14,1397.1, Rsv monoc antb seasn .5ml im,90380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1397.1,,,,,,,fee schedule,1164.14,1397.1, Rsv monoc antb seasnl 1ml im,90381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1164.14,,,,,,,fee schedule,1164.14,1397.1, Rsv monoc antb seasnl 1ml im,90381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1397.1,,,,,,,fee schedule,1164.14,1397.1, Rsv monoc antb seasn .7ml im,90382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1163.86,,,,,,,fee schedule,1163.86,1396.76, Rsv monoc antb seasn .7ml im,90382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1396.76,,,,,,,fee schedule,1163.86,1396.76, Rh ig full-dose im,90384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,173.39,,,,,,,fee schedule,173.39,208.08, Rh ig full-dose im,90384,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,208.08,,,,,,,fee schedule,173.39,208.08, Rh ig minidose im,90385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.46,,,,,,,fee schedule,62.46,84, Rh ig minidose im,90385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,74.96,,,,,,,fee schedule,62.46,84, Rh ig minidose im,90385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,83.2,,,,,,,fee schedule,62.46,84,APC Rh ig minidose im,90385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,84,,,,,,,fee schedule,62.46,84,APC Rh ig minidose im,90385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,80,,,,,,,fee schedule,62.46,84,APC Rh ig iv,90386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.59,,,,,,,fee schedule,21.59,25.91, Rh ig iv,90386,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,25.91,,,,,,,fee schedule,21.59,25.91, Tetanus ig im,90389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1358.89,,,,,,,fee schedule,1358.89,1630.82, Tetanus ig im,90389,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1630.82,,,,,,,fee schedule,1358.89,1630.82, Varicella-zoster ig im,90396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4774.27,,,,,,,fee schedule,2363.25,5729.63, Varicella-zoster ig im,90396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5729.63,,,,,,,fee schedule,2363.25,5729.63, Varicella-zoster ig im,90396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2457.78,,,,,,,fee schedule,2363.25,5729.63,APC Varicella-zoster ig im,90396,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2481.41,,,,,,,fee schedule,2363.25,5729.63,APC Varicella-zoster ig im,90396,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2363.25,,,,,,,fee schedule,2363.25,5729.63,APC Immunization admin,90471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.03,,,,,,,fee schedule,83.03,95.08, Immunization admin,90471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,95.08,,,,,,,fee schedule,83.03,95.08, Immunization admin,90471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,83.03,95.08,APC Immunization admin,90471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,83.03,95.08,APC Immunization admin,90471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,83.03,95.08,APC Immunization admin each add,90472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.78,,,,,,,fee schedule,54.78,62.74, Immunization admin each add,90472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.74,,,,,,,fee schedule,54.78,62.74, Immune admin oral/nasal,90473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,89.31,APC Immune admin oral/nasal,90473,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,89.31,APC Immune admin oral/nasal,90473,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,89.31,APC Immune admin oral/nasal addl,90474,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.36,,,,,,,fee schedule,42.36,48.51, Immune admin oral/nasal addl,90474,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.51,,,,,,,fee schedule,42.36,48.51, Admn sarscov2 vacc 1 dose,90480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62,,,,,,,fee schedule,48.01,71, Admn sarscov2 vacc 1 dose,90480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71,,,,,,,fee schedule,48.01,71, Admn sarscov2 vacc 1 dose,90480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.93,,,,,,,fee schedule,48.01,71,APC Admn sarscov2 vacc 1 dose,90480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50.41,,,,,,,fee schedule,48.01,71,APC Admn sarscov2 vacc 1 dose,90480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.01,,,,,,,fee schedule,48.01,71,APC Anthrax vaccine sc or im,90581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,207.23,,,,,,,fee schedule,207.23,248.7, Anthrax vaccine sc or im,90581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,248.7,,,,,,,fee schedule,207.23,248.7, Bcg vaccine percut,90585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,380.92,,,,,,,fee schedule,380.92,457.15, Bcg vaccine percut,90585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,457.15,,,,,,,fee schedule,380.92,457.15, Bcg vaccine intravesical,90586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,243.08,,,,,,,fee schedule,243.08,457.15, Bcg vaccine intravesical,90586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,243.08,,,,,,,fee schedule,243.08,457.15, Bcg vaccine intravesical,90586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,380.92,,,,,,,fee schedule,243.08,457.15, Bcg vaccine intravesical,90586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,457.15,,,,,,,fee schedule,243.08,457.15, Dengue vacc quad 3 dose subq,90587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,138.16,,,,,,,fee schedule,138.16,165.8, Dengue vacc quad 3 dose subq,90587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,165.8,,,,,,,fee schedule,138.16,165.8, Chikungunya vaccine live im,90589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,575.65,,,,,,,fee schedule,575.65,690.84, Chikungunya vaccine live im,90589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,690.84,,,,,,,fee schedule,575.65,690.84, Chikungunya vacc recomb im,90593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,575.65,,,,,,,fee schedule,575.65,690.84, Chikungunya vacc recomb im,90593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,690.84,,,,,,,fee schedule,575.65,690.84, Smallpox&monkeypox vac 0.5ml,90611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,565.19,,,,,,,fee schedule,0.01,678.28, Smallpox&monkeypox vac 0.5ml,90611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,678.28,,,,,,,fee schedule,0.01,678.28, Smallpox&monkeypox vac 0.5ml,90611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.01,,,,,,,fee schedule,0.01,678.28,APC Smallpox&monkeypox vac 0.5ml,90611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.01,,,,,,,fee schedule,0.01,678.28,APC Smallpox&monkeypox vac 0.5ml,90611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.01,,,,,,,fee schedule,0.01,678.28,APC Menacwy-tt vaccine im,90619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,359.99,,,,,,,fee schedule,359.99,432.02, Menacwy-tt vaccine im,90619,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,432.02,,,,,,,fee schedule,359.99,432.02, Menb rp w/omv vaccine im,90620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,496.39,,,,,,,fee schedule,496.39,595.72, Menb rp w/omv vaccine im,90620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,595.72,,,,,,,fee schedule,496.39,595.72, Menb rlp vaccine im,90621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,433.98,,,,,,,fee schedule,433.98,520.82, Menb rlp vaccine im,90621,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,520.82,,,,,,,fee schedule,433.98,520.82, Vaccinia vrs vac 0.3 ml perq,90622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.01,0.02, Vaccinia vrs vac 0.3 ml perq,90622,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.01,0.02, Vaccinia vrs vac 0.3 ml perq,90622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.01,,,,,,,fee schedule,0.01,0.02,APC Vaccinia vrs vac 0.3 ml perq,90622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.01,,,,,,,fee schedule,0.01,0.02,APC Vaccinia vrs vac 0.3 ml perq,90622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.01,,,,,,,fee schedule,0.01,0.02,APC Menacwy-tt menb-fhbp vacc im,90623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,495.9,,,,,,,fee schedule,495.9,595.14, Menacwy-tt menb-fhbp vacc im,90623,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,595.14,,,,,,,fee schedule,495.9,595.14, Menb-4c&menacwy vacc im,90624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,524.89,,,,,,,fee schedule,524.89,629.92, Menb-4c&menacwy vacc im,90624,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,629.92,,,,,,,fee schedule,524.89,629.92, Cholera vaccine live oral,90625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,610.19,,,,,,,fee schedule,610.19,732.29, Cholera vaccine live oral,90625,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,732.29,,,,,,,fee schedule,610.19,732.29, Tic-brn enceph vac 0.25ml im,90626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,636.15,,,,,,,fee schedule,636.15,763.45, Tic-brn enceph vac 0.25ml im,90626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,763.45,,,,,,,fee schedule,636.15,763.45, Tic-brn enceph vac 0.5ml im,90627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,636.15,,,,,,,fee schedule,636.15,763.45, Tic-brn enceph vac 0.5ml im,90627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,763.45,,,,,,,fee schedule,636.15,763.45, Hepa vaccine adult im,90632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.14,,,,,,,fee schedule,113.14,210.35, Hepa vaccine adult im,90632,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.14,,,,,,,fee schedule,113.14,210.35, Hepa vaccine adult im,90632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,175.27,,,,,,,fee schedule,113.14,210.35, Hepa vaccine adult im,90632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,210.35,,,,,,,fee schedule,113.14,210.35, Hepa vacc ped/adol 2 dose im,90633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.92,,,,,,,fee schedule,81.92,98.31, Hepa vacc ped/adol 2 dose im,90633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.31,,,,,,,fee schedule,81.92,98.31, Hep a/hep b vacc adult im,90636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.21,,,,,,,fee schedule,277.21,332.68, Hep a/hep b vacc adult im,90636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,332.68,,,,,,,fee schedule,277.21,332.68, Hib-mency vacc 6wk-18m0 im,90644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.73,,,,,,,fee schedule,51.73,62.09, Hib-mency vacc 6wk-18m0 im,90644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,62.09,,,,,,,fee schedule,51.73,62.09, Hib prp-omp vacc 3 dose im,90647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,65.88,,,,,,,fee schedule,65.88,79.07, Hib prp-omp vacc 3 dose im,90647,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.07,,,,,,,fee schedule,65.88,79.07, Hib prp-t vaccine 4 dose im,90648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.57,,,,,,,fee schedule,27.57,33.08, Hib prp-t vaccine 4 dose im,90648,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.08,,,,,,,fee schedule,27.57,33.08, 4vhpv vaccine 3 dose im,90649,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,335.28,,,,,,,fee schedule,335.28,402.37, 4vhpv vaccine 3 dose im,90649,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,402.37,,,,,,,fee schedule,335.28,402.37, 2vhpv vaccine 3 dose im,90650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,277.55,,,,,,,fee schedule,277.55,333.09, 2vhpv vaccine 3 dose im,90650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,333.09,,,,,,,fee schedule,277.55,333.09, 9vhpv vaccine 3 dose im,90651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,688.88,,,,,,,fee schedule,688.88,826.72, 9vhpv vaccine 3 dose im,90651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,826.72,,,,,,,fee schedule,688.88,826.72, Iiv adjuvant vaccine im,90653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.95,,,,,,,fee schedule,129.95,216.63, Iiv adjuvant vaccine im,90653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.95,,,,,,,fee schedule,129.95,216.63, Iiv adjuvant vaccine im,90653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.51,,,,,,,fee schedule,129.95,216.63, Iiv adjuvant vaccine im,90653,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,216.63,,,,,,,fee schedule,129.95,216.63, Iiv3 vacc no prsv 0.25 ml im,90655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.15,,,,,,,fee schedule,26.15,31.38, Iiv3 vacc no prsv 0.25 ml im,90655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,31.38,,,,,,,fee schedule,26.15,31.38, Iiv3 vacc no prsv 0.5 ml im,90656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.78,,,,,,,fee schedule,34.78,51.48, Iiv3 vacc no prsv 0.5 ml im,90656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.78,,,,,,,fee schedule,34.78,51.48, Iiv3 vacc no prsv 0.5 ml im,90656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.89,,,,,,,fee schedule,34.78,51.48, Iiv3 vacc no prsv 0.5 ml im,90656,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.48,,,,,,,fee schedule,34.78,51.48, Iiv3 vaccine splt 0.25 ml im,90657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.01,,,,,,,fee schedule,17.01,24.47, Iiv3 vaccine splt 0.25 ml im,90657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.01,,,,,,,fee schedule,17.01,24.47, Iiv3 vaccine splt 0.25 ml im,90657,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.39,,,,,,,fee schedule,17.01,24.47, Iiv3 vaccine splt 0.25 ml im,90657,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.47,,,,,,,fee schedule,17.01,24.47, Iiv3 vaccine splt 0.5 ml im,90658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.02,,,,,,,fee schedule,34.02,48.94, Iiv3 vaccine splt 0.5 ml im,90658,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.02,,,,,,,fee schedule,34.02,48.94, Iiv3 vaccine splt 0.5 ml im,90658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.78,,,,,,,fee schedule,34.02,48.94, Iiv3 vaccine splt 0.5 ml im,90658,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.94,,,,,,,fee schedule,34.02,48.94, Laiv3 vaccine intranasal,90660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.95,,,,,,,fee schedule,44.95,65.79, Laiv3 vaccine intranasal,90660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.95,,,,,,,fee schedule,44.95,65.79, Laiv3 vaccine intranasal,90660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.82,,,,,,,fee schedule,44.95,65.79, Laiv3 vaccine intranasal,90660,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.79,,,,,,,fee schedule,44.95,65.79, Cciiv3 vac no prsv 0.5 ml im,90661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.35,,,,,,,fee schedule,57.35,109.37, Cciiv3 vac no prsv 0.5 ml im,90661,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.35,,,,,,,fee schedule,57.35,109.37, Cciiv3 vac no prsv 0.5 ml im,90661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,91.13,,,,,,,fee schedule,57.35,109.37, Cciiv3 vac no prsv 0.5 ml im,90661,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.37,,,,,,,fee schedule,57.35,109.37, Iiv no prsv increased ag im,90662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.97,,,,,,,fee schedule,129.97,216.63, Iiv no prsv increased ag im,90662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.97,,,,,,,fee schedule,129.97,216.63, Iiv no prsv increased ag im,90662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.51,,,,,,,fee schedule,129.97,216.63, Iiv no prsv increased ag im,90662,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,216.63,,,,,,,fee schedule,129.97,216.63, Pcv13 vaccine im,90670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,401.59,,,,,,,fee schedule,401.59,568.82, Pcv13 vaccine im,90670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,401.59,,,,,,,fee schedule,401.59,568.82, Pcv13 vaccine im,90670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,473.98,,,,,,,fee schedule,401.59,568.82, Pcv13 vaccine im,90670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,568.82,,,,,,,fee schedule,401.59,568.82, Pcv15 vaccine im,90671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,406.49,,,,,,,fee schedule,406.49,604.47, Pcv15 vaccine im,90671,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,406.49,,,,,,,fee schedule,406.49,604.47, Pcv15 vaccine im,90671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,503.68,,,,,,,fee schedule,406.49,604.47, Pcv15 vaccine im,90671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,604.47,,,,,,,fee schedule,406.49,604.47, Laiv4 vaccine intranasal,90672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.29,,,,,,,fee schedule,51.29,61.55, Laiv4 vaccine intranasal,90672,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.55,,,,,,,fee schedule,51.29,61.55, Riv3 vaccine no preserv im,90673,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.97,,,,,,,fee schedule,129.97,216.63, Riv3 vaccine no preserv im,90673,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.97,,,,,,,fee schedule,129.97,216.63, Riv3 vaccine no preserv im,90673,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,180.51,,,,,,,fee schedule,129.97,216.63, Riv3 vaccine no preserv im,90673,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,216.63,,,,,,,fee schedule,129.97,216.63, Cciiv4 vac no prsv 0.5 ml im,90674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63,,,,,,,fee schedule,63,75.61, Cciiv4 vac no prsv 0.5 ml im,90674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75.61,,,,,,,fee schedule,63,75.61, Rabies vaccine im,90675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,485.71,,,,,,,fee schedule,315.22,1091.8, Rabies vaccine im,90675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,485.71,,,,,,,fee schedule,315.22,1091.8, Rabies vaccine im,90675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,909.75,,,,,,,fee schedule,315.22,1091.8, Rabies vaccine im,90675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1091.8,,,,,,,fee schedule,315.22,1091.8, Rabies vaccine im,90675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,327.83,,,,,,,fee schedule,315.22,1091.8,APC Rabies vaccine im,90675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,330.98,,,,,,,fee schedule,315.22,1091.8,APC Rabies vaccine im,90675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,315.22,,,,,,,fee schedule,315.22,1091.8,APC Pcv20 vaccine im,90677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,487.06,,,,,,,fee schedule,487.06,689.83, Pcv20 vaccine im,90677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,487.06,,,,,,,fee schedule,487.06,689.83, Pcv20 vaccine im,90677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,574.81,,,,,,,fee schedule,487.06,689.83, Pcv20 vaccine im,90677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,689.83,,,,,,,fee schedule,487.06,689.83, Rsv vacc pref bivalent im,90678,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,642.23,,,,,,,fee schedule,642.23,770.74, Rsv vacc pref bivalent im,90678,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,770.74,,,,,,,fee schedule,642.23,770.74, Rsv vacc pref recomb adjt im,90679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,641.27,,,,,,,fee schedule,641.27,769.6, Rsv vacc pref recomb adjt im,90679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,769.6,,,,,,,fee schedule,641.27,769.6, Rv5 vacc 3 dose live oral,90680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,215.07,,,,,,,fee schedule,215.07,258.1, Rv5 vacc 3 dose live oral,90680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,258.1,,,,,,,fee schedule,215.07,258.1, Rv1 vacc 2 dose live oral,90681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,307.75,,,,,,,fee schedule,307.75,369.33, Rv1 vacc 2 dose live oral,90681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,369.33,,,,,,,fee schedule,307.75,369.33, Riv4 vacc recombinant dna im,90682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,135.04,,,,,,,fee schedule,135.04,162.06, Riv4 vacc recombinant dna im,90682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,162.06,,,,,,,fee schedule,135.04,162.06, Rsv vacc mrna lipid nano im,90683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,607.05,,,,,,,fee schedule,607.05,728.53, Rsv vacc mrna lipid nano im,90683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,728.53,,,,,,,fee schedule,607.05,728.53, Pcv21 vaccine im,90684,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,510.39,,,,,,,fee schedule,510.39,758.92, Pcv21 vaccine im,90684,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,510.39,,,,,,,fee schedule,510.39,758.92, Pcv21 vaccine im,90684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,632.38,,,,,,,fee schedule,510.39,758.92, Pcv21 vaccine im,90684,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,758.92,,,,,,,fee schedule,510.39,758.92, Iiv4 vacc no prsv 0.25 ml im,90685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40,,,,,,,fee schedule,40,48, Iiv4 vacc no prsv 0.25 ml im,90685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48,,,,,,,fee schedule,40,48, Iiv4 vacc no prsv 0.5 ml im,90686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.3,,,,,,,fee schedule,41.3,49.57, Iiv4 vacc no prsv 0.5 ml im,90686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,49.57,,,,,,,fee schedule,41.3,49.57, Iiv4 vaccine splt 0.25 ml im,90687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.31,,,,,,,fee schedule,19.31,23.17, Iiv4 vaccine splt 0.25 ml im,90687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.17,,,,,,,fee schedule,19.31,23.17, Iiv4 vaccine splt 0.5 ml im,90688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.59,,,,,,,fee schedule,38.59,46.32, Iiv4 vaccine splt 0.5 ml im,90688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.32,,,,,,,fee schedule,38.59,46.32, Typhoid vaccine oral,90690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,245.49,,,,,,,fee schedule,245.49,294.62, Typhoid vaccine oral,90690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,294.62,,,,,,,fee schedule,245.49,294.62, Typhoid vaccine im,90691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,322.16,,,,,,,fee schedule,322.16,386.63, Typhoid vaccine im,90691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,386.63,,,,,,,fee schedule,322.16,386.63, Vacc aiiv4 no prsrv 0.5ml im,90694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,142.31,,,,,,,fee schedule,142.31,170.78, Vacc aiiv4 no prsrv 0.5ml im,90694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.78,,,,,,,fee schedule,142.31,170.78, Dtap-ipv vaccine 4-6 yrs im,90696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,131.5,,,,,,,fee schedule,131.5,157.82, Dtap-ipv vaccine 4-6 yrs im,90696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,157.82,,,,,,,fee schedule,131.5,157.82, Dtap-ipv-hib-hepb vaccine im,90697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,327.84,,,,,,,fee schedule,327.84,393.44, Dtap-ipv-hib-hepb vaccine im,90697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,393.44,,,,,,,fee schedule,327.84,393.44, Dtap-ipv/hib vaccine im,90698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,251.32,,,,,,,fee schedule,251.32,301.62, Dtap-ipv/hib vaccine im,90698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,301.62,,,,,,,fee schedule,251.32,301.62, Dtap vaccine < 7 yrs im,90700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.94,,,,,,,fee schedule,61.94,74.33, Dtap vaccine < 7 yrs im,90700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,74.33,,,,,,,fee schedule,61.94,74.33, Dt vaccine under 7 yrs im,90702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,138.34,,,,,,,fee schedule,138.34,166.03, Dt vaccine under 7 yrs im,90702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,166.03,,,,,,,fee schedule,138.34,166.03, Mmr vaccine sc,90707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,199.27,,,,,,,fee schedule,199.27,239.15, Mmr vaccine sc,90707,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,239.15,,,,,,,fee schedule,199.27,239.15, Mmrv vaccine sc,90710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,605.31,,,,,,,fee schedule,605.31,726.44, Mmrv vaccine sc,90710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,726.44,,,,,,,fee schedule,605.31,726.44, Poliovirus ipv sc/im,90713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,93.64,,,,,,,fee schedule,93.64,112.37, Poliovirus ipv sc/im,90713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,112.37,,,,,,,fee schedule,93.64,112.37, Td vacc no presv 7 yrs+ im,90714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.61,,,,,,,fee schedule,56.61,106.14, Td vacc no presv 7 yrs+ im,90714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.61,,,,,,,fee schedule,56.61,106.14, Td vacc no presv 7 yrs+ im,90714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.44,,,,,,,fee schedule,56.61,106.14, Td vacc no presv 7 yrs+ im,90714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,106.14,,,,,,,fee schedule,56.61,106.14, Tdap vaccine 7 yrs/> im,90715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.81,,,,,,,fee schedule,61.81,122.47, Tdap vaccine 7 yrs/> im,90715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.81,,,,,,,fee schedule,61.81,122.47, Tdap vaccine 7 yrs/> im,90715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,102.05,,,,,,,fee schedule,61.81,122.47, Tdap vaccine 7 yrs/> im,90715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,122.47,,,,,,,fee schedule,61.81,122.47, Var vaccine live subq,90716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,402.15,,,,,,,fee schedule,402.15,482.63, Var vaccine live subq,90716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,482.63,,,,,,,fee schedule,402.15,482.63, Yellow fever vaccine subq,90717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,492.26,,,,,,,fee schedule,492.26,590.76, Yellow fever vaccine subq,90717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,590.76,,,,,,,fee schedule,492.26,590.76, Dtap-hep b-ipv vaccine im,90723,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,216.9,,,,,,,fee schedule,216.9,260.3, Dtap-hep b-ipv vaccine im,90723,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,260.3,,,,,,,fee schedule,216.9,260.3, Ppsv23 vacc 2 yrs+ subq/im,90732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,207.77,,,,,,,fee schedule,207.77,294.12, Ppsv23 vacc 2 yrs+ subq/im,90732,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,207.77,,,,,,,fee schedule,207.77,294.12, Ppsv23 vacc 2 yrs+ subq/im,90732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,245.08,,,,,,,fee schedule,207.77,294.12, Ppsv23 vacc 2 yrs+ subq/im,90732,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,294.12,,,,,,,fee schedule,207.77,294.12, Mpsv4 vaccine subq,90733,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,257.83,,,,,,,fee schedule,257.83,309.42, Mpsv4 vaccine subq,90733,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,309.42,,,,,,,fee schedule,257.83,309.42, Mcv4 menacwy vaccine im,90734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,349.05,,,,,,,fee schedule,349.05,418.9, Mcv4 menacwy vaccine im,90734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,418.9,,,,,,,fee schedule,349.05,418.9, Hzv vaccine live subq,90736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,445.18,,,,,,,fee schedule,445.18,534.26, Hzv vaccine live subq,90736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,534.26,,,,,,,fee schedule,445.18,534.26, Inactivated je vacc im,90738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,617.69,,,,,,,fee schedule,617.69,741.29, Inactivated je vacc im,90738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,741.29,,,,,,,fee schedule,617.69,741.29, Hepb vacc 2 dose adult im,90739,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.38,,,,,,,fee schedule,276.38,391.27, Hepb vacc 2 dose adult im,90739,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,276.38,,,,,,,fee schedule,276.38,391.27, Hepb vacc 2 dose adult im,90739,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,326.03,,,,,,,fee schedule,276.38,391.27, Hepb vacc 2 dose adult im,90739,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,391.27,,,,,,,fee schedule,276.38,391.27, Hepb vacc 3 dose immunsup im,90740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,255.95,,,,,,,fee schedule,255.95,492.61, Hepb vacc 3 dose immunsup im,90740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,255.95,,,,,,,fee schedule,255.95,492.61, Hepb vacc 3 dose immunsup im,90740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,410.47,,,,,,,fee schedule,255.95,492.61, Hepb vacc 3 dose immunsup im,90740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,492.61,,,,,,,fee schedule,255.95,492.61, Hepb vacc 2 dose adolesc im,90743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.97,,,,,,,fee schedule,116.97,181.41, Hepb vacc 2 dose adolesc im,90743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.97,,,,,,,fee schedule,116.97,181.41, Hepb vacc 2 dose adolesc im,90743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,151.16,,,,,,,fee schedule,116.97,181.41, Hepb vacc 2 dose adolesc im,90743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,181.41,,,,,,,fee schedule,116.97,181.41, Hepb vacc 3 dose ped/adol im,90744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.3,,,,,,,fee schedule,49.3,73.48, Hepb vacc 3 dose ped/adol im,90744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.3,,,,,,,fee schedule,49.3,73.48, Hepb vacc 3 dose ped/adol im,90744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.23,,,,,,,fee schedule,49.3,73.48, Hepb vacc 3 dose ped/adol im,90744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.48,,,,,,,fee schedule,49.3,73.48, Hepb vaccine 3 dose adult im,90746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.54,,,,,,,fee schedule,109.54,181.41, Hepb vaccine 3 dose adult im,90746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.54,,,,,,,fee schedule,109.54,181.41, Hepb vaccine 3 dose adult im,90746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,151.16,,,,,,,fee schedule,109.54,181.41, Hepb vaccine 3 dose adult im,90746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,181.41,,,,,,,fee schedule,109.54,181.41, Hepb vacc 4 dose immunsup im,90747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,219.09,,,,,,,fee schedule,219.09,362.96, Hepb vacc 4 dose immunsup im,90747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,219.09,,,,,,,fee schedule,219.09,362.96, Hepb vacc 4 dose immunsup im,90747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,302.44,,,,,,,fee schedule,219.09,362.96, Hepb vacc 4 dose immunsup im,90747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,362.96,,,,,,,fee schedule,219.09,362.96, Hib-hepb vaccine im,90748,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.05,,,,,,,fee schedule,88.05,105.67, Hib-hepb vaccine im,90748,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.67,,,,,,,fee schedule,88.05,105.67, Hzv vacc recombinant im njx,90750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,451.12,,,,,,,fee schedule,451.12,541.39, Hzv vacc recombinant im njx,90750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,541.39,,,,,,,fee schedule,451.12,541.39, Cciiv4 vacc abx free im,90756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.7,,,,,,,fee schedule,59.7,71.64, Cciiv4 vacc abx free im,90756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.64,,,,,,,fee schedule,59.7,71.64, Hep b vac 3ag 10mcg 3 dos im,90759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.91,,,,,,,fee schedule,114.91,162.66, Hep b vac 3ag 10mcg 3 dos im,90759,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.91,,,,,,,fee schedule,114.91,162.66, Hep b vac 3ag 10mcg 3 dos im,90759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,135.54,,,,,,,fee schedule,114.91,162.66, Hep b vac 3ag 10mcg 3 dos im,90759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,162.66,,,,,,,fee schedule,114.91,162.66, Psytx complex interactive,90785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.65,,,,,,,fee schedule,415.65,475.98, Psytx complex interactive,90785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.98,,,,,,,fee schedule,415.65,475.98, Psytx w pt 30 minutes,90832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.65,,,,,,,fee schedule,209.68,475.98, Psytx w pt 30 minutes,90832,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.98,,,,,,,fee schedule,209.68,475.98, Psytx w pt 30 minutes,90832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,218.07,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt 30 minutes,90832,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,220.17,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt 30 minutes,90832,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.68,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt w e/m 30 min,90833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.65,,,,,,,fee schedule,415.65,475.98, Psytx w pt w e/m 30 min,90833,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.98,,,,,,,fee schedule,415.65,475.98, Psytx w pt 45 minutes,90834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.65,,,,,,,fee schedule,209.68,475.98, Psytx w pt 45 minutes,90834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.98,,,,,,,fee schedule,209.68,475.98, Psytx w pt 45 minutes,90834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,218.07,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt 45 minutes,90834,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,220.17,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt 45 minutes,90834,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.68,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt w e/m 45 min,90836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.65,,,,,,,fee schedule,415.65,475.98, Psytx w pt w e/m 45 min,90836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.98,,,,,,,fee schedule,415.65,475.98, Psytx w pt 60 minutes,90837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.65,,,,,,,fee schedule,209.68,475.98, Psytx w pt 60 minutes,90837,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.98,,,,,,,fee schedule,209.68,475.98, Psytx w pt 60 minutes,90837,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,218.07,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt 60 minutes,90837,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,220.17,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt 60 minutes,90837,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.68,,,,,,,fee schedule,209.68,475.98,APC Psytx w pt w e/m 60 min,90838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.65,,,,,,,fee schedule,415.65,475.98, Psytx w pt w e/m 60 min,90838,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.98,,,,,,,fee schedule,415.65,475.98, Tcranial magn stim tx plan,90867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Tcranial magn stim tx plan,90867,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Tcranial magn stim tx plan,90867,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Tcranial magn stim tx deli,90868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Tcranial magn stim tx deli,90868,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Tcranial magn stim tx deli,90868,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Tcran magn stim redetemine,90869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Tcran magn stim redetemine,90869,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Tcran magn stim redetemine,90869,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Electroconvulsive therapy,90870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1087.85,,,,,,,fee schedule,1014.47,1245.77, Electroconvulsive therapy,90870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1245.77,,,,,,,fee schedule,1014.47,1245.77, Electroconvulsive therapy,90870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1245.77,APC Electroconvulsive therapy,90870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1245.77,APC Electroconvulsive therapy,90870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1245.77,APC Psychiatric service/therapy,90899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,165.17,,,,,,,fee schedule,44.26,189.14, Psychiatric service/therapy,90899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,189.14,,,,,,,fee schedule,44.26,189.14, Psychiatric service/therapy,90899,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.03,,,,,,,fee schedule,44.26,189.14,APC Psychiatric service/therapy,90899,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.48,,,,,,,fee schedule,44.26,189.14,APC Psychiatric service/therapy,90899,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.26,,,,,,,fee schedule,44.26,189.14,APC Bfb training 1st 15 min,90912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.84,,,,,,,fee schedule,40.23,42.24,APC Bfb training 1st 15 min,90912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.24,,,,,,,fee schedule,40.23,42.24,APC Bfb training 1st 15 min,90912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.23,,,,,,,fee schedule,40.23,42.24,APC Bfb training ea addl 15 min,90913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.56,,,,,,,fee schedule,22.65,23.78,APC Bfb training ea addl 15 min,90913,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.78,,,,,,,fee schedule,22.65,23.78,APC Bfb training ea addl 15 min,90913,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.65,,,,,,,fee schedule,22.65,23.78,APC Hemodialysis one evaluation,90935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.14,,,,,,,fee schedule,181.14,851.31, Hemodialysis one evaluation,90935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,207.43,,,,,,,fee schedule,181.14,851.31, Hemodialysis one evaluation,90935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,843.21,,,,,,,fee schedule,181.14,851.31,APC Hemodialysis one evaluation,90935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,851.31,,,,,,,fee schedule,181.14,851.31,APC Hemodialysis one evaluation,90935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,810.77,,,,,,,fee schedule,181.14,851.31,APC Dialysis one evaluation,90945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,187.84,,,,,,,fee schedule,187.84,517.58, Dialysis one evaluation,90945,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,215.1,,,,,,,fee schedule,187.84,517.58, Dialysis one evaluation,90945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,512.65,,,,,,,fee schedule,187.84,517.58,APC Dialysis one evaluation,90945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,517.58,,,,,,,fee schedule,187.84,517.58,APC Dialysis one evaluation,90945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,492.93,,,,,,,fee schedule,187.84,517.58,APC Esophagus motility study,91010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,440.83,1866, Esophagus motility study,91010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,440.83,1866, Esophagus motility study,91010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,634.36,,,,,,,fee schedule,440.83,1866, Esophagus motility study,91010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,726.44,,,,,,,fee schedule,440.83,1866, Esophagus motility study,91010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,1866,APC Esophagus motility study,91010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,1866,APC Esophagus motility study,91010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,1866,APC Esophgl motil w/stim/perfus,91013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,808.95,,,,,,,fee schedule,808.95,926.38, Esophgl motil w/stim/perfus,91013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,926.38,,,,,,,fee schedule,808.95,926.38, Gastric motility studies,91020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,440.83,1866, Gastric motility studies,91020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,440.83,1866, Gastric motility studies,91020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,666.45,,,,,,,fee schedule,440.83,1866, Gastric motility studies,91020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,763.19,,,,,,,fee schedule,440.83,1866, Gastric motility studies,91020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,1866,APC Gastric motility studies,91020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,1866,APC Gastric motility studies,91020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,1866,APC Duodenal motility study,91022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,440.83,1866, Duodenal motility study,91022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,440.83,1866, Duodenal motility study,91022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,534.69,,,,,,,fee schedule,440.83,1866, Duodenal motility study,91022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,612.3,,,,,,,fee schedule,440.83,1866, Duodenal motility study,91022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,1866,APC Duodenal motility study,91022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,1866,APC Duodenal motility study,91022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,1866,APC Acid perfusion of esophagus,91030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,370.83,,,,,,,fee schedule,370.83,462.87, Acid perfusion of esophagus,91030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,424.67,,,,,,,fee schedule,370.83,462.87, Acid perfusion of esophagus,91030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,370.83,462.87,APC Acid perfusion of esophagus,91030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,370.83,462.87,APC Acid perfusion of esophagus,91030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,370.83,462.87,APC Gastroesophageal reflux test,91034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,701,,,,,,,fee schedule,440.83,802.75, Gastroesophageal reflux test,91034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,802.75,,,,,,,fee schedule,440.83,802.75, Gastroesophageal reflux test,91034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,802.75,APC Gastroesophageal reflux test,91034,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,802.75,APC Gastroesophageal reflux test,91034,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,802.75,APC G-esoph reflx tst w/electrod,91035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1393.39,,,,,,,fee schedule,1014.47,1595.65, G-esoph reflx tst w/electrod,91035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1595.65,,,,,,,fee schedule,1014.47,1595.65, G-esoph reflx tst w/electrod,91035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1595.65,APC G-esoph reflx tst w/electrod,91035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1595.65,APC G-esoph reflx tst w/electrod,91035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1595.65,APC Esoph imped function test,91037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,438.74,,,,,,,fee schedule,255.08,502.42, Esoph imped function test,91037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,502.42,,,,,,,fee schedule,255.08,502.42, Esoph imped function test,91037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,502.42,APC Esoph imped function test,91037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,502.42,APC Esoph imped function test,91037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,502.42,APC Esoph imped funct test > 1hr,91038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,370.93,,,,,,,fee schedule,370.93,462.87, Esoph imped funct test > 1hr,91038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,424.78,,,,,,,fee schedule,370.93,462.87, Esoph imped funct test > 1hr,91038,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,370.93,462.87,APC Esoph imped funct test > 1hr,91038,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,370.93,462.87,APC Esoph imped funct test > 1hr,91038,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,370.93,462.87,APC Esoph balloon distension tst,91040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1369.73,,,,,,,fee schedule,440.83,1568.56, Esoph balloon distension tst,91040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1568.56,,,,,,,fee schedule,440.83,1568.56, Esoph balloon distension tst,91040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,1568.56,APC Esoph balloon distension tst,91040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,1568.56,APC Esoph balloon distension tst,91040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,1568.56,APC Breath hydrogen/methane test,91065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,188.08,,,,,,,fee schedule,188.08,267.83, Breath hydrogen/methane test,91065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,215.39,,,,,,,fee schedule,188.08,267.83, Breath hydrogen/methane test,91065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,188.08,267.83,APC Breath hydrogen/methane test,91065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,188.08,267.83,APC Breath hydrogen/methane test,91065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,188.08,267.83,APC Gi tract capsule endoscopy,91110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2891.01,,,,,,,fee schedule,1071.46,3310.67, Gi tract capsule endoscopy,91110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3310.67,,,,,,,fee schedule,1071.46,3310.67, Gi tract capsule endoscopy,91110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,3310.67,APC Gi tract capsule endoscopy,91110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,3310.67,APC Gi tract capsule endoscopy,91110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,3310.67,APC Esophageal Capsule Endoscopy,91111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2050.54,,,,,,,fee schedule,1071.46,2348.2, Esophageal Capsule Endoscopy,91111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2348.2,,,,,,,fee schedule,1071.46,2348.2, Esophageal Capsule Endoscopy,91111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,1071.46,2348.2,APC Esophageal Capsule Endoscopy,91111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,1071.46,2348.2,APC Esophageal Capsule Endoscopy,91111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,1071.46,2348.2,APC Gi wireless capsule measure,91112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,750.45,,,,,,,fee schedule,750.45,1125.04, Gi wireless capsule measure,91112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,859.38,,,,,,,fee schedule,750.45,1125.04, Gi wireless capsule measure,91112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1114.32,,,,,,,fee schedule,750.45,1125.04,APC Gi wireless capsule measure,91112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1125.04,,,,,,,fee schedule,750.45,1125.04,APC Gi wireless capsule measure,91112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1071.46,,,,,,,fee schedule,750.45,1125.04,APC Gi trc img intral colon i&r,91113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,1153.53,APC Gi trc img intral colon i&r,91113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,1153.53,APC Gi trc img intral colon i&r,91113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,1153.53,APC Colon motility 6 hr study,91117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Colon motility 6 hr study,91117,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Colon motility 6 hr study,91117,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Rectal sensation test,91120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1351.82,,,,,,,fee schedule,1351.82,1548.06, Rectal sensation test,91120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1548.06,,,,,,,fee schedule,1351.82,1548.06, Anal pressure record,91122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,770.93,,,,,,,fee schedule,770.93,882.84, Anal pressure record,91122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,882.84,,,,,,,fee schedule,770.93,882.84, Rct snsatn tone&cmplianc std,91124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,255.08,1866, Rct snsatn tone&cmplianc std,91124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,255.08,1866, Rct snsatn tone&cmplianc std,91124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,1866,APC Rct snsatn tone&cmplianc std,91124,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,1866,APC Rct snsatn tone&cmplianc std,91124,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,1866,APC Anrct mano rct snsatn&balo,91125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,440.83,1866, Anrct mano rct snsatn&balo,91125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,440.83,1866, Anrct mano rct snsatn&balo,91125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,1866,APC Anrct mano rct snsatn&balo,91125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,1866,APC Anrct mano rct snsatn&balo,91125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,1866,APC Electrogastrography,91132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,654.7,,,,,,,fee schedule,255.08,749.73, Electrogastrography,91132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,749.73,,,,,,,fee schedule,255.08,749.73, Electrogastrography,91132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,749.73,APC Electrogastrography,91132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,749.73,APC Electrogastrography,91132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,749.73,APC Electrogastrography W/Test,91133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,654.7,,,,,,,fee schedule,157.18,749.73, Electrogastrography W/Test,91133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,749.73,,,,,,,fee schedule,157.18,749.73, Electrogastrography W/Test,91133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,749.73,APC Electrogastrography W/Test,91133,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,749.73,APC Electrogastrography W/Test,91133,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,749.73,APC Liver elastography,91200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Liver elastography,91200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Liver elastography,91200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Gastroenterology procedure,91299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,429.34,,,,,,,fee schedule,152.01,491.66, Gastroenterology procedure,91299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,491.66,,,,,,,fee schedule,152.01,491.66, Gastroenterology procedure,91299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,491.66,APC Gastroenterology procedure,91299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,491.66,APC Gastroenterology procedure,91299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,491.66,APC Coronavirus vaccine 5,91304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,251.44,,,,,,,fee schedule,251.44,422.92, Coronavirus vaccine 5,91304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,251.44,,,,,,,fee schedule,251.44,422.92, Coronavirus vaccine 5,91304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,352.4,,,,,,,fee schedule,251.44,422.92, Coronavirus vaccine 5,91304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,422.92,,,,,,,fee schedule,251.44,422.92, Sarscov2 vac 3mcg trs-suc im,91318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.04,,,,,,,fee schedule,102.04,144.45, Sarscov2 vac 3mcg trs-suc im,91318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.04,,,,,,,fee schedule,102.04,144.45, Sarscov2 vac 3mcg trs-suc im,91318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,120.36,,,,,,,fee schedule,102.04,144.45, Sarscov2 vac 3mcg trs-suc im,91318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,144.45,,,,,,,fee schedule,102.04,144.45, Sarscv2 vac 10mcg trs-suc im,91319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,136.64,,,,,,,fee schedule,136.64,208.91, Sarscv2 vac 10mcg trs-suc im,91319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,136.64,,,,,,,fee schedule,136.64,208.91, Sarscv2 vac 10mcg trs-suc im,91319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,174.08,,,,,,,fee schedule,136.64,208.91, Sarscv2 vac 10mcg trs-suc im,91319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,208.91,,,,,,,fee schedule,136.64,208.91, Sarscv2 vac 30mcg trs-suc im,91320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,242.67,,,,,,,fee schedule,242.67,371.01, Sarscv2 vac 30mcg trs-suc im,91320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,242.67,,,,,,,fee schedule,242.67,371.01, Sarscv2 vac 30mcg trs-suc im,91320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,309.15,,,,,,,fee schedule,242.67,371.01, Sarscv2 vac 30mcg trs-suc im,91320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,371.01,,,,,,,fee schedule,242.67,371.01, Sarscov2 vac 25 mcg/.25ml im,91321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,228.92,,,,,,,fee schedule,228.92,324.07, Sarscov2 vac 25 mcg/.25ml im,91321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,228.92,,,,,,,fee schedule,228.92,324.07, Sarscov2 vac 25 mcg/.25ml im,91321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,270.03,,,,,,,fee schedule,228.92,324.07, Sarscov2 vac 25 mcg/.25ml im,91321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,324.07,,,,,,,fee schedule,228.92,324.07, Sarscov2 vac 50 mcg/0.5ml im,91322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,251.63,,,,,,,fee schedule,251.63,356.23, Sarscov2 vac 50 mcg/0.5ml im,91322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,251.63,,,,,,,fee schedule,251.63,356.23, Sarscov2 vac 50 mcg/0.5ml im,91322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,296.83,,,,,,,fee schedule,251.63,356.23, Sarscov2 vac 50 mcg/0.5ml im,91322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,356.23,,,,,,,fee schedule,251.63,356.23, Sarscov2 vac 10 mcg/0.2ml im,91323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,370.75,,,,,,,fee schedule,370.75,444.94, Sarscov2 vac 10 mcg/0.2ml im,91323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,444.94,,,,,,,fee schedule,370.75,444.94, Eye exam new patient,92002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.88,,,,,,,fee schedule,157.28,343.41, Eye exam new patient,92002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,343.41,,,,,,,fee schedule,157.28,343.41, Eye exam new patient,92002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,343.41,APC Eye exam new patient,92002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,343.41,APC Eye exam new patient,92002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,343.41,APC Eye exam new patient,92004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,242.77,,,,,,,fee schedule,157.28,278.01, Eye exam new patient,92004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,278.01,,,,,,,fee schedule,157.28,278.01, Eye exam new patient,92004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,278.01,APC Eye exam new patient,92004,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,278.01,APC Eye exam new patient,92004,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,278.01,APC Eye exam establish patient,92012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.95,,,,,,,fee schedule,123.95,165.14, Eye exam establish patient,92012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.94,,,,,,,fee schedule,123.95,165.14, Eye exam establish patient,92012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,123.95,165.14,APC Eye exam establish patient,92012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,123.95,165.14,APC Eye exam establish patient,92012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,123.95,165.14,APC Eye exam&tx estab pt 1/>vst,92014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,190.22,,,,,,,fee schedule,157.28,217.83, Eye exam&tx estab pt 1/>vst,92014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,217.83,,,,,,,fee schedule,157.28,217.83, Eye exam&tx estab pt 1/>vst,92014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,217.83,APC Eye exam&tx estab pt 1/>vst,92014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,217.83,APC Eye exam&tx estab pt 1/>vst,92014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,217.83,APC New eye exam & treatment,92018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,346.26,,,,,,,fee schedule,346.26,2949.06, New eye exam & treatment,92018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,396.52,,,,,,,fee schedule,346.26,2949.06, New eye exam & treatment,92018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,346.26,2949.06,APC New eye exam & treatment,92018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,346.26,2949.06,APC New eye exam & treatment,92018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,346.26,2949.06,APC Eye exam & treatment,92019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,171.19,,,,,,,fee schedule,171.19,2949.06, Eye exam & treatment,92019,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,196.05,,,,,,,fee schedule,171.19,2949.06, Eye exam & treatment,92019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2920.97,,,,,,,fee schedule,171.19,2949.06,APC Eye exam & treatment,92019,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2949.06,,,,,,,fee schedule,171.19,2949.06,APC Eye exam & treatment,92019,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2808.63,,,,,,,fee schedule,171.19,2949.06,APC Special eye evaluation,92020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.96,,,,,,,fee schedule,75.96,165.03, Special eye evaluation,92020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.99,,,,,,,fee schedule,75.96,165.03, Special eye evaluation,92020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,75.96,165.03,APC Special eye evaluation,92020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,75.96,165.03,APC Special eye evaluation,92020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,75.96,165.03,APC Corneal Topography,92025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.02,,,,,,,fee schedule,69.69,100.79, Corneal Topography,92025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.79,,,,,,,fee schedule,69.69,100.79, Corneal Topography,92025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,100.79,APC Corneal Topography,92025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,100.79,APC Corneal Topography,92025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,100.79,APC Special eye evaluation,92060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.51,,,,,,,fee schedule,69.69,175.8, Special eye evaluation,92060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,175.8,,,,,,,fee schedule,69.69,175.8, Special eye evaluation,92060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,175.8,APC Special eye evaluation,92060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,175.8,APC Special eye evaluation,92060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,175.8,APC Orthoptic/pleoptic training,92065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,98.38,,,,,,,fee schedule,98.38,112.66, Orthoptic/pleoptic training,92065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,112.66,,,,,,,fee schedule,98.38,112.66, Orthop traing supvj phys/qhp,92066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.66,,,,,,,fee schedule,69.69,87.78, Orthop traing supvj phys/qhp,92066,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.78,,,,,,,fee schedule,69.69,87.78, Orthop traing supvj phys/qhp,92066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,87.78,APC Orthop traing supvj phys/qhp,92066,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,87.78,APC Orthop traing supvj phys/qhp,92066,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,87.78,APC Visual field examination(s),92081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,143.96,,,,,,,fee schedule,69.69,164.86, Visual field examination(s),92081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,164.86,,,,,,,fee schedule,69.69,164.86, Visual field examination(s),92081,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,164.86,APC Visual field examination(s),92081,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,164.86,APC Visual field examination(s),92081,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,164.86,APC Visual field examination(s),92082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,184.76,,,,,,,fee schedule,69.69,211.58, Visual field examination(s),92082,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,211.58,,,,,,,fee schedule,69.69,211.58, Visual field examination(s),92082,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,211.58,APC Visual field examination(s),92082,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,211.58,APC Visual field examination(s),92082,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,211.58,APC Visual field examination(s),92083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,213.38,,,,,,,fee schedule,157.18,244.35, Visual field examination(s),92083,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,244.35,,,,,,,fee schedule,157.18,244.35, Visual field examination(s),92083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,244.35,APC Visual field examination(s),92083,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,244.35,APC Visual field examination(s),92083,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,244.35,APC Serial tonometry exam(s),92100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,245.72,,,,,,,fee schedule,245.72,281.39, Serial tonometry exam(s),92100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,281.39,,,,,,,fee schedule,245.72,281.39, Cmptr ophth dx img ant segmt,92132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Cmptr ophth dx img ant segmt,92132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Cmptr ophth dx img ant segmt,92132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Cmptr ophth img optic nerve,92133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.93,,,,,,,fee schedule,69.69,144.22, Cmptr ophth img optic nerve,92133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,144.22,,,,,,,fee schedule,69.69,144.22, Cmptr ophth img optic nerve,92133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,144.22,APC Cmptr ophth img optic nerve,92133,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,144.22,APC Cmptr ophth img optic nerve,92133,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,144.22,APC Cptr ophth dx img post segmt,92134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.93,,,,,,,fee schedule,69.69,144.22, Cptr ophth dx img post segmt,92134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,144.22,,,,,,,fee schedule,69.69,144.22, Cptr ophth dx img post segmt,92134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,144.22,APC Cptr ophth dx img post segmt,92134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,144.22,APC Cptr ophth dx img post segmt,92134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,144.22,APC Ophthalmic biometry,92136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,247.53,,,,,,,fee schedule,157.18,283.46, Ophthalmic biometry,92136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,283.46,,,,,,,fee schedule,157.18,283.46, Ophthalmic biometry,92136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,283.46,APC Ophthalmic biometry,92136,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,283.46,APC Ophthalmic biometry,92136,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,283.46,APC Cptrz oph img pst sg rta oct,92137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Cptrz oph img pst sg rta oct,92137,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Cptrz oph img pst sg rta oct,92137,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Corneal hysteresis deter,92145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Corneal hysteresis deter,92145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Corneal hysteresis deter,92145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Opscpy extnd rta draw uni/bi,92201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.31,,,,,,,fee schedule,63.31,73.17, Opscpy extnd rta draw uni/bi,92201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.51,,,,,,,fee schedule,63.31,73.17, Opscpy extnd rta draw uni/bi,92201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,63.31,73.17,APC Opscpy extnd rta draw uni/bi,92201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,63.31,73.17,APC Opscpy extnd rta draw uni/bi,92201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,63.31,73.17,APC Opscpy extnd on/mac draw,92202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.31,,,,,,,fee schedule,63.31,73.17, Opscpy extnd on/mac draw,92202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.51,,,,,,,fee schedule,63.31,73.17, Opscpy extnd on/mac draw,92202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,63.31,73.17,APC Opscpy extnd on/mac draw,92202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,63.31,73.17,APC Opscpy extnd on/mac draw,92202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,63.31,73.17,APC Remote dx retinal imaging,92227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Remote dx retinal imaging,92227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Remote dx retinal imaging,92227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Remote retinal imaging mgmt,92228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Remote retinal imaging mgmt,92228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Remote retinal imaging mgmt,92228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Img rta detc/mntr ds poc aly,92229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.04,,,,,,,fee schedule,69.69,495.43, Img rta detc/mntr ds poc aly,92229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,158.07,,,,,,,fee schedule,69.69,495.43, Img rta detc/mntr ds poc aly,92229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,412.85,,,,,,,fee schedule,69.69,495.43, Img rta detc/mntr ds poc aly,92229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,495.43,,,,,,,fee schedule,69.69,495.43, Img rta detc/mntr ds poc aly,92229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,495.43,APC Img rta detc/mntr ds poc aly,92229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,495.43,APC Img rta detc/mntr ds poc aly,92229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,495.43,APC Eye exam with photos,92230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,234.61,,,,,,,fee schedule,234.61,462.87, Eye exam with photos,92230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.66,,,,,,,fee schedule,234.61,462.87, Eye exam with photos,92230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,234.61,462.87,APC Eye exam with photos,92230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,234.61,462.87,APC Eye exam with photos,92230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,234.61,462.87,APC Fluorescein angrph uni/bi,92235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,383.14,,,,,,,fee schedule,255.08,438.75, Fluorescein angrph uni/bi,92235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,438.75,,,,,,,fee schedule,255.08,438.75, Fluorescein angrph uni/bi,92235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,438.75,APC Fluorescein angrph uni/bi,92235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,438.75,APC Fluorescein angrph uni/bi,92235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,438.75,APC Icg angiography uni/bi,92240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,808.85,,,,,,,fee schedule,255.08,926.27, Icg angiography uni/bi,92240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,926.27,,,,,,,fee schedule,255.08,926.27, Icg angiography uni/bi,92240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,926.27,APC Icg angiography uni/bi,92240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,926.27,APC Icg angiography uni/bi,92240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,926.27,APC Fluorescein icg angiography,92242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Fluorescein icg angiography,92242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Fluorescein icg angiography,92242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Eye exam with photos,92250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,218.84,,,,,,,fee schedule,157.18,250.6, Eye exam with photos,92250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,250.6,,,,,,,fee schedule,157.18,250.6, Eye exam with photos,92250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,250.6,APC Eye exam with photos,92250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,250.6,APC Eye exam with photos,92250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,250.6,APC Ophthalmoscopy/dynamometry,92260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.1,,,,,,,fee schedule,44.12,57.37, Ophthalmoscopy/dynamometry,92260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.37,,,,,,,fee schedule,44.12,57.37, Ophthalmoscopy/dynamometry,92260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,57.37,APC Ophthalmoscopy/dynamometry,92260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,57.37,APC Ophthalmoscopy/dynamometry,92260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,57.37,APC Eye muscle evaluation,92265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,254.25,,,,,,,fee schedule,69.69,291.16, Eye muscle evaluation,92265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,291.16,,,,,,,fee schedule,69.69,291.16, Eye muscle evaluation,92265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,291.16,APC Eye muscle evaluation,92265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,291.16,APC Eye muscle evaluation,92265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,291.16,APC Electro-oculography,92270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,257.92,,,,,,,fee schedule,157.18,295.36, Electro-oculography,92270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,295.36,,,,,,,fee schedule,157.18,295.36, Electro-oculography,92270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,295.36,APC Electro-oculography,92270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,295.36,APC Electro-oculography,92270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,295.36,APC Full field erg w/i&r,92273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,324.19,,,,,,,fee schedule,255.08,371.24, Full field erg w/i&r,92273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,371.24,,,,,,,fee schedule,255.08,371.24, Full field erg w/i&r,92273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,371.24,APC Full field erg w/i&r,92273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,371.24,APC Full field erg w/i&r,92273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,371.24,APC Multifocal erg w/i&r,92274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,324.19,,,,,,,fee schedule,152.01,371.24, Multifocal erg w/i&r,92274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,371.24,,,,,,,fee schedule,152.01,371.24, Multifocal erg w/i&r,92274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,371.24,APC Multifocal erg w/i&r,92274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,371.24,APC Multifocal erg w/i&r,92274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,371.24,APC Color vision examination,92283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.88,,,,,,,fee schedule,69.69,130.41, Color vision examination,92283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.41,,,,,,,fee schedule,69.69,130.41, Color vision examination,92283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,130.41,APC Color vision examination,92283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,130.41,APC Color vision examination,92283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,130.41,APC Dark adaptation eye exam,92284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,238.85,,,,,,,fee schedule,238.85,554.12, Dark adaptation eye exam,92284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,273.52,,,,,,,fee schedule,238.85,554.12, Dark adaptation eye exam,92284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,238.85,554.12,APC Dark adaptation eye exam,92284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,238.85,554.12,APC Dark adaptation eye exam,92284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,238.85,554.12,APC Eye photography,92285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,133.87,,,,,,,fee schedule,44.12,153.3, Eye photography,92285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,153.3,,,,,,,fee schedule,44.12,153.3, Eye photography,92285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,153.3,APC Eye photography,92285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,153.3,APC Eye photography,92285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,153.3,APC Internal eye photography,92286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,414.83,,,,,,,fee schedule,157.18,475.05, Internal eye photography,92286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.05,,,,,,,fee schedule,157.18,475.05, Internal eye photography,92286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,475.05,APC Internal eye photography,92286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,475.05,APC Internal eye photography,92286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,475.05,APC Internal eye photography,92287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,351.81,,,,,,,fee schedule,157.18,402.88, Internal eye photography,92287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,402.88,,,,,,,fee schedule,157.18,402.88, Internal eye photography,92287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,402.88,APC Internal eye photography,92287,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,402.88,APC Internal eye photography,92287,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,402.88,APC Contact lens fitting,92312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Contact lens fitting,92312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Contact lens fitting,92312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Contact lens fitting,92313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Contact lens fitting,92313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Contact lens fitting,92313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Rx cntact lens aphakia 1 eye,92315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Rx cntact lens aphakia 1 eye,92315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Rx cntact lens aphakia 1 eye,92315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Rx cntact lens aphakia 2 eye,92316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Rx cntact lens aphakia 2 eye,92316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Rx cntact lens aphakia 2 eye,92316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Rx corneoscleral cntact lens,92317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Rx corneoscleral cntact lens,92317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Rx corneoscleral cntact lens,92317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Modification of contact lens,92325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Modification of contact lens,92325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Modification of contact lens,92325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Replacement of contact lens,92326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Replacement of contact lens,92326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Replacement of contact lens,92326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Fit aphakia spectcl monofocl,92352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Fit aphakia spectcl monofocl,92352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Fit aphakia spectcl monofocl,92352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Fit aphakia spectcl multifoc,92353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Fit aphakia spectcl multifoc,92353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Fit aphakia spectcl multifoc,92353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Fit spectacles single system,92354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Fit spectacles single system,92354,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Fit spectacles single system,92354,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Fit spectacles compound lens,92355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Fit spectacles compound lens,92355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Fit spectacles compound lens,92355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Aphakia prosth service temp,92358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Aphakia prosth service temp,92358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Aphakia prosth service temp,92358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Repair & adjust spectacles,92371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Repair & adjust spectacles,92371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Repair & adjust spectacles,92371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Eye service or procedure,92499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.88,,,,,,,fee schedule,34.17,55.98, Eye service or procedure,92499,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.98,,,,,,,fee schedule,34.17,55.98, Eye service or procedure,92499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,55.98,APC Eye service or procedure,92499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,55.98,APC Eye service or procedure,92499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,55.98,APC Ear and throat examination,92502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,279.25,,,,,,,fee schedule,279.25,668.99, Ear and throat examination,92502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,319.78,,,,,,,fee schedule,279.25,668.99, Ear and throat examination,92502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,662.62,,,,,,,fee schedule,279.25,668.99,APC Ear and throat examination,92502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,668.99,,,,,,,fee schedule,279.25,668.99,APC Ear and throat examination,92502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,637.13,,,,,,,fee schedule,279.25,668.99,APC Ear microscopy examination,92504,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.39,,,,,,,fee schedule,75.39,86.34, Ear microscopy examination,92504,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.34,,,,,,,fee schedule,75.39,86.34, Speech/hearing therapy,92507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,209.58,,,,,,,fee schedule,84.3,233.1, Speech/hearing therapy,92507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,233.1,,,,,,,fee schedule,84.3,233.1, Speech/hearing therapy,92507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,87.67,,,,,,,fee schedule,84.3,233.1,APC Speech/hearing therapy,92507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,88.52,,,,,,,fee schedule,84.3,233.1,APC Speech/hearing therapy,92507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,84.3,,,,,,,fee schedule,84.3,233.1,APC Speech/hearing therapy,92508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,124.75,,,,,,,fee schedule,26.94,138.75, Speech/hearing therapy,92508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.75,,,,,,,fee schedule,26.94,138.75, Speech/hearing therapy,92508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.02,,,,,,,fee schedule,26.94,138.75,APC Speech/hearing therapy,92508,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.29,,,,,,,fee schedule,26.94,138.75,APC Speech/hearing therapy,92508,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.94,,,,,,,fee schedule,26.94,138.75,APC Nasopharyngoscopy,92511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,235.8,1866, Nasopharyngoscopy,92511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,235.8,1866, Nasopharyngoscopy,92511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,461.23,,,,,,,fee schedule,235.8,1866, Nasopharyngoscopy,92511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,528.18,,,,,,,fee schedule,235.8,1866, Nasopharyngoscopy,92511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.24,,,,,,,fee schedule,235.8,1866,APC Nasopharyngoscopy,92511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,247.59,,,,,,,fee schedule,235.8,1866,APC Nasopharyngoscopy,92511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,235.8,,,,,,,fee schedule,235.8,1866,APC Nasal function studies,92512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.4,,,,,,,fee schedule,185.4,267.83, Nasal function studies,92512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.32,,,,,,,fee schedule,185.4,267.83, Nasal function studies,92512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,185.4,267.83,APC Nasal function studies,92512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,185.4,267.83,APC Nasal function studies,92512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,185.4,267.83,APC Facial nerve function test,92516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,179.5,,,,,,,fee schedule,179.5,267.83, Facial nerve function test,92516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,205.56,,,,,,,fee schedule,179.5,267.83, Facial nerve function test,92516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,179.5,267.83,APC Facial nerve function test,92516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,179.5,267.83,APC Facial nerve function test,92516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,179.5,267.83,APC Vemp test i&r cervical,92517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,346.08,,,,,,,fee schedule,152.01,396.32, Vemp test i&r cervical,92517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,396.32,,,,,,,fee schedule,152.01,396.32, Vemp test i&r cervical,92517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,396.32,APC Vemp test i&r cervical,92517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,396.32,APC Vemp test i&r cervical,92517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,396.32,APC Vemp test i&r ocular,92518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,346.08,,,,,,,fee schedule,152.01,396.32, Vemp test i&r ocular,92518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,396.32,,,,,,,fee schedule,152.01,396.32, Vemp test i&r ocular,92518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,396.32,APC Vemp test i&r ocular,92518,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,396.32,APC Vemp test i&r ocular,92518,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,396.32,APC Vemp tst i&r cervical&ocular,92519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,655.84,,,,,,,fee schedule,255.08,751.04, Vemp tst i&r cervical&ocular,92519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,751.04,,,,,,,fee schedule,255.08,751.04, Vemp tst i&r cervical&ocular,92519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,751.04,APC Vemp tst i&r cervical&ocular,92519,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,751.04,APC Vemp tst i&r cervical&ocular,92519,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,751.04,APC Laryngeal function studies,92520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,135.43,,,,,,,fee schedule,135.43,165.03, Laryngeal function studies,92520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,155.09,,,,,,,fee schedule,135.43,165.03, Laryngeal function studies,92520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,135.43,165.03,APC Laryngeal function studies,92520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,135.43,165.03,APC Laryngeal function studies,92520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,135.43,165.03,APC Evaluation of speech fluency,92521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,354.29,,,,,,,fee schedule,147.69,394.05, Evaluation of speech fluency,92521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,394.05,,,,,,,fee schedule,147.69,394.05, Evaluation of speech fluency,92521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,153.6,,,,,,,fee schedule,147.69,394.05,APC Evaluation of speech fluency,92521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,155.07,,,,,,,fee schedule,147.69,394.05,APC Evaluation of speech fluency,92521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.69,,,,,,,fee schedule,147.69,394.05,APC Evaluate speech production,92522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,354.29,,,,,,,fee schedule,123.77,394.05, Evaluate speech production,92522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,394.05,,,,,,,fee schedule,123.77,394.05, Evaluate speech production,92522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.72,,,,,,,fee schedule,123.77,394.05,APC Evaluate speech production,92522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.96,,,,,,,fee schedule,123.77,394.05,APC Evaluate speech production,92522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.77,,,,,,,fee schedule,123.77,394.05,APC Speech sound lang comprehen,92523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,354.29,,,,,,,fee schedule,250.84,394.05, Speech sound lang comprehen,92523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,394.05,,,,,,,fee schedule,250.84,394.05, Speech sound lang comprehen,92523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,260.87,,,,,,,fee schedule,250.84,394.05,APC Speech sound lang comprehen,92523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.38,,,,,,,fee schedule,250.84,394.05,APC Speech sound lang comprehen,92523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,250.84,,,,,,,fee schedule,250.84,394.05,APC Behavral qualit analys voice,92524,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,354.29,,,,,,,fee schedule,121.04,394.05, Behavral qualit analys voice,92524,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,394.05,,,,,,,fee schedule,121.04,394.05, Behavral qualit analys voice,92524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.88,,,,,,,fee schedule,121.04,394.05,APC Behavral qualit analys voice,92524,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,127.09,,,,,,,fee schedule,121.04,394.05,APC Behavral qualit analys voice,92524,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,121.04,,,,,,,fee schedule,121.04,394.05,APC Oral function therapy,92526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,242.17,,,,,,,fee schedule,93.58,277.33, Oral function therapy,92526,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,277.33,,,,,,,fee schedule,93.58,277.33, Oral function therapy,92526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,97.32,,,,,,,fee schedule,93.58,277.33,APC Oral function therapy,92526,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,98.26,,,,,,,fee schedule,93.58,277.33,APC Oral function therapy,92526,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,93.58,,,,,,,fee schedule,93.58,277.33,APC Spontaneous nystagmus study,92531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.96,,,,,,,fee schedule,72.96,83.55, Spontaneous nystagmus study,92531,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.55,,,,,,,fee schedule,72.96,83.55, Positional nystagmus test,92532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.96,,,,,,,fee schedule,72.96,83.55, Positional nystagmus test,92532,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.55,,,,,,,fee schedule,72.96,83.55, Caloric vestibular test,92533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.96,,,,,,,fee schedule,72.96,83.55, Caloric vestibular test,92533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.55,,,,,,,fee schedule,72.96,83.55, Optokinetic nystagmus test,92534,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.96,,,,,,,fee schedule,72.96,83.55, Optokinetic nystagmus test,92534,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.55,,,,,,,fee schedule,72.96,83.55, Caloric vstblr test w/rec,92537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.31,,,,,,,fee schedule,76.31,159.61, Caloric vstblr test w/rec,92537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.39,,,,,,,fee schedule,76.31,159.61, Caloric vstblr test w/rec,92537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,76.31,159.61,APC Caloric vstblr test w/rec,92537,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,76.31,159.61,APC Caloric vstblr test w/rec,92537,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,76.31,159.61,APC Caloric vstblr test w/rec,92538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.31,,,,,,,fee schedule,76.31,267.83, Caloric vstblr test w/rec,92538,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.39,,,,,,,fee schedule,76.31,267.83, Caloric vstblr test w/rec,92538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,76.31,267.83,APC Caloric vstblr test w/rec,92538,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,76.31,267.83,APC Caloric vstblr test w/rec,92538,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,76.31,267.83,APC Basic vestibular evaluation,92540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,993.14,,,,,,,fee schedule,255.08,1137.31, Basic vestibular evaluation,92540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1137.31,,,,,,,fee schedule,255.08,1137.31, Basic vestibular evaluation,92540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,1137.31,APC Basic vestibular evaluation,92540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,1137.31,APC Basic vestibular evaluation,92540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,1137.31,APC Spontaneous nystagmus test,92541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.86,,,,,,,fee schedule,157.18,183.07, Spontaneous nystagmus test,92541,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,183.07,,,,,,,fee schedule,157.18,183.07, Spontaneous nystagmus test,92541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,183.07,APC Spontaneous nystagmus test,92541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,183.07,APC Spontaneous nystagmus test,92541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,183.07,APC Positional nystagmus test,92542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.57,,,,,,,fee schedule,157.18,188.46, Positional nystagmus test,92542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,188.46,,,,,,,fee schedule,157.18,188.46, Positional nystagmus test,92542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,188.46,APC Positional nystagmus test,92542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,188.46,APC Positional nystagmus test,92542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,188.46,APC Optokinetic nystagmus test,92544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,130.42,,,,,,,fee schedule,130.42,159.61, Optokinetic nystagmus test,92544,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,149.36,,,,,,,fee schedule,130.42,159.61, Optokinetic nystagmus test,92544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,130.42,159.61,APC Optokinetic nystagmus test,92544,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,130.42,159.61,APC Optokinetic nystagmus test,92544,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,130.42,159.61,APC Oscillating tracking test,92545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.11,,,,,,,fee schedule,116.11,267.83, Oscillating tracking test,92545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,132.97,,,,,,,fee schedule,116.11,267.83, Oscillating tracking test,92545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,116.11,267.83,APC Oscillating tracking test,92545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,116.11,267.83,APC Oscillating tracking test,92545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,116.11,267.83,APC Sinusoidal rotational test,92546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,256.01,,,,,,,fee schedule,152.01,293.17, Sinusoidal rotational test,92546,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,293.17,,,,,,,fee schedule,152.01,293.17, Sinusoidal rotational test,92546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,293.17,APC Sinusoidal rotational test,92546,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,293.17,APC Sinusoidal rotational test,92546,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,293.17,APC Supplemental electrical test,92547,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.31,,,,,,,fee schedule,14.31,16.39, Supplemental electrical test,92547,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.39,,,,,,,fee schedule,14.31,16.39, Posturography,92548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,317.81,,,,,,,fee schedule,157.18,363.95, Posturography,92548,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,363.95,,,,,,,fee schedule,157.18,363.95, Posturography,92548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,363.95,APC Posturography,92548,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,363.95,APC Posturography,92548,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,363.95,APC Cdp-sot 6 cond w/i&r mct&adt,92549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,270.39,,,,,,,fee schedule,157.18,309.65, Cdp-sot 6 cond w/i&r mct&adt,92549,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,309.65,,,,,,,fee schedule,157.18,309.65, Cdp-sot 6 cond w/i&r mct&adt,92549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,309.65,APC Cdp-sot 6 cond w/i&r mct&adt,92549,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,309.65,APC Cdp-sot 6 cond w/i&r mct&adt,92549,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,309.65,APC Tympanometry & reflex thresh,92550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,210.5,,,,,,,fee schedule,210.5,267.83, Tympanometry & reflex thresh,92550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,241.06,,,,,,,fee schedule,210.5,267.83, Tympanometry & reflex thresh,92550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,210.5,267.83,APC Tympanometry & reflex thresh,92550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,210.5,267.83,APC Tympanometry & reflex thresh,92550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,210.5,267.83,APC Pure tone hearing test air,92551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,31.42,,,,,,,fee schedule,31.42,35.98, Pure tone hearing test air,92551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.98,,,,,,,fee schedule,31.42,35.98, Pure tone audiometry air,92552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.44,,,,,,,fee schedule,53.44,165.03, Pure tone audiometry air,92552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.2,,,,,,,fee schedule,53.44,165.03, Pure tone audiometry air,92552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,53.44,165.03,APC Pure tone audiometry air,92552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,53.44,165.03,APC Pure tone audiometry air,92552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,53.44,165.03,APC Audiometry air & bone,92553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.15,,,,,,,fee schedule,80.15,159.61, Audiometry air & bone,92553,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.79,,,,,,,fee schedule,80.15,159.61, Audiometry air & bone,92553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,80.15,159.61,APC Audiometry air & bone,92553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,80.15,159.61,APC Audiometry air & bone,92553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,80.15,159.61,APC Speech threshold audiometry,92555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.62,,,,,,,fee schedule,46.62,73.17, Speech threshold audiometry,92555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.39,,,,,,,fee schedule,46.62,73.17, Speech threshold audiometry,92555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,46.62,73.17,APC Speech threshold audiometry,92555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,46.62,73.17,APC Speech threshold audiometry,92555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,46.62,73.17,APC Speech audiometry complete,92556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.94,,,,,,,fee schedule,69.69,80.09, Speech audiometry complete,92556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.09,,,,,,,fee schedule,69.69,80.09, Speech audiometry complete,92556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,80.09,APC Speech audiometry complete,92556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,80.09,APC Speech audiometry complete,92556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,80.09,APC Comprehensive hearing test,92557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,145.55,,,,,,,fee schedule,145.55,166.68, Comprehensive hearing test,92557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,166.68,,,,,,,fee schedule,145.55,166.68, Comprehensive hearing test,92557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,145.55,166.68,APC Comprehensive hearing test,92557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,145.55,166.68,APC Comprehensive hearing test,92557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,145.55,166.68,APC Loudness balance test,92562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,50.02,267.83, Loudness balance test,92562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.28,,,,,,,fee schedule,50.02,267.83, Loudness balance test,92562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,50.02,267.83,APC Loudness balance test,92562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,50.02,267.83,APC Loudness balance test,92562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,50.02,267.83,APC Tone decay hearing test,92563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.62,,,,,,,fee schedule,44.12,53.39, Tone decay hearing test,92563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.39,,,,,,,fee schedule,44.12,53.39, Tone decay hearing test,92563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,53.39,APC Tone decay hearing test,92563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,53.39,APC Tone decay hearing test,92563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,53.39,APC Stenger test pure tone,92565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.91,,,,,,,fee schedule,48.91,73.17, Stenger test pure tone,92565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56,,,,,,,fee schedule,48.91,73.17, Stenger test pure tone,92565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,48.91,73.17,APC Stenger test pure tone,92565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,48.91,73.17,APC Stenger test pure tone,92565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,48.91,73.17,APC Tympanometry,92567,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.26,,,,,,,fee schedule,44.12,73.58, Tympanometry,92567,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.58,,,,,,,fee schedule,44.12,73.58, Tympanometry,92567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,73.58,APC Tympanometry,92567,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,73.58,APC Tympanometry,92567,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,73.58,APC Acoustic refl threshold tst,92568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.62,,,,,,,fee schedule,44.12,53.39, Acoustic refl threshold tst,92568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.39,,,,,,,fee schedule,44.12,53.39, Acoustic refl threshold tst,92568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,53.39,APC Acoustic refl threshold tst,92568,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,53.39,APC Acoustic refl threshold tst,92568,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,53.39,APC Acoustic immitance testing,92570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.02,,,,,,,fee schedule,50.02,159.61, Acoustic immitance testing,92570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.28,,,,,,,fee schedule,50.02,159.61, Acoustic immitance testing,92570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,50.02,159.61,APC Acoustic immitance testing,92570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,50.02,159.61,APC Acoustic immitance testing,92570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,50.02,159.61,APC Filtered speech hearing test,92571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.76,,,,,,,fee schedule,44.12,54.7, Filtered speech hearing test,92571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.7,,,,,,,fee schedule,44.12,54.7, Filtered speech hearing test,92571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,54.7,APC Filtered speech hearing test,92571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,54.7,APC Filtered speech hearing test,92571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,54.7,APC Staggered spondaic word test,92572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.09,,,,,,,fee schedule,11.09,159.61, Staggered spondaic word test,92572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.69,,,,,,,fee schedule,11.09,159.61, Staggered spondaic word test,92572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,11.09,159.61,APC Staggered spondaic word test,92572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,11.09,159.61,APC Staggered spondaic word test,92572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,11.09,159.61,APC Sensorineural acuity test,92575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.81,,,,,,,fee schedule,35.81,46.33, Sensorineural acuity test,92575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.01,,,,,,,fee schedule,35.81,46.33, Sensorineural acuity test,92575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,35.81,46.33,APC Sensorineural acuity test,92575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,35.81,46.33,APC Sensorineural acuity test,92575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,35.81,46.33,APC Synthetic sentence test,92576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.31,,,,,,,fee schedule,44.12,62.2, Synthetic sentence test,92576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.2,,,,,,,fee schedule,44.12,62.2, Synthetic sentence test,92576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,62.2,APC Synthetic sentence test,92576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,62.2,APC Synthetic sentence test,92576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,62.2,APC Stenger test speech,92577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.84,,,,,,,fee schedule,87.84,462.87, Stenger test speech,92577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.59,,,,,,,fee schedule,87.84,462.87, Stenger test speech,92577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,87.84,462.87,APC Stenger test speech,92577,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,87.84,462.87,APC Stenger test speech,92577,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,87.84,462.87,APC Visual audiometry (vra),92579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,88.11,267.83, Visual audiometry (vra),92579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.91,,,,,,,fee schedule,88.11,267.83, Visual audiometry (vra),92579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,88.11,267.83,APC Visual audiometry (vra),92579,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,88.11,267.83,APC Visual audiometry (vra),92579,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,88.11,267.83,APC Conditioning play audiometry,92582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.11,,,,,,,fee schedule,88.11,159.61, Conditioning play audiometry,92582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.91,,,,,,,fee schedule,88.11,159.61, Conditioning play audiometry,92582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,88.11,159.61,APC Conditioning play audiometry,92582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,88.11,159.61,APC Conditioning play audiometry,92582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,88.11,159.61,APC Select picture audiometry,92583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108,,,,,,,fee schedule,69.69,123.68, Select picture audiometry,92583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.68,,,,,,,fee schedule,69.69,123.68, Select picture audiometry,92583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,123.68,APC Select picture audiometry,92583,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,123.68,APC Select picture audiometry,92583,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,123.68,APC Electrocochleography,92584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,298.72,,,,,,,fee schedule,152.01,342.08, Electrocochleography,92584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,342.08,,,,,,,fee schedule,152.01,342.08, Electrocochleography,92584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,342.08,APC Electrocochleography,92584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,342.08,APC Electrocochleography,92584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,342.08,APC Evoked auditory test limited,92587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,178.81,,,,,,,fee schedule,178.81,267.83, Evoked auditory test limited,92587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,204.76,,,,,,,fee schedule,178.81,267.83, Evoked auditory test limited,92587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,178.81,267.83,APC Evoked auditory test limited,92587,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,178.81,267.83,APC Evoked auditory test limited,92587,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,178.81,267.83,APC Evoked auditory tst complete,92588,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,232.75,,,,,,,fee schedule,232.75,462.87, Evoked auditory tst complete,92588,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,266.53,,,,,,,fee schedule,232.75,462.87, Evoked auditory tst complete,92588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,232.75,462.87,APC Evoked auditory tst complete,92588,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,232.75,462.87,APC Evoked auditory tst complete,92588,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,232.75,462.87,APC Hearing aid exam one ear,92590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.73,,,,,,,fee schedule,181.73,208.12, Hearing aid exam one ear,92590,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.12,,,,,,,fee schedule,181.73,208.12, Hearing aid exam both ears,92591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.73,,,,,,,fee schedule,181.73,208.12, Hearing aid exam both ears,92591,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.12,,,,,,,fee schedule,181.73,208.12, Hearing aid check one ear,92592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.73,,,,,,,fee schedule,181.73,208.12, Hearing aid check one ear,92592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.12,,,,,,,fee schedule,181.73,208.12, Hearing aid check both ears,92593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.73,,,,,,,fee schedule,181.73,208.12, Hearing aid check both ears,92593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.12,,,,,,,fee schedule,181.73,208.12, Electro hearng aid test one,92594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.73,,,,,,,fee schedule,181.73,208.12, Electro hearng aid test one,92594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.12,,,,,,,fee schedule,181.73,208.12, Electro hearng aid tst both,92595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,181.73,,,,,,,fee schedule,181.73,208.12, Electro hearng aid tst both,92595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.12,,,,,,,fee schedule,181.73,208.12, Ear protector evaluation,92596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.22,,,,,,,fee schedule,44.12,82.7, Ear protector evaluation,92596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.7,,,,,,,fee schedule,44.12,82.7, Ear protector evaluation,92596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,82.7,APC Ear protector evaluation,92596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,82.7,APC Ear protector evaluation,92596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,82.7,APC Oral speech device eval,92597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,364.27,,,,,,,fee schedule,78.67,405.15, Oral speech device eval,92597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,405.15,,,,,,,fee schedule,78.67,405.15, Oral speech device eval,92597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,81.82,,,,,,,fee schedule,78.67,405.15,APC Oral speech device eval,92597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,82.6,,,,,,,fee schedule,78.67,405.15,APC Oral speech device eval,92597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,78.67,,,,,,,fee schedule,78.67,405.15,APC Cochlear implt f/up exam <7,92601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,403.47,,,,,,,fee schedule,152.01,462.04, Cochlear implt f/up exam <7,92601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,462.04,,,,,,,fee schedule,152.01,462.04, Cochlear implt f/up exam <7,92601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,462.04,APC Cochlear implt f/up exam <7,92601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,462.04,APC Cochlear implt f/up exam <7,92601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,462.04,APC Reprogram cochlear implt 7/>,92602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,567.94,,,,,,,fee schedule,152.01,650.39, Reprogram cochlear implt 7/>,92602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,650.39,,,,,,,fee schedule,152.01,650.39, Reprogram cochlear implt 7/>,92602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,650.39,APC Reprogram cochlear implt 7/>,92602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,650.39,APC Reprogram cochlear implt 7/>,92602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,650.39,APC Cochlear implt f/up exam 7/>,92603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,249.07,,,,,,,fee schedule,152.01,285.22, Cochlear implt f/up exam 7/>,92603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,285.22,,,,,,,fee schedule,152.01,285.22, Cochlear implt f/up exam 7/>,92603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,285.22,APC Cochlear implt f/up exam 7/>,92603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,285.22,APC Cochlear implt f/up exam 7/>,92603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,285.22,APC Reprogram cochlear implt 7/>,92604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,302.68,,,,,,,fee schedule,152.01,346.62, Reprogram cochlear implt 7/>,92604,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,346.62,,,,,,,fee schedule,152.01,346.62, Reprogram cochlear implt 7/>,92604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,346.62,APC Reprogram cochlear implt 7/>,92604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,346.62,APC Reprogram cochlear implt 7/>,92604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,346.62,APC Ex for speech device rx 1hr,92607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,354.04,,,,,,,fee schedule,136.32,405.44, Ex for speech device rx 1hr,92607,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,405.44,,,,,,,fee schedule,136.32,405.44, Ex for speech device rx 1hr,92607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,141.77,,,,,,,fee schedule,136.32,405.44,APC Ex for speech device rx 1hr,92607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,143.14,,,,,,,fee schedule,136.32,405.44,APC Ex for speech device rx 1hr,92607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,136.32,,,,,,,fee schedule,136.32,405.44,APC Ex for speech device rx addl,92608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.79,,,,,,,fee schedule,53.37,76.48, Ex for speech device rx addl,92608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.48,,,,,,,fee schedule,53.37,76.48, Ex for speech device rx addl,92608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,55.5,,,,,,,fee schedule,53.37,76.48,APC Ex for speech device rx addl,92608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,56.04,,,,,,,fee schedule,53.37,76.48,APC Ex for speech device rx addl,92608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,53.37,,,,,,,fee schedule,53.37,76.48,APC Use of speech device service,92609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.14,,,,,,,fee schedule,114.56,120.29,APC Use of speech device service,92609,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.29,,,,,,,fee schedule,114.56,120.29,APC Use of speech device service,92609,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.56,,,,,,,fee schedule,114.56,120.29,APC Evaluate swallowing function,92610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,396.38,,,,,,,fee schedule,62.66,453.92, Evaluate swallowing function,92610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,453.92,,,,,,,fee schedule,62.66,453.92, Evaluate swallowing function,92610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,65.17,,,,,,,fee schedule,62.66,453.92,APC Evaluate swallowing function,92610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.79,,,,,,,fee schedule,62.66,453.92,APC Evaluate swallowing function,92610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.66,,,,,,,fee schedule,62.66,453.92,APC Motion fluoroscopy/swallow,92611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,396.38,,,,,,,fee schedule,102.27,453.92, Motion fluoroscopy/swallow,92611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,453.92,,,,,,,fee schedule,102.27,453.92, Motion fluoroscopy/swallow,92611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.36,,,,,,,fee schedule,102.27,453.92,APC Motion fluoroscopy/swallow,92611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.38,,,,,,,fee schedule,102.27,453.92,APC Motion fluoroscopy/swallow,92611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.27,,,,,,,fee schedule,102.27,453.92,APC Endoscopy swallow (fees) vid,92612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,439.78,,,,,,,fee schedule,58.5,503.62, Endoscopy swallow (fees) vid,92612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,503.62,,,,,,,fee schedule,58.5,503.62, Endoscopy swallow (fees) vid,92612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.84,,,,,,,fee schedule,58.5,503.62,APC Endoscopy swallow (fees) vid,92612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61.42,,,,,,,fee schedule,58.5,503.62,APC Endoscopy swallow (fees) vid,92612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58.5,,,,,,,fee schedule,58.5,503.62,APC Endoscopy swallow (fees) i&r,92613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.76,,,,,,,fee schedule,119.76,137.14, Endoscopy swallow (fees) i&r,92613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,137.14,,,,,,,fee schedule,119.76,137.14, Laryngoscopic sensory vid,92614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,412.52,,,,,,,fee schedule,58.47,472.41, Laryngoscopic sensory vid,92614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,472.41,,,,,,,fee schedule,58.47,472.41, Laryngoscopic sensory vid,92614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.81,,,,,,,fee schedule,58.47,472.41,APC Laryngoscopic sensory vid,92614,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61.39,,,,,,,fee schedule,58.47,472.41,APC Laryngoscopic sensory vid,92614,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58.47,,,,,,,fee schedule,58.47,472.41,APC Laryngoscopic sensory i&r,92615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.93,,,,,,,fee schedule,91.93,105.28, Laryngoscopic sensory i&r,92615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.28,,,,,,,fee schedule,91.93,105.28, Fees w/laryngeal sense test,92616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,575.46,,,,,,,fee schedule,86.31,658.99, Fees w/laryngeal sense test,92616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,658.99,,,,,,,fee schedule,86.31,658.99, Fees w/laryngeal sense test,92616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,89.76,,,,,,,fee schedule,86.31,658.99,APC Fees w/laryngeal sense test,92616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,90.63,,,,,,,fee schedule,86.31,658.99,APC Fees w/laryngeal sense test,92616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,86.31,,,,,,,fee schedule,86.31,658.99,APC Fees w/laryngeal sense i&r,92617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,112.37,,,,,,,fee schedule,112.37,128.68, Fees w/laryngeal sense i&r,92617,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.68,,,,,,,fee schedule,112.37,128.68, Auditory function 60 min,92620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.64,,,,,,,fee schedule,134.64,159.61, Auditory function 60 min,92620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,154.18,,,,,,,fee schedule,134.64,159.61, Auditory function 60 min,92620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,134.64,159.61,APC Auditory function 60 min,92620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,134.64,159.61,APC Auditory function 60 min,92620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,134.64,159.61,APC Auditory function + 15 min,92621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.6,,,,,,,fee schedule,33.6,38.48, Auditory function + 15 min,92621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,38.48,,,,,,,fee schedule,33.6,38.48, Dx aly aud oi snd prcsr 1st,92622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Dx aly aud oi snd prcsr 1st,92622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Dx aly aud oi snd prcsr 1st,92622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Tinnitus assessment,92625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,132.38,,,,,,,fee schedule,132.38,159.61, Tinnitus assessment,92625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,151.6,,,,,,,fee schedule,132.38,159.61, Tinnitus assessment,92625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,132.38,159.61,APC Tinnitus assessment,92625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,132.38,159.61,APC Tinnitus assessment,92625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,132.38,159.61,APC Eval aud rehab status,92626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,214.32,,,,,,,fee schedule,152.01,245.43, Eval aud rehab status,92626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,245.43,,,,,,,fee schedule,152.01,245.43, Eval aud rehab status,92626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,245.43,APC Eval aud rehab status,92626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,245.43,APC Eval aud rehab status,92626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,245.43,APC Eval aud status rehab add-on,92627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.53,,,,,,,fee schedule,52.53,60.15, Eval aud status rehab add-on,92627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.15,,,,,,,fee schedule,52.53,60.15, Aud brainstem implt programg,92640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Aud brainstem implt programg,92640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Aud brainstem implt programg,92640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Aep scr auditory potential,92650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,222.23,,,,,,,fee schedule,222.23,254.49, Aep scr auditory potential,92650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,254.49,,,,,,,fee schedule,222.23,254.49, Aep hearing status deter i&r,92651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,222.23,,,,,,,fee schedule,222.23,267.83, Aep hearing status deter i&r,92651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,254.49,,,,,,,fee schedule,222.23,267.83, Aep hearing status deter i&r,92651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,222.23,267.83,APC Aep hearing status deter i&r,92651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,222.23,267.83,APC Aep hearing status deter i&r,92651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,222.23,267.83,APC Aep thrshld est mlt freq i&r,92652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,297.97,,,,,,,fee schedule,255.08,341.23, Aep thrshld est mlt freq i&r,92652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,341.23,,,,,,,fee schedule,255.08,341.23, Aep thrshld est mlt freq i&r,92652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,341.23,APC Aep thrshld est mlt freq i&r,92652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,341.23,APC Aep thrshld est mlt freq i&r,92652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,341.23,APC Aep neurodiagnostic i&r,92653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,297.97,,,,,,,fee schedule,255.08,341.23, Aep neurodiagnostic i&r,92653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,341.23,,,,,,,fee schedule,255.08,341.23, Aep neurodiagnostic i&r,92653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,341.23,APC Aep neurodiagnostic i&r,92653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,341.23,APC Aep neurodiagnostic i&r,92653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,341.23,APC Ent procedure/service,92700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Ent procedure/service,92700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Ent procedure/service,92700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Prq cardiac angioplast 1 art,92920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1447.95,7059.88, Prq cardiac angioplast 1 art,92920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1447.95,7059.88, Prq cardiac angioplast 1 art,92920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1447.95,,,,,,,fee schedule,1447.95,7059.88, Prq cardiac angioplast 1 art,92920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1658.13,,,,,,,fee schedule,1447.95,7059.88, Prq cardiac angioplast 1 art,92920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,1447.95,7059.88,APC Prq cardiac angioplast 1 art,92920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,1447.95,7059.88,APC Prq cardiac angioplast 1 art,92920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,1447.95,7059.88,APC Prq cardiac angio addl art,92921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,102.28,1866, Prq cardiac angio addl art,92921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,102.28,1866, Prq cardiac angio addl art,92921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.28,,,,,,,fee schedule,102.28,1866, Prq cardiac angio addl art,92921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.12,,,,,,,fee schedule,102.28,1866, Prq card angio/athrect 1 art,92924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1750.31,14319.55, Prq card angio/athrect 1 art,92924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1750.31,14319.55, Prq card angio/athrect 1 art,92924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1750.31,,,,,,,fee schedule,1750.31,14319.55, Prq card angio/athrect 1 art,92924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2004.39,,,,,,,fee schedule,1750.31,14319.55, Prq card angio/athrect 1 art,92924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,1750.31,14319.55,APC Prq card angio/athrect 1 art,92924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,1750.31,14319.55,APC Prq card angio/athrect 1 art,92924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,1750.31,14319.55,APC Prq card angio/athrect addl,92925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,92.06,1866, Prq card angio/athrect addl,92925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,92.06,1866, Prq card angio/athrect addl,92925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.06,,,,,,,fee schedule,92.06,1866, Prq card angio/athrect addl,92925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.42,,,,,,,fee schedule,92.06,1866, Prq card stent w/angio 1 vsl,92928,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,1653.94,14319.55, Prq card stent w/angio 1 vsl,92928,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,1653.94,14319.55, Prq card stent w/angio 1 vsl,92928,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1653.94,,,,,,,fee schedule,1653.94,14319.55, Prq card stent w/angio 1 vsl,92928,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1894.02,,,,,,,fee schedule,1653.94,14319.55, Prq card stent w/angio 1 vsl,92928,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,1653.94,14319.55,APC Prq card stent w/angio 1 vsl,92928,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,1653.94,14319.55,APC Prq card stent w/angio 1 vsl,92928,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,1653.94,14319.55,APC Prq card stent w/angio addl,92929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,66.96,1866, Prq card stent w/angio addl,92929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,66.96,1866, Prq card stent w/angio addl,92929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.96,,,,,,,fee schedule,66.96,1866, Prq card stent w/angio addl,92929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.68,,,,,,,fee schedule,66.96,1866, Prq tcat plmt ntrac st 2+les,92930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,22738.78, Prq tcat plmt ntrac st 2+les,92930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,22738.78, Prq tcat plmt ntrac st 2+les,92930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,22738.78, Prq tcat plmt ntrac st 2+les,92930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,22738.78, Prq tcat plmt ntrac st 2+les,92930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,22738.78,APC Prq tcat plmt ntrac st 2+les,92930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,22738.78,APC Prq tcat plmt ntrac st 2+les,92930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,22738.78,APC Prq card stent/ath/angio,92933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,1905.16,22738.78, Prq card stent/ath/angio,92933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,1905.16,22738.78, Prq card stent/ath/angio,92933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1905.16,,,,,,,fee schedule,1905.16,22738.78, Prq card stent/ath/angio,92933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2181.72,,,,,,,fee schedule,1905.16,22738.78, Prq card stent/ath/angio,92933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,1905.16,22738.78,APC Prq card stent/ath/angio,92933,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,1905.16,22738.78,APC Prq card stent/ath/angio,92933,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,1905.16,22738.78,APC Prq card stent/ath/angio,92934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,20.46,1866, Prq card stent/ath/angio,92934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,20.46,1866, Prq card stent/ath/angio,92934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.46,,,,,,,fee schedule,20.46,1866, Prq card stent/ath/angio,92934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.43,,,,,,,fee schedule,20.46,1866, Prq revasc byp graft 1 vsl,92937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,1653.94,14319.55, Prq revasc byp graft 1 vsl,92937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,1653.94,14319.55, Prq revasc byp graft 1 vsl,92937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1653.94,,,,,,,fee schedule,1653.94,14319.55, Prq revasc byp graft 1 vsl,92937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1894.02,,,,,,,fee schedule,1653.94,14319.55, Prq revasc byp graft 1 vsl,92937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,1653.94,14319.55,APC Prq revasc byp graft 1 vsl,92937,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,1653.94,14319.55,APC Prq revasc byp graft 1 vsl,92937,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,1653.94,14319.55,APC Prq revasc byp graft addl,92938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,66.02,1866, Prq revasc byp graft addl,92938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,66.02,1866, Prq revasc byp graft addl,92938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.02,,,,,,,fee schedule,66.02,1866, Prq revasc byp graft addl,92938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.6,,,,,,,fee schedule,66.02,1866, Prq card revasc mi 1 vsl,92941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1907.22,,,,,,,fee schedule,1907.22,2184.07, Prq card revasc mi 1 vsl,92941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2184.07,,,,,,,fee schedule,1907.22,2184.07, Prq card revasc chronic 1vsl,92943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,1907.22,14319.55, Prq card revasc chronic 1vsl,92943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,1907.22,14319.55, Prq card revasc chronic 1vsl,92943,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1907.22,,,,,,,fee schedule,1907.22,14319.55, Prq card revasc chronic 1vsl,92943,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2184.07,,,,,,,fee schedule,1907.22,14319.55, Prq card revasc chronic 1vsl,92943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,1907.22,14319.55,APC Prq card revasc chronic 1vsl,92943,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,1907.22,14319.55,APC Prq card revasc chronic 1vsl,92943,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,1907.22,14319.55,APC Prq card revasc chronic addl,92944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,22.32,1866, Prq card revasc chronic addl,92944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,22.32,1866, Prq card revasc chronic addl,92944,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.32,,,,,,,fee schedule,22.32,1866, Prq card revasc chronic addl,92944,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.56,,,,,,,fee schedule,22.32,1866, Prq trl rvs ch occ ant&rtrgr,92945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Prq trl rvs ch occ ant&rtrgr,92945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Prq trl rvs ch occ ant&rtrgr,92945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Prq trl rvs ch occ ant&rtrgr,92945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Prq trl rvs ch occ ant&rtrgr,92945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4081,18617,APC Prq trl rvs ch occ ant&rtrgr,92945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4081,18617,APC Prq trl rvs ch occ ant&rtrgr,92945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4081,18617,APC Heart/lung resuscitation cpr,92950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,415.52,,,,,,,fee schedule,255.08,475.84, Heart/lung resuscitation cpr,92950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,475.84,,,,,,,fee schedule,255.08,475.84, Heart/lung resuscitation cpr,92950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,475.84,APC Heart/lung resuscitation cpr,92950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,475.84,APC Heart/lung resuscitation cpr,92950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,475.84,APC Temporary external pacing,92953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,812.04,,,,,,,fee schedule,780.8,819.84,APC Temporary external pacing,92953,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,819.84,,,,,,,fee schedule,780.8,819.84,APC Temporary external pacing,92953,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,780.8,,,,,,,fee schedule,780.8,819.84,APC Cardioversion electric ext,92960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,945.2,,,,,,,fee schedule,780.8,1082.41, Cardioversion electric ext,92960,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1082.41,,,,,,,fee schedule,780.8,1082.41, Cardioversion electric ext,92960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,812.04,,,,,,,fee schedule,780.8,1082.41,APC Cardioversion electric ext,92960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,819.84,,,,,,,fee schedule,780.8,1082.41,APC Cardioversion electric ext,92960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,780.8,,,,,,,fee schedule,780.8,1082.41,APC Cardioversion electric int,92961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,716.99,,,,,,,fee schedule,716.99,821.07, Cardioversion electric int,92961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,821.07,,,,,,,fee schedule,716.99,821.07, Cardioversion electric int,92961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,812.04,,,,,,,fee schedule,716.99,821.07,APC Cardioversion electric int,92961,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,819.84,,,,,,,fee schedule,716.99,821.07,APC Cardioversion electric int,92961,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,780.8,,,,,,,fee schedule,716.99,821.07,APC Perq trluml coronry lithotrp,92972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Perq trluml coronry lithotrp,92972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Dissolve clot heart vessel,92977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,347.42,,,,,,,fee schedule,347.42,397.86, Dissolve clot heart vessel,92977,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,397.86,,,,,,,fee schedule,347.42,397.86, Endoluminl ivus oct c 1st,92978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,801.91,,,,,,,fee schedule,801.91,918.31, Endoluminl ivus oct c 1st,92978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,918.31,,,,,,,fee schedule,801.91,918.31, Endoluminl ivus oct c ea,92979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,482.09,,,,,,,fee schedule,482.09,552.07, Endoluminl ivus oct c ea,92979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,552.07,,,,,,,fee schedule,482.09,552.07, Revision of aortic valve,92986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,17574.15, Revision of aortic valve,92986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,17574.15, Revision of aortic valve,92986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15346.44,,,,,,,fee schedule,4147,17574.15, Revision of aortic valve,92986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17574.15,,,,,,,fee schedule,4147,17574.15, Revision of aortic valve,92986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6992.65,,,,,,,fee schedule,4147,17574.15,APC Revision of aortic valve,92986,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7059.88,,,,,,,fee schedule,4147,17574.15,APC Revision of aortic valve,92986,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6723.7,,,,,,,fee schedule,4147,17574.15,APC Revision of mitral valve,92987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,29154.47, Revision of mitral valve,92987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,29154.47, Revision of mitral valve,92987,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25458.84,,,,,,,fee schedule,4147,29154.47, Revision of mitral valve,92987,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29154.47,,,,,,,fee schedule,4147,29154.47, Revision of mitral valve,92987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,29154.47,APC Revision of mitral valve,92987,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,29154.47,APC Revision of mitral valve,92987,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,29154.47,APC Revision of pulmonary valve,92990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,20324.57, Revision of pulmonary valve,92990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,20324.57, Revision of pulmonary valve,92990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17748.22,,,,,,,fee schedule,4147,20324.57, Revision of pulmonary valve,92990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20324.57,,,,,,,fee schedule,4147,20324.57, Revision of pulmonary valve,92990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,20324.57,APC Revision of pulmonary valve,92990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,20324.57,APC Revision of pulmonary valve,92990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,20324.57,APC Pul art balloon repr percut,92997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,31638.59, Pul art balloon repr percut,92997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,31638.59, Pul art balloon repr percut,92997,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27628.07,,,,,,,fee schedule,4147,31638.59, Pul art balloon repr percut,92997,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,31638.59,,,,,,,fee schedule,4147,31638.59, Pul art balloon repr percut,92997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,31638.59,APC Pul art balloon repr percut,92997,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,31638.59,APC Pul art balloon repr percut,92997,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,31638.59,APC Electrocardiogram complete,93000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.28,,,,,,,fee schedule,77.28,88.49, Electrocardiogram complete,93000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.49,,,,,,,fee schedule,77.28,88.49, Electrocardiogram tracing,93005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.82,,,,,,,fee schedule,52.82,73.17, Electrocardiogram tracing,93005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,60.49,,,,,,,fee schedule,52.82,73.17, Electrocardiogram tracing,93005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,52.82,73.17,APC Electrocardiogram tracing,93005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,52.82,73.17,APC Electrocardiogram tracing,93005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,52.82,73.17,APC Electrocardiogram report,93010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.45,,,,,,,fee schedule,24.45,28, Electrocardiogram report,93010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28,,,,,,,fee schedule,24.45,28, Cardiovascular stress test,93015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,308.66,,,,,,,fee schedule,308.66,353.47, Cardiovascular stress test,93015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,353.47,,,,,,,fee schedule,308.66,353.47, Cardiovascular stress test,93016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.86,,,,,,,fee schedule,66.86,76.57, Cardiovascular stress test,93016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.57,,,,,,,fee schedule,66.86,76.57, Cardiovascular stress test,93017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,200.31,,,,,,,fee schedule,200.31,267.83, Cardiovascular stress test,93017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,229.39,,,,,,,fee schedule,200.31,267.83, Cardiovascular stress test,93017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,200.31,267.83,APC Cardiovascular stress test,93017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,200.31,267.83,APC Cardiovascular stress test,93017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,200.31,267.83,APC Cardiovascular stress test,93018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.93,,,,,,,fee schedule,42.93,49.16, Cardiovascular stress test,93018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.16,,,,,,,fee schedule,42.93,49.16, Cardiac drug stress test,93024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,304.92,,,,,,,fee schedule,304.92,554.12, Cardiac drug stress test,93024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,349.18,,,,,,,fee schedule,304.92,554.12, Cardiac drug stress test,93024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,304.92,554.12,APC Cardiac drug stress test,93024,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,304.92,554.12,APC Cardiac drug stress test,93024,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,304.92,554.12,APC Microvolt t-wave assess,93025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,947.86,,,,,,,fee schedule,152.01,1085.45, Microvolt t-wave assess,93025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1085.45,,,,,,,fee schedule,152.01,1085.45, Microvolt t-wave assess,93025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,1085.45,APC Microvolt t-wave assess,93025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,1085.45,APC Microvolt t-wave assess,93025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,1085.45,APC Rhythm ECG with report,93040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.23,,,,,,,fee schedule,40.23,46.06, Rhythm ECG with report,93040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.06,,,,,,,fee schedule,40.23,46.06, Rhythm ecg tracing,93041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.91,,,,,,,fee schedule,17.91,73.17, Rhythm ecg tracing,93041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.5,,,,,,,fee schedule,17.91,73.17, Rhythm ecg tracing,93041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,17.91,73.17,APC Rhythm ecg tracing,93041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,17.91,73.17,APC Rhythm ecg tracing,93041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,17.91,73.17,APC Rhythm ecg report,93042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.32,,,,,,,fee schedule,22.32,25.56, Rhythm ecg report,93042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.56,,,,,,,fee schedule,22.32,25.56, Art pressure waveform analys,93050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Art pressure waveform analys,93050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Art pressure waveform analys,93050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Interrog crtd sins bat ip wo,93145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Interrog crtd sins bat ip wo,93145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Interrog crtd sins bat ip wo,93145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Interrog crtd sins bat ip w/,93146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Interrog crtd sins bat ip w/,93146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Interrog crtd sins bat ip w/,93146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Ecg monit/reprt up to 48 hrs,93224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,482.01,,,,,,,fee schedule,482.01,551.98, Ecg monit/reprt up to 48 hrs,93224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,551.98,,,,,,,fee schedule,482.01,551.98, Ecg monit/reprt up to 48 hrs,93225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,147.73,,,,,,,fee schedule,147.73,169.18, Ecg monit/reprt up to 48 hrs,93225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,169.18,,,,,,,fee schedule,147.73,169.18, Ecg monit/reprt up to 48 hrs,93225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,147.73,169.18,APC Ecg monit/reprt up to 48 hrs,93225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,147.73,169.18,APC Ecg monit/reprt up to 48 hrs,93225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,147.73,169.18,APC Ecg monit/reprt up to 48 hrs,93226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,259.68,,,,,,,fee schedule,69.69,297.38, Ecg monit/reprt up to 48 hrs,93226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,297.38,,,,,,,fee schedule,69.69,297.38, Ecg monit/reprt up to 48 hrs,93226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,297.38,APC Ecg monit/reprt up to 48 hrs,93226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,297.38,APC Ecg monit/reprt up to 48 hrs,93226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,297.38,APC Ecg monit/reprt up to 48 hrs,93227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,77.77,,,,,,,fee schedule,77.77,89.06, Ecg monit/reprt up to 48 hrs,93227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.06,,,,,,,fee schedule,77.77,89.06, Remote 30 day ecg rev/report,93228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.07,,,,,,,fee schedule,69.07,79.09, Remote 30 day ecg rev/report,93228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.09,,,,,,,fee schedule,69.07,79.09, Remote 30 day ecg tech supp,93229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.07,,,,,,,fee schedule,69.07,462.87, Remote 30 day ecg tech supp,93229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,79.09,,,,,,,fee schedule,69.07,462.87, Remote 30 day ecg tech supp,93229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,69.07,462.87,APC Remote 30 day ecg tech supp,93229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,69.07,462.87,APC Remote 30 day ecg tech supp,93229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,69.07,462.87,APC Ext ecg>48hr<7d rec scan a/r,93241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1058.12,,,,,,,fee schedule,1058.12,1211.71, Ext ecg>48hr<7d rec scan a/r,93241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1211.71,,,,,,,fee schedule,1058.12,1211.71, Ext ecg>48hr<7d recording,93242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.92,,,,,,,fee schedule,44.12,96.11, Ext ecg>48hr<7d recording,93242,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.11,,,,,,,fee schedule,44.12,96.11, Ext ecg>48hr<7d recording,93242,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,96.11,APC Ext ecg>48hr<7d recording,93242,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,96.11,APC Ext ecg>48hr<7d recording,93242,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,96.11,APC Ext ecg>48hr<7d scan a/r,93243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.04,,,,,,,fee schedule,138.04,165.03, Ext ecg>48hr<7d scan a/r,93243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,158.07,,,,,,,fee schedule,138.04,165.03, Ext ecg>48hr<7d scan a/r,93243,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,138.04,165.03,APC Ext ecg>48hr<7d scan a/r,93243,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,138.04,165.03,APC Ext ecg>48hr<7d scan a/r,93243,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,138.04,165.03,APC Ext ecg>48hr<7d rev&interpj,93244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.56,,,,,,,fee schedule,79.56,91.11, Ext ecg>48hr<7d rev&interpj,93244,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.11,,,,,,,fee schedule,79.56,91.11, Ext ecg>7d<15d rec scan a/r,93245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1058.12,,,,,,,fee schedule,1058.12,1211.71, Ext ecg>7d<15d rec scan a/r,93245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1211.71,,,,,,,fee schedule,1058.12,1211.71, Ext ecg>7d<15d recording,93246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.04,,,,,,,fee schedule,44.12,158.07, Ext ecg>7d<15d recording,93246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,158.07,,,,,,,fee schedule,44.12,158.07, Ext ecg>7d<15d recording,93246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,158.07,APC Ext ecg>7d<15d recording,93246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,158.07,APC Ext ecg>7d<15d recording,93246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,158.07,APC Ext ecg>7d<15d scan a/r,93247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,277.64,,,,,,,fee schedule,157.18,317.94, Ext ecg>7d<15d scan a/r,93247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,317.94,,,,,,,fee schedule,157.18,317.94, Ext ecg>7d<15d scan a/r,93247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,317.94,APC Ext ecg>7d<15d scan a/r,93247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,317.94,APC Ext ecg>7d<15d scan a/r,93247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,317.94,APC Ext ecg>7d<15d rev&interpj,93248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,79.56,,,,,,,fee schedule,79.56,91.11, Ext ecg>7d<15d rev&interpj,93248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.11,,,,,,,fee schedule,79.56,91.11, Prgrmg dev eval impltbl sys,93260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.2,,,,,,,fee schedule,44.09,96.42, Prgrmg dev eval impltbl sys,93260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.42,,,,,,,fee schedule,44.09,96.42, Prgrmg dev eval impltbl sys,93260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,96.42,APC Prgrmg dev eval impltbl sys,93260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,96.42,APC Prgrmg dev eval impltbl sys,93260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,96.42,APC Interrogate subq defib,93261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.2,,,,,,,fee schedule,44.09,96.42, Interrogate subq defib,93261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.42,,,,,,,fee schedule,44.09,96.42, Interrogate subq defib,93261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,96.42,APC Interrogate subq defib,93261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,96.42,APC Interrogate subq defib,93261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,96.42,APC ECG record/review,93268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,920.33,,,,,,,fee schedule,920.33,1053.92, ECG record/review,93268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1053.92,,,,,,,fee schedule,920.33,1053.92, Remote 30 day ecg rev/report,93270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,147.73,,,,,,,fee schedule,44.09,169.18, Remote 30 day ecg rev/report,93270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,169.18,,,,,,,fee schedule,44.09,169.18, Remote 30 day ecg rev/report,93270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,169.18,APC Remote 30 day ecg rev/report,93270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,169.18,APC Remote 30 day ecg rev/report,93270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,169.18,APC Ecg/monitoring and analysis,93271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,698.02,,,,,,,fee schedule,112.31,799.35, Ecg/monitoring and analysis,93271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,799.35,,,,,,,fee schedule,112.31,799.35, Ecg/monitoring and analysis,93271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.8,,,,,,,fee schedule,112.31,799.35,APC Ecg/monitoring and analysis,93271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.93,,,,,,,fee schedule,112.31,799.35,APC Ecg/monitoring and analysis,93271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.31,,,,,,,fee schedule,112.31,799.35,APC Ecg/review interpret only,93272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.5,,,,,,,fee schedule,74.5,85.31, Ecg/review interpret only,93272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.31,,,,,,,fee schedule,74.5,85.31, ECG/signal-averaged,93278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,177.02,,,,,,,fee schedule,69.69,202.72, ECG/signal-averaged,93278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,202.72,,,,,,,fee schedule,69.69,202.72, ECG/signal-averaged,93278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,202.72,APC ECG/signal-averaged,93278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,202.72,APC ECG/signal-averaged,93278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,202.72,APC Pm device progr eval sngl,93279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,176.23,,,,,,,fee schedule,44.09,201.81, Pm device progr eval sngl,93279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,201.81,,,,,,,fee schedule,44.09,201.81, Pm device progr eval sngl,93279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,201.81,APC Pm device progr eval sngl,93279,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,201.81,APC Pm device progr eval sngl,93279,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,201.81,APC Pm device progr eval dual,93280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,194.43,,,,,,,fee schedule,44.09,222.66, Pm device progr eval dual,93280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,222.66,,,,,,,fee schedule,44.09,222.66, Pm device progr eval dual,93280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,222.66,APC Pm device progr eval dual,93280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,222.66,APC Pm device progr eval dual,93280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,222.66,APC Pm device progr eval multi,93281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,218.19,,,,,,,fee schedule,44.09,249.86, Pm device progr eval multi,93281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,249.86,,,,,,,fee schedule,44.09,249.86, Pm device progr eval multi,93281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,249.86,APC Pm device progr eval multi,93281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,249.86,APC Pm device progr eval multi,93281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,249.86,APC Prgrmg eval implantable dfb,93282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,232.57,,,,,,,fee schedule,44.09,266.34, Prgrmg eval implantable dfb,93282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,266.34,,,,,,,fee schedule,44.09,266.34, Prgrmg eval implantable dfb,93282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,266.34,APC Prgrmg eval implantable dfb,93282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,266.34,APC Prgrmg eval implantable dfb,93282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,266.34,APC Prgrmg eval implantable dfb,93283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,258.47,,,,,,,fee schedule,44.09,295.98, Prgrmg eval implantable dfb,93283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,295.98,,,,,,,fee schedule,44.09,295.98, Prgrmg eval implantable dfb,93283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,295.98,APC Prgrmg eval implantable dfb,93283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,295.98,APC Prgrmg eval implantable dfb,93283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,295.98,APC Prgrmg eval implantable dfb,93284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,273.49,,,,,,,fee schedule,44.09,313.2, Prgrmg eval implantable dfb,93284,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,313.2,,,,,,,fee schedule,44.09,313.2, Prgrmg eval implantable dfb,93284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,313.2,APC Prgrmg eval implantable dfb,93284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,313.2,APC Prgrmg eval implantable dfb,93284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,313.2,APC Ilr device eval progr,93285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.71,,,,,,,fee schedule,44.09,86.71, Ilr device eval progr,93285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.71,,,,,,,fee schedule,44.09,86.71, Ilr device eval progr,93285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,86.71,APC Ilr device eval progr,93285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,86.71,APC Ilr device eval progr,93285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,86.71,APC Pm device eval in person,93288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,124.52,,,,,,,fee schedule,44.09,142.6, Pm device eval in person,93288,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,142.6,,,,,,,fee schedule,44.09,142.6, Pm device eval in person,93288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,142.6,APC Pm device eval in person,93288,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,142.6,APC Pm device eval in person,93288,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,142.6,APC Interrog device eval heart,93289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,196.22,,,,,,,fee schedule,44.09,224.7, Interrog device eval heart,93289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,224.7,,,,,,,fee schedule,44.09,224.7, Interrog device eval heart,93289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,224.7,APC Interrog device eval heart,93289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,224.7,APC Interrog device eval heart,93289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,224.7,APC Icm device eval,93290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.03,,,,,,,fee schedule,44.09,101.96, Icm device eval,93290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.96,,,,,,,fee schedule,44.09,101.96, Icm device eval,93290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,101.96,APC Icm device eval,93290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,101.96,APC Icm device eval,93290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,101.96,APC Ilr device interrogate,93291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,147.46,,,,,,,fee schedule,34.17,168.87, Ilr device interrogate,93291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,168.87,,,,,,,fee schedule,34.17,168.87, Ilr device interrogate,93291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,168.87,APC Ilr device interrogate,93291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,168.87,APC Ilr device interrogate,93291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,168.87,APC Wcd device interrogate,93292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.68,,,,,,,fee schedule,44.09,130.19, Wcd device interrogate,93292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,130.19,,,,,,,fee schedule,44.09,130.19, Wcd device interrogate,93292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,130.19,APC Wcd device interrogate,93292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,130.19,APC Wcd device interrogate,93292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,130.19,APC Pm phone r-strip device eval,93293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.22,,,,,,,fee schedule,44.09,113.63, Pm phone r-strip device eval,93293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.63,,,,,,,fee schedule,44.09,113.63, Pm phone r-strip device eval,93293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,113.63,APC Pm phone r-strip device eval,93293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,113.63,APC Pm phone r-strip device eval,93293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,113.63,APC Pm device interrogate remote,93294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,160.8,,,,,,,fee schedule,160.8,184.15, Pm device interrogate remote,93294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,184.15,,,,,,,fee schedule,160.8,184.15, Pm/icd remote tech serv,93296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,186.64,,,,,,,fee schedule,44.09,213.74, Pm/icd remote tech serv,93296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,213.74,,,,,,,fee schedule,44.09,213.74, Pm/icd remote tech serv,93296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,213.74,APC Pm/icd remote tech serv,93296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,213.74,APC Pm/icd remote tech serv,93296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,213.74,APC Icm device interrogat remote,93297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,186.64,,,,,,,fee schedule,44.09,213.74, Icm device interrogat remote,93297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,213.74,,,,,,,fee schedule,44.09,213.74, Icm device interrogat remote,93297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,213.74,APC Icm device interrogat remote,93297,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,213.74,APC Icm device interrogat remote,93297,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,213.74,APC Ilr device interrogat remote,93298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,186.64,,,,,,,fee schedule,44.09,213.74, Ilr device interrogat remote,93298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,213.74,,,,,,,fee schedule,44.09,213.74, Ilr device interrogat remote,93298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.85,,,,,,,fee schedule,44.09,213.74,APC Ilr device interrogat remote,93298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.29,,,,,,,fee schedule,44.09,213.74,APC Ilr device interrogat remote,93298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.09,,,,,,,fee schedule,44.09,213.74,APC Echo transthoracic,93303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,644.4,,,,,,,fee schedule,644.4,737.95, Echo transthoracic,93303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,737.95,,,,,,,fee schedule,644.4,737.95, Echo transthoracic,93303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,644.4,737.95,APC Echo transthoracic,93303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,644.4,737.95,APC Echo transthoracic,93303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,644.4,737.95,APC Echo transthoracic,93304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,339.91,,,,,,,fee schedule,339.91,677.78, Echo transthoracic,93304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,389.25,,,,,,,fee schedule,339.91,677.78, Echo transthoracic,93304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,339.91,677.78,APC Echo transthoracic,93304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,339.91,677.78,APC Echo transthoracic,93304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,339.91,677.78,APC Tte w/doppler complete,93306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,782.32,,,,,,,fee schedule,645.5,895.88, Tte w/doppler complete,93306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,895.88,,,,,,,fee schedule,645.5,895.88, Tte w/doppler complete,93306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,895.88,APC Tte w/doppler complete,93306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,895.88,APC Tte w/doppler complete,93306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,895.88,APC Tte w/o doppler complete,93307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,591.31,,,,,,,fee schedule,281.87,677.14, Tte w/o doppler complete,93307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,677.14,,,,,,,fee schedule,281.87,677.14, Tte w/o doppler complete,93307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,677.14,APC Tte w/o doppler complete,93307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,677.14,APC Tte w/o doppler complete,93307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,677.14,APC Tte f-up or lmtd,93308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,308.26,,,,,,,fee schedule,281.87,353.01, Tte f-up or lmtd,93308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,353.01,,,,,,,fee schedule,281.87,353.01, Tte f-up or lmtd,93308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,353.01,APC Tte f-up or lmtd,93308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,353.01,APC Tte f-up or lmtd,93308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,353.01,APC Echo transesophageal,93312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,767.96,,,,,,,fee schedule,645.5,879.43, Echo transesophageal,93312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,879.43,,,,,,,fee schedule,645.5,879.43, Echo transesophageal,93312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,879.43,APC Echo transesophageal,93312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,879.43,APC Echo transesophageal,93312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,879.43,APC Echo transesophageal,93313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,122.74,,,,,,,fee schedule,122.74,677.78, Echo transesophageal,93313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,140.55,,,,,,,fee schedule,122.74,677.78, Echo transesophageal,93313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,122.74,677.78,APC Echo transesophageal,93313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,122.74,677.78,APC Echo transesophageal,93313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,122.74,677.78,APC Echo transesophageal,93314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,635.35,,,,,,,fee schedule,635.35,727.58, Echo transesophageal,93314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,727.58,,,,,,,fee schedule,635.35,727.58, Echo transesophageal,93315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,821.9,,,,,,,fee schedule,645.5,941.2, Echo transesophageal,93315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,941.2,,,,,,,fee schedule,645.5,941.2, Echo transesophageal,93315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,941.2,APC Echo transesophageal,93315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,941.2,APC Echo transesophageal,93315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,941.2,APC Echo transesophageal,93316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.26,,,,,,,fee schedule,125.26,677.78, Echo transesophageal,93316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,143.45,,,,,,,fee schedule,125.26,677.78, Echo transesophageal,93316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,125.26,677.78,APC Echo transesophageal,93316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,125.26,677.78,APC Echo transesophageal,93316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,125.26,677.78,APC Echo transesophageal,93317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.92,,,,,,,fee schedule,121.92,139.61, Echo transesophageal,93317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,139.61,,,,,,,fee schedule,121.92,139.61, Echo Transesophageal Intraop,93318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.92,,,,,,,fee schedule,121.92,677.78, Echo Transesophageal Intraop,93318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,139.61,,,,,,,fee schedule,121.92,677.78, Echo Transesophageal Intraop,93318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,121.92,677.78,APC Echo Transesophageal Intraop,93318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,121.92,677.78,APC Echo Transesophageal Intraop,93318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,121.92,677.78,APC Doppler echo exam heart,93320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,259.95,,,,,,,fee schedule,259.95,297.69, Doppler echo exam heart,93320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,297.69,,,,,,,fee schedule,259.95,297.69, Doppler echo exam heart,93321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,155.45,,,,,,,fee schedule,155.45,178.01, Doppler echo exam heart,93321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,178.01,,,,,,,fee schedule,155.45,178.01, Doppler color flow add-on,93325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,358.71,,,,,,,fee schedule,358.71,410.78, Doppler color flow add-on,93325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,410.78,,,,,,,fee schedule,358.71,410.78, Stress tte only,93350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,426.11,,,,,,,fee schedule,426.11,677.78, Stress tte only,93350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,487.97,,,,,,,fee schedule,426.11,677.78, Stress tte only,93350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,426.11,677.78,APC Stress tte only,93350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,426.11,677.78,APC Stress tte only,93350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,426.11,677.78,APC Stress tte complete,93351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,736.54,,,,,,,fee schedule,645.5,843.45, Stress tte complete,93351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,843.45,,,,,,,fee schedule,645.5,843.45, Stress tte complete,93351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,843.45,APC Stress tte complete,93351,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,843.45,APC Stress tte complete,93351,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,843.45,APC Admin ecg contrast agent,93352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,112.99,,,,,,,fee schedule,112.99,129.39, Admin ecg contrast agent,93352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.39,,,,,,,fee schedule,112.99,129.39, Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2456.71,,,,,,,fee schedule,1544,18617, Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2813.33,,,,,,,fee schedule,1544,18617, Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,1544,18617,APC Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,1544,18617,APC Right heart cath,93451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,1544,18617,APC Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6677.05,,,,,,,fee schedule,3829.84,18617, Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7646.3,,,,,,,fee schedule,3829.84,18617, Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC Left hrt cath w/ventrclgrphy,93452,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6988.99,,,,,,,fee schedule,3829.84,18617, R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8003.52,,,,,,,fee schedule,3829.84,18617, R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath w/ventriclgrphy,93453,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,2150.88,18617, Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,2150.88,18617, Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2150.88,,,,,,,fee schedule,2150.88,18617, Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2463.1,,,,,,,fee schedule,2150.88,18617, Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2150.88,18617, Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2150.88,18617, Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,2150.88,18617,APC Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,2150.88,18617,APC Coronary artery angio s&i,93454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,2150.88,18617,APC Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6885.05,,,,,,,fee schedule,3829.84,18617, Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7884.49,,,,,,,fee schedule,3829.84,18617, Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC Coronary art/grft angio s&i,93455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8323.82,,,,,,,fee schedule,3829.84,18617, R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9532.12,,,,,,,fee schedule,3829.84,18617, R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R hrt coronary artery angio,93456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8664.48,,,,,,,fee schedule,3829.84,18617, R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9922.22,,,,,,,fee schedule,3829.84,18617, R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R hrt art/grft angio,93457,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13646.45,,,,,,,fee schedule,3829.84,18617, L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15627.38,,,,,,,fee schedule,3829.84,18617, L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC L hrt artery/ventricle angio,93458,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7178.34,,,,,,,fee schedule,3829.84,18617, L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8220.35,,,,,,,fee schedule,3829.84,18617, L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC L hrt art/grft angio,93459,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8041.5,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9208.81,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R&l hrt art/ventricle angio,93460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8254.63,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9452.88,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R&l hrt art/ventricle angio,93461,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC L hrt cath trnsptl puncture,93462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, L hrt cath trnsptl puncture,93462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,381.5,18617, Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,381.5,18617, Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,381.5,,,,,,,fee schedule,381.5,18617, Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,436.88,,,,,,,fee schedule,381.5,18617, Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,381.5,18617, Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,381.5,18617, Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1934,,,,,,,fee schedule,381.5,18617,APC Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1952.6,,,,,,,fee schedule,381.5,18617,APC Insert/place heart catheter,93503,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1859.62,,,,,,,fee schedule,381.5,18617,APC Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,888.16,18617, Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,888.16,18617, Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,888.16,,,,,,,fee schedule,888.16,18617, Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1017.09,,,,,,,fee schedule,888.16,18617, Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,888.16,18617, Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,888.16,18617, Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3879.28,,,,,,,fee schedule,888.16,18617,APC Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3916.58,,,,,,,fee schedule,888.16,18617,APC Biopsy of heart lining,93505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3730.07,,,,,,,fee schedule,888.16,18617,APC Inject congenital card cath,93563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.48,,,,,,,fee schedule,58.48,66.97, Inject congenital card cath,93563,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.97,,,,,,,fee schedule,58.48,66.97, Inject hrt congntl art/grft,93564,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.57,,,,,,,fee schedule,62.57,71.65, Inject hrt congntl art/grft,93564,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.65,,,,,,,fee schedule,62.57,71.65, Inject l ventr/atrial angio,93565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.96,,,,,,,fee schedule,41.96,48.05, Inject l ventr/atrial angio,93565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.05,,,,,,,fee schedule,41.96,48.05, Inject r ventr/atrial angio,93566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1288.01,,,,,,,fee schedule,1288.01,1474.98, Inject r ventr/atrial angio,93566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1474.98,,,,,,,fee schedule,1288.01,1474.98, Inject suprvlv aortography,93567,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.88,,,,,,,fee schedule,36.88,42.23, Inject suprvlv aortography,93567,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.23,,,,,,,fee schedule,36.88,42.23, Inject pulm art hrt cath,93568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.96,,,,,,,fee schedule,41.96,48.05, Inject pulm art hrt cath,93568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.05,,,,,,,fee schedule,41.96,48.05, Heart flow reserve measure,93571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,798.49,,,,,,,fee schedule,798.49,914.39, Heart flow reserve measure,93571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,914.39,,,,,,,fee schedule,798.49,914.39, Heart flow reserve measure,93572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,474.4,,,,,,,fee schedule,474.4,543.26, Heart flow reserve measure,93572,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,543.26,,,,,,,fee schedule,474.4,543.26, Transcath closure of asd,93580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,40714.75, Transcath closure of asd,93580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,40714.75, Transcath closure of asd,93580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35553.73,,,,,,,fee schedule,4081,40714.75, Transcath closure of asd,93580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40714.75,,,,,,,fee schedule,4081,40714.75, Transcath closure of asd,93580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,40714.75,APC Transcath closure of asd,93580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,40714.75,APC Transcath closure of asd,93580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,40714.75,APC Transcath closure of vsd,93581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,34382.97, Transcath closure of vsd,93581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,34382.97, Transcath closure of vsd,93581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30024.57,,,,,,,fee schedule,4081,34382.97, Transcath closure of vsd,93581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34382.97,,,,,,,fee schedule,4081,34382.97, Transcath closure of vsd,93581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,34382.97,APC Transcath closure of vsd,93581,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,34382.97,APC Transcath closure of vsd,93581,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,34382.97,APC Perq transcath closure pda,93582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,36877.34, Perq transcath closure pda,93582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,36877.34, Perq transcath closure pda,93582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32202.75,,,,,,,fee schedule,4081,36877.34, Perq transcath closure pda,93582,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36877.34,,,,,,,fee schedule,4081,36877.34, Perq transcath closure pda,93582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,36877.34,APC Perq transcath closure pda,93582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,36877.34,APC Perq transcath closure pda,93582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,36877.34,APC Perq transcath septal reduxn,93583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, Perq transcath septal reduxn,93583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, Vngrph chd anom/persist svc,93584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Vngrph chd anom/persist svc,93584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Vngrph chd azygs/hemiazygs,93585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Vngrph chd azygs/hemiazygs,93585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Vngrph chd coronary sinus,93586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Vngrph chd coronary sinus,93586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Vngrph chd vnvn cltrl at/abv,93587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Vngrph chd vnvn cltrl at/abv,93587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Vngrph chd vnvn cltrl below,93588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Vngrph chd vnvn cltrl below,93588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Perq transcath cls mitral,93590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,22738.78, Perq transcath cls mitral,93590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,22738.78, Perq transcath cls mitral,93590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,22738.78,APC Perq transcath cls mitral,93590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,22738.78,APC Perq transcath cls mitral,93590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,22738.78,APC Perq transcath cls aortic,93591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,22738.78, Perq transcath cls aortic,93591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,22738.78, Perq transcath cls aortic,93591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,22738.78,APC Perq transcath cls aortic,93591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,22738.78,APC Perq transcath cls aortic,93591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,22738.78,APC Perq transcath closure each,93592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Perq transcath closure each,93592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7344.57,,,,,,,fee schedule,3829.84,18617, R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8410.72,,,,,,,fee schedule,3829.84,18617, R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R hrt cath chd nml nt cnj,93593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7344.57,,,,,,,fee schedule,3829.84,18617, R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8410.72,,,,,,,fee schedule,3829.84,18617, R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R hrt cath chd abnl nt cnj,93594,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7344.57,,,,,,,fee schedule,3829.84,18617, L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8410.72,,,,,,,fee schedule,3829.84,18617, L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC L hrt cath chd nm/abn nt cnj,93595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7344.57,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8410.72,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath chd nml nt cnj,93596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7344.57,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8410.72,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3829.84,18617, R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3983.03,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4021.33,,,,,,,fee schedule,3829.84,18617,APC R&l hrt cath chd abnl nt cnj,93597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3829.84,,,,,,,fee schedule,3829.84,18617,APC Bundle of His recording,93600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,549.89,9674.8, Bundle of His recording,93600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,549.89,9674.8, Bundle of His recording,93600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,549.89,,,,,,,fee schedule,549.89,9674.8, Bundle of His recording,93600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,629.71,,,,,,,fee schedule,549.89,9674.8, Bundle of His recording,93600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,549.89,9674.8,APC Bundle of His recording,93600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,549.89,9674.8,APC Bundle of His recording,93600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,549.89,9674.8,APC Intra-atrial recording,93602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,449.03,,,,,,,fee schedule,449.03,9674.8, Intra-atrial recording,93602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,514.21,,,,,,,fee schedule,449.03,9674.8, Intra-atrial recording,93602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,449.03,9674.8,APC Intra-atrial recording,93602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,449.03,9674.8,APC Intra-atrial recording,93602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,449.03,9674.8,APC Right ventricular recording,93603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,516.96,,,,,,,fee schedule,516.96,1510.25, Right ventricular recording,93603,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,592,,,,,,,fee schedule,516.96,1510.25, Right ventricular recording,93603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1495.87,,,,,,,fee schedule,516.96,1510.25,APC Right ventricular recording,93603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1510.25,,,,,,,fee schedule,516.96,1510.25,APC Right ventricular recording,93603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1438.33,,,,,,,fee schedule,516.96,1510.25,APC Map tachycardia add-on,93609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1067.44,5028, Map tachycardia add-on,93609,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1067.44,5028, Map tachycardia add-on,93609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1067.44,,,,,,,fee schedule,1067.44,5028, Map tachycardia add-on,93609,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1222.39,,,,,,,fee schedule,1067.44,5028, Intra-atrial pacing,93610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,613.18,,,,,,,fee schedule,613.18,9674.8, Intra-atrial pacing,93610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,702.19,,,,,,,fee schedule,613.18,9674.8, Intra-atrial pacing,93610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,613.18,9674.8,APC Intra-atrial pacing,93610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,613.18,9674.8,APC Intra-atrial pacing,93610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,613.18,9674.8,APC Intraventricular pacing,93612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,643.56,,,,,,,fee schedule,643.56,9674.8, Intraventricular pacing,93612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,736.98,,,,,,,fee schedule,643.56,9674.8, Intraventricular pacing,93612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,643.56,9674.8,APC Intraventricular pacing,93612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,643.56,9674.8,APC Intraventricular pacing,93612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,643.56,9674.8,APC Electrophys map 3d add-on,93613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1078.97,,,,,,,fee schedule,1078.97,1235.6, Electrophys map 3d add-on,93613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1235.6,,,,,,,fee schedule,1078.97,1235.6, Esophageal recording,93615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,168.94,,,,,,,fee schedule,168.94,1510.25, Esophageal recording,93615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,193.46,,,,,,,fee schedule,168.94,1510.25, Esophageal recording,93615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1495.87,,,,,,,fee schedule,168.94,1510.25,APC Esophageal recording,93615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1510.25,,,,,,,fee schedule,168.94,1510.25,APC Esophageal recording,93615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1438.33,,,,,,,fee schedule,168.94,1510.25,APC Esophageal recording,93616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.63,,,,,,,fee schedule,241.63,1510.25, Esophageal recording,93616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,276.7,,,,,,,fee schedule,241.63,1510.25, Esophageal recording,93616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1495.87,,,,,,,fee schedule,241.63,1510.25,APC Esophageal recording,93616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1510.25,,,,,,,fee schedule,241.63,1510.25,APC Esophageal recording,93616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1438.33,,,,,,,fee schedule,241.63,1510.25,APC Heart rhythm pacing,93618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1091.27,5028, Heart rhythm pacing,93618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1091.27,5028, Heart rhythm pacing,93618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1091.27,,,,,,,fee schedule,1091.27,5028, Heart rhythm pacing,93618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1249.69,,,,,,,fee schedule,1091.27,5028, Heart rhythm pacing,93618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1495.87,,,,,,,fee schedule,1091.27,5028,APC Heart rhythm pacing,93618,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1510.25,,,,,,,fee schedule,1091.27,5028,APC Heart rhythm pacing,93618,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1438.33,,,,,,,fee schedule,1091.27,5028,APC Electrophysiology evaluation,93619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,2017.75,9674.8, Electrophysiology evaluation,93619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,2017.75,9674.8, Electrophysiology evaluation,93619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2017.75,,,,,,,fee schedule,2017.75,9674.8, Electrophysiology evaluation,93619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2310.65,,,,,,,fee schedule,2017.75,9674.8, Electrophysiology evaluation,93619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,2017.75,9674.8,APC Electrophysiology evaluation,93619,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,2017.75,9674.8,APC Electrophysiology evaluation,93619,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,2017.75,9674.8,APC Electrophysiology evaluation,93620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1078.97,9674.8, Electrophysiology evaluation,93620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1078.97,9674.8, Electrophysiology evaluation,93620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1078.97,,,,,,,fee schedule,1078.97,9674.8, Electrophysiology evaluation,93620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1235.6,,,,,,,fee schedule,1078.97,9674.8, Electrophysiology evaluation,93620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,1078.97,9674.8,APC Electrophysiology evaluation,93620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,1078.97,9674.8,APC Electrophysiology evaluation,93620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,1078.97,9674.8,APC Electrophysiology evaluation,93621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1078.97,5028, Electrophysiology evaluation,93621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1078.97,5028, Electrophysiology evaluation,93621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1078.97,,,,,,,fee schedule,1078.97,5028, Electrophysiology evaluation,93621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1235.6,,,,,,,fee schedule,1078.97,5028, Electrophysiology evaluation,93622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1078.97,5028, Electrophysiology evaluation,93622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1078.97,5028, Electrophysiology evaluation,93622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1078.97,,,,,,,fee schedule,1078.97,5028, Electrophysiology evaluation,93622,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1235.6,,,,,,,fee schedule,1078.97,5028, Electrophysiologic study,93624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,971.04,,,,,,,fee schedule,971.04,9674.8, Electrophysiologic study,93624,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1112,,,,,,,fee schedule,971.04,9674.8, Electrophysiologic study,93624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,971.04,9674.8,APC Electrophysiologic study,93624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,971.04,9674.8,APC Electrophysiologic study,93624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,971.04,9674.8,APC Heart pacing mapping,93631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1890.7,,,,,,,fee schedule,1890.7,2165.16, Heart pacing mapping,93631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2165.16,,,,,,,fee schedule,1890.7,2165.16, Evaluation heart device,93640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1361.5,5028, Evaluation heart device,93640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1361.5,5028, Evaluation heart device,93640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1361.5,,,,,,,fee schedule,1361.5,5028, Evaluation heart device,93640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1559.13,,,,,,,fee schedule,1361.5,5028, Electrophysiology evaluation,93641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1713.93,5028, Electrophysiology evaluation,93641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1713.93,5028, Electrophysiology evaluation,93641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1713.93,,,,,,,fee schedule,1713.93,5028, Electrophysiology evaluation,93641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1962.72,,,,,,,fee schedule,1713.93,5028, Electrophysiology evaluation,93642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1438.33,5028, Electrophysiology evaluation,93642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1438.33,5028, Electrophysiology evaluation,93642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1596.55,,,,,,,fee schedule,1438.33,5028, Electrophysiology evaluation,93642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1828.31,,,,,,,fee schedule,1438.33,5028, Electrophysiology evaluation,93642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1495.87,,,,,,,fee schedule,1438.33,5028,APC Electrophysiology evaluation,93642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1510.25,,,,,,,fee schedule,1438.33,5028,APC Electrophysiology evaluation,93642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1438.33,,,,,,,fee schedule,1438.33,5028,APC Ablate heart dysrhythm focus,93650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,1600.72,9674.8, Ablate heart dysrhythm focus,93650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,1600.72,9674.8, Ablate heart dysrhythm focus,93650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1600.72,,,,,,,fee schedule,1600.72,9674.8, Ablate heart dysrhythm focus,93650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1833.08,,,,,,,fee schedule,1600.72,9674.8, Ablate heart dysrhythm focus,93650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.66,,,,,,,fee schedule,1600.72,9674.8,APC Ablate heart dysrhythm focus,93650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.8,,,,,,,fee schedule,1600.72,9674.8,APC Ablate heart dysrhythm focus,93650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.09,,,,,,,fee schedule,1600.72,9674.8,APC Ep & ablate supravent arrhyt,93653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,32421.71, Ep & ablate supravent arrhyt,93653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,32421.71, Ep & ablate supravent arrhyt,93653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24153.94,,,,,,,fee schedule,4147,32421.71, Ep & ablate supravent arrhyt,93653,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27660.15,,,,,,,fee schedule,4147,32421.71, Ep & ablate supravent arrhyt,93653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32112.94,,,,,,,fee schedule,4147,32421.71,APC Ep & ablate supravent arrhyt,93653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32421.71,,,,,,,fee schedule,4147,32421.71,APC Ep & ablate supravent arrhyt,93653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30877.82,,,,,,,fee schedule,4147,32421.71,APC Ep & ablate ventric tachy,93654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,32421.71, Ep & ablate ventric tachy,93654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,32421.71, Ep & ablate ventric tachy,93654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24153.94,,,,,,,fee schedule,4147,32421.71, Ep & ablate ventric tachy,93654,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27660.15,,,,,,,fee schedule,4147,32421.71, Ep & ablate ventric tachy,93654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32112.94,,,,,,,fee schedule,4147,32421.71,APC Ep & ablate ventric tachy,93654,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32421.71,,,,,,,fee schedule,4147,32421.71,APC Ep & ablate ventric tachy,93654,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30877.82,,,,,,,fee schedule,4147,32421.71,APC Ablate arrhythmia add on,93655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,27660.15, Ablate arrhythmia add on,93655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,27660.15, Ablate arrhythmia add on,93655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24153.94,,,,,,,fee schedule,1544,27660.15, Ablate arrhythmia add on,93655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27660.15,,,,,,,fee schedule,1544,27660.15, Tx atrial fib pulm vein isol,93656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,32421.71, Tx atrial fib pulm vein isol,93656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,32421.71, Tx atrial fib pulm vein isol,93656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24153.94,,,,,,,fee schedule,4147,32421.71, Tx atrial fib pulm vein isol,93656,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27660.15,,,,,,,fee schedule,4147,32421.71, Tx atrial fib pulm vein isol,93656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32112.94,,,,,,,fee schedule,4147,32421.71,APC Tx atrial fib pulm vein isol,93656,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32421.71,,,,,,,fee schedule,4147,32421.71,APC Tx atrial fib pulm vein isol,93656,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30877.82,,,,,,,fee schedule,4147,32421.71,APC Tx l/r atrial fib addl,93657,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,27660.15, Tx l/r atrial fib addl,93657,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,27660.15, Tx l/r atrial fib addl,93657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24153.94,,,,,,,fee schedule,1544,27660.15, Tx l/r atrial fib addl,93657,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27660.15,,,,,,,fee schedule,1544,27660.15, Tilt table evaluation,93660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,275.58,,,,,,,fee schedule,275.58,462.87, Tilt table evaluation,93660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,315.58,,,,,,,fee schedule,275.58,462.87, Tilt table evaluation,93660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,275.58,462.87,APC Tilt table evaluation,93660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,275.58,462.87,APC Tilt table evaluation,93660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,275.58,462.87,APC Intracardiac Ecg (Ice),93662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,409.92,,,,,,,fee schedule,409.92,469.42, Intracardiac Ecg (Ice),93662,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,469.42,,,,,,,fee schedule,409.92,469.42, Peripheral Vascular Rehab,93668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Peripheral Vascular Rehab,93668,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Peripheral Vascular Rehab,93668,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Bioimpedance cv analysis,93701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.47,,,,,,,fee schedule,99.47,165.03, Bioimpedance cv analysis,93701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.91,,,,,,,fee schedule,99.47,165.03, Bioimpedance cv analysis,93701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,99.47,165.03,APC Bioimpedance cv analysis,93701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,99.47,165.03,APC Bioimpedance cv analysis,93701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,99.47,165.03,APC Bis xtracell fluid analysis,93702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.97,,,,,,,fee schedule,152.01,188.92, Bis xtracell fluid analysis,93702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,188.92,,,,,,,fee schedule,152.01,188.92, Bis xtracell fluid analysis,93702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,188.92,APC Bis xtracell fluid analysis,93702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,188.92,APC Bis xtracell fluid analysis,93702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,188.92,APC Analyze pacemaker system,93724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1182.39,,,,,,,fee schedule,362.84,1354.03, Analyze pacemaker system,93724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1354.03,,,,,,,fee schedule,362.84,1354.03, Analyze pacemaker system,93724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.35,,,,,,,fee schedule,362.84,1354.03,APC Analyze pacemaker system,93724,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.98,,,,,,,fee schedule,362.84,1354.03,APC Analyze pacemaker system,93724,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.84,,,,,,,fee schedule,362.84,1354.03,APC Temperature gradient studies,93740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.64,,,,,,,fee schedule,26.64,159.61, Temperature gradient studies,93740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.5,,,,,,,fee schedule,26.64,159.61, Temperature gradient studies,93740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,26.64,159.61,APC Temperature gradient studies,93740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,26.64,159.61,APC Temperature gradient studies,93740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,26.64,159.61,APC Interrogation vad in person,93750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,404.04,,,,,,,fee schedule,112.31,462.69, Interrogation vad in person,93750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,462.69,,,,,,,fee schedule,112.31,462.69, Interrogation vad in person,93750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.8,,,,,,,fee schedule,112.31,462.69,APC Interrogation vad in person,93750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.93,,,,,,,fee schedule,112.31,462.69,APC Interrogation vad in person,93750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.31,,,,,,,fee schedule,112.31,462.69,APC Measure venous pressure,93770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.36,,,,,,,fee schedule,23.36,26.75, Measure venous pressure,93770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.75,,,,,,,fee schedule,23.36,26.75, Ambulatory BP monitoring,93784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,190.89,,,,,,,fee schedule,190.89,218.59, Ambulatory BP monitoring,93784,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,218.59,,,,,,,fee schedule,190.89,218.59, Ambulatory BP recording,93786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.16,,,,,,,fee schedule,89.16,165.03, Ambulatory BP recording,93786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.1,,,,,,,fee schedule,89.16,165.03, Ambulatory BP recording,93786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,89.16,165.03,APC Ambulatory BP recording,93786,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,89.16,165.03,APC Ambulatory BP recording,93786,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,89.16,165.03,APC Ambulatory BP analysis,93788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.95,,,,,,,fee schedule,49.95,165.03, Ambulatory BP analysis,93788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.2,,,,,,,fee schedule,49.95,165.03, Ambulatory BP analysis,93788,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,49.95,165.03,APC Ambulatory BP analysis,93788,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,49.95,165.03,APC Ambulatory BP analysis,93788,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,49.95,165.03,APC Review/report BP recording,93790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.76,,,,,,,fee schedule,51.76,59.27, Review/report BP recording,93790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,59.27,,,,,,,fee schedule,51.76,59.27, Cardiovascular procedure,93799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,204.38,,,,,,,fee schedule,152.01,234.04, Cardiovascular procedure,93799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,234.04,,,,,,,fee schedule,152.01,234.04, Cardiovascular procedure,93799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,234.04,APC Cardiovascular procedure,93799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,234.04,APC Cardiovascular procedure,93799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,234.04,APC Extracranial bilat study,93880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,723.22,,,,,,,fee schedule,281.87,1259.18, Extracranial bilat study,93880,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,828.2,,,,,,,fee schedule,281.87,1259.18, Extracranial bilat study,93880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1049.32,,,,,,,fee schedule,281.87,1259.18, Extracranial bilat study,93880,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1259.18,,,,,,,fee schedule,281.87,1259.18, Extracranial bilat study,93880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1259.18,APC Extracranial bilat study,93880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1259.18,APC Extracranial bilat study,93880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1259.18,APC Extracranial uni/ltd study,93882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,459.44,,,,,,,fee schedule,123.5,835.83, Extracranial uni/ltd study,93882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,526.14,,,,,,,fee schedule,123.5,835.83, Extracranial uni/ltd study,93882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,696.52,,,,,,,fee schedule,123.5,835.83, Extracranial uni/ltd study,93882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,835.83,,,,,,,fee schedule,123.5,835.83, Extracranial uni/ltd study,93882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,835.83,APC Extracranial uni/ltd study,93882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,835.83,APC Extracranial uni/ltd study,93882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,835.83,APC Intracranial complete study,93886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,897.07,,,,,,,fee schedule,281.87,1888.91, Intracranial complete study,93886,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1027.28,,,,,,,fee schedule,281.87,1888.91, Intracranial complete study,93886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1574.09,,,,,,,fee schedule,281.87,1888.91, Intracranial complete study,93886,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1888.91,,,,,,,fee schedule,281.87,1888.91, Intracranial complete study,93886,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1888.91,APC Intracranial complete study,93886,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1888.91,APC Intracranial complete study,93886,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1888.91,APC Intracranial limited study,93888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,570.38,,,,,,,fee schedule,123.5,1116.28, Intracranial limited study,93888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,653.17,,,,,,,fee schedule,123.5,1116.28, Intracranial limited study,93888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,930.24,,,,,,,fee schedule,123.5,1116.28, Intracranial limited study,93888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1116.28,,,,,,,fee schedule,123.5,1116.28, Intracranial limited study,93888,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1116.28,APC Intracranial limited study,93888,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1116.28,APC Intracranial limited study,93888,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1116.28,APC Tcd vasoreactivity study,93890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,768.16,,,,,,,fee schedule,768.16,879.66, Tcd vasoreactivity study,93890,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,879.66,,,,,,,fee schedule,768.16,879.66, Tcd emboli detect w/o inj,93892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,841.04,,,,,,,fee schedule,123.5,963.13, Tcd emboli detect w/o inj,93892,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,963.13,,,,,,,fee schedule,123.5,963.13, Tcd emboli detect w/o inj,93892,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,963.13,APC Tcd emboli detect w/o inj,93892,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,963.13,APC Tcd emboli detect w/o inj,93892,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,963.13,APC Tcd emboli detect w/inj,93893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,838.86,,,,,,,fee schedule,123.5,960.63, Tcd emboli detect w/inj,93893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,960.63,,,,,,,fee schedule,123.5,960.63, Tcd emboli detect w/inj,93893,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,960.63,APC Tcd emboli detect w/inj,93893,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,960.63,APC Tcd emboli detect w/inj,93893,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,960.63,APC Upr/l xtremity art 2 levels,93922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,341.97,,,,,,,fee schedule,157.18,582.81, Upr/l xtremity art 2 levels,93922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,391.61,,,,,,,fee schedule,157.18,582.81, Upr/l xtremity art 2 levels,93922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,485.68,,,,,,,fee schedule,157.18,582.81, Upr/l xtremity art 2 levels,93922,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,582.81,,,,,,,fee schedule,157.18,582.81, Upr/l xtremity art 2 levels,93922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,582.81,APC Upr/l xtremity art 2 levels,93922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,582.81,APC Upr/l xtremity art 2 levels,93922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,582.81,APC Upr/lxtr art stdy 3+ lvls,93923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,524.54,,,,,,,fee schedule,255.08,899.03, Upr/lxtr art stdy 3+ lvls,93923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,600.69,,,,,,,fee schedule,255.08,899.03, Upr/lxtr art stdy 3+ lvls,93923,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,749.19,,,,,,,fee schedule,255.08,899.03, Upr/lxtr art stdy 3+ lvls,93923,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,899.03,,,,,,,fee schedule,255.08,899.03, Upr/lxtr art stdy 3+ lvls,93923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,899.03,APC Upr/lxtr art stdy 3+ lvls,93923,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,899.03,APC Upr/lxtr art stdy 3+ lvls,93923,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,899.03,APC Lwr xtr vasc stdy bilat,93924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,619.23,,,,,,,fee schedule,255.08,1127.23, Lwr xtr vasc stdy bilat,93924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,709.12,,,,,,,fee schedule,255.08,1127.23, Lwr xtr vasc stdy bilat,93924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,939.36,,,,,,,fee schedule,255.08,1127.23, Lwr xtr vasc stdy bilat,93924,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1127.23,,,,,,,fee schedule,255.08,1127.23, Lwr xtr vasc stdy bilat,93924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,1127.23,APC Lwr xtr vasc stdy bilat,93924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,1127.23,APC Lwr xtr vasc stdy bilat,93924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,1127.23,APC Lower extremity study,93925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,860.88,,,,,,,fee schedule,281.87,1677.13, Lower extremity study,93925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,985.85,,,,,,,fee schedule,281.87,1677.13, Lower extremity study,93925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1397.61,,,,,,,fee schedule,281.87,1677.13, Lower extremity study,93925,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1677.13,,,,,,,fee schedule,281.87,1677.13, Lower extremity study,93925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1677.13,APC Lower extremity study,93925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1677.13,APC Lower extremity study,93925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1677.13,APC Lower extremity study,93926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,521.77,,,,,,,fee schedule,123.5,1000.76, Lower extremity study,93926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,597.51,,,,,,,fee schedule,123.5,1000.76, Lower extremity study,93926,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,833.97,,,,,,,fee schedule,123.5,1000.76, Lower extremity study,93926,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1000.76,,,,,,,fee schedule,123.5,1000.76, Lower extremity study,93926,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1000.76,APC Lower extremity study,93926,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1000.76,APC Lower extremity study,93926,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1000.76,APC Upper extremity study,93930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,688.45,,,,,,,fee schedule,281.87,1325.22, Upper extremity study,93930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,788.38,,,,,,,fee schedule,281.87,1325.22, Upper extremity study,93930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1104.35,,,,,,,fee schedule,281.87,1325.22, Upper extremity study,93930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1325.22,,,,,,,fee schedule,281.87,1325.22, Upper extremity study,93930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1325.22,APC Upper extremity study,93930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1325.22,APC Upper extremity study,93930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1325.22,APC Upper extremity study,93931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,449.15,,,,,,,fee schedule,123.5,830.28, Upper extremity study,93931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,514.35,,,,,,,fee schedule,123.5,830.28, Upper extremity study,93931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,691.9,,,,,,,fee schedule,123.5,830.28, Upper extremity study,93931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,830.28,,,,,,,fee schedule,123.5,830.28, Upper extremity study,93931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,830.28,APC Upper extremity study,93931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,830.28,APC Upper extremity study,93931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,830.28,APC Extremity study,93970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,702.26,,,,,,,fee schedule,281.87,1275.74, Extremity study,93970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,804.2,,,,,,,fee schedule,281.87,1275.74, Extremity study,93970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1063.12,,,,,,,fee schedule,281.87,1275.74, Extremity study,93970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1275.74,,,,,,,fee schedule,281.87,1275.74, Extremity study,93970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1275.74,APC Extremity study,93970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1275.74,APC Extremity study,93970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1275.74,APC Extremity study,93971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,478.07,,,,,,,fee schedule,123.5,811.09, Extremity study,93971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,547.47,,,,,,,fee schedule,123.5,811.09, Extremity study,93971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,675.91,,,,,,,fee schedule,123.5,811.09, Extremity study,93971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,811.09,,,,,,,fee schedule,123.5,811.09, Extremity study,93971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,811.09,APC Extremity study,93971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,811.09,APC Extremity study,93971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,811.09,APC Vascular study,93975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1092.46,,,,,,,fee schedule,281.87,1734.86, Vascular study,93975,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1251.05,,,,,,,fee schedule,281.87,1734.86, Vascular study,93975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1445.71,,,,,,,fee schedule,281.87,1734.86, Vascular study,93975,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1734.86,,,,,,,fee schedule,281.87,1734.86, Vascular study,93975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1734.86,APC Vascular study,93975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1734.86,APC Vascular study,93975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1734.86,APC Vascular study,93976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,642.22,,,,,,,fee schedule,123.5,1000.76, Vascular study,93976,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,735.45,,,,,,,fee schedule,123.5,1000.76, Vascular study,93976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,833.97,,,,,,,fee schedule,123.5,1000.76, Vascular study,93976,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1000.76,,,,,,,fee schedule,123.5,1000.76, Vascular study,93976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1000.76,APC Vascular study,93976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1000.76,APC Vascular study,93976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1000.76,APC Vascular study,93978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,613.55,,,,,,,fee schedule,281.87,1179.49, Vascular study,93978,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,702.62,,,,,,,fee schedule,281.87,1179.49, Vascular study,93978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,982.91,,,,,,,fee schedule,281.87,1179.49, Vascular study,93978,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1179.49,,,,,,,fee schedule,281.87,1179.49, Vascular study,93978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1179.49,APC Vascular study,93978,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1179.49,APC Vascular study,93978,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1179.49,APC Vascular study,93979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,431.32,,,,,,,fee schedule,123.5,780.8, Vascular study,93979,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,493.93,,,,,,,fee schedule,123.5,780.8, Vascular study,93979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,650.67,,,,,,,fee schedule,123.5,780.8, Vascular study,93979,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,780.8,,,,,,,fee schedule,123.5,780.8, Vascular study,93979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,780.8,APC Vascular study,93979,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,780.8,APC Vascular study,93979,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,780.8,APC Penile vascular study,93980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,483.38,,,,,,,fee schedule,123.5,553.54, Penile vascular study,93980,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,553.54,,,,,,,fee schedule,123.5,553.54, Penile vascular study,93980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,400.96,,,,,,,fee schedule,123.5,553.54, Penile vascular study,93980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,481.15,,,,,,,fee schedule,123.5,553.54, Penile vascular study,93980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,553.54,APC Penile vascular study,93980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,553.54,APC Penile vascular study,93980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,553.54,APC Penile vascular study,93981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,397.94,,,,,,,fee schedule,123.5,455.71, Penile vascular study,93981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,455.71,,,,,,,fee schedule,123.5,455.71, Penile vascular study,93981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,343.67,,,,,,,fee schedule,123.5,455.71, Penile vascular study,93981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,412.4,,,,,,,fee schedule,123.5,455.71, Penile vascular study,93981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,455.71,APC Penile vascular study,93981,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,455.71,APC Penile vascular study,93981,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,455.71,APC Dup-scan hemo compl bi std,93985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,577.94,,,,,,,fee schedule,281.87,1737.63, Dup-scan hemo compl bi std,93985,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,661.83,,,,,,,fee schedule,281.87,1737.63, Dup-scan hemo compl bi std,93985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1448.02,,,,,,,fee schedule,281.87,1737.63, Dup-scan hemo compl bi std,93985,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1737.63,,,,,,,fee schedule,281.87,1737.63, Dup-scan hemo compl bi std,93985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1737.63,APC Dup-scan hemo compl bi std,93985,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1737.63,APC Dup-scan hemo compl bi std,93985,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1737.63,APC Dup-scan hemo compl uni std,93986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,277.96,,,,,,,fee schedule,123.5,1011.71, Dup-scan hemo compl uni std,93986,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,318.31,,,,,,,fee schedule,123.5,1011.71, Dup-scan hemo compl uni std,93986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,843.09,,,,,,,fee schedule,123.5,1011.71, Dup-scan hemo compl uni std,93986,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1011.71,,,,,,,fee schedule,123.5,1011.71, Dup-scan hemo compl uni std,93986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1011.71,APC Dup-scan hemo compl uni std,93986,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1011.71,APC Dup-scan hemo compl uni std,93986,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1011.71,APC Doppler flow testing,93990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,500.29,,,,,,,fee schedule,123.5,1022.73, Doppler flow testing,93990,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,572.91,,,,,,,fee schedule,123.5,1022.73, Doppler flow testing,93990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,852.27,,,,,,,fee schedule,123.5,1022.73, Doppler flow testing,93990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1022.73,,,,,,,fee schedule,123.5,1022.73, Doppler flow testing,93990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,1022.73,APC Doppler flow testing,93990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,1022.73,APC Doppler flow testing,93990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,1022.73,APC Noninvas vasc dx study proc,93998,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.11,,,,,,,fee schedule,34.17,140.98, Noninvas vasc dx study proc,93998,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,140.98,,,,,,,fee schedule,34.17,140.98, Noninvas vasc dx study proc,93998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,140.98,APC Noninvas vasc dx study proc,93998,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,140.98,APC Noninvas vasc dx study proc,93998,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,140.98,APC Vent mgmt inpat init day,94002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,232.8,,,,,,,fee schedule,232.8,766.31, Vent mgmt inpat init day,94002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,266.59,,,,,,,fee schedule,232.8,766.31, Vent mgmt inpat init day,94002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,759.01,,,,,,,fee schedule,232.8,766.31,APC Vent mgmt inpat init day,94002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,766.31,,,,,,,fee schedule,232.8,766.31,APC Vent mgmt inpat init day,94002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,729.82,,,,,,,fee schedule,232.8,766.31,APC Vent mgmt inpat subq day,94003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,387.57,,,,,,,fee schedule,387.57,766.31, Vent mgmt inpat subq day,94003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,443.84,,,,,,,fee schedule,387.57,766.31, Vent mgmt inpat subq day,94003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,759.01,,,,,,,fee schedule,387.57,766.31,APC Vent mgmt inpat subq day,94003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,766.31,,,,,,,fee schedule,387.57,766.31,APC Vent mgmt inpat subq day,94003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,729.82,,,,,,,fee schedule,387.57,766.31,APC Breathing capacity test,94010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,95.43,,,,,,,fee schedule,95.43,267.83, Breathing capacity test,94010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.28,,,,,,,fee schedule,95.43,267.83, Breathing capacity test,94010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,95.43,267.83,APC Breathing capacity test,94010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,95.43,267.83,APC Breathing capacity test,94010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,95.43,267.83,APC Spirometry up to 2 yrs old,94011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Spirometry up to 2 yrs old,94011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Spirometry up to 2 yrs old,94011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Spirmtry w/brnchdil inf-2 yr,94012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Spirmtry w/brnchdil inf-2 yr,94012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Spirmtry w/brnchdil inf-2 yr,94012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Meas lung vol thru 2 yrs,94013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,771.03,,,,,,,fee schedule,440.83,882.96, Meas lung vol thru 2 yrs,94013,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,882.96,,,,,,,fee schedule,440.83,882.96, Meas lung vol thru 2 yrs,94013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,882.96,APC Meas lung vol thru 2 yrs,94013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,882.96,APC Meas lung vol thru 2 yrs,94013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,882.96,APC Patient recorded spirometry,94014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,137.54,,,,,,,fee schedule,137.54,554.12, Patient recorded spirometry,94014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,157.51,,,,,,,fee schedule,137.54,554.12, Patient recorded spirometry,94014,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,137.54,554.12,APC Patient recorded spirometry,94014,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,137.54,554.12,APC Patient recorded spirometry,94014,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,137.54,554.12,APC Patient recorded spirometry,94015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.66,,,,,,,fee schedule,70.66,267.83, Patient recorded spirometry,94015,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.91,,,,,,,fee schedule,70.66,267.83, Patient recorded spirometry,94015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,70.66,267.83,APC Patient recorded spirometry,94015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,70.66,267.83,APC Patient recorded spirometry,94015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,70.66,267.83,APC Review patient spirometry,94016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.89,,,,,,,fee schedule,26.96,76.59, Review patient spirometry,94016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.59,,,,,,,fee schedule,26.96,76.59, Review patient spirometry,94016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.04,,,,,,,fee schedule,26.96,76.59,APC Review patient spirometry,94016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.31,,,,,,,fee schedule,26.96,76.59,APC Review patient spirometry,94016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.96,,,,,,,fee schedule,26.96,76.59,APC Evaluation of wheezing,94060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,158.15,,,,,,,fee schedule,158.15,462.87, Evaluation of wheezing,94060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,181.11,,,,,,,fee schedule,158.15,462.87, Evaluation of wheezing,94060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,158.15,462.87,APC Evaluation of wheezing,94060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,158.15,462.87,APC Evaluation of wheezing,94060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,158.15,462.87,APC Evaluation of wheezing,94070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,163.56,,,,,,,fee schedule,163.56,462.87, Evaluation of wheezing,94070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,187.3,,,,,,,fee schedule,163.56,462.87, Evaluation of wheezing,94070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,163.56,462.87,APC Evaluation of wheezing,94070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,163.56,462.87,APC Evaluation of wheezing,94070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,163.56,462.87,APC Vital capacity test,94150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.14,,,,,,,fee schedule,66.14,159.61, Vital capacity test,94150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.74,,,,,,,fee schedule,66.14,159.61, Vital capacity test,94150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,66.14,159.61,APC Vital capacity test,94150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,66.14,159.61,APC Vital capacity test,94150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,66.14,159.61,APC Lung function test (MBC/MVV),94200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.41,,,,,,,fee schedule,63.41,73.17, Lung function test (MBC/MVV),94200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.62,,,,,,,fee schedule,63.41,73.17, Lung function test (MBC/MVV),94200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,63.41,73.17,APC Lung function test (MBC/MVV),94200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,63.41,73.17,APC Lung function test (MBC/MVV),94200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,63.41,73.17,APC Respiratory flow volume loop,94375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.28,,,,,,,fee schedule,101.28,267.83, Respiratory flow volume loop,94375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,115.99,,,,,,,fee schedule,101.28,267.83, Respiratory flow volume loop,94375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,101.28,267.83,APC Respiratory flow volume loop,94375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,101.28,267.83,APC Respiratory flow volume loop,94375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,101.28,267.83,APC Hypoxia response curve,94450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,139.43,,,,,,,fee schedule,139.43,159.66, Hypoxia response curve,94450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,159.66,,,,,,,fee schedule,139.43,159.66, Hypoxia response curve,94450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,139.43,159.66,APC Hypoxia response curve,94450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,139.43,159.66,APC Hypoxia response curve,94450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,139.43,159.66,APC Hast w/report,94452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,107.33,,,,,,,fee schedule,107.33,165.03, Hast w/report,94452,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.92,,,,,,,fee schedule,107.33,165.03, Hast w/report,94452,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,107.33,165.03,APC Hast w/report,94452,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,107.33,165.03,APC Hast w/report,94452,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,107.33,165.03,APC Hast w/oxygen titrate,94453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,159.56,,,,,,,fee schedule,157.18,182.73, Hast w/oxygen titrate,94453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,182.73,,,,,,,fee schedule,157.18,182.73, Hast w/oxygen titrate,94453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,182.73,APC Hast w/oxygen titrate,94453,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,182.73,APC Hast w/oxygen titrate,94453,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,182.73,APC Surfactant Admin Thru Tube,94610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.03,,,,,,,fee schedule,258.69,271.62,APC Surfactant Admin Thru Tube,94610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.62,,,,,,,fee schedule,258.69,271.62,APC Surfactant Admin Thru Tube,94610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.69,,,,,,,fee schedule,258.69,271.62,APC Exercise tst brncspsm,94617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Exercise tst brncspsm,94617,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Exercise tst brncspsm,94617,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Pulmonary stress testing,94618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,357.12,,,,,,,fee schedule,157.18,408.96, Pulmonary stress testing,94618,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,408.96,,,,,,,fee schedule,157.18,408.96, Pulmonary stress testing,94618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,408.96,APC Pulmonary stress testing,94618,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,408.96,APC Pulmonary stress testing,94618,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,408.96,APC Exercise tst brncspsm wo ecg,94619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.04,,,,,,,fee schedule,69.69,158.07, Exercise tst brncspsm wo ecg,94619,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,158.07,,,,,,,fee schedule,69.69,158.07, Exercise tst brncspsm wo ecg,94619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,158.07,APC Exercise tst brncspsm wo ecg,94619,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,158.07,APC Exercise tst brncspsm wo ecg,94619,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,158.07,APC Pulm stress test/complex,94621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,208.52,,,,,,,fee schedule,208.52,462.87, Pulm stress test/complex,94621,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,238.79,,,,,,,fee schedule,208.52,462.87, Pulm stress test/complex,94621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,208.52,462.87,APC Pulm stress test/complex,94621,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,208.52,462.87,APC Pulm stress test/complex,94621,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,208.52,462.87,APC Phy/qhp op pulm rhb w/o mntr,94625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,140.99,,,,,,,fee schedule,69.69,161.45, Phy/qhp op pulm rhb w/o mntr,94625,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,161.45,,,,,,,fee schedule,69.69,161.45, Phy/qhp op pulm rhb w/o mntr,94625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,161.45,APC Phy/qhp op pulm rhb w/o mntr,94625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,161.45,APC Phy/qhp op pulm rhb w/o mntr,94625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,161.45,APC Phy/qhp op pulm rhb w/mntr,94626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,140.99,,,,,,,fee schedule,69.69,161.45, Phy/qhp op pulm rhb w/mntr,94626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,161.45,,,,,,,fee schedule,69.69,161.45, Phy/qhp op pulm rhb w/mntr,94626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,161.45,APC Phy/qhp op pulm rhb w/mntr,94626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,161.45,APC Phy/qhp op pulm rhb w/mntr,94626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,161.45,APC Airway inhalation treatment,94640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.81,,,,,,,fee schedule,35.81,271.62, Airway inhalation treatment,94640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.01,,,,,,,fee schedule,35.81,271.62, Airway inhalation treatment,94640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.03,,,,,,,fee schedule,35.81,271.62,APC Airway inhalation treatment,94640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.62,,,,,,,fee schedule,35.81,271.62,APC Airway inhalation treatment,94640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.69,,,,,,,fee schedule,35.81,271.62,APC Aerosol inhalation treatment,94642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,259.16,,,,,,,fee schedule,258.69,296.78, Aerosol inhalation treatment,94642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,296.78,,,,,,,fee schedule,258.69,296.78, Aerosol inhalation treatment,94642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.03,,,,,,,fee schedule,258.69,296.78,APC Aerosol inhalation treatment,94642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.62,,,,,,,fee schedule,258.69,296.78,APC Aerosol inhalation treatment,94642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.69,,,,,,,fee schedule,258.69,296.78,APC Cbt 1st hour,94644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.08,,,,,,,fee schedule,102.08,165.03, Cbt 1st hour,94644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.89,,,,,,,fee schedule,102.08,165.03, Cbt 1st hour,94644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,102.08,165.03,APC Cbt 1st hour,94644,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,102.08,165.03,APC Cbt 1st hour,94644,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,102.08,165.03,APC Cbt each addl hour,94645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,133.28,,,,,,,fee schedule,133.28,152.62, Cbt each addl hour,94645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,152.62,,,,,,,fee schedule,133.28,152.62, Pos airway pressure cpap,94660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,152.2,,,,,,,fee schedule,152.2,271.62, Pos airway pressure cpap,94660,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,174.29,,,,,,,fee schedule,152.2,271.62, Pos airway pressure cpap,94660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.03,,,,,,,fee schedule,152.2,271.62,APC Pos airway pressure cpap,94660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.62,,,,,,,fee schedule,152.2,271.62,APC Pos airway pressure cpap,94660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.69,,,,,,,fee schedule,152.2,271.62,APC Evaluate pt use of inhaler,94664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44,,,,,,,fee schedule,44,271.62, Evaluate pt use of inhaler,94664,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.38,,,,,,,fee schedule,44,271.62, Evaluate pt use of inhaler,94664,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.03,,,,,,,fee schedule,44,271.62,APC Evaluate pt use of inhaler,94664,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.62,,,,,,,fee schedule,44,271.62,APC Evaluate pt use of inhaler,94664,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.69,,,,,,,fee schedule,44,271.62,APC Chest wall manipulation,94667,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.26,,,,,,,fee schedule,61.26,165.03, Chest wall manipulation,94667,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.15,,,,,,,fee schedule,61.26,165.03, Chest wall manipulation,94667,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,61.26,165.03,APC Chest wall manipulation,94667,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,61.26,165.03,APC Chest wall manipulation,94667,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,61.26,165.03,APC Chest wall manipulation,94668,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.89,,,,,,,fee schedule,59.89,165.03, Chest wall manipulation,94668,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.59,,,,,,,fee schedule,59.89,165.03, Chest wall manipulation,94668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,59.89,165.03,APC Chest wall manipulation,94668,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,59.89,165.03,APC Chest wall manipulation,94668,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,59.89,165.03,APC Mechanical chest wall oscill,94669,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.03,,,,,,,fee schedule,258.69,271.62,APC Mechanical chest wall oscill,94669,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.62,,,,,,,fee schedule,258.69,271.62,APC Mechanical chest wall oscill,94669,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.69,,,,,,,fee schedule,258.69,271.62,APC Exhaled air analysis o2,94680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,242.89,,,,,,,fee schedule,152.01,278.15, Exhaled air analysis o2,94680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,278.15,,,,,,,fee schedule,152.01,278.15, Exhaled air analysis o2,94680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,278.15,APC Exhaled air analysis o2,94680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,278.15,APC Exhaled air analysis o2,94680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,278.15,APC Exhaled air analysis o2/co2,94681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,317.14,,,,,,,fee schedule,317.14,462.87, Exhaled air analysis o2/co2,94681,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,363.18,,,,,,,fee schedule,317.14,462.87, Exhaled air analysis o2/co2,94681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,317.14,462.87,APC Exhaled air analysis o2/co2,94681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,317.14,462.87,APC Exhaled air analysis o2/co2,94681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,317.14,462.87,APC Exhaled air analysis,94690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,237.19,,,,,,,fee schedule,69.69,271.62, Exhaled air analysis,94690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,271.62,,,,,,,fee schedule,69.69,271.62, Exhaled air analysis,94690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,271.62,APC Exhaled air analysis,94690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,271.62,APC Exhaled air analysis,94690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,271.62,APC Pulm funct tst plethysmograp,94726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.26,,,,,,,fee schedule,116.26,462.87, Pulm funct tst plethysmograp,94726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,133.14,,,,,,,fee schedule,116.26,462.87, Pulm funct tst plethysmograp,94726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,116.26,462.87,APC Pulm funct tst plethysmograp,94726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,116.26,462.87,APC Pulm funct tst plethysmograp,94726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,116.26,462.87,APC Pulm function test by gas,94727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.26,,,,,,,fee schedule,116.26,267.83, Pulm function test by gas,94727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,133.14,,,,,,,fee schedule,116.26,267.83, Pulm function test by gas,94727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,116.26,267.83,APC Pulm function test by gas,94727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,116.26,267.83,APC Pulm function test by gas,94727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,116.26,267.83,APC Pulm funct test oscillometry,94728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.2,,,,,,,fee schedule,111.2,159.61, Pulm funct test oscillometry,94728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.35,,,,,,,fee schedule,111.2,159.61, Pulm funct test oscillometry,94728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,111.2,159.61,APC Pulm funct test oscillometry,94728,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,111.2,159.61,APC Pulm funct test oscillometry,94728,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,111.2,159.61,APC Co/membane diffuse capacity,94729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,367.34,,,,,,,fee schedule,367.34,420.66, Co/membane diffuse capacity,94729,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,420.66,,,,,,,fee schedule,367.34,420.66, Measure blood oxygen level,94760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.27,,,,,,,fee schedule,6.27,7.19, Measure blood oxygen level,94760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.19,,,,,,,fee schedule,6.27,7.19, Measure blood oxygen level,94761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.17,,,,,,,fee schedule,13.17,15.08, Measure blood oxygen level,94761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.08,,,,,,,fee schedule,13.17,15.08, Measure blood oxygen level,94762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.07,,,,,,,fee schedule,62.07,159.61, Measure blood oxygen level,94762,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.09,,,,,,,fee schedule,62.07,159.61, Measure blood oxygen level,94762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,62.07,159.61,APC Measure blood oxygen level,94762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,62.07,159.61,APC Measure blood oxygen level,94762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,62.07,159.61,APC Breath recording infant,94772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.42,,,,,,,fee schedule,106.42,462.87, Breath recording infant,94772,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.86,,,,,,,fee schedule,106.42,462.87, Breath recording infant,94772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,106.42,462.87,APC Breath recording infant,94772,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,106.42,462.87,APC Breath recording infant,94772,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,106.42,462.87,APC Ped home apnea rec compl,94774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.42,,,,,,,fee schedule,106.42,121.86, Ped home apnea rec compl,94774,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.86,,,,,,,fee schedule,106.42,121.86, Ped home apnea rec hk-up,94775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.42,,,,,,,fee schedule,106.42,159.61, Ped home apnea rec hk-up,94775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.86,,,,,,,fee schedule,106.42,159.61, Ped home apnea rec hk-up,94775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,106.42,159.61,APC Ped home apnea rec hk-up,94775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,106.42,159.61,APC Ped home apnea rec hk-up,94775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,106.42,159.61,APC Ped home apnea rec downld,94776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.42,,,,,,,fee schedule,106.42,159.61, Ped home apnea rec downld,94776,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.86,,,,,,,fee schedule,106.42,159.61, Ped home apnea rec downld,94776,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,106.42,159.61,APC Ped home apnea rec downld,94776,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,106.42,159.61,APC Ped home apnea rec downld,94776,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,106.42,159.61,APC Ped home apnea rec report,94777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.42,,,,,,,fee schedule,106.42,121.86, Ped home apnea rec report,94777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.86,,,,,,,fee schedule,106.42,121.86, Car seat/bed test 60 min,94780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Car seat/bed test 60 min,94780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Car seat/bed test 60 min,94780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Pulmonary service/procedure,94799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.03,,,,,,,fee schedule,102.03,159.61, Pulmonary service/procedure,94799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.84,,,,,,,fee schedule,102.03,159.61, Pulmonary service/procedure,94799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,102.03,159.61,APC Pulmonary service/procedure,94799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,102.03,159.61,APC Pulmonary service/procedure,94799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,102.03,159.61,APC Percut allergy skin tests,95004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.23,,,,,,,fee schedule,12.23,1065.19, Percut allergy skin tests,95004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14,,,,,,,fee schedule,12.23,1065.19, Percut allergy skin tests,95004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,12.23,1065.19,APC Percut allergy skin tests,95004,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,12.23,1065.19,APC Percut allergy skin tests,95004,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,12.23,1065.19,APC Exhaled Nitric Oxide Meas,95012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.65,,,,,,,fee schedule,44.12,67.17, Exhaled Nitric Oxide Meas,95012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.17,,,,,,,fee schedule,44.12,67.17, Exhaled Nitric Oxide Meas,95012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,67.17,APC Exhaled Nitric Oxide Meas,95012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,67.17,APC Exhaled Nitric Oxide Meas,95012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,67.17,APC Perq & icut allg test venoms,95017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.73,,,,,,,fee schedule,34.17,55.81, Perq & icut allg test venoms,95017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.81,,,,,,,fee schedule,34.17,55.81, Perq & icut allg test venoms,95017,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,55.81,APC Perq & icut allg test venoms,95017,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,55.81,APC Perq & icut allg test venoms,95017,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,55.81,APC Perq&ic allg test drugs/biol,95018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.73,,,,,,,fee schedule,44.12,55.81, Perq&ic allg test drugs/biol,95018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.81,,,,,,,fee schedule,44.12,55.81, Perq&ic allg test drugs/biol,95018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,55.81,APC Perq&ic allg test drugs/biol,95018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,55.81,APC Perq&ic allg test drugs/biol,95018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,55.81,APC Icut allergy test drug/bug,95024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.91,,,,,,,fee schedule,17.91,73.17, Icut allergy test drug/bug,95024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.5,,,,,,,fee schedule,17.91,73.17, Icut allergy test drug/bug,95024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,17.91,73.17,APC Icut allergy test drug/bug,95024,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,17.91,73.17,APC Icut allergy test drug/bug,95024,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,17.91,73.17,APC Icut allergy titrate-airborn,95027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.91,,,,,,,fee schedule,17.91,35.88, Icut allergy titrate-airborn,95027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.5,,,,,,,fee schedule,17.91,35.88, Icut allergy titrate-airborn,95027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,17.91,35.88,APC Icut allergy titrate-airborn,95027,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,17.91,35.88,APC Icut allergy titrate-airborn,95027,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,17.91,35.88,APC Icut allergy test-delayed,95028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.98,,,,,,,fee schedule,26.98,46.33, Icut allergy test-delayed,95028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.9,,,,,,,fee schedule,26.98,46.33, Icut allergy test-delayed,95028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,26.98,46.33,APC Icut allergy test-delayed,95028,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,26.98,46.33,APC Icut allergy test-delayed,95028,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,26.98,46.33,APC Allergy patch tests,95044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.47,,,,,,,fee schedule,41.47,1065.19, Allergy patch tests,95044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.48,,,,,,,fee schedule,41.47,1065.19, Allergy patch tests,95044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,41.47,1065.19,APC Allergy patch tests,95044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,41.47,1065.19,APC Allergy patch tests,95044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,41.47,1065.19,APC Photo patch test,95052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.26,,,,,,,fee schedule,29.26,73.17, Photo patch test,95052,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.51,,,,,,,fee schedule,29.26,73.17, Photo patch test,95052,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,29.26,73.17,APC Photo patch test,95052,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,29.26,73.17,APC Photo patch test,95052,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,29.26,73.17,APC Photosensitivity tests,95056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.16,,,,,,,fee schedule,20.16,165.03, Photosensitivity tests,95056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.09,,,,,,,fee schedule,20.16,165.03, Photosensitivity tests,95056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,20.16,165.03,APC Photosensitivity tests,95056,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,20.16,165.03,APC Photosensitivity tests,95056,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,20.16,165.03,APC Eye allergy tests,95060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.47,,,,,,,fee schedule,41.47,165.03, Eye allergy tests,95060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.48,,,,,,,fee schedule,41.47,165.03, Eye allergy tests,95060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,41.47,165.03,APC Eye allergy tests,95060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,41.47,165.03,APC Eye allergy tests,95060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,41.47,165.03,APC Nose allergy test,95065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.58,,,,,,,fee schedule,23.58,46.33, Nose allergy test,95065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.01,,,,,,,fee schedule,23.58,46.33, Nose allergy test,95065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,23.58,46.33,APC Nose allergy test,95065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,23.58,46.33,APC Nose allergy test,95065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,23.58,46.33,APC Bronchial allergy tests,95070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,260.6,,,,,,,fee schedule,260.6,462.87, Bronchial allergy tests,95070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,298.43,,,,,,,fee schedule,260.6,462.87, Bronchial allergy tests,95070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,260.6,462.87,APC Bronchial allergy tests,95070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,260.6,462.87,APC Bronchial allergy tests,95070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,260.6,462.87,APC Ingest challenge ini 120 min,95076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.6,,,,,,,fee schedule,126.6,462.87, Ingest challenge ini 120 min,95076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,144.98,,,,,,,fee schedule,126.6,462.87, Ingest challenge ini 120 min,95076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,126.6,462.87,APC Ingest challenge ini 120 min,95076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,126.6,462.87,APC Ingest challenge ini 120 min,95076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,126.6,462.87,APC Ingest challenge addl 60 min,95079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,126.6,,,,,,,fee schedule,126.6,144.98, Ingest challenge addl 60 min,95079,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,144.98,,,,,,,fee schedule,126.6,144.98, Immunotherapy one injection,95115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Immunotherapy one injection,95115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Immunotherapy one injection,95115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Immunotherapy injections,95117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.04,,,,,,,fee schedule,55.32,72.19, Immunotherapy injections,95117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,72.19,,,,,,,fee schedule,55.32,72.19, Immunotherapy injections,95117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,72.19,APC Immunotherapy injections,95117,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,72.19,APC Immunotherapy injections,95117,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,72.19,APC Antigen therapy services,95144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95144,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95144,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95148,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95148,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95149,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95149,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95149,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,89.31,APC Antigen therapy services,95165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Antigen therapy services,95170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Allergy immunology services,95199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Allergy immunology services,95199,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Allergy immunology services,95199,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Cont gluc mntr pt prov eqp,95249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Cont gluc mntr pt prov eqp,95249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Cont gluc mntr pt prov eqp,95249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Glucose monitoring cont,95250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,387.67,,,,,,,fee schedule,157.28,443.95, Glucose monitoring cont,95250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,443.95,,,,,,,fee schedule,157.28,443.95, Glucose monitoring cont,95250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,443.95,APC Glucose monitoring cont,95250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,443.95,APC Glucose monitoring cont,95250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,443.95,APC Gluc monitor cont phys i&r,95251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.52,,,,,,,fee schedule,106.52,121.98, Gluc monitor cont phys i&r,95251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.98,,,,,,,fee schedule,106.52,121.98, Eeg cont rec w/vid eeg tech,95700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,255.08,2410.08, Eeg cont rec w/vid eeg tech,95700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,255.08,2410.08, Eeg cont rec w/vid eeg tech,95700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,2410.08,APC Eeg cont rec w/vid eeg tech,95700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,2410.08,APC Eeg cont rec w/vid eeg tech,95700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,2410.08,APC Eeg w/o vid 2-12 hr unmntr,95705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,255.08,2410.08, Eeg w/o vid 2-12 hr unmntr,95705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,255.08,2410.08, Eeg w/o vid 2-12 hr unmntr,95705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,2410.08,APC Eeg w/o vid 2-12 hr unmntr,95705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,2410.08,APC Eeg w/o vid 2-12 hr unmntr,95705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,2410.08,APC Eeg wo vid 2-12hr intmt mntr,95706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,255.08,2410.08, Eeg wo vid 2-12hr intmt mntr,95706,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,255.08,2410.08, Eeg wo vid 2-12hr intmt mntr,95706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,2410.08,APC Eeg wo vid 2-12hr intmt mntr,95706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,2410.08,APC Eeg wo vid 2-12hr intmt mntr,95706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,2410.08,APC Eeg w/o vid 2-12hr cont mntr,95707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,255.08,2410.08, Eeg w/o vid 2-12hr cont mntr,95707,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,255.08,2410.08, Eeg w/o vid 2-12hr cont mntr,95707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,2410.08,APC Eeg w/o vid 2-12hr cont mntr,95707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,2410.08,APC Eeg w/o vid 2-12hr cont mntr,95707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,2410.08,APC Eeg wo vid ea 12-26hr unmntr,95708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,440.83,2410.08, Eeg wo vid ea 12-26hr unmntr,95708,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,440.83,2410.08, Eeg wo vid ea 12-26hr unmntr,95708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,2410.08,APC Eeg wo vid ea 12-26hr unmntr,95708,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,2410.08,APC Eeg wo vid ea 12-26hr unmntr,95708,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,2410.08,APC Eeg w/o vid ea 12-26hr intmt,95709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,440.83,2410.08, Eeg w/o vid ea 12-26hr intmt,95709,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,440.83,2410.08, Eeg w/o vid ea 12-26hr intmt,95709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,2410.08,APC Eeg w/o vid ea 12-26hr intmt,95709,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,2410.08,APC Eeg w/o vid ea 12-26hr intmt,95709,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,2410.08,APC Eeg w/o vid ea 12-26hr cont,95710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,440.83,2410.08, Eeg w/o vid ea 12-26hr cont,95710,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,440.83,2410.08, Eeg w/o vid ea 12-26hr cont,95710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,2410.08,APC Eeg w/o vid ea 12-26hr cont,95710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,2410.08,APC Eeg w/o vid ea 12-26hr cont,95710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,2410.08,APC Veeg 2-12 hr unmonitored,95711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,255.08,2410.08, Veeg 2-12 hr unmonitored,95711,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,255.08,2410.08, Veeg 2-12 hr unmonitored,95711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,2410.08,APC Veeg 2-12 hr unmonitored,95711,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,2410.08,APC Veeg 2-12 hr unmonitored,95711,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,2410.08,APC Veeg 2-12 hr intmt mntr,95712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,440.83,2410.08, Veeg 2-12 hr intmt mntr,95712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,440.83,2410.08, Veeg 2-12 hr intmt mntr,95712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,2410.08,APC Veeg 2-12 hr intmt mntr,95712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,2410.08,APC Veeg 2-12 hr intmt mntr,95712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,2410.08,APC Veeg 2-12 hr cont mntr,95713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,440.83,2410.08, Veeg 2-12 hr cont mntr,95713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,440.83,2410.08, Veeg 2-12 hr cont mntr,95713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,2410.08,APC Veeg 2-12 hr cont mntr,95713,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,2410.08,APC Veeg 2-12 hr cont mntr,95713,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,2410.08,APC Veeg ea 12-26 hr unmntr,95714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,440.83,2410.08, Veeg ea 12-26 hr unmntr,95714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,440.83,2410.08, Veeg ea 12-26 hr unmntr,95714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,2410.08,APC Veeg ea 12-26 hr unmntr,95714,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,2410.08,APC Veeg ea 12-26 hr unmntr,95714,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,2410.08,APC Veeg ea 12-26hr intmt mntr,95715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,440.83,2410.08, Veeg ea 12-26hr intmt mntr,95715,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,440.83,2410.08, Veeg ea 12-26hr intmt mntr,95715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,2410.08,APC Veeg ea 12-26hr intmt mntr,95715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,2410.08,APC Veeg ea 12-26hr intmt mntr,95715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,2410.08,APC Veeg ea 12-26hr cont mntr,95716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,1014.47,2410.08, Veeg ea 12-26hr cont mntr,95716,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,1014.47,2410.08, Veeg ea 12-26hr cont mntr,95716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,2410.08,APC Veeg ea 12-26hr cont mntr,95716,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,2410.08,APC Veeg ea 12-26hr cont mntr,95716,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,2410.08,APC Eeg phys/qhp 2-12 hr w/o vid,95717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phys/qhp 2-12 hr w/o vid,95717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phys/qhp 2-12 hr w/veeg,95718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phys/qhp 2-12 hr w/veeg,95718,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phys/qhp ea incr w/o vid,95719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phys/qhp ea incr w/o vid,95719,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp ea incr w/veeg,95720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp ea incr w/veeg,95720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>36<60 hr w/o vid,95721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>36<60 hr w/o vid,95721,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>36<60 hr w/veeg,95722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>36<60 hr w/veeg,95722,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>60<84 hr w/o vid,95723,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>60<84 hr w/o vid,95723,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>60<84 hr w/veeg,95724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>60<84 hr w/veeg,95724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>84 hr w/o vid,95725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>84 hr w/o vid,95725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>84 hr w/veeg,95726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2104.58,,,,,,,fee schedule,2104.58,2410.08, Eeg phy/qhp>84 hr w/veeg,95726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2410.08,,,,,,,fee schedule,2104.58,2410.08, Polysom <6 yrs 4/> paramtrs,95782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1999.2,,,,,,,fee schedule,1014.47,2289.41, Polysom <6 yrs 4/> paramtrs,95782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2289.41,,,,,,,fee schedule,1014.47,2289.41, Polysom <6 yrs 4/> paramtrs,95782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,2289.41,APC Polysom <6 yrs 4/> paramtrs,95782,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,2289.41,APC Polysom <6 yrs 4/> paramtrs,95782,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,2289.41,APC Polysom <6 yrs cpap/bilvl,95783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1999.2,,,,,,,fee schedule,1014.47,2289.41, Polysom <6 yrs cpap/bilvl,95783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2289.41,,,,,,,fee schedule,1014.47,2289.41, Polysom <6 yrs cpap/bilvl,95783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,2289.41,APC Polysom <6 yrs cpap/bilvl,95783,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,2289.41,APC Polysom <6 yrs cpap/bilvl,95783,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,2289.41,APC Slp stdy unattended,95800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Slp stdy unattended,95800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Slp stdy unattended,95800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Slp stdy unatnd w/anal,95801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Slp stdy unatnd w/anal,95801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Slp stdy unatnd w/anal,95801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Actigraphy testing,95803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.52,,,,,,,fee schedule,69.69,121.98, Actigraphy testing,95803,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.98,,,,,,,fee schedule,69.69,121.98, Actigraphy testing,95803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,121.98,APC Actigraphy testing,95803,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,121.98,APC Actigraphy testing,95803,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,121.98,APC Multiple sleep latency test,95805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2182.38,,,,,,,fee schedule,1014.47,2499.17, Multiple sleep latency test,95805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2499.17,,,,,,,fee schedule,1014.47,2499.17, Multiple sleep latency test,95805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,2499.17,APC Multiple sleep latency test,95805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,2499.17,APC Multiple sleep latency test,95805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,2499.17,APC Sleep study unatt&resp efft,95806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,574.81,,,,,,,fee schedule,255.08,658.26, Sleep study unatt&resp efft,95806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,658.26,,,,,,,fee schedule,255.08,658.26, Sleep study unatt&resp efft,95806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,658.26,APC Sleep study unatt&resp efft,95806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,658.26,APC Sleep study unatt&resp efft,95806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,658.26,APC Sleep study attended,95807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1552.55,,,,,,,fee schedule,440.83,1777.93, Sleep study attended,95807,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1777.93,,,,,,,fee schedule,440.83,1777.93, Sleep study attended,95807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,1777.93,APC Sleep study attended,95807,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,1777.93,APC Sleep study attended,95807,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,1777.93,APC Polysom any age 1-3> param,95808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1806.66,,,,,,,fee schedule,1014.47,2068.91, Polysom any age 1-3> param,95808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2068.91,,,,,,,fee schedule,1014.47,2068.91, Polysom any age 1-3> param,95808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,2068.91,APC Polysom any age 1-3> param,95808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,2068.91,APC Polysom any age 1-3> param,95808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,2068.91,APC Polysom 6/> yrs 4/> param,95810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2384.12,,,,,,,fee schedule,1014.47,2730.21, Polysom 6/> yrs 4/> param,95810,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2730.21,,,,,,,fee schedule,1014.47,2730.21, Polysom 6/> yrs 4/> param,95810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,2730.21,APC Polysom 6/> yrs 4/> param,95810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,2730.21,APC Polysom 6/> yrs 4/> param,95810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,2730.21,APC Polysom 6/>yrs cpap 4/> parm,95811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2605.49,,,,,,,fee schedule,1014.47,2983.7, Polysom 6/>yrs cpap 4/> parm,95811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2983.7,,,,,,,fee schedule,1014.47,2983.7, Polysom 6/>yrs cpap 4/> parm,95811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,2983.7,APC Polysom 6/>yrs cpap 4/> parm,95811,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,2983.7,APC Polysom 6/>yrs cpap 4/> parm,95811,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,2983.7,APC Eeg 41-60 minutes,95812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,578.81,,,,,,,fee schedule,255.08,662.83, Eeg 41-60 minutes,95812,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,662.83,,,,,,,fee schedule,255.08,662.83, Eeg 41-60 minutes,95812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,662.83,APC Eeg 41-60 minutes,95812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,662.83,APC Eeg 41-60 minutes,95812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,662.83,APC Eeg over 1 hour,95813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,758.78,,,,,,,fee schedule,255.08,868.93, Eeg over 1 hour,95813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,868.93,,,,,,,fee schedule,255.08,868.93, Eeg over 1 hour,95813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,868.93,APC Eeg over 1 hour,95813,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,868.93,APC Eeg over 1 hour,95813,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,868.93,APC Eeg awake and drowsy,95816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,541.61,,,,,,,fee schedule,255.08,620.23, Eeg awake and drowsy,95816,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,620.23,,,,,,,fee schedule,255.08,620.23, Eeg awake and drowsy,95816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,620.23,APC Eeg awake and drowsy,95816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,620.23,APC Eeg awake and drowsy,95816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,620.23,APC Eeg awake and asleep,95819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,458.73,,,,,,,fee schedule,255.08,525.31, Eeg awake and asleep,95819,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,525.31,,,,,,,fee schedule,255.08,525.31, Eeg awake and asleep,95819,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,525.31,APC Eeg awake and asleep,95819,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,525.31,APC Eeg awake and asleep,95819,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,525.31,APC Eeg coma or sleep only,95822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,645.27,,,,,,,fee schedule,255.08,738.94, Eeg coma or sleep only,95822,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,738.94,,,,,,,fee schedule,255.08,738.94, Eeg coma or sleep only,95822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,738.94,APC Eeg coma or sleep only,95822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,738.94,APC Eeg coma or sleep only,95822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,738.94,APC Eeg cerebral death only,95824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,677.56,,,,,,,fee schedule,440.83,775.92, Eeg cerebral death only,95824,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,775.92,,,,,,,fee schedule,440.83,775.92, Eeg cerebral death only,95824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,775.92,APC Eeg cerebral death only,95824,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,775.92,APC Eeg cerebral death only,95824,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,775.92,APC Surgery electrocorticogram,95829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4174.36,,,,,,,fee schedule,4174.36,4780.32, Surgery electrocorticogram,95829,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4780.32,,,,,,,fee schedule,4174.36,4780.32, Insert electrodes for EEG,95830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,550.71,,,,,,,fee schedule,550.71,630.65, Insert electrodes for EEG,95830,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,630.65,,,,,,,fee schedule,550.71,630.65, Range of motion measurements,95851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.35,,,,,,,fee schedule,7.18,24.45, Range of motion measurements,95851,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.45,,,,,,,fee schedule,7.18,24.45, Range of motion measurements,95851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.47,,,,,,,fee schedule,7.18,24.45,APC Range of motion measurements,95851,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.54,,,,,,,fee schedule,7.18,24.45,APC Range of motion measurements,95851,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.18,,,,,,,fee schedule,7.18,24.45,APC Range of motion measurements,95852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.57,,,,,,,fee schedule,5.42,17.84, Range of motion measurements,95852,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.84,,,,,,,fee schedule,5.42,17.84, Range of motion measurements,95852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.64,,,,,,,fee schedule,5.42,17.84,APC Range of motion measurements,95852,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.69,,,,,,,fee schedule,5.42,17.84,APC Range of motion measurements,95852,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.42,,,,,,,fee schedule,5.42,17.84,APC Cholinesterase challenge,95857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.17,,,,,,,fee schedule,72.17,267.83, Cholinesterase challenge,95857,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.64,,,,,,,fee schedule,72.17,267.83, Cholinesterase challenge,95857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,72.17,267.83,APC Cholinesterase challenge,95857,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,72.17,267.83,APC Cholinesterase challenge,95857,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,72.17,267.83,APC Muscle test one limb,95860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,261.96,,,,,,,fee schedule,157.18,299.99, Muscle test one limb,95860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,299.99,,,,,,,fee schedule,157.18,299.99, Muscle test one limb,95860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,299.99,APC Muscle test one limb,95860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,299.99,APC Muscle test one limb,95860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,299.99,APC Muscle test 2 limbs,95861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,324.09,,,,,,,fee schedule,157.18,371.13, Muscle test 2 limbs,95861,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,371.13,,,,,,,fee schedule,157.18,371.13, Muscle test 2 limbs,95861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,371.13,APC Muscle test 2 limbs,95861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,371.13,APC Muscle test 2 limbs,95861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,371.13,APC Muscle test 3 limbs,95863,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,394.96,,,,,,,fee schedule,152.01,452.3, Muscle test 3 limbs,95863,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,452.3,,,,,,,fee schedule,152.01,452.3, Muscle test 3 limbs,95863,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,452.3,APC Muscle test 3 limbs,95863,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,452.3,APC Muscle test 3 limbs,95863,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,452.3,APC Muscle test 4 limbs,95864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,516.21,,,,,,,fee schedule,152.01,591.15, Muscle test 4 limbs,95864,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,591.15,,,,,,,fee schedule,152.01,591.15, Muscle test 4 limbs,95864,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,591.15,APC Muscle test 4 limbs,95864,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,591.15,APC Muscle test 4 limbs,95864,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,591.15,APC Muscle test larynx,95865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,311.88,,,,,,,fee schedule,157.18,357.16, Muscle test larynx,95865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,357.16,,,,,,,fee schedule,157.18,357.16, Muscle test larynx,95865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,357.16,APC Muscle test larynx,95865,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,357.16,APC Muscle test larynx,95865,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,357.16,APC Muscle test hemidiaphragm,95866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,255.94,,,,,,,fee schedule,152.01,293.09, Muscle test hemidiaphragm,95866,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,293.09,,,,,,,fee schedule,152.01,293.09, Muscle test hemidiaphragm,95866,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,293.09,APC Muscle test hemidiaphragm,95866,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,293.09,APC Muscle test hemidiaphragm,95866,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,293.09,APC Muscle test cran nerv unilat,95867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,189.57,,,,,,,fee schedule,189.57,267.83, Muscle test cran nerv unilat,95867,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,217.09,,,,,,,fee schedule,189.57,267.83, Muscle test cran nerv unilat,95867,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,189.57,267.83,APC Muscle test cran nerv unilat,95867,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,189.57,267.83,APC Muscle test cran nerv unilat,95867,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,189.57,267.83,APC Muscle test cran nerve bilat,95868,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,263.28,,,,,,,fee schedule,255.08,301.49, Muscle test cran nerve bilat,95868,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,301.49,,,,,,,fee schedule,255.08,301.49, Muscle test cran nerve bilat,95868,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,301.49,APC Muscle test cran nerve bilat,95868,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,301.49,APC Muscle test cran nerve bilat,95868,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,301.49,APC Muscle test thor paraspinal,95869,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.96,,,,,,,fee schedule,81.96,267.83, Muscle test thor paraspinal,95869,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,93.86,,,,,,,fee schedule,81.96,267.83, Muscle test thor paraspinal,95869,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,81.96,267.83,APC Muscle test thor paraspinal,95869,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,81.96,267.83,APC Muscle test thor paraspinal,95869,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,81.96,267.83,APC Muscle test nonparaspinal,95870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.96,,,,,,,fee schedule,81.96,165.03, Muscle test nonparaspinal,95870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,93.86,,,,,,,fee schedule,81.96,165.03, Muscle test nonparaspinal,95870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,81.96,165.03,APC Muscle test nonparaspinal,95870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,81.96,165.03,APC Muscle test nonparaspinal,95870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,81.96,165.03,APC Muscle test one fiber,95872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,298.84,,,,,,,fee schedule,255.08,342.22, Muscle test one fiber,95872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,342.22,,,,,,,fee schedule,255.08,342.22, Muscle test one fiber,95872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,342.22,APC Muscle test one fiber,95872,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,342.22,APC Muscle test one fiber,95872,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,342.22,APC Limb exercise test,95875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,282.65,,,,,,,fee schedule,152.01,323.67, Limb exercise test,95875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,323.67,,,,,,,fee schedule,152.01,323.67, Limb exercise test,95875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,323.67,APC Limb exercise test,95875,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,323.67,APC Limb exercise test,95875,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,323.67,APC Motor &/ sens nrve cndj test,95905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,761.11,,,,,,,fee schedule,527.74,871.6, Motor &/ sens nrve cndj test,95905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,871.6,,,,,,,fee schedule,527.74,871.6, Motor &/ sens nrve cndj test,95905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,871.6,APC Motor &/ sens nrve cndj test,95905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,871.6,APC Motor &/ sens nrve cndj test,95905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,871.6,APC Nvr cndj tst 1-2 studies,95907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.19,,,,,,,fee schedule,175.19,267.83, Nvr cndj tst 1-2 studies,95907,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.62,,,,,,,fee schedule,175.19,267.83, Nvr cndj tst 1-2 studies,95907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,175.19,267.83,APC Nvr cndj tst 1-2 studies,95907,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,175.19,267.83,APC Nvr cndj tst 1-2 studies,95907,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,175.19,267.83,APC Nrv cndj tst 3-4 studies,95908,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.19,,,,,,,fee schedule,175.19,267.83, Nrv cndj tst 3-4 studies,95908,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.62,,,,,,,fee schedule,175.19,267.83, Nrv cndj tst 3-4 studies,95908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,175.19,267.83,APC Nrv cndj tst 3-4 studies,95908,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,175.19,267.83,APC Nrv cndj tst 3-4 studies,95908,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,175.19,267.83,APC Nrv cndj tst 5-6 studies,95909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.19,,,,,,,fee schedule,175.19,267.83, Nrv cndj tst 5-6 studies,95909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.62,,,,,,,fee schedule,175.19,267.83, Nrv cndj tst 5-6 studies,95909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,175.19,267.83,APC Nrv cndj tst 5-6 studies,95909,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,175.19,267.83,APC Nrv cndj tst 5-6 studies,95909,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,175.19,267.83,APC Nrv cndj test 7-8 studies,95910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.19,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 7-8 studies,95910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.62,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 7-8 studies,95910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 7-8 studies,95910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 7-8 studies,95910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 9-10 studies,95911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.19,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 9-10 studies,95911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.62,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 9-10 studies,95911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 9-10 studies,95911,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 9-10 studies,95911,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 11-12 studies,95912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.19,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 11-12 studies,95912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.62,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 11-12 studies,95912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 11-12 studies,95912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 11-12 studies,95912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 13/> studies,95913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,175.19,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 13/> studies,95913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.62,,,,,,,fee schedule,175.19,462.87, Nrv cndj test 13/> studies,95913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 13/> studies,95913,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,175.19,462.87,APC Nrv cndj test 13/> studies,95913,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,175.19,462.87,APC Quan puplmtry phy/qhp uni/bi,95919,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,165.03,APC Quan puplmtry phy/qhp uni/bi,95919,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,165.03,APC Quan puplmtry phy/qhp uni/bi,95919,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,165.03,APC Autonomic nrv parasym inervj,95921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,174.57,,,,,,,fee schedule,152.01,199.91, Autonomic nrv parasym inervj,95921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,199.91,,,,,,,fee schedule,152.01,199.91, Autonomic nrv parasym inervj,95921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,199.91,APC Autonomic nrv parasym inervj,95921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,199.91,APC Autonomic nrv parasym inervj,95921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,199.91,APC Autonomic nrv adrenrg inervj,95922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,189.3,,,,,,,fee schedule,157.18,216.78, Autonomic nrv adrenrg inervj,95922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,216.78,,,,,,,fee schedule,157.18,216.78, Autonomic nrv adrenrg inervj,95922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,216.78,APC Autonomic nrv adrenrg inervj,95922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,216.78,APC Autonomic nrv adrenrg inervj,95922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,216.78,APC Autonomic nrv syst funj test,95923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,315.08,,,,,,,fee schedule,157.18,360.82, Autonomic nrv syst funj test,95923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,360.82,,,,,,,fee schedule,157.18,360.82, Autonomic nrv syst funj test,95923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,360.82,APC Autonomic nrv syst funj test,95923,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,360.82,APC Autonomic nrv syst funj test,95923,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,360.82,APC Ans parasymp & symp w/tilt,95924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,197.98,,,,,,,fee schedule,197.98,267.83, Ans parasymp & symp w/tilt,95924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,226.72,,,,,,,fee schedule,197.98,267.83, Ans parasymp & symp w/tilt,95924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,197.98,267.83,APC Ans parasymp & symp w/tilt,95924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,197.98,267.83,APC Ans parasymp & symp w/tilt,95924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,197.98,267.83,APC Somatosensory testing,95925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,190.24,,,,,,,fee schedule,190.24,267.83, Somatosensory testing,95925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,217.86,,,,,,,fee schedule,190.24,267.83, Somatosensory testing,95925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,190.24,267.83,APC Somatosensory testing,95925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,190.24,267.83,APC Somatosensory testing,95925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,190.24,267.83,APC Somatosensory testing,95926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,190.51,,,,,,,fee schedule,190.51,267.83, Somatosensory testing,95926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,218.17,,,,,,,fee schedule,190.51,267.83, Somatosensory testing,95926,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,190.51,267.83,APC Somatosensory testing,95926,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,190.51,267.83,APC Somatosensory testing,95926,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,190.51,267.83,APC Somatosensory testing,95927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,192.77,,,,,,,fee schedule,192.77,267.83, Somatosensory testing,95927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,220.75,,,,,,,fee schedule,192.77,267.83, Somatosensory testing,95927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,192.77,267.83,APC Somatosensory testing,95927,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,192.77,267.83,APC Somatosensory testing,95927,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,192.77,267.83,APC C motor evoked uppr limbs,95928,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,498.6,,,,,,,fee schedule,498.6,1065.19, C motor evoked uppr limbs,95928,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,570.98,,,,,,,fee schedule,498.6,1065.19, C motor evoked uppr limbs,95928,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,498.6,1065.19,APC C motor evoked uppr limbs,95928,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,498.6,1065.19,APC C motor evoked uppr limbs,95928,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,498.6,1065.19,APC C motor evoked lwr limbs,95929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,520.18,,,,,,,fee schedule,440.83,595.69, C motor evoked lwr limbs,95929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,595.69,,,,,,,fee schedule,440.83,595.69, C motor evoked lwr limbs,95929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,595.69,APC C motor evoked lwr limbs,95929,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,595.69,APC C motor evoked lwr limbs,95929,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,595.69,APC Visual evoked potential test,95930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,291.42,,,,,,,fee schedule,255.08,333.73, Visual evoked potential test,95930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333.73,,,,,,,fee schedule,255.08,333.73, Visual evoked potential test,95930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,333.73,APC Visual evoked potential test,95930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,333.73,APC Visual evoked potential test,95930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,333.73,APC Blink reflex test,95933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,182.68,,,,,,,fee schedule,69.69,209.19, Blink reflex test,95933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,209.19,,,,,,,fee schedule,69.69,209.19, Blink reflex test,95933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,209.19,APC Blink reflex test,95933,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,209.19,APC Blink reflex test,95933,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,209.19,APC Neuromuscular junction test,95937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,141.16,,,,,,,fee schedule,141.16,161.65, Neuromuscular junction test,95937,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,161.65,,,,,,,fee schedule,141.16,161.65, Neuromuscular junction test,95937,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,141.16,161.65,APC Neuromuscular junction test,95937,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,141.16,161.65,APC Neuromuscular junction test,95937,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,141.16,161.65,APC Somatosensory testing,95938,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1065.19,APC Somatosensory testing,95938,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1065.19,APC Somatosensory testing,95938,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1065.19,APC C motor evoked upr&lwr limbs,95939,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1065.19,APC C motor evoked upr&lwr limbs,95939,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1065.19,APC C motor evoked upr&lwr limbs,95939,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1065.19,APC Ionm in operatng room 15 min,95940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,417.11,,,,,,,fee schedule,417.11,477.66, Ionm in operatng room 15 min,95940,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,477.66,,,,,,,fee schedule,417.11,477.66, Ionm remote/>1 pt or per hr,95941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,417.11,,,,,,,fee schedule,417.11,477.66, Ionm remote/>1 pt or per hr,95941,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,477.66,,,,,,,fee schedule,417.11,477.66, EEG monitoring/giving drugs,95954,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,737.2,,,,,,,fee schedule,440.83,844.22, EEG monitoring/giving drugs,95954,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,844.22,,,,,,,fee schedule,440.83,844.22, EEG monitoring/giving drugs,95954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,844.22,APC EEG monitoring/giving drugs,95954,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,844.22,APC EEG monitoring/giving drugs,95954,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,844.22,APC EEG during surgery,95955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,382.99,,,,,,,fee schedule,382.99,438.58, EEG during surgery,95955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,438.58,,,,,,,fee schedule,382.99,438.58, EEG digital analysis,95957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,504.73,,,,,,,fee schedule,504.73,578, EEG digital analysis,95957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,578,,,,,,,fee schedule,504.73,578, EEG monitoring/function test,95958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,845.33,,,,,,,fee schedule,845.33,1065.19, EEG monitoring/function test,95958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,968.04,,,,,,,fee schedule,845.33,1065.19, EEG monitoring/function test,95958,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,845.33,1065.19,APC EEG monitoring/function test,95958,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,845.33,1065.19,APC EEG monitoring/function test,95958,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,845.33,1065.19,APC Electrode stimulation brain,95961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,638.4,,,,,,,fee schedule,638.4,1065.19, Electrode stimulation brain,95961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,731.07,,,,,,,fee schedule,638.4,1065.19, Electrode stimulation brain,95961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,638.4,1065.19,APC Electrode stimulation brain,95961,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,638.4,1065.19,APC Electrode stimulation brain,95961,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,638.4,1065.19,APC Electrode stim brain add-on,95962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,656.95,,,,,,,fee schedule,656.95,752.32, Electrode stim brain add-on,95962,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,752.32,,,,,,,fee schedule,656.95,752.32, Meg spontaneous,95965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,586.1,,,,,,,fee schedule,586.1,1065.19, Meg spontaneous,95965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,671.18,,,,,,,fee schedule,586.1,1065.19, Meg spontaneous,95965,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,586.1,1065.19,APC Meg spontaneous,95965,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,586.1,1065.19,APC Meg spontaneous,95965,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,586.1,1065.19,APC Meg evoked single,95966,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,586.1,,,,,,,fee schedule,586.1,1065.19, Meg evoked single,95966,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,671.18,,,,,,,fee schedule,586.1,1065.19, Meg evoked single,95966,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,586.1,1065.19,APC Meg evoked single,95966,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,586.1,1065.19,APC Meg evoked single,95966,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,586.1,1065.19,APC Meg evoked each addl,95967,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,586.1,,,,,,,fee schedule,586.1,671.18, Meg evoked each addl,95967,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,671.18,,,,,,,fee schedule,586.1,671.18, Analyze neurostim no prog,95970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.07,,,,,,,fee schedule,59.07,165.03, Analyze neurostim no prog,95970,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.65,,,,,,,fee schedule,59.07,165.03, Analyze neurostim no prog,95970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,59.07,165.03,APC Analyze neurostim no prog,95970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,59.07,165.03,APC Analyze neurostim no prog,95970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,59.07,165.03,APC Analyze neurostim simple,95971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,107.83,,,,,,,fee schedule,107.83,123.48, Analyze neurostim simple,95971,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.48,,,,,,,fee schedule,107.83,123.48, Analyze neurostim simple,95971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.8,,,,,,,fee schedule,107.83,123.48,APC Analyze neurostim simple,95971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.93,,,,,,,fee schedule,107.83,123.48,APC Analyze neurostim simple,95971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.31,,,,,,,fee schedule,107.83,123.48,APC Analyze neurostim complex,95972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,204.6,,,,,,,fee schedule,112.31,234.3, Analyze neurostim complex,95972,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,234.3,,,,,,,fee schedule,112.31,234.3, Analyze neurostim complex,95972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.8,,,,,,,fee schedule,112.31,234.3,APC Analyze neurostim complex,95972,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.93,,,,,,,fee schedule,112.31,234.3,APC Analyze neurostim complex,95972,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.31,,,,,,,fee schedule,112.31,234.3,APC Io anal gast n-stim subsq,95981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,197.98,,,,,,,fee schedule,69.69,226.72, Io anal gast n-stim subsq,95981,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,226.72,,,,,,,fee schedule,69.69,226.72, Io anal gast n-stim subsq,95981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,226.72,APC Io anal gast n-stim subsq,95981,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,226.72,APC Io anal gast n-stim subsq,95981,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,226.72,APC Alys brn npgt prgrmg 15 min,95983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,467.5,,,,,,,fee schedule,112.31,535.37, Alys brn npgt prgrmg 15 min,95983,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,535.37,,,,,,,fee schedule,112.31,535.37, Alys brn npgt prgrmg 15 min,95983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.8,,,,,,,fee schedule,112.31,535.37,APC Alys brn npgt prgrmg 15 min,95983,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.93,,,,,,,fee schedule,112.31,535.37,APC Alys brn npgt prgrmg 15 min,95983,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.31,,,,,,,fee schedule,112.31,535.37,APC Alys brn npgt prgrmg addl 15,95984,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,467.5,,,,,,,fee schedule,467.5,535.37, Alys brn npgt prgrmg addl 15,95984,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,535.37,,,,,,,fee schedule,467.5,535.37, Spin/brain pump refil & main,95990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,409.72,APC Spin/brain pump refil & main,95990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,409.72,APC Spin/brain pump refil & main,95990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,409.72,APC Spin/brain pump refil & main,95991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377.12,,,,,,,fee schedule,362.62,380.75,APC Spin/brain pump refil & main,95991,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.75,,,,,,,fee schedule,362.62,380.75,APC Spin/brain pump refil & main,95991,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.62,,,,,,,fee schedule,362.62,380.75,APC Neurological procedure,95999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Neurological procedure,95999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Neurological procedure,95999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Motion analysis video/3d,96000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,232.1,,,,,,,fee schedule,232.1,462.87, Motion analysis video/3d,96000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,265.8,,,,,,,fee schedule,232.1,462.87, Motion analysis video/3d,96000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,232.1,462.87,APC Motion analysis video/3d,96000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,232.1,462.87,APC Motion analysis video/3d,96000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,232.1,462.87,APC Motion test w/ft press meas,96001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,273.77,,,,,,,fee schedule,273.77,1065.19, Motion test w/ft press meas,96001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,313.51,,,,,,,fee schedule,273.77,1065.19, Motion test w/ft press meas,96001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,273.77,1065.19,APC Motion test w/ft press meas,96001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,273.77,1065.19,APC Motion test w/ft press meas,96001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,273.77,1065.19,APC Dynamic surface emg,96002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,54.41,,,,,,,fee schedule,54.41,267.83, Dynamic surface emg,96002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.31,,,,,,,fee schedule,54.41,267.83, Dynamic surface emg,96002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,54.41,267.83,APC Dynamic surface emg,96002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,54.41,267.83,APC Dynamic surface emg,96002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,54.41,267.83,APC Dynamic fine wire emg,96003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.39,,,,,,,fee schedule,47.39,54.27, Dynamic fine wire emg,96003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.27,,,,,,,fee schedule,47.39,54.27, Phys review of motion tests,96004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,296.63,,,,,,,fee schedule,296.63,339.69, Phys review of motion tests,96004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,339.69,,,,,,,fee schedule,296.63,339.69, Functional Brain Mapping,96020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,296.63,,,,,,,fee schedule,296.63,339.69, Functional Brain Mapping,96020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,339.69,,,,,,,fee schedule,296.63,339.69, Assessment of aphasia,96105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,111.43,,,,,,,fee schedule,107.14,112.5,APC Assessment of aphasia,96105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,112.5,,,,,,,fee schedule,107.14,112.5,APC Assessment of aphasia,96105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,107.14,,,,,,,fee schedule,107.14,112.5,APC Developmental screen w/score,96110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.23,,,,,,,fee schedule,36.23,41.49, Developmental screen w/score,96110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.49,,,,,,,fee schedule,36.23,41.49, Devel tst phys/qhp 1st hr,96112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC Devel tst phys/qhp 1st hr,96112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC Devel tst phys/qhp 1st hr,96112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Neurobehavioral status exam,96116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,242,,,,,,,fee schedule,242,277.13, Neurobehavioral status exam,96116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,277.13,,,,,,,fee schedule,242,277.13, Neurobehavioral status exam,96116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,242,277.13,APC Neurobehavioral status exam,96116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,242,277.13,APC Neurobehavioral status exam,96116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,242,277.13,APC Cognitive test by hc pro,96125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,118.62,,,,,,,fee schedule,114.06,119.76,APC Cognitive test by hc pro,96125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,119.76,,,,,,,fee schedule,114.06,119.76,APC Cognitive test by hc pro,96125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.06,,,,,,,fee schedule,114.06,119.76,APC Brief emotional/behav assmt,96127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,46.33,APC Brief emotional/behav assmt,96127,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,46.33,APC Brief emotional/behav assmt,96127,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,46.33,APC Psycl tst eval phys/qhp 1st,96130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,267.83, Psycl tst eval phys/qhp 1st,96130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,267.83, Psycl tst eval phys/qhp 1st,96130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,63.76,267.83,APC Psycl tst eval phys/qhp 1st,96130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,63.76,267.83,APC Psycl tst eval phys/qhp 1st,96130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,63.76,267.83,APC Psycl tst eval phys/qhp ea,96131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,73.02, Psycl tst eval phys/qhp ea,96131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,73.02, Nrpsyc tst eval phys/qhp 1st,96132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,462.87, Nrpsyc tst eval phys/qhp 1st,96132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,462.87, Nrpsyc tst eval phys/qhp 1st,96132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,63.76,462.87,APC Nrpsyc tst eval phys/qhp 1st,96132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,63.76,462.87,APC Nrpsyc tst eval phys/qhp 1st,96132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,63.76,462.87,APC Nrpsyc tst eval phys/qhp ea,96133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,73.02, Nrpsyc tst eval phys/qhp ea,96133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,73.02, Psycl/nrpsyc tst phy/qhp 1st,96136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,165.03, Psycl/nrpsyc tst phy/qhp 1st,96136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,165.03, Psycl/nrpsyc tst phy/qhp 1st,96136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,63.76,165.03,APC Psycl/nrpsyc tst phy/qhp 1st,96136,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,63.76,165.03,APC Psycl/nrpsyc tst phy/qhp 1st,96136,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,63.76,165.03,APC Psycl/nrpsyc tst phy/qhp ea,96137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,73.02, Psycl/nrpsyc tst phy/qhp ea,96137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,73.02, Psycl/nrpsyc tech 1st,96138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,554.12, Psycl/nrpsyc tech 1st,96138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,554.12, Psycl/nrpsyc tech 1st,96138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,63.76,554.12,APC Psycl/nrpsyc tech 1st,96138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,63.76,554.12,APC Psycl/nrpsyc tech 1st,96138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,63.76,554.12,APC Psycl/nrpsyc tst tech ea,96139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,63.76,73.02, Psycl/nrpsyc tst tech ea,96139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,63.76,73.02, Psycl/nrpsyc tst auto result,96146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.76,,,,,,,fee schedule,34.17,73.02, Psycl/nrpsyc tst auto result,96146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.02,,,,,,,fee schedule,34.17,73.02, Psycl/nrpsyc tst auto result,96146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,73.02,APC Psycl/nrpsyc tst auto result,96146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,73.02,APC Psycl/nrpsyc tst auto result,96146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,73.02,APC Hlth bhv assmt/reassessment,96156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.86,,,,,,,fee schedule,57.86,126.01, Hlth bhv assmt/reassessment,96156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.26,,,,,,,fee schedule,57.86,126.01, Hlth bhv assmt/reassessment,96156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,124.81,,,,,,,fee schedule,57.86,126.01,APC Hlth bhv assmt/reassessment,96156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.01,,,,,,,fee schedule,57.86,126.01,APC Hlth bhv assmt/reassessment,96156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.01,,,,,,,fee schedule,57.86,126.01,APC Hlth bhv ivntj indiv 1st 30,96158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.74,,,,,,,fee schedule,59.74,220.17, Hlth bhv ivntj indiv 1st 30,96158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.42,,,,,,,fee schedule,59.74,220.17, Hlth bhv ivntj indiv 1st 30,96158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,218.07,,,,,,,fee schedule,59.74,220.17,APC Hlth bhv ivntj indiv 1st 30,96158,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,220.17,,,,,,,fee schedule,59.74,220.17,APC Hlth bhv ivntj indiv 1st 30,96158,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.68,,,,,,,fee schedule,59.74,220.17,APC Hlth bhv ivntj grp 1st 30,96164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.47,,,,,,,fee schedule,12.47,46.48, Hlth bhv ivntj grp 1st 30,96164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.29,,,,,,,fee schedule,12.47,46.48, Hlth bhv ivntj grp 1st 30,96164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.03,,,,,,,fee schedule,12.47,46.48,APC Hlth bhv ivntj grp 1st 30,96164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.48,,,,,,,fee schedule,12.47,46.48,APC Hlth bhv ivntj grp 1st 30,96164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.26,,,,,,,fee schedule,12.47,46.48,APC Hlth bhv ivntj grp ea addl,96165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.47,,,,,,,fee schedule,12.47,14.29, Hlth bhv ivntj grp ea addl,96165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.29,,,,,,,fee schedule,12.47,14.29, Hlth bhv ivntj fam 1st 30,96167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.96,,,,,,,fee schedule,44.26,61.8, Hlth bhv ivntj fam 1st 30,96167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.8,,,,,,,fee schedule,44.26,61.8, Hlth bhv ivntj fam 1st 30,96167,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.03,,,,,,,fee schedule,44.26,61.8,APC Hlth bhv ivntj fam 1st 30,96167,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.48,,,,,,,fee schedule,44.26,61.8,APC Hlth bhv ivntj fam 1st 30,96167,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.26,,,,,,,fee schedule,44.26,61.8,APC Hlth bhv ivntj fam ea addl,96168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.96,,,,,,,fee schedule,53.96,61.8, Hlth bhv ivntj fam ea addl,96168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.8,,,,,,,fee schedule,53.96,61.8, Hlth bhv ivntj fam wo pt 1st,96170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.4,,,,,,,fee schedule,59.4,68.02, Hlth bhv ivntj fam wo pt 1st,96170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.02,,,,,,,fee schedule,59.4,68.02, Hlth bhv ivntj fam w/o pt ea,96171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,59.4,,,,,,,fee schedule,59.4,68.02, Hlth bhv ivntj fam w/o pt ea,96171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,68.02,,,,,,,fee schedule,59.4,68.02, Mlt fam grp bhv train 1st 60,96202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.41,,,,,,,fee schedule,18.66,19.59,APC Mlt fam grp bhv train 1st 60,96202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.59,,,,,,,fee schedule,18.66,19.59,APC Mlt fam grp bhv train 1st 60,96202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.66,,,,,,,fee schedule,18.66,19.59,APC Mlt fam grp bhv train ea add,96203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.6,,,,,,,fee schedule,5.38,5.65,APC Mlt fam grp bhv train ea add,96203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.65,,,,,,,fee schedule,5.38,5.65,APC Mlt fam grp bhv train ea add,96203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.38,,,,,,,fee schedule,5.38,5.65,APC Hydration iv infusion init,96360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,481.57,,,,,,,fee schedule,251.28,551.47, Hydration iv infusion init,96360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,551.47,,,,,,,fee schedule,251.28,551.47, Hydration iv infusion init,96360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,551.47,APC Hydration iv infusion init,96360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,551.47,APC Hydration iv infusion init,96360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,551.47,APC Hydrate iv infusion add-on,96361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.32,,,,,,,fee schedule,55.32,146.94, Hydrate iv infusion add-on,96361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,146.94,,,,,,,fee schedule,55.32,146.94, Hydrate iv infusion add-on,96361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,146.94,APC Hydrate iv infusion add-on,96361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,146.94,APC Hydrate iv infusion add-on,96361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,146.94,APC Ther/proph/diag iv inf init,96365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,676.1,,,,,,,fee schedule,251.28,774.24, Ther/proph/diag iv inf init,96365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,774.24,,,,,,,fee schedule,251.28,774.24, Ther/proph/diag iv inf init,96365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,774.24,APC Ther/proph/diag iv inf init,96365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,774.24,APC Ther/proph/diag iv inf init,96365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,774.24,APC Ther/proph/diag iv inf addon,96366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,155.5,,,,,,,fee schedule,55.32,178.07, Ther/proph/diag iv inf addon,96366,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,178.07,,,,,,,fee schedule,55.32,178.07, Ther/proph/diag iv inf addon,96366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,178.07,APC Ther/proph/diag iv inf addon,96366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,178.07,APC Ther/proph/diag iv inf addon,96366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,178.07,APC Tx/proph/dg addl seq iv inf,96367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,89.31,APC Tx/proph/dg addl seq iv inf,96367,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,89.31,APC Tx/proph/dg addl seq iv inf,96367,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,89.31,APC Sc ther infusion up to 1 hr,96369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,688.99,,,,,,,fee schedule,251.28,789.01, Sc ther infusion up to 1 hr,96369,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,789.01,,,,,,,fee schedule,251.28,789.01, Sc ther infusion up to 1 hr,96369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,789.01,APC Sc ther infusion up to 1 hr,96369,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,789.01,APC Sc ther infusion up to 1 hr,96369,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,789.01,APC Sc ther infusion addl hr,96370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,431.67,,,,,,,fee schedule,55.32,494.33, Sc ther infusion addl hr,96370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,494.33,,,,,,,fee schedule,55.32,494.33, Sc ther infusion addl hr,96370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,494.33,APC Sc ther infusion addl hr,96370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,494.33,APC Sc ther infusion addl hr,96370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,494.33,APC Sc ther infusion reset pump,96371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,89.31,APC Sc ther infusion reset pump,96371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,89.31,APC Sc ther infusion reset pump,96371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,89.31,APC Ther/proph/diag inj sc/im,96372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.46,,,,,,,fee schedule,85.06,175.74, Ther/proph/diag inj sc/im,96372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,175.74,,,,,,,fee schedule,85.06,175.74, Ther/proph/diag inj sc/im,96372,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,175.74,APC Ther/proph/diag inj sc/im,96372,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,175.74,APC Ther/proph/diag inj sc/im,96372,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,175.74,APC Ther/proph/diag inj ia,96373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,290.85,,,,,,,fee schedule,251.28,333.08, Ther/proph/diag inj ia,96373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333.08,,,,,,,fee schedule,251.28,333.08, Ther/proph/diag inj ia,96373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,333.08,APC Ther/proph/diag inj ia,96373,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,333.08,APC Ther/proph/diag inj ia,96373,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,333.08,APC Ther/proph/diag inj iv push,96374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,289.42,,,,,,,fee schedule,251.28,331.43, Ther/proph/diag inj iv push,96374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,331.43,,,,,,,fee schedule,251.28,331.43, Ther/proph/diag inj iv push,96374,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,331.43,APC Ther/proph/diag inj iv push,96374,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,331.43,APC Ther/proph/diag inj iv push,96374,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,331.43,APC Tx/pro/dx inj new drug addon,96375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,174.69,,,,,,,fee schedule,55.32,200.05, Tx/pro/dx inj new drug addon,96375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,200.05,,,,,,,fee schedule,55.32,200.05, Tx/pro/dx inj new drug addon,96375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,200.05,APC Tx/pro/dx inj new drug addon,96375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,200.05,APC Tx/pro/dx inj new drug addon,96375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,200.05,APC Applicaton on-body injector,96377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,55.32,1866, Applicaton on-body injector,96377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,55.32,1866, Applicaton on-body injector,96377,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,1866,APC Applicaton on-body injector,96377,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,1866,APC Applicaton on-body injector,96377,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,1866,APC Ther/prop/diag inj/inf proc,96379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Ther/prop/diag inj/inf proc,96379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Ther/prop/diag inj/inf proc,96379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Chemo anti-neopl sq/im,96401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.04,,,,,,,fee schedule,85.06,111.13, Chemo anti-neopl sq/im,96401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.13,,,,,,,fee schedule,85.06,111.13, Chemo anti-neopl sq/im,96401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,111.13,APC Chemo anti-neopl sq/im,96401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,111.13,APC Chemo anti-neopl sq/im,96401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,111.13,APC Chemo hormon antineopl sq/im,96402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.04,,,,,,,fee schedule,85.06,111.13, Chemo hormon antineopl sq/im,96402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.13,,,,,,,fee schedule,85.06,111.13, Chemo hormon antineopl sq/im,96402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,111.13,APC Chemo hormon antineopl sq/im,96402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,111.13,APC Chemo hormon antineopl sq/im,96402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,111.13,APC Chemo intralesional up to 7,96405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.04,,,,,,,fee schedule,85.06,111.13, Chemo intralesional up to 7,96405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.13,,,,,,,fee schedule,85.06,111.13, Chemo intralesional up to 7,96405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,111.13,APC Chemo intralesional up to 7,96405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,111.13,APC Chemo intralesional up to 7,96405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,111.13,APC Chemo intralesional over 7,96406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,362.68,,,,,,,fee schedule,251.28,415.32, Chemo intralesional over 7,96406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,415.32,,,,,,,fee schedule,251.28,415.32, Chemo intralesional over 7,96406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,415.32,APC Chemo intralesional over 7,96406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,415.32,APC Chemo intralesional over 7,96406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,415.32,APC Chemo iv push sngl drug,96409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,362.68,,,,,,,fee schedule,362.68,415.32, Chemo iv push sngl drug,96409,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,415.32,,,,,,,fee schedule,362.68,415.32, Chemo iv push sngl drug,96409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,362.68,415.32,APC Chemo iv push sngl drug,96409,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,362.68,415.32,APC Chemo iv push sngl drug,96409,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,362.68,415.32,APC Chemo iv push addl drug,96411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.23,,,,,,,fee schedule,85.06,212.12, Chemo iv push addl drug,96411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.12,,,,,,,fee schedule,85.06,212.12, Chemo iv push addl drug,96411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,212.12,APC Chemo iv push addl drug,96411,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,212.12,APC Chemo iv push addl drug,96411,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,212.12,APC Chemo iv infusion 1 hr,96413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,542.38,,,,,,,fee schedule,390.2,621.11, Chemo iv infusion 1 hr,96413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,621.11,,,,,,,fee schedule,390.2,621.11, Chemo iv infusion 1 hr,96413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,621.11,APC Chemo iv infusion 1 hr,96413,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,621.11,APC Chemo iv infusion 1 hr,96413,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,621.11,APC Chemo iv infusion addl hr,96415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.04,,,,,,,fee schedule,85.06,111.13, Chemo iv infusion addl hr,96415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.13,,,,,,,fee schedule,85.06,111.13, Chemo iv infusion addl hr,96415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,111.13,APC Chemo iv infusion addl hr,96415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,111.13,APC Chemo iv infusion addl hr,96415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,111.13,APC Chemo prolong infuse w/pump,96416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,409.72,APC Chemo prolong infuse w/pump,96416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,409.72,APC Chemo prolong infuse w/pump,96416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,409.72,APC Chemo iv infus each addl seq,96417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,167.95,,,,,,,fee schedule,85.06,192.32, Chemo iv infus each addl seq,96417,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,192.32,,,,,,,fee schedule,85.06,192.32, Chemo iv infus each addl seq,96417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,192.32,APC Chemo iv infus each addl seq,96417,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,192.32,APC Chemo iv infus each addl seq,96417,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,192.32,APC Chemo ia push tecnique,96420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.23,,,,,,,fee schedule,185.23,409.72, Chemo ia push tecnique,96420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.12,,,,,,,fee schedule,185.23,409.72, Chemo ia push tecnique,96420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,185.23,409.72,APC Chemo ia push tecnique,96420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,185.23,409.72,APC Chemo ia push tecnique,96420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,185.23,409.72,APC Chemo ia infusion up to 1 hr,96422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,571.64,,,,,,,fee schedule,390.2,654.62, Chemo ia infusion up to 1 hr,96422,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,654.62,,,,,,,fee schedule,390.2,654.62, Chemo ia infusion up to 1 hr,96422,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,654.62,APC Chemo ia infusion up to 1 hr,96422,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,654.62,APC Chemo ia infusion up to 1 hr,96422,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,654.62,APC Chemo ia infuse each addl hr,96423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.23,,,,,,,fee schedule,55.32,212.12, Chemo ia infuse each addl hr,96423,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.12,,,,,,,fee schedule,55.32,212.12, Chemo ia infuse each addl hr,96423,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,212.12,APC Chemo ia infuse each addl hr,96423,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,212.12,APC Chemo ia infuse each addl hr,96423,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,212.12,APC Chemotherapy infusion method,96425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,571.64,,,,,,,fee schedule,390.2,654.62, Chemotherapy infusion method,96425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,654.62,,,,,,,fee schedule,390.2,654.62, Chemotherapy infusion method,96425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,654.62,APC Chemotherapy infusion method,96425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,654.62,APC Chemotherapy infusion method,96425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,654.62,APC Chemotherapy intracavitary,96440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,362.68,,,,,,,fee schedule,362.68,415.32, Chemotherapy intracavitary,96440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,415.32,,,,,,,fee schedule,362.68,415.32, Chemotherapy intracavitary,96440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,362.68,415.32,APC Chemotherapy intracavitary,96440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,362.68,415.32,APC Chemotherapy intracavitary,96440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,362.68,415.32,APC Chemotx admn prtl cavity,96446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,362.68,,,,,,,fee schedule,362.68,415.32, Chemotx admn prtl cavity,96446,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,415.32,,,,,,,fee schedule,362.68,415.32, Chemotx admn prtl cavity,96446,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,362.68,415.32,APC Chemotx admn prtl cavity,96446,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,362.68,415.32,APC Chemotx admn prtl cavity,96446,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,362.68,415.32,APC Chemotherapy into cns,96450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,571.64,,,,,,,fee schedule,390.2,654.62, Chemotherapy into cns,96450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,654.62,,,,,,,fee schedule,390.2,654.62, Chemotherapy into cns,96450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,654.62,APC Chemotherapy into cns,96450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,654.62,APC Chemotherapy into cns,96450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,654.62,APC Refill/maint portable pump,96521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,362.68,,,,,,,fee schedule,251.28,415.32, Refill/maint portable pump,96521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,415.32,,,,,,,fee schedule,251.28,415.32, Refill/maint portable pump,96521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,415.32,APC Refill/maint portable pump,96521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,415.32,APC Refill/maint portable pump,96521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,415.32,APC Refill/maint pump/resvr syst,96522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,362.68,,,,,,,fee schedule,251.28,415.32, Refill/maint pump/resvr syst,96522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,415.32,,,,,,,fee schedule,251.28,415.32, Refill/maint pump/resvr syst,96522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,415.32,APC Refill/maint pump/resvr syst,96522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,415.32,APC Refill/maint pump/resvr syst,96522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,415.32,APC Irrig drug delivery device,96523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,121.84,,,,,,,fee schedule,69.69,139.53, Irrig drug delivery device,96523,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,139.53,,,,,,,fee schedule,69.69,139.53, Irrig drug delivery device,96523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,139.53,APC Irrig drug delivery device,96523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,139.53,APC Irrig drug delivery device,96523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,139.53,APC Chemotherapy injection,96542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,409.72,APC Chemotherapy injection,96542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,409.72,APC Chemotherapy injection,96542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,409.72,APC Chemotherapy unspecified,96549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Chemotherapy unspecified,96549,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Chemotherapy unspecified,96549,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Photodynamic tx skin,96567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,248.87,APC Photodynamic tx skin,96567,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,248.87,APC Photodynamic tx skin,96567,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,248.87,APC Pdt dstr prmlg les phys/qhp,96573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,248.87,APC Pdt dstr prmlg les phys/qhp,96573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,248.87,APC Pdt dstr prmlg les phys/qhp,96573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,248.87,APC Dbrdmt prmlg les w/pdt,96574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,1866, Dbrdmt prmlg les w/pdt,96574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,1866, Dbrdmt prmlg les w/pdt,96574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,1866,APC Dbrdmt prmlg les w/pdt,96574,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,1866,APC Dbrdmt prmlg les w/pdt,96574,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,1866,APC Ultraviolet light therapy,96900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,364.27,,,,,,,fee schedule,44.12,405.15, Ultraviolet light therapy,96900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,405.15,,,,,,,fee schedule,44.12,405.15, Ultraviolet light therapy,96900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,405.15,APC Ultraviolet light therapy,96900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,405.15,APC Ultraviolet light therapy,96900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,405.15,APC Photochemotherapy with UV-B,96910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Photochemotherapy with UV-B,96910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Photochemotherapy with UV-B,96910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Photochemotherapy with UV-A,96912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,73.17,APC Photochemotherapy with UV-A,96912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,73.17,APC Photochemotherapy with UV-A,96912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,73.17,APC Photochemotherapy uv-a or b,96913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,504.25,APC Photochemotherapy uv-a or b,96913,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,504.25,APC Photochemotherapy uv-a or b,96913,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,504.25,APC Laser tx skin < 250 sq cm,96920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,1866, Laser tx skin < 250 sq cm,96920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,1866, Laser tx skin < 250 sq cm,96920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,1866,APC Laser tx skin < 250 sq cm,96920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,1866,APC Laser tx skin < 250 sq cm,96920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,1866,APC Laser tx skin 250-500 sq cm,96921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,1866, Laser tx skin 250-500 sq cm,96921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,1866, Laser tx skin 250-500 sq cm,96921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,1866,APC Laser tx skin 250-500 sq cm,96921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,1866,APC Laser tx skin 250-500 sq cm,96921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,1866,APC Laser tx skin >500 sq cm,96922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,480.23,1866, Laser tx skin >500 sq cm,96922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,480.23,1866, Laser tx skin >500 sq cm,96922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,1866,APC Laser tx skin >500 sq cm,96922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,1866,APC Laser tx skin >500 sq cm,96922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,1866,APC Dermatological procedure,96999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,248.87,APC Dermatological procedure,96999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,248.87,APC Dermatological procedure,96999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,248.87,APC Mechanical traction therapy,97012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.8,,,,,,,fee schedule,15.9,111, Mechanical traction therapy,97012,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111,,,,,,,fee schedule,15.9,111, Mechanical traction therapy,97012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.54,,,,,,,fee schedule,15.9,111,APC Mechanical traction therapy,97012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.7,,,,,,,fee schedule,15.9,111,APC Mechanical traction therapy,97012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.9,,,,,,,fee schedule,15.9,111,APC Electric stimulation therapy,97014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.32,,,,,,,fee schedule,92.32,102.68, Electric stimulation therapy,97014,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.68,,,,,,,fee schedule,92.32,102.68, Vasopneumatic device therapy,97016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,107.29,,,,,,,fee schedule,13.4,119.33, Vasopneumatic device therapy,97016,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,119.33,,,,,,,fee schedule,13.4,119.33, Vasopneumatic device therapy,97016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.94,,,,,,,fee schedule,13.4,119.33,APC Vasopneumatic device therapy,97016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.07,,,,,,,fee schedule,13.4,119.33,APC Vasopneumatic device therapy,97016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.4,,,,,,,fee schedule,13.4,119.33,APC Paraffin bath therapy,97018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.81,,,,,,,fee schedule,6.81,105.45, Paraffin bath therapy,97018,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.45,,,,,,,fee schedule,6.81,105.45, Paraffin bath therapy,97018,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.08,,,,,,,fee schedule,6.81,105.45,APC Paraffin bath therapy,97018,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.15,,,,,,,fee schedule,6.81,105.45,APC Paraffin bath therapy,97018,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.81,,,,,,,fee schedule,6.81,105.45,APC Whirlpool therapy,97022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.8,,,,,,,fee schedule,17.77,111, Whirlpool therapy,97022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111,,,,,,,fee schedule,17.77,111, Whirlpool therapy,97022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.48,,,,,,,fee schedule,17.77,111,APC Whirlpool therapy,97022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.66,,,,,,,fee schedule,17.77,111,APC Whirlpool therapy,97022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.77,,,,,,,fee schedule,17.77,111,APC Diathermy eg microwave,97024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.83,,,,,,,fee schedule,8.39,94.35, Diathermy eg microwave,97024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.35,,,,,,,fee schedule,8.39,94.35, Diathermy eg microwave,97024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.73,,,,,,,fee schedule,8.39,94.35,APC Diathermy eg microwave,97024,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.81,,,,,,,fee schedule,8.39,94.35,APC Diathermy eg microwave,97024,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.39,,,,,,,fee schedule,8.39,94.35,APC Infrared therapy,97026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.9,,,,,,,fee schedule,7.6,7.98,APC Infrared therapy,97026,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.98,,,,,,,fee schedule,7.6,7.98,APC Infrared therapy,97026,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.6,,,,,,,fee schedule,7.6,7.98,APC Ultraviolet therapy,97028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.32,,,,,,,fee schedule,9.48,102.68, Ultraviolet therapy,97028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.68,,,,,,,fee schedule,9.48,102.68, Ultraviolet therapy,97028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.86,,,,,,,fee schedule,9.48,102.68,APC Ultraviolet therapy,97028,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.95,,,,,,,fee schedule,9.48,102.68,APC Ultraviolet therapy,97028,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.48,,,,,,,fee schedule,9.48,102.68,APC Electrical stimulation,97032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.82,,,,,,,fee schedule,16.26,99.9, Electrical stimulation,97032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.9,,,,,,,fee schedule,16.26,99.9, Electrical stimulation,97032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.91,,,,,,,fee schedule,16.26,99.9,APC Electrical stimulation,97032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.07,,,,,,,fee schedule,16.26,99.9,APC Electrical stimulation,97032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.26,,,,,,,fee schedule,16.26,99.9,APC Electric current therapy,97033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.3,,,,,,,fee schedule,21.33,113.78, Electric current therapy,97033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.78,,,,,,,fee schedule,21.33,113.78, Electric current therapy,97033,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.18,,,,,,,fee schedule,21.33,113.78,APC Electric current therapy,97033,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.4,,,,,,,fee schedule,21.33,113.78,APC Electric current therapy,97033,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.33,,,,,,,fee schedule,21.33,113.78,APC Contrast bath therapy,97034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.34,,,,,,,fee schedule,15.63,91.58, Contrast bath therapy,97034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.58,,,,,,,fee schedule,15.63,91.58, Contrast bath therapy,97034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.26,,,,,,,fee schedule,15.63,91.58,APC Contrast bath therapy,97034,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.41,,,,,,,fee schedule,15.63,91.58,APC Contrast bath therapy,97034,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.63,,,,,,,fee schedule,15.63,91.58,APC Ultrasound therapy,97035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,84.83,,,,,,,fee schedule,16.03,94.35, Ultrasound therapy,97035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.35,,,,,,,fee schedule,16.03,94.35, Ultrasound therapy,97035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.67,,,,,,,fee schedule,16.03,94.35,APC Ultrasound therapy,97035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.83,,,,,,,fee schedule,16.03,94.35,APC Ultrasound therapy,97035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.03,,,,,,,fee schedule,16.03,94.35,APC Hydrotherapy,97036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.76,,,,,,,fee schedule,39.74,133.2, Hydrotherapy,97036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,133.2,,,,,,,fee schedule,39.74,133.2, Hydrotherapy,97036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.33,,,,,,,fee schedule,39.74,133.2,APC Hydrotherapy,97036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.73,,,,,,,fee schedule,39.74,133.2,APC Hydrotherapy,97036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.74,,,,,,,fee schedule,39.74,133.2,APC Appl modality 1+lllt po pain,97037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,190.92,,,,,,,fee schedule,44.12,212.34, Appl modality 1+lllt po pain,97037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.34,,,,,,,fee schedule,44.12,212.34, Appl modality 1+lllt po pain,97037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,212.34,APC Appl modality 1+lllt po pain,97037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,212.34,APC Appl modality 1+lllt po pain,97037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,212.34,APC Therapeutic exercises,97110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.76,,,,,,,fee schedule,32.35,133.2, Therapeutic exercises,97110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,133.2,,,,,,,fee schedule,32.35,133.2, Therapeutic exercises,97110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.64,,,,,,,fee schedule,32.35,133.2,APC Therapeutic exercises,97110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.97,,,,,,,fee schedule,32.35,133.2,APC Therapeutic exercises,97110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.35,,,,,,,fee schedule,32.35,133.2,APC Neuromuscular reeducation,97112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.77,,,,,,,fee schedule,36.47,127.65, Neuromuscular reeducation,97112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.65,,,,,,,fee schedule,36.47,127.65, Neuromuscular reeducation,97112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.93,,,,,,,fee schedule,36.47,127.65,APC Neuromuscular reeducation,97112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.29,,,,,,,fee schedule,36.47,127.65,APC Neuromuscular reeducation,97112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.47,,,,,,,fee schedule,36.47,127.65,APC Aquatic therapy/exercises,97113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,139.72,,,,,,,fee schedule,41.66,155.4, Aquatic therapy/exercises,97113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,155.4,,,,,,,fee schedule,41.66,155.4, Aquatic therapy/exercises,97113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.33,,,,,,,fee schedule,41.66,155.4,APC Aquatic therapy/exercises,97113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.74,,,,,,,fee schedule,41.66,155.4,APC Aquatic therapy/exercises,97113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.66,,,,,,,fee schedule,41.66,155.4,APC Gait training therapy,97116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.78,,,,,,,fee schedule,32.35,122.1, Gait training therapy,97116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.1,,,,,,,fee schedule,32.35,122.1, Gait training therapy,97116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.64,,,,,,,fee schedule,32.35,122.1,APC Gait training therapy,97116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.97,,,,,,,fee schedule,32.35,122.1,APC Gait training therapy,97116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.35,,,,,,,fee schedule,32.35,122.1,APC Massage therapy,97124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.8,,,,,,,fee schedule,33.55,111, Massage therapy,97124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111,,,,,,,fee schedule,33.55,111, Massage therapy,97124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.89,,,,,,,fee schedule,33.55,111,APC Massage therapy,97124,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.23,,,,,,,fee schedule,33.55,111,APC Massage therapy,97124,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.55,,,,,,,fee schedule,33.55,111,APC Ther ivntj 1st 15 min,97129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,177.15,,,,,,,fee schedule,21.12,197.03, Ther ivntj 1st 15 min,97129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,197.03,,,,,,,fee schedule,21.12,197.03, Ther ivntj 1st 15 min,97129,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.96,,,,,,,fee schedule,21.12,197.03,APC Ther ivntj 1st 15 min,97129,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.18,,,,,,,fee schedule,21.12,197.03,APC Ther ivntj 1st 15 min,97129,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.12,,,,,,,fee schedule,21.12,197.03,APC Ther ivntj ea addl 15 min,97130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.44,,,,,,,fee schedule,19.65,20.63,APC Ther ivntj ea addl 15 min,97130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.63,,,,,,,fee schedule,19.65,20.63,APC Ther ivntj ea addl 15 min,97130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.65,,,,,,,fee schedule,19.65,20.63,APC Manual therapy 1/> regions,97140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.78,,,,,,,fee schedule,30.85,122.1, Manual therapy 1/> regions,97140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.1,,,,,,,fee schedule,30.85,122.1, Manual therapy 1/> regions,97140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.08,,,,,,,fee schedule,30.85,122.1,APC Manual therapy 1/> regions,97140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.39,,,,,,,fee schedule,30.85,122.1,APC Manual therapy 1/> regions,97140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.85,,,,,,,fee schedule,30.85,122.1,APC Group therapeutic procedures,97150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,94.81,,,,,,,fee schedule,20.02,105.45, Group therapeutic procedures,97150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.45,,,,,,,fee schedule,20.02,105.45, Group therapeutic procedures,97150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.82,,,,,,,fee schedule,20.02,105.45,APC Group therapeutic procedures,97150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.02,,,,,,,fee schedule,20.02,105.45,APC Group therapeutic procedures,97150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.02,,,,,,,fee schedule,20.02,105.45,APC Pt eval low complex 20 min,97161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.4,,,,,,,fee schedule,108.88,333, Pt eval low complex 20 min,97161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333,,,,,,,fee schedule,108.88,333, Pt eval low complex 20 min,97161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,113.24,,,,,,,fee schedule,108.88,333,APC Pt eval low complex 20 min,97161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,114.32,,,,,,,fee schedule,108.88,333,APC Pt eval low complex 20 min,97161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,108.88,,,,,,,fee schedule,108.88,333,APC Pt eval mod complex 30 min,97162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.4,,,,,,,fee schedule,108.88,333, Pt eval mod complex 30 min,97162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333,,,,,,,fee schedule,108.88,333, Pt eval mod complex 30 min,97162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,113.24,,,,,,,fee schedule,108.88,333,APC Pt eval mod complex 30 min,97162,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,114.32,,,,,,,fee schedule,108.88,333,APC Pt eval mod complex 30 min,97162,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,108.88,,,,,,,fee schedule,108.88,333,APC Pt eval high complex 45 min,97163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.4,,,,,,,fee schedule,108.88,333, Pt eval high complex 45 min,97163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333,,,,,,,fee schedule,108.88,333, Pt eval high complex 45 min,97163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,113.24,,,,,,,fee schedule,108.88,333,APC Pt eval high complex 45 min,97163,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,114.32,,,,,,,fee schedule,108.88,333,APC Pt eval high complex 45 min,97163,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,108.88,,,,,,,fee schedule,108.88,333,APC Pt re-eval est plan care,97164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.67,,,,,,,fee schedule,75.48,183.15, Pt re-eval est plan care,97164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,183.15,,,,,,,fee schedule,75.48,183.15, Pt re-eval est plan care,97164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,78.5,,,,,,,fee schedule,75.48,183.15,APC Pt re-eval est plan care,97164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,79.25,,,,,,,fee schedule,75.48,183.15,APC Pt re-eval est plan care,97164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,75.48,,,,,,,fee schedule,75.48,183.15,APC Ot eval low complex 30 min,97165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.4,,,,,,,fee schedule,112.03,333, Ot eval low complex 30 min,97165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333,,,,,,,fee schedule,112.03,333, Ot eval low complex 30 min,97165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.51,,,,,,,fee schedule,112.03,333,APC Ot eval low complex 30 min,97165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.63,,,,,,,fee schedule,112.03,333,APC Ot eval low complex 30 min,97165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.03,,,,,,,fee schedule,112.03,333,APC Ot eval mod complex 45 min,97166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.4,,,,,,,fee schedule,112.03,333, Ot eval mod complex 45 min,97166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333,,,,,,,fee schedule,112.03,333, Ot eval mod complex 45 min,97166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.51,,,,,,,fee schedule,112.03,333,APC Ot eval mod complex 45 min,97166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.63,,,,,,,fee schedule,112.03,333,APC Ot eval mod complex 45 min,97166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.03,,,,,,,fee schedule,112.03,333,APC Ot eval high complex 60 min,97167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.4,,,,,,,fee schedule,112.03,333, Ot eval high complex 60 min,97167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,333,,,,,,,fee schedule,112.03,333, Ot eval high complex 60 min,97167,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.51,,,,,,,fee schedule,112.03,333,APC Ot eval high complex 60 min,97167,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.63,,,,,,,fee schedule,112.03,333,APC Ot eval high complex 60 min,97167,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.03,,,,,,,fee schedule,112.03,333,APC Ot re-eval est plan care,97168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.67,,,,,,,fee schedule,76.66,183.15, Ot re-eval est plan care,97168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,183.15,,,,,,,fee schedule,76.66,183.15, Ot re-eval est plan care,97168,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79.73,,,,,,,fee schedule,76.66,183.15,APC Ot re-eval est plan care,97168,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80.49,,,,,,,fee schedule,76.66,183.15,APC Ot re-eval est plan care,97168,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,76.66,,,,,,,fee schedule,76.66,183.15,APC Athletic trn eval low cmplx,97169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.72,,,,,,,fee schedule,241.72,268.84, Athletic trn eval low cmplx,97169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.84,,,,,,,fee schedule,241.72,268.84, Athletic trn eval mod cmplx,97170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.72,,,,,,,fee schedule,241.72,268.84, Athletic trn eval mod cmplx,97170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.84,,,,,,,fee schedule,241.72,268.84, Athletic trn eval high cmplx,97171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.72,,,,,,,fee schedule,241.72,268.84, Athletic trn eval high cmplx,97171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.84,,,,,,,fee schedule,241.72,268.84, Athletic trn re-eval plan cr,97172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.72,,,,,,,fee schedule,241.72,268.84, Athletic trn re-eval plan cr,97172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.84,,,,,,,fee schedule,241.72,268.84, Therapeutic activities,97530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.74,,,,,,,fee schedule,39.47,144.3, Therapeutic activities,97530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,144.3,,,,,,,fee schedule,39.47,144.3, Therapeutic activities,97530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.05,,,,,,,fee schedule,39.47,144.3,APC Therapeutic activities,97530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.44,,,,,,,fee schedule,39.47,144.3,APC Therapeutic activities,97530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.47,,,,,,,fee schedule,39.47,144.3,APC Sensory Integration,97533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,143.86,,,,,,,fee schedule,69.6,160.01, Sensory Integration,97533,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,160.01,,,,,,,fee schedule,69.6,160.01, Sensory Integration,97533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.38,,,,,,,fee schedule,69.6,160.01,APC Sensory Integration,97533,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.08,,,,,,,fee schedule,69.6,160.01,APC Sensory Integration,97533,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.6,,,,,,,fee schedule,69.6,160.01,APC Self care mngment training,97535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.76,,,,,,,fee schedule,36.28,133.2, Self care mngment training,97535,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,133.2,,,,,,,fee schedule,36.28,133.2, Self care mngment training,97535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,36.28,133.2,APC Self care mngment training,97535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.09,,,,,,,fee schedule,36.28,133.2,APC Self care mngment training,97535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.28,,,,,,,fee schedule,36.28,133.2,APC Community/work reintegration,97537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,119.76,,,,,,,fee schedule,35.76,133.2, Community/work reintegration,97537,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,133.2,,,,,,,fee schedule,35.76,133.2, Community/work reintegration,97537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.19,,,,,,,fee schedule,35.76,133.2,APC Community/work reintegration,97537,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.55,,,,,,,fee schedule,35.76,133.2,APC Community/work reintegration,97537,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.76,,,,,,,fee schedule,35.76,133.2,APC Wheelchair mngment training,97542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.8,,,,,,,fee schedule,34.58,111, Wheelchair mngment training,97542,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111,,,,,,,fee schedule,34.58,111, Wheelchair mngment training,97542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.96,,,,,,,fee schedule,34.58,111,APC Wheelchair mngment training,97542,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.31,,,,,,,fee schedule,34.58,111,APC Wheelchair mngment training,97542,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.58,,,,,,,fee schedule,34.58,111,APC Rmvl devital tis 20 cm/<,97597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,237.02,1866, Rmvl devital tis 20 cm/<,97597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,237.02,1866, Rmvl devital tis 20 cm/<,97597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,274.6,,,,,,,fee schedule,237.02,1866, Rmvl devital tis 20 cm/<,97597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,305.42,,,,,,,fee schedule,237.02,1866, Rmvl devital tis 20 cm/<,97597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,1866,APC Rmvl devital tis 20 cm/<,97597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,1866,APC Rmvl devital tis 20 cm/<,97597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,1866,APC Rmvl devital tis addl 20cm/<,97598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,347.9,1866, Rmvl devital tis addl 20cm/<,97598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,347.9,1866, Rmvl devital tis addl 20cm/<,97598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,347.9,,,,,,,fee schedule,347.9,1866, Rmvl devital tis addl 20cm/<,97598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,386.95,,,,,,,fee schedule,347.9,1866, Wound(s) care non-selective,97602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,248.87,APC Wound(s) care non-selective,97602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,248.87,APC Wound(s) care non-selective,97602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,248.87,APC Neg press wound tx <=50 cm,97605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,180.94,,,,,,,fee schedule,180.94,248.87, Neg press wound tx <=50 cm,97605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,201.24,,,,,,,fee schedule,180.94,248.87, Neg press wound tx <=50 cm,97605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,180.94,248.87,APC Neg press wound tx <=50 cm,97605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,180.94,248.87,APC Neg press wound tx <=50 cm,97605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,180.94,248.87,APC Neg press wound tx >50 cm,97606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,176.85,,,,,,,fee schedule,176.85,504.25, Neg press wound tx >50 cm,97606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,196.69,,,,,,,fee schedule,176.85,504.25, Neg press wound tx >50 cm,97606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,176.85,504.25,APC Neg press wound tx >50 cm,97606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,176.85,504.25,APC Neg press wound tx >50 cm,97606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,176.85,504.25,APC Neg press wnd tx <=50 sq cm,97607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,504.25,APC Neg press wnd tx <=50 sq cm,97607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,504.25,APC Neg press wnd tx <=50 sq cm,97607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,504.25,APC Neg press wound tx >50 cm,97608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.44,,,,,,,fee schedule,480.23,504.25,APC Neg press wound tx >50 cm,97608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.25,,,,,,,fee schedule,480.23,504.25,APC Neg press wound tx >50 cm,97608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.23,,,,,,,fee schedule,480.23,504.25,APC Low frequency non-thermal us,97610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,248.87,APC Low frequency non-thermal us,97610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,248.87,APC Low frequency non-thermal us,97610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,248.87,APC Physical performance test,97750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,184.63,,,,,,,fee schedule,37.85,205.35, Physical performance test,97750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,205.35,,,,,,,fee schedule,37.85,205.35, Physical performance test,97750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.36,,,,,,,fee schedule,37.85,205.35,APC Physical performance test,97750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.74,,,,,,,fee schedule,37.85,205.35,APC Physical performance test,97750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.85,,,,,,,fee schedule,37.85,205.35,APC Assistive technology assess,97755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,187.72,,,,,,,fee schedule,41.87,208.79, Assistive technology assess,97755,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,208.79,,,,,,,fee schedule,41.87,208.79, Assistive technology assess,97755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.54,,,,,,,fee schedule,41.87,208.79,APC Assistive technology assess,97755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.96,,,,,,,fee schedule,41.87,208.79,APC Assistive technology assess,97755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.87,,,,,,,fee schedule,41.87,208.79,APC Orthotic mgmt and training,97760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.67,,,,,,,fee schedule,52.21,183.15, Orthotic mgmt and training,97760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,183.15,,,,,,,fee schedule,52.21,183.15, Orthotic mgmt and training,97760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54.3,,,,,,,fee schedule,52.21,183.15,APC Orthotic mgmt and training,97760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.82,,,,,,,fee schedule,52.21,183.15,APC Orthotic mgmt and training,97760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52.21,,,,,,,fee schedule,52.21,183.15,APC Prosthetic training,97761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.67,,,,,,,fee schedule,45.52,183.15, Prosthetic training,97761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,183.15,,,,,,,fee schedule,45.52,183.15, Prosthetic training,97761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,47.34,,,,,,,fee schedule,45.52,183.15,APC Prosthetic training,97761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,47.8,,,,,,,fee schedule,45.52,183.15,APC Prosthetic training,97761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,45.52,,,,,,,fee schedule,45.52,183.15,APC Orthc/prostc mgmt sbsq enc,97763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,104.79,,,,,,,fee schedule,57.01,116.55, Orthc/prostc mgmt sbsq enc,97763,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.55,,,,,,,fee schedule,57.01,116.55, Orthc/prostc mgmt sbsq enc,97763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,59.29,,,,,,,fee schedule,57.01,116.55,APC Orthc/prostc mgmt sbsq enc,97763,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.86,,,,,,,fee schedule,57.01,116.55,APC Orthc/prostc mgmt sbsq enc,97763,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,57.01,,,,,,,fee schedule,57.01,116.55,APC Medical nutrition indiv in,97802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.02,,,,,,,fee schedule,28.87,30.31,APC Medical nutrition indiv in,97802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.31,,,,,,,fee schedule,28.87,30.31,APC Medical nutrition indiv in,97802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.87,,,,,,,fee schedule,28.87,30.31,APC Med nutrition indiv subseq,97803,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.04,,,,,,,fee schedule,24.08,25.28,APC Med nutrition indiv subseq,97803,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.28,,,,,,,fee schedule,24.08,25.28,APC Med nutrition indiv subseq,97803,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.08,,,,,,,fee schedule,24.08,25.28,APC Medical nutrition group,97804,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.04,,,,,,,fee schedule,13.5,14.18,APC Medical nutrition group,97804,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.18,,,,,,,fee schedule,13.5,14.18,APC Medical nutrition group,97804,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.5,,,,,,,fee schedule,13.5,14.18,APC Acupunct w/o stimul 15 min,97810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Acupunct w/o stimul 15 min,97810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Acupunct w/o stimul 15 min,97810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Acupunct w/stimul 15 min,97813,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Acupunct w/stimul 15 min,97813,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Acupunct w/stimul 15 min,97813,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Rem ther mntr 1st setup&edu,98975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Rem ther mntr 1st setup&edu,98975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Rem ther mntr 1st setup&edu,98975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Anogenital exam child w imag,99170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,248.39,,,,,,,fee schedule,238.83,250.78,APC Anogenital exam child w imag,99170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,250.78,,,,,,,fee schedule,238.83,250.78,APC Anogenital exam child w imag,99170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,238.83,,,,,,,fee schedule,238.83,250.78,APC Ocular Function Screen,99172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,256.26,,,,,,,fee schedule,256.26,293.46, Ocular Function Screen,99172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,293.46,,,,,,,fee schedule,256.26,293.46, Visual acuity screen,99173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.46,,,,,,,fee schedule,7.46,8.55, Visual acuity screen,99173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.55,,,,,,,fee schedule,7.46,8.55, Ocular instrumnt screen bil,99174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.09,,,,,,,fee schedule,76.09,87.13, Ocular instrumnt screen bil,99174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.13,,,,,,,fee schedule,76.09,87.13, Phlebotomy,99195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,212.11,,,,,,,fee schedule,157.18,242.91, Phlebotomy,99195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,242.91,,,,,,,fee schedule,157.18,242.91, Phlebotomy,99195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,242.91,APC Phlebotomy,99195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,242.91,APC Phlebotomy,99195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,242.91,APC Emergency dept visit,99281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,103.6,,,,,,,fee schedule,99.62,104.6,APC Emergency dept visit,99281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,104.6,,,,,,,fee schedule,99.62,104.6,APC Emergency dept visit,99281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,99.62,,,,,,,fee schedule,99.62,104.6,APC Emergency dept visit,99282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,188.64,,,,,,,fee schedule,181.39,190.46,APC Emergency dept visit,99282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,190.46,,,,,,,fee schedule,181.39,190.46,APC Emergency dept visit,99282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,181.39,,,,,,,fee schedule,181.39,190.46,APC Emergency dept visit,99283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,335.38,,,,,,,fee schedule,322.48,338.6,APC Emergency dept visit,99283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,338.6,,,,,,,fee schedule,322.48,338.6,APC Emergency dept visit,99283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,322.48,,,,,,,fee schedule,322.48,338.6,APC Emergency dept visit,99284,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,512.65,,,,,,,fee schedule,492.93,517.58,APC Emergency dept visit,99284,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,517.58,,,,,,,fee schedule,492.93,517.58,APC Emergency dept visit,99284,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,492.93,,,,,,,fee schedule,492.93,517.58,APC Emergency dept visit,99285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,731.67,,,,,,,fee schedule,703.53,738.7,APC Emergency dept visit,99285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,738.7,,,,,,,fee schedule,703.53,738.7,APC Emergency dept visit,99285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,703.53,,,,,,,fee schedule,703.53,738.7,APC Critical care first hour,99291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1014.86,,,,,,,fee schedule,975.82,1024.62,APC Critical care first hour,99291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1024.62,,,,,,,fee schedule,975.82,1024.62,APC Critical care first hour,99291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,975.82,,,,,,,fee schedule,975.82,1024.62,APC Rem mntr physiol param setup,99453,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Rem mntr physiol param setup,99453,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Rem mntr physiol param setup,99453,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Init nb em per day hosp,99460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Init nb em per day hosp,99460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Init nb em per day hosp,99460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Same day nb discharge,99463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Same day nb discharge,99463,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Same day nb discharge,99463,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Nb resuscitation,99465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,812.04,,,,,,,fee schedule,780.8,819.84,APC Nb resuscitation,99465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,819.84,,,,,,,fee schedule,780.8,819.84,APC Nb resuscitation,99465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,780.8,,,,,,,fee schedule,780.8,819.84,APC Self-meas bp pt educaj/train,99473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Self-meas bp pt educaj/train,99473,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Self-meas bp pt educaj/train,99473,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Trans care mgmt 14 day disch,99495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Trans care mgmt 14 day disch,99495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Trans care mgmt 14 day disch,99495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Trans care mgmt 7 day disch,99496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Trans care mgmt 7 day disch,99496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Trans care mgmt 7 day disch,99496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Miscellaneous M >=66.50,A2001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2382.98,,,,,,,fee schedule,147.01,2859.83, Miscellaneous M >=66.50,A2001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2859.83,,,,,,,fee schedule,147.01,2859.83, Miscellaneous M >=66.50,A2001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2859.83,APC Miscellaneous M >=66.50,A2001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2859.83,APC Miscellaneous M >=66.50,A2001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2859.83,APC Miscellaneous M <46.50 and A >=77.50,A2004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.78,,,,,,,fee schedule,24.78,29.74, Miscellaneous M <46.50 and A >=77.50,A2004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.74,,,,,,,fee schedule,24.78,29.74, "Restrata, per sq cm",A2007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,384.45,,,,,,,fee schedule,147.01,461.39, "Restrata, per sq cm",A2007,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,461.39,,,,,,,fee schedule,147.01,461.39, "Restrata, per sq cm",A2007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,461.39,APC "Restrata, per sq cm",A2007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,461.39,APC "Restrata, per sq cm",A2007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,461.39,APC "Theragenesis, per sq cm",A2008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,282.72,,,,,,,fee schedule,147.01,339.3, "Theragenesis, per sq cm",A2008,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,339.3,,,,,,,fee schedule,147.01,339.3, "Theragenesis, per sq cm",A2008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,339.3,APC "Theragenesis, per sq cm",A2008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,339.3,APC "Theragenesis, per sq cm",A2008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,339.3,APC "Symphony, per sq cm",A2009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,174.06,,,,,,,fee schedule,147.01,208.89, "Symphony, per sq cm",A2009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,208.89,,,,,,,fee schedule,147.01,208.89, "Symphony, per sq cm",A2009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,208.89,APC "Symphony, per sq cm",A2009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,208.89,APC "Symphony, per sq cm",A2009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,208.89,APC "Innovamatrix fs, per sq cm",A2013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2573.61,,,,,,,fee schedule,147.01,3088.61, "Innovamatrix fs, per sq cm",A2013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3088.61,,,,,,,fee schedule,147.01,3088.61, "Innovamatrix fs, per sq cm",A2013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3088.61,APC "Innovamatrix fs, per sq cm",A2013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3088.61,APC "Innovamatrix fs, per sq cm",A2013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3088.61,APC Omeza collag per 100 mg,A2014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,244.26,,,,,,,fee schedule,244.26,293.14, Omeza collag per 100 mg,A2014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,293.14,,,,,,,fee schedule,244.26,293.14, Kerecis marigen shld sq cm,A2019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1135.06,,,,,,,fee schedule,147.01,1362.2, Kerecis marigen shld sq cm,A2019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1362.2,,,,,,,fee schedule,147.01,1362.2, Kerecis marigen shld sq cm,A2019,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1362.2,APC Kerecis marigen shld sq cm,A2019,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1362.2,APC Kerecis marigen shld sq cm,A2019,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1362.2,APC Neomatrix per sq cm,A2021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3287.03,,,,,,,fee schedule,147.01,3944.79, Neomatrix per sq cm,A2021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3944.79,,,,,,,fee schedule,147.01,3944.79, Neomatrix per sq cm,A2021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3944.79,APC Neomatrix per sq cm,A2021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3944.79,APC Neomatrix per sq cm,A2021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3944.79,APC Innovabrn/innovamatx xl sqcm,A2022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2716.59,,,,,,,fee schedule,147.01,3260.2, Innovabrn/innovamatx xl sqcm,A2022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3260.2,,,,,,,fee schedule,147.01,3260.2, Innovabrn/innovamatx xl sqcm,A2022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3260.2,APC Innovabrn/innovamatx xl sqcm,A2022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3260.2,APC Innovabrn/innovamatx xl sqcm,A2022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3260.2,APC "Innovamatrix pd, 1 mg",A2023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.99,,,,,,,fee schedule,30.99,37.19, "Innovamatrix pd, 1 mg",A2023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,37.19,,,,,,,fee schedule,30.99,37.19, Miro3d per cubic cm,A2025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,397.16,,,,,,,fee schedule,147.01,476.64, Miro3d per cubic cm,A2025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,476.64,,,,,,,fee schedule,147.01,476.64, Miro3d per cubic cm,A2025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,476.64,APC Miro3d per cubic cm,A2025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,476.64,APC Miro3d per cubic cm,A2025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,476.64,APC Micromatrix flex per mg,A2028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1491.56,,,,,,,fee schedule,1491.56,1790.03, Micromatrix flex per mg,A2028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1790.03,,,,,,,fee schedule,1491.56,1790.03, Mirotract matrix sheet,A2029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,794.33,,,,,,,fee schedule,147.01,953.28, Mirotract matrix sheet,A2029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,953.28,,,,,,,fee schedule,147.01,953.28, Mirotract matrix sheet,A2029,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,953.28,APC Mirotract matrix sheet,A2029,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,953.28,APC Mirotract matrix sheet,A2029,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,953.28,APC "Miro3d fibers, per mg",A2030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.75,,,,,,,fee schedule,8.75,10.5, "Miro3d fibers, per mg",A2030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.5,,,,,,,fee schedule,8.75,10.5, "Mirodry, per sq cm",A2031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,953.19,,,,,,,fee schedule,147.01,1143.93, "Mirodry, per sq cm",A2031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1143.93,,,,,,,fee schedule,147.01,1143.93, "Mirodry, per sq cm",A2031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1143.93,APC "Mirodry, per sq cm",A2031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1143.93,APC "Mirodry, per sq cm",A2031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1143.93,APC "Myriad matrix, per sq cm",A2032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.89,,,,,,,fee schedule,32.89,39.48, "Myriad matrix, per sq cm",A2032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.48,,,,,,,fee schedule,32.89,39.48, "Myriad morcells, 4 mg",A2033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.97,,,,,,,fee schedule,20.97,25.17, "Myriad morcells, 4 mg",A2033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,25.17,,,,,,,fee schedule,20.97,25.17, Chlorhexidine antisept,A4248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.06,0.07, Chlorhexidine antisept,A4248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.06,0.07, Neuromod sti sys adj rehab,A4593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.24,,,,,,,fee schedule,48.31,50.73,APC Neuromod sti sys adj rehab,A4593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50.73,,,,,,,fee schedule,48.31,50.73,APC Neuromod sti sys adj rehab,A4593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.31,,,,,,,fee schedule,48.31,50.73,APC In111 satumomab,A4642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2579.41,,,,,,,fee schedule,2579.41,3095.56, In111 satumomab,A4642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3095.56,,,,,,,fee schedule,2579.41,3095.56, Protamine sulfate per 50 mg,A4802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,25.38,,,,,,,fee schedule,25.38,30.46, Protamine sulfate per 50 mg,A4802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.46,,,,,,,fee schedule,25.38,30.46, G com garmnt glove nghttime,A6520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,131.51,,,,,,,fee schedule,126.45,132.77,APC G com garmnt glove nghttime,A6520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,132.77,,,,,,,fee schedule,126.45,132.77,APC G com garmnt glove nghttime,A6520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,126.45,,,,,,,fee schedule,126.45,132.77,APC G com garmnt glove nght cust,A6521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,521.82,,,,,,,fee schedule,501.75,526.84,APC G com garmnt glove nght cust,A6521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,526.84,,,,,,,fee schedule,501.75,526.84,APC G com garmnt glove nght cust,A6521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,501.75,,,,,,,fee schedule,501.75,526.84,APC G com garment arm nighttime,A6522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,319.55,,,,,,,fee schedule,307.26,322.62,APC G com garment arm nighttime,A6522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,322.62,,,,,,,fee schedule,307.26,322.62,APC G com garment arm nighttime,A6522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,307.26,,,,,,,fee schedule,307.26,322.62,APC G com garment arm nght custm,A6523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,758.18,,,,,,,fee schedule,729.02,765.47,APC G com garment arm nght custm,A6523,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,765.47,,,,,,,fee schedule,729.02,765.47,APC G com garment arm nght custm,A6523,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,729.02,,,,,,,fee schedule,729.02,765.47,APC G com garmnt lwr leg/ft nght,A6524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,398.67,,,,,,,fee schedule,383.34,402.51,APC G com garmnt lwr leg/ft nght,A6524,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,402.51,,,,,,,fee schedule,383.34,402.51,APC G com garmnt lwr leg/ft nght,A6524,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,383.34,,,,,,,fee schedule,383.34,402.51,APC G com garm lwrleg/ft ngt cus,A6525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,804.86,,,,,,,fee schedule,773.9,812.6,APC G com garm lwrleg/ft ngt cus,A6525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,812.6,,,,,,,fee schedule,773.9,812.6,APC G com garm lwrleg/ft ngt cus,A6525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,773.9,,,,,,,fee schedule,773.9,812.6,APC G com garmt full leg/ft nght,A6526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,720.78,,,,,,,fee schedule,693.06,727.71,APC G com garmt full leg/ft nght,A6526,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,727.71,,,,,,,fee schedule,693.06,727.71,APC G com garmt full leg/ft nght,A6526,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,693.06,,,,,,,fee schedule,693.06,727.71,APC G garmt full leg/ft nght cus,A6527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1325.43,,,,,,,fee schedule,1274.45,1338.17,APC G garmt full leg/ft nght cus,A6527,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1338.17,,,,,,,fee schedule,1274.45,1338.17,APC G garmt full leg/ft nght cus,A6527,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1274.45,,,,,,,fee schedule,1274.45,1338.17,APC G com garment bra nighttime,A6528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,693.08,,,,,,,fee schedule,666.42,699.74,APC G com garment bra nighttime,A6528,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,699.74,,,,,,,fee schedule,666.42,699.74,APC G com garment bra nighttime,A6528,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,666.42,,,,,,,fee schedule,666.42,699.74,APC G com garmt bra night custm,A6529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1095.16,,,,,,,fee schedule,1053.04,1105.69,APC G com garmt bra night custm,A6529,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1105.69,,,,,,,fee schedule,1053.04,1105.69,APC G com garmt bra night custm,A6529,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1053.04,,,,,,,fee schedule,1053.04,1105.69,APC Compression stocking bk18-30,A6530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.63,,,,,,,fee schedule,39.07,41.02,APC Compression stocking bk18-30,A6530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.02,,,,,,,fee schedule,39.07,41.02,APC Compression stocking bk18-30,A6530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.07,,,,,,,fee schedule,39.07,41.02,APC Compression stocking bk30-40,A6531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.13,,,,,,,fee schedule,61.66,64.74,APC Compression stocking bk30-40,A6531,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.74,,,,,,,fee schedule,61.66,64.74,APC Compression stocking bk30-40,A6531,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.66,,,,,,,fee schedule,61.66,64.74,APC Compression stocking bk40-50,A6532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,90.36,,,,,,,fee schedule,86.88,91.22,APC Compression stocking bk40-50,A6532,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,91.22,,,,,,,fee schedule,86.88,91.22,APC Compression stocking bk40-50,A6532,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,86.88,,,,,,,fee schedule,86.88,91.22,APC Gc stocking thighlngth 18-30,A6533,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.05,,,,,,,fee schedule,54.86,57.6,APC Gc stocking thighlngth 18-30,A6533,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,57.6,,,,,,,fee schedule,54.86,57.6,APC Gc stocking thighlngth 18-30,A6533,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,54.86,,,,,,,fee schedule,54.86,57.6,APC Gc stocking thighlngth 30-40,A6534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,65.16,,,,,,,fee schedule,62.65,65.78,APC Gc stocking thighlngth 30-40,A6534,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.78,,,,,,,fee schedule,62.65,65.78,APC Gc stocking thighlngth 30-40,A6534,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.65,,,,,,,fee schedule,62.65,65.78,APC Gc stocking thighlngth 40-50,A6535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,75.02,,,,,,,fee schedule,72.13,75.74,APC Gc stocking thighlngth 40-50,A6535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75.74,,,,,,,fee schedule,72.13,75.74,APC Gc stocking thighlngth 40-50,A6535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,72.13,,,,,,,fee schedule,72.13,75.74,APC Gc stocking full lngth 18-30,A6536,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.91,,,,,,,fee schedule,73.95,77.65,APC Gc stocking full lngth 18-30,A6536,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77.65,,,,,,,fee schedule,73.95,77.65,APC Gc stocking full lngth 18-30,A6536,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.95,,,,,,,fee schedule,73.95,77.65,APC Gc stocking full lngth 30-40,A6537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,91.18,,,,,,,fee schedule,87.67,92.05,APC Gc stocking full lngth 30-40,A6537,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92.05,,,,,,,fee schedule,87.67,92.05,APC Gc stocking full lngth 30-40,A6537,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,87.67,,,,,,,fee schedule,87.67,92.05,APC Gc stocking full lngth 40-50,A6538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.76,,,,,,,fee schedule,102.65,107.78,APC Gc stocking full lngth 40-50,A6538,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.78,,,,,,,fee schedule,102.65,107.78,APC Gc stocking full lngth 40-50,A6538,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.65,,,,,,,fee schedule,102.65,107.78,APC Gc stocking waistlngth 18-30,A6539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,101.77,,,,,,,fee schedule,97.86,102.75,APC Gc stocking waistlngth 18-30,A6539,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,102.75,,,,,,,fee schedule,97.86,102.75,APC Gc stocking waistlngth 18-30,A6539,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,97.86,,,,,,,fee schedule,97.86,102.75,APC Gc stocking waistlngth 30-40,A6540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,121.35,,,,,,,fee schedule,116.68,122.51,APC Gc stocking waistlngth 30-40,A6540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,122.51,,,,,,,fee schedule,116.68,122.51,APC Gc stocking waistlngth 30-40,A6540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,116.68,,,,,,,fee schedule,116.68,122.51,APC Gc stocking waistlngth 40-50,A6541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,143.74,,,,,,,fee schedule,138.21,145.12,APC Gc stocking waistlngth 40-50,A6541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,145.12,,,,,,,fee schedule,138.21,145.12,APC Gc stocking waistlngth 40-50,A6541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,138.21,,,,,,,fee schedule,138.21,145.12,APC Grad comp non-elastic BK,A6545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,126.27,,,,,,,fee schedule,121.41,127.48,APC Grad comp non-elastic BK,A6545,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,127.48,,,,,,,fee schedule,121.41,127.48,APC Grad comp non-elastic BK,A6545,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,121.41,,,,,,,fee schedule,121.41,127.48,APC Grad com stocking bk 30-40,A6552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.29,,,,,,,fee schedule,57.97,60.87,APC Grad com stocking bk 30-40,A6552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,60.87,,,,,,,fee schedule,57.97,60.87,APC Grad com stocking bk 30-40,A6552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,57.97,,,,,,,fee schedule,57.97,60.87,APC G com stcking bk 30-40 custm,A6553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,235.44,,,,,,,fee schedule,226.38,237.7,APC G com stcking bk 30-40 custm,A6553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,237.7,,,,,,,fee schedule,226.38,237.7,APC G com stcking bk 30-40 custm,A6553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,226.38,,,,,,,fee schedule,226.38,237.7,APC Grad com stocking bk 40+,A6554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.91,,,,,,,fee schedule,79.72,83.71,APC Grad com stocking bk 40+,A6554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,83.71,,,,,,,fee schedule,79.72,83.71,APC Grad com stocking bk 40+,A6554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79.72,,,,,,,fee schedule,79.72,83.71,APC G com stcking bk 40+ custm,A6555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,235.44,,,,,,,fee schedule,226.38,237.7,APC G com stcking bk 40+ custm,A6555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,237.7,,,,,,,fee schedule,226.38,237.7,APC G com stcking bk 40+ custm,A6555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,226.38,,,,,,,fee schedule,226.38,237.7,APC G com stcking thgh18-30 cust,A6556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,322.66,,,,,,,fee schedule,310.25,325.76,APC G com stcking thgh18-30 cust,A6556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,325.76,,,,,,,fee schedule,310.25,325.76,APC G com stcking thgh18-30 cust,A6556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,310.25,,,,,,,fee schedule,310.25,325.76,APC G com stcking thgh30-40 cust,A6557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,322.66,,,,,,,fee schedule,310.25,325.76,APC G com stcking thgh30-40 cust,A6557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,325.76,,,,,,,fee schedule,310.25,325.76,APC G com stcking thgh30-40 cust,A6557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,310.25,,,,,,,fee schedule,310.25,325.76,APC G com stcking thgh 40+ cust,A6558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,332.98,,,,,,,fee schedule,320.17,336.18,APC G com stcking thgh 40+ cust,A6558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,336.18,,,,,,,fee schedule,320.17,336.18,APC G com stcking thgh 40+ cust,A6558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,320.17,,,,,,,fee schedule,320.17,336.18,APC G com stckng waist18-30 cust,A6562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.98,,,,,,,fee schedule,1015.37,1066.14,APC G com stckng waist18-30 cust,A6562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1066.14,,,,,,,fee schedule,1015.37,1066.14,APC G com stckng waist18-30 cust,A6562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1015.37,,,,,,,fee schedule,1015.37,1066.14,APC G com stckng waist30-40 cust,A6563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.98,,,,,,,fee schedule,1015.37,1066.14,APC G com stckng waist30-40 cust,A6563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1066.14,,,,,,,fee schedule,1015.37,1066.14,APC G com stckng waist30-40 cust,A6563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1015.37,,,,,,,fee schedule,1015.37,1066.14,APC G com stckng waist 40+ cust,A6564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1137.53,,,,,,,fee schedule,1093.78,1148.47,APC G com stckng waist 40+ cust,A6564,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1148.47,,,,,,,fee schedule,1093.78,1148.47,APC G com stckng waist 40+ cust,A6564,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1093.78,,,,,,,fee schedule,1093.78,1148.47,APC Grad comp gauntlet custom,A6565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.47,,,,,,,fee schedule,175.45,184.22,APC Grad comp gauntlet custom,A6565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.22,,,,,,,fee schedule,175.45,184.22,APC Grad comp gauntlet custom,A6565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.45,,,,,,,fee schedule,175.45,184.22,APC Grad com garment neck/head,A6566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,264.94,,,,,,,fee schedule,254.75,267.49,APC Grad com garment neck/head,A6566,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.49,,,,,,,fee schedule,254.75,267.49,APC Grad com garment neck/head,A6566,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,254.75,,,,,,,fee schedule,254.75,267.49,APC G com garment neck/head cust,A6567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,832.44,,,,,,,fee schedule,800.42,840.44,APC G com garment neck/head cust,A6567,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,840.44,,,,,,,fee schedule,800.42,840.44,APC G com garment neck/head cust,A6567,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,800.42,,,,,,,fee schedule,800.42,840.44,APC G com garment torso/shldr,A6568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,172.91,,,,,,,fee schedule,166.26,174.57,APC G com garment torso/shldr,A6568,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,174.57,,,,,,,fee schedule,166.26,174.57,APC G com garment torso/shldr,A6568,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,166.26,,,,,,,fee schedule,166.26,174.57,APC G com garmnt torso/shdr cust,A6569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,984.61,,,,,,,fee schedule,946.74,994.08,APC G com garmnt torso/shdr cust,A6569,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,994.08,,,,,,,fee schedule,946.74,994.08,APC G com garmnt torso/shdr cust,A6569,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,946.74,,,,,,,fee schedule,946.74,994.08,APC Grad com garment genital,A6570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,117.81,,,,,,,fee schedule,113.28,118.94,APC Grad com garment genital,A6570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,118.94,,,,,,,fee schedule,113.28,118.94,APC Grad com garment genital,A6570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,113.28,,,,,,,fee schedule,113.28,118.94,APC G com garment genital custm,A6571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,708.07,,,,,,,fee schedule,680.84,714.88,APC G com garment genital custm,A6571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,714.88,,,,,,,fee schedule,680.84,714.88,APC G com garment genital custm,A6571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,680.84,,,,,,,fee schedule,680.84,714.88,APC Grad com garment toe caps,A6572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,109.31,,,,,,,fee schedule,105.11,110.37,APC Grad com garment toe caps,A6572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,110.37,,,,,,,fee schedule,105.11,110.37,APC Grad com garment toe caps,A6572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,105.11,,,,,,,fee schedule,105.11,110.37,APC Grad com garmnt toe cap cust,A6573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,259.41,,,,,,,fee schedule,249.43,261.9,APC Grad com garmnt toe cap cust,A6573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,261.9,,,,,,,fee schedule,249.43,261.9,APC Grad com garmnt toe cap cust,A6573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,249.43,,,,,,,fee schedule,249.43,261.9,APC Custom gradient sleev/glov,A6574,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,330.71,,,,,,,fee schedule,317.99,333.89,APC Custom gradient sleev/glov,A6574,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,333.89,,,,,,,fee schedule,317.99,333.89,APC Custom gradient sleev/glov,A6574,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,317.99,,,,,,,fee schedule,317.99,333.89,APC Gradient comp sleev/glov,A6575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,107.17,,,,,,,fee schedule,103.05,108.2,APC Gradient comp sleev/glov,A6575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,108.2,,,,,,,fee schedule,103.05,108.2,APC Gradient comp sleev/glov,A6575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,103.05,,,,,,,fee schedule,103.05,108.2,APC Custom grad com sleeve med,A6576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,202.97,,,,,,,fee schedule,195.16,204.92,APC Custom grad com sleeve med,A6576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,204.92,,,,,,,fee schedule,195.16,204.92,APC Custom grad com sleeve med,A6576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,195.16,,,,,,,fee schedule,195.16,204.92,APC Custom grad cm sleeve heavy,A6577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,167.99,,,,,,,fee schedule,161.53,169.61,APC Custom grad cm sleeve heavy,A6577,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,169.61,,,,,,,fee schedule,161.53,169.61,APC Custom grad cm sleeve heavy,A6577,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,161.53,,,,,,,fee schedule,161.53,169.61,APC Gradient comp sleeve,A6578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.73,,,,,,,fee schedule,79.55,83.53,APC Gradient comp sleeve,A6578,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,83.53,,,,,,,fee schedule,79.55,83.53,APC Gradient comp sleeve,A6578,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79.55,,,,,,,fee schedule,79.55,83.53,APC Custom grad com glove med,A6579,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,325.79,,,,,,,fee schedule,313.26,328.92,APC Custom grad com glove med,A6579,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,328.92,,,,,,,fee schedule,313.26,328.92,APC Custom grad com glove med,A6579,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,313.26,,,,,,,fee schedule,313.26,328.92,APC Custom grad com glove heavy,A6580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,323.4,,,,,,,fee schedule,310.96,326.51,APC Custom grad com glove heavy,A6580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,326.51,,,,,,,fee schedule,310.96,326.51,APC Custom grad com glove heavy,A6580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,310.96,,,,,,,fee schedule,310.96,326.51,APC Gradient comp glove,A6581,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,75.91,,,,,,,fee schedule,72.99,76.64,APC Gradient comp glove,A6581,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,76.64,,,,,,,fee schedule,72.99,76.64,APC Gradient comp glove,A6581,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,72.99,,,,,,,fee schedule,72.99,76.64,APC Gradient comp gauntlet,A6582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.63,,,,,,,fee schedule,48.68,51.11,APC Gradient comp gauntlet,A6582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.11,,,,,,,fee schedule,48.68,51.11,APC Gradient comp gauntlet,A6582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.68,,,,,,,fee schedule,48.68,51.11,APC Grad com wrap w straps bk,A6583,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,166.54,,,,,,,fee schedule,160.13,168.14,APC Grad com wrap w straps bk,A6583,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,168.14,,,,,,,fee schedule,160.13,168.14,APC Grad com wrap w straps bk,A6583,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,160.13,,,,,,,fee schedule,160.13,168.14,APC Grad com wrap w straps ak,A6585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,197.18,,,,,,,fee schedule,189.6,199.08,APC Grad com wrap w straps ak,A6585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,199.08,,,,,,,fee schedule,189.6,199.08,APC Grad com wrap w straps ak,A6585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,189.6,,,,,,,fee schedule,189.6,199.08,APC Grad com wrap w straps leg,A6586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,580.93,,,,,,,fee schedule,558.59,586.52,APC Grad com wrap w straps leg,A6586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,586.52,,,,,,,fee schedule,558.59,586.52,APC Grad com wrap w straps leg,A6586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,558.59,,,,,,,fee schedule,558.59,586.52,APC Grad com wrap w straps foot,A6587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.1,,,,,,,fee schedule,73.17,76.83,APC Grad com wrap w straps foot,A6587,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,76.83,,,,,,,fee schedule,73.17,76.83,APC Grad com wrap w straps foot,A6587,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,73.17,76.83,APC Grad com wrap w straps arm,A6588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,253.62,,,,,,,fee schedule,243.87,256.06,APC Grad com wrap w straps arm,A6588,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,256.06,,,,,,,fee schedule,243.87,256.06,APC Grad com wrap w straps arm,A6588,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,243.87,,,,,,,fee schedule,243.87,256.06,APC Grad com wrap w straps bra,A6589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,100.12,,,,,,,fee schedule,96.27,101.08,APC Grad com wrap w straps bra,A6589,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,101.08,,,,,,,fee schedule,96.27,101.08,APC Grad com wrap w straps bra,A6589,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,96.27,,,,,,,fee schedule,96.27,101.08,APC G comp bandge liner lwr extr,A6594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.45,,,,,,,fee schedule,35.05,36.8,APC G comp bandge liner lwr extr,A6594,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.8,,,,,,,fee schedule,35.05,36.8,APC G comp bandge liner lwr extr,A6594,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.05,,,,,,,fee schedule,35.05,36.8,APC G comp bandge liner upr extr,A6595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.86,,,,,,,fee schedule,34.48,36.2,APC G comp bandge liner upr extr,A6595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.2,,,,,,,fee schedule,34.48,36.2,APC G comp bandge liner upr extr,A6595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.48,,,,,,,fee schedule,34.48,36.2,APC G comp bandge conform gauze,A6596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.19,,,,,,,fee schedule,0.18,0.19,APC G comp bandge conform gauze,A6596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.19,,,,,,,fee schedule,0.18,0.19,APC G comp bandge conform gauze,A6596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.18,,,,,,,fee schedule,0.18,0.19,APC G comp bandage long stretch,A6597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.61,,,,,,,fee schedule,1.55,1.63,APC G comp bandage long stretch,A6597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.63,,,,,,,fee schedule,1.55,1.63,APC G comp bandage long stretch,A6597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.55,,,,,,,fee schedule,1.55,1.63,APC G comp bandage med stretch,A6598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.78,,,,,,,fee schedule,0.75,0.79,APC G comp bandage med stretch,A6598,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.79,,,,,,,fee schedule,0.75,0.79,APC G comp bandage med stretch,A6598,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.75,,,,,,,fee schedule,0.75,0.79,APC G comp bandage short stretch,A6599,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.77,,,,,,,fee schedule,1.7,1.78,APC G comp bandage short stretch,A6599,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.78,,,,,,,fee schedule,1.7,1.78,APC G comp bandage short stretch,A6599,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.7,,,,,,,fee schedule,1.7,1.78,APC G com bandge hgh dn foam sht,A6600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.19,,,,,,,fee schedule,3.07,3.22,APC G com bandge hgh dn foam sht,A6600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.22,,,,,,,fee schedule,3.07,3.22,APC G com bandge hgh dn foam sht,A6600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.07,,,,,,,fee schedule,3.07,3.22,APC G com bandge hgh dn foam pad,A6601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.59,,,,,,,fee schedule,3.45,3.62,APC G com bandge hgh dn foam pad,A6601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.62,,,,,,,fee schedule,3.45,3.62,APC G com bandge hgh dn foam pad,A6601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.45,,,,,,,fee schedule,3.45,3.62,APC G com bandge hgh dn foamroll,A6602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.23,,,,,,,fee schedule,5.03,5.28,APC G com bandge hgh dn foamroll,A6602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.28,,,,,,,fee schedule,5.03,5.28,APC G com bandge hgh dn foamroll,A6602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.03,,,,,,,fee schedule,5.03,5.28,APC G com bandge low dn foamchnl,A6603,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.45,,,,,,,fee schedule,2.36,2.48,APC G com bandge low dn foamchnl,A6603,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.48,,,,,,,fee schedule,2.36,2.48,APC G com bandge low dn foamchnl,A6603,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.36,,,,,,,fee schedule,2.36,2.48,APC G com bandge low dn foam flt,A6604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.44,,,,,,,fee schedule,1.38,1.45,APC G com bandge low dn foam flt,A6604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.45,,,,,,,fee schedule,1.38,1.45,APC G com bandge low dn foam flt,A6604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.38,,,,,,,fee schedule,1.38,1.45,APC G com bandage padded foam,A6605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.63,,,,,,,fee schedule,1.57,1.65,APC G com bandage padded foam,A6605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.65,,,,,,,fee schedule,1.57,1.65,APC G com bandage padded foam,A6605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.57,,,,,,,fee schedule,1.57,1.65,APC G com bandage padded textile,A6606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.86,,,,,,,fee schedule,4.67,4.9,APC G com bandage padded textile,A6606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.9,,,,,,,fee schedule,4.67,4.9,APC G com bandage padded textile,A6606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.67,,,,,,,fee schedule,4.67,4.9,APC G com bandage tub protct lyr,A6607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.3,,,,,,,fee schedule,1.25,1.31,APC G com bandage tub protct lyr,A6607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.31,,,,,,,fee schedule,1.25,1.31,APC G com bandage tub protct lyr,A6607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.25,,,,,,,fee schedule,1.25,1.31,APC G com bandage tub protct pad,A6608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.42,,,,,,,fee schedule,5.21,5.47,APC G com bandage tub protct pad,A6608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.47,,,,,,,fee schedule,5.21,5.47,APC G com bandage tub protct pad,A6608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.21,,,,,,,fee schedule,5.21,5.47,APC G com stcking bk 18-30 custm,A6610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,235.44,,,,,,,fee schedule,226.38,237.7,APC G com stcking bk 18-30 custm,A6610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,237.7,,,,,,,fee schedule,226.38,237.7,APC G com stcking bk 18-30 custm,A6610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,226.38,,,,,,,fee schedule,226.38,237.7,APC "Artificial saliva, 1 ml",A9154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.41,,,,,,,fee schedule,0.41,0.49, "Artificial saliva, 1 ml",A9154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.49,,,,,,,fee schedule,0.41,0.49, Oral mucoadhesive per 1 ml,A9156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.62,,,,,,,fee schedule,4.62,5.54, Oral mucoadhesive per 1 ml,A9156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.54,,,,,,,fee schedule,4.62,5.54, "Lice treatment, topical",A9180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.7,,,,,,,fee schedule,1.7,2.04, "Lice treatment, topical",A9180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.04,,,,,,,fee schedule,1.7,2.04, Tc99m sestamibi,A9500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,205.57,,,,,,,fee schedule,205.57,246.71, Tc99m sestamibi,A9500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,246.71,,,,,,,fee schedule,205.57,246.71, Tc99m tetrofosmin,A9502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,162.57,,,,,,,fee schedule,162.57,195.1, Tc99m tetrofosmin,A9502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,195.1,,,,,,,fee schedule,162.57,195.1, Tc99m medronate,A9503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.78,,,,,,,fee schedule,24.78,29.74, Tc99m medronate,A9503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.74,,,,,,,fee schedule,24.78,29.74, Tc99m apcitide,A9504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,808.92,,,,,,,fee schedule,808.92,970.79, Tc99m apcitide,A9504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,970.79,,,,,,,fee schedule,808.92,970.79, Tl201 thallium,A9505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.26,,,,,,,fee schedule,62.26,74.71, Tl201 thallium,A9505,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,74.71,,,,,,,fee schedule,62.26,74.71, In111 capromab,A9507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8380.47,,,,,,,fee schedule,1730.29,10057.45, In111 capromab,A9507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10057.45,,,,,,,fee schedule,1730.29,10057.45, In111 capromab,A9507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1799.5,,,,,,,fee schedule,1730.29,10057.45,APC In111 capromab,A9507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1816.8,,,,,,,fee schedule,1730.29,10057.45,APC In111 capromab,A9507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1730.29,,,,,,,fee schedule,1730.29,10057.45,APC "I131 iodobenguate, dx",A9508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1637.37,,,,,,,fee schedule,953.01,1965.03, "I131 iodobenguate, dx",A9508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1965.03,,,,,,,fee schedule,953.01,1965.03, "I131 iodobenguate, dx",A9508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,991.13,,,,,,,fee schedule,953.01,1965.03,APC "I131 iodobenguate, dx",A9508,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1000.66,,,,,,,fee schedule,953.01,1965.03,APC "I131 iodobenguate, dx",A9508,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,953.01,,,,,,,fee schedule,953.01,1965.03,APC Iodine I-123 sod iodide mil,A9509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,267.75,,,,,,,fee schedule,267.75,321.33, Iodine I-123 sod iodide mil,A9509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,321.33,,,,,,,fee schedule,267.75,321.33, Tc99m disofenin,A9510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.45,,,,,,,fee schedule,133.45,160.15, Tc99m disofenin,A9510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,160.15,,,,,,,fee schedule,133.45,160.15, Tc99m pertechnetate,A9512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.23,,,,,,,fee schedule,3.23,3.88, Tc99m pertechnetate,A9512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.88,,,,,,,fee schedule,3.23,3.88, Lutetium lu 177 dotatat ther,A9513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,581.5,,,,,,,fee schedule,319.94,697.86, Lutetium lu 177 dotatat ther,A9513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,697.86,,,,,,,fee schedule,319.94,697.86, Lutetium lu 177 dotatat ther,A9513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,332.74,,,,,,,fee schedule,319.94,697.86,APC Lutetium lu 177 dotatat ther,A9513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,335.94,,,,,,,fee schedule,319.94,697.86,APC Lutetium lu 177 dotatat ther,A9513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,319.94,,,,,,,fee schedule,319.94,697.86,APC Choline c-11,A9515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9531.9,,,,,,,fee schedule,2516.43,11439.3, Choline c-11,A9515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11439.3,,,,,,,fee schedule,2516.43,11439.3, Choline c-11,A9515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2617.09,,,,,,,fee schedule,2516.43,11439.3,APC Choline c-11,A9515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2642.25,,,,,,,fee schedule,2516.43,11439.3,APC Choline c-11,A9515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2516.43,,,,,,,fee schedule,2516.43,11439.3,APC Iodine I-123 sod iodide mic,A9516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,202.52,,,,,,,fee schedule,202.52,243.05, Iodine I-123 sod iodide mic,A9516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,243.05,,,,,,,fee schedule,202.52,243.05, "I131 iodide cap, rx",A9517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,165.48,,,,,,,fee schedule,24.07,198.6, "I131 iodide cap, rx",A9517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,198.6,,,,,,,fee schedule,24.07,198.6, "I131 iodide cap, rx",A9517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.03,,,,,,,fee schedule,24.07,198.6,APC "I131 iodide cap, rx",A9517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.27,,,,,,,fee schedule,24.07,198.6,APC "I131 iodide cap, rx",A9517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.07,,,,,,,fee schedule,24.07,198.6,APC Tc99 tilmanocept diag 0.5mci,A9520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1261.22,,,,,,,fee schedule,1261.22,1513.6, Tc99 tilmanocept diag 0.5mci,A9520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1513.6,,,,,,,fee schedule,1261.22,1513.6, Tc99m exametazime,A9521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3267.48,,,,,,,fee schedule,3267.48,3921.32, Tc99m exametazime,A9521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3921.32,,,,,,,fee schedule,3267.48,3921.32, "I131 serum albumin, dx",A9524,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,712.52,,,,,,,fee schedule,712.52,855.1, "I131 serum albumin, dx",A9524,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,855.1,,,,,,,fee schedule,712.52,855.1, Nitrogen n-13 ammonia,A9526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1381.94,,,,,,,fee schedule,1381.94,1658.47, Nitrogen n-13 ammonia,A9526,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1658.47,,,,,,,fee schedule,1381.94,1658.47, Iodine I-125 sodium iodide,A9527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,343.82,,,,,,,fee schedule,343.82,416.14, Iodine I-125 sodium iodide,A9527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,412.62,,,,,,,fee schedule,343.82,416.14, Iodine I-125 sodium iodide,A9527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,412.17,,,,,,,fee schedule,343.82,416.14,APC Iodine I-125 sodium iodide,A9527,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,416.14,,,,,,,fee schedule,343.82,416.14,APC Iodine I-125 sodium iodide,A9527,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,396.32,,,,,,,fee schedule,343.82,416.14,APC "Iodine i-131 iodide cap, dx",A9528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,150.06,,,,,,,fee schedule,150.06,180.09, "Iodine i-131 iodide cap, dx",A9528,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,180.09,,,,,,,fee schedule,150.06,180.09, "I131 iodide sol, rx",A9530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.48,,,,,,,fee schedule,17.48,21.81, "I131 iodide sol, rx",A9530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.97,,,,,,,fee schedule,17.48,21.81, "I131 iodide sol, rx",A9530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.6,,,,,,,fee schedule,17.48,21.81,APC "I131 iodide sol, rx",A9530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.81,,,,,,,fee schedule,17.48,21.81,APC "I131 iodide sol, rx",A9530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.77,,,,,,,fee schedule,17.48,21.81,APC I131 max 100uci,A9531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.67,,,,,,,fee schedule,6.67,8.01, I131 max 100uci,A9531,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.01,,,,,,,fee schedule,6.67,8.01, "I125 serum albumin, dx",A9532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,325.82,,,,,,,fee schedule,325.82,492.51, "I125 serum albumin, dx",A9532,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,391.02,,,,,,,fee schedule,325.82,492.51, "I125 serum albumin, dx",A9532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,487.82,,,,,,,fee schedule,325.82,492.51,APC "I125 serum albumin, dx",A9532,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,492.51,,,,,,,fee schedule,325.82,492.51,APC "I125 serum albumin, dx",A9532,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,469.06,,,,,,,fee schedule,325.82,492.51,APC Tc99m depreotide,A9536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1231.9,,,,,,,fee schedule,1231.9,1478.41, Tc99m depreotide,A9536,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1478.41,,,,,,,fee schedule,1231.9,1478.41, Tc99m mebrofenin,A9537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,105.45,,,,,,,fee schedule,105.45,126.55, Tc99m mebrofenin,A9537,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,126.55,,,,,,,fee schedule,105.45,126.55, Tc99m pyrophosphate,A9538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.1,,,,,,,fee schedule,122.1,146.54, Tc99m pyrophosphate,A9538,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,146.54,,,,,,,fee schedule,122.1,146.54, Tc99m pentetate,A9539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.73,,,,,,,fee schedule,59.73,71.69, Tc99m pentetate,A9539,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.69,,,,,,,fee schedule,59.73,71.69, Tc99m maa,A9540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.19,,,,,,,fee schedule,57.19,68.64, Tc99m maa,A9540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,68.64,,,,,,,fee schedule,57.19,68.64, Tc99m sulfur colloid,A9541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,509.69,,,,,,,fee schedule,509.69,611.69, Tc99m sulfur colloid,A9541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,611.69,,,,,,,fee schedule,509.69,611.69, "In111 ibritumomab, dx",A9542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6324.92,,,,,,,fee schedule,6324.92,7590.58, "In111 ibritumomab, dx",A9542,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7590.58,,,,,,,fee schedule,6324.92,7590.58, "Y90 ibritumomab, rx",A9543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129265.35,,,,,,,fee schedule,56824.55,155132.25, "Y90 ibritumomab, rx",A9543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155132.25,,,,,,,fee schedule,56824.55,155132.25, "Y90 ibritumomab, rx",A9543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,59097.53,,,,,,,fee schedule,56824.55,155132.25,APC "Y90 ibritumomab, rx",A9543,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59665.78,,,,,,,fee schedule,56824.55,155132.25,APC "Y90 ibritumomab, rx",A9543,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56824.55,,,,,,,fee schedule,56824.55,155132.25,APC Co57/58,A9546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.06,,,,,,,fee schedule,2.06,2.47, Co57/58,A9546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.47,,,,,,,fee schedule,2.06,2.47, In111 oxyquinoline,A9547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4012.89,,,,,,,fee schedule,831.46,4815.9, In111 oxyquinoline,A9547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4815.9,,,,,,,fee schedule,831.46,4815.9, In111 oxyquinoline,A9547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,864.72,,,,,,,fee schedule,831.46,4815.9,APC In111 oxyquinoline,A9547,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,873.03,,,,,,,fee schedule,831.46,4815.9,APC In111 oxyquinoline,A9547,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,831.46,,,,,,,fee schedule,831.46,4815.9,APC In111 pentetate,A9548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1688.1,,,,,,,fee schedule,745.62,2025.9, In111 pentetate,A9548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2025.9,,,,,,,fee schedule,745.62,2025.9, In111 pentetate,A9548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,775.44,,,,,,,fee schedule,745.62,2025.9,APC In111 pentetate,A9548,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,782.9,,,,,,,fee schedule,745.62,2025.9,APC In111 pentetate,A9548,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,745.62,,,,,,,fee schedule,745.62,2025.9,APC Tc99m succimer,A9551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1142.73,,,,,,,fee schedule,659.93,1371.39, Tc99m succimer,A9551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1371.39,,,,,,,fee schedule,659.93,1371.39, Tc99m succimer,A9551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,686.33,,,,,,,fee schedule,659.93,1371.39,APC Tc99m succimer,A9551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,692.93,,,,,,,fee schedule,659.93,1371.39,APC Tc99m succimer,A9551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,659.93,,,,,,,fee schedule,659.93,1371.39,APC Cr51 chromate,A9553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,669.64,,,,,,,fee schedule,669.64,2013.86, Cr51 chromate,A9553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,803.64,,,,,,,fee schedule,669.64,2013.86, Cr51 chromate,A9553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1994.68,,,,,,,fee schedule,669.64,2013.86,APC Cr51 chromate,A9553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2013.86,,,,,,,fee schedule,669.64,2013.86,APC Cr51 chromate,A9553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1917.96,,,,,,,fee schedule,669.64,2013.86,APC "I125 iothalamate, dx",A9554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,71.49,,,,,,,fee schedule,71.49,682.12, "I125 iothalamate, dx",A9554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,85.79,,,,,,,fee schedule,71.49,682.12, "I125 iothalamate, dx",A9554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.63,,,,,,,fee schedule,71.49,682.12,APC "I125 iothalamate, dx",A9554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.12,,,,,,,fee schedule,71.49,682.12,APC "I125 iothalamate, dx",A9554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.64,,,,,,,fee schedule,71.49,682.12,APC Rb82 rubidium,A9555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,823.31,,,,,,,fee schedule,823.31,988.06, Rb82 rubidium,A9555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,988.06,,,,,,,fee schedule,823.31,988.06, Ga67 gallium,A9556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,257.4,,,,,,,fee schedule,257.4,308.91, Ga67 gallium,A9556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,308.91,,,,,,,fee schedule,257.4,308.91, Tc99m bicisate,A9557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6989.41,,,,,,,fee schedule,775.52,8388.03, Tc99m bicisate,A9557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8388.03,,,,,,,fee schedule,775.52,8388.03, Tc99m bicisate,A9557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,806.54,,,,,,,fee schedule,775.52,8388.03,APC Tc99m bicisate,A9557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,814.3,,,,,,,fee schedule,775.52,8388.03,APC Tc99m bicisate,A9557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,775.52,,,,,,,fee schedule,775.52,8388.03,APC Xe133 xenon 10mci,A9558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,486.31,,,,,,,fee schedule,486.31,583.63, Xe133 xenon 10mci,A9558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,583.63,,,,,,,fee schedule,486.31,583.63, Co57 cyano,A9559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,255.94,,,,,,,fee schedule,255.94,307.16, Co57 cyano,A9559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,307.16,,,,,,,fee schedule,255.94,307.16, Tc99m labeled rbc,A9560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,178.06,,,,,,,fee schedule,178.06,213.69, Tc99m labeled rbc,A9560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,213.69,,,,,,,fee schedule,178.06,213.69, Tc99m oxidronate,A9561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.88,,,,,,,fee schedule,83.88,100.67, Tc99m oxidronate,A9561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.67,,,,,,,fee schedule,83.88,100.67, P32 na phosphate,A9563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,581.2,,,,,,,fee schedule,278.24,697.51, P32 na phosphate,A9563,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,697.51,,,,,,,fee schedule,278.24,697.51, P32 na phosphate,A9563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,289.37,,,,,,,fee schedule,278.24,697.51,APC P32 na phosphate,A9563,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,292.15,,,,,,,fee schedule,278.24,697.51,APC P32 na phosphate,A9563,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,278.24,,,,,,,fee schedule,278.24,697.51,APC P32 chromic phosphate,A9564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,240.52,,,,,,,fee schedule,240.52,288.65, P32 chromic phosphate,A9564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,288.65,,,,,,,fee schedule,240.52,288.65, Technetium tc-99m aerosol,A9567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.37,,,,,,,fee schedule,32.37,38.85, Technetium tc-99m aerosol,A9567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.85,,,,,,,fee schedule,32.37,38.85, Technetium tc99m arcitumomab,A9568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1994.04,,,,,,,fee schedule,1994.04,2393.06, Technetium tc99m arcitumomab,A9568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2393.06,,,,,,,fee schedule,1994.04,2393.06, Technetium TC-99m auto WBC,A9569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3267.48,,,,,,,fee schedule,934.13,3921.32, Technetium TC-99m auto WBC,A9569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3921.32,,,,,,,fee schedule,934.13,3921.32, Technetium TC-99m auto WBC,A9569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,971.5,,,,,,,fee schedule,934.13,3921.32,APC Technetium TC-99m auto WBC,A9569,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,980.84,,,,,,,fee schedule,934.13,3921.32,APC Technetium TC-99m auto WBC,A9569,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,934.13,,,,,,,fee schedule,934.13,3921.32,APC Indium In-111 auto WBC,A9570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8025.79,,,,,,,fee schedule,1103.19,9631.8, Indium In-111 auto WBC,A9570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9631.8,,,,,,,fee schedule,1103.19,9631.8, Indium In-111 auto WBC,A9570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1147.32,,,,,,,fee schedule,1103.19,9631.8,APC Indium In-111 auto WBC,A9570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1158.35,,,,,,,fee schedule,1103.19,9631.8,APC Indium In-111 auto WBC,A9570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1103.19,,,,,,,fee schedule,1103.19,9631.8,APC Indium IN-111 auto platelet,A9571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8025.79,,,,,,,fee schedule,8025.79,9631.8, Indium IN-111 auto platelet,A9571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9631.8,,,,,,,fee schedule,8025.79,9631.8, Indium In-111 pentetreotide,A9572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7377.69,,,,,,,fee schedule,2000.94,8854.02, Indium In-111 pentetreotide,A9572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8854.02,,,,,,,fee schedule,2000.94,8854.02, Indium In-111 pentetreotide,A9572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2080.98,,,,,,,fee schedule,2000.94,8854.02,APC Indium In-111 pentetreotide,A9572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2100.99,,,,,,,fee schedule,2000.94,8854.02,APC Indium In-111 pentetreotide,A9572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2000.94,,,,,,,fee schedule,2000.94,8854.02,APC "Inj, gadopiclenol, 1 ml",A9573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.3,,,,,,,fee schedule,5.3,7.54, "Inj, gadopiclenol, 1 ml",A9573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.3,,,,,,,fee schedule,5.3,7.54, "Inj, gadopiclenol, 1 ml",A9573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.28,,,,,,,fee schedule,5.3,7.54, "Inj, gadopiclenol, 1 ml",A9573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.54,,,,,,,fee schedule,5.3,7.54, Inj gadoterate meglumi 0.1ml,A9575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.18,,,,,,,fee schedule,0.18,0.25, Inj gadoterate meglumi 0.1ml,A9575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.18,,,,,,,fee schedule,0.18,0.25, Inj gadoterate meglumi 0.1ml,A9575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.21,,,,,,,fee schedule,0.18,0.25, Inj gadoterate meglumi 0.1ml,A9575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.25,,,,,,,fee schedule,0.18,0.25, Inj prohance multipack,A9576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.19,,,,,,,fee schedule,2.19,3.16, Inj prohance multipack,A9576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.19,,,,,,,fee schedule,2.19,3.16, Inj prohance multipack,A9576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.64,,,,,,,fee schedule,2.19,3.16, Inj prohance multipack,A9576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.16,,,,,,,fee schedule,2.19,3.16, Inj multihance,A9577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.71,,,,,,,fee schedule,2.71,3.9, Inj multihance,A9577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.71,,,,,,,fee schedule,2.71,3.9, Inj multihance,A9577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.25,,,,,,,fee schedule,2.71,3.9, Inj multihance,A9577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.9,,,,,,,fee schedule,2.71,3.9, Inj multihance multipack,A9578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.66,,,,,,,fee schedule,2.66,3.84, Inj multihance multipack,A9578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.66,,,,,,,fee schedule,2.66,3.84, Inj multihance multipack,A9578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.2,,,,,,,fee schedule,2.66,3.84, Inj multihance multipack,A9578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.84,,,,,,,fee schedule,2.66,3.84, "Gad-base MR contrast NOS,1ml",A9579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.29,,,,,,,fee schedule,2.29,3.32, "Gad-base MR contrast NOS,1ml",A9579,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.29,,,,,,,fee schedule,2.29,3.32, "Gad-base MR contrast NOS,1ml",A9579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.77,,,,,,,fee schedule,2.29,3.32, "Gad-base MR contrast NOS,1ml",A9579,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.32,,,,,,,fee schedule,2.29,3.32, Sodium fluoride F-18,A9580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,571.91,,,,,,,fee schedule,571.91,686.36, Sodium fluoride F-18,A9580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,686.36,,,,,,,fee schedule,571.91,686.36, Gadoxetate disodium inj,A9581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.89,,,,,,,fee schedule,22.89,33.04, Gadoxetate disodium inj,A9581,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.89,,,,,,,fee schedule,22.89,33.04, Gadoxetate disodium inj,A9581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.53,,,,,,,fee schedule,22.89,33.04, Gadoxetate disodium inj,A9581,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.04,,,,,,,fee schedule,22.89,33.04, Iodine I-123 iobenguane,A9582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9738.57,,,,,,,fee schedule,2317.5,11687.33, Iodine I-123 iobenguane,A9582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11687.33,,,,,,,fee schedule,2317.5,11687.33, Iodine I-123 iobenguane,A9582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2410.2,,,,,,,fee schedule,2317.5,11687.33,APC Iodine I-123 iobenguane,A9582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2433.38,,,,,,,fee schedule,2317.5,11687.33,APC Iodine I-123 iobenguane,A9582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2317.5,,,,,,,fee schedule,2317.5,11687.33,APC Iodine i-123 ioflupane,A9584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4941.34,,,,,,,fee schedule,1387.74,5930.13, Iodine i-123 ioflupane,A9584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5930.13,,,,,,,fee schedule,1387.74,5930.13, Iodine i-123 ioflupane,A9584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1443.25,,,,,,,fee schedule,1387.74,5930.13,APC Iodine i-123 ioflupane,A9584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1457.13,,,,,,,fee schedule,1387.74,5930.13,APC Iodine i-123 ioflupane,A9584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1387.74,,,,,,,fee schedule,1387.74,5930.13,APC Gadobutrol injection,A9585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.41,,,,,,,fee schedule,0.41,0.61, Gadobutrol injection,A9585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.41,,,,,,,fee schedule,0.41,0.61, Gadobutrol injection,A9585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.5,,,,,,,fee schedule,0.41,0.61, Gadobutrol injection,A9585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.61,,,,,,,fee schedule,0.41,0.61, Florbetapir F18,A9586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5447.29,,,,,,,fee schedule,1825.64,6537.34, Florbetapir F18,A9586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6537.34,,,,,,,fee schedule,1825.64,6537.34, Florbetapir F18,A9586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1898.67,,,,,,,fee schedule,1825.64,6537.34,APC Florbetapir F18,A9586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1916.92,,,,,,,fee schedule,1825.64,6537.34,APC Florbetapir F18,A9586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1825.64,,,,,,,fee schedule,1825.64,6537.34,APC Gallium ga-68,A9587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,110.14,,,,,,,fee schedule,49.63,132.18, Gallium ga-68,A9587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,132.18,,,,,,,fee schedule,49.63,132.18, Gallium ga-68,A9587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,51.62,,,,,,,fee schedule,49.63,132.18,APC Gallium ga-68,A9587,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.11,,,,,,,fee schedule,49.63,132.18,APC Gallium ga-68,A9587,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.63,,,,,,,fee schedule,49.63,132.18,APC Fluciclovine f-18,A9588,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,984.93,,,,,,,fee schedule,322.27,1182.02, Fluciclovine f-18,A9588,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1182.02,,,,,,,fee schedule,322.27,1182.02, Fluciclovine f-18,A9588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,335.16,,,,,,,fee schedule,322.27,1182.02,APC Fluciclovine f-18,A9588,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,338.38,,,,,,,fee schedule,322.27,1182.02,APC Fluciclovine f-18,A9588,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,322.27,,,,,,,fee schedule,322.27,1182.02,APC Insti hexaminolevulinate hcl,A9589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2217.12,,,,,,,fee schedule,2217.12,3199.06, Insti hexaminolevulinate hcl,A9589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2217.12,,,,,,,fee schedule,2217.12,3199.06, Insti hexaminolevulinate hcl,A9589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2665.64,,,,,,,fee schedule,2217.12,3199.06, Insti hexaminolevulinate hcl,A9589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3199.06,,,,,,,fee schedule,2217.12,3199.06, Iodine i-131 iobenguane 1mci,A9590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,610.79,,,,,,,fee schedule,610.79,733.01, Iodine i-131 iobenguane 1mci,A9590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,733.01,,,,,,,fee schedule,610.79,733.01, Fluoroestradiol f 18,A9591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1466.32,,,,,,,fee schedule,460.42,1759.75, Fluoroestradiol f 18,A9591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1759.75,,,,,,,fee schedule,460.42,1759.75, Fluoroestradiol f 18,A9591,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,478.84,,,,,,,fee schedule,460.42,1759.75,APC Fluoroestradiol f 18,A9591,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,483.44,,,,,,,fee schedule,460.42,1759.75,APC Fluoroestradiol f 18,A9591,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,460.42,,,,,,,fee schedule,460.42,1759.75,APC Copper cu 64 dotatate diag,A9592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1834.89,,,,,,,fee schedule,594.28,2202.07, Copper cu 64 dotatate diag,A9592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2202.07,,,,,,,fee schedule,594.28,2202.07, Copper cu 64 dotatate diag,A9592,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,618.05,,,,,,,fee schedule,594.28,2202.07,APC Copper cu 64 dotatate diag,A9592,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,623.99,,,,,,,fee schedule,594.28,2202.07,APC Copper cu 64 dotatate diag,A9592,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,594.28,,,,,,,fee schedule,594.28,2202.07,APC Gallium ga-68 psma-11 ucsf,A9593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1482.9,,,,,,,fee schedule,550.13,1779.64, Gallium ga-68 psma-11 ucsf,A9593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1779.64,,,,,,,fee schedule,550.13,1779.64, Gallium ga-68 psma-11 ucsf,A9593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,572.14,,,,,,,fee schedule,550.13,1779.64,APC Gallium ga-68 psma-11 ucsf,A9593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,577.64,,,,,,,fee schedule,550.13,1779.64,APC Gallium ga-68 psma-11 ucsf,A9593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,550.13,,,,,,,fee schedule,550.13,1779.64,APC "Gallium ga-68 psma-11, ucla",A9594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1451.91,,,,,,,fee schedule,363.5,1742.45, "Gallium ga-68 psma-11, ucla",A9594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1742.45,,,,,,,fee schedule,363.5,1742.45, "Gallium ga-68 psma-11, ucla",A9594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,378.04,,,,,,,fee schedule,363.5,1742.45,APC "Gallium ga-68 psma-11, ucla",A9594,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,381.68,,,,,,,fee schedule,363.5,1742.45,APC "Gallium ga-68 psma-11, ucla",A9594,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,363.5,,,,,,,fee schedule,363.5,1742.45,APC "Piflu f-18, dia 1 millicurie",A9595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1172.54,,,,,,,fee schedule,346.49,1407.17, "Piflu f-18, dia 1 millicurie",A9595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1407.17,,,,,,,fee schedule,346.49,1407.17, "Piflu f-18, dia 1 millicurie",A9595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,360.35,,,,,,,fee schedule,346.49,1407.17,APC "Piflu f-18, dia 1 millicurie",A9595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,363.81,,,,,,,fee schedule,346.49,1407.17,APC "Piflu f-18, dia 1 millicurie",A9595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,346.49,,,,,,,fee schedule,346.49,1407.17,APC Gallium illuccix 1 millicure,A9596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1969.66,,,,,,,fee schedule,478.52,2363.81, Gallium illuccix 1 millicure,A9596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2363.81,,,,,,,fee schedule,478.52,2363.81, Gallium illuccix 1 millicure,A9596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,497.66,,,,,,,fee schedule,478.52,2363.81,APC Gallium illuccix 1 millicure,A9596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,502.45,,,,,,,fee schedule,478.52,2363.81,APC Gallium illuccix 1 millicure,A9596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,478.52,,,,,,,fee schedule,478.52,2363.81,APC Sr89 strontium,A9600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7148.93,,,,,,,fee schedule,4146.34,8579.48, Sr89 strontium,A9600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8579.48,,,,,,,fee schedule,4146.34,8579.48, Sr89 strontium,A9600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4312.19,,,,,,,fee schedule,4146.34,8579.48,APC Sr89 strontium,A9600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4353.65,,,,,,,fee schedule,4146.34,8579.48,APC Sr89 strontium,A9600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4146.34,,,,,,,fee schedule,4146.34,8579.48,APC Flortaucipir inj 1 millicuri,A9601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,667.23,,,,,,,fee schedule,371,800.75, Flortaucipir inj 1 millicuri,A9601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,800.75,,,,,,,fee schedule,371,800.75, Flortaucipir inj 1 millicuri,A9601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,385.84,,,,,,,fee schedule,371,800.75,APC Flortaucipir inj 1 millicuri,A9601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,389.55,,,,,,,fee schedule,371,800.75,APC Flortaucipir inj 1 millicuri,A9601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,371,,,,,,,fee schedule,371,800.75,APC Fluorodopa f-18 diag per mci,A9602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,951.02,,,,,,,fee schedule,855.55,1141.33, Fluorodopa f-18 diag per mci,A9602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1141.33,,,,,,,fee schedule,855.55,1141.33, Fluorodopa f-18 diag per mci,A9602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,889.77,,,,,,,fee schedule,855.55,1141.33,APC Fluorodopa f-18 diag per mci,A9602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,898.33,,,,,,,fee schedule,855.55,1141.33,APC Fluorodopa f-18 diag per mci,A9602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,855.55,,,,,,,fee schedule,855.55,1141.33,APC "Inj, pafolacianine, 0.1 mg",A9603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,253.19,,,,,,,fee schedule,253.19,303.86, "Inj, pafolacianine, 0.1 mg",A9603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,303.86,,,,,,,fee schedule,253.19,303.86, Sm 153 lexidronam,A9604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31041.36,,,,,,,fee schedule,3159.8,37252.96, Sm 153 lexidronam,A9604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,37252.96,,,,,,,fee schedule,3159.8,37252.96, Sm 153 lexidronam,A9604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3286.19,,,,,,,fee schedule,3159.8,37252.96,APC Sm 153 lexidronam,A9604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3317.79,,,,,,,fee schedule,3159.8,37252.96,APC Sm 153 lexidronam,A9604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3159.8,,,,,,,fee schedule,3159.8,37252.96,APC Radium ra223 dichloride ther,A9606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,299.92,,,,,,,fee schedule,171.09,386.69, Radium ra223 dichloride ther,A9606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,299.92,,,,,,,fee schedule,171.09,386.69, Radium ra223 dichloride ther,A9606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,322.22,,,,,,,fee schedule,171.09,386.69, Radium ra223 dichloride ther,A9606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,386.69,,,,,,,fee schedule,171.09,386.69, Radium ra223 dichloride ther,A9606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,177.93,,,,,,,fee schedule,171.09,386.69,APC Radium ra223 dichloride ther,A9606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,179.64,,,,,,,fee schedule,171.09,386.69,APC Radium ra223 dichloride ther,A9606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,171.09,,,,,,,fee schedule,171.09,386.69,APC Lutetium lu 177 vipivotide,A9607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,473.53,,,,,,,fee schedule,259.6,568.29, Lutetium lu 177 vipivotide,A9607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,568.29,,,,,,,fee schedule,259.6,568.29, Lutetium lu 177 vipivotide,A9607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,269.98,,,,,,,fee schedule,259.6,568.29,APC Lutetium lu 177 vipivotide,A9607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,272.58,,,,,,,fee schedule,259.6,568.29,APC Lutetium lu 177 vipivotide,A9607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,259.6,,,,,,,fee schedule,259.6,568.29,APC Flotufolastat f18 diag 1 mci,A9608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1207.17,,,,,,,fee schedule,671.22,1448.73, Flotufolastat f18 diag 1 mci,A9608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1448.73,,,,,,,fee schedule,671.22,1448.73, Flotufolastat f18 diag 1 mci,A9608,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,698.07,,,,,,,fee schedule,671.22,1448.73,APC Flotufolastat f18 diag 1 mci,A9608,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,704.78,,,,,,,fee schedule,671.22,1448.73,APC Flotufolastat f18 diag 1 mci,A9608,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,671.22,,,,,,,fee schedule,671.22,1448.73,APC "Flurpiridaz f18, diag, 1 mci",A9611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,953.19,,,,,,,fee schedule,530,1143.93, "Flurpiridaz f18, diag, 1 mci",A9611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1143.93,,,,,,,fee schedule,530,1143.93, "Flurpiridaz f18, diag, 1 mci",A9611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,551.2,,,,,,,fee schedule,530,1143.93,APC "Flurpiridaz f18, diag, 1 mci",A9611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,556.5,,,,,,,fee schedule,530,1143.93,APC "Flurpiridaz f18, diag, 1 mci",A9611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,530,,,,,,,fee schedule,530,1143.93,APC "Inj, fluorescein, 1 mg",A9612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.71,,,,,,,fee schedule,0.71,0.85, "Inj, fluorescein, 1 mg",A9612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.85,,,,,,,fee schedule,0.71,0.85, "Inj, pegulicianine, 1 mg",A9615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.45,,,,,,,fee schedule,37.51,80.95, "Inj, pegulicianine, 1 mg",A9615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,80.95,,,,,,,fee schedule,37.51,80.95, "Inj, pegulicianine, 1 mg",A9615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.01,,,,,,,fee schedule,37.51,80.95,APC "Inj, pegulicianine, 1 mg",A9615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.38,,,,,,,fee schedule,37.51,80.95,APC "Inj, pegulicianine, 1 mg",A9615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.51,,,,,,,fee schedule,37.51,80.95,APC Gallium gozellix 1 millicuri,A9616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2106.55,,,,,,,fee schedule,1171.3,2528.09, Gallium gozellix 1 millicuri,A9616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2528.09,,,,,,,fee schedule,1171.3,2528.09, Gallium gozellix 1 millicuri,A9616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1218.15,,,,,,,fee schedule,1171.3,2528.09,APC Gallium gozellix 1 millicuri,A9616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1229.86,,,,,,,fee schedule,1171.3,2528.09,APC Gallium gozellix 1 millicuri,A9616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1171.3,,,,,,,fee schedule,1171.3,2528.09,APC Gallium locametz 1 millicuri,A9800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1166.93,,,,,,,fee schedule,362.5,1400.44, Gallium locametz 1 millicuri,A9800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1400.44,,,,,,,fee schedule,362.5,1400.44, Gallium locametz 1 millicuri,A9800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,377,,,,,,,fee schedule,362.5,1400.44,APC Gallium locametz 1 millicuri,A9800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,380.62,,,,,,,fee schedule,362.5,1400.44,APC Gallium locametz 1 millicuri,A9800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,362.5,,,,,,,fee schedule,362.5,1400.44,APC "Brachytx, non-str,Yttrium-90",C2616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18481.85,,,,,,,fee schedule,17771.01,18659.56,APC "Brachytx, non-str,Yttrium-90",C2616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18659.56,,,,,,,fee schedule,17771.01,18659.56,APC "Brachytx, non-str,Yttrium-90",C2616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17771.01,,,,,,,fee schedule,17771.01,18659.56,APC Low cost skin substitute app,C5271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Low cost skin substitute app,C5272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Low cost skin substitute app,C5273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Low cost skin substitute app,C5273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Low cost skin substitute app,C5273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Low cost skin substitute app,C5273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Low cost skin substitute app,C5274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Low cost skin substitute app,C5274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Low cost skin substitute app,C5275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Low cost skin substitute app,C5276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Low cost skin substitute app,C5277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,2762,4166, Low cost skin substitute app,C5278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Low cost skin substitute app,C5278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Deb bone 20 cm2 w/drug dev,C7500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Deb bone 20 cm2 w/drug dev,C7500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Deb bone 20 cm2 w/drug dev,C7500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Deb bone 20 cm2 w/drug dev,C7500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Perc bx breast lesions stero,C7501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Perc bx breast lesions stero,C7501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Perc bx breast lesions stero,C7501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Perc bx breast lesions stero,C7501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Perc bx breast lesions mr,C7502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,9918, Perc bx breast lesions mr,C7502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,9918, Perc bx breast lesions mr,C7502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,3408,9918, Perc bx breast lesions mr,C7502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,3408,9918, Open exc cerv node(s) w/ id,C7503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Open exc cerv node(s) w/ id,C7503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Perq cvt&ls inj vert bodies,C7504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Perq cvt&ls inj vert bodies,C7504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Perq ls&cvt inj vert bodies,C7505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Perq ls&cvt inj vert bodies,C7505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Fusion of finger joints,C7506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Fusion of finger joints,C7506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Perq thor&lumb vert aug,C7507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,3972, Perq thor&lumb vert aug,C7507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,3972, Perq lumb&thor vert aug,C7508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,3972, Perq lumb&thor vert aug,C7508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,3972, Dx bronch w/ navigation,C7509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Dx bronch w/ navigation,C7509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Dx bronch w/ navigation,C7509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Dx bronch w/ navigation,C7509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Bronch/lavag w/ navigation,C7510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Bronch/lavag w/ navigation,C7510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Bronch/lavag w/ navigation,C7510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Bronch/lavag w/ navigation,C7510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ navigation,C7511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ navigation,C7511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ navigation,C7511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ navigation,C7511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ ebus,C7512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ ebus,C7512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ ebus,C7512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Bronch/bpsy(s) w/ ebus,C7512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Cath/angio dialcir w/aplasty,C7513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Cath/angio dialcir w/aplasty,C7513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Cath/angio dialcir w/aplasty,C7513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Cath/angio dialcir w/aplasty,C7513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/stents,C7514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/stents,C7514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/stents,C7514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/stents,C7514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/embol,C7515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/embol,C7515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/embol,C7515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4147,13320, Cath/angio dial cir w/embol,C7515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4147,13320, Cor angio w/ ivus or oct,C7516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, Cor angio w/ ivus or oct,C7516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, Cor angio w/ilic/fem angio,C7517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Cor angio w/ilic/fem angio,C7517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Cor/gft angio w/ ivus or oct,C7518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, Cor/gft angio w/ ivus or oct,C7518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, Cor/gft angio w/ flow resrv,C7519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Cor/gft angio w/ flow resrv,C7519,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Cor/gft angio w/ilic/fem ang,C7520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Cor/gft angio w/ilic/fem ang,C7520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, R hrt angio w/ ivus or oct,C7521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, R hrt angio w/ ivus or oct,C7521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, R hrt angio w/flow resrv,C7522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, R hrt angio w/flow resrv,C7522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, L hrt angio w/ ivus or oct,C7523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, L hrt angio w/ ivus or oct,C7523,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, L hrt angio w/flow resrv,C7524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, L hrt angio w/flow resrv,C7524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, L hrt gft ang w/ ivus or oct,C7525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, L hrt gft ang w/ ivus or oct,C7525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, L hrt gft ang w/flow resrv,C7526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, L hrt gft ang w/flow resrv,C7526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, R&l hrt angio w/ ivus or oct,C7527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, R&l hrt angio w/ ivus or oct,C7527,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, R&l hrt angio w/flow resrv,C7528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, R&l hrt angio w/flow resrv,C7528,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, R&l hrt gft ang w/flow resrv,C7529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, R&l hrt gft ang w/flow resrv,C7529,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Cath/aplasty dial cir w/stnt,C7530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Cath/aplasty dial cir w/stnt,C7530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Angio fem/pop w/ us,C7531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,3972, Angio fem/pop w/ us,C7531,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,3972, Angio w/ us non-coronary,C7532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Angio w/ us non-coronary,C7532,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Fem/pop revasc w/arthr & us,C7534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,3972, Fem/pop revasc w/arthr & us,C7534,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,3972, Fem/pop revasc w/stent & us,C7535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,3972, Fem/pop revasc w/stent & us,C7535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,3972, Insrt atril pm w/l vent lead,C7537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Insrt atril pm w/l vent lead,C7537,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Insrt vent pm w/l vent lead,C7538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Insrt vent pm w/l vent lead,C7538,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Insrt a & v pm w/l vent lead,C7539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Insrt a & v pm w/l vent lead,C7539,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Rmv&rplc pm dul w/l vnt lead,C7540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Rmv&rplc pm dul w/l vnt lead,C7540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Ercp w/ pancreatoscopy,C7541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Ercp w/ pancreatoscopy,C7541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Ercp w/bx & pancreatoscopy,C7542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Ercp w/bx & pancreatoscopy,C7542,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, "Ercp w/otomy, pancreatoscopy",C7543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, "Ercp w/otomy, pancreatoscopy",C7543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Ercp rmv calc pancreatoscopy,C7544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Ercp rmv calc pancreatoscopy,C7544,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Exch bil cath w/ rmv calculi,C7545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Exch bil cath w/ rmv calculi,C7545,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, Rep nph/urt cath w/dil stric,C7546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Rep nph/urt cath w/dil stric,C7546,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Rep nph/urt cath w/dil stric,C7546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Rep nph/urt cath w/dil stric,C7546,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Cnvrt neph cath w/ dil stric,C7547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Cnvrt neph cath w/ dil stric,C7547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Cnvrt neph cath w/ dil stric,C7547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Cnvrt neph cath w/ dil stric,C7547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Exch neph cath w/ dil stric,C7548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Exch neph cath w/ dil stric,C7548,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Exch neph cath w/ dil stric,C7548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Exch neph cath w/ dil stric,C7548,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Chge urtr stent w/ dil stric,C7549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Chge urtr stent w/ dil stric,C7549,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Chge urtr stent w/ dil stric,C7549,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Chge urtr stent w/ dil stric,C7549,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Cysto w/ bx(s) w/ blue light,C7550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Cysto w/ bx(s) w/ blue light,C7550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Cysto w/ bx(s) w/ blue light,C7550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Cysto w/ bx(s) w/ blue light,C7550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Exc neuroma w/ implnt nv end,C7551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,5044, Exc neuroma w/ implnt nv end,C7551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,5044, R hrt art/grft ang hrt flow,C7552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, R hrt art/grft ang hrt flow,C7552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, R&l hrt art/vent ang drg ad,C7553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, R&l hrt art/vent ang drg ad,C7553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Cystureth blu li cyst fl img,C7554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,9918, Cystureth blu li cyst fl img,C7554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,9918, Cystureth blu li cyst fl img,C7554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8266,,,,,,,fee schedule,2816,9918, Cystureth blu li cyst fl img,C7554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9918,,,,,,,fee schedule,2816,9918, Rmvl thyrd w/autotran parath,C7555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Rmvl thyrd w/autotran parath,C7555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Bronch lavage w/ebus,C7556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,13320, Bronch lavage w/ebus,C7556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,13320, Bronch lavage w/ebus,C7556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,2816,13320, Bronch lavage w/ebus,C7556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,2816,13320, Cor angio/vent w/ffr,C7557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, Cor angio/vent w/ffr,C7557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, Cor angio/vent w/drug admin,C7558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, Cor angio/vent w/drug admin,C7558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, Ercp remove forgn body&endo,C7560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Ercp remove forgn body&endo,C7560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Ercp remove forgn body&endo,C7560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Ercp remove forgn body&endo,C7560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, R&l hrt angio w/ffr & 3d map,C7562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,4934, R&l hrt angio w/ffr & 3d map,C7562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,4934, Trluml ballo angiop all art,C7563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,5028, Trluml ballo angiop all art,C7563,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,5028, Vein mech throm w/intrvas us,C7564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Vein mech throm w/intrvas us,C7564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Vein mech throm w/intrvas us,C7564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Vein mech throm w/intrvas us,C7564,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Rpr aa hrn < 3 rdc w/ rmvl,C7565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Rpr aa hrn < 3 rdc w/ rmvl,C7565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Rpr aa hrn < 3 rdc w/ rmvl,C7565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Rpr aa hrn < 3 rdc w/ rmvl,C7565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Fuse finger joints w/grafts,C7566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Fuse finger joints w/grafts,C7566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Fuse finger joints w/grafts,C7566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Fuse finger joints w/grafts,C7566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Bronch/needle bx(s) w/ nav,C7567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Bronch/needle bx(s) w/ nav,C7567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Bronch/needle bx(s) w/ nav,C7567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Bronch/needle bx(s) w/ nav,C7567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Cor angio w/flow resrv,C7568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Cor angio w/flow resrv,C7568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Cor angio w/flow resrv,C7568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Cor angio w/flow resrv,C7568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Ptca w/ ivus or oct,C7569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Ptca w/ ivus or oct,C7569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Ptca w/ ivus or oct,C7569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Ptca w/ ivus or oct,C7569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Cor angio w/ffr & 3d map,C7570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, Cor angio w/ffr & 3d map,C7570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, Cor angio w/ffr & 3d map,C7570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, Cor angio w/ffr & 3d map,C7570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, Pcta w/ cor lithotrip,C7571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Pcta w/ cor lithotrip,C7571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Pcta w/ cor lithotrip,C7571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Pcta w/ cor lithotrip,C7571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, 3d anat seg imaging preop,C8001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC 3d anat seg imaging preop,C8001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC 3d anat seg imaging preop,C8001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC "Prep skin cell susp, automtd",C8002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8719.1,,,,,,,fee schedule,8383.75,8802.94,APC "Prep skin cell susp, automtd",C8002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8802.94,,,,,,,fee schedule,8383.75,8802.94,APC "Prep skin cell susp, automtd",C8002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8383.75,,,,,,,fee schedule,8383.75,8802.94,APC Imp extar knee shck absrb,C8003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,21749.16, Imp extar knee shck absrb,C8003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,21749.16, Imp extar knee shck absrb,C8003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,21749.16, Imp extar knee shck absrb,C8003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,21749.16, Imp extar knee shck absrb,C8003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21542.02,,,,,,,fee schedule,4224,21749.16,APC Imp extar knee shck absrb,C8003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21749.16,,,,,,,fee schedule,4224,21749.16,APC Imp extar knee shck absrb,C8003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20713.48,,,,,,,fee schedule,4224,21749.16,APC Sim ang w/prs cath rad emb,C8004,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,13637.67,14319.55,APC Sim ang w/prs cath rad emb,C8004,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,13637.67,14319.55,APC Sim ang w/prs cath rad emb,C8004,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,13637.67,14319.55,APC Pef bronch ablt 3d nav ebus,C8005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,21247.62, Pef bronch ablt 3d nav ebus,C8005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,21247.62, Pef bronch ablt 3d nav ebus,C8005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21045.26,,,,,,,fee schedule,4147,21247.62,APC Pef bronch ablt 3d nav ebus,C8005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21247.62,,,,,,,fee schedule,4147,21247.62,APC Pef bronch ablt 3d nav ebus,C8005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20235.83,,,,,,,fee schedule,4147,21247.62,APC Inst pleu-perit shnt w pump,C8006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,8030.21, Inst pleu-perit shnt w pump,C8006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,8030.21, Inst pleu-perit shnt w pump,C8006,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7953.73,,,,,,,fee schedule,2816,8030.21,APC Inst pleu-perit shnt w pump,C8006,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8030.21,,,,,,,fee schedule,2816,8030.21,APC Inst pleu-perit shnt w pump,C8006,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7647.81,,,,,,,fee schedule,2816,8030.21,APC Opn mplnt hpgls ns ary ps gn,C8007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,36453.58,38276.26,APC Opn mplnt hpgls ns ary ps gn,C8007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,36453.58,38276.26,APC Opn mplnt hpgls ns ary ps gn,C8007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,36453.58,38276.26,APC Rv/rpl hpgls ns inc cnt pg,C8008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,13163.37,13821.53,APC Rv/rpl hpgls ns inc cnt pg,C8008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,13163.37,13821.53,APC Rv/rpl hpgls ns inc cnt pg,C8008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,13163.37,13821.53,APC Rmv hpgls ns ary and pg,C8009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,4035.65,4237.43,APC Rmv hpgls ns ary and pg,C8009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,4035.65,4237.43,APC Rmv hpgls ns ary and pg,C8009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,4035.65,4237.43,APC Opn mplnt hpgls ns ary rec,C8011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37911.73,,,,,,,fee schedule,36453.58,38276.26,APC Opn mplnt hpgls ns ary rec,C8011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38276.26,,,,,,,fee schedule,36453.58,38276.26,APC Opn mplnt hpgls ns ary rec,C8011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36453.58,,,,,,,fee schedule,36453.58,38276.26,APC Rv/rpl hpgls ns ary rec,C8012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13689.9,,,,,,,fee schedule,13163.37,13821.53,APC Rv/rpl hpgls ns ary rec,C8012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13821.53,,,,,,,fee schedule,13163.37,13821.53,APC Rv/rpl hpgls ns ary rec,C8012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13163.37,,,,,,,fee schedule,13163.37,13821.53,APC Rmv hpls ns ary rec,C8013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4197.07,,,,,,,fee schedule,4035.65,4237.43,APC Rmv hpls ns ary rec,C8013,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4237.43,,,,,,,fee schedule,4035.65,4237.43,APC Rmv hpls ns ary rec,C8013,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4035.65,,,,,,,fee schedule,4035.65,4237.43,APC "Mra w/cont, abd",C8900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2033.57,,,,,,,fee schedule,412.14,2557.68, "Mra w/cont, abd",C8900,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2557.68,,,,,,,fee schedule,412.14,2557.68, "Mra w/cont, abd",C8900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2557.68,APC "Mra w/cont, abd",C8900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2557.68,APC "Mra w/cont, abd",C8900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2557.68,APC "Mra w/o cont, abd",C8901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1763.55,,,,,,,fee schedule,281.87,2218.07, "Mra w/o cont, abd",C8901,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2218.07,,,,,,,fee schedule,281.87,2218.07, "Mra w/o cont, abd",C8901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,2218.07,APC "Mra w/o cont, abd",C8901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,2218.07,APC "Mra w/o cont, abd",C8901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,2218.07,APC "Mra w/o fol w/cont, abd",C8902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2232.93,,,,,,,fee schedule,412.14,2808.43, "Mra w/o fol w/cont, abd",C8902,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2808.43,,,,,,,fee schedule,412.14,2808.43, "Mra w/o fol w/cont, abd",C8902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2808.43,APC "Mra w/o fol w/cont, abd",C8902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2808.43,APC "Mra w/o fol w/cont, abd",C8902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2808.43,APC "Mri w/cont, breast, uni",C8903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,716.94,,,,,,,fee schedule,207.21,901.71, "Mri w/cont, breast, uni",C8903,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,901.71,,,,,,,fee schedule,207.21,901.71, "Mri w/cont, breast, uni",C8903,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.5,,,,,,,fee schedule,207.21,901.71,APC "Mri w/cont, breast, uni",C8903,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.57,,,,,,,fee schedule,207.21,901.71,APC "Mri w/cont, breast, uni",C8903,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.21,,,,,,,fee schedule,207.21,901.71,APC "Mri w/o fol w/cont, brst, un",C8905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1119.48,,,,,,,fee schedule,412.14,1408, "Mri w/o fol w/cont, brst, un",C8905,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1408,,,,,,,fee schedule,412.14,1408, "Mri w/o fol w/cont, brst, un",C8905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1408,APC "Mri w/o fol w/cont, brst, un",C8905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1408,APC "Mri w/o fol w/cont, brst, un",C8905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1408,APC "Mri w/cont, breast, bi",C8906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2231.04,,,,,,,fee schedule,412.14,2806.05, "Mri w/cont, breast, bi",C8906,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2806.05,,,,,,,fee schedule,412.14,2806.05, "Mri w/cont, breast, bi",C8906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2806.05,APC "Mri w/cont, breast, bi",C8906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2806.05,APC "Mri w/cont, breast, bi",C8906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2806.05,APC "Mri w/o fol w/cont, breast,",C8908,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2387.13,,,,,,,fee schedule,412.14,3002.37, "Mri w/o fol w/cont, breast,",C8908,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3002.37,,,,,,,fee schedule,412.14,3002.37, "Mri w/o fol w/cont, breast,",C8908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,3002.37,APC "Mri w/o fol w/cont, breast,",C8908,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,3002.37,APC "Mri w/o fol w/cont, breast,",C8908,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,3002.37,APC "MRA w/cont, chest",C8909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,903.5,,,,,,,fee schedule,412.14,1136.36, "MRA w/cont, chest",C8909,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1136.36,,,,,,,fee schedule,412.14,1136.36, "MRA w/cont, chest",C8909,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1136.36,APC "MRA w/cont, chest",C8909,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1136.36,APC "MRA w/cont, chest",C8909,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1136.36,APC "MRA w/o cont, chest",C8910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1348.9,,,,,,,fee schedule,281.87,1696.56, "MRA w/o cont, chest",C8910,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1696.56,,,,,,,fee schedule,281.87,1696.56, "MRA w/o cont, chest",C8910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,1696.56,APC "MRA w/o cont, chest",C8910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,1696.56,APC "MRA w/o cont, chest",C8910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,1696.56,APC "MRA w/o fol w/cont, chest",C8911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1839.93,,,,,,,fee schedule,412.14,2314.14, "MRA w/o fol w/cont, chest",C8911,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2314.14,,,,,,,fee schedule,412.14,2314.14, "MRA w/o fol w/cont, chest",C8911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2314.14,APC "MRA w/o fol w/cont, chest",C8911,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2314.14,APC "MRA w/o fol w/cont, chest",C8911,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2314.14,APC "Mra w/cont, lwr ext",C8912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1156.38,,,,,,,fee schedule,412.14,1454.41, "Mra w/cont, lwr ext",C8912,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1454.41,,,,,,,fee schedule,412.14,1454.41, "Mra w/cont, lwr ext",C8912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1454.41,APC "Mra w/cont, lwr ext",C8912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1454.41,APC "Mra w/cont, lwr ext",C8912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1454.41,APC "Mra w/o cont, lwr ext",C8913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,791.9,,,,,,,fee schedule,281.87,996, "Mra w/o cont, lwr ext",C8913,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,996,,,,,,,fee schedule,281.87,996, "Mra w/o cont, lwr ext",C8913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,996,APC "Mra w/o cont, lwr ext",C8913,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,996,APC "Mra w/o cont, lwr ext",C8913,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,996,APC "Mra w/o fol w/cont, lwr ext",C8914,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1098.79,,,,,,,fee schedule,412.14,1381.98, "Mra w/o fol w/cont, lwr ext",C8914,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1381.98,,,,,,,fee schedule,412.14,1381.98, "Mra w/o fol w/cont, lwr ext",C8914,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1381.98,APC "Mra w/o fol w/cont, lwr ext",C8914,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1381.98,APC "Mra w/o fol w/cont, lwr ext",C8914,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1381.98,APC "MRA w/cont, pelvis",C8918,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,932.6,,,,,,,fee schedule,412.14,1172.96, "MRA w/cont, pelvis",C8918,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1172.96,,,,,,,fee schedule,412.14,1172.96, "MRA w/cont, pelvis",C8918,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1172.96,APC "MRA w/cont, pelvis",C8918,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1172.96,APC "MRA w/cont, pelvis",C8918,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1172.96,APC "MRA w/o cont, pelvis",C8919,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,784.36,,,,,,,fee schedule,281.87,986.52, "MRA w/o cont, pelvis",C8919,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,986.52,,,,,,,fee schedule,281.87,986.52, "MRA w/o cont, pelvis",C8919,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,986.52,APC "MRA w/o cont, pelvis",C8919,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,986.52,APC "MRA w/o cont, pelvis",C8919,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,986.52,APC "Mra w/o fol w/cont, pelvis",C8920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2106.67,,,,,,,fee schedule,412.14,2649.62, "Mra w/o fol w/cont, pelvis",C8920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2649.62,,,,,,,fee schedule,412.14,2649.62, "Mra w/o fol w/cont, pelvis",C8920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2649.62,APC "Mra w/o fol w/cont, pelvis",C8920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2649.62,APC "Mra w/o fol w/cont, pelvis",C8920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2649.62,APC "Tte w or w/o fol w/cont, com",C8921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1868.46,,,,,,,fee schedule,926.08,2139.68, "Tte w or w/o fol w/cont, com",C8921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2139.68,,,,,,,fee schedule,926.08,2139.68, "Tte w or w/o fol w/cont, com",C8921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2139.68,APC "Tte w or w/o fol w/cont, com",C8921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2139.68,APC "Tte w or w/o fol w/cont, com",C8921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2139.68,APC "Tte w or w/o fol w/cont, f/u",C8922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1919.87,,,,,,,fee schedule,926.08,2198.56, "Tte w or w/o fol w/cont, f/u",C8922,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2198.56,,,,,,,fee schedule,926.08,2198.56, "Tte w or w/o fol w/cont, f/u",C8922,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2198.56,APC "Tte w or w/o fol w/cont, f/u",C8922,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2198.56,APC "Tte w or w/o fol w/cont, f/u",C8922,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2198.56,APC "2d tte w or w/o fol w/con,co",C8923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1326.9,,,,,,,fee schedule,926.08,1519.51, "2d tte w or w/o fol w/con,co",C8923,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1519.51,,,,,,,fee schedule,926.08,1519.51, "2d tte w or w/o fol w/con,co",C8923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,1519.51,APC "2d tte w or w/o fol w/con,co",C8923,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,1519.51,APC "2d tte w or w/o fol w/con,co",C8923,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,1519.51,APC "2d tte w or w/o fol w/con,fu",C8924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1016.23,,,,,,,fee schedule,412.14,1163.75, "2d tte w or w/o fol w/con,fu",C8924,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1163.75,,,,,,,fee schedule,412.14,1163.75, "2d tte w or w/o fol w/con,fu",C8924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1163.75,APC "2d tte w or w/o fol w/con,fu",C8924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1163.75,APC "2d tte w or w/o fol w/con,fu",C8924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1163.75,APC "2d tee w or w/o fol w/con,in",C8925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2086.9,,,,,,,fee schedule,926.08,2389.83, "2d tee w or w/o fol w/con,in",C8925,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2389.83,,,,,,,fee schedule,926.08,2389.83, "2d tee w or w/o fol w/con,in",C8925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2389.83,APC "2d tee w or w/o fol w/con,in",C8925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2389.83,APC "2d tee w or w/o fol w/con,in",C8925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2389.83,APC "Tee w or w/o fol w/cont,cong",C8926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3424.83,,,,,,,fee schedule,926.08,3921.98, "Tee w or w/o fol w/cont,cong",C8926,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3921.98,,,,,,,fee schedule,926.08,3921.98, "Tee w or w/o fol w/cont,cong",C8926,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,3921.98,APC "Tee w or w/o fol w/cont,cong",C8926,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,3921.98,APC "Tee w or w/o fol w/cont,cong",C8926,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,3921.98,APC "TEE w or w/o fol w/cont, mon",C8927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2747.57,,,,,,,fee schedule,926.08,3146.41, "TEE w or w/o fol w/cont, mon",C8927,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3146.41,,,,,,,fee schedule,926.08,3146.41, "TEE w or w/o fol w/cont, mon",C8927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,3146.41,APC "TEE w or w/o fol w/cont, mon",C8927,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,3146.41,APC "TEE w or w/o fol w/cont, mon",C8927,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,3146.41,APC "Tte w or w/o fol w/con,stres",C8928,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2505.27,,,,,,,fee schedule,926.08,2868.94, "Tte w or w/o fol w/con,stres",C8928,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2868.94,,,,,,,fee schedule,926.08,2868.94, "Tte w or w/o fol w/con,stres",C8928,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2868.94,APC "Tte w or w/o fol w/con,stres",C8928,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2868.94,APC "Tte w or w/o fol w/con,stres",C8928,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2868.94,APC "TTE w or wo fol wcon,Doppler",C8929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1547.25,,,,,,,fee schedule,926.08,1771.85, "TTE w or wo fol wcon,Doppler",C8929,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1771.85,,,,,,,fee schedule,926.08,1771.85, "TTE w or wo fol wcon,Doppler",C8929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,1771.85,APC "TTE w or wo fol wcon,Doppler",C8929,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,1771.85,APC "TTE w or wo fol wcon,Doppler",C8929,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,1771.85,APC "TTE w or w/o contr, cont ECG",C8930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1885.94,,,,,,,fee schedule,926.08,2159.71, "TTE w or w/o contr, cont ECG",C8930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2159.71,,,,,,,fee schedule,926.08,2159.71, "TTE w or w/o contr, cont ECG",C8930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,963.12,,,,,,,fee schedule,926.08,2159.71,APC "TTE w or w/o contr, cont ECG",C8930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,972.38,,,,,,,fee schedule,926.08,2159.71,APC "TTE w or w/o contr, cont ECG",C8930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,926.08,,,,,,,fee schedule,926.08,2159.71,APC "MRA, w/dye, spinal canal",C8931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1554.52,,,,,,,fee schedule,412.14,1955.17, "MRA, w/dye, spinal canal",C8931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1955.17,,,,,,,fee schedule,412.14,1955.17, "MRA, w/dye, spinal canal",C8931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1955.17,APC "MRA, w/dye, spinal canal",C8931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1955.17,APC "MRA, w/dye, spinal canal",C8931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1955.17,APC "MRA, w/o dye, spinal canal",C8932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,726.19,,,,,,,fee schedule,281.87,913.35, "MRA, w/o dye, spinal canal",C8932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,913.35,,,,,,,fee schedule,281.87,913.35, "MRA, w/o dye, spinal canal",C8932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,913.35,APC "MRA, w/o dye, spinal canal",C8932,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,913.35,APC "MRA, w/o dye, spinal canal",C8932,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,913.35,APC "MRA, w/o&w/dye, spinal canal",C8933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1023.13,,,,,,,fee schedule,412.14,1286.82, "MRA, w/o&w/dye, spinal canal",C8933,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1286.82,,,,,,,fee schedule,412.14,1286.82, "MRA, w/o&w/dye, spinal canal",C8933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1286.82,APC "MRA, w/o&w/dye, spinal canal",C8933,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1286.82,APC "MRA, w/o&w/dye, spinal canal",C8933,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1286.82,APC "MRA, w/dye, upper extremity",C8934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1413.47,,,,,,,fee schedule,412.14,1777.77, "MRA, w/dye, upper extremity",C8934,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1777.77,,,,,,,fee schedule,412.14,1777.77, "MRA, w/dye, upper extremity",C8934,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1777.77,APC "MRA, w/dye, upper extremity",C8934,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1777.77,APC "MRA, w/dye, upper extremity",C8934,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1777.77,APC "MRA, w/o dye, upper extr",C8935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,704.19,,,,,,,fee schedule,281.87,885.68, "MRA, w/o dye, upper extr",C8935,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,885.68,,,,,,,fee schedule,281.87,885.68, "MRA, w/o dye, upper extr",C8935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,885.68,APC "MRA, w/o dye, upper extr",C8935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,885.68,APC "MRA, w/o dye, upper extr",C8935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,885.68,APC "MRA, w/o&w/dye, upper extr",C8936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1910.24,,,,,,,fee schedule,412.14,2402.57, "MRA, w/o&w/dye, upper extr",C8936,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2402.57,,,,,,,fee schedule,412.14,2402.57, "MRA, w/o&w/dye, upper extr",C8936,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,2402.57,APC "MRA, w/o&w/dye, upper extr",C8936,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,2402.57,APC "MRA, w/o&w/dye, upper extr",C8936,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,2402.57,APC "Prolonged iv inf, req pump",C8957,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.33,,,,,,,fee schedule,251.28,263.84,APC "Prolonged iv inf, req pump",C8957,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.84,,,,,,,fee schedule,251.28,263.84,APC "Prolonged iv inf, req pump",C8957,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.28,,,,,,,fee schedule,251.28,263.84,APC Cocaine hcl nasal solution,C9046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.21,,,,,,,fee schedule,3.21,3.86, Cocaine hcl nasal solution,C9046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.86,,,,,,,fee schedule,3.21,3.86, "Injection, caplacizumab-yhdp",C9047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1485.54,,,,,,,fee schedule,801.26,1782.8, "Injection, caplacizumab-yhdp",C9047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1782.8,,,,,,,fee schedule,801.26,1782.8, "Injection, caplacizumab-yhdp",C9047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,833.31,,,,,,,fee schedule,801.26,1782.8,APC "Injection, caplacizumab-yhdp",C9047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,841.33,,,,,,,fee schedule,801.26,1782.8,APC "Injection, caplacizumab-yhdp",C9047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,801.26,,,,,,,fee schedule,801.26,1782.8,APC Gallium ga-68 dotatoc,C9067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.45,,,,,,,fee schedule,3.61,17.34, Gallium ga-68 dotatoc,C9067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.34,,,,,,,fee schedule,3.61,17.34, Gallium ga-68 dotatoc,C9067,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.75,,,,,,,fee schedule,3.61,17.34,APC Gallium ga-68 dotatoc,C9067,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.79,,,,,,,fee schedule,3.61,17.34,APC Gallium ga-68 dotatoc,C9067,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.61,,,,,,,fee schedule,3.61,17.34,APC "Bupivacaine implant, 1 mg",C9089,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.59,,,,,,,fee schedule,1.59,1.91, "Bupivacaine implant, 1 mg",C9089,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.91,,,,,,,fee schedule,1.59,1.91, "Inj, oliceridine 0.1 mg",C9101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.47,,,,,,,fee schedule,2.47,2.96, "Inj, oliceridine 0.1 mg",C9101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.96,,,,,,,fee schedule,2.47,2.96, Cocaine hcl nasal (numbrino),C9143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.28,,,,,,,fee schedule,4.28,5.14, Cocaine hcl nasal (numbrino),C9143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.14,,,,,,,fee schedule,4.28,5.14, "Inj, bupivacaine (posimir)",C9144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.92,,,,,,,fee schedule,0.92,1.1, "Inj, bupivacaine (posimir)",C9144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.1,,,,,,,fee schedule,0.92,1.1, "Inj, aponvie, 1 mg",C9145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.64,,,,,,,fee schedule,3.64,4.37, "Inj, aponvie, 1 mg",C9145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.37,,,,,,,fee schedule,3.64,4.37, Artiss fibrin sealant,C9250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,350.57,,,,,,,fee schedule,143.7,420.72, Artiss fibrin sealant,C9250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,420.72,,,,,,,fee schedule,143.7,420.72, Artiss fibrin sealant,C9250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,149.45,,,,,,,fee schedule,143.7,420.72,APC Artiss fibrin sealant,C9250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,150.88,,,,,,,fee schedule,143.7,420.72,APC Artiss fibrin sealant,C9250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,143.7,,,,,,,fee schedule,143.7,420.72,APC "Injection, lacosamide",C9254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.37,,,,,,,fee schedule,0.37,0.45, "Injection, lacosamide",C9254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.45,,,,,,,fee schedule,0.37,0.45, Bevacizumab injection,C9257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.79,,,,,,,fee schedule,1.86,4.55, Bevacizumab injection,C9257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.55,,,,,,,fee schedule,1.86,4.55, Bevacizumab injection,C9257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.93,,,,,,,fee schedule,1.86,4.55,APC Bevacizumab injection,C9257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.95,,,,,,,fee schedule,1.86,4.55,APC Bevacizumab injection,C9257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.86,,,,,,,fee schedule,1.86,4.55,APC "Patch, lidocaine/tetracaine",C9285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.32,,,,,,,fee schedule,32.32,38.78, "Patch, lidocaine/tetracaine",C9285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.78,,,,,,,fee schedule,32.32,38.78, "Injection, glucarpidase",C9293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,824.19,,,,,,,fee schedule,449.1,989.12, "Injection, glucarpidase",C9293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,989.12,,,,,,,fee schedule,449.1,989.12, "Injection, glucarpidase",C9293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,467.07,,,,,,,fee schedule,449.1,989.12,APC "Injection, glucarpidase",C9293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,471.56,,,,,,,fee schedule,449.1,989.12,APC "Injection, glucarpidase",C9293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,449.1,,,,,,,fee schedule,449.1,989.12,APC "Inj, nipocalimab-aahu, 3 mg",C9305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.47,,,,,,,fee schedule,59.47,71.37, "Inj, nipocalimab-aahu, 3 mg",C9305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.37,,,,,,,fee schedule,59.47,71.37, Telisotuzumab vedotin-tllv,C9306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,266.52,,,,,,,fee schedule,266.52,319.85, Telisotuzumab vedotin-tllv,C9306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,319.85,,,,,,,fee schedule,266.52,319.85, "Neuragen nerve guide, per cm",C9352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1978.82,,,,,,,fee schedule,1978.82,2374.8, "Neuragen nerve guide, per cm",C9352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2374.8,,,,,,,fee schedule,1978.82,2374.8, "Neurawrap nerve protector,cm",C9353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2110.61,,,,,,,fee schedule,2110.61,2532.95, "Neurawrap nerve protector,cm",C9353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2532.95,,,,,,,fee schedule,2110.61,2532.95, "Veritas collagen matrix, cm2",C9354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.22,,,,,,,fee schedule,36.22,43.47, "Veritas collagen matrix, cm2",C9354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,43.47,,,,,,,fee schedule,36.22,43.47, "Neuromatrix nerve cuff, cm",C9355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,340.61,,,,,,,fee schedule,340.61,408.76, "Neuromatrix nerve cuff, cm",C9355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,408.76,,,,,,,fee schedule,340.61,408.76, "TenoGlide tendon prot, cm2",C9356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,209.42,,,,,,,fee schedule,209.42,251.33, "TenoGlide tendon prot, cm2",C9356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,251.33,,,,,,,fee schedule,209.42,251.33, NeuroMend nerve wrap,C9361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,331.3,,,,,,,fee schedule,331.3,397.59, NeuroMend nerve wrap,C9361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,397.59,,,,,,,fee schedule,331.3,397.59, Integra Meshed Bil Wound Mat,C9363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,128.61,,,,,,,fee schedule,128.61,154.36, Integra Meshed Bil Wound Mat,C9363,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,154.34,,,,,,,fee schedule,128.61,154.36, Integra Meshed Bil Wound Mat,C9363,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,128.61,154.36,APC Integra Meshed Bil Wound Mat,C9363,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,128.61,154.36,APC Integra Meshed Bil Wound Mat,C9363,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,128.61,154.36,APC "Porcine implant, Permacol",C9364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.37,,,,,,,fee schedule,34.37,41.25, "Porcine implant, Permacol",C9364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.25,,,,,,,fee schedule,34.37,41.25, "Injection, cangrelor",C9460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.18,,,,,,,fee schedule,20.02,45.82, "Injection, cangrelor",C9460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.82,,,,,,,fee schedule,20.02,45.82, "Injection, cangrelor",C9460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.82,,,,,,,fee schedule,20.02,45.82,APC "Injection, cangrelor",C9460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.02,,,,,,,fee schedule,20.02,45.82,APC "Injection, cangrelor",C9460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.02,,,,,,,fee schedule,20.02,45.82,APC "Injection, delafloxacin",C9462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.95,,,,,,,fee schedule,0.95,1.14, "Injection, delafloxacin",C9462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.14,,,,,,,fee schedule,0.95,1.14, Sotalol hydrochloride IV,C9482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.03,,,,,,,fee schedule,46.03,55.25, Sotalol hydrochloride IV,C9482,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,55.25,,,,,,,fee schedule,46.03,55.25, Conivaptan HCL,C9488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.96,,,,,,,fee schedule,84.96,101.97, Conivaptan HCL,C9488,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,101.97,,,,,,,fee schedule,84.96,101.97, Perc drug-el cor stent sing,C9600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Perc drug-el cor stent sing,C9600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Perc drug-el cor stent sing,C9600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Perc drug-el cor stent sing,C9600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Perc drug-el cor stent sing,C9600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4081,18617,APC Perc drug-el cor stent sing,C9600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4081,18617,APC Perc drug-el cor stent sing,C9600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4081,18617,APC Perc drug-el cor stent bran,C9601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Perc drug-el cor stent bran,C9601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Perc d-e cor stent ather s,C9602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,22738.78, Perc d-e cor stent ather s,C9602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,22738.78, Perc d-e cor stent ather s,C9602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,22738.78, Perc d-e cor stent ather s,C9602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,22738.78, Perc d-e cor stent ather s,C9602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,22738.78,APC Perc d-e cor stent ather s,C9602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,22738.78,APC Perc d-e cor stent ather s,C9602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,22738.78,APC Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,18617, Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,18617, Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,18617, Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,18617, Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4081,18617,APC Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4081,18617,APC Perc d-e cor revasc t cabg s,C9604,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4081,18617,APC Perc d-e cor revasc w AMI s,C9606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Perc d-e cor revasc w AMI s,C9606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Perc d-e cor revasc w AMI s,C9606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Perc d-e cor revasc w AMI s,C9606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4081,,,,,,,fee schedule,4081,22738.78, Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4934,,,,,,,fee schedule,4081,22738.78, Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4081,22738.78, Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4081,22738.78, Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4081,22738.78,APC Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4081,22738.78,APC Perc d-e cor revasc chro sin,C9607,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4081,22738.78,APC Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,855,18617, Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,855,18617, Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,18617, Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,18617, Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,855,18617, Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,855,18617, Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,855,18617,APC Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,855,18617,APC Place endorectal app,C9725,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,855,18617,APC Rxt breast appl place/remov,C9726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,490, Rxt breast appl place/remov,C9726,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,490, Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,428,18617, Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,428,18617, Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,428,,,,,,,fee schedule,428,18617, Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,490,,,,,,,fee schedule,428,18617, Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,428,18617, Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,428,18617, Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,428,18617,APC Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,428,18617,APC Insert palate implants,C9727,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,428,18617,APC "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1406,18617, "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1406,18617, "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1700.54,,,,,,,fee schedule,1406,18617,APC "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1716.89,,,,,,,fee schedule,1406,18617,APC "Place device/marker, non pro",C9728,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1635.14,,,,,,,fee schedule,1406,18617,APC Non-ophthalmic FVA,C9733,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,925.12,,,,,,,fee schedule,412.14,1163.55, Non-ophthalmic FVA,C9733,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1163.55,,,,,,,fee schedule,412.14,1163.55, Non-ophthalmic FVA,C9733,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,412.14,1163.55,APC Non-ophthalmic FVA,C9733,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,432.75,,,,,,,fee schedule,412.14,1163.55,APC Non-ophthalmic FVA,C9733,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.14,,,,,,,fee schedule,412.14,1163.55,APC "U/s trtmt, not leiomyomata",C9734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,11101,15925.26, "U/s trtmt, not leiomyomata",C9734,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,11101,15925.26, "U/s trtmt, not leiomyomata",C9734,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,11101,15925.26,APC "U/s trtmt, not leiomyomata",C9734,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,11101,15925.26,APC "U/s trtmt, not leiomyomata",C9734,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,11101,15925.26,APC Blue light cysto imag agent,C9738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Blue light cysto imag agent,C9738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4224,13320, Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4224,13320, Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6587.5,,,,,,,fee schedule,4224,13320,APC Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6650.84,,,,,,,fee schedule,4224,13320,APC Cystoscopy prostatic imp 1-3,C9739,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6334.13,,,,,,,fee schedule,4224,13320,APC Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,3291,18617, Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,3291,18617, Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,3291,18617,APC Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,3291,18617,APC Cysto impl 4 or more,C9740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,3291,18617,APC Nasal endo eustachian tube,C9745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,9637,11081, Nasal endo eustachian tube,C9745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,9637,11081, Trans imp balloon cont,C9746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16249,,,,,,,fee schedule,16249,18686, Trans imp balloon cont,C9746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18686,,,,,,,fee schedule,16249,18686, "Ablation, HIFU, prostate",C9747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,14820,17041, "Ablation, HIFU, prostate",C9747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,14820,17041, Repair nasal stenosis w/imp,C9749,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4457,,,,,,,fee schedule,4457,5123, Repair nasal stenosis w/imp,C9749,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5123,,,,,,,fee schedule,4457,5123, "Microwave bronch, 3d, ebus",C9751,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, "Microwave bronch, 3d, ebus",C9751,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, "Microwave bronch, 3d, ebus",C9751,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,4147,18617, "Microwave bronch, 3d, ebus",C9751,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,4147,18617, "Microwave bronch, 3d, ebus",C9751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, "Microwave bronch, 3d, ebus",C9751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Fluorescence lymph map w/ICG,C9756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Fluorescence lymph map w/ICG,C9756,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,17939, Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,17939, Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,17939, Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,17939, Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6296,,,,,,,fee schedule,3291,17939, Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555,,,,,,,fee schedule,3291,17939, Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,17939,APC Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,17939,APC Spine/lumbar disk surgery,C9757,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,17939,APC Non-blind interatrial shunt,C9760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,33388.77, Non-blind interatrial shunt,C9760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,33388.77, Non-blind interatrial shunt,C9760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,33388.77, Non-blind interatrial shunt,C9760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,33388.77, Non-blind interatrial shunt,C9760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33070.78,,,,,,,fee schedule,1406,33388.77,APC Non-blind interatrial shunt,C9760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33388.77,,,,,,,fee schedule,1406,33388.77,APC Non-blind interatrial shunt,C9760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31798.83,,,,,,,fee schedule,1406,33388.77,APC "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,13320, "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,13320, "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,4224,13320, "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,4224,13320, "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,4224,13320, "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,4224,13320, "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11630.48,,,,,,,fee schedule,4224,13320,APC "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11742.31,,,,,,,fee schedule,4224,13320,APC "Cysto, litho, vacuum kidney",C9761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11183.16,,,,,,,fee schedule,4224,13320,APC Cardiac MRI seg dys strain,C9762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,677.78,APC Cardiac MRI seg dys strain,C9762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,677.78,APC Cardiac MRI seg dys strain,C9762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,677.78,APC Cardiac MRI seg dys stress,C9763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.32,,,,,,,fee schedule,645.5,677.78,APC Cardiac MRI seg dys stress,C9763,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.78,,,,,,,fee schedule,645.5,677.78,APC Cardiac MRI seg dys stress,C9763,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.5,,,,,,,fee schedule,645.5,677.78,APC Revasc intravasc lithotripsy,C9764,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,18617, Revasc intravasc lithotripsy,C9764,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,18617, Revasc intravasc lithotripsy,C9764,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,18617, Revasc intravasc lithotripsy,C9764,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,18617, Revasc intravasc lithotripsy,C9764,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,18617,APC Revasc intravasc lithotripsy,C9764,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,18617,APC Revasc intravasc lithotripsy,C9764,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,18617,APC Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11336,,,,,,,fee schedule,4224,22738.78, Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13036,,,,,,,fee schedule,4224,22738.78, Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4224,22738.78, Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4224,22738.78, Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revasc intra lithotrip-stent,C9765,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revasc intra lithotrip-ather,C9766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,22738.78, Revasc intra lithotrip-ather,C9766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,22738.78, Revasc intra lithotrip-ather,C9766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,22738.78, Revasc intra lithotrip-ather,C9766,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,22738.78, Revasc intra lithotrip-ather,C9766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,3291,22738.78,APC Revasc intra lithotrip-ather,C9766,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,3291,22738.78,APC Revasc intra lithotrip-ather,C9766,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,3291,22738.78,APC Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,22738.78, Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,22738.78, Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3291,22738.78, Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3291,22738.78, Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,22738.78, Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,22738.78, Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,3291,22738.78,APC Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,3291,22738.78,APC Revasc lithotrip-stent-ather,C9767,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,3291,22738.78,APC Endo us-guide hep porto grad,C9768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Endo us-guide hep porto grad,C9768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Cysto w/temp pros implant,C9769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, Cysto w/temp pros implant,C9769,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, Cysto w/temp pros implant,C9769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5567,,,,,,,fee schedule,3408,13320, Cysto w/temp pros implant,C9769,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6404,,,,,,,fee schedule,3408,13320, Cysto w/temp pros implant,C9769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, Cysto w/temp pros implant,C9769,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, Revasc lithotrip tibi/perone,C9772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,14319.55, Revasc lithotrip tibi/perone,C9772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,14319.55, Revasc lithotrip tibi/perone,C9772,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4224,14319.55,APC Revasc lithotrip tibi/perone,C9772,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4224,14319.55,APC Revasc lithotrip tibi/perone,C9772,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4224,14319.55,APC Revasc lithotr-stent tib/per,C9773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revasc lithotr-stent tib/per,C9773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revasc lithotr-stent tib/per,C9773,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revasc lithotr-stent tib/per,C9773,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revasc lithotr-stent tib/per,C9773,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revasc lithotr-ather tib/per,C9774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revasc lithotr-ather tib/per,C9774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revasc lithotr-ather tib/per,C9774,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revasc lithotr-ather tib/per,C9774,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revasc lithotr-ather tib/per,C9774,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Revasc lith-sten-ath tib/per,C9775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,22738.78, Revasc lith-sten-ath tib/per,C9775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,22738.78, Revasc lith-sten-ath tib/per,C9775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,4224,22738.78,APC Revasc lith-sten-ath tib/per,C9775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,4224,22738.78,APC Revasc lith-sten-ath tib/per,C9775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,4224,22738.78,APC Esophag mucosal integ add-on,C9777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,13320, Esophag mucosal integ add-on,C9777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,13320, Esophag mucosal integ add-on,C9777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1544,13320, Esophag mucosal integ add-on,C9777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1544,13320, Esophag mucosal integ add-on,C9777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,1544,13320,APC Esophag mucosal integ add-on,C9777,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,1544,13320,APC Esophag mucosal integ add-on,C9777,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,1544,13320,APC "Colpopexy, min/inv, ex-perit",C9778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,6205.1, "Colpopexy, min/inv, ex-perit",C9778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,6205.1, "Colpopexy, min/inv, ex-perit",C9778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6146,,,,,,,fee schedule,3291,6205.1,APC "Colpopexy, min/inv, ex-perit",C9778,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6205.1,,,,,,,fee schedule,3291,6205.1,APC "Colpopexy, min/inv, ex-perit",C9778,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5909.62,,,,,,,fee schedule,3291,6205.1,APC ESD endoscopy or colonoscopy,C9779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13320, ESD endoscopy or colonoscopy,C9779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13320, ESD endoscopy or colonoscopy,C9779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,3408,13320, ESD endoscopy or colonoscopy,C9779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,3408,13320, ESD endoscopy or colonoscopy,C9779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4736.83,,,,,,,fee schedule,3408,13320,APC ESD endoscopy or colonoscopy,C9779,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4782.37,,,,,,,fee schedule,3408,13320,APC ESD endoscopy or colonoscopy,C9779,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4554.64,,,,,,,fee schedule,3408,13320,APC Insert cv cath inf & sup app,C9780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,10017.06, Insert cv cath inf & sup app,C9780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,10017.06, Insert cv cath inf & sup app,C9780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9921.66,,,,,,,fee schedule,3408,10017.06,APC Insert cv cath inf & sup app,C9780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10017.06,,,,,,,fee schedule,3408,10017.06,APC Insert cv cath inf & sup app,C9780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9540.05,,,,,,,fee schedule,3408,10017.06,APC Arthro/shoul surg; w/spacer,C9781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Arthro/shoul surg; w/spacer,C9781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Arthro/shoul surg; w/spacer,C9781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Arthro/shoul surg; w/spacer,C9781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Arthro/shoul surg; w/spacer,C9781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15773.59,,,,,,,fee schedule,3291,18617,APC Arthro/shoul surg; w/spacer,C9781,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15925.26,,,,,,,fee schedule,3291,18617,APC Arthro/shoul surg; w/spacer,C9781,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15166.91,,,,,,,fee schedule,3291,18617,APC Blind myocar trpl bon marrow,C9782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,21247.62, Blind myocar trpl bon marrow,C9782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,21247.62, Blind myocar trpl bon marrow,C9782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,21247.62, Blind myocar trpl bon marrow,C9782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,21247.62, Blind myocar trpl bon marrow,C9782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21045.26,,,,,,,fee schedule,1406,21247.62,APC Blind myocar trpl bon marrow,C9782,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21247.62,,,,,,,fee schedule,1406,21247.62,APC Blind myocar trpl bon marrow,C9782,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20235.83,,,,,,,fee schedule,1406,21247.62,APC Blind cor sinus reducer impl,C9783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Blind cor sinus reducer impl,C9783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Blind cor sinus reducer impl,C9783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Blind cor sinus reducer impl,C9783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Blind cor sinus reducer impl,C9783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14183.17,,,,,,,fee schedule,4147,18617,APC Blind cor sinus reducer impl,C9783,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14319.55,,,,,,,fee schedule,4147,18617,APC Blind cor sinus reducer impl,C9783,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13637.67,,,,,,,fee schedule,4147,18617,APC Endo sleeve gastro w/tube,C9784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Endo sleeve gastro w/tube,C9784,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Endo sleeve gastro w/tube,C9784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Endo sleeve gastro w/tube,C9784,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Endo outlet restrict w/tube,C9785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Endo outlet restrict w/tube,C9785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Endo outlet restrict w/tube,C9785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Endo outlet restrict w/tube,C9785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Endo outlet restrict w/tube,C9785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,18617,APC Endo outlet restrict w/tube,C9785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,18617,APC Endo outlet restrict w/tube,C9785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,18617,APC Instill pharm renal pelvis,C9789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1445.95,13320, Instill pharm renal pelvis,C9789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1445.95,13320, Instill pharm renal pelvis,C9789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,1445.95,13320, Instill pharm renal pelvis,C9789,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,1445.95,13320, Instill pharm renal pelvis,C9789,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1503.79,,,,,,,fee schedule,1445.95,13320,APC Instill pharm renal pelvis,C9789,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1518.25,,,,,,,fee schedule,1445.95,13320,APC Instill pharm renal pelvis,C9789,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1445.95,,,,,,,fee schedule,1445.95,13320,APC Kidney histotripsy w/image,C9790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4224,,,,,,,fee schedule,4224,6253, Kidney histotripsy w/image,C9790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,6253,,,,,,,fee schedule,4224,6253, Blind/nonblind trans atrial,C9792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,4147,,,,,,,fee schedule,4147,18617, Blind/nonblind trans atrial,C9792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5028,,,,,,,fee schedule,4147,18617, Blind/nonblind trans atrial,C9792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,4147,18617, Blind/nonblind trans atrial,C9792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,4147,18617, Blind/nonblind trans atrial,C9792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11725.48,,,,,,,fee schedule,4147,18617,APC Blind/nonblind trans atrial,C9792,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11838.23,,,,,,,fee schedule,4147,18617,APC Blind/nonblind trans atrial,C9792,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11274.5,,,,,,,fee schedule,4147,18617,APC Pre-plan 3d model w/ccta,C9793,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1065.19,APC Pre-plan 3d model w/ccta,C9793,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1065.19,APC Pre-plan 3d model w/ccta,C9793,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1065.19,APC Rpr intst excl anrect fist,C9796,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,18617, Rpr intst excl anrect fist,C9796,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,18617, Rpr intst excl anrect fist,C9796,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,2816,18617, Rpr intst excl anrect fist,C9796,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,2816,18617, Rpr intst excl anrect fist,C9796,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3410.17,,,,,,,fee schedule,2816,18617,APC Rpr intst excl anrect fist,C9796,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3442.96,,,,,,,fee schedule,2816,18617,APC Rpr intst excl anrect fist,C9796,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3279.01,,,,,,,fee schedule,2816,18617,APC Vasc emb/occ w/prs cath,C9797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,22738.78, Vasc emb/occ w/prs cath,C9797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,22738.78, Vasc emb/occ w/prs cath,C9797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,22738.78, Vasc emb/occ w/prs cath,C9797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,22738.78, Vasc emb/occ w/prs cath,C9797,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22522.22,,,,,,,fee schedule,3408,22738.78,APC Vasc emb/occ w/prs cath,C9797,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22738.78,,,,,,,fee schedule,3408,22738.78,APC Vasc emb/occ w/prs cath,C9797,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21655.98,,,,,,,fee schedule,3408,22738.78,APC Endo defect closure GI tract,C9901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,13185.37, Endo defect closure GI tract,C9901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,13185.37, Endo defect closure GI tract,C9901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13059.8,,,,,,,fee schedule,3408,13185.37,APC Endo defect closure GI tract,C9901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13185.37,,,,,,,fee schedule,3408,13185.37,APC Endo defect closure GI tract,C9901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12557.5,,,,,,,fee schedule,3408,13185.37,APC Periodic oral evaluation,D0120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Periodic oral evaluation,D0120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Periodic oral evaluation,D0120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Limit oral eval problm focus,D0140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Limit oral eval problm focus,D0140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Limit oral eval problm focus,D0140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Comprehensve oral evaluation,D0150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Comprehensve oral evaluation,D0150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Comprehensve oral evaluation,D0150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Extensv oral eval prob focus,D0160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Extensv oral eval prob focus,D0160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Extensv oral eval prob focus,D0160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC "Re-eval,est pt,problem focus",D0170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC "Re-eval,est pt,problem focus",D0170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC "Re-eval,est pt,problem focus",D0170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Re-eval post-op visit,D0171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Re-eval post-op visit,D0171,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Re-eval post-op visit,D0171,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Comp periodontal evaluation,D0180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Comp periodontal evaluation,D0180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Comp periodontal evaluation,D0180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Assessment of a patient,D0191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Assessment of a patient,D0191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Assessment of a patient,D0191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Intraor complete film series,D0210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Intraor complete film series,D0210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Intraor complete film series,D0210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Intraoral periapical first,D0220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Intraoral periapical first,D0220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Intraoral periapical first,D0220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Intraoral occlusal film,D0240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Intraoral occlusal film,D0240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Intraoral occlusal film,D0240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Extraoral 2d project image,D0250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Extraoral 2d project image,D0250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Extraoral 2d project image,D0250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Extraoral posterior image,D0251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Extraoral posterior image,D0251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Extraoral posterior image,D0251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Dental bitewing single image,D0270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Dental bitewing single image,D0270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Dental bitewing single image,D0270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Dental bitewings two images,D0272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Dental bitewings two images,D0272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Dental bitewings two images,D0272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Bitewings - three images,D0273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Bitewings - three images,D0273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Bitewings - three images,D0273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Bitewings four images,D0274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Bitewings four images,D0274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Bitewings four images,D0274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Vert bitewings 7 to 8 images,D0277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Vert bitewings 7 to 8 images,D0277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Vert bitewings 7 to 8 images,D0277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Dental saliography,D0310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Dental saliography,D0310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Dental saliography,D0310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Dental tmj arthrogram incl i,D0320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Dental tmj arthrogram incl i,D0320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Dental tmj arthrogram incl i,D0320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC Other tmj images by report,D0321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Other tmj images by report,D0321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Other tmj images by report,D0321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Dental tomographic survey,D0322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Dental tomographic survey,D0322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Dental tomographic survey,D0322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Panoramic image,D0330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,293.15,,,,,,,fee schedule,281.87,295.96,APC Panoramic image,D0330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,295.96,,,,,,,fee schedule,281.87,295.96,APC Panoramic image,D0330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,281.87,,,,,,,fee schedule,281.87,295.96,APC 2d cephalometric image,D0340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC 2d cephalometric image,D0340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC 2d cephalometric image,D0340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Oral/facial photo images,D0350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Oral/facial photo images,D0350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Oral/facial photo images,D0350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Cone beam ct capt & interp,D0364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt & interp,D0364,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt & interp,D0364,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete man,D0365,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete man,D0365,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete man,D0365,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete max,D0366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete max,D0366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete max,D0366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interp both jaw,D0367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interp both jaw,D0367,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interp both jaw,D0367,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete TMJ,D0368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete TMJ,D0368,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct interprete TMJ,D0368,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Max MRI capture & interprete,D0369,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Max MRI capture & interprete,D0369,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Max MRI capture & interprete,D0369,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Max ultrasound capt & interp,D0370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Max ultrasound capt & interp,D0370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Max ultrasound capt & interp,D0370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Sialoendoscopy capt & interp,D0371,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Sialoendoscopy capt & interp,D0371,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Sialoendoscopy capt & interp,D0371,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Cone beam ct capture limited,D0380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capture limited,D0380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capture limited,D0380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt mandible,D0381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt mandible,D0381,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt mandible,D0381,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt maxilla,D0382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt maxilla,D0382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capt maxilla,D0382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct both jaws,D0383,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct both jaws,D0383,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct both jaws,D0383,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capture TMJ,D0384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capture TMJ,D0384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Cone beam ct capture TMJ,D0384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Max MRI image capture,D0385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Max MRI image capture,D0385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Max MRI image capture,D0385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Max ultrasound image capture,D0386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,123.5,129.68,APC Max ultrasound image capture,D0386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,123.5,129.68,APC Max ultrasound image capture,D0386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,123.5,129.68,APC Trtmnt simulation 3d image,D0393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Trtmnt simulation 3d image,D0393,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Trtmnt simulation 3d image,D0393,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Digital sub 2 or more images,D0394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Digital sub 2 or more images,D0394,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Digital sub 2 or more images,D0394,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Fusion 2 or more 3d images,D0395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Fusion 2 or more 3d images,D0395,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Fusion 2 or more 3d images,D0395,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=61.50,D0701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=61.50,D0701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=61.50,D0701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=52.50 and M <61.50,D0702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=52.50 and M <61.50,D0702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=52.50 and M <61.50,D0702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=41.50 and M <52.50,D0703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=41.50 and M <52.50,D0703,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Fracture of lower extremity M >=41.50 and M <52.50,D0703,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Extra oral post radio image,D0705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Extra oral post radio image,D0705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Extra oral post radio image,D0705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Intraoral occlus radio image,D0706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Intraoral occlus radio image,D0706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Intraoral occlus radio image,D0706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Intraoral periap radio image,D0707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Intraoral periap radio image,D0707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Intraoral periap radio image,D0707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Intraoral bite radio image,D0708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Intraoral bite radio image,D0708,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Intraoral bite radio image,D0708,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Intraoral cmplt radio images,D0709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Intraoral cmplt radio images,D0709,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Intraoral cmplt radio images,D0709,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC Dental prophylaxis adult,D1110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Dental prophylaxis adult,D1110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Dental prophylaxis adult,D1110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Apicoectomy - anterior,D3410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Apicoectomy - anterior,D3410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Apicoectomy - anterior,D3410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Apicoectomy - anterior,D3410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Apicoectomy - anterior,D3410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Apicoectomy - anterior,D3410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Apicoectomy - anterior,D3410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Root surgery bicuspid,D3421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Root surgery bicuspid,D3421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Root surgery bicuspid,D3421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Root surgery bicuspid,D3421,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Root surgery bicuspid,D3421,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Root surgery bicuspid,D3421,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Root surgery bicuspid,D3421,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Root surgery molar,D3425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Root surgery molar,D3425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Root surgery molar,D3425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Root surgery molar,D3425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Root surgery molar,D3425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Root surgery molar,D3425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Root surgery molar,D3425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Bone graft peri per tooth,D3428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Bone graft peri per tooth,D3428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Bone graft peri per tooth,D3428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Bone graft peri per tooth,D3428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Bone graft peri per tooth,D3428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Bone graft peri per tooth,D3428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Bone graft peri per tooth,D3428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Guided tissue regeneration,D3432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Guided tissue regeneration,D3432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Guided tissue regeneration,D3432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Guided tissue regeneration,D3432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Guided tissue regeneration,D3432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Guided tissue regeneration,D3432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Guided tissue regeneration,D3432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Root amputation,D3450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Root amputation,D3450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Root amputation,D3450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Root amputation,D3450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Root amputation,D3450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Root amputation,D3450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Root amputation,D3450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Isolation- tooth w rubb dam,D3910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Isolation- tooth w rubb dam,D3910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Isolation- tooth w rubb dam,D3910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Isolation- tooth w rubb dam,D3910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Isolation- tooth w rubb dam,D3910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Isolation- tooth w rubb dam,D3910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Isolation- tooth w rubb dam,D3910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Tooth splitting,D3920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Tooth splitting,D3920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Tooth splitting,D3920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Tooth splitting,D3920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Tooth splitting,D3920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Tooth splitting,D3920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Tooth splitting,D3920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Endodontic procedure,D3999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Endodontic procedure,D3999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Endodontic procedure,D3999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Endodontic procedure,D3999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Endodontic procedure,D3999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Endodontic procedure,D3999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Endodontic procedure,D3999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Gingivectomy/plasty 4 or mor,D4210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 4 or mor,D4210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 4 or mor,D4210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 4 or mor,D4210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 4 or mor,D4210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty 4 or mor,D4210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty 4 or mor,D4210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty 1 to 3,D4211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 1 to 3,D4211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 1 to 3,D4211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 1 to 3,D4211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty 1 to 3,D4211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty 1 to 3,D4211,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty 1 to 3,D4211,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty rest,D4212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty rest,D4212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty rest,D4212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty rest,D4212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gingivectomy/plasty rest,D4212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty rest,D4212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Gingivectomy/plasty rest,D4212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Ana crown exp 4 or> per quad,D4230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ana crown exp 4 or> per quad,D4230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ana crown exp 4 or> per quad,D4230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ana crown exp 4 or> per quad,D4230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ana crown exp 4 or> per quad,D4230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Ana crown exp 4 or> per quad,D4230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Ana crown exp 4 or> per quad,D4230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Ana crown exp 1-3 per quad,D4231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Ana crown exp 1-3 per quad,D4231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Ana crown exp 1-3 per quad,D4231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Ana crown exp 1-3 per quad,D4231,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Ana crown exp 1-3 per quad,D4231,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Ana crown exp 1-3 per quad,D4231,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Ana crown exp 1-3 per quad,D4231,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Gingival flap proc w/ planin,D4240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gingival flap proc w/ planin,D4240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gingival flap proc w/ planin,D4240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gingival flap proc w/ planin,D4240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gingival flap proc w/ planin,D4240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Gingival flap proc w/ planin,D4240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Gingival flap proc w/ planin,D4240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Gngvl flap w rootplan 1-3 th,D4241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Gngvl flap w rootplan 1-3 th,D4241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Gngvl flap w rootplan 1-3 th,D4241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Gngvl flap w rootplan 1-3 th,D4241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Gngvl flap w rootplan 1-3 th,D4241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Gngvl flap w rootplan 1-3 th,D4241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Gngvl flap w rootplan 1-3 th,D4241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Apically positioned flap,D4245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Apically positioned flap,D4245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Apically positioned flap,D4245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Apically positioned flap,D4245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Apically positioned flap,D4245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Apically positioned flap,D4245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Apically positioned flap,D4245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Crown lengthen hard tissue,D4249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Crown lengthen hard tissue,D4249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Crown lengthen hard tissue,D4249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Crown lengthen hard tissue,D4249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Crown lengthen hard tissue,D4249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Crown lengthen hard tissue,D4249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Crown lengthen hard tissue,D4249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Osseous surgery 4 or more,D4260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Osseous surgery 4 or more,D4260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Osseous surgery 4 or more,D4260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Osseous surgery 4 or more,D4260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Osseous surgery 4 or more,D4260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Osseous surgery 4 or more,D4260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Osseous surgery 4 or more,D4260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Osseous surg 1 to 3 teeth,D4261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Osseous surg 1 to 3 teeth,D4261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Osseous surg 1 to 3 teeth,D4261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Osseous surg 1 to 3 teeth,D4261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Osseous surg 1 to 3 teeth,D4261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Osseous surg 1 to 3 teeth,D4261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Osseous surg 1 to 3 teeth,D4261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Bone replce graft first site,D4263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Bone replce graft first site,D4263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Bone replce graft first site,D4263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Bone replce graft first site,D4263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Bone replce graft first site,D4263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Bone replce graft first site,D4263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Bone replce graft first site,D4263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Guided tiss regen resorble,D4266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Guided tiss regen resorble,D4266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Guided tiss regen resorble,D4266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Guided tiss regen resorble,D4266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Guided tiss regen resorble,D4266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Guided tiss regen resorble,D4266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Guided tiss regen resorble,D4266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Guided tiss regen nonresorb,D4267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Guided tiss regen nonresorb,D4267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Guided tiss regen nonresorb,D4267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Guided tiss regen nonresorb,D4267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Guided tiss regen nonresorb,D4267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Guided tiss regen nonresorb,D4267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Guided tiss regen nonresorb,D4267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Surgical revision procedure,D4268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Surgical revision procedure,D4268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Surgical revision procedure,D4268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Surgical revision procedure,D4268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Surgical revision procedure,D4268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Surgical revision procedure,D4268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Surgical revision procedure,D4268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Pedicle soft tissue graft pr,D4270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pedicle soft tissue graft pr,D4270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pedicle soft tissue graft pr,D4270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pedicle soft tissue graft pr,D4270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pedicle soft tissue graft pr,D4270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Pedicle soft tissue graft pr,D4270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Pedicle soft tissue graft pr,D4270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Auto tissue graft 1st tooth,D4273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Auto tissue graft 1st tooth,D4273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Auto tissue graft 1st tooth,D4273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Auto tissue graft 1st tooth,D4273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Auto tissue graft 1st tooth,D4273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Auto tissue graft 1st tooth,D4273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Auto tissue graft 1st tooth,D4273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Mesial/distal wedge proc,D4274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Mesial/distal wedge proc,D4274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Mesial/distal wedge proc,D4274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Mesial/distal wedge proc,D4274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Mesial/distal wedge proc,D4274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Mesial/distal wedge proc,D4274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Mesial/distal wedge proc,D4274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Non-auto graft 1st tooth,D4275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Non-auto graft 1st tooth,D4275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Non-auto graft 1st tooth,D4275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Non-auto graft 1st tooth,D4275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Non-auto graft 1st tooth,D4275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Non-auto graft 1st tooth,D4275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Non-auto graft 1st tooth,D4275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Con tissue w dble ped graft,D4276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Con tissue w dble ped graft,D4276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Con tissue w dble ped graft,D4276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Con tissue w dble ped graft,D4276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Con tissue w dble ped graft,D4276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Con tissue w dble ped graft,D4276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Con tissue w dble ped graft,D4276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Soft tissue graft firsttooth,D4277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Soft tissue graft firsttooth,D4277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Soft tissue graft firsttooth,D4277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Soft tissue graft firsttooth,D4277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Soft tissue graft firsttooth,D4277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Soft tissue graft firsttooth,D4277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Soft tissue graft firsttooth,D4277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Gingival irrigation per quad,D4921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Gingival irrigation per quad,D4921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Gingival irrigation per quad,D4921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Unspecified periodontal proc,D4999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,290.99,,,,,,,fee schedule,279.8,293.79,APC Unspecified periodontal proc,D4999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,293.79,,,,,,,fee schedule,279.8,293.79,APC Unspecified periodontal proc,D4999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,279.8,,,,,,,fee schedule,279.8,293.79,APC Odontics endosteal implant,D6010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Odontics endosteal implant,D6010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Odontics endosteal implant,D6010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Odontics endosteal implant,D6010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Second stage implant surgery,D6011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Second stage implant surgery,D6011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Second stage implant surgery,D6011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Second stage implant surgery,D6011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Endosteal implant,D6012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Endosteal implant,D6012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Endosteal implant,D6012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Endosteal implant,D6012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surgical place mini implant,D6013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surgical place mini implant,D6013,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surgical place mini implant,D6013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surgical place mini implant,D6013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Odontics eposteal implant,D6040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Odontics eposteal implant,D6040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Odontics eposteal implant,D6040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Odontics eposteal implant,D6040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Odontics transosteal implnt,D6050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Odontics transosteal implnt,D6050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Odontics transosteal implnt,D6050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Odontics transosteal implnt,D6050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Interim abutment,D6051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Interim abutment,D6051,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Interim abutment,D6051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Interim abutment,D6051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bone graft repair perimplant,D6103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bone graft repair perimplant,D6103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bone graft repair perimplant,D6103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bone graft repair perimplant,D6103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bone graft time of implant,D6104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bone graft time of implant,D6104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bone graft time of implant,D6104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bone graft time of implant,D6104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Extraction coronal remnants,D7111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Extraction coronal remnants,D7111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Extraction coronal remnants,D7111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Extraction coronal remnants,D7111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Extraction coronal remnants,D7111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Extraction coronal remnants,D7111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Extraction coronal remnants,D7111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Extraction erupted tooth/exr,D7140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Extraction erupted tooth/exr,D7140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Extraction erupted tooth/exr,D7140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Extraction erupted tooth/exr,D7140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Extraction erupted tooth/exr,D7140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Extraction erupted tooth/exr,D7140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Extraction erupted tooth/exr,D7140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Rem imp tooth w mucoper flp,D7210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rem imp tooth w mucoper flp,D7210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rem imp tooth w mucoper flp,D7210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rem imp tooth w mucoper flp,D7210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rem imp tooth w mucoper flp,D7210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Rem imp tooth w mucoper flp,D7210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Rem imp tooth w mucoper flp,D7210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Impact tooth remov soft tiss,D7220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Impact tooth remov soft tiss,D7220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Impact tooth remov soft tiss,D7220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Impact tooth remov soft tiss,D7220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Impact tooth remov soft tiss,D7220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov soft tiss,D7220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov soft tiss,D7220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov part bony,D7230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Impact tooth remov part bony,D7230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Impact tooth remov part bony,D7230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Impact tooth remov part bony,D7230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Impact tooth remov part bony,D7230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov part bony,D7230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov part bony,D7230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov comp bony,D7240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Impact tooth remov comp bony,D7240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Impact tooth remov comp bony,D7240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Impact tooth remov comp bony,D7240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Impact tooth remov comp bony,D7240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov comp bony,D7240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Impact tooth remov comp bony,D7240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Impact tooth rem bony w/comp,D7241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Impact tooth rem bony w/comp,D7241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Impact tooth rem bony w/comp,D7241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Impact tooth rem bony w/comp,D7241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Impact tooth rem bony w/comp,D7241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Impact tooth rem bony w/comp,D7241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Impact tooth rem bony w/comp,D7241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Tooth root removal,D7250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Tooth root removal,D7250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Tooth root removal,D7250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Tooth root removal,D7250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Tooth root removal,D7250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Tooth root removal,D7250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Tooth root removal,D7250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Coronectomy,D7251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Coronectomy,D7251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Coronectomy,D7251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Coronectomy,D7251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Coronectomy,D7251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Coronectomy,D7251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Coronectomy,D7251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Oral antral fistula closure,D7260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Oral antral fistula closure,D7260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Oral antral fistula closure,D7260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Oral antral fistula closure,D7260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Oral antral fistula closure,D7260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Oral antral fistula closure,D7260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Oral antral fistula closure,D7260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Primary closure sinus perf,D7261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Primary closure sinus perf,D7261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Primary closure sinus perf,D7261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Primary closure sinus perf,D7261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Primary closure sinus perf,D7261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Primary closure sinus perf,D7261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Primary closure sinus perf,D7261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Tooth reimplantation,D7270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Tooth reimplantation,D7270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Tooth reimplantation,D7270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Tooth reimplantation,D7270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Tooth reimplantation,D7270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Tooth reimplantation,D7270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Tooth reimplantation,D7270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Tooth transplantation,D7272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Tooth transplantation,D7272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Tooth transplantation,D7272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Tooth transplantation,D7272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Tooth transplantation,D7272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Tooth transplantation,D7272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Tooth transplantation,D7272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Exposure of unerupted tooth,D7280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Exposure of unerupted tooth,D7280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Exposure of unerupted tooth,D7280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Exposure of unerupted tooth,D7280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Exposure of unerupted tooth,D7280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Exposure of unerupted tooth,D7280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Exposure of unerupted tooth,D7280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Mobilize erupted/malpos toot,D7282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Mobilize erupted/malpos toot,D7282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Mobilize erupted/malpos toot,D7282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Mobilize erupted/malpos toot,D7282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Place device impacted tooth,D7283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Place device impacted tooth,D7283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Place device impacted tooth,D7283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Place device impacted tooth,D7283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue hard,D7285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue hard,D7285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue hard,D7285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue hard,D7285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue soft,D7286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue soft,D7286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue soft,D7286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Biopsy of oral tissue soft,D7286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Exfoliative cytolog collect,D7287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Exfoliative cytolog collect,D7287,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Exfoliative cytolog collect,D7287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Exfoliative cytolog collect,D7287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Brush biopsy,D7288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Brush biopsy,D7288,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Brush biopsy,D7288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Brush biopsy,D7288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repositioning of teeth,D7290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repositioning of teeth,D7290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repositioning of teeth,D7290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repositioning of teeth,D7290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transseptal fiberotomy,D7291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Transseptal fiberotomy,D7291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Transseptal fiberotomy,D7291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Transseptal fiberotomy,D7291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Transseptal fiberotomy,D7291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Transseptal fiberotomy,D7291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Transseptal fiberotomy,D7291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Screw retained plate,D7292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Screw retained plate,D7292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Screw retained plate,D7292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Screw retained plate,D7292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Temp anchorage dev w flap,D7293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Temp anchorage dev w flap,D7293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Temp anchorage dev w flap,D7293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Temp anchorage dev w flap,D7293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Temp anchorage dev w/o flap,D7294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Temp anchorage dev w/o flap,D7294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Temp anchorage dev w/o flap,D7294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Temp anchorage dev w/o flap,D7294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Bone harvest,auto graft proc",D7295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Bone harvest,auto graft proc",D7295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Bone harvest,auto graft proc",D7295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Bone harvest,auto graft proc",D7295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Alveoplasty w/ extraction,D7310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Alveoplasty w/ extraction,D7310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Alveoplasty w/ extraction,D7310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Alveoplasty w/ extraction,D7310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Alveoplasty w/ extraction,D7310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Alveoplasty w/ extraction,D7310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Alveoplasty w/ extraction,D7310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Alveoloplasty w/extract 1-3,D7311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Alveoloplasty w/extract 1-3,D7311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Alveoloplasty w/extract 1-3,D7311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Alveoloplasty w/extract 1-3,D7311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Alveoloplasty w/extract 1-3,D7311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Alveoloplasty w/extract 1-3,D7311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Alveoloplasty w/extract 1-3,D7311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Alveoplasty w/o extraction,D7320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Alveoplasty w/o extraction,D7320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Alveoplasty w/o extraction,D7320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Alveoplasty w/o extraction,D7320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Alveoplasty w/o extraction,D7320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Alveoplasty w/o extraction,D7320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Alveoplasty w/o extraction,D7320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Alveoloplasty not w/extracts,D7321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Alveoloplasty not w/extracts,D7321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Alveoloplasty not w/extracts,D7321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Alveoloplasty not w/extracts,D7321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Alveoloplasty not w/extracts,D7321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Alveoloplasty not w/extracts,D7321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Alveoloplasty not w/extracts,D7321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Vestibuloplasty ridge extens,D7340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vestibuloplasty ridge extens,D7340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vestibuloplasty ridge extens,D7340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vestibuloplasty ridge extens,D7340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vestibuloplasty ridge extens,D7340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Vestibuloplasty ridge extens,D7340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Vestibuloplasty ridge extens,D7340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Vestibuloplasty exten graft,D7350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Vestibuloplasty exten graft,D7350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Vestibuloplasty exten graft,D7350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Vestibuloplasty exten graft,D7350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vestibuloplasty exten graft,D7350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Vestibuloplasty exten graft,D7350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Vestibuloplasty exten graft,D7350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Rad exc lesion up to 1.25 cm,D7410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rad exc lesion up to 1.25 cm,D7410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rad exc lesion up to 1.25 cm,D7410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rad exc lesion up to 1.25 cm,D7410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rad exc lesion up to 1.25 cm,D7410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Rad exc lesion up to 1.25 cm,D7410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Rad exc lesion up to 1.25 cm,D7410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Excision benign lesion>1.25c,D7411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision benign lesion>1.25c,D7411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision benign lesion>1.25c,D7411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision benign lesion>1.25c,D7411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision benign lesion>1.25c,D7411,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Excision benign lesion>1.25c,D7411,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Excision benign lesion>1.25c,D7411,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Excision benign lesion compl,D7412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision benign lesion compl,D7412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision benign lesion compl,D7412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision benign lesion compl,D7412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision benign lesion compl,D7412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Excision benign lesion compl,D7412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Excision benign lesion compl,D7412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Excision malig lesion<=1.25c,D7413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision malig lesion<=1.25c,D7413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision malig lesion<=1.25c,D7413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision malig lesion<=1.25c,D7413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision malig lesion<=1.25c,D7413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Excision malig lesion<=1.25c,D7413,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Excision malig lesion<=1.25c,D7413,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Excision malig lesion>1.25cm,D7414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision malig lesion>1.25cm,D7414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision malig lesion>1.25cm,D7414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision malig lesion>1.25cm,D7414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision malig lesion>1.25cm,D7414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Excision malig lesion>1.25cm,D7414,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Excision malig lesion>1.25cm,D7414,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Excision malig les complicat,D7415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision malig les complicat,D7415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision malig les complicat,D7415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision malig les complicat,D7415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision malig les complicat,D7415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1906.27,,,,,,,fee schedule,1406,18617,APC Excision malig les complicat,D7415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1924.6,,,,,,,fee schedule,1406,18617,APC Excision malig les complicat,D7415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1832.96,,,,,,,fee schedule,1406,18617,APC Malig tumor exc to 1.25 cm,D7440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Malig tumor exc to 1.25 cm,D7440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Malig tumor exc to 1.25 cm,D7440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Malig tumor exc to 1.25 cm,D7440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Malig tumor exc to 1.25 cm,D7440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Malig tumor exc to 1.25 cm,D7440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Malig tumor exc to 1.25 cm,D7440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Malig tumor > 1.25 cm,D7441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Malig tumor > 1.25 cm,D7441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Malig tumor > 1.25 cm,D7441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Malig tumor > 1.25 cm,D7441,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Malig tumor > 1.25 cm,D7441,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Malig tumor > 1.25 cm,D7441,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Malig tumor > 1.25 cm,D7441,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Rem odontogen cyst to 1.25cm,D7450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rem odontogen cyst to 1.25cm,D7450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rem odontogen cyst to 1.25cm,D7450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rem odontogen cyst to 1.25cm,D7450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rem odontogen cyst to 1.25cm,D7450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Rem odontogen cyst to 1.25cm,D7450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Rem odontogen cyst to 1.25cm,D7450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Rem odontogen cyst > 1.25 cm,D7451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rem odontogen cyst > 1.25 cm,D7451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rem odontogen cyst > 1.25 cm,D7451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rem odontogen cyst > 1.25 cm,D7451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rem odontogen cyst > 1.25 cm,D7451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Rem odontogen cyst > 1.25 cm,D7451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Rem odontogen cyst > 1.25 cm,D7451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Rem nonodonto cyst to 1.25cm,D7460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst to 1.25cm,D7460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst to 1.25cm,D7460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst to 1.25cm,D7460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst to 1.25cm,D7460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Rem nonodonto cyst to 1.25cm,D7460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Rem nonodonto cyst to 1.25cm,D7460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Rem nonodonto cyst > 1.25 cm,D7461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst > 1.25 cm,D7461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst > 1.25 cm,D7461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst > 1.25 cm,D7461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Rem nonodonto cyst > 1.25 cm,D7461,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Rem nonodonto cyst > 1.25 cm,D7461,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Rem nonodonto cyst > 1.25 cm,D7461,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Lesion destruction,D7465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lesion destruction,D7465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lesion destruction,D7465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lesion destruction,D7465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rem exostosis any site,D7471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Rem exostosis any site,D7471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Rem exostosis any site,D7471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Rem exostosis any site,D7471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Rem exostosis any site,D7471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,1406,18617,APC Rem exostosis any site,D7471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,1406,18617,APC Rem exostosis any site,D7471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,1406,18617,APC Removal of torus palatinus,D7472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Removal of torus palatinus,D7472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Removal of torus palatinus,D7472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Removal of torus palatinus,D7472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Removal of torus palatinus,D7472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Removal of torus palatinus,D7472,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Removal of torus palatinus,D7472,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Remove torus mandibularis,D7473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Remove torus mandibularis,D7473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Remove torus mandibularis,D7473,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Remove torus mandibularis,D7473,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Remove torus mandibularis,D7473,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Remove torus mandibularis,D7473,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Remove torus mandibularis,D7473,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Surg reduct osseoustuberosit,D7485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surg reduct osseoustuberosit,D7485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surg reduct osseoustuberosit,D7485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surg reduct osseoustuberosit,D7485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surg reduct osseoustuberosit,D7485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Surg reduct osseoustuberosit,D7485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Surg reduct osseoustuberosit,D7485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Maxilla or mandible resectio,D7490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Maxilla or mandible resectio,D7490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Maxilla or mandible resectio,D7490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Maxilla or mandible resectio,D7490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, I&d absc intraoral soft tiss,D7510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, I&d absc intraoral soft tiss,D7510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, I&d absc intraoral soft tiss,D7510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, I&d absc intraoral soft tiss,D7510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, I&d absc intraoral soft tiss,D7510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC I&d absc intraoral soft tiss,D7510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC I&d absc intraoral soft tiss,D7510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Incision/drain abscess intra,D7511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, Incision/drain abscess intra,D7511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, Incision/drain abscess intra,D7511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Incision/drain abscess intra,D7511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Incision/drain abscess intra,D7511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Incision/drain abscess intra,D7511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Incision/drain abscess intra,D7511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC I&d abscess extraoral,D7520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, I&d abscess extraoral,D7520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, I&d abscess extraoral,D7520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, I&d abscess extraoral,D7520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, I&d abscess extraoral,D7520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC I&d abscess extraoral,D7520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC I&d abscess extraoral,D7520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Incision/drain abscess extra,D7521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,836.55,18617, Incision/drain abscess extra,D7521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,836.55,18617, Incision/drain abscess extra,D7521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,836.55,18617, Incision/drain abscess extra,D7521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,836.55,18617, Incision/drain abscess extra,D7521,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,870.01,,,,,,,fee schedule,836.55,18617,APC Incision/drain abscess extra,D7521,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,878.38,,,,,,,fee schedule,836.55,18617,APC Incision/drain abscess extra,D7521,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,836.55,,,,,,,fee schedule,836.55,18617,APC Removal fb skin/areolar tiss,D7530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Removal fb skin/areolar tiss,D7530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Removal fb skin/areolar tiss,D7530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Removal fb skin/areolar tiss,D7530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Removal fb skin/areolar tiss,D7530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Removal fb skin/areolar tiss,D7530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Removal fb skin/areolar tiss,D7530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Removal of fb reaction,D7540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Removal of fb reaction,D7540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Removal of fb reaction,D7540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Removal of fb reaction,D7540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Removal of fb reaction,D7540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Removal of fb reaction,D7540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Removal of fb reaction,D7540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Removal of sloughed off bone,D7550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Removal of sloughed off bone,D7550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Removal of sloughed off bone,D7550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Removal of sloughed off bone,D7550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Removal of sloughed off bone,D7550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Removal of sloughed off bone,D7550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Removal of sloughed off bone,D7550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Maxillary sinusotomy,D7560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Maxillary sinusotomy,D7560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Maxillary sinusotomy,D7560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Maxillary sinusotomy,D7560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Maxilla open reduct simple,D7610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Maxilla open reduct simple,D7610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Maxilla open reduct simple,D7610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Maxilla open reduct simple,D7610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open red simpl mandible fx,D7630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open red simpl mandible fx,D7630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open red simpl mandible fx,D7630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open red simpl mandible fx,D7630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open red simp malar/zygom fx,D7650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open red simp malar/zygom fx,D7650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open red simp malar/zygom fx,D7650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open red simp malar/zygom fx,D7650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Closd rductn splint alveolus,D7670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,4112.54,APC Closd rductn splint alveolus,D7670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,4112.54,APC Closd rductn splint alveolus,D7670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,4112.54,APC Alveolus open reduction,D7671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Alveolus open reduction,D7671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Alveolus open reduction,D7671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Alveolus open reduction,D7671,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Alveolus open reduction,D7671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Alveolus open reduction,D7671,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Alveolus open reduction,D7671,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Reduct simple facial bone fx,D7680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reduct simple facial bone fx,D7680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reduct simple facial bone fx,D7680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reduct simple facial bone fx,D7680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Maxilla open reduct compound,D7710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Maxilla open reduct compound,D7710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Maxilla open reduct compound,D7710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Maxilla open reduct compound,D7710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open reduct compd mandble fx,D7730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open reduct compd mandble fx,D7730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open reduct compd mandble fx,D7730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open reduct compd mandble fx,D7730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open red comp malar/zygma fx,D7750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open red comp malar/zygma fx,D7750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open red comp malar/zygma fx,D7750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open red comp malar/zygma fx,D7750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open reduc compd alveolus fx,D7770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Open reduc compd alveolus fx,D7770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Open reduc compd alveolus fx,D7770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Open reduc compd alveolus fx,D7770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Open reduc compd alveolus fx,D7770,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Open reduc compd alveolus fx,D7770,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Open reduc compd alveolus fx,D7770,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Alveolus clsd reduc stblz te,D7771,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,4112.54,APC Alveolus clsd reduc stblz te,D7771,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,4112.54,APC Alveolus clsd reduc stblz te,D7771,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,4112.54,APC Reduct compnd facial bone fx,D7780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reduct compnd facial bone fx,D7780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reduct compnd facial bone fx,D7780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reduct compnd facial bone fx,D7780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj open reduct-dislocation,D7810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj open reduct-dislocation,D7810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj open reduct-dislocation,D7810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj open reduct-dislocation,D7810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj manipulation under anest,D7830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj manipulation under anest,D7830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj manipulation under anest,D7830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj manipulation under anest,D7830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Removal of tmj condyle,D7840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Removal of tmj condyle,D7840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Removal of tmj condyle,D7840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Removal of tmj condyle,D7840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj meniscectomy,D7850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj meniscectomy,D7850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj meniscectomy,D7850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj meniscectomy,D7850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj repair of joint disc,D7852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj repair of joint disc,D7852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj repair of joint disc,D7852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj repair of joint disc,D7852,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj excisn of joint membrane,D7854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj excisn of joint membrane,D7854,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj excisn of joint membrane,D7854,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj excisn of joint membrane,D7854,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj cutting of a muscle,D7856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj cutting of a muscle,D7856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj cutting of a muscle,D7856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj cutting of a muscle,D7856,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj reconstruction,D7858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj reconstruction,D7858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj reconstruction,D7858,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj reconstruction,D7858,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj cutting into joint,D7860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj cutting into joint,D7860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj cutting into joint,D7860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj cutting into joint,D7860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj reshaping components,D7865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj reshaping components,D7865,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj reshaping components,D7865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj reshaping components,D7865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj aspiration joint fluid,D7870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj aspiration joint fluid,D7870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj aspiration joint fluid,D7870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj aspiration joint fluid,D7870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lysis + lavage w catheters,D7871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lysis + lavage w catheters,D7871,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lysis + lavage w catheters,D7871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lysis + lavage w catheters,D7871,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj diagnostic arthroscopy,D7872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj diagnostic arthroscopy,D7872,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj diagnostic arthroscopy,D7872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj diagnostic arthroscopy,D7872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj arthroscopy lysis adhesn,D7873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj arthroscopy lysis adhesn,D7873,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj arthroscopy lysis adhesn,D7873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj arthroscopy lysis adhesn,D7873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj arthroscopy disc reposit,D7874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj arthroscopy disc reposit,D7874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj arthroscopy disc reposit,D7874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj arthroscopy disc reposit,D7874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj arthroscopy disc reposit,D7874,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,1406,18617,APC Tmj arthroscopy disc reposit,D7874,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,1406,18617,APC Tmj arthroscopy disc reposit,D7874,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,1406,18617,APC Tmj arthroscopy synovectomy,D7875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj arthroscopy synovectomy,D7875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj arthroscopy synovectomy,D7875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj arthroscopy synovectomy,D7875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj arthroscopy discectomy,D7876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj arthroscopy discectomy,D7876,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj arthroscopy discectomy,D7876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj arthroscopy discectomy,D7876,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Tmj arthroscopy debridement,D7877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Tmj arthroscopy debridement,D7877,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Tmj arthroscopy debridement,D7877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Tmj arthroscopy debridement,D7877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dent sutur recent wnd to 5cm,D7910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Dent sutur recent wnd to 5cm,D7910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Dent sutur recent wnd to 5cm,D7910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Dent sutur recent wnd to 5cm,D7910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dental suture wound to 5 cm,D7911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Dental suture wound to 5 cm,D7911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Dental suture wound to 5 cm,D7911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Dental suture wound to 5 cm,D7911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Suture complicate wnd > 5 cm,D7912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Suture complicate wnd > 5 cm,D7912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Suture complicate wnd > 5 cm,D7912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Suture complicate wnd > 5 cm,D7912,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dental skin graft,D7920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Dental skin graft,D7920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Dental skin graft,D7920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Dental skin graft,D7920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Collect & appl blood product,D7921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Collect & appl blood product,D7921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Collect & appl blood product,D7921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Collect & appl blood product,D7921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reshaping bone orthognathic,D7940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,763.72,18617, Reshaping bone orthognathic,D7940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,763.72,18617, Reshaping bone orthognathic,D7940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,763.72,18617, Reshaping bone orthognathic,D7940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,763.72,18617, Reshaping bone orthognathic,D7940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,794.27,,,,,,,fee schedule,763.72,18617,APC Reshaping bone orthognathic,D7940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,801.91,,,,,,,fee schedule,763.72,18617,APC Reshaping bone orthognathic,D7940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,763.72,,,,,,,fee schedule,763.72,18617,APC Bone cutting ramus closed,D7941,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bone cutting ramus closed,D7941,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bone cutting ramus closed,D7941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bone cutting ramus closed,D7941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cutting ramus open w/graft,D7943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cutting ramus open w/graft,D7943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cutting ramus open w/graft,D7943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cutting ramus open w/graft,D7943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bone cutting segmented,D7944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bone cutting segmented,D7944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bone cutting segmented,D7944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bone cutting segmented,D7944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bone cutting body mandible,D7945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bone cutting body mandible,D7945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bone cutting body mandible,D7945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bone cutting body mandible,D7945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruction maxilla total,D7946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruction maxilla total,D7946,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruction maxilla total,D7946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruction maxilla total,D7946,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct maxilla segment,D7947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct maxilla segment,D7947,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct maxilla segment,D7947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct maxilla segment,D7947,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct midface no graft,D7948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct midface no graft,D7948,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct midface no graft,D7948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct midface no graft,D7948,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Reconstruct midface w/graft,D7949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Reconstruct midface w/graft,D7949,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Reconstruct midface w/graft,D7949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Reconstruct midface w/graft,D7949,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mandible graft,D7950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Mandible graft,D7950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Mandible graft,D7950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Mandible graft,D7950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Mandible graft,D7950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7273.09,,,,,,,fee schedule,1406,18617,APC Mandible graft,D7950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7343.03,,,,,,,fee schedule,1406,18617,APC Mandible graft,D7950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6993.36,,,,,,,fee schedule,1406,18617,APC Sinus aug w bone or bone sub,D7951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sinus aug w bone or bone sub,D7951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sinus aug w bone or bone sub,D7951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sinus aug w bone or bone sub,D7951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sinus augmentation vertical,D7952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sinus augmentation vertical,D7952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sinus augmentation vertical,D7952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sinus augmentation vertical,D7952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Bone replacement graft,D7953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Bone replacement graft,D7953,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Bone replacement graft,D7953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Bone replacement graft,D7953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Repair maxillofacial defects,D7955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Repair maxillofacial defects,D7955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Repair maxillofacial defects,D7955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Repair maxillofacial defects,D7955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Frenuloplasty,D7963,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Frenuloplasty,D7963,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Frenuloplasty,D7963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Frenuloplasty,D7963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision hyperplastic tissue,D7970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision hyperplastic tissue,D7970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision hyperplastic tissue,D7970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision hyperplastic tissue,D7970,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision pericoronal gingiva,D7971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision pericoronal gingiva,D7971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision pericoronal gingiva,D7971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision pericoronal gingiva,D7971,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Surg redct fibrous tuberosit,D7972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Surg redct fibrous tuberosit,D7972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Surg redct fibrous tuberosit,D7972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Surg redct fibrous tuberosit,D7972,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sialolithotomy,D7980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sialolithotomy,D7980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sialolithotomy,D7980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sialolithotomy,D7980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Excision of salivary gland,D7981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Excision of salivary gland,D7981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Excision of salivary gland,D7981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Excision of salivary gland,D7981,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sialodochoplasty,D7982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sialodochoplasty,D7982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sialodochoplasty,D7982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sialodochoplasty,D7982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Closure of salivary fistula,D7983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Closure of salivary fistula,D7983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Closure of salivary fistula,D7983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Closure of salivary fistula,D7983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Emergency tracheotomy,D7990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Emergency tracheotomy,D7990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Emergency tracheotomy,D7990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Emergency tracheotomy,D7990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dental coronoidectomy,D7991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Dental coronoidectomy,D7991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Dental coronoidectomy,D7991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Dental coronoidectomy,D7991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Synthetic graft facial bones,D7995,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Synthetic graft facial bones,D7995,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Synthetic graft facial bones,D7995,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Synthetic graft facial bones,D7995,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant mandible for augment,D7996,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant mandible for augment,D7996,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant mandible for augment,D7996,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant mandible for augment,D7996,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Appliance removal,D7997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Appliance removal,D7997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Appliance removal,D7997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Appliance removal,D7997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Intraoral place of fix dev,D7998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Intraoral place of fix dev,D7998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Intraoral place of fix dev,D7998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Intraoral place of fix dev,D7998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Oral surgery procedure,D7999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Oral surgery procedure,D7999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Oral surgery procedure,D7999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Oral surgery procedure,D7999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Penile contractur devic manu,E0201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.38,,,,,,,fee schedule,146.52,153.85,APC Penile contractur devic manu,E0201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,153.85,,,,,,,fee schedule,146.52,153.85,APC Penile contractur devic manu,E0201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,146.52,,,,,,,fee schedule,146.52,153.85,APC Transcut tibial nerv stimula,E0736,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.34,,,,,,,fee schedule,51.29,53.85,APC Transcut tibial nerv stimula,E0736,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.85,,,,,,,fee schedule,51.29,53.85,APC Transcut tibial nerv stimula,E0736,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.29,,,,,,,fee schedule,51.29,53.85,APC Upper extremity rehab,E0738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2121.23,,,,,,,fee schedule,2039.64,2141.62,APC Upper extremity rehab,E0738,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2141.62,,,,,,,fee schedule,2039.64,2141.62,APC Upper extremity rehab,E0738,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2039.64,,,,,,,fee schedule,2039.64,2141.62,APC Rehab sys active assist rt,E0739,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1661.57,,,,,,,fee schedule,1597.66,1677.54,APC Rehab sys active assist rt,E0739,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1677.54,,,,,,,fee schedule,1597.66,1677.54,APC Rehab sys active assist rt,E0739,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1597.66,,,,,,,fee schedule,1597.66,1677.54,APC Vr cbt therapy,E1905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,701.76,,,,,,,fee schedule,674.77,708.51,APC Vr cbt therapy,E1905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,708.51,,,,,,,fee schedule,674.77,708.51,APC Vr cbt therapy,E1905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,674.77,,,,,,,fee schedule,674.77,708.51,APC Glucose monitor w cartridge,E2104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,56.7,,,,,,,fee schedule,54.52,57.25,APC Glucose monitor w cartridge,E2104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,57.25,,,,,,,fee schedule,54.52,57.25,APC Glucose monitor w cartridge,E2104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,54.52,,,,,,,fee schedule,54.52,57.25,APC Admin influenza virus vac,G0008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Admin influenza virus vac,G0008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Admin influenza virus vac,G0008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Admin pneumococcal vaccine,G0009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Admin pneumococcal vaccine,G0009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Admin pneumococcal vaccine,G0009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Admin hepatitis b vaccine,G0010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.53,,,,,,,fee schedule,55.32,58.08,APC Admin hepatitis b vaccine,G0010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.08,,,,,,,fee schedule,55.32,58.08,APC Admin hepatitis b vaccine,G0010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.32,,,,,,,fee schedule,55.32,58.08,APC Injection of hiv prep drug,G0012,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,88.46,,,,,,,fee schedule,85.06,89.31,APC Injection of hiv prep drug,G0012,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89.31,,,,,,,fee schedule,85.06,89.31,APC Injection of hiv prep drug,G0012,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,85.06,,,,,,,fee schedule,85.06,89.31,APC Semen analysis,G0027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.54,,,,,,,fee schedule,6.5,33.27, Semen analysis,G0027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.27,,,,,,,fee schedule,6.5,33.27, Semen analysis,G0027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.5,33.27, Semen analysis,G0027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.5,33.27, Semen analysis,G0027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.76,,,,,,,fee schedule,6.5,33.27,APC Semen analysis,G0027,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.82,,,,,,,fee schedule,6.5,33.27,APC Semen analysis,G0027,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.5,,,,,,,fee schedule,6.5,33.27,APC Pt scr tob & cess int,G0030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,256.92,,,,,,,fee schedule,256.92,323.14, Pt scr tob & cess int,G0030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,323.14,,,,,,,fee schedule,256.92,323.14, Pall serv during meas,G0031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,319.4,,,,,,,fee schedule,319.4,401.72, Pall serv during meas,G0031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,401.72,,,,,,,fee schedule,319.4,401.72, 2+ antipsy schiz,G0032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,251.6,,,,,,,fee schedule,251.6,316.44, 2+ antipsy schiz,G0032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,316.44,,,,,,,fee schedule,251.6,316.44, 2+ benzo seiz,G0033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,322.05,,,,,,,fee schedule,322.05,405.05, 2+ benzo seiz,G0033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,405.05,,,,,,,fee schedule,322.05,405.05, Pall serv during meas,G0034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,254.57,,,,,,,fee schedule,254.57,320.18, Pall serv during meas,G0034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,320.18,,,,,,,fee schedule,254.57,320.18, Pt ed pos 23,G0035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,319.72,,,,,,,fee schedule,319.72,402.12, Pt ed pos 23,G0035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,402.12,,,,,,,fee schedule,319.72,402.12, Pt/ptn decln assess,G0036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,253.23,,,,,,,fee schedule,253.23,318.49, Pt/ptn decln assess,G0036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,318.49,,,,,,,fee schedule,253.23,318.49, Pt not able to participate,G0037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,317.04,,,,,,,fee schedule,317.04,398.76, Pt not able to participate,G0037,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,398.76,,,,,,,fee schedule,317.04,398.76, Clin pt no ref,G0038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,249.94,,,,,,,fee schedule,249.94,314.36, Clin pt no ref,G0038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,314.36,,,,,,,fee schedule,249.94,314.36, "Pt no ref, rn spec",G0039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,318.06,,,,,,,fee schedule,318.06,400.04, "Pt no ref, rn spec",G0039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,400.04,,,,,,,fee schedule,318.06,400.04, Pt/ptn decln referral,G0041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,319.72,,,,,,,fee schedule,319.72,402.12, Pt/ptn decln referral,G0041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,402.12,,,,,,,fee schedule,319.72,402.12, Ref to therapy,G0042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,259.89,,,,,,,fee schedule,259.89,326.87, Ref to therapy,G0042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,326.87,,,,,,,fee schedule,259.89,326.87, Pt mech pros ht valv,G0043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,323.39,,,,,,,fee schedule,323.39,406.74, Pt mech pros ht valv,G0043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,406.74,,,,,,,fee schedule,323.39,406.74, Pt mitral stenosis,G0044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,257.24,,,,,,,fee schedule,257.24,323.54, Pt mitral stenosis,G0044,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,323.54,,,,,,,fee schedule,257.24,323.54, mRS 90 days post stk,G0045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,318.38,,,,,,,fee schedule,318.38,400.44, mRS 90 days post stk,G0045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,400.44,,,,,,,fee schedule,318.38,400.44, No mRS 90 days post stk,G0046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,257.24,,,,,,,fee schedule,257.24,323.54, No mRS 90 days post stk,G0046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,323.54,,,,,,,fee schedule,257.24,323.54, Ped blunt hd traum,G0047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,319.72,,,,,,,fee schedule,319.72,402.12, Ped blunt hd traum,G0047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,402.12,,,,,,,fee schedule,319.72,402.12, CA screen;pelvic/breast exam,G0101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.38,,,,,,,fee schedule,120.01,155.18, CA screen;pelvic/breast exam,G0101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,155.18,,,,,,,fee schedule,120.01,155.18, CA screen;pelvic/breast exam,G0101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,124.81,,,,,,,fee schedule,120.01,155.18,APC CA screen;pelvic/breast exam,G0101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.01,,,,,,,fee schedule,120.01,155.18,APC CA screen;pelvic/breast exam,G0101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.01,,,,,,,fee schedule,120.01,155.18,APC Prostate ca screening; dre,G0102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.63,,,,,,,fee schedule,72.63,91.35, Prostate ca screening; dre,G0102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.35,,,,,,,fee schedule,72.63,91.35, PSA Screening,G0103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.53,,,,,,,fee schedule,19.31,94.06, PSA Screening,G0103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,94.06,,,,,,,fee schedule,19.31,94.06, PSA Screening,G0103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.45,,,,,,,fee schedule,19.31,94.06, PSA Screening,G0103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.23,,,,,,,fee schedule,19.31,94.06, PSA Screening,G0103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.08,,,,,,,fee schedule,19.31,94.06,APC PSA Screening,G0103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.28,,,,,,,fee schedule,19.31,94.06,APC PSA Screening,G0103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.31,,,,,,,fee schedule,19.31,94.06,APC CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,18617, CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,18617, CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,18617, CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,18617, CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1098.6,18617, CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1098.6,18617, CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,18617,APC CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,18617,APC CA screen;flexi sigmoidscope,G0104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,18617,APC Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1098.6,4466, Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1098.6,4466, Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,4466, Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,4466, Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1098.6,4466, Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1098.6,4466, Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,4466,APC Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,4466,APC Colorectal scrn; hi risk ind,G0105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,4466,APC Colon CA screen;barium enema,G0106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,681.99,18617, Colon CA screen;barium enema,G0106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,681.99,18617, Colon CA screen;barium enema,G0106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,681.99,,,,,,,fee schedule,681.99,18617, Colon CA screen;barium enema,G0106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,857.76,,,,,,,fee schedule,681.99,18617, Colon CA screen;barium enema,G0106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,681.99,18617, Colon CA screen;barium enema,G0106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,681.99,18617, Diab manage trn per indiv,G0108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.37,,,,,,,fee schedule,61.89,64.98,APC Diab manage trn per indiv,G0108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.98,,,,,,,fee schedule,61.89,64.98,APC Diab manage trn per indiv,G0108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.89,,,,,,,fee schedule,61.89,64.98,APC Diab manage trn ind/group,G0109,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,17.83,18.72,APC Diab manage trn ind/group,G0109,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.72,,,,,,,fee schedule,17.83,18.72,APC Diab manage trn ind/group,G0109,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.83,,,,,,,fee schedule,17.83,18.72,APC Glaucoma scrn hgh risk direc,G0117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.47,,,,,,,fee schedule,34.17,121.92, Glaucoma scrn hgh risk direc,G0117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,121.92,,,,,,,fee schedule,34.17,121.92, Glaucoma scrn hgh risk direc,G0117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,121.92,APC Glaucoma scrn hgh risk direc,G0117,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,121.92,APC Glaucoma scrn hgh risk direc,G0117,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,121.92,APC Glaucoma scrn hgh risk direc,G0118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,127.84,,,,,,,fee schedule,44.12,146.4, Glaucoma scrn hgh risk direc,G0118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,146.4,,,,,,,fee schedule,44.12,146.4, Glaucoma scrn hgh risk direc,G0118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,146.4,APC Glaucoma scrn hgh risk direc,G0118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,146.4,APC Glaucoma scrn hgh risk direc,G0118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,146.4,APC Colon ca scrn; barium enema,G0120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,681.99,18617, Colon ca scrn; barium enema,G0120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,681.99,18617, Colon ca scrn; barium enema,G0120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,681.99,,,,,,,fee schedule,681.99,18617, Colon ca scrn; barium enema,G0120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,857.76,,,,,,,fee schedule,681.99,18617, Colon ca scrn; barium enema,G0120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,681.99,18617, Colon ca scrn; barium enema,G0120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,681.99,18617, Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,1098.6,4466, Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,1098.6,4466, Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,4466, Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,4466, Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,1098.6,4466, Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,1098.6,4466, Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,4466,APC Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,4466,APC Colon ca scrn not hi rsk ind,G0121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,4466,APC Colon ca scrn; barium enema,G0122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,814.74,,,,,,,fee schedule,814.74,1024.73, Colon ca scrn; barium enema,G0122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1024.73,,,,,,,fee schedule,814.74,1024.73, Screen cerv/vag thin layer,G0123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.01,,,,,,,fee schedule,20.26,103.61, Screen cerv/vag thin layer,G0123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.61,,,,,,,fee schedule,20.26,103.61, Screen cerv/vag thin layer,G0123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,64.58,,,,,,,fee schedule,20.26,103.61, Screen cerv/vag thin layer,G0123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.8,,,,,,,fee schedule,20.26,103.61, Screen cerv/vag thin layer,G0123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.07,,,,,,,fee schedule,20.26,103.61,APC Screen cerv/vag thin layer,G0123,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.27,,,,,,,fee schedule,20.26,103.61,APC Screen cerv/vag thin layer,G0123,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.26,,,,,,,fee schedule,20.26,103.61,APC Trim nail(s),G0127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,69.69,984, Trim nail(s),G0127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,69.69,984, Trim nail(s),G0127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,984,APC Trim nail(s),G0127,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,984,APC Trim nail(s),G0127,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,984,APC Single energy x-ray study,G0130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,109.94,,,,,,,fee schedule,109.94,138.27, Single energy x-ray study,G0130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.27,,,,,,,fee schedule,109.94,138.27, Single energy x-ray study,G0130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.44,,,,,,,fee schedule,109.94,138.27,APC Single energy x-ray study,G0130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.68,,,,,,,fee schedule,109.94,138.27,APC Single energy x-ray study,G0130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,109.94,138.27,APC "Scr c/v cyto,thinlayer,rescr",G0143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.01,,,,,,,fee schedule,27.05,103.61, "Scr c/v cyto,thinlayer,rescr",G0143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.61,,,,,,,fee schedule,27.05,103.61, "Scr c/v cyto,thinlayer,rescr",G0143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.44,,,,,,,fee schedule,27.05,103.61, "Scr c/v cyto,thinlayer,rescr",G0143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.79,,,,,,,fee schedule,27.05,103.61, "Scr c/v cyto,thinlayer,rescr",G0143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.13,,,,,,,fee schedule,27.05,103.61,APC "Scr c/v cyto,thinlayer,rescr",G0143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.4,,,,,,,fee schedule,27.05,103.61,APC "Scr c/v cyto,thinlayer,rescr",G0143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.05,,,,,,,fee schedule,27.05,103.61,APC "Scr c/v cyto,thinlayer,rescr",G0144,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.01,,,,,,,fee schedule,43.97,159.51, "Scr c/v cyto,thinlayer,rescr",G0144,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,109.25,,,,,,,fee schedule,43.97,159.51, "Scr c/v cyto,thinlayer,rescr",G0144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,139.57,,,,,,,fee schedule,43.97,159.51, "Scr c/v cyto,thinlayer,rescr",G0144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,159.51,,,,,,,fee schedule,43.97,159.51, "Scr c/v cyto,thinlayer,rescr",G0144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.73,,,,,,,fee schedule,43.97,159.51,APC "Scr c/v cyto,thinlayer,rescr",G0144,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.17,,,,,,,fee schedule,43.97,159.51,APC "Scr c/v cyto,thinlayer,rescr",G0144,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,43.97,,,,,,,fee schedule,43.97,159.51,APC "Scr c/v cyto,thinlayer,rescr",G0145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,120.28,,,,,,,fee schedule,26.49,135.46, "Scr c/v cyto,thinlayer,rescr",G0145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,135.46,,,,,,,fee schedule,26.49,135.46, "Scr c/v cyto,thinlayer,rescr",G0145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.37,,,,,,,fee schedule,26.49,135.46, "Scr c/v cyto,thinlayer,rescr",G0145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.42,,,,,,,fee schedule,26.49,135.46, "Scr c/v cyto,thinlayer,rescr",G0145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.55,,,,,,,fee schedule,26.49,135.46,APC "Scr c/v cyto,thinlayer,rescr",G0145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.81,,,,,,,fee schedule,26.49,135.46,APC "Scr c/v cyto,thinlayer,rescr",G0145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.49,,,,,,,fee schedule,26.49,135.46,APC "Scr c/v cyto, automated sys",G0147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.68,,,,,,,fee schedule,18.54,64.29, "Scr c/v cyto, automated sys",G0147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.19,,,,,,,fee schedule,18.54,64.29, "Scr c/v cyto, automated sys",G0147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,64.29, "Scr c/v cyto, automated sys",G0147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,64.29, "Scr c/v cyto, automated sys",G0147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,64.29,APC "Scr c/v cyto, automated sys",G0147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,64.29,APC "Scr c/v cyto, automated sys",G0147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,64.29,APC "Scr c/v cyto, autosys, rescr",G0148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69,,,,,,,fee schedule,31.94,116.67, "Scr c/v cyto, autosys, rescr",G0148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,77.7,,,,,,,fee schedule,31.94,116.67, "Scr c/v cyto, autosys, rescr",G0148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,102.09,,,,,,,fee schedule,31.94,116.67, "Scr c/v cyto, autosys, rescr",G0148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,116.67,,,,,,,fee schedule,31.94,116.67, "Scr c/v cyto, autosys, rescr",G0148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.22,,,,,,,fee schedule,31.94,116.67,APC "Scr c/v cyto, autosys, rescr",G0148,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.54,,,,,,,fee schedule,31.94,116.67,APC "Scr c/v cyto, autosys, rescr",G0148,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.94,,,,,,,fee schedule,31.94,116.67,APC "Extrnl counterpulse, per tx",G0166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,484.72,,,,,,,fee schedule,157.18,3314, "Extrnl counterpulse, per tx",G0166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,609.65,,,,,,,fee schedule,157.18,3314, "Extrnl counterpulse, per tx",G0166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,157.18,3314, "Extrnl counterpulse, per tx",G0166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,157.18,3314, "Extrnl counterpulse, per tx",G0166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.46,,,,,,,fee schedule,157.18,3314,APC "Extrnl counterpulse, per tx",G0166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.03,,,,,,,fee schedule,157.18,3314,APC "Extrnl counterpulse, per tx",G0166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.18,,,,,,,fee schedule,157.18,3314,APC "Opps service,sched team conf",G0175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,512.65,,,,,,,fee schedule,492.93,517.58,APC "Opps service,sched team conf",G0175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,517.58,,,,,,,fee schedule,492.93,517.58,APC "Opps service,sched team conf",G0175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,492.93,,,,,,,fee schedule,492.93,517.58,APC Software meas of cardiac vol,G0183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.92,,,,,,,fee schedule,102.81,107.95,APC Software meas of cardiac vol,G0183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.95,,,,,,,fee schedule,102.81,107.95,APC Software meas of cardiac vol,G0183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.81,,,,,,,fee schedule,102.81,107.95,APC "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,649.74,3314, "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,649.74,3314, "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,649.74,3314, "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,649.74,3314, "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,649.74,3314, "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,649.74,3314, "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.73,,,,,,,fee schedule,649.74,3314,APC "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.22,,,,,,,fee schedule,649.74,3314,APC "Dstry eye lesn,fdr vssl tech",G0186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.74,,,,,,,fee schedule,649.74,3314,APC PET not otherwise specified,G0235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,491.16,,,,,,,fee schedule,472.27,495.88,APC PET not otherwise specified,G0235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.88,,,,,,,fee schedule,472.27,495.88,APC PET not otherwise specified,G0235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,472.27,,,,,,,fee schedule,472.27,495.88,APC Therapeutic procd strg endur,G0237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,276.95,,,,,,,fee schedule,34.17,308.03, Therapeutic procd strg endur,G0237,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,308.03,,,,,,,fee schedule,34.17,308.03, Therapeutic procd strg endur,G0237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,308.03,APC Therapeutic procd strg endur,G0237,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,308.03,APC Therapeutic procd strg endur,G0237,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,308.03,APC "Oth resp proc, indiv",G0238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,264.47,,,,,,,fee schedule,34.17,294.15, "Oth resp proc, indiv",G0238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,294.15,,,,,,,fee schedule,34.17,294.15, "Oth resp proc, indiv",G0238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,294.15,APC "Oth resp proc, indiv",G0238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,294.15,APC "Oth resp proc, indiv",G0238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,294.15,APC "Oth resp proc, group",G0239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,286.93,,,,,,,fee schedule,44.12,319.13, "Oth resp proc, group",G0239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,319.13,,,,,,,fee schedule,44.12,319.13, "Oth resp proc, group",G0239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,319.13,APC "Oth resp proc, group",G0239,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,319.13,APC "Oth resp proc, group",G0239,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,319.13,APC Initial foot exam pt lops,G0245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Initial foot exam pt lops,G0245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Initial foot exam pt lops,G0245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Followup eval of foot pt lop,G0246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Followup eval of foot pt lop,G0246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Followup eval of foot pt lop,G0246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Routine footcare pt w lops,G0247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,237.02,984, Routine footcare pt w lops,G0247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,237.02,984, Routine footcare pt w lops,G0247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,246.5,,,,,,,fee schedule,237.02,984,APC Routine footcare pt w lops,G0247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.87,,,,,,,fee schedule,237.02,984,APC Routine footcare pt w lops,G0247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.02,,,,,,,fee schedule,237.02,984,APC Demonstrate use home inr mon,G0248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Demonstrate use home inr mon,G0248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Demonstrate use home inr mon,G0248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Provide INR test mater/equip,G0249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Provide INR test mater/equip,G0249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Provide INR test mater/equip,G0249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Unsched dialysis ESRD pt hos,G0257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,843.21,,,,,,,fee schedule,810.77,851.31,APC Unsched dialysis ESRD pt hos,G0257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,851.31,,,,,,,fee schedule,810.77,851.31,APC Unsched dialysis ESRD pt hos,G0257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,810.77,,,,,,,fee schedule,810.77,851.31,APC Inject for sacroiliac joint,G0259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Inject for sacroiliac joint,G0259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,833.89,3314, Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,833.89,3314, Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,833.89,3314, Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,833.89,3314, Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,833.89,3314, Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,833.89,3314, Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,867.24,,,,,,,fee schedule,833.89,3314,APC Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,875.58,,,,,,,fee schedule,833.89,3314,APC Inj for sacroiliac jt anesth,G0260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,833.89,,,,,,,fee schedule,833.89,3314,APC MNT subs tx for change dx,G0270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.04,,,,,,,fee schedule,24.08,25.28,APC MNT subs tx for change dx,G0270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.28,,,,,,,fee schedule,24.08,25.28,APC MNT subs tx for change dx,G0270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.08,,,,,,,fee schedule,24.08,25.28,APC Group MNT 2 or more 30 mins,G0271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.04,,,,,,,fee schedule,13.5,14.18,APC Group MNT 2 or more 30 mins,G0271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.18,,,,,,,fee schedule,13.5,14.18,APC Group MNT 2 or more 30 mins,G0271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.5,,,,,,,fee schedule,13.5,14.18,APC Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8190,,,,,,,fee schedule,1406,18617, Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9420,,,,,,,fee schedule,1406,18617, Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,1406,18617,APC Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,1406,18617,APC Pild/placebo control clin tr,G0276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,1406,18617,APC "Hbot, full body chamber, 30m",G0277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,310.17,,,,,,,fee schedule,162.56,355.2, "Hbot, full body chamber, 30m",G0277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,355.2,,,,,,,fee schedule,162.56,355.2, "Hbot, full body chamber, 30m",G0277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,169.07,,,,,,,fee schedule,162.56,355.2,APC "Hbot, full body chamber, 30m",G0277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,170.69,,,,,,,fee schedule,162.56,355.2,APC "Hbot, full body chamber, 30m",G0277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,162.56,,,,,,,fee schedule,162.56,355.2,APC "Iliac art angio,cardiac cath",G0278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,313.77,,,,,,,fee schedule,313.77,359.32, "Iliac art angio,cardiac cath",G0278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,359.32,,,,,,,fee schedule,313.77,359.32, "Tomosynthesis, mammo",G0279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,132.88,,,,,,,fee schedule,132.88,159.46, "Tomosynthesis, mammo",G0279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,159.46,,,,,,,fee schedule,132.88,159.46, "Tomosynthesis, mammo",G0279,HCPCS,,,,,facility,outpatient,,,TC,,,Aetna,Medicare Managed Care Plan,15.55,,,,,,,fee schedule,14.95,15.7,APC "Tomosynthesis, mammo",G0279,HCPCS,,,,,facility,outpatient,,,TC,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.7,,,,,,,fee schedule,14.95,15.7,APC "Tomosynthesis, mammo",G0279,HCPCS,,,,,facility,outpatient,,,TC,,,Kaiser,Medicare Managed Care Plan,14.95,,,,,,,fee schedule,14.95,15.7,APC Elec stim unattend for press,G0281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.32,,,,,,,fee schedule,13,102.68, Elec stim unattend for press,G0281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.68,,,,,,,fee schedule,13,102.68, Elec stim unattend for press,G0281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.52,,,,,,,fee schedule,13,102.68,APC Elec stim unattend for press,G0281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.65,,,,,,,fee schedule,13,102.68,APC Elec stim unattend for press,G0281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13,,,,,,,fee schedule,13,102.68,APC Elec stim other than wound,G0283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.32,,,,,,,fee schedule,14.18,102.68, Elec stim other than wound,G0283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.68,,,,,,,fee schedule,14.18,102.68, Elec stim other than wound,G0283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.75,,,,,,,fee schedule,14.18,102.68,APC Elec stim other than wound,G0283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.89,,,,,,,fee schedule,14.18,102.68,APC Elec stim other than wound,G0283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.18,,,,,,,fee schedule,14.18,102.68,APC "Non-cov surg proc,clin trial",G0293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,44.12,2460, "Non-cov surg proc,clin trial",G0293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,44.12,2460, "Non-cov surg proc,clin trial",G0293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,2460,APC "Non-cov surg proc,clin trial",G0293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,2460,APC "Non-cov surg proc,clin trial",G0293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,2460,APC "Non-cov proc, clinical trial",G0294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,44.12,984, "Non-cov proc, clinical trial",G0294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,44.12,984, "Non-cov proc, clinical trial",G0294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,984,APC "Non-cov proc, clinical trial",G0294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,984,APC "Non-cov proc, clinical trial",G0294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,984,APC Pre-op service LVRS complete,G0302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,462.87,APC Pre-op service LVRS complete,G0302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,462.87,APC Pre-op service LVRS complete,G0302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,462.87,APC Pre-op service LVRS 10-15dos,G0303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Pre-op service LVRS 10-15dos,G0303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Pre-op service LVRS 10-15dos,G0303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Pre-op service LVRS 1-9 dos,G0304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,462.87,APC Pre-op service LVRS 1-9 dos,G0304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,462.87,APC Pre-op service LVRS 1-9 dos,G0304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,462.87,APC Post op service LVRS min 6,G0305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,462.87,APC Post op service LVRS min 6,G0305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,462.87,APC Post op service LVRS min 6,G0305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,462.87,APC CBC/diffwbc w/o platelet,G0306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.3,,,,,,,fee schedule,7.77,39.75, CBC/diffwbc w/o platelet,G0306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.75,,,,,,,fee schedule,7.77,39.75, CBC/diffwbc w/o platelet,G0306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.99,,,,,,,fee schedule,7.77,39.75, CBC/diffwbc w/o platelet,G0306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.56,,,,,,,fee schedule,7.77,39.75, CBC/diffwbc w/o platelet,G0306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.08,,,,,,,fee schedule,7.77,39.75,APC CBC/diffwbc w/o platelet,G0306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.16,,,,,,,fee schedule,7.77,39.75,APC CBC/diffwbc w/o platelet,G0306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.77,,,,,,,fee schedule,7.77,39.75,APC CBC without platelet,G0307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.38,,,,,,,fee schedule,6.47,33.09, CBC without platelet,G0307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.09,,,,,,,fee schedule,6.47,33.09, CBC without platelet,G0307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.84,,,,,,,fee schedule,6.47,33.09, CBC without platelet,G0307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.82,,,,,,,fee schedule,6.47,33.09, CBC without platelet,G0307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.47,33.09,APC CBC without platelet,G0307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.79,,,,,,,fee schedule,6.47,33.09,APC CBC without platelet,G0307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.47,,,,,,,fee schedule,6.47,33.09,APC Fecal blood scrn immunoassay,G0328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,72.22,,,,,,,fee schedule,18.05,81.33, Fecal blood scrn immunoassay,G0328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.33,,,,,,,fee schedule,18.05,81.33, Fecal blood scrn immunoassay,G0328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.28,,,,,,,fee schedule,18.05,81.33, Fecal blood scrn immunoassay,G0328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.46,,,,,,,fee schedule,18.05,81.33, Fecal blood scrn immunoassay,G0328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.77,,,,,,,fee schedule,18.05,81.33,APC Fecal blood scrn immunoassay,G0328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.95,,,,,,,fee schedule,18.05,81.33,APC Fecal blood scrn immunoassay,G0328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.05,,,,,,,fee schedule,18.05,81.33,APC Electromagntic tx for ulcers,G0329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.86,,,,,,,fee schedule,12.32,33.78, Electromagntic tx for ulcers,G0329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.78,,,,,,,fee schedule,12.32,33.78, Electromagntic tx for ulcers,G0329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.81,,,,,,,fee schedule,12.32,33.78,APC Electromagntic tx for ulcers,G0329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.94,,,,,,,fee schedule,12.32,33.78,APC Electromagntic tx for ulcers,G0329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.32,,,,,,,fee schedule,12.32,33.78,APC Facility svs dental rehab,G0330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4073.37,,,,,,,fee schedule,3916.7,4112.54,APC Facility svs dental rehab,G0330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4112.54,,,,,,,fee schedule,3916.7,4112.54,APC Facility svs dental rehab,G0330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3916.7,,,,,,,fee schedule,3916.7,4112.54,APC "Robot lin-radsurg com, first",G0339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8185.59,,,,,,,fee schedule,8185.59,9373.82, "Robot lin-radsurg com, first",G0339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9373.82,,,,,,,fee schedule,8185.59,9373.82, Robt lin-radsurg fractx 2-5,G0340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5839.88,,,,,,,fee schedule,5839.88,6687.6, Robt lin-radsurg fractx 2-5,G0340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6687.6,,,,,,,fee schedule,5839.88,6687.6, Percutaneous islet celltrans,G0341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Percutaneous islet celltrans,G0341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Percutaneous islet celltrans,G0341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Percutaneous islet celltrans,G0341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparoscopy islet cell trans,G0342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laparoscopy islet cell trans,G0342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laparoscopy islet cell trans,G0342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laparoscopy islet cell trans,G0342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laparotomy islet cell transp,G0343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laparotomy islet cell transp,G0343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laparotomy islet cell transp,G0343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laparotomy islet cell transp,G0343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Vessel mapping hemo access,G0365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,984, Vessel mapping hemo access,G0365,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,984, Direct refer hospital observ,G0379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,731.67,,,,,,,fee schedule,703.53,738.7,APC Direct refer hospital observ,G0379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,738.7,,,,,,,fee schedule,703.53,738.7,APC Direct refer hospital observ,G0379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,703.53,,,,,,,fee schedule,703.53,738.7,APC Home sleep test/type 2 porta,G0398,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 2 porta,G0398,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 2 porta,G0398,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 3 porta,G0399,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 3 porta,G0399,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 3 porta,G0399,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 4 porta,G0400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,265.28,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 4 porta,G0400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.83,,,,,,,fee schedule,255.08,267.83,APC Home sleep test/type 4 porta,G0400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,255.08,,,,,,,fee schedule,255.08,267.83,APC Initial preventive exam,G0402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Initial preventive exam,G0402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Initial preventive exam,G0402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC EKG tracing for initial prev,G0404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC EKG tracing for initial prev,G0404,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC EKG tracing for initial prev,G0404,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,3291,18617, Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,3291,18617, Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9637,,,,,,,fee schedule,3291,18617, Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11081,,,,,,,fee schedule,3291,18617, Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3291,18617, Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3291,18617, Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3291,18617,APC Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3291,18617,APC Open tx iliac spine uni/bil,G0412,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3291,18617,APC Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3291,,,,,,,fee schedule,855,13320, Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,3972,,,,,,,fee schedule,855,13320, Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,855,,,,,,,fee schedule,855,13320, Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,984,,,,,,,fee schedule,855,13320, Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11101,,,,,,,fee schedule,855,13320, Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13320,,,,,,,fee schedule,855,13320, Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,855,13320,APC Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,855,13320,APC Pelvic ring fracture uni/bil,G0413,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,855,13320,APC Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14820,,,,,,,fee schedule,3560,18617, Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17041,,,,,,,fee schedule,3560,18617, Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8914.97,,,,,,,fee schedule,3560,18617,APC Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9000.7,,,,,,,fee schedule,3560,18617,APC Pelvic ring fx treat int fix,G0414,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8572.09,,,,,,,fee schedule,3560,18617,APC Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3560,,,,,,,fee schedule,3560,18617, Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4311,,,,,,,fee schedule,3560,18617, Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15598,,,,,,,fee schedule,3560,18617, Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17939,,,,,,,fee schedule,3560,18617, Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3560,18617, Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3560,18617, Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4019.98,,,,,,,fee schedule,3560,18617,APC Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4058.63,,,,,,,fee schedule,3560,18617,APC Open tx post pelvic fxcture,G0415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3865.36,,,,,,,fee schedule,3560,18617,APC "Prostate biopsy, any mthd",G0416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,373.51,,,,,,,fee schedule,373.51,684.33, "Prostate biopsy, any mthd",G0416,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,427.73,,,,,,,fee schedule,373.51,684.33, "Prostate biopsy, any mthd",G0416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,598.79,,,,,,,fee schedule,373.51,684.33, "Prostate biopsy, any mthd",G0416,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,684.33,,,,,,,fee schedule,373.51,684.33, "Prostate biopsy, any mthd",G0416,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.39,,,,,,,fee schedule,373.51,684.33,APC "Prostate biopsy, any mthd",G0416,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,444.62,,,,,,,fee schedule,373.51,684.33,APC "Prostate biopsy, any mthd",G0416,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,423.45,,,,,,,fee schedule,373.51,684.33,APC Collagen Meniscus Implant,G0428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Collagen Meniscus Implant,G0428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Collagen Meniscus Implant,G0428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Collagen Meniscus Implant,G0428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3563,,,,,,,fee schedule,1406,18617, Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4097,,,,,,,fee schedule,1406,18617, Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,1406,18617,APC Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,1406,18617,APC Dermal filler injection(s),G0429,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,1406,18617,APC EIA HIV-1/HIV-2 screen,G0432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.15,,,,,,,fee schedule,19.57,71.43, EIA HIV-1/HIV-2 screen,G0432,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.11,,,,,,,fee schedule,19.57,71.43, EIA HIV-1/HIV-2 screen,G0432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.5,,,,,,,fee schedule,19.57,71.43, EIA HIV-1/HIV-2 screen,G0432,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,71.43,,,,,,,fee schedule,19.57,71.43, EIA HIV-1/HIV-2 screen,G0432,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.35,,,,,,,fee schedule,19.57,71.43,APC EIA HIV-1/HIV-2 screen,G0432,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.55,,,,,,,fee schedule,19.57,71.43,APC EIA HIV-1/HIV-2 screen,G0432,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,19.57,71.43,APC ELISA HIV-1/HIV-2 screen,G0433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.15,,,,,,,fee schedule,18.29,71.11, ELISA HIV-1/HIV-2 screen,G0433,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,71.11,,,,,,,fee schedule,18.29,71.11, ELISA HIV-1/HIV-2 screen,G0433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.33,,,,,,,fee schedule,18.29,71.11, ELISA HIV-1/HIV-2 screen,G0433,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.66,,,,,,,fee schedule,18.29,71.11, ELISA HIV-1/HIV-2 screen,G0433,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.02,,,,,,,fee schedule,18.29,71.11,APC ELISA HIV-1/HIV-2 screen,G0433,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.2,,,,,,,fee schedule,18.29,71.11,APC ELISA HIV-1/HIV-2 screen,G0433,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.29,,,,,,,fee schedule,18.29,71.11,APC Oral hiv-1/hiv-2 screen,G0435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.67,,,,,,,fee schedule,11.98,57.06, Oral hiv-1/hiv-2 screen,G0435,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.06,,,,,,,fee schedule,11.98,57.06, Oral hiv-1/hiv-2 screen,G0435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.54,,,,,,,fee schedule,11.98,57.06, Oral hiv-1/hiv-2 screen,G0435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.04,,,,,,,fee schedule,11.98,57.06, Oral hiv-1/hiv-2 screen,G0435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.46,,,,,,,fee schedule,11.98,57.06,APC Oral hiv-1/hiv-2 screen,G0435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.58,,,,,,,fee schedule,11.98,57.06,APC Oral hiv-1/hiv-2 screen,G0435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.98,,,,,,,fee schedule,11.98,57.06,APC Place perm pacing cardiovert,G0448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, Place perm pacing cardiovert,G0448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, Place perm pacing cardiovert,G0448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, Place perm pacing cardiovert,G0448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Molecular pathology interpr,G0452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.4,,,,,,,fee schedule,10.4,11.88, Molecular pathology interpr,G0452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.88,,,,,,,fee schedule,10.4,11.88, Fecal microbiota prep instil,G0455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1098.6,2460, Fecal microbiota prep instil,G0455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1098.6,2460, Fecal microbiota prep instil,G0455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,1098.6,2460, Fecal microbiota prep instil,G0455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,1098.6,2460, Fecal microbiota prep instil,G0455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.54,,,,,,,fee schedule,1098.6,2460,APC Fecal microbiota prep instil,G0455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.53,,,,,,,fee schedule,1098.6,2460,APC Fecal microbiota prep instil,G0455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.6,,,,,,,fee schedule,1098.6,2460,APC Autologous PRP for ulcers,G0460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2138,,,,,,,fee schedule,2138,2559.32, Autologous PRP for ulcers,G0460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2460,,,,,,,fee schedule,2138,2559.32, Autologous PRP for ulcers,G0460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2138,2559.32,APC Autologous PRP for ulcers,G0460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2138,2559.32,APC Autologous PRP for ulcers,G0460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2138,2559.32,APC Hospital outpt clinic visit,G0463,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Hospital outpt clinic visit,G0463,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Hospital outpt clinic visit,G0463,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Autolog prp diab wound ulcer,G0465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.94,,,,,,,fee schedule,2437.45,2559.32,APC Autolog prp diab wound ulcer,G0465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2559.32,,,,,,,fee schedule,2437.45,2559.32,APC Autolog prp diab wound ulcer,G0465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2437.45,,,,,,,fee schedule,2437.45,2559.32,APC Ven blood coll snf/hha,G0471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.36,,,,,,,fee schedule,11.34,39.27, Ven blood coll snf/hha,G0471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.27,,,,,,,fee schedule,11.34,39.27, Ven blood coll snf/hha,G0471,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.79,,,,,,,fee schedule,11.34,39.27,APC Ven blood coll snf/hha,G0471,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.91,,,,,,,fee schedule,11.34,39.27,APC Ven blood coll snf/hha,G0471,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.34,,,,,,,fee schedule,11.34,39.27,APC Hep c screen high risk/other,G0472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,85.38,,,,,,,fee schedule,46.35,169.02, Hep c screen high risk/other,G0472,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.15,,,,,,,fee schedule,46.35,169.02, Hep c screen high risk/other,G0472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,147.89,,,,,,,fee schedule,46.35,169.02, Hep c screen high risk/other,G0472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,169.02,,,,,,,fee schedule,46.35,169.02, Hep c screen high risk/other,G0472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.2,,,,,,,fee schedule,46.35,169.02,APC Hep c screen high risk/other,G0472,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48.67,,,,,,,fee schedule,46.35,169.02,APC Hep c screen high risk/other,G0472,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.35,,,,,,,fee schedule,46.35,169.02,APC Hiv combination assay,G0475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.07,,,,,,,fee schedule,24.08,88.08, Hiv combination assay,G0475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.08,,,,,,,fee schedule,24.08,88.08, Hiv combination assay,G0475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.04,,,,,,,fee schedule,24.08,88.08,APC Hiv combination assay,G0475,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.28,,,,,,,fee schedule,24.08,88.08,APC Hiv combination assay,G0475,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.08,,,,,,,fee schedule,24.08,88.08,APC Hpv combo assay ca screen,G0476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.46,,,,,,,fee schedule,35.09,127.38, Hpv combo assay ca screen,G0476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.38,,,,,,,fee schedule,35.09,127.38, Hpv combo assay ca screen,G0476,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,127.38,APC Hpv combo assay ca screen,G0476,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,127.38,APC Hpv combo assay ca screen,G0476,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,127.38,APC Drug test def 1-7 classes,G0480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,351.1,,,,,,,fee schedule,114.43,415.44, Drug test def 1-7 classes,G0480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,395.39,,,,,,,fee schedule,114.43,415.44, Drug test def 1-7 classes,G0480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,363.51,,,,,,,fee schedule,114.43,415.44, Drug test def 1-7 classes,G0480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,415.44,,,,,,,fee schedule,114.43,415.44, Drug test def 1-7 classes,G0480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.01,,,,,,,fee schedule,114.43,415.44,APC Drug test def 1-7 classes,G0480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.15,,,,,,,fee schedule,114.43,415.44,APC Drug test def 1-7 classes,G0480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.43,,,,,,,fee schedule,114.43,415.44,APC Drug test def 8-14 classes,G0481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,540.15,,,,,,,fee schedule,156.59,608.29, Drug test def 8-14 classes,G0481,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,608.29,,,,,,,fee schedule,156.59,608.29, Drug test def 8-14 classes,G0481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,162.85,,,,,,,fee schedule,156.59,608.29,APC Drug test def 8-14 classes,G0481,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,164.42,,,,,,,fee schedule,156.59,608.29,APC Drug test def 8-14 classes,G0481,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.59,,,,,,,fee schedule,156.59,608.29,APC Drug test def 15-21 classes,G0482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,729.2,,,,,,,fee schedule,198.74,821.19, Drug test def 15-21 classes,G0482,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,821.19,,,,,,,fee schedule,198.74,821.19, Drug test def 15-21 classes,G0482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,206.69,,,,,,,fee schedule,198.74,821.19,APC Drug test def 15-21 classes,G0482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,208.68,,,,,,,fee schedule,198.74,821.19,APC Drug test def 15-21 classes,G0482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,198.74,,,,,,,fee schedule,198.74,821.19,APC Drug test def 22+ classes,G0483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,945.26,,,,,,,fee schedule,246.92,1064.51, Drug test def 22+ classes,G0483,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1064.51,,,,,,,fee schedule,246.92,1064.51, Drug test def 22+ classes,G0483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.8,,,,,,,fee schedule,246.92,1064.51,APC Drug test def 22+ classes,G0483,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.27,,,,,,,fee schedule,246.92,1064.51,APC Drug test def 22+ classes,G0483,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,246.92,,,,,,,fee schedule,246.92,1064.51,APC Chemo extend iv infus w/pump,G0498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.81,,,,,,,fee schedule,390.2,409.72,APC Chemo extend iv infus w/pump,G0498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.72,,,,,,,fee schedule,390.2,409.72,APC Chemo extend iv infus w/pump,G0498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.2,,,,,,,fee schedule,390.2,409.72,APC Hepb screen high risk indiv,G0499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,89.57,,,,,,,fee schedule,28.27,102.36, Hepb screen high risk indiv,G0499,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,102.36,,,,,,,fee schedule,28.27,102.36, Hepb screen high risk indiv,G0499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.4,,,,,,,fee schedule,28.27,102.36,APC Hepb screen high risk indiv,G0499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.68,,,,,,,fee schedule,28.27,102.36,APC Hepb screen high risk indiv,G0499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.27,,,,,,,fee schedule,28.27,102.36,APC "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,3314, "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,3314, "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,818.42,,,,,,,fee schedule,527.74,3314, "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,937.23,,,,,,,fee schedule,527.74,3314, "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,527.74,3314, "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,527.74,3314, "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,3314,APC "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,3314,APC "Insert drug del implant, >4",G0516,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,3314,APC Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,3314, Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,3314, Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,818.42,,,,,,,fee schedule,527.74,3314, Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,937.23,,,,,,,fee schedule,527.74,3314, Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,527.74,3314, Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,527.74,3314, Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,3314,APC Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,3314,APC Remove drug implant,G0517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,3314,APC Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,527.74,3314, Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,527.74,3314, Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,818.42,,,,,,,fee schedule,527.74,3314, Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,937.23,,,,,,,fee schedule,527.74,3314, Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2762,,,,,,,fee schedule,527.74,3314, Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3314,,,,,,,fee schedule,527.74,3314, Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.84,,,,,,,fee schedule,527.74,3314,APC Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,554.12,,,,,,,fee schedule,527.74,3314,APC Remove w insert drug implant,G0518,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.74,,,,,,,fee schedule,527.74,3314,APC No pt prsnt train initial 30,G0541,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC No pt prsnt train initial 30,G0541,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC No pt prsnt train initial 30,G0541,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Group train w/o patient,G0543,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Group train w/o patient,G0543,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Group train w/o patient,G0543,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Supply of digital device,G0552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Supply of digital device,G0552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Supply of digital device,G0552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Monthly tx for dmht 20mins,G0553,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,163.57,,,,,,,fee schedule,157.28,165.14,APC Monthly tx for dmht 20mins,G0553,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,165.14,,,,,,,fee schedule,157.28,165.14,APC Monthly tx for dmht 20mins,G0553,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,157.28,,,,,,,fee schedule,157.28,165.14,APC Replacment pt electronic sys,G0555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1055.05,,,,,,,fee schedule,1014.47,1065.19,APC Replacment pt electronic sys,G0555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1065.19,,,,,,,fee schedule,1014.47,1065.19,APC Replacment pt electronic sys,G0555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1014.47,,,,,,,fee schedule,1014.47,1065.19,APC "Temp tube delivery, unil",G0561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, "Temp tube delivery, unil",G0561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, 365 d implant glucose sensor,G0564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, 365 d implant glucose sensor,G0564,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, Rem/ins glu snsr 365 dif sit,G0565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,2816,,,,,,,fee schedule,2816,4166, Rem/ins glu snsr 365 dif sit,G0565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,4166,,,,,,,fee schedule,2816,4166, 3d bn img algor drvd fr mri,G0566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.09,,,,,,,fee schedule,152.01,159.61,APC 3d bn img algor drvd fr mri,G0566,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,159.61,,,,,,,fee schedule,152.01,159.61,APC 3d bn img algor drvd fr mri,G0566,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.01,,,,,,,fee schedule,152.01,159.61,APC Screening Hep C detect,G0567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Screening Hep C detect,G0567,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Screening Hep C detect,G0567,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Intraop nerve cryoablation,G0571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,1866, Intraop nerve cryoablation,G0571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,1866, Drug test def simple all cl,G0659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,233.45,,,,,,,fee schedule,62.14,262.9, Drug test def simple all cl,G0659,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,262.9,,,,,,,fee schedule,62.14,262.9, Drug test def simple all cl,G0659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,197.9,,,,,,,fee schedule,62.14,262.9, Drug test def simple all cl,G0659,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,226.17,,,,,,,fee schedule,62.14,262.9, Drug test def simple all cl,G0659,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.63,,,,,,,fee schedule,62.14,262.9,APC Drug test def simple all cl,G0659,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.25,,,,,,,fee schedule,62.14,262.9,APC Drug test def simple all cl,G0659,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.14,,,,,,,fee schedule,62.14,262.9,APC Blinded conv. Tx MDD clin tr,G2000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.46,,,,,,,fee schedule,440.83,462.87,APC Blinded conv. Tx MDD clin tr,G2000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.87,,,,,,,fee schedule,440.83,462.87,APC Blinded conv. Tx MDD clin tr,G2000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.83,,,,,,,fee schedule,440.83,462.87,APC Alcohol/sub abuse assess,G2011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Alcohol/sub abuse assess,G2011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Alcohol/sub abuse assess,G2011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Specimen collect COVID-19,G2023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.25,,,,,,,fee schedule,76.25,85.86, Specimen collect COVID-19,G2023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.86,,,,,,,fee schedule,76.25,85.86, Spec coll SNF/Lab COVID-19,G2024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.75,,,,,,,fee schedule,82.75,93.18, Spec coll SNF/Lab COVID-19,G2024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,93.18,,,,,,,fee schedule,82.75,93.18, Warfarin respon genetic test,G9143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,555.68,,,,,,,fee schedule,384.33,625.79, Warfarin respon genetic test,G9143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,625.79,,,,,,,fee schedule,384.33,625.79, Warfarin respon genetic test,G9143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,384.33,,,,,,,fee schedule,384.33,625.79, Warfarin respon genetic test,G9143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,439.23,,,,,,,fee schedule,384.33,625.79, "Inj., omadacycline, 1 mg",J0121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.24,,,,,,,fee schedule,4.13,9.2, "Inj., omadacycline, 1 mg",J0121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.24,,,,,,,fee schedule,4.13,9.2, "Inj., omadacycline, 1 mg",J0121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.66,,,,,,,fee schedule,4.13,9.2, "Inj., omadacycline, 1 mg",J0121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.2,,,,,,,fee schedule,4.13,9.2, "Inj., omadacycline, 1 mg",J0121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.3,,,,,,,fee schedule,4.13,9.2,APC "Inj., omadacycline, 1 mg",J0121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.34,,,,,,,fee schedule,4.13,9.2,APC "Inj., omadacycline, 1 mg",J0121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.13,,,,,,,fee schedule,4.13,9.2,APC "Inj., eravacycline, 1 mg",J0122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.01,,,,,,,fee schedule,1.29,2.98, "Inj., eravacycline, 1 mg",J0122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.01,,,,,,,fee schedule,1.29,2.98, "Inj., eravacycline, 1 mg",J0122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.49,,,,,,,fee schedule,1.29,2.98, "Inj., eravacycline, 1 mg",J0122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.98,,,,,,,fee schedule,1.29,2.98, "Inj., eravacycline, 1 mg",J0122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.34,,,,,,,fee schedule,1.29,2.98,APC "Inj., eravacycline, 1 mg",J0122,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.35,,,,,,,fee schedule,1.29,2.98,APC "Inj., eravacycline, 1 mg",J0122,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.29,,,,,,,fee schedule,1.29,2.98,APC Abatacept injection,J0129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.27,,,,,,,fee schedule,44.72,98.94, Abatacept injection,J0129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.27,,,,,,,fee schedule,44.72,98.94, Abatacept injection,J0129,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,82.44,,,,,,,fee schedule,44.72,98.94, Abatacept injection,J0129,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98.94,,,,,,,fee schedule,44.72,98.94, Abatacept injection,J0129,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.51,,,,,,,fee schedule,44.72,98.94,APC Abatacept injection,J0129,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.95,,,,,,,fee schedule,44.72,98.94,APC Abatacept injection,J0129,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.72,,,,,,,fee schedule,44.72,98.94,APC Abciximab injection,J0130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2670.93,,,,,,,fee schedule,2670.93,3205.4, Abciximab injection,J0130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3205.4,,,,,,,fee schedule,2670.93,3205.4, Acetaminophen injection,J0131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.13, Acetaminophen injection,J0131,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.13, Acetaminophen injection,J0131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.08,0.13, Acetaminophen injection,J0131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.08,0.13, Acetylcysteine injection,J0132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.58,,,,,,,fee schedule,0.58,0.85, Acetylcysteine injection,J0132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.58,,,,,,,fee schedule,0.58,0.85, Acetylcysteine injection,J0132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.71,,,,,,,fee schedule,0.58,0.85, Acetylcysteine injection,J0132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.85,,,,,,,fee schedule,0.58,0.85, Acyclovir injection,J0133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.05,,,,,,,fee schedule,0.05,0.09, Acyclovir injection,J0133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.05,,,,,,,fee schedule,0.05,0.09, Acyclovir injection,J0133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.05,0.09, Acyclovir injection,J0133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.05,0.09, Inj acetaminophen -fresenius,J0134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.13, Inj acetaminophen -fresenius,J0134,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.13, Inj acetaminophen -fresenius,J0134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.08,0.13, Inj acetaminophen -fresenius,J0134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.08,0.13, "Inj, acetaminophen (b braun)",J0136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.11, "Inj, acetaminophen (b braun)",J0136,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.11, "Inj, acetaminophen (b braun)",J0136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.08,0.11, "Inj, acetaminophen (b braun)",J0136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.08,0.11, "Inj, acetaminophen (hikma)",J0137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.11, "Inj, acetaminophen (hikma)",J0137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.11, "Inj, acetaminophen (hikma)",J0137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.08,0.11, "Inj, acetaminophen (hikma)",J0137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.08,0.11, "Injection, acetaminoph 10 mg",J0138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.35,,,,,,,fee schedule,0.07,0.35, "Injection, acetaminoph 10 mg",J0138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.35,,,,,,,fee schedule,0.07,0.35, "Injection, acetaminoph 10 mg",J0138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.07,0.35, "Injection, acetaminoph 10 mg",J0138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.07,0.35, "Injection, acetaminoph 10 mg",J0138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.1,,,,,,,fee schedule,0.07,0.35,APC "Injection, acetaminoph 10 mg",J0138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.1,,,,,,,fee schedule,0.07,0.35,APC "Injection, acetaminoph 10 mg",J0138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.09,,,,,,,fee schedule,0.07,0.35,APC Adenosine inj 1mg,J0153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.71,,,,,,,fee schedule,0.71,1.26, Adenosine inj 1mg,J0153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.71,,,,,,,fee schedule,0.71,1.26, Adenosine inj 1mg,J0153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.05,,,,,,,fee schedule,0.71,1.26, Adenosine inj 1mg,J0153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.26,,,,,,,fee schedule,0.71,1.26, Epinephrine in nacl (endo),J0163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.81,,,,,,,fee schedule,1.81,2.18, Epinephrine in nacl (endo),J0163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.18,,,,,,,fee schedule,1.81,2.18, Epinephrine in nacl (baxter),J0164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.74,,,,,,,fee schedule,1.74,2.09, Epinephrine in nacl (baxter),J0164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.09,,,,,,,fee schedule,1.74,2.09, Inj epinephrine nos 0.1 mg,J0165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.91,,,,,,,fee schedule,0.9,1.08, Inj epinephrine nos 0.1 mg,J0165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.91,,,,,,,fee schedule,0.9,1.08, Inj epinephrine nos 0.1 mg,J0165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.9,,,,,,,fee schedule,0.9,1.08, Inj epinephrine nos 0.1 mg,J0165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.08,,,,,,,fee schedule,0.9,1.08, Inj epinephrine (bpi),J0166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.55,,,,,,,fee schedule,1.98,3.55, Inj epinephrine (bpi),J0166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.55,,,,,,,fee schedule,1.98,3.55, Inj epinephrine (bpi),J0166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.98,,,,,,,fee schedule,1.98,3.55, Inj epinephrine (bpi),J0166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.38,,,,,,,fee schedule,1.98,3.55, Inj epinephrine (hospira),J0167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.16,,,,,,,fee schedule,1.16,3.19, Inj epinephrine (hospira),J0167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.16,,,,,,,fee schedule,1.16,3.19, Inj epinephrine (hospira),J0167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.65,,,,,,,fee schedule,1.16,3.19, Inj epinephrine (hospira),J0167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.19,,,,,,,fee schedule,1.16,3.19, Epinephrine (intl med sys),J0168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.38,,,,,,,fee schedule,3.38,5.7, Epinephrine (intl med sys),J0168,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.38,,,,,,,fee schedule,3.38,5.7, Epinephrine (intl med sys),J0168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.75,,,,,,,fee schedule,3.38,5.7, Epinephrine (intl med sys),J0168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.7,,,,,,,fee schedule,3.38,5.7, Inj epinephrine (adrenalin),J0169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.06,,,,,,,fee schedule,2.06,3.05, Inj epinephrine (adrenalin),J0169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.06,,,,,,,fee schedule,2.06,3.05, Inj epinephrine (adrenalin),J0169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.54,,,,,,,fee schedule,2.06,3.05, Inj epinephrine (adrenalin),J0169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.05,,,,,,,fee schedule,2.06,3.05, "Inj, aducanumab-avwa, 2 mg",J0172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.31,,,,,,,fee schedule,9.31,13.41, "Inj, aducanumab-avwa, 2 mg",J0172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.31,,,,,,,fee schedule,9.31,13.41, "Inj, aducanumab-avwa, 2 mg",J0172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.18,,,,,,,fee schedule,9.31,13.41, "Inj, aducanumab-avwa, 2 mg",J0172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.41,,,,,,,fee schedule,9.31,13.41, "Inj, lecanemab-irmb",J0174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.06,,,,,,,fee schedule,1.34,2.96, "Inj, lecanemab-irmb",J0174,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.06,,,,,,,fee schedule,1.34,2.96, "Inj, lecanemab-irmb",J0174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.47,,,,,,,fee schedule,1.34,2.96, "Inj, lecanemab-irmb",J0174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.96,,,,,,,fee schedule,1.34,2.96, "Inj, lecanemab-irmb",J0174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.39,,,,,,,fee schedule,1.34,2.96,APC "Inj, lecanemab-irmb",J0174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.4,,,,,,,fee schedule,1.34,2.96,APC "Inj, lecanemab-irmb",J0174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.34,,,,,,,fee schedule,1.34,2.96,APC "Inj, donanemab-azbt, 2 mg",J0175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.45,,,,,,,fee schedule,4.14,9.26, "Inj, donanemab-azbt, 2 mg",J0175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.45,,,,,,,fee schedule,4.14,9.26, "Inj, donanemab-azbt, 2 mg",J0175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.72,,,,,,,fee schedule,4.14,9.26, "Inj, donanemab-azbt, 2 mg",J0175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.26,,,,,,,fee schedule,4.14,9.26, "Inj, donanemab-azbt, 2 mg",J0175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.31,,,,,,,fee schedule,4.14,9.26,APC "Inj, donanemab-azbt, 2 mg",J0175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.35,,,,,,,fee schedule,4.14,9.26,APC "Inj, donanemab-azbt, 2 mg",J0175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.14,,,,,,,fee schedule,4.14,9.26,APC "Inj, aflibercept hd, 1 mg",J0177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,497.71,,,,,,,fee schedule,301.18,698.43, "Inj, aflibercept hd, 1 mg",J0177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,497.71,,,,,,,fee schedule,301.18,698.43, "Inj, aflibercept hd, 1 mg",J0177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,581.97,,,,,,,fee schedule,301.18,698.43, "Inj, aflibercept hd, 1 mg",J0177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,698.43,,,,,,,fee schedule,301.18,698.43, "Inj, aflibercept hd, 1 mg",J0177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,313.22,,,,,,,fee schedule,301.18,698.43,APC "Inj, aflibercept hd, 1 mg",J0177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,316.24,,,,,,,fee schedule,301.18,698.43,APC "Inj, aflibercept hd, 1 mg",J0177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,301.18,,,,,,,fee schedule,301.18,698.43,APC Aflibercept injection,J0178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1229.78,,,,,,,fee schedule,731.88,1730.61, Aflibercept injection,J0178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1229.78,,,,,,,fee schedule,731.88,1730.61, Aflibercept injection,J0178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1442.05,,,,,,,fee schedule,731.88,1730.61, Aflibercept injection,J0178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1730.61,,,,,,,fee schedule,731.88,1730.61, Aflibercept injection,J0178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,761.16,,,,,,,fee schedule,731.88,1730.61,APC Aflibercept injection,J0178,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,768.48,,,,,,,fee schedule,731.88,1730.61,APC Aflibercept injection,J0178,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,731.88,,,,,,,fee schedule,731.88,1730.61,APC "Inj, brolucizumab-dbll, 1 mg",J0179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,538.89,,,,,,,fee schedule,353.07,776.32, "Inj, brolucizumab-dbll, 1 mg",J0179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,538.89,,,,,,,fee schedule,353.07,776.32, "Inj, brolucizumab-dbll, 1 mg",J0179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,646.88,,,,,,,fee schedule,353.07,776.32, "Inj, brolucizumab-dbll, 1 mg",J0179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,776.32,,,,,,,fee schedule,353.07,776.32, "Inj, brolucizumab-dbll, 1 mg",J0179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,367.19,,,,,,,fee schedule,353.07,776.32,APC "Inj, brolucizumab-dbll, 1 mg",J0179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,370.72,,,,,,,fee schedule,353.07,776.32,APC "Inj, brolucizumab-dbll, 1 mg",J0179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,353.07,,,,,,,fee schedule,353.07,776.32,APC Agalsidase beta injection,J0180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,358.43,,,,,,,fee schedule,227.58,516.23, Agalsidase beta injection,J0180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,358.43,,,,,,,fee schedule,227.58,516.23, Agalsidase beta injection,J0180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,430.15,,,,,,,fee schedule,227.58,516.23, Agalsidase beta injection,J0180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,516.23,,,,,,,fee schedule,227.58,516.23, Agalsidase beta injection,J0180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,236.68,,,,,,,fee schedule,227.58,516.23,APC Agalsidase beta injection,J0180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,238.96,,,,,,,fee schedule,227.58,516.23,APC Agalsidase beta injection,J0180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,227.58,,,,,,,fee schedule,227.58,516.23,APC "Inj, amisulpride, 1 mg",J0184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.19,,,,,,,fee schedule,9.56,21.82, "Inj, amisulpride, 1 mg",J0184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.82,,,,,,,fee schedule,9.56,21.82, "Inj, amisulpride, 1 mg",J0184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.94,,,,,,,fee schedule,9.56,21.82,APC "Inj, amisulpride, 1 mg",J0184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.04,,,,,,,fee schedule,9.56,21.82,APC "Inj, amisulpride, 1 mg",J0184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.56,,,,,,,fee schedule,9.56,21.82,APC "Inj., aprepitant, 1 mg",J0185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.76,,,,,,,fee schedule,1.69,3.68, "Inj., aprepitant, 1 mg",J0185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.76,,,,,,,fee schedule,1.69,3.68, "Inj., aprepitant, 1 mg",J0185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.07,,,,,,,fee schedule,1.69,3.68, "Inj., aprepitant, 1 mg",J0185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.68,,,,,,,fee schedule,1.69,3.68, "Inj., aprepitant, 1 mg",J0185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.76,,,,,,,fee schedule,1.69,3.68,APC "Inj., aprepitant, 1 mg",J0185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.78,,,,,,,fee schedule,1.69,3.68,APC "Inj., aprepitant, 1 mg",J0185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.69,,,,,,,fee schedule,1.69,3.68,APC Alatrofloxacin mesylate,J0200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.75,,,,,,,fee schedule,31.75,38.11, Alatrofloxacin mesylate,J0200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.11,,,,,,,fee schedule,31.75,38.11, "Injection, alemtuzumab",J0202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3799.21,,,,,,,fee schedule,2440.42,5450.24, "Injection, alemtuzumab",J0202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3799.21,,,,,,,fee schedule,2440.42,5450.24, "Injection, alemtuzumab",J0202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4541.46,,,,,,,fee schedule,2440.42,5450.24, "Injection, alemtuzumab",J0202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5450.24,,,,,,,fee schedule,2440.42,5450.24, "Injection, alemtuzumab",J0202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2538.03,,,,,,,fee schedule,2440.42,5450.24,APC "Injection, alemtuzumab",J0202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2562.44,,,,,,,fee schedule,2440.42,5450.24,APC "Injection, alemtuzumab",J0202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2440.42,,,,,,,fee schedule,2440.42,5450.24,APC Alglucerase injection,J0205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.55,,,,,,,fee schedule,78.55,94.27, Alglucerase injection,J0205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.27,,,,,,,fee schedule,78.55,94.27, Inj allopurinol sodium 1 mg,J0206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.06,,,,,,,fee schedule,3.81,10.59, Inj allopurinol sodium 1 mg,J0206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.06,,,,,,,fee schedule,3.81,10.59, Inj allopurinol sodium 1 mg,J0206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.82,,,,,,,fee schedule,3.81,10.59, Inj allopurinol sodium 1 mg,J0206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.59,,,,,,,fee schedule,3.81,10.59, Inj allopurinol sodium 1 mg,J0206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.96,,,,,,,fee schedule,3.81,10.59,APC Inj allopurinol sodium 1 mg,J0206,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4,,,,,,,fee schedule,3.81,10.59,APC Inj allopurinol sodium 1 mg,J0206,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.81,,,,,,,fee schedule,3.81,10.59,APC Amifostine,J0207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2042.52,,,,,,,fee schedule,2042.52,2451.24, Amifostine,J0207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2451.24,,,,,,,fee schedule,2042.52,2451.24, Inj sodium thiosulfate 100mg,J0208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,174.12,,,,,,,fee schedule,95.45,208.96, Inj sodium thiosulfate 100mg,J0208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,208.96,,,,,,,fee schedule,95.45,208.96, Inj sodium thiosulfate 100mg,J0208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,99.27,,,,,,,fee schedule,95.45,208.96,APC Inj sodium thiosulfate 100mg,J0208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,100.22,,,,,,,fee schedule,95.45,208.96,APC Inj sodium thiosulfate 100mg,J0208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,95.45,,,,,,,fee schedule,95.45,208.96,APC "Inj, sod thiosulfate (hope)",J0209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.53,,,,,,,fee schedule,0.88,1.84, "Inj, sod thiosulfate (hope)",J0209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.84,,,,,,,fee schedule,0.88,1.84, "Inj, sod thiosulfate (hope)",J0209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.92,,,,,,,fee schedule,0.88,1.84,APC "Inj, sod thiosulfate (hope)",J0209,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.93,,,,,,,fee schedule,0.88,1.84,APC "Inj, sod thiosulfate (hope)",J0209,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.88,,,,,,,fee schedule,0.88,1.84,APC Methyldopate hcl injection,J0210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.25,,,,,,,fee schedule,79.25,95.1, Methyldopate hcl injection,J0210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.1,,,,,,,fee schedule,79.25,95.1, "Inj, nithiodote, 3mg / 125mg",J0211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.74,,,,,,,fee schedule,2.17,4.49, "Inj, nithiodote, 3mg / 125mg",J0211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.49,,,,,,,fee schedule,2.17,4.49, "Inj, nithiodote, 3mg / 125mg",J0211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.25,,,,,,,fee schedule,2.17,4.49,APC "Inj, nithiodote, 3mg / 125mg",J0211,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.27,,,,,,,fee schedule,2.17,4.49,APC "Inj, nithiodote, 3mg / 125mg",J0211,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.17,,,,,,,fee schedule,2.17,4.49,APC Alefacept,J0215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,77.83,,,,,,,fee schedule,77.83,93.4, Alefacept,J0215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,93.4,,,,,,,fee schedule,77.83,93.4, "Inj, alfentanil hcl, 500mcg",J0216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.8,,,,,,,fee schedule,4.8,5.76, "Inj, alfentanil hcl, 500mcg",J0216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.76,,,,,,,fee schedule,4.8,5.76, Inj velmanase alfa-tycv 1 mg,J0217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,723.9,,,,,,,fee schedule,465.23,1043.51, Inj velmanase alfa-tycv 1 mg,J0217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,723.9,,,,,,,fee schedule,465.23,1043.51, Inj velmanase alfa-tycv 1 mg,J0217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,869.51,,,,,,,fee schedule,465.23,1043.51, Inj velmanase alfa-tycv 1 mg,J0217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1043.51,,,,,,,fee schedule,465.23,1043.51, Inj velmanase alfa-tycv 1 mg,J0217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,483.84,,,,,,,fee schedule,465.23,1043.51,APC Inj velmanase alfa-tycv 1 mg,J0217,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,488.5,,,,,,,fee schedule,465.23,1043.51,APC Inj velmanase alfa-tycv 1 mg,J0217,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,465.23,,,,,,,fee schedule,465.23,1043.51,APC Inj olipudase alfa-rpcp 1mg,J0218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,613.02,,,,,,,fee schedule,395.6,882.98, Inj olipudase alfa-rpcp 1mg,J0218,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,613.02,,,,,,,fee schedule,395.6,882.98, Inj olipudase alfa-rpcp 1mg,J0218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,735.75,,,,,,,fee schedule,395.6,882.98, Inj olipudase alfa-rpcp 1mg,J0218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,882.98,,,,,,,fee schedule,395.6,882.98, Inj olipudase alfa-rpcp 1mg,J0218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,411.42,,,,,,,fee schedule,395.6,882.98,APC Inj olipudase alfa-rpcp 1mg,J0218,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,415.38,,,,,,,fee schedule,395.6,882.98,APC Inj olipudase alfa-rpcp 1mg,J0218,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,395.6,,,,,,,fee schedule,395.6,882.98,APC Inj aval alfa-nqpt 4mg,J0219,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.7,,,,,,,fee schedule,81.2,181.48, Inj aval alfa-nqpt 4mg,J0219,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.7,,,,,,,fee schedule,81.2,181.48, Inj aval alfa-nqpt 4mg,J0219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,151.22,,,,,,,fee schedule,81.2,181.48, Inj aval alfa-nqpt 4mg,J0219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,181.48,,,,,,,fee schedule,81.2,181.48, Inj aval alfa-nqpt 4mg,J0219,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,84.45,,,,,,,fee schedule,81.2,181.48,APC Inj aval alfa-nqpt 4mg,J0219,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,85.26,,,,,,,fee schedule,81.2,181.48,APC Inj aval alfa-nqpt 4mg,J0219,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,81.2,,,,,,,fee schedule,81.2,181.48,APC Alglucosidase alfa injection,J0220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,386.32,,,,,,,fee schedule,386.32,463.63, Alglucosidase alfa injection,J0220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,463.63,,,,,,,fee schedule,386.32,463.63, Lumizyme injection,J0221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,321.62,,,,,,,fee schedule,207.51,463.38, Lumizyme injection,J0221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,321.62,,,,,,,fee schedule,207.51,463.38, Lumizyme injection,J0221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,386.12,,,,,,,fee schedule,207.51,463.38, Lumizyme injection,J0221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,463.38,,,,,,,fee schedule,207.51,463.38, Lumizyme injection,J0221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,215.81,,,,,,,fee schedule,207.51,463.38,APC Lumizyme injection,J0221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,217.89,,,,,,,fee schedule,207.51,463.38,APC Lumizyme injection,J0221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.51,,,,,,,fee schedule,207.51,463.38,APC "Inj., patisiran, 0.1 mg",J0222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,155.38,,,,,,,fee schedule,100.9,224.23, "Inj., patisiran, 0.1 mg",J0222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,155.38,,,,,,,fee schedule,100.9,224.23, "Inj., patisiran, 0.1 mg",J0222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,186.84,,,,,,,fee schedule,100.9,224.23, "Inj., patisiran, 0.1 mg",J0222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,224.23,,,,,,,fee schedule,100.9,224.23, "Inj., patisiran, 0.1 mg",J0222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,104.93,,,,,,,fee schedule,100.9,224.23,APC "Inj., patisiran, 0.1 mg",J0222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,105.94,,,,,,,fee schedule,100.9,224.23,APC "Inj., patisiran, 0.1 mg",J0222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,100.9,,,,,,,fee schedule,100.9,224.23,APC Inj givosiran 0.5 mg,J0223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,182.42,,,,,,,fee schedule,120.98,263.24, Inj givosiran 0.5 mg,J0223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,182.42,,,,,,,fee schedule,120.98,263.24, Inj givosiran 0.5 mg,J0223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,219.35,,,,,,,fee schedule,120.98,263.24, Inj givosiran 0.5 mg,J0223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,263.24,,,,,,,fee schedule,120.98,263.24, Inj givosiran 0.5 mg,J0223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.82,,,,,,,fee schedule,120.98,263.24,APC Inj givosiran 0.5 mg,J0223,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,127.03,,,,,,,fee schedule,120.98,263.24,APC Inj givosiran 0.5 mg,J0223,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.98,,,,,,,fee schedule,120.98,263.24,APC "Inj. lumasiran, 0.5 mg",J0224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,512.28,,,,,,,fee schedule,327.72,738.06, "Inj. lumasiran, 0.5 mg",J0224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,512.28,,,,,,,fee schedule,327.72,738.06, "Inj. lumasiran, 0.5 mg",J0224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,614.99,,,,,,,fee schedule,327.72,738.06, "Inj. lumasiran, 0.5 mg",J0224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,738.06,,,,,,,fee schedule,327.72,738.06, "Inj. lumasiran, 0.5 mg",J0224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,340.82,,,,,,,fee schedule,327.72,738.06,APC "Inj. lumasiran, 0.5 mg",J0224,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,344.1,,,,,,,fee schedule,327.72,738.06,APC "Inj. lumasiran, 0.5 mg",J0224,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,327.72,,,,,,,fee schedule,327.72,738.06,APC "Inj, vutrisiran, 1 mg",J0225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7757.89,,,,,,,fee schedule,5019.27,11223.16, "Inj, vutrisiran, 1 mg",J0225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7757.89,,,,,,,fee schedule,5019.27,11223.16, "Inj, vutrisiran, 1 mg",J0225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9351.8,,,,,,,fee schedule,5019.27,11223.16, "Inj, vutrisiran, 1 mg",J0225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11223.16,,,,,,,fee schedule,5019.27,11223.16, "Inj, vutrisiran, 1 mg",J0225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5220.04,,,,,,,fee schedule,5019.27,11223.16,APC "Inj, vutrisiran, 1 mg",J0225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5270.24,,,,,,,fee schedule,5019.27,11223.16,APC "Inj, vutrisiran, 1 mg",J0225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5019.27,,,,,,,fee schedule,5019.27,11223.16,APC "Inj, remdesivir, 1 mg?",J0248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.48,,,,,,,fee schedule,6.9,15.1, "Inj, remdesivir, 1 mg?",J0248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.48,,,,,,,fee schedule,6.9,15.1, "Inj, remdesivir, 1 mg?",J0248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.58,,,,,,,fee schedule,6.9,15.1, "Inj, remdesivir, 1 mg?",J0248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.1,,,,,,,fee schedule,6.9,15.1, "Inj, remdesivir, 1 mg?",J0248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.17,,,,,,,fee schedule,6.9,15.1,APC "Inj, remdesivir, 1 mg?",J0248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.24,,,,,,,fee schedule,6.9,15.1,APC "Inj, remdesivir, 1 mg?",J0248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.9,,,,,,,fee schedule,6.9,15.1,APC Alpha 1 proteinase inhibitor,J0256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.07,,,,,,,fee schedule,5.14,12.25, Alpha 1 proteinase inhibitor,J0256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.07,,,,,,,fee schedule,5.14,12.25, Alpha 1 proteinase inhibitor,J0256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.2,,,,,,,fee schedule,5.14,12.25, Alpha 1 proteinase inhibitor,J0256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.25,,,,,,,fee schedule,5.14,12.25, Alpha 1 proteinase inhibitor,J0256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.35,,,,,,,fee schedule,5.14,12.25,APC Alpha 1 proteinase inhibitor,J0256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.4,,,,,,,fee schedule,5.14,12.25,APC Alpha 1 proteinase inhibitor,J0256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.14,,,,,,,fee schedule,5.14,12.25,APC Glassia injection,J0257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.89,,,,,,,fee schedule,5.66,12.65, Glassia injection,J0257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.89,,,,,,,fee schedule,5.66,12.65, Glassia injection,J0257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.54,,,,,,,fee schedule,5.66,12.65, Glassia injection,J0257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.65,,,,,,,fee schedule,5.66,12.65, Glassia injection,J0257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.89,,,,,,,fee schedule,5.66,12.65,APC Glassia injection,J0257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.94,,,,,,,fee schedule,5.66,12.65,APC Glassia injection,J0257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.66,,,,,,,fee schedule,5.66,12.65,APC Alprostadil for injection,J0270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.59,,,,,,,fee schedule,19.59,23.51, Alprostadil for injection,J0270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.51,,,,,,,fee schedule,19.59,23.51, Alprostadil urethral suppos,J0275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.07,,,,,,,fee schedule,48.07,57.69, Alprostadil urethral suppos,J0275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.69,,,,,,,fee schedule,48.07,57.69, Amikacin sulfate injection,J0278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.96,,,,,,,fee schedule,0.96,1.41, Amikacin sulfate injection,J0278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.96,,,,,,,fee schedule,0.96,1.41, Amikacin sulfate injection,J0278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.18,,,,,,,fee schedule,0.96,1.41, Amikacin sulfate injection,J0278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.41,,,,,,,fee schedule,0.96,1.41, Aminophyllin 250 MG inj,J0280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.92,,,,,,,fee schedule,12.92,23.19, Aminophyllin 250 MG inj,J0280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.92,,,,,,,fee schedule,12.92,23.19, Aminophyllin 250 MG inj,J0280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.33,,,,,,,fee schedule,12.92,23.19, Aminophyllin 250 MG inj,J0280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.19,,,,,,,fee schedule,12.92,23.19, Inj aminocaproic acid 1 gram,J0281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.33,,,,,,,fee schedule,2.33,3.84, Inj aminocaproic acid 1 gram,J0281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.33,,,,,,,fee schedule,2.33,3.84, Inj aminocaproic acid 1 gram,J0281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.2,,,,,,,fee schedule,2.33,3.84, Inj aminocaproic acid 1 gram,J0281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.84,,,,,,,fee schedule,2.33,3.84, Amiodarone HCl,J0282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.79,,,,,,,fee schedule,0.79,0.96, Amiodarone HCl,J0282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.79,,,,,,,fee schedule,0.79,0.96, Amiodarone HCl,J0282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.8,,,,,,,fee schedule,0.79,0.96, Amiodarone HCl,J0282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.96,,,,,,,fee schedule,0.79,0.96, "Inj, amiodarone (nexterone)",J0283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.06,,,,,,,fee schedule,4.06,5.85, "Inj, amiodarone (nexterone)",J0283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.06,,,,,,,fee schedule,4.06,5.85, "Inj, amiodarone (nexterone)",J0283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.88,,,,,,,fee schedule,4.06,5.85, "Inj, amiodarone (nexterone)",J0283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.85,,,,,,,fee schedule,4.06,5.85, Amphotericin B,J0285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.11,,,,,,,fee schedule,53.11,97.37, Amphotericin B,J0285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.11,,,,,,,fee schedule,53.11,97.37, Amphotericin B,J0285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.13,,,,,,,fee schedule,53.11,97.37, Amphotericin B,J0285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,97.37,,,,,,,fee schedule,53.11,97.37, Amphotericin b lipid complex,J0287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.04,,,,,,,fee schedule,16.04,23.1, Amphotericin b lipid complex,J0287,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.04,,,,,,,fee schedule,16.04,23.1, Amphotericin b lipid complex,J0287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.25,,,,,,,fee schedule,16.04,23.1, Amphotericin b lipid complex,J0287,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.1,,,,,,,fee schedule,16.04,23.1, Ampho b cholesteryl sulfate,J0288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.17,,,,,,,fee schedule,26.17,31.4, Ampho b cholesteryl sulfate,J0288,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,31.4,,,,,,,fee schedule,26.17,31.4, Amphotericin b liposome inj,J0289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.21,,,,,,,fee schedule,22.81,48.18, Amphotericin b liposome inj,J0289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.21,,,,,,,fee schedule,22.81,48.18, Amphotericin b liposome inj,J0289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.15,,,,,,,fee schedule,22.81,48.18, Amphotericin b liposome inj,J0289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.18,,,,,,,fee schedule,22.81,48.18, Amphotericin b liposome inj,J0289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.72,,,,,,,fee schedule,22.81,48.18,APC Amphotericin b liposome inj,J0289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.95,,,,,,,fee schedule,22.81,48.18,APC Amphotericin b liposome inj,J0289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.81,,,,,,,fee schedule,22.81,48.18,APC Ampicillin 500 MG inj,J0290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.76,,,,,,,fee schedule,0.76,1.23, Ampicillin 500 MG inj,J0290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.76,,,,,,,fee schedule,0.76,1.23, Ampicillin 500 MG inj,J0290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.03,,,,,,,fee schedule,0.76,1.23, Ampicillin 500 MG inj,J0290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.23,,,,,,,fee schedule,0.76,1.23, "Inj., plazomicin, 5 mg",J0291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.56,,,,,,,fee schedule,3.51,7.85, "Inj., plazomicin, 5 mg",J0291,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.56,,,,,,,fee schedule,3.51,7.85, "Inj., plazomicin, 5 mg",J0291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.54,,,,,,,fee schedule,3.51,7.85, "Inj., plazomicin, 5 mg",J0291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.85,,,,,,,fee schedule,3.51,7.85, "Inj., plazomicin, 5 mg",J0291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.65,,,,,,,fee schedule,3.51,7.85,APC "Inj., plazomicin, 5 mg",J0291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.68,,,,,,,fee schedule,3.51,7.85,APC "Inj., plazomicin, 5 mg",J0291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.51,,,,,,,fee schedule,3.51,7.85,APC Ampicillin sodium per 1.5 gm,J0295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.33,,,,,,,fee schedule,2.33,3.12, Ampicillin sodium per 1.5 gm,J0295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.33,,,,,,,fee schedule,2.33,3.12, Ampicillin sodium per 1.5 gm,J0295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.6,,,,,,,fee schedule,2.33,3.12, Ampicillin sodium per 1.5 gm,J0295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.12,,,,,,,fee schedule,2.33,3.12, Amobarbital 125 MG inj,J0300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,349.37,,,,,,,fee schedule,349.37,419.28, Amobarbital 125 MG inj,J0300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,419.28,,,,,,,fee schedule,349.37,419.28, Succinycholine chloride inj,J0330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.72,,,,,,,fee schedule,1.72,2.06, Succinycholine chloride inj,J0330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.06,,,,,,,fee schedule,1.72,2.06, Anidulafungin injection,J0348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.76,,,,,,,fee schedule,0.76,1.17, Anidulafungin injection,J0348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.76,,,,,,,fee schedule,0.76,1.17, Anidulafungin injection,J0348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.97,,,,,,,fee schedule,0.76,1.17, Anidulafungin injection,J0348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.17,,,,,,,fee schedule,0.76,1.17, "Inj, rezafungin, 1 mg",J0349,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.53,,,,,,,fee schedule,10.79,23.84, "Inj, rezafungin, 1 mg",J0349,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.53,,,,,,,fee schedule,10.79,23.84, "Inj, rezafungin, 1 mg",J0349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.87,,,,,,,fee schedule,10.79,23.84, "Inj, rezafungin, 1 mg",J0349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.84,,,,,,,fee schedule,10.79,23.84, "Inj, rezafungin, 1 mg",J0349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.22,,,,,,,fee schedule,10.79,23.84,APC "Inj, rezafungin, 1 mg",J0349,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.33,,,,,,,fee schedule,10.79,23.84,APC "Inj, rezafungin, 1 mg",J0349,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.79,,,,,,,fee schedule,10.79,23.84,APC Hydralazine hcl injection,J0360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.07,,,,,,,fee schedule,8.07,12.56, Hydralazine hcl injection,J0360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.07,,,,,,,fee schedule,8.07,12.56, Hydralazine hcl injection,J0360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.47,,,,,,,fee schedule,8.07,12.56, Hydralazine hcl injection,J0360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.56,,,,,,,fee schedule,8.07,12.56, Apomorphine hydrochloride,J0364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.18,,,,,,,fee schedule,66.18,79.42, Apomorphine hydrochloride,J0364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.42,,,,,,,fee schedule,66.18,79.42, "Aprotonin, 10,000 kiu",J0365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.95,,,,,,,fee schedule,4.95,5.94, "Aprotonin, 10,000 kiu",J0365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.94,,,,,,,fee schedule,4.95,5.94, Inj metaraminol bitartrate,J0380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.13,,,,,,,fee schedule,2.13,2.56, Inj metaraminol bitartrate,J0380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.56,,,,,,,fee schedule,2.13,2.56, "Inj, artesunate, 1mg",J0391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,93.21,,,,,,,fee schedule,51.83,111.86, "Inj, artesunate, 1mg",J0391,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,111.86,,,,,,,fee schedule,51.83,111.86, "Inj, artesunate, 1mg",J0391,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.9,,,,,,,fee schedule,51.83,111.86,APC "Inj, artesunate, 1mg",J0391,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.42,,,,,,,fee schedule,51.83,111.86,APC "Inj, artesunate, 1mg",J0391,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.83,,,,,,,fee schedule,51.83,111.86,APC Arbutamine HCl injection,J0395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,299.04,,,,,,,fee schedule,299.04,358.88, Arbutamine HCl injection,J0395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,358.88,,,,,,,fee schedule,299.04,358.88, Aripiprazole injection,J0400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.4,,,,,,,fee schedule,1.4,1.68, Aripiprazole injection,J0400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.68,,,,,,,fee schedule,1.4,1.68, Inj aripiprazole ext rel 1mg,J0401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.27,,,,,,,fee schedule,7.27,16.33, Inj aripiprazole ext rel 1mg,J0401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.27,,,,,,,fee schedule,7.27,16.33, Inj aripiprazole ext rel 1mg,J0401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.61,,,,,,,fee schedule,7.27,16.33, Inj aripiprazole ext rel 1mg,J0401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.33,,,,,,,fee schedule,7.27,16.33, Inj aripiprazole ext rel 1mg,J0401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.56,,,,,,,fee schedule,7.27,16.33,APC Inj aripiprazole ext rel 1mg,J0401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.63,,,,,,,fee schedule,7.27,16.33,APC Inj aripiprazole ext rel 1mg,J0401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.27,,,,,,,fee schedule,7.27,16.33,APC "Inj, abilify asimtufii, 1 mg",J0402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.39,,,,,,,fee schedule,6.02,13.53, "Inj, abilify asimtufii, 1 mg",J0402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.39,,,,,,,fee schedule,6.02,13.53, "Inj, abilify asimtufii, 1 mg",J0402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.27,,,,,,,fee schedule,6.02,13.53, "Inj, abilify asimtufii, 1 mg",J0402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.53,,,,,,,fee schedule,6.02,13.53, "Inj, abilify asimtufii, 1 mg",J0402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.26,,,,,,,fee schedule,6.02,13.53,APC "Inj, abilify asimtufii, 1 mg",J0402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.32,,,,,,,fee schedule,6.02,13.53,APC "Inj, abilify asimtufii, 1 mg",J0402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.02,,,,,,,fee schedule,6.02,13.53,APC Azithromycin,J0456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.08,,,,,,,fee schedule,3.81,4.58, Azithromycin,J0456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.08,,,,,,,fee schedule,3.81,4.58, Azithromycin,J0456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.81,,,,,,,fee schedule,3.81,4.58, Azithromycin,J0456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.58,,,,,,,fee schedule,3.81,4.58, "Injection, aztreonam, 100 mg",J0457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.14,,,,,,,fee schedule,4.14,5.67, "Injection, aztreonam, 100 mg",J0457,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.14,,,,,,,fee schedule,4.14,5.67, "Injection, aztreonam, 100 mg",J0457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.73,,,,,,,fee schedule,4.14,5.67, "Injection, aztreonam, 100 mg",J0457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.67,,,,,,,fee schedule,4.14,5.67, Aztreonam/avibactam 10 mg,J0458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.12,,,,,,,fee schedule,1.68,3.75, Aztreonam/avibactam 10 mg,J0458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.75,,,,,,,fee schedule,1.68,3.75, Aztreonam/avibactam 10 mg,J0458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.74,,,,,,,fee schedule,1.68,3.75,APC Aztreonam/avibactam 10 mg,J0458,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.76,,,,,,,fee schedule,1.68,3.75,APC Aztreonam/avibactam 10 mg,J0458,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.68,,,,,,,fee schedule,1.68,3.75,APC Atropine sulfate injection,J0461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.1,,,,,,,fee schedule,0.1,0.22, Atropine sulfate injection,J0461,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.1,,,,,,,fee schedule,0.1,0.22, Atropine sulfate injection,J0461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.19,,,,,,,fee schedule,0.1,0.22, Atropine sulfate injection,J0461,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.22,,,,,,,fee schedule,0.1,0.22, "Atropine sulf, nte, 0.01 mg",J0462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.26,,,,,,,fee schedule,0.26,0.31, "Atropine sulf, nte, 0.01 mg",J0462,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.31,,,,,,,fee schedule,0.26,0.31, Dimecaprol injection,J0470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,101.95,,,,,,,fee schedule,101.95,122.36, Dimecaprol injection,J0470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,122.36,,,,,,,fee schedule,101.95,122.36, Baclofen 10 mg injection,J0475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,273.69,,,,,,,fee schedule,178.05,406.48, Baclofen 10 mg injection,J0475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,273.69,,,,,,,fee schedule,178.05,406.48, Baclofen 10 mg injection,J0475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,338.7,,,,,,,fee schedule,178.05,406.48, Baclofen 10 mg injection,J0475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,406.48,,,,,,,fee schedule,178.05,406.48, Baclofen 10 mg injection,J0475,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,185.17,,,,,,,fee schedule,178.05,406.48,APC Baclofen 10 mg injection,J0475,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,186.95,,,,,,,fee schedule,178.05,406.48,APC Baclofen 10 mg injection,J0475,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,178.05,,,,,,,fee schedule,178.05,406.48,APC Baclofen intrathecal trial,J0476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,104.61,,,,,,,fee schedule,93.36,112.04, Baclofen intrathecal trial,J0476,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,104.61,,,,,,,fee schedule,93.36,112.04, Baclofen intrathecal trial,J0476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,93.36,,,,,,,fee schedule,93.36,112.04, Baclofen intrathecal trial,J0476,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,112.04,,,,,,,fee schedule,93.36,112.04, Basiliximab,J0480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7273.18,,,,,,,fee schedule,4812.31,10512.6, Basiliximab,J0480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7273.18,,,,,,,fee schedule,4812.31,10512.6, Basiliximab,J0480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8759.72,,,,,,,fee schedule,4812.31,10512.6, Basiliximab,J0480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10512.6,,,,,,,fee schedule,4812.31,10512.6, Basiliximab,J0480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5004.81,,,,,,,fee schedule,4812.31,10512.6,APC Basiliximab,J0480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5052.93,,,,,,,fee schedule,4812.31,10512.6,APC Basiliximab,J0480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4812.31,,,,,,,fee schedule,4812.31,10512.6,APC Belatacept injection,J0485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.06,,,,,,,fee schedule,3.89,8.73, Belatacept injection,J0485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.06,,,,,,,fee schedule,3.89,8.73, Belatacept injection,J0485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.27,,,,,,,fee schedule,3.89,8.73, Belatacept injection,J0485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.73,,,,,,,fee schedule,3.89,8.73, Belatacept injection,J0485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.05,,,,,,,fee schedule,3.89,8.73,APC Belatacept injection,J0485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.09,,,,,,,fee schedule,3.89,8.73,APC Belatacept injection,J0485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.89,,,,,,,fee schedule,3.89,8.73,APC Belimumab injection,J0490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.19,,,,,,,fee schedule,57.19,125.77, Belimumab injection,J0490,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.19,,,,,,,fee schedule,57.19,125.77, Belimumab injection,J0490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,104.79,,,,,,,fee schedule,57.19,125.77, Belimumab injection,J0490,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,125.77,,,,,,,fee schedule,57.19,125.77, Belimumab injection,J0490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,59.48,,,,,,,fee schedule,57.19,125.77,APC Belimumab injection,J0490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,60.05,,,,,,,fee schedule,57.19,125.77,APC Belimumab injection,J0490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,57.19,,,,,,,fee schedule,57.19,125.77,APC Inj anifrolumab-fnia 1mg,J0491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.18,,,,,,,fee schedule,18.31,40.55, Inj anifrolumab-fnia 1mg,J0491,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.18,,,,,,,fee schedule,18.31,40.55, Inj anifrolumab-fnia 1mg,J0491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.79,,,,,,,fee schedule,18.31,40.55, Inj anifrolumab-fnia 1mg,J0491,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.55,,,,,,,fee schedule,18.31,40.55, Inj anifrolumab-fnia 1mg,J0491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.04,,,,,,,fee schedule,18.31,40.55,APC Inj anifrolumab-fnia 1mg,J0491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.22,,,,,,,fee schedule,18.31,40.55,APC Inj anifrolumab-fnia 1mg,J0491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.31,,,,,,,fee schedule,18.31,40.55,APC Dicyclomine injection,J0500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,18.17,,,,,,,fee schedule,18.17,25.48, Dicyclomine injection,J0500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.17,,,,,,,fee schedule,18.17,25.48, Dicyclomine injection,J0500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.23,,,,,,,fee schedule,18.17,25.48, Dicyclomine injection,J0500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,25.48,,,,,,,fee schedule,18.17,25.48, Inj benztropine mesylate,J0515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.88,,,,,,,fee schedule,26.88,34.36, Inj benztropine mesylate,J0515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.88,,,,,,,fee schedule,26.88,34.36, Inj benztropine mesylate,J0515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.63,,,,,,,fee schedule,26.88,34.36, Inj benztropine mesylate,J0515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.36,,,,,,,fee schedule,26.88,34.36, "Inj., benralizumab, 1 mg",J0517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,261.71,,,,,,,fee schedule,163.36,369.18, "Inj., benralizumab, 1 mg",J0517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,261.71,,,,,,,fee schedule,163.36,369.18, "Inj., benralizumab, 1 mg",J0517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,307.62,,,,,,,fee schedule,163.36,369.18, "Inj., benralizumab, 1 mg",J0517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,369.18,,,,,,,fee schedule,163.36,369.18, "Inj., benralizumab, 1 mg",J0517,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,169.89,,,,,,,fee schedule,163.36,369.18,APC "Inj., benralizumab, 1 mg",J0517,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,171.52,,,,,,,fee schedule,163.36,369.18,APC "Inj., benralizumab, 1 mg",J0517,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,163.36,,,,,,,fee schedule,163.36,369.18,APC Bethanechol chloride inject,J0520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.39,,,,,,,fee schedule,8.39,10.07, Bethanechol chloride inject,J0520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.07,,,,,,,fee schedule,8.39,10.07, Inj cefotetan disodium 10 mg,J0525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.47,,,,,,,fee schedule,0.47,0.56, Inj cefotetan disodium 10 mg,J0525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.56,,,,,,,fee schedule,0.47,0.56, PenG benzathine/procaine inj,J0558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.39,,,,,,,fee schedule,19.52,43.78, PenG benzathine/procaine inj,J0558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.39,,,,,,,fee schedule,19.52,43.78, PenG benzathine/procaine inj,J0558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.48,,,,,,,fee schedule,19.52,43.78, PenG benzathine/procaine inj,J0558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,43.78,,,,,,,fee schedule,19.52,43.78, PenG benzathine/procaine inj,J0558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.3,,,,,,,fee schedule,19.52,43.78,APC PenG benzathine/procaine inj,J0558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.5,,,,,,,fee schedule,19.52,43.78,APC PenG benzathine/procaine inj,J0558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.52,,,,,,,fee schedule,19.52,43.78,APC Penicillin g benzathine inj,J0561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.61,,,,,,,fee schedule,31.46,67.31, Penicillin g benzathine inj,J0561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,45.61,,,,,,,fee schedule,31.46,67.31, Penicillin g benzathine inj,J0561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.09,,,,,,,fee schedule,31.46,67.31, Penicillin g benzathine inj,J0561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.31,,,,,,,fee schedule,31.46,67.31, Penicillin g benzathine inj,J0561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.72,,,,,,,fee schedule,31.46,67.31,APC Penicillin g benzathine inj,J0561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.04,,,,,,,fee schedule,31.46,67.31,APC Penicillin g benzathine inj,J0561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.46,,,,,,,fee schedule,31.46,67.31,APC "Inj, bezlotoxumab, 10 mg",J0565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.99,,,,,,,fee schedule,39.83,89.34, "Inj, bezlotoxumab, 10 mg",J0565,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.99,,,,,,,fee schedule,39.83,89.34, "Inj, bezlotoxumab, 10 mg",J0565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,74.44,,,,,,,fee schedule,39.83,89.34, "Inj, bezlotoxumab, 10 mg",J0565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.34,,,,,,,fee schedule,39.83,89.34, "Inj, bezlotoxumab, 10 mg",J0565,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.42,,,,,,,fee schedule,39.83,89.34,APC "Inj, bezlotoxumab, 10 mg",J0565,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.82,,,,,,,fee schedule,39.83,89.34,APC "Inj, bezlotoxumab, 10 mg",J0565,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.83,,,,,,,fee schedule,39.83,89.34,APC "Inj., cerliponase alfa 1 mg",J0567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,223.5,,,,,,,fee schedule,121.17,268.22, "Inj., cerliponase alfa 1 mg",J0567,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,268.22,,,,,,,fee schedule,121.17,268.22, "Inj., cerliponase alfa 1 mg",J0567,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,126.02,,,,,,,fee schedule,121.17,268.22,APC "Inj., cerliponase alfa 1 mg",J0567,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,127.23,,,,,,,fee schedule,121.17,268.22,APC "Inj., cerliponase alfa 1 mg",J0567,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,121.17,,,,,,,fee schedule,121.17,268.22,APC Buprenorphine oral 1mg,J0571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.5,,,,,,,fee schedule,0.5,0.61, Buprenorphine oral 1mg,J0571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.61,,,,,,,fee schedule,0.5,0.61, "Inj, brixadi, 7 days or less",J0577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,658.17,,,,,,,fee schedule,417.21,943.5, "Inj, brixadi, 7 days or less",J0577,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,658.17,,,,,,,fee schedule,417.21,943.5, "Inj, brixadi, 7 days or less",J0577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,786.18,,,,,,,fee schedule,417.21,943.5, "Inj, brixadi, 7 days or less",J0577,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,943.5,,,,,,,fee schedule,417.21,943.5, "Inj, brixadi, 7 days or less",J0577,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.9,,,,,,,fee schedule,417.21,943.5,APC "Inj, brixadi, 7 days or less",J0577,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,438.07,,,,,,,fee schedule,417.21,943.5,APC "Inj, brixadi, 7 days or less",J0577,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,417.21,,,,,,,fee schedule,417.21,943.5,APC "Inj brixadi, more than 7 day",J0578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2632.69,,,,,,,fee schedule,1668.84,3773.94, "Inj brixadi, more than 7 day",J0578,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2632.69,,,,,,,fee schedule,1668.84,3773.94, "Inj brixadi, more than 7 day",J0578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3144.67,,,,,,,fee schedule,1668.84,3773.94, "Inj brixadi, more than 7 day",J0578,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3773.94,,,,,,,fee schedule,1668.84,3773.94, "Inj brixadi, more than 7 day",J0578,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1735.59,,,,,,,fee schedule,1668.84,3773.94,APC "Inj brixadi, more than 7 day",J0578,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1752.28,,,,,,,fee schedule,1668.84,3773.94,APC "Inj brixadi, more than 7 day",J0578,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1668.84,,,,,,,fee schedule,1668.84,3773.94,APC Bivalirudin (endo) 1 mg,J0582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.26,,,,,,,fee schedule,0.26,0.31, Bivalirudin (endo) 1 mg,J0582,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.31,,,,,,,fee schedule,0.26,0.31, Bivalirudin,J0583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.26,,,,,,,fee schedule,0.26,0.38, Bivalirudin,J0583,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.26,,,,,,,fee schedule,0.26,0.38, Bivalirudin,J0583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.32,,,,,,,fee schedule,0.26,0.38, Bivalirudin,J0583,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.38,,,,,,,fee schedule,0.26,0.38, "Injection, burosumab-twza 1m",J0584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,749.61,,,,,,,fee schedule,498.72,1085.93, "Injection, burosumab-twza 1m",J0584,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,749.61,,,,,,,fee schedule,498.72,1085.93, "Injection, burosumab-twza 1m",J0584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,904.86,,,,,,,fee schedule,498.72,1085.93, "Injection, burosumab-twza 1m",J0584,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1085.93,,,,,,,fee schedule,498.72,1085.93, "Injection, burosumab-twza 1m",J0584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,518.66,,,,,,,fee schedule,498.72,1085.93,APC "Injection, burosumab-twza 1m",J0584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,523.65,,,,,,,fee schedule,498.72,1085.93,APC "Injection, burosumab-twza 1m",J0584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,498.72,,,,,,,fee schedule,498.72,1085.93,APC "Injection,onabotulinumtoxina",J0585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.11,,,,,,,fee schedule,6.51,14.02, "Injection,onabotulinumtoxina",J0585,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.11,,,,,,,fee schedule,6.51,14.02, "Injection,onabotulinumtoxina",J0585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.68,,,,,,,fee schedule,6.51,14.02, "Injection,onabotulinumtoxina",J0585,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.02,,,,,,,fee schedule,6.51,14.02, "Injection,onabotulinumtoxina",J0585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.77,,,,,,,fee schedule,6.51,14.02,APC "Injection,onabotulinumtoxina",J0585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.84,,,,,,,fee schedule,6.51,14.02,APC "Injection,onabotulinumtoxina",J0585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.51,,,,,,,fee schedule,6.51,14.02,APC Abobotulinumtoxina,J0586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.27,,,,,,,fee schedule,8.9,19.63, Abobotulinumtoxina,J0586,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.27,,,,,,,fee schedule,8.9,19.63, Abobotulinumtoxina,J0586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.35,,,,,,,fee schedule,8.9,19.63, Abobotulinumtoxina,J0586,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.63,,,,,,,fee schedule,8.9,19.63, Abobotulinumtoxina,J0586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.26,,,,,,,fee schedule,8.9,19.63,APC Abobotulinumtoxina,J0586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.35,,,,,,,fee schedule,8.9,19.63,APC Abobotulinumtoxina,J0586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.9,,,,,,,fee schedule,8.9,19.63,APC "Inj, rimabotulinumtoxinb",J0587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.77,,,,,,,fee schedule,13.28,29.81, "Inj, rimabotulinumtoxinb",J0587,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.77,,,,,,,fee schedule,13.28,29.81, "Inj, rimabotulinumtoxinb",J0587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.84,,,,,,,fee schedule,13.28,29.81, "Inj, rimabotulinumtoxinb",J0587,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.81,,,,,,,fee schedule,13.28,29.81, "Inj, rimabotulinumtoxinb",J0587,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.81,,,,,,,fee schedule,13.28,29.81,APC "Inj, rimabotulinumtoxinb",J0587,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.95,,,,,,,fee schedule,13.28,29.81,APC "Inj, rimabotulinumtoxinb",J0587,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.28,,,,,,,fee schedule,13.28,29.81,APC Incobotulinumtoxin a,J0588,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.27,,,,,,,fee schedule,5.29,12.49, Incobotulinumtoxin a,J0588,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.27,,,,,,,fee schedule,5.29,12.49, Incobotulinumtoxin a,J0588,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.41,,,,,,,fee schedule,5.29,12.49, Incobotulinumtoxin a,J0588,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.49,,,,,,,fee schedule,5.29,12.49, Incobotulinumtoxin a,J0588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.5,,,,,,,fee schedule,5.29,12.49,APC Incobotulinumtoxin a,J0588,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.55,,,,,,,fee schedule,5.29,12.49,APC Incobotulinumtoxin a,J0588,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.29,,,,,,,fee schedule,5.29,12.49,APC Inj daxibotulinumtoxina-lanm,J0589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.83,,,,,,,fee schedule,3.09,7.07, Inj daxibotulinumtoxina-lanm,J0589,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.83,,,,,,,fee schedule,3.09,7.07, Inj daxibotulinumtoxina-lanm,J0589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.89,,,,,,,fee schedule,3.09,7.07, Inj daxibotulinumtoxina-lanm,J0589,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.07,,,,,,,fee schedule,3.09,7.07, Inj daxibotulinumtoxina-lanm,J0589,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.22,,,,,,,fee schedule,3.09,7.07,APC Inj daxibotulinumtoxina-lanm,J0589,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.25,,,,,,,fee schedule,3.09,7.07,APC Inj daxibotulinumtoxina-lanm,J0589,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.09,,,,,,,fee schedule,3.09,7.07,APC "Inj deoxycholic acid, 1 mg",J0591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.6,,,,,,,fee schedule,28.6,34.32, "Inj deoxycholic acid, 1 mg",J0591,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.32,,,,,,,fee schedule,28.6,34.32, Buprenorphine hydrochloride,J0592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.44,,,,,,,fee schedule,6.44,9.35, Buprenorphine hydrochloride,J0592,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.44,,,,,,,fee schedule,6.44,9.35, Buprenorphine hydrochloride,J0592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.79,,,,,,,fee schedule,6.44,9.35, Buprenorphine hydrochloride,J0592,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.35,,,,,,,fee schedule,6.44,9.35, "Inj., lanadelumab-flyo, 1 mg",J0593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,135.33,,,,,,,fee schedule,86.85,195.77, "Inj., lanadelumab-flyo, 1 mg",J0593,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,135.33,,,,,,,fee schedule,86.85,195.77, "Inj., lanadelumab-flyo, 1 mg",J0593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.13,,,,,,,fee schedule,86.85,195.77, "Inj., lanadelumab-flyo, 1 mg",J0593,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,195.77,,,,,,,fee schedule,86.85,195.77, "Inj., lanadelumab-flyo, 1 mg",J0593,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,90.32,,,,,,,fee schedule,86.85,195.77,APC "Inj., lanadelumab-flyo, 1 mg",J0593,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,91.19,,,,,,,fee schedule,86.85,195.77,APC "Inj., lanadelumab-flyo, 1 mg",J0593,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,86.85,,,,,,,fee schedule,86.85,195.77,APC Busulfan injection,J0594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.85,,,,,,,fee schedule,0.68,2.85, Busulfan injection,J0594,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.85,,,,,,,fee schedule,0.68,2.85, Busulfan injection,J0594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.64,,,,,,,fee schedule,0.68,2.85, Busulfan injection,J0594,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.97,,,,,,,fee schedule,0.68,2.85, Busulfan injection,J0594,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.7,,,,,,,fee schedule,0.68,2.85,APC Busulfan injection,J0594,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.71,,,,,,,fee schedule,0.68,2.85,APC Busulfan injection,J0594,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.68,,,,,,,fee schedule,0.68,2.85,APC Butorphanol tartrate 1 mg,J0595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.87,,,,,,,fee schedule,7.87,14.42, Butorphanol tartrate 1 mg,J0595,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.87,,,,,,,fee schedule,7.87,14.42, Butorphanol tartrate 1 mg,J0595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.02,,,,,,,fee schedule,7.87,14.42, Butorphanol tartrate 1 mg,J0595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.42,,,,,,,fee schedule,7.87,14.42, "Injection, ruconest",J0596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.19,,,,,,,fee schedule,36.67,82.48, "Injection, ruconest",J0596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.19,,,,,,,fee schedule,36.67,82.48, "Injection, ruconest",J0596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.72,,,,,,,fee schedule,36.67,82.48, "Injection, ruconest",J0596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.48,,,,,,,fee schedule,36.67,82.48, "Injection, ruconest",J0596,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.14,,,,,,,fee schedule,36.67,82.48,APC "Injection, ruconest",J0596,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.51,,,,,,,fee schedule,36.67,82.48,APC "Injection, ruconest",J0596,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.67,,,,,,,fee schedule,36.67,82.48,APC "C-1 esterase, berinert",J0597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,118.09,,,,,,,fee schedule,76.05,170.15, "C-1 esterase, berinert",J0597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,118.09,,,,,,,fee schedule,76.05,170.15, "C-1 esterase, berinert",J0597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,141.78,,,,,,,fee schedule,76.05,170.15, "C-1 esterase, berinert",J0597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.15,,,,,,,fee schedule,76.05,170.15, "C-1 esterase, berinert",J0597,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79.09,,,,,,,fee schedule,76.05,170.15,APC "C-1 esterase, berinert",J0597,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,79.85,,,,,,,fee schedule,76.05,170.15,APC "C-1 esterase, berinert",J0597,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,76.05,,,,,,,fee schedule,76.05,170.15,APC "C-1 esterase, cinryze",J0598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.3,,,,,,,fee schedule,65.5,147.21, "C-1 esterase, cinryze",J0598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.3,,,,,,,fee schedule,65.5,147.21, "C-1 esterase, cinryze",J0598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.66,,,,,,,fee schedule,65.5,147.21, "C-1 esterase, cinryze",J0598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.21,,,,,,,fee schedule,65.5,147.21, "C-1 esterase, cinryze",J0598,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,68.12,,,,,,,fee schedule,65.5,147.21,APC "C-1 esterase, cinryze",J0598,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.78,,,,,,,fee schedule,65.5,147.21,APC "C-1 esterase, cinryze",J0598,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,65.5,,,,,,,fee schedule,65.5,147.21,APC "Inj., haegarda 10 units",J0599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.06,,,,,,,fee schedule,23.06,27.68, "Inj., haegarda 10 units",J0599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.68,,,,,,,fee schedule,23.06,27.68, Edetate calcium disodium inj,J0600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10047.2,,,,,,,fee schedule,6102.87,14374, Edetate calcium disodium inj,J0600,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10047.2,,,,,,,fee schedule,6102.87,14374, Edetate calcium disodium inj,J0600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11977.26,,,,,,,fee schedule,6102.87,14374, Edetate calcium disodium inj,J0600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14374,,,,,,,fee schedule,6102.87,14374, Edetate calcium disodium inj,J0600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6346.98,,,,,,,fee schedule,6102.87,14374,APC Edetate calcium disodium inj,J0600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6408.01,,,,,,,fee schedule,6102.87,14374,APC Edetate calcium disodium inj,J0600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6102.87,,,,,,,fee schedule,6102.87,14374,APC Sevelamer carbonate 20 mg,J0601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, Sevelamer carbonate 20 mg,J0601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Sevelamer carbonate pdr 20mg,J0602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.09,0.11, Sevelamer carbonate pdr 20mg,J0602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.09,0.11, Sevelamer hydrochloride 20mg,J0603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.19,,,,,,,fee schedule,0.19,0.22, Sevelamer hydrochloride 20mg,J0603,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.22,,,,,,,fee schedule,0.19,0.22, "Cinacalcet, esrd on dialysis",J0604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.04,,,,,,,fee schedule,0.04,0.04, "Cinacalcet, esrd on dialysis",J0604,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.04,,,,,,,fee schedule,0.04,0.04, Sucroferric oxyhydroxide 5mg,J0605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.34,,,,,,,fee schedule,0.34,0.4, Sucroferric oxyhydroxide 5mg,J0605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.4,,,,,,,fee schedule,0.34,0.4, "Inj, etelcalcetide, 0.1 mg",J0606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.87,,,,,,,fee schedule,2.36,9.44, "Inj, etelcalcetide, 0.1 mg",J0606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.44,,,,,,,fee schedule,2.36,9.44, "Inj, etelcalcetide, 0.1 mg",J0606,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.45,,,,,,,fee schedule,2.36,9.44,APC "Inj, etelcalcetide, 0.1 mg",J0606,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.47,,,,,,,fee schedule,2.36,9.44,APC "Inj, etelcalcetide, 0.1 mg",J0606,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.36,,,,,,,fee schedule,2.36,9.44,APC Lanthanum carbonate oral 5mg,J0607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Lanthanum carbonate oral 5mg,J0607,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.07,0.09, Lanthanum carbonate pwdr 5mg,J0608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.11,0.13, Lanthanum carbonate pwdr 5mg,J0608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.11,0.13, Ferric citrate orl 3 mg iron,J0609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.21,,,,,,,fee schedule,0.21,0.25, Ferric citrate orl 3 mg iron,J0609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.25,,,,,,,fee schedule,0.21,0.25, Calcium glucon (fresenius),J0612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Calcium glucon (fresenius),J0612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.07,,,,,,,fee schedule,0.07,0.09, Calcium glucon (fresenius),J0612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Calcium glucon (fresenius),J0612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.07,0.09, Calcium glucon (wg critical),J0613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.12,,,,,,,fee schedule,0.12,0.2, Calcium glucon (wg critical),J0613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.12,,,,,,,fee schedule,0.12,0.2, Calcium glucon (wg critical),J0613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.17,,,,,,,fee schedule,0.12,0.2, Calcium glucon (wg critical),J0613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.2,,,,,,,fee schedule,0.12,0.2, "Inj, treosulfan, 50 mg",J0614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.42,,,,,,,fee schedule,31.61,72.52, "Inj, treosulfan, 50 mg",J0614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.52,,,,,,,fee schedule,31.61,72.52, "Inj, treosulfan, 50 mg",J0614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.87,,,,,,,fee schedule,31.61,72.52,APC "Inj, treosulfan, 50 mg",J0614,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.19,,,,,,,fee schedule,31.61,72.52,APC "Inj, treosulfan, 50 mg",J0614,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.61,,,,,,,fee schedule,31.61,72.52,APC "Calcium acetate, oral, 23 mg",J0615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.04,,,,,,,fee schedule,0.04,0.04, "Calcium acetate, oral, 23 mg",J0615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.04,,,,,,,fee schedule,0.04,0.04, Inj metoprolol tartrate 1 mg,J0616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.21,,,,,,,fee schedule,0.21,0.27, Inj metoprolol tartrate 1 mg,J0616,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.21,,,,,,,fee schedule,0.21,0.27, Inj metoprolol tartrate 1 mg,J0616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.22,,,,,,,fee schedule,0.21,0.27, Inj metoprolol tartrate 1 mg,J0616,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.27,,,,,,,fee schedule,0.21,0.27, "Inj, calcium chloride, 2 mg",J0618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.06,0.07, "Inj, calcium chloride, 2 mg",J0618,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.06,0.07, Calcium glycer & lact/10 ML,J0620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.73,,,,,,,fee schedule,16.73,20.07, Calcium glycer & lact/10 ML,J0620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.07,,,,,,,fee schedule,16.73,20.07, Calcitonin salmon injection,J0630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1525.1,,,,,,,fee schedule,1525.1,1830.29, Calcitonin salmon injection,J0630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1830.29,,,,,,,fee schedule,1525.1,1830.29, Inj calcitriol per 0.1 mcg,J0636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.89,,,,,,,fee schedule,1.89,2.27, Inj calcitriol per 0.1 mcg,J0636,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.27,,,,,,,fee schedule,1.89,2.27, Caspofungin acetate,J0637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.53,,,,,,,fee schedule,3.53,7.94, Caspofungin acetate,J0637,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.53,,,,,,,fee schedule,3.53,7.94, Caspofungin acetate,J0637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.62,,,,,,,fee schedule,3.53,7.94, Caspofungin acetate,J0637,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.94,,,,,,,fee schedule,3.53,7.94, Canakinumab injection,J0638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,219.48,,,,,,,fee schedule,149.57,317.61, Canakinumab injection,J0638,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,219.48,,,,,,,fee schedule,149.57,317.61, Canakinumab injection,J0638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,264.65,,,,,,,fee schedule,149.57,317.61, Canakinumab injection,J0638,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,317.61,,,,,,,fee schedule,149.57,317.61, Canakinumab injection,J0638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,155.56,,,,,,,fee schedule,149.57,317.61,APC Canakinumab injection,J0638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.05,,,,,,,fee schedule,149.57,317.61,APC Canakinumab injection,J0638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,149.57,,,,,,,fee schedule,149.57,317.61,APC Leucovorin calcium injection,J0640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.14,,,,,,,fee schedule,6.02,7.22, Leucovorin calcium injection,J0640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.14,,,,,,,fee schedule,6.02,7.22, Leucovorin calcium injection,J0640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.02,,,,,,,fee schedule,6.02,7.22, Leucovorin calcium injection,J0640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.22,,,,,,,fee schedule,6.02,7.22, Levoleucovorin injection,J0641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.05,,,,,,,fee schedule,0.05,0.13, Levoleucovorin injection,J0641,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.05,,,,,,,fee schedule,0.05,0.13, Levoleucovorin injection,J0641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.05,0.13, Levoleucovorin injection,J0641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.05,0.13, "Injection, khapzory, 0.5 mg",J0642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.75,,,,,,,fee schedule,1.75,3.19, "Injection, khapzory, 0.5 mg",J0642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.75,,,,,,,fee schedule,1.75,3.19, "Injection, khapzory, 0.5 mg",J0642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.65,,,,,,,fee schedule,1.75,3.19, "Injection, khapzory, 0.5 mg",J0642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.19,,,,,,,fee schedule,1.75,3.19, "Inj, levothyroxine nos 10mcg",J0650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.98,,,,,,,fee schedule,11.98,15.41, "Inj, levothyroxine nos 10mcg",J0650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.98,,,,,,,fee schedule,11.98,15.41, "Inj, levothyroxine nos 10mcg",J0650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.84,,,,,,,fee schedule,11.98,15.41, "Inj, levothyroxine nos 10mcg",J0650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.41,,,,,,,fee schedule,11.98,15.41, "Inj, levothyroxine, freskabi",J0651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.04,,,,,,,fee schedule,6.96,15.32, "Inj, levothyroxine, freskabi",J0651,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.04,,,,,,,fee schedule,6.96,15.32, "Inj, levothyroxine, freskabi",J0651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.77,,,,,,,fee schedule,6.96,15.32, "Inj, levothyroxine, freskabi",J0651,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.32,,,,,,,fee schedule,6.96,15.32, "Inj, levothyroxine, freskabi",J0651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.24,,,,,,,fee schedule,6.96,15.32,APC "Inj, levothyroxine, freskabi",J0651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.31,,,,,,,fee schedule,6.96,15.32,APC "Inj, levothyroxine, freskabi",J0651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.96,,,,,,,fee schedule,6.96,15.32,APC "Inj, levothyroxine, hikma",J0652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8,,,,,,,fee schedule,8,11.53, "Inj, levothyroxine, hikma",J0652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8,,,,,,,fee schedule,8,11.53, "Inj, levothyroxine, hikma",J0652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.61,,,,,,,fee schedule,8,11.53, "Inj, levothyroxine, hikma",J0652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.53,,,,,,,fee schedule,8,11.53, "Inj, bupivacaine, nos, 0.5mg",J0665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, bupivacaine, nos, 0.5mg",J0665,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, bupivacaine, nos, 0.5mg",J0665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, bupivacaine, nos, 0.5mg",J0665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, bupivacaine liposome",J0666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.33,,,,,,,fee schedule,1.41,3.3, "Inj, bupivacaine liposome",J0666,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.33,,,,,,,fee schedule,1.41,3.3, "Inj, bupivacaine liposome",J0666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.75,,,,,,,fee schedule,1.41,3.3, "Inj, bupivacaine liposome",J0666,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.3,,,,,,,fee schedule,1.41,3.3, "Inj, bupivacaine liposome",J0666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.47,,,,,,,fee schedule,1.41,3.3,APC "Inj, bupivacaine liposome",J0666,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.48,,,,,,,fee schedule,1.41,3.3,APC "Inj, bupivacaine liposome",J0666,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.41,,,,,,,fee schedule,1.41,3.3,APC "Instill, bupivac and meloxic",J0668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.44,,,,,,,fee schedule,0.83,1.73, "Instill, bupivac and meloxic",J0668,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.73,,,,,,,fee schedule,0.83,1.73, "Instill, bupivac and meloxic",J0668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.86,,,,,,,fee schedule,0.83,1.73,APC "Instill, bupivac and meloxic",J0668,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.87,,,,,,,fee schedule,0.83,1.73,APC "Instill, bupivac and meloxic",J0668,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.83,,,,,,,fee schedule,0.83,1.73,APC Inj mepivacaine HCL/10 ml,J0670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.96,,,,,,,fee schedule,5.96,8.86, Inj mepivacaine HCL/10 ml,J0670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.96,,,,,,,fee schedule,5.96,8.86, Inj mepivacaine HCL/10 ml,J0670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.38,,,,,,,fee schedule,5.96,8.86, Inj mepivacaine HCL/10 ml,J0670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.86,,,,,,,fee schedule,5.96,8.86, "Inj, carboprost, 0.1 mg",J0675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.54,,,,,,,fee schedule,15.56,96.65, "Inj, carboprost, 0.1 mg",J0675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.65,,,,,,,fee schedule,15.56,96.65, "Inj, carboprost, 0.1 mg",J0675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.18,,,,,,,fee schedule,15.56,96.65,APC "Inj, carboprost, 0.1 mg",J0675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.34,,,,,,,fee schedule,15.56,96.65,APC "Inj, carboprost, 0.1 mg",J0675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.56,,,,,,,fee schedule,15.56,96.65,APC Inj ceftobipole medocarl 3mg,J0681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.02,,,,,,,fee schedule,1.1,2.42, Inj ceftobipole medocarl 3mg,J0681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.42,,,,,,,fee schedule,1.1,2.42, Inj ceftobipole medocarl 3mg,J0681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.14,,,,,,,fee schedule,1.1,2.42,APC Inj ceftobipole medocarl 3mg,J0681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.15,,,,,,,fee schedule,1.1,2.42,APC Inj ceftobipole medocarl 3mg,J0681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.1,,,,,,,fee schedule,1.1,2.42,APC Inj cefazolin (wg crit care),J0687,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.55,,,,,,,fee schedule,1.55,2.13, Inj cefazolin (wg crit care),J0687,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.55,,,,,,,fee schedule,1.55,2.13, Inj cefazolin (wg crit care),J0687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.78,,,,,,,fee schedule,1.55,2.13, Inj cefazolin (wg crit care),J0687,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.13,,,,,,,fee schedule,1.55,2.13, "Inj cefazolin sodium, hikma",J0688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.42,,,,,,,fee schedule,1.42,2.09, "Inj cefazolin sodium, hikma",J0688,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.42,,,,,,,fee schedule,1.42,2.09, "Inj cefazolin sodium, hikma",J0688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.74,,,,,,,fee schedule,1.42,2.09, "Inj cefazolin sodium, hikma",J0688,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.09,,,,,,,fee schedule,1.42,2.09, "Inj cefazolin sodium, baxter",J0689,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.08,,,,,,,fee schedule,2.08,2.92, "Inj cefazolin sodium, baxter",J0689,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.08,,,,,,,fee schedule,2.08,2.92, "Inj cefazolin sodium, baxter",J0689,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.43,,,,,,,fee schedule,2.08,2.92, "Inj cefazolin sodium, baxter",J0689,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.92,,,,,,,fee schedule,2.08,2.92, Cefazolin sodium injection,J0690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.3,,,,,,,fee schedule,1.3,1.79, Cefazolin sodium injection,J0690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.3,,,,,,,fee schedule,1.3,1.79, Cefazolin sodium injection,J0690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.5,,,,,,,fee schedule,1.3,1.79, Cefazolin sodium injection,J0690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.79,,,,,,,fee schedule,1.3,1.79, Inj lefamulin 1 mg,J0691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.31,,,,,,,fee schedule,1.31,1.57, Inj lefamulin 1 mg,J0691,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.57,,,,,,,fee schedule,1.31,1.57, Cefepime hcl for injection,J0692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.91,,,,,,,fee schedule,1.91,2.74, Cefepime hcl for injection,J0692,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.91,,,,,,,fee schedule,1.91,2.74, Cefepime hcl for injection,J0692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.28,,,,,,,fee schedule,1.91,2.74, Cefepime hcl for injection,J0692,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.74,,,,,,,fee schedule,1.91,2.74, Cefoxitin sodium injection,J0694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.99,,,,,,,fee schedule,7.99,10.72, Cefoxitin sodium injection,J0694,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.99,,,,,,,fee schedule,7.99,10.72, Cefoxitin sodium injection,J0694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.93,,,,,,,fee schedule,7.99,10.72, Cefoxitin sodium injection,J0694,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.72,,,,,,,fee schedule,7.99,10.72, Inj ceftolozane tazobactam,J0695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.21,,,,,,,fee schedule,8.84,20.34, Inj ceftolozane tazobactam,J0695,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.21,,,,,,,fee schedule,8.84,20.34, Inj ceftolozane tazobactam,J0695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.95,,,,,,,fee schedule,8.84,20.34, Inj ceftolozane tazobactam,J0695,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.34,,,,,,,fee schedule,8.84,20.34, Inj ceftolozane tazobactam,J0695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.19,,,,,,,fee schedule,8.84,20.34,APC Inj ceftolozane tazobactam,J0695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.28,,,,,,,fee schedule,8.84,20.34,APC Inj ceftolozane tazobactam,J0695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.84,,,,,,,fee schedule,8.84,20.34,APC Ceftriaxone sodium injection,J0696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.74,,,,,,,fee schedule,0.74,0.96, Ceftriaxone sodium injection,J0696,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.74,,,,,,,fee schedule,0.74,0.96, Ceftriaxone sodium injection,J0696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.8,,,,,,,fee schedule,0.74,0.96, Ceftriaxone sodium injection,J0696,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.96,,,,,,,fee schedule,0.74,0.96, Sterile cefuroxime injection,J0697,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.56,,,,,,,fee schedule,3.46,4.15, Sterile cefuroxime injection,J0697,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.56,,,,,,,fee schedule,3.46,4.15, Sterile cefuroxime injection,J0697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.46,,,,,,,fee schedule,3.46,4.15, Sterile cefuroxime injection,J0697,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.15,,,,,,,fee schedule,3.46,4.15, Cefotaxime sodium injection,J0698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.69,,,,,,,fee schedule,18.69,22.43, Cefotaxime sodium injection,J0698,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.43,,,,,,,fee schedule,18.69,22.43, "Inj, cefiderocol, 10 mg",J0699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.73,,,,,,,fee schedule,2.42,5.43, "Inj, cefiderocol, 10 mg",J0699,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.73,,,,,,,fee schedule,2.42,5.43, "Inj, cefiderocol, 10 mg",J0699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.52,,,,,,,fee schedule,2.42,5.43, "Inj, cefiderocol, 10 mg",J0699,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.43,,,,,,,fee schedule,2.42,5.43, "Inj, cefiderocol, 10 mg",J0699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.52,,,,,,,fee schedule,2.42,5.43,APC "Inj, cefiderocol, 10 mg",J0699,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.54,,,,,,,fee schedule,2.42,5.43,APC "Inj, cefiderocol, 10 mg",J0699,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.42,,,,,,,fee schedule,2.42,5.43,APC Inj. cefepime hcl (baxter),J0701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.14,,,,,,,fee schedule,9.14,13.55, Inj. cefepime hcl (baxter),J0701,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.14,,,,,,,fee schedule,9.14,13.55, Inj. cefepime hcl (baxter),J0701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.29,,,,,,,fee schedule,9.14,13.55, Inj. cefepime hcl (baxter),J0701,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.55,,,,,,,fee schedule,9.14,13.55, Betamethasone acet&sod phosp,J0702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.73,,,,,,,fee schedule,10.73,15.61, Betamethasone acet&sod phosp,J0702,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.73,,,,,,,fee schedule,10.73,15.61, Betamethasone acet&sod phosp,J0702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.01,,,,,,,fee schedule,10.73,15.61, Betamethasone acet&sod phosp,J0702,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.61,,,,,,,fee schedule,10.73,15.61, "Inj, cefepime hcl (b braun)",J0703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.9,,,,,,,fee schedule,7.9,11.13, "Inj, cefepime hcl (b braun)",J0703,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.9,,,,,,,fee schedule,7.9,11.13, "Inj, cefepime hcl (b braun)",J0703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.27,,,,,,,fee schedule,7.9,11.13, "Inj, cefepime hcl (b braun)",J0703,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.13,,,,,,,fee schedule,7.9,11.13, Caffeine citrate injection,J0706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.3,,,,,,,fee schedule,2.3,2.76, Caffeine citrate injection,J0706,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.76,,,,,,,fee schedule,2.3,2.76, Cephapirin sodium injection,J0710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.6,,,,,,,fee schedule,2.6,3.12, Cephapirin sodium injection,J0710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.12,,,,,,,fee schedule,2.6,3.12, Ceftaroline fosamil inj,J0712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.6,,,,,,,fee schedule,4.25,9.49, Ceftaroline fosamil inj,J0712,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.6,,,,,,,fee schedule,4.25,9.49, Ceftaroline fosamil inj,J0712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.91,,,,,,,fee schedule,4.25,9.49, Ceftaroline fosamil inj,J0712,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.49,,,,,,,fee schedule,4.25,9.49, Ceftaroline fosamil inj,J0712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.42,,,,,,,fee schedule,4.25,9.49,APC Ceftaroline fosamil inj,J0712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.47,,,,,,,fee schedule,4.25,9.49,APC Ceftaroline fosamil inj,J0712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.25,,,,,,,fee schedule,4.25,9.49,APC Inj ceftazidime per 500 mg,J0713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.56,,,,,,,fee schedule,2.56,3.52, Inj ceftazidime per 500 mg,J0713,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.56,,,,,,,fee schedule,2.56,3.52, Inj ceftazidime per 500 mg,J0713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.93,,,,,,,fee schedule,2.56,3.52, Inj ceftazidime per 500 mg,J0713,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.52,,,,,,,fee schedule,2.56,3.52, Ceftazidime and avibactam,J0714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,163.37,,,,,,,fee schedule,104.75,234.91, Ceftazidime and avibactam,J0714,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,163.37,,,,,,,fee schedule,104.75,234.91, Ceftazidime and avibactam,J0714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,195.74,,,,,,,fee schedule,104.75,234.91, Ceftazidime and avibactam,J0714,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,234.91,,,,,,,fee schedule,104.75,234.91, Ceftazidime and avibactam,J0714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,108.94,,,,,,,fee schedule,104.75,234.91,APC Ceftazidime and avibactam,J0714,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,109.99,,,,,,,fee schedule,104.75,234.91,APC Ceftazidime and avibactam,J0714,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,104.75,,,,,,,fee schedule,104.75,234.91,APC Ceftizoxime sodium / 500 MG,J0715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.79,,,,,,,fee schedule,9.79,11.75, Ceftizoxime sodium / 500 MG,J0715,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.75,,,,,,,fee schedule,9.79,11.75, Centruroides immune f(ab),J0716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10001.06,,,,,,,fee schedule,10001.06,12002.34, Centruroides immune f(ab),J0716,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12002.34,,,,,,,fee schedule,10001.06,12002.34, Certolizumab pegol inj 1mg,J0717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.98,,,,,,,fee schedule,3.79,8.77, Certolizumab pegol inj 1mg,J0717,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.98,,,,,,,fee schedule,3.79,8.77, Certolizumab pegol inj 1mg,J0717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.31,,,,,,,fee schedule,3.79,8.77, Certolizumab pegol inj 1mg,J0717,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.77,,,,,,,fee schedule,3.79,8.77, Certolizumab pegol inj 1mg,J0717,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.94,,,,,,,fee schedule,3.79,8.77,APC Certolizumab pegol inj 1mg,J0717,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.98,,,,,,,fee schedule,3.79,8.77,APC Certolizumab pegol inj 1mg,J0717,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.79,,,,,,,fee schedule,3.79,8.77,APC Chloramphenicol sodium injec,J0720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.74,,,,,,,fee schedule,92.74,111.3, Chloramphenicol sodium injec,J0720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,111.3,,,,,,,fee schedule,92.74,111.3, Chorionic gonadotropin/1000u,J0725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.26,,,,,,,fee schedule,27.26,41.36, Chorionic gonadotropin/1000u,J0725,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.26,,,,,,,fee schedule,27.26,41.36, Chorionic gonadotropin/1000u,J0725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.46,,,,,,,fee schedule,27.26,41.36, Chorionic gonadotropin/1000u,J0725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.36,,,,,,,fee schedule,27.26,41.36, Clonidine hydrochloride,J0735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.51,,,,,,,fee schedule,27.51,40.76, Clonidine hydrochloride,J0735,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.51,,,,,,,fee schedule,27.51,40.76, Clonidine hydrochloride,J0735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.96,,,,,,,fee schedule,27.51,40.76, Clonidine hydrochloride,J0735,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.76,,,,,,,fee schedule,27.51,40.76, "Inj, clindamycin phosp 300mg",J0736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.61,,,,,,,fee schedule,2.61,4.1, "Inj, clindamycin phosp 300mg",J0736,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.61,,,,,,,fee schedule,2.61,4.1, "Inj, clindamycin phosp 300mg",J0736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.42,,,,,,,fee schedule,2.61,4.1, "Inj, clindamycin phosp 300mg",J0736,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.1,,,,,,,fee schedule,2.61,4.1, "Inj, clindamycin (baxter)",J0737,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.67,,,,,,,fee schedule,2.67,4.96, "Inj, clindamycin (baxter)",J0737,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.67,,,,,,,fee schedule,2.67,4.96, "Inj, clindamycin (baxter)",J0737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.13,,,,,,,fee schedule,2.67,4.96, "Inj, clindamycin (baxter)",J0737,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.96,,,,,,,fee schedule,2.67,4.96, "Hiv prep, inj, lenacapavir",J0738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.15,,,,,,,fee schedule,16.1,36.18, "Hiv prep, inj, lenacapavir",J0738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.18,,,,,,,fee schedule,16.1,36.18, "Hiv prep, inj, lenacapavir",J0738,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16.75,,,,,,,fee schedule,16.1,36.18,APC "Hiv prep, inj, lenacapavir",J0738,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.91,,,,,,,fee schedule,16.1,36.18,APC "Hiv prep, inj, lenacapavir",J0738,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.1,,,,,,,fee schedule,16.1,36.18,APC "Injection, cabotegravir 1 mg",J0739,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.94,,,,,,,fee schedule,7.14,15.75, "Injection, cabotegravir 1 mg",J0739,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.94,,,,,,,fee schedule,7.14,15.75, "Injection, cabotegravir 1 mg",J0739,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.12,,,,,,,fee schedule,7.14,15.75, "Injection, cabotegravir 1 mg",J0739,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.75,,,,,,,fee schedule,7.14,15.75, "Injection, cabotegravir 1 mg",J0739,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.43,,,,,,,fee schedule,7.14,15.75,APC "Injection, cabotegravir 1 mg",J0739,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.5,,,,,,,fee schedule,7.14,15.75,APC "Injection, cabotegravir 1 mg",J0739,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.14,,,,,,,fee schedule,7.14,15.75,APC Cidofovir injection,J0740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,824.03,,,,,,,fee schedule,560.79,1225.33, Cidofovir injection,J0740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,824.03,,,,,,,fee schedule,560.79,1225.33, Cidofovir injection,J0740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1021.02,,,,,,,fee schedule,560.79,1225.33, Cidofovir injection,J0740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1225.33,,,,,,,fee schedule,560.79,1225.33, Cidofovir injection,J0740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,583.22,,,,,,,fee schedule,560.79,1225.33,APC Cidofovir injection,J0740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,588.83,,,,,,,fee schedule,560.79,1225.33,APC Cidofovir injection,J0740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,560.79,,,,,,,fee schedule,560.79,1225.33,APC "Inj, cabote rilpivir 2mg 3mg",J0741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.78,,,,,,,fee schedule,24.18,53.05, "Inj, cabote rilpivir 2mg 3mg",J0741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.78,,,,,,,fee schedule,24.18,53.05, "Inj, cabote rilpivir 2mg 3mg",J0741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.2,,,,,,,fee schedule,24.18,53.05, "Inj, cabote rilpivir 2mg 3mg",J0741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.05,,,,,,,fee schedule,24.18,53.05, "Inj, cabote rilpivir 2mg 3mg",J0741,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.15,,,,,,,fee schedule,24.18,53.05,APC "Inj, cabote rilpivir 2mg 3mg",J0741,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.39,,,,,,,fee schedule,24.18,53.05,APC "Inj, cabote rilpivir 2mg 3mg",J0741,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.18,,,,,,,fee schedule,24.18,53.05,APC Inj imip 4 cilas 4 releb 2mg,J0742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.06,,,,,,,fee schedule,4.06,5.85, Inj imip 4 cilas 4 releb 2mg,J0742,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.06,,,,,,,fee schedule,4.06,5.85, Inj imip 4 cilas 4 releb 2mg,J0742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.88,,,,,,,fee schedule,4.06,5.85, Inj imip 4 cilas 4 releb 2mg,J0742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.85,,,,,,,fee schedule,4.06,5.85, Cilastatin sodium injection,J0743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.86,,,,,,,fee schedule,10.86,22.99, Cilastatin sodium injection,J0743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.86,,,,,,,fee schedule,10.86,22.99, Cilastatin sodium injection,J0743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.16,,,,,,,fee schedule,10.86,22.99, Cilastatin sodium injection,J0743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.99,,,,,,,fee schedule,10.86,22.99, Ciprofloxacin iv,J0744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.61,,,,,,,fee schedule,3.61,6.5, Ciprofloxacin iv,J0744,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.61,,,,,,,fee schedule,3.61,6.5, Ciprofloxacin iv,J0744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.42,,,,,,,fee schedule,3.61,6.5, Ciprofloxacin iv,J0744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.5,,,,,,,fee schedule,3.61,6.5, "Hiv prep, ftc/tdf 200/300mg",J0750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.71,,,,,,,fee schedule,0.49,3.88, "Hiv prep, ftc/tdf 200/300mg",J0750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.71,,,,,,,fee schedule,0.49,3.88, "Hiv prep, ftc/tdf 200/300mg",J0750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.23,,,,,,,fee schedule,0.49,3.88, "Hiv prep, ftc/tdf 200/300mg",J0750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.88,,,,,,,fee schedule,0.49,3.88, "Hiv prep, ftc/tdf 200/300mg",J0750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.51,,,,,,,fee schedule,0.49,3.88,APC "Hiv prep, ftc/tdf 200/300mg",J0750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.51,,,,,,,fee schedule,0.49,3.88,APC "Hiv prep, ftc/tdf 200/300mg",J0750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.49,,,,,,,fee schedule,0.49,3.88,APC "Hiv prep, ftc/taf 200/25mg",J0751,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,110.95,,,,,,,fee schedule,71.44,159.97, "Hiv prep, ftc/taf 200/25mg",J0751,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,110.95,,,,,,,fee schedule,71.44,159.97, "Hiv prep, ftc/taf 200/25mg",J0751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.3,,,,,,,fee schedule,71.44,159.97, "Hiv prep, ftc/taf 200/25mg",J0751,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,159.97,,,,,,,fee schedule,71.44,159.97, "Hiv prep, ftc/taf 200/25mg",J0751,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,74.29,,,,,,,fee schedule,71.44,159.97,APC "Hiv prep, ftc/taf 200/25mg",J0751,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75.01,,,,,,,fee schedule,71.44,159.97,APC "Hiv prep, ftc/taf 200/25mg",J0751,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,71.44,,,,,,,fee schedule,71.44,159.97,APC "Hiv prep, oral lenacapavir",J0752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,839.24,,,,,,,fee schedule,621.96,1007.17, "Hiv prep, oral lenacapavir",J0752,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1007.17,,,,,,,fee schedule,621.96,1007.17, "Hiv prep, oral lenacapavir",J0752,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,646.84,,,,,,,fee schedule,621.96,1007.17,APC "Hiv prep, oral lenacapavir",J0752,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,653.06,,,,,,,fee schedule,621.96,1007.17,APC "Hiv prep, oral lenacapavir",J0752,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,621.96,,,,,,,fee schedule,621.96,1007.17,APC "Inj, clevidepine, 1 mg",J0759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.73,,,,,,,fee schedule,2.84,8.07, "Inj, clevidepine, 1 mg",J0759,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.07,,,,,,,fee schedule,2.84,8.07, "Inj, clevidepine, 1 mg",J0759,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.96,,,,,,,fee schedule,2.84,8.07,APC "Inj, clevidepine, 1 mg",J0759,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.99,,,,,,,fee schedule,2.84,8.07,APC "Inj, clevidepine, 1 mg",J0759,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.84,,,,,,,fee schedule,2.84,8.07,APC Colistimethate sodium inj,J0770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.72,,,,,,,fee schedule,17.72,29.29, Colistimethate sodium inj,J0770,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.72,,,,,,,fee schedule,17.72,29.29, Colistimethate sodium inj,J0770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.41,,,,,,,fee schedule,17.72,29.29, Colistimethate sodium inj,J0770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.29,,,,,,,fee schedule,17.72,29.29, "Collagenase, clost hist inj",J0775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.88,,,,,,,fee schedule,78.35,170.27, "Collagenase, clost hist inj",J0775,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.88,,,,,,,fee schedule,78.35,170.27, "Collagenase, clost hist inj",J0775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,141.88,,,,,,,fee schedule,78.35,170.27, "Collagenase, clost hist inj",J0775,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.27,,,,,,,fee schedule,78.35,170.27, "Collagenase, clost hist inj",J0775,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,81.49,,,,,,,fee schedule,78.35,170.27,APC "Collagenase, clost hist inj",J0775,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,82.27,,,,,,,fee schedule,78.35,170.27,APC "Collagenase, clost hist inj",J0775,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,78.35,,,,,,,fee schedule,78.35,170.27,APC Prochlorperazine injection,J0780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.93,,,,,,,fee schedule,3.38,4.06, Prochlorperazine injection,J0780,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.93,,,,,,,fee schedule,3.38,4.06, Prochlorperazine injection,J0780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.38,,,,,,,fee schedule,3.38,4.06, Prochlorperazine injection,J0780,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.06,,,,,,,fee schedule,3.38,4.06, Inj crizanlizumab-tmca 5mg,J0791,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,201.7,,,,,,,fee schedule,129.94,290.42, Inj crizanlizumab-tmca 5mg,J0791,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,201.7,,,,,,,fee schedule,129.94,290.42, Inj crizanlizumab-tmca 5mg,J0791,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,242,,,,,,,fee schedule,129.94,290.42, Inj crizanlizumab-tmca 5mg,J0791,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,290.42,,,,,,,fee schedule,129.94,290.42, Inj crizanlizumab-tmca 5mg,J0791,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,135.14,,,,,,,fee schedule,129.94,290.42,APC Inj crizanlizumab-tmca 5mg,J0791,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,136.44,,,,,,,fee schedule,129.94,290.42,APC Inj crizanlizumab-tmca 5mg,J0791,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,129.94,,,,,,,fee schedule,129.94,290.42,APC Corticorelin ovine triflutal,J0795,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.4,,,,,,,fee schedule,17.4,20.88, Corticorelin ovine triflutal,J0795,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.88,,,,,,,fee schedule,17.4,20.88, Inj. acthar gel to 40 units,J0801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6518.16,,,,,,,fee schedule,4094.26,9273.95, Inj. acthar gel to 40 units,J0801,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6518.16,,,,,,,fee schedule,4094.26,9273.95, Inj. acthar gel to 40 units,J0801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7727.6,,,,,,,fee schedule,4094.26,9273.95, Inj. acthar gel to 40 units,J0801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9273.95,,,,,,,fee schedule,4094.26,9273.95, Inj. acthar gel to 40 units,J0801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4258.03,,,,,,,fee schedule,4094.26,9273.95,APC Inj. acthar gel to 40 units,J0801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4298.97,,,,,,,fee schedule,4094.26,9273.95,APC Inj. acthar gel to 40 units,J0801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4094.26,,,,,,,fee schedule,4094.26,9273.95,APC "Inj. (ani), up to 40 units",J0802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5521.77,,,,,,,fee schedule,3571.35,7928.11, "Inj. (ani), up to 40 units",J0802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5521.77,,,,,,,fee schedule,3571.35,7928.11, "Inj. (ani), up to 40 units",J0802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6606.17,,,,,,,fee schedule,3571.35,7928.11, "Inj. (ani), up to 40 units",J0802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7928.11,,,,,,,fee schedule,3571.35,7928.11, "Inj. (ani), up to 40 units",J0802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3714.21,,,,,,,fee schedule,3571.35,7928.11,APC "Inj. (ani), up to 40 units",J0802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3749.92,,,,,,,fee schedule,3571.35,7928.11,APC "Inj. (ani), up to 40 units",J0802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3571.35,,,,,,,fee schedule,3571.35,7928.11,APC Cosyntropin cortrosyn inj,J0834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.61,,,,,,,fee schedule,43.61,56.9, Cosyntropin cortrosyn inj,J0834,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.61,,,,,,,fee schedule,43.61,56.9, Cosyntropin cortrosyn inj,J0834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.42,,,,,,,fee schedule,43.61,56.9, Cosyntropin cortrosyn inj,J0834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.9,,,,,,,fee schedule,43.61,56.9, Crotalidae poly immune fab,J0840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2897.05,,,,,,,fee schedule,1841.02,4101.8, Crotalidae poly immune fab,J0840,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2897.05,,,,,,,fee schedule,1841.02,4101.8, Crotalidae poly immune fab,J0840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3417.86,,,,,,,fee schedule,1841.02,4101.8, Crotalidae poly immune fab,J0840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4101.8,,,,,,,fee schedule,1841.02,4101.8, Crotalidae poly immune fab,J0840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1914.66,,,,,,,fee schedule,1841.02,4101.8,APC Crotalidae poly immune fab,J0840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1933.07,,,,,,,fee schedule,1841.02,4101.8,APC Crotalidae poly immune fab,J0840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1841.02,,,,,,,fee schedule,1841.02,4101.8,APC Inj crotalidae im f(ab')2 eq,J0841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1625.32,,,,,,,fee schedule,1625.32,2344.27, Inj crotalidae im f(ab')2 eq,J0841,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1625.32,,,,,,,fee schedule,1625.32,2344.27, Inj crotalidae im f(ab')2 eq,J0841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1953.39,,,,,,,fee schedule,1625.32,2344.27, Inj crotalidae im f(ab')2 eq,J0841,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2344.27,,,,,,,fee schedule,1625.32,2344.27, Cytomegalovirus imm IV /vial,J0850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2816.58,,,,,,,fee schedule,1808.61,4056.8, Cytomegalovirus imm IV /vial,J0850,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2816.58,,,,,,,fee schedule,1808.61,4056.8, Cytomegalovirus imm IV /vial,J0850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3380.37,,,,,,,fee schedule,1808.61,4056.8, Cytomegalovirus imm IV /vial,J0850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4056.8,,,,,,,fee schedule,1808.61,4056.8, Cytomegalovirus imm IV /vial,J0850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1880.95,,,,,,,fee schedule,1808.61,4056.8,APC Cytomegalovirus imm IV /vial,J0850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1899.04,,,,,,,fee schedule,1808.61,4056.8,APC Cytomegalovirus imm IV /vial,J0850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1808.61,,,,,,,fee schedule,1808.61,4056.8,APC "Injection, imetelstat, 1 mg",J0870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,88.77,,,,,,,fee schedule,58.17,127.92, "Injection, imetelstat, 1 mg",J0870,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,88.77,,,,,,,fee schedule,58.17,127.92, "Injection, imetelstat, 1 mg",J0870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,106.59,,,,,,,fee schedule,58.17,127.92, "Injection, imetelstat, 1 mg",J0870,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,127.92,,,,,,,fee schedule,58.17,127.92, "Injection, imetelstat, 1 mg",J0870,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.5,,,,,,,fee schedule,58.17,127.92,APC "Injection, imetelstat, 1 mg",J0870,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61.08,,,,,,,fee schedule,58.17,127.92,APC "Injection, imetelstat, 1 mg",J0870,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58.17,,,,,,,fee schedule,58.17,127.92,APC Daptomycin (xellia) unrefrig,J0872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.07,0.09, Daptomycin (xellia) unrefrig,J0872,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.07,0.09, Daptomycin (xellia) unrefrig,J0872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Daptomycin (xellia) unrefrig,J0872,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.07,0.09, "Inj, daptomycin (xellia)",J0873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.07,,,,,,,fee schedule,0.06,0.07, "Inj, daptomycin (xellia)",J0873,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.07,,,,,,,fee schedule,0.06,0.07, "Inj, daptomycin (xellia)",J0873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.06,0.07, "Inj, daptomycin (xellia)",J0873,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.06,0.07, "Inj, daptomycin (baxter)",J0874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.1,,,,,,,fee schedule,0.1,0.13, "Inj, daptomycin (baxter)",J0874,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.1,,,,,,,fee schedule,0.1,0.13, "Inj, daptomycin (baxter)",J0874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.1,0.13, "Inj, daptomycin (baxter)",J0874,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.1,0.13, "Injection, dalbavancin",J0875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.21,,,,,,,fee schedule,15,35.01, "Injection, dalbavancin",J0875,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.21,,,,,,,fee schedule,15,35.01, "Injection, dalbavancin",J0875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.18,,,,,,,fee schedule,15,35.01, "Injection, dalbavancin",J0875,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.01,,,,,,,fee schedule,15,35.01, "Injection, dalbavancin",J0875,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.6,,,,,,,fee schedule,15,35.01,APC "Injection, dalbavancin",J0875,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.75,,,,,,,fee schedule,15,35.01,APC "Injection, dalbavancin",J0875,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15,,,,,,,fee schedule,15,35.01,APC "Inj, daptomycin (hospira)",J0877,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.13, "Inj, daptomycin (hospira)",J0877,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.13, "Inj, daptomycin (hospira)",J0877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.08,0.13, "Inj, daptomycin (hospira)",J0877,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.08,0.13, Daptomycin injection,J0878,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.05,,,,,,,fee schedule,0.05,0.07, Daptomycin injection,J0878,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.05,,,,,,,fee schedule,0.05,0.07, Daptomycin injection,J0878,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.05,0.07, Daptomycin injection,J0878,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.05,0.07, "Difelikefalin, esrd on dialy",J0879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.45,,,,,,,fee schedule,0.45,0.54, "Difelikefalin, esrd on dialy",J0879,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.54,,,,,,,fee schedule,0.45,0.54, "Darbepoetin alfa, non-esrd",J0881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.67,,,,,,,fee schedule,3.07,6.37, "Darbepoetin alfa, non-esrd",J0881,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.67,,,,,,,fee schedule,3.07,6.37, "Darbepoetin alfa, non-esrd",J0881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.31,,,,,,,fee schedule,3.07,6.37, "Darbepoetin alfa, non-esrd",J0881,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.37,,,,,,,fee schedule,3.07,6.37, "Darbepoetin alfa, non-esrd",J0881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.19,,,,,,,fee schedule,3.07,6.37,APC "Darbepoetin alfa, non-esrd",J0881,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.23,,,,,,,fee schedule,3.07,6.37,APC "Darbepoetin alfa, non-esrd",J0881,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.07,,,,,,,fee schedule,3.07,6.37,APC "Darbepoetin alfa, esrd use",J0882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.67,,,,,,,fee schedule,3.07,6.57, "Darbepoetin alfa, esrd use",J0882,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.67,,,,,,,fee schedule,3.07,6.57, "Darbepoetin alfa, esrd use",J0882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.48,,,,,,,fee schedule,3.07,6.57, "Darbepoetin alfa, esrd use",J0882,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.57,,,,,,,fee schedule,3.07,6.57, "Darbepoetin alfa, esrd use",J0882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.19,,,,,,,fee schedule,3.07,6.57,APC "Darbepoetin alfa, esrd use",J0882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.23,,,,,,,fee schedule,3.07,6.57,APC "Darbepoetin alfa, esrd use",J0882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.07,,,,,,,fee schedule,3.07,6.57,APC Argatroban nonesrd use 1mg,J0883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.16,,,,,,,fee schedule,1.01,1.79, Argatroban nonesrd use 1mg,J0883,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.16,,,,,,,fee schedule,1.01,1.79, Argatroban nonesrd use 1mg,J0883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.5,,,,,,,fee schedule,1.01,1.79, Argatroban nonesrd use 1mg,J0883,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.79,,,,,,,fee schedule,1.01,1.79, Argatroban nonesrd use 1mg,J0883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.05,,,,,,,fee schedule,1.01,1.79,APC Argatroban nonesrd use 1mg,J0883,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.06,,,,,,,fee schedule,1.01,1.79,APC Argatroban nonesrd use 1mg,J0883,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.01,,,,,,,fee schedule,1.01,1.79,APC Argatroban esrd dialysis 1mg,J0884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.16,,,,,,,fee schedule,1.16,1.79, Argatroban esrd dialysis 1mg,J0884,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.16,,,,,,,fee schedule,1.16,1.79, Argatroban esrd dialysis 1mg,J0884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.5,,,,,,,fee schedule,1.16,1.79, Argatroban esrd dialysis 1mg,J0884,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.79,,,,,,,fee schedule,1.16,1.79, "Epoetin alfa, non-esrd",J0885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.95,,,,,,,fee schedule,7.3,19.16, "Epoetin alfa, non-esrd",J0885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.95,,,,,,,fee schedule,7.3,19.16, "Epoetin alfa, non-esrd",J0885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.96,,,,,,,fee schedule,7.3,19.16, "Epoetin alfa, non-esrd",J0885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.16,,,,,,,fee schedule,7.3,19.16, "Epoetin alfa, non-esrd",J0885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.6,,,,,,,fee schedule,7.3,19.16,APC "Epoetin alfa, non-esrd",J0885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.67,,,,,,,fee schedule,7.3,19.16,APC "Epoetin alfa, non-esrd",J0885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.3,,,,,,,fee schedule,7.3,19.16,APC Epoetin beta esrd use,J0887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.19,,,,,,,fee schedule,2.19,3.3, Epoetin beta esrd use,J0887,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.19,,,,,,,fee schedule,2.19,3.3, Epoetin beta esrd use,J0887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.75,,,,,,,fee schedule,2.19,3.3, Epoetin beta esrd use,J0887,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.3,,,,,,,fee schedule,2.19,3.3, Epoetin beta non esrd,J0888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.19,,,,,,,fee schedule,2.19,3.3, Epoetin beta non esrd,J0888,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.19,,,,,,,fee schedule,2.19,3.3, Epoetin beta non esrd,J0888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.75,,,,,,,fee schedule,2.19,3.3, Epoetin beta non esrd,J0888,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.3,,,,,,,fee schedule,2.19,3.3, Daprodustat oral 1mg esrd,J0889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.46,,,,,,,fee schedule,7.46,8.95, Daprodustat oral 1mg esrd,J0889,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.95,,,,,,,fee schedule,7.46,8.95, Peginesatide injection,J0890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.33,,,,,,,fee schedule,15.33,18.39, Peginesatide injection,J0890,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18.39,,,,,,,fee schedule,15.33,18.39, Argatroban nonesrd (accord),J0891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.55,,,,,,,fee schedule,1.82,9.06, Argatroban nonesrd (accord),J0891,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.06,,,,,,,fee schedule,1.82,9.06, Argatroban nonesrd (accord),J0891,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.89,,,,,,,fee schedule,1.82,9.06,APC Argatroban nonesrd (accord),J0891,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.91,,,,,,,fee schedule,1.82,9.06,APC Argatroban nonesrd (accord),J0891,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.82,,,,,,,fee schedule,1.82,9.06,APC Argatroban dialysis (accord),J0892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.55,,,,,,,fee schedule,7.55,9.06, Argatroban dialysis (accord),J0892,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.06,,,,,,,fee schedule,7.55,9.06, "Inj, decitabine (sun pharma)",J0893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.2,,,,,,,fee schedule,1.2,1.75, "Inj, decitabine (sun pharma)",J0893,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.2,,,,,,,fee schedule,1.2,1.75, "Inj, decitabine (sun pharma)",J0893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.46,,,,,,,fee schedule,1.2,1.75, "Inj, decitabine (sun pharma)",J0893,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.75,,,,,,,fee schedule,1.2,1.75, Decitabine injection,J0894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.48,,,,,,,fee schedule,2.28,2.74, Decitabine injection,J0894,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.48,,,,,,,fee schedule,2.28,2.74, Decitabine injection,J0894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.28,,,,,,,fee schedule,2.28,2.74, Decitabine injection,J0894,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.74,,,,,,,fee schedule,2.28,2.74, Deferoxamine mesylate inj,J0895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.04,,,,,,,fee schedule,14.04,20.21, Deferoxamine mesylate inj,J0895,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.04,,,,,,,fee schedule,14.04,20.21, Deferoxamine mesylate inj,J0895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.84,,,,,,,fee schedule,14.04,20.21, Deferoxamine mesylate inj,J0895,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.21,,,,,,,fee schedule,14.04,20.21, Inj luspatercept-aamt 0.25mg,J0896,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.32,,,,,,,fee schedule,42.75,94.16, Inj luspatercept-aamt 0.25mg,J0896,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.32,,,,,,,fee schedule,42.75,94.16, Inj luspatercept-aamt 0.25mg,J0896,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.46,,,,,,,fee schedule,42.75,94.16, Inj luspatercept-aamt 0.25mg,J0896,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.16,,,,,,,fee schedule,42.75,94.16, Inj luspatercept-aamt 0.25mg,J0896,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.46,,,,,,,fee schedule,42.75,94.16,APC Inj luspatercept-aamt 0.25mg,J0896,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.89,,,,,,,fee schedule,42.75,94.16,APC Inj luspatercept-aamt 0.25mg,J0896,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.75,,,,,,,fee schedule,42.75,94.16,APC Denosumab injection,J0897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,45.51,,,,,,,fee schedule,29.51,65.9, Denosumab injection,J0897,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,45.51,,,,,,,fee schedule,29.51,65.9, Denosumab injection,J0897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.91,,,,,,,fee schedule,29.51,65.9, Denosumab injection,J0897,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.9,,,,,,,fee schedule,29.51,65.9, Denosumab injection,J0897,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.69,,,,,,,fee schedule,29.51,65.9,APC Denosumab injection,J0897,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30.98,,,,,,,fee schedule,29.51,65.9,APC Denosumab injection,J0897,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.51,,,,,,,fee schedule,29.51,65.9,APC Argatroban nonesrd (auromed),J0898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.26,,,,,,,fee schedule,2.26,3.63, Argatroban nonesrd (auromed),J0898,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.26,,,,,,,fee schedule,2.26,3.63, Argatroban nonesrd (auromed),J0898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.03,,,,,,,fee schedule,2.26,3.63, Argatroban nonesrd (auromed),J0898,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.63,,,,,,,fee schedule,2.26,3.63, "Argatroban dialysis, auromed",J0899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.26,,,,,,,fee schedule,2.26,3.63, "Argatroban dialysis, auromed",J0899,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.26,,,,,,,fee schedule,2.26,3.63, "Argatroban dialysis, auromed",J0899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.03,,,,,,,fee schedule,2.26,3.63, "Argatroban dialysis, auromed",J0899,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.63,,,,,,,fee schedule,2.26,3.63, Vadadustat oral 1mg for esrd,J0901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.26,,,,,,,fee schedule,0.26,0.31, Vadadustat oral 1mg for esrd,J0901,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.31,,,,,,,fee schedule,0.26,0.31, Inst tauro 1.35mg/hep 100u,J0911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.89,,,,,,,fee schedule,5.03,19.07, Inst tauro 1.35mg/hep 100u,J0911,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.07,,,,,,,fee schedule,5.03,19.07, Inst tauro 1.35mg/hep 100u,J0911,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.23,,,,,,,fee schedule,5.03,19.07,APC Inst tauro 1.35mg/hep 100u,J0911,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.28,,,,,,,fee schedule,5.03,19.07,APC Inst tauro 1.35mg/hep 100u,J0911,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.03,,,,,,,fee schedule,5.03,19.07,APC Brompheniramine maleate inj,J0945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.5,,,,,,,fee schedule,1.5,1.79, Brompheniramine maleate inj,J0945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.79,,,,,,,fee schedule,1.5,1.79, Depo-estradiol cypionate inj,J1000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.03,,,,,,,fee schedule,73.03,110.54, Depo-estradiol cypionate inj,J1000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.03,,,,,,,fee schedule,73.03,110.54, Depo-estradiol cypionate inj,J1000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,92.1,,,,,,,fee schedule,73.03,110.54, Depo-estradiol cypionate inj,J1000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,110.54,,,,,,,fee schedule,73.03,110.54, "Inj, methylpred acetate 1 mg",J1010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.18,,,,,,,fee schedule,0.18,0.27, "Inj, methylpred acetate 1 mg",J1010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.18,,,,,,,fee schedule,0.18,0.27, "Inj, methylpred acetate 1 mg",J1010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.22,,,,,,,fee schedule,0.18,0.27, "Inj, methylpred acetate 1 mg",J1010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.27,,,,,,,fee schedule,0.18,0.27, Medroxyprogesterone acetate,J1050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.07,,,,,,,fee schedule,1.07,1.28, Medroxyprogesterone acetate,J1050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.28,,,,,,,fee schedule,1.07,1.28, Inj testosterone cypionate,J1071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.05,,,,,,,fee schedule,0.05,0.07, Inj testosterone cypionate,J1071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.05,,,,,,,fee schedule,0.05,0.07, Inj testosterone cypionate,J1071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.05,0.07, Inj testosterone cypionate,J1071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.05,0.07, "Inj, testosterone, azmiro",J1072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.06,,,,,,,fee schedule,0.14,2.98, "Inj, testosterone, azmiro",J1072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.06,,,,,,,fee schedule,0.14,2.98, "Inj, testosterone, azmiro",J1072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.49,,,,,,,fee schedule,0.14,2.98, "Inj, testosterone, azmiro",J1072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.98,,,,,,,fee schedule,0.14,2.98, "Inj, testosterone, azmiro",J1072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.14,,,,,,,fee schedule,0.14,2.98,APC "Inj, testosterone, azmiro",J1072,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.14,,,,,,,fee schedule,0.14,2.98,APC "Inj, testosterone, azmiro",J1072,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.14,,,,,,,fee schedule,0.14,2.98,APC "Injection, dexamethasone 9%",J1095,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.19,,,,,,,fee schedule,2.19,2.62, "Injection, dexamethasone 9%",J1095,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.62,,,,,,,fee schedule,2.19,2.62, Dexametha opth insert 0.1 mg,J1096,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,157.97,,,,,,,fee schedule,92.55,230.89, Dexametha opth insert 0.1 mg,J1096,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,157.97,,,,,,,fee schedule,92.55,230.89, Dexametha opth insert 0.1 mg,J1096,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,192.39,,,,,,,fee schedule,92.55,230.89, Dexametha opth insert 0.1 mg,J1096,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,230.89,,,,,,,fee schedule,92.55,230.89, Dexametha opth insert 0.1 mg,J1096,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,96.25,,,,,,,fee schedule,92.55,230.89,APC Dexametha opth insert 0.1 mg,J1096,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,97.17,,,,,,,fee schedule,92.55,230.89,APC Dexametha opth insert 0.1 mg,J1096,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,92.55,,,,,,,fee schedule,92.55,230.89,APC Phenylep ketorolac opth soln,J1097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,224.95,,,,,,,fee schedule,96.61,269.97, Phenylep ketorolac opth soln,J1097,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,269.97,,,,,,,fee schedule,96.61,269.97, Phenylep ketorolac opth soln,J1097,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,100.47,,,,,,,fee schedule,96.61,269.97,APC Phenylep ketorolac opth soln,J1097,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,101.44,,,,,,,fee schedule,96.61,269.97,APC Phenylep ketorolac opth soln,J1097,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,96.61,,,,,,,fee schedule,96.61,269.97,APC Dexamethasone sodium phos,J1100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.18,,,,,,,fee schedule,0.17,0.2, Dexamethasone sodium phos,J1100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.18,,,,,,,fee schedule,0.17,0.2, Dexamethasone sodium phos,J1100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.17,,,,,,,fee schedule,0.17,0.2, Dexamethasone sodium phos,J1100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.2,,,,,,,fee schedule,0.17,0.2, Inj dihydroergotamine mesylt,J1110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,151.11,,,,,,,fee schedule,112.14,151.11, Inj dihydroergotamine mesylt,J1110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,151.11,,,,,,,fee schedule,112.14,151.11, Inj dihydroergotamine mesylt,J1110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,112.14,,,,,,,fee schedule,112.14,151.11, Inj dihydroergotamine mesylt,J1110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,134.58,,,,,,,fee schedule,112.14,151.11, Acetazolamid sodium injectio,J1120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.81,,,,,,,fee schedule,26.81,44.5, Acetazolamid sodium injectio,J1120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.81,,,,,,,fee schedule,26.81,44.5, Acetazolamid sodium injectio,J1120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.08,,,,,,,fee schedule,26.81,44.5, Acetazolamid sodium injectio,J1120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.5,,,,,,,fee schedule,26.81,44.5, Inj diclofenac sodium 0.5mg,J1130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.39,,,,,,,fee schedule,0.39,0.47, Inj diclofenac sodium 0.5mg,J1130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.47,,,,,,,fee schedule,0.39,0.47, Digoxin injection,J1160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.22,,,,,,,fee schedule,6.22,20.3, Digoxin injection,J1160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.22,,,,,,,fee schedule,6.22,20.3, Digoxin injection,J1160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.91,,,,,,,fee schedule,6.22,20.3, Digoxin injection,J1160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.3,,,,,,,fee schedule,6.22,20.3, Digoxin immune fab (ovine),J1162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7734.11,,,,,,,fee schedule,5166.99,11592.34, Digoxin immune fab (ovine),J1162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7734.11,,,,,,,fee schedule,5166.99,11592.34, Digoxin immune fab (ovine),J1162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9659.42,,,,,,,fee schedule,5166.99,11592.34, Digoxin immune fab (ovine),J1162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11592.34,,,,,,,fee schedule,5166.99,11592.34, Digoxin immune fab (ovine),J1162,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5373.67,,,,,,,fee schedule,5166.99,11592.34,APC Digoxin immune fab (ovine),J1162,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5425.34,,,,,,,fee schedule,5166.99,11592.34,APC Digoxin immune fab (ovine),J1162,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5166.99,,,,,,,fee schedule,5166.99,11592.34,APC "Inj, diltiazem hcl, 0.5 mg",J1163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.05,,,,,,,fee schedule,0.05,0.07, "Inj, diltiazem hcl, 0.5 mg",J1163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.05,,,,,,,fee schedule,0.05,0.07, "Inj, diltiazem hcl, 0.5 mg",J1163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.05,0.07, "Inj, diltiazem hcl, 0.5 mg",J1163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.05,0.07, Phenytoin sodium injection,J1165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.02,,,,,,,fee schedule,0.84,1.02, Phenytoin sodium injection,J1165,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.02,,,,,,,fee schedule,0.84,1.02, Phenytoin sodium injection,J1165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.84,,,,,,,fee schedule,0.84,1.02, Phenytoin sodium injection,J1165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.01,,,,,,,fee schedule,0.84,1.02, "Inj, hydromorphone, 0.1 mg",J1171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.13,,,,,,,fee schedule,0.13,0.2, "Inj, hydromorphone, 0.1 mg",J1171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.13,,,,,,,fee schedule,0.13,0.2, "Inj, hydromorphone, 0.1 mg",J1171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.17,,,,,,,fee schedule,0.13,0.2, "Inj, hydromorphone, 0.1 mg",J1171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.2,,,,,,,fee schedule,0.13,0.2, Dexrazoxane hcl injection,J1190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.95,,,,,,,fee schedule,49.74,141.44, Dexrazoxane hcl injection,J1190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.95,,,,,,,fee schedule,49.74,141.44, Dexrazoxane hcl injection,J1190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,117.86,,,,,,,fee schedule,49.74,141.44, Dexrazoxane hcl injection,J1190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,141.44,,,,,,,fee schedule,49.74,141.44, Dexrazoxane hcl injection,J1190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,51.73,,,,,,,fee schedule,49.74,141.44,APC Dexrazoxane hcl injection,J1190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.22,,,,,,,fee schedule,49.74,141.44,APC Dexrazoxane hcl injection,J1190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.74,,,,,,,fee schedule,49.74,141.44,APC Diphenhydramine hcl injectio,J1200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.4,,,,,,,fee schedule,1.4,1.7, Diphenhydramine hcl injectio,J1200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.4,,,,,,,fee schedule,1.4,1.7, Diphenhydramine hcl injectio,J1200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.42,,,,,,,fee schedule,1.4,1.7, Diphenhydramine hcl injectio,J1200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.7,,,,,,,fee schedule,1.4,1.7, Inj. cetirizine hcl 0.5mg,J1201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.53,,,,,,,fee schedule,16.92,37.05, Inj. cetirizine hcl 0.5mg,J1201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.53,,,,,,,fee schedule,16.92,37.05, Inj. cetirizine hcl 0.5mg,J1201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.88,,,,,,,fee schedule,16.92,37.05, Inj. cetirizine hcl 0.5mg,J1201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,37.05,,,,,,,fee schedule,16.92,37.05, Inj. cetirizine hcl 0.5mg,J1201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.6,,,,,,,fee schedule,16.92,37.05,APC Inj. cetirizine hcl 0.5mg,J1201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.77,,,,,,,fee schedule,16.92,37.05,APC Inj. cetirizine hcl 0.5mg,J1201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,16.92,,,,,,,fee schedule,16.92,37.05,APC Miglustat oral 65 mg,J1202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.9,,,,,,,fee schedule,63.9,76.69, Miglustat oral 65 mg,J1202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.69,,,,,,,fee schedule,63.9,76.69, "Inj, cipaglucosidase, 5 mg",J1203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,139.77,,,,,,,fee schedule,92.4,204.58, "Inj, cipaglucosidase, 5 mg",J1203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,139.77,,,,,,,fee schedule,92.4,204.58, "Inj, cipaglucosidase, 5 mg",J1203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,170.47,,,,,,,fee schedule,92.4,204.58, "Inj, cipaglucosidase, 5 mg",J1203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,204.58,,,,,,,fee schedule,92.4,204.58, "Inj, cipaglucosidase, 5 mg",J1203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,96.09,,,,,,,fee schedule,92.4,204.58,APC "Inj, cipaglucosidase, 5 mg",J1203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,97.02,,,,,,,fee schedule,92.4,204.58,APC "Inj, cipaglucosidase, 5 mg",J1203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,92.4,,,,,,,fee schedule,92.4,204.58,APC Chlorothiazide sodium inj,J1205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.87,,,,,,,fee schedule,62.87,88.49, Chlorothiazide sodium inj,J1205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.87,,,,,,,fee schedule,62.87,88.49, Chlorothiazide sodium inj,J1205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,73.73,,,,,,,fee schedule,62.87,88.49, Chlorothiazide sodium inj,J1205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.49,,,,,,,fee schedule,62.87,88.49, Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1156.39,,,,,,,fee schedule,748.98,1679.65, Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1156.39,,,,,,,fee schedule,748.98,1679.65, Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1399.58,,,,,,,fee schedule,748.98,1679.65, Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1679.65,,,,,,,fee schedule,748.98,1679.65, Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,778.93,,,,,,,fee schedule,748.98,1679.65,APC Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,786.42,,,,,,,fee schedule,748.98,1679.65,APC Dimethyl sulfoxide 50% 50 ML,J1212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,748.98,,,,,,,fee schedule,748.98,1679.65,APC Methadone injection,J1230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.67,,,,,,,fee schedule,35.67,43.36, Methadone injection,J1230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.67,,,,,,,fee schedule,35.67,43.36, Methadone injection,J1230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.13,,,,,,,fee schedule,35.67,43.36, Methadone injection,J1230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,43.36,,,,,,,fee schedule,35.67,43.36, Dimenhydrinate injection,J1240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.05,,,,,,,fee schedule,11.48,13.77, Dimenhydrinate injection,J1240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.05,,,,,,,fee schedule,11.48,13.77, Dimenhydrinate injection,J1240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.48,,,,,,,fee schedule,11.48,13.77, Dimenhydrinate injection,J1240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.77,,,,,,,fee schedule,11.48,13.77, Dipyridamole injection,J1245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.01,,,,,,,fee schedule,6.01,18.86, Dipyridamole injection,J1245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.01,,,,,,,fee schedule,6.01,18.86, Dipyridamole injection,J1245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.72,,,,,,,fee schedule,6.01,18.86, Dipyridamole injection,J1245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18.86,,,,,,,fee schedule,6.01,18.86, Inj dobutamine HCL/250 mg,J1250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.42,,,,,,,fee schedule,12.42,15.88, Inj dobutamine HCL/250 mg,J1250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.42,,,,,,,fee schedule,12.42,15.88, Inj dobutamine HCL/250 mg,J1250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.23,,,,,,,fee schedule,12.42,15.88, Inj dobutamine HCL/250 mg,J1250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.88,,,,,,,fee schedule,12.42,15.88, Dolasetron mesylate,J1260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.53,,,,,,,fee schedule,11.53,13.84, Dolasetron mesylate,J1260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.84,,,,,,,fee schedule,11.53,13.84, Dopamine injection,J1265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.02,,,,,,,fee schedule,1.02,1.86, Dopamine injection,J1265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.02,,,,,,,fee schedule,1.02,1.86, Dopamine injection,J1265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.55,,,,,,,fee schedule,1.02,1.86, Dopamine injection,J1265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.86,,,,,,,fee schedule,1.02,1.86, Doripenem injection,J1267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.64,,,,,,,fee schedule,1.64,1.97, Doripenem injection,J1267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.97,,,,,,,fee schedule,1.64,1.97, "Injection, doxercalciferol",J1270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.58,,,,,,,fee schedule,0.58,0.79, "Injection, doxercalciferol",J1270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.58,,,,,,,fee schedule,0.58,0.79, "Injection, doxercalciferol",J1270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.65,,,,,,,fee schedule,0.58,0.79, "Injection, doxercalciferol",J1270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.79,,,,,,,fee schedule,0.58,0.79, Inj doxycycline hyclate 1 mg,J1271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.18,,,,,,,fee schedule,0.18,0.25, Inj doxycycline hyclate 1 mg,J1271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.18,,,,,,,fee schedule,0.18,0.25, Inj doxycycline hyclate 1 mg,J1271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.21,,,,,,,fee schedule,0.18,0.25, Inj doxycycline hyclate 1 mg,J1271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.25,,,,,,,fee schedule,0.18,0.25, Ecallantide injection,J1290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,902.81,,,,,,,fee schedule,578.75,1300.87, Ecallantide injection,J1290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,902.81,,,,,,,fee schedule,578.75,1300.87, Ecallantide injection,J1290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1083.96,,,,,,,fee schedule,578.75,1300.87, Ecallantide injection,J1290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1300.87,,,,,,,fee schedule,578.75,1300.87, Ecallantide injection,J1290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,601.9,,,,,,,fee schedule,578.75,1300.87,APC Ecallantide injection,J1290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,607.68,,,,,,,fee schedule,578.75,1300.87,APC Ecallantide injection,J1290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,578.75,,,,,,,fee schedule,578.75,1300.87,APC "Inj, eculizumab, 2 mg",J1299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.7,,,,,,,fee schedule,44.7,100.53, "Inj, eculizumab, 2 mg",J1299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.7,,,,,,,fee schedule,44.7,100.53, "Inj, eculizumab, 2 mg",J1299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.77,,,,,,,fee schedule,44.7,100.53, "Inj, eculizumab, 2 mg",J1299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.53,,,,,,,fee schedule,44.7,100.53, "Inj, eculizumab, 2 mg",J1299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.49,,,,,,,fee schedule,44.7,100.53,APC "Inj, eculizumab, 2 mg",J1299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.93,,,,,,,fee schedule,44.7,100.53,APC "Inj, eculizumab, 2 mg",J1299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.7,,,,,,,fee schedule,44.7,100.53,APC "Injection, edaravone, 1 mg",J1301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.32,,,,,,,fee schedule,15.18,47.08, "Injection, edaravone, 1 mg",J1301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.32,,,,,,,fee schedule,15.18,47.08, "Injection, edaravone, 1 mg",J1301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.23,,,,,,,fee schedule,15.18,47.08, "Injection, edaravone, 1 mg",J1301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.08,,,,,,,fee schedule,15.18,47.08, "Injection, edaravone, 1 mg",J1301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.79,,,,,,,fee schedule,15.18,47.08,APC "Injection, edaravone, 1 mg",J1301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.94,,,,,,,fee schedule,15.18,47.08,APC "Injection, edaravone, 1 mg",J1301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.18,,,,,,,fee schedule,15.18,47.08,APC "Inj, sutimlimab-jome, 10 mg",J1302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.18,,,,,,,fee schedule,19.64,42.3, "Inj, sutimlimab-jome, 10 mg",J1302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.18,,,,,,,fee schedule,19.64,42.3, "Inj, sutimlimab-jome, 10 mg",J1302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.25,,,,,,,fee schedule,19.64,42.3, "Inj, sutimlimab-jome, 10 mg",J1302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.3,,,,,,,fee schedule,19.64,42.3, "Inj, sutimlimab-jome, 10 mg",J1302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.43,,,,,,,fee schedule,19.64,42.3,APC "Inj, sutimlimab-jome, 10 mg",J1302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.62,,,,,,,fee schedule,19.64,42.3,APC "Inj, sutimlimab-jome, 10 mg",J1302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.64,,,,,,,fee schedule,19.64,42.3,APC "Inj., ravulizumab-cwvz 10 mg",J1303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,350.54,,,,,,,fee schedule,223.68,504.92, "Inj., ravulizumab-cwvz 10 mg",J1303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,350.54,,,,,,,fee schedule,223.68,504.92, "Inj., ravulizumab-cwvz 10 mg",J1303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,420.73,,,,,,,fee schedule,223.68,504.92, "Inj., ravulizumab-cwvz 10 mg",J1303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,504.92,,,,,,,fee schedule,223.68,504.92, "Inj., ravulizumab-cwvz 10 mg",J1303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,232.62,,,,,,,fee schedule,223.68,504.92,APC "Inj., ravulizumab-cwvz 10 mg",J1303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,234.86,,,,,,,fee schedule,223.68,504.92,APC "Inj., ravulizumab-cwvz 10 mg",J1303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,223.68,,,,,,,fee schedule,223.68,504.92,APC Inj tofersen intrathec 1 mg,J1304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.81,,,,,,,fee schedule,160.01,357.53, Inj tofersen intrathec 1 mg,J1304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,241.81,,,,,,,fee schedule,160.01,357.53, Inj tofersen intrathec 1 mg,J1304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,297.92,,,,,,,fee schedule,160.01,357.53, Inj tofersen intrathec 1 mg,J1304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,357.53,,,,,,,fee schedule,160.01,357.53, Inj tofersen intrathec 1 mg,J1304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,166.41,,,,,,,fee schedule,160.01,357.53,APC Inj tofersen intrathec 1 mg,J1304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,168.01,,,,,,,fee schedule,160.01,357.53,APC Inj tofersen intrathec 1 mg,J1304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,160.01,,,,,,,fee schedule,160.01,357.53,APC "Inj, evinacumab-dgnb, 5mg",J1305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,295.37,,,,,,,fee schedule,197.63,434.6, "Inj, evinacumab-dgnb, 5mg",J1305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,295.37,,,,,,,fee schedule,197.63,434.6, "Inj, evinacumab-dgnb, 5mg",J1305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,362.14,,,,,,,fee schedule,197.63,434.6, "Inj, evinacumab-dgnb, 5mg",J1305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,434.6,,,,,,,fee schedule,197.63,434.6, "Inj, evinacumab-dgnb, 5mg",J1305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,205.54,,,,,,,fee schedule,197.63,434.6,APC "Inj, evinacumab-dgnb, 5mg",J1305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,207.51,,,,,,,fee schedule,197.63,434.6,APC "Inj, evinacumab-dgnb, 5mg",J1305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,197.63,,,,,,,fee schedule,197.63,434.6,APC "Injection, inclisiran, 1 mg",J1306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.22,,,,,,,fee schedule,12.61,27.63, "Injection, inclisiran, 1 mg",J1306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.22,,,,,,,fee schedule,12.61,27.63, "Injection, inclisiran, 1 mg",J1306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.03,,,,,,,fee schedule,12.61,27.63, "Injection, inclisiran, 1 mg",J1306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.63,,,,,,,fee schedule,12.61,27.63, "Injection, inclisiran, 1 mg",J1306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.11,,,,,,,fee schedule,12.61,27.63,APC "Injection, inclisiran, 1 mg",J1306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.24,,,,,,,fee schedule,12.61,27.63,APC "Injection, inclisiran, 1 mg",J1306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.61,,,,,,,fee schedule,12.61,27.63,APC "Inj, crovalimab-akkz, 10 mg",J1307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,991.88,,,,,,,fee schedule,551.51,1190.36, "Inj, crovalimab-akkz, 10 mg",J1307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1190.36,,,,,,,fee schedule,551.51,1190.36, "Inj, crovalimab-akkz, 10 mg",J1307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,573.57,,,,,,,fee schedule,551.51,1190.36,APC "Inj, crovalimab-akkz, 10 mg",J1307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,579.09,,,,,,,fee schedule,551.51,1190.36,APC "Inj, crovalimab-akkz, 10 mg",J1307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,551.51,,,,,,,fee schedule,551.51,1190.36,APC "Inj, famotidine, 0.25 mg",J1308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, famotidine, 0.25 mg",J1308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, famotidine, 0.25 mg",J1308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, famotidine, 0.25 mg",J1308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Amitriptyline injection,J1320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.19,,,,,,,fee schedule,4.19,5.02, Amitriptyline injection,J1320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.02,,,,,,,fee schedule,4.19,5.02, "Elosulfase alfa, injection",J1322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,477.56,,,,,,,fee schedule,311.95,692.37, "Elosulfase alfa, injection",J1322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,477.56,,,,,,,fee schedule,311.95,692.37, "Elosulfase alfa, injection",J1322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,576.92,,,,,,,fee schedule,311.95,692.37, "Elosulfase alfa, injection",J1322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,692.37,,,,,,,fee schedule,311.95,692.37, "Elosulfase alfa, injection",J1322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,324.42,,,,,,,fee schedule,311.95,692.37,APC "Elosulfase alfa, injection",J1322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,327.54,,,,,,,fee schedule,311.95,692.37,APC "Elosulfase alfa, injection",J1322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,311.95,,,,,,,fee schedule,311.95,692.37,APC "Inj, elranatamab-bcmm, 1 mg",J1323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,288.45,,,,,,,fee schedule,186.79,412.87, "Inj, elranatamab-bcmm, 1 mg",J1323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,288.45,,,,,,,fee schedule,186.79,412.87, "Inj, elranatamab-bcmm, 1 mg",J1323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,344.03,,,,,,,fee schedule,186.79,412.87, "Inj, elranatamab-bcmm, 1 mg",J1323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,412.87,,,,,,,fee schedule,186.79,412.87, "Inj, elranatamab-bcmm, 1 mg",J1323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,194.26,,,,,,,fee schedule,186.79,412.87,APC "Inj, elranatamab-bcmm, 1 mg",J1323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,196.13,,,,,,,fee schedule,186.79,412.87,APC "Inj, elranatamab-bcmm, 1 mg",J1323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,186.79,,,,,,,fee schedule,186.79,412.87,APC Enfuvirtide injection,J1324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.27,,,,,,,fee schedule,1.27,1.53, Enfuvirtide injection,J1324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.53,,,,,,,fee schedule,1.27,1.53, Epoprostenol injection,J1325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,25.21,,,,,,,fee schedule,25.21,36.34, Epoprostenol injection,J1325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.21,,,,,,,fee schedule,25.21,36.34, Epoprostenol injection,J1325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.28,,,,,,,fee schedule,25.21,36.34, Epoprostenol injection,J1325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.34,,,,,,,fee schedule,25.21,36.34, "Inj, zolbetuximab-clzb, 2 mg",J1326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.24,,,,,,,fee schedule,33.65,75.61, "Inj, zolbetuximab-clzb, 2 mg",J1326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.24,,,,,,,fee schedule,33.65,75.61, "Inj, zolbetuximab-clzb, 2 mg",J1326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63,,,,,,,fee schedule,33.65,75.61, "Inj, zolbetuximab-clzb, 2 mg",J1326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75.61,,,,,,,fee schedule,33.65,75.61, "Inj, zolbetuximab-clzb, 2 mg",J1326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.99,,,,,,,fee schedule,33.65,75.61,APC "Inj, zolbetuximab-clzb, 2 mg",J1326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.33,,,,,,,fee schedule,33.65,75.61,APC "Inj, zolbetuximab-clzb, 2 mg",J1326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.65,,,,,,,fee schedule,33.65,75.61,APC Eptifibatide injection,J1327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.06,,,,,,,fee schedule,3.26,22.88, Eptifibatide injection,J1327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.88,,,,,,,fee schedule,3.26,22.88, Eptifibatide injection,J1327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.39,,,,,,,fee schedule,3.26,22.88,APC Eptifibatide injection,J1327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.42,,,,,,,fee schedule,3.26,22.88,APC Eptifibatide injection,J1327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.26,,,,,,,fee schedule,3.26,22.88,APC Ergonovine maleate injection,J1330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.1,,,,,,,fee schedule,9.1,10.92, Ergonovine maleate injection,J1330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.92,,,,,,,fee schedule,9.1,10.92, Ertapenem injection,J1335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.04,,,,,,,fee schedule,14.04,22.12, Ertapenem injection,J1335,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.04,,,,,,,fee schedule,14.04,22.12, Ertapenem injection,J1335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.43,,,,,,,fee schedule,14.04,22.12, Ertapenem injection,J1335,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.12,,,,,,,fee schedule,14.04,22.12, Erythro lactobionate /500 MG,J1364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.82,,,,,,,fee schedule,116.82,144.94, Erythro lactobionate /500 MG,J1364,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.82,,,,,,,fee schedule,116.82,144.94, Erythro lactobionate /500 MG,J1364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,120.77,,,,,,,fee schedule,116.82,144.94, Erythro lactobionate /500 MG,J1364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,144.94,,,,,,,fee schedule,116.82,144.94, "Inj, esomeprazole sod, 1 mg",J1370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.37,,,,,,,fee schedule,0.37,0.45, "Inj, esomeprazole sod, 1 mg",J1370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.45,,,,,,,fee schedule,0.37,0.45, Estradiol valerate 10 MG inj,J1380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.01,,,,,,,fee schedule,12.01,16.26, Estradiol valerate 10 MG inj,J1380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.01,,,,,,,fee schedule,12.01,16.26, Estradiol valerate 10 MG inj,J1380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,12.01,16.26, Estradiol valerate 10 MG inj,J1380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.26,,,,,,,fee schedule,12.01,16.26, Inj estrogen conjugate 25 MG,J1410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,608.24,,,,,,,fee schedule,391.72,879.39, Inj estrogen conjugate 25 MG,J1410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,608.24,,,,,,,fee schedule,391.72,879.39, Inj estrogen conjugate 25 MG,J1410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,732.76,,,,,,,fee schedule,391.72,879.39, Inj estrogen conjugate 25 MG,J1410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,879.39,,,,,,,fee schedule,391.72,879.39, Inj estrogen conjugate 25 MG,J1410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,407.39,,,,,,,fee schedule,391.72,879.39,APC Inj estrogen conjugate 25 MG,J1410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,411.3,,,,,,,fee schedule,391.72,879.39,APC Inj estrogen conjugate 25 MG,J1410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,391.72,,,,,,,fee schedule,391.72,879.39,APC "Injection, casimersen, 10 mg",J1426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,305.02,,,,,,,fee schedule,166.2,366.06, "Injection, casimersen, 10 mg",J1426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,366.06,,,,,,,fee schedule,166.2,366.06, "Injection, casimersen, 10 mg",J1426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,172.85,,,,,,,fee schedule,166.2,366.06,APC "Injection, casimersen, 10 mg",J1426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,174.51,,,,,,,fee schedule,166.2,366.06,APC "Injection, casimersen, 10 mg",J1426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,166.2,,,,,,,fee schedule,166.2,366.06,APC Inj. viltolarsen,J1427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,107.52,,,,,,,fee schedule,107.52,129.04, Inj. viltolarsen,J1427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,129.04,,,,,,,fee schedule,107.52,129.04, "Inj, eteplirsen, 10 mg",J1428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,305.02,,,,,,,fee schedule,167.51,366.06, "Inj, eteplirsen, 10 mg",J1428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,366.06,,,,,,,fee schedule,167.51,366.06, "Inj, eteplirsen, 10 mg",J1428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,174.21,,,,,,,fee schedule,167.51,366.06,APC "Inj, eteplirsen, 10 mg",J1428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,175.89,,,,,,,fee schedule,167.51,366.06,APC "Inj, eteplirsen, 10 mg",J1428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,167.51,,,,,,,fee schedule,167.51,366.06,APC Inj golodirsen 10 mg,J1429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,305.02,,,,,,,fee schedule,305.02,366.06, Inj golodirsen 10 mg,J1429,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,366.06,,,,,,,fee schedule,305.02,366.06, Ethanolamine oleate 100 mg,J1430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,808.68,,,,,,,fee schedule,518.63,1141.6, Ethanolamine oleate 100 mg,J1430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,808.68,,,,,,,fee schedule,518.63,1141.6, Ethanolamine oleate 100 mg,J1430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,951.25,,,,,,,fee schedule,518.63,1141.6, Ethanolamine oleate 100 mg,J1430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1141.6,,,,,,,fee schedule,518.63,1141.6, Ethanolamine oleate 100 mg,J1430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,539.37,,,,,,,fee schedule,518.63,1141.6,APC Ethanolamine oleate 100 mg,J1430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,544.56,,,,,,,fee schedule,518.63,1141.6,APC Ethanolamine oleate 100 mg,J1430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,518.63,,,,,,,fee schedule,518.63,1141.6,APC "Inj, focinvez, 1mg",J1434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.47,,,,,,,fee schedule,2.55,6.37, "Inj, focinvez, 1mg",J1434,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.47,,,,,,,fee schedule,2.55,6.37, "Inj, focinvez, 1mg",J1434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.31,,,,,,,fee schedule,2.55,6.37, "Inj, focinvez, 1mg",J1434,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.37,,,,,,,fee schedule,2.55,6.37, "Inj, focinvez, 1mg",J1434,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.65,,,,,,,fee schedule,2.55,6.37,APC "Inj, focinvez, 1mg",J1434,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.67,,,,,,,fee schedule,2.55,6.37,APC "Inj, focinvez, 1mg",J1434,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.55,,,,,,,fee schedule,2.55,6.37,APC Injection estrone per 1 MG,J1435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.45,,,,,,,fee schedule,0.45,0.54, Injection estrone per 1 MG,J1435,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.54,,,,,,,fee schedule,0.45,0.54, Inj. fe derisomaltose 10 mg,J1437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,29.5,,,,,,,fee schedule,21.93,49.39, Inj. fe derisomaltose 10 mg,J1437,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,29.5,,,,,,,fee schedule,21.93,49.39, Inj. fe derisomaltose 10 mg,J1437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.16,,,,,,,fee schedule,21.93,49.39, Inj. fe derisomaltose 10 mg,J1437,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,49.39,,,,,,,fee schedule,21.93,49.39, Inj. fe derisomaltose 10 mg,J1437,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.81,,,,,,,fee schedule,21.93,49.39,APC Inj. fe derisomaltose 10 mg,J1437,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.03,,,,,,,fee schedule,21.93,49.39,APC Inj. fe derisomaltose 10 mg,J1437,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.93,,,,,,,fee schedule,21.93,49.39,APC Etanercept injection,J1438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1943.93,,,,,,,fee schedule,1943.93,2332.92, Etanercept injection,J1438,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2332.92,,,,,,,fee schedule,1943.93,2332.92, Inj ferric carboxymaltos 1mg,J1439,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.78,,,,,,,fee schedule,1.1,2.49, Inj ferric carboxymaltos 1mg,J1439,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.78,,,,,,,fee schedule,1.1,2.49, Inj ferric carboxymaltos 1mg,J1439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.07,,,,,,,fee schedule,1.1,2.49, Inj ferric carboxymaltos 1mg,J1439,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.49,,,,,,,fee schedule,1.1,2.49, Inj ferric carboxymaltos 1mg,J1439,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.15,,,,,,,fee schedule,1.1,2.49,APC Inj ferric carboxymaltos 1mg,J1439,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.16,,,,,,,fee schedule,1.1,2.49,APC Inj ferric carboxymaltos 1mg,J1439,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.1,,,,,,,fee schedule,1.1,2.49,APC Fecal?microbiota jslm 1 ml,J1440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,99.68,,,,,,,fee schedule,64.32,143.19, Fecal?microbiota jslm 1 ml,J1440,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,99.68,,,,,,,fee schedule,64.32,143.19, Fecal?microbiota jslm 1 ml,J1440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.32,,,,,,,fee schedule,64.32,143.19, Fecal?microbiota jslm 1 ml,J1440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,143.19,,,,,,,fee schedule,64.32,143.19, Fecal?microbiota jslm 1 ml,J1440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.89,,,,,,,fee schedule,64.32,143.19,APC Fecal?microbiota jslm 1 ml,J1440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.54,,,,,,,fee schedule,64.32,143.19,APC Fecal?microbiota jslm 1 ml,J1440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.32,,,,,,,fee schedule,64.32,143.19,APC Inj filgrastim excl biosimil,J1442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.53,,,,,,,fee schedule,1.02,2.24, Inj filgrastim excl biosimil,J1442,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.53,,,,,,,fee schedule,1.02,2.24, Inj filgrastim excl biosimil,J1442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.87,,,,,,,fee schedule,1.02,2.24, Inj filgrastim excl biosimil,J1442,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.24,,,,,,,fee schedule,1.02,2.24, Inj filgrastim excl biosimil,J1442,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.06,,,,,,,fee schedule,1.02,2.24,APC Inj filgrastim excl biosimil,J1442,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.07,,,,,,,fee schedule,1.02,2.24,APC Inj filgrastim excl biosimil,J1442,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.02,,,,,,,fee schedule,1.02,2.24,APC Inj ferric pyrophosphate cit,J1443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.06,0.07, Inj ferric pyrophosphate cit,J1443,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.06,0.07, Fe pyro cit pow 0.1 mg iron,J1444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.06,0.07, Fe pyro cit pow 0.1 mg iron,J1444,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.06,0.07, Inj triferic avnu 0.1mg iron,J1445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.34,,,,,,,fee schedule,0.34,0.4, Inj triferic avnu 0.1mg iron,J1445,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.4,,,,,,,fee schedule,0.34,0.4, Inj tbo filgrastim 1 microg,J1447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.46,,,,,,,fee schedule,0.25,0.63, Inj tbo filgrastim 1 microg,J1447,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.46,,,,,,,fee schedule,0.25,0.63, Inj tbo filgrastim 1 microg,J1447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.52,,,,,,,fee schedule,0.25,0.63, Inj tbo filgrastim 1 microg,J1447,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.63,,,,,,,fee schedule,0.25,0.63, Inj tbo filgrastim 1 microg,J1447,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.26,,,,,,,fee schedule,0.25,0.63,APC Inj tbo filgrastim 1 microg,J1447,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.26,,,,,,,fee schedule,0.25,0.63,APC Inj tbo filgrastim 1 microg,J1447,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.25,,,,,,,fee schedule,0.25,0.63,APC "Injection, trilaciclib, 1mg",J1448,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.4,,,,,,,fee schedule,5.49,12.25, "Injection, trilaciclib, 1mg",J1448,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.4,,,,,,,fee schedule,5.49,12.25, "Injection, trilaciclib, 1mg",J1448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.2,,,,,,,fee schedule,5.49,12.25, "Injection, trilaciclib, 1mg",J1448,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.25,,,,,,,fee schedule,5.49,12.25, "Injection, trilaciclib, 1mg",J1448,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.71,,,,,,,fee schedule,5.49,12.25,APC "Injection, trilaciclib, 1mg",J1448,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.76,,,,,,,fee schedule,5.49,12.25,APC "Injection, trilaciclib, 1mg",J1448,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.49,,,,,,,fee schedule,5.49,12.25,APC Inj eflapegrastim-xnst 0.1mg,J1449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.87,,,,,,,fee schedule,32.87,46.81, Inj eflapegrastim-xnst 0.1mg,J1449,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.87,,,,,,,fee schedule,32.87,46.81, Inj eflapegrastim-xnst 0.1mg,J1449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.01,,,,,,,fee schedule,32.87,46.81, Inj eflapegrastim-xnst 0.1mg,J1449,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.81,,,,,,,fee schedule,32.87,46.81, Inj eflapegrastim-xnst 0.1mg,J1449,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.51,,,,,,,fee schedule,32.87,46.81,APC Inj eflapegrastim-xnst 0.1mg,J1449,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.9,,,,,,,fee schedule,32.87,46.81,APC Inj eflapegrastim-xnst 0.1mg,J1449,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.96,,,,,,,fee schedule,32.87,46.81,APC Fluconazole,J1450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.51,,,,,,,fee schedule,3.51,5.07, Fluconazole,J1450,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.51,,,,,,,fee schedule,3.51,5.07, Fluconazole,J1450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.22,,,,,,,fee schedule,3.51,5.07, Fluconazole,J1450,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.07,,,,,,,fee schedule,3.51,5.07, "Fomepizole, 15 mg",J1451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.09,,,,,,,fee schedule,6.54,28.91, "Fomepizole, 15 mg",J1451,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.91,,,,,,,fee schedule,6.54,28.91, "Fomepizole, 15 mg",J1451,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.8,,,,,,,fee schedule,6.54,28.91,APC "Fomepizole, 15 mg",J1451,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.87,,,,,,,fee schedule,6.54,28.91,APC "Fomepizole, 15 mg",J1451,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.54,,,,,,,fee schedule,6.54,28.91,APC Intraocular Fomivirsen na,J1452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,396.23,,,,,,,fee schedule,396.23,475.52, Intraocular Fomivirsen na,J1452,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,475.52,,,,,,,fee schedule,396.23,475.52, Fosaprepitant injection,J1453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.18,,,,,,,fee schedule,0.18,0.22, Fosaprepitant injection,J1453,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.18,,,,,,,fee schedule,0.18,0.22, Fosaprepitant injection,J1453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.19,,,,,,,fee schedule,0.18,0.22, Fosaprepitant injection,J1453,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.22,,,,,,,fee schedule,0.18,0.22, "Inj fosnetupitant, palonoset",J1454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,943.85,,,,,,,fee schedule,524.18,1290.85, "Inj fosnetupitant, palonoset",J1454,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,943.85,,,,,,,fee schedule,524.18,1290.85, "Inj fosnetupitant, palonoset",J1454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1075.61,,,,,,,fee schedule,524.18,1290.85, "Inj fosnetupitant, palonoset",J1454,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1290.85,,,,,,,fee schedule,524.18,1290.85, "Inj fosnetupitant, palonoset",J1454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,545.14,,,,,,,fee schedule,524.18,1290.85,APC "Inj fosnetupitant, palonoset",J1454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,550.39,,,,,,,fee schedule,524.18,1290.85,APC "Inj fosnetupitant, palonoset",J1454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,524.18,,,,,,,fee schedule,524.18,1290.85,APC Foscarnet sodium injection,J1455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.26,,,,,,,fee schedule,24.26,36.07, Foscarnet sodium injection,J1455,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.26,,,,,,,fee schedule,24.26,36.07, Foscarnet sodium injection,J1455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.05,,,,,,,fee schedule,24.26,36.07, Foscarnet sodium injection,J1455,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.07,,,,,,,fee schedule,24.26,36.07, "Inj, fosaprepitant (teva)",J1456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.77,,,,,,,fee schedule,0.04,2.31, "Inj, fosaprepitant (teva)",J1456,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.77,,,,,,,fee schedule,0.04,2.31, "Inj, fosaprepitant (teva)",J1456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.93,,,,,,,fee schedule,0.04,2.31, "Inj, fosaprepitant (teva)",J1456,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.31,,,,,,,fee schedule,0.04,2.31, "Inj, fosaprepitant (teva)",J1456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.04,,,,,,,fee schedule,0.04,2.31,APC "Inj, fosaprepitant (teva)",J1456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.04,,,,,,,fee schedule,0.04,2.31,APC "Inj, fosaprepitant (teva)",J1456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.04,,,,,,,fee schedule,0.04,2.31,APC Gallium nitrate injection,J1457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.89,,,,,,,fee schedule,3.89,4.67, Gallium nitrate injection,J1457,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.67,,,,,,,fee schedule,3.89,4.67, Galsulfase injection,J1458,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,786.87,,,,,,,fee schedule,513.6,1141.15, Galsulfase injection,J1458,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,786.87,,,,,,,fee schedule,513.6,1141.15, Galsulfase injection,J1458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,950.87,,,,,,,fee schedule,513.6,1141.15, Galsulfase injection,J1458,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1141.15,,,,,,,fee schedule,513.6,1141.15, Galsulfase injection,J1458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,534.14,,,,,,,fee schedule,513.6,1141.15,APC Galsulfase injection,J1458,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,539.27,,,,,,,fee schedule,513.6,1141.15,APC Galsulfase injection,J1458,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,513.6,,,,,,,fee schedule,513.6,1141.15,APC Inj IVIG privigen 500 mg,J1459,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.51,,,,,,,fee schedule,49.53,113.81, Inj IVIG privigen 500 mg,J1459,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.51,,,,,,,fee schedule,49.53,113.81, Inj IVIG privigen 500 mg,J1459,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.83,,,,,,,fee schedule,49.53,113.81, Inj IVIG privigen 500 mg,J1459,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,113.81,,,,,,,fee schedule,49.53,113.81, Inj IVIG privigen 500 mg,J1459,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,51.51,,,,,,,fee schedule,49.53,113.81,APC Inj IVIG privigen 500 mg,J1459,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.01,,,,,,,fee schedule,49.53,113.81,APC Inj IVIG privigen 500 mg,J1459,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.53,,,,,,,fee schedule,49.53,113.81,APC Gamma globulin 1 CC inj,J1460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.37,,,,,,,fee schedule,48.95,109.97, Gamma globulin 1 CC inj,J1460,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.37,,,,,,,fee schedule,48.95,109.97, Gamma globulin 1 CC inj,J1460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,91.64,,,,,,,fee schedule,48.95,109.97, Gamma globulin 1 CC inj,J1460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.97,,,,,,,fee schedule,48.95,109.97, Gamma globulin 1 CC inj,J1460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.91,,,,,,,fee schedule,48.95,109.97,APC Gamma globulin 1 CC inj,J1460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.4,,,,,,,fee schedule,48.95,109.97,APC Gamma globulin 1 CC inj,J1460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.95,,,,,,,fee schedule,48.95,109.97,APC Inj cutaquig 100 mg,J1551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.11,,,,,,,fee schedule,13.93,31.92, Inj cutaquig 100 mg,J1551,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.11,,,,,,,fee schedule,13.93,31.92, Inj cutaquig 100 mg,J1551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.6,,,,,,,fee schedule,13.93,31.92, Inj cutaquig 100 mg,J1551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,31.92,,,,,,,fee schedule,13.93,31.92, Inj cutaquig 100 mg,J1551,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.48,,,,,,,fee schedule,13.93,31.92,APC Inj cutaquig 100 mg,J1551,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.62,,,,,,,fee schedule,13.93,31.92,APC Inj cutaquig 100 mg,J1551,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.93,,,,,,,fee schedule,13.93,31.92,APC "Inj, alyglo, 500 mg",J1552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,204.11,,,,,,,fee schedule,123.12,292.13, "Inj, alyglo, 500 mg",J1552,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,204.11,,,,,,,fee schedule,123.12,292.13, "Inj, alyglo, 500 mg",J1552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,243.42,,,,,,,fee schedule,123.12,292.13, "Inj, alyglo, 500 mg",J1552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,292.13,,,,,,,fee schedule,123.12,292.13, "Inj, alyglo, 500 mg",J1552,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,128.05,,,,,,,fee schedule,123.12,292.13,APC "Inj, alyglo, 500 mg",J1552,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,129.28,,,,,,,fee schedule,123.12,292.13,APC "Inj, alyglo, 500 mg",J1552,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,123.12,,,,,,,fee schedule,123.12,292.13,APC Inj. asceniv,J1554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,772.86,,,,,,,fee schedule,500.93,1114.19, Inj. asceniv,J1554,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,772.86,,,,,,,fee schedule,500.93,1114.19, Inj. asceniv,J1554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,928.41,,,,,,,fee schedule,500.93,1114.19, Inj. asceniv,J1554,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1114.19,,,,,,,fee schedule,500.93,1114.19, Inj. asceniv,J1554,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,520.96,,,,,,,fee schedule,500.93,1114.19,APC Inj. asceniv,J1554,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,525.97,,,,,,,fee schedule,500.93,1114.19,APC Inj. asceniv,J1554,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,500.93,,,,,,,fee schedule,500.93,1114.19,APC "Inj cuvitru, 100 mg",J1555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.37,,,,,,,fee schedule,17.58,37.77, "Inj cuvitru, 100 mg",J1555,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.37,,,,,,,fee schedule,17.58,37.77, "Inj cuvitru, 100 mg",J1555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.47,,,,,,,fee schedule,17.58,37.77, "Inj cuvitru, 100 mg",J1555,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,37.77,,,,,,,fee schedule,17.58,37.77, "Inj cuvitru, 100 mg",J1555,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.28,,,,,,,fee schedule,17.58,37.77,APC "Inj cuvitru, 100 mg",J1555,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.46,,,,,,,fee schedule,17.58,37.77,APC "Inj cuvitru, 100 mg",J1555,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.58,,,,,,,fee schedule,17.58,37.77,APC "Inj, imm glob bivigam, 500mg",J1556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,120.27,,,,,,,fee schedule,79.44,173.59, "Inj, imm glob bivigam, 500mg",J1556,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,120.27,,,,,,,fee schedule,79.44,173.59, "Inj, imm glob bivigam, 500mg",J1556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,144.64,,,,,,,fee schedule,79.44,173.59, "Inj, imm glob bivigam, 500mg",J1556,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,173.59,,,,,,,fee schedule,79.44,173.59, "Inj, imm glob bivigam, 500mg",J1556,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.62,,,,,,,fee schedule,79.44,173.59,APC "Inj, imm glob bivigam, 500mg",J1556,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,83.41,,,,,,,fee schedule,79.44,173.59,APC "Inj, imm glob bivigam, 500mg",J1556,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79.44,,,,,,,fee schedule,79.44,173.59,APC Gammaplex injection,J1557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.23,,,,,,,fee schedule,64.65,142.83, Gammaplex injection,J1557,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,97.23,,,,,,,fee schedule,64.65,142.83, Gammaplex injection,J1557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.02,,,,,,,fee schedule,64.65,142.83, Gammaplex injection,J1557,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.83,,,,,,,fee schedule,64.65,142.83, Gammaplex injection,J1557,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,67.24,,,,,,,fee schedule,64.65,142.83,APC Gammaplex injection,J1557,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.88,,,,,,,fee schedule,64.65,142.83,APC Gammaplex injection,J1557,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.65,,,,,,,fee schedule,64.65,142.83,APC "Inj. xembify, 100 mg",J1558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.22,,,,,,,fee schedule,15.37,33.29, "Inj. xembify, 100 mg",J1558,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.22,,,,,,,fee schedule,15.37,33.29, "Inj. xembify, 100 mg",J1558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.74,,,,,,,fee schedule,15.37,33.29, "Inj. xembify, 100 mg",J1558,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.29,,,,,,,fee schedule,15.37,33.29, "Inj. xembify, 100 mg",J1558,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.98,,,,,,,fee schedule,15.37,33.29,APC "Inj. xembify, 100 mg",J1558,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16.14,,,,,,,fee schedule,15.37,33.29,APC "Inj. xembify, 100 mg",J1558,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.37,,,,,,,fee schedule,15.37,33.29,APC Hizentra injection,J1559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.98,,,,,,,fee schedule,14.52,32.16, Hizentra injection,J1559,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.98,,,,,,,fee schedule,14.52,32.16, Hizentra injection,J1559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.8,,,,,,,fee schedule,14.52,32.16, Hizentra injection,J1559,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.16,,,,,,,fee schedule,14.52,32.16, Hizentra injection,J1559,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.1,,,,,,,fee schedule,14.52,32.16,APC Hizentra injection,J1559,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.24,,,,,,,fee schedule,14.52,32.16,APC Hizentra injection,J1559,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.52,,,,,,,fee schedule,14.52,32.16,APC Gamma globulin > 10 CC inj,J1560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,260.06,,,,,,,fee schedule,160.29,382.39, Gamma globulin > 10 CC inj,J1560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,260.06,,,,,,,fee schedule,160.29,382.39, Gamma globulin > 10 CC inj,J1560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,318.63,,,,,,,fee schedule,160.29,382.39, Gamma globulin > 10 CC inj,J1560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,382.39,,,,,,,fee schedule,160.29,382.39, Gamma globulin > 10 CC inj,J1560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,166.7,,,,,,,fee schedule,160.29,382.39,APC Gamma globulin > 10 CC inj,J1560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,168.3,,,,,,,fee schedule,160.29,382.39,APC Gamma globulin > 10 CC inj,J1560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,160.29,,,,,,,fee schedule,160.29,382.39,APC Gamunex-c/gammaked,J1561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.76,,,,,,,fee schedule,49.73,109.82, Gamunex-c/gammaked,J1561,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.76,,,,,,,fee schedule,49.73,109.82, Gamunex-c/gammaked,J1561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,91.51,,,,,,,fee schedule,49.73,109.82, Gamunex-c/gammaked,J1561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,109.82,,,,,,,fee schedule,49.73,109.82, Gamunex-c/gammaked,J1561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,51.72,,,,,,,fee schedule,49.73,109.82,APC Gamunex-c/gammaked,J1561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.21,,,,,,,fee schedule,49.73,109.82,APC Gamunex-c/gammaked,J1561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.73,,,,,,,fee schedule,49.73,109.82,APC "Immune globulin, powder",J1566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,127.18,,,,,,,fee schedule,80.4,176.73, "Immune globulin, powder",J1566,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.18,,,,,,,fee schedule,80.4,176.73, "Immune globulin, powder",J1566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,147.26,,,,,,,fee schedule,80.4,176.73, "Immune globulin, powder",J1566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,176.73,,,,,,,fee schedule,80.4,176.73, "Immune globulin, powder",J1566,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,83.61,,,,,,,fee schedule,80.4,176.73,APC "Immune globulin, powder",J1566,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,84.41,,,,,,,fee schedule,80.4,176.73,APC "Immune globulin, powder",J1566,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,80.4,,,,,,,fee schedule,80.4,176.73,APC Octagam injection,J1568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.31,,,,,,,fee schedule,47.04,106.59, Octagam injection,J1568,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.31,,,,,,,fee schedule,47.04,106.59, Octagam injection,J1568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.81,,,,,,,fee schedule,47.04,106.59, Octagam injection,J1568,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,106.59,,,,,,,fee schedule,47.04,106.59, Octagam injection,J1568,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.92,,,,,,,fee schedule,47.04,106.59,APC Octagam injection,J1568,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.39,,,,,,,fee schedule,47.04,106.59,APC Octagam injection,J1568,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.04,,,,,,,fee schedule,47.04,106.59,APC Gammagard liquid injection,J1569,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.4,,,,,,,fee schedule,49.08,101.63, Gammagard liquid injection,J1569,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.4,,,,,,,fee schedule,49.08,101.63, Gammagard liquid injection,J1569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.68,,,,,,,fee schedule,49.08,101.63, Gammagard liquid injection,J1569,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,101.63,,,,,,,fee schedule,49.08,101.63, Gammagard liquid injection,J1569,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,51.04,,,,,,,fee schedule,49.08,101.63,APC Gammagard liquid injection,J1569,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.54,,,,,,,fee schedule,49.08,101.63,APC Gammagard liquid injection,J1569,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.08,,,,,,,fee schedule,49.08,101.63,APC Ganciclovir sodium injection,J1570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.68,,,,,,,fee schedule,61.68,88.69, Ganciclovir sodium injection,J1570,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.68,,,,,,,fee schedule,61.68,88.69, Ganciclovir sodium injection,J1570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,73.9,,,,,,,fee schedule,61.68,88.69, Ganciclovir sodium injection,J1570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.69,,,,,,,fee schedule,61.68,88.69, HepaGam B IM injection,J1571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.56,,,,,,,fee schedule,70.23,149.47, HepaGam B IM injection,J1571,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.56,,,,,,,fee schedule,70.23,149.47, HepaGam B IM injection,J1571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,124.55,,,,,,,fee schedule,70.23,149.47, HepaGam B IM injection,J1571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,149.47,,,,,,,fee schedule,70.23,149.47, HepaGam B IM injection,J1571,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.04,,,,,,,fee schedule,70.23,149.47,APC HepaGam B IM injection,J1571,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.75,,,,,,,fee schedule,70.23,149.47,APC HepaGam B IM injection,J1571,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.23,,,,,,,fee schedule,70.23,149.47,APC Flebogamma injection,J1572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,100.93,,,,,,,fee schedule,90.74,121.12, Flebogamma injection,J1572,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,121.12,,,,,,,fee schedule,90.74,121.12, Flebogamma injection,J1572,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,94.37,,,,,,,fee schedule,90.74,121.12,APC Flebogamma injection,J1572,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,95.28,,,,,,,fee schedule,90.74,121.12,APC Flebogamma injection,J1572,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,90.74,,,,,,,fee schedule,90.74,121.12,APC "Hepagam B intravenous, inj",J1573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.56,,,,,,,fee schedule,70.23,149.47, "Hepagam B intravenous, inj",J1573,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.56,,,,,,,fee schedule,70.23,149.47, "Hepagam B intravenous, inj",J1573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,124.55,,,,,,,fee schedule,70.23,149.47, "Hepagam B intravenous, inj",J1573,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,149.47,,,,,,,fee schedule,70.23,149.47, "Hepagam B intravenous, inj",J1573,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.04,,,,,,,fee schedule,70.23,149.47,APC "Hepagam B intravenous, inj",J1573,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.75,,,,,,,fee schedule,70.23,149.47,APC "Hepagam B intravenous, inj",J1573,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.23,,,,,,,fee schedule,70.23,149.47,APC "Inj, ganciclovir (exela)",J1574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.32,,,,,,,fee schedule,95.32,114.39, "Inj, ganciclovir (exela)",J1574,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,114.39,,,,,,,fee schedule,95.32,114.39, Hyqvia 100mg immuneglobulin,J1575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.63,,,,,,,fee schedule,18.8,40.71, Hyqvia 100mg immuneglobulin,J1575,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.63,,,,,,,fee schedule,18.8,40.71, Hyqvia 100mg immuneglobulin,J1575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.92,,,,,,,fee schedule,18.8,40.71, Hyqvia 100mg immuneglobulin,J1575,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.71,,,,,,,fee schedule,18.8,40.71, Hyqvia 100mg immuneglobulin,J1575,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.56,,,,,,,fee schedule,18.8,40.71,APC Hyqvia 100mg immuneglobulin,J1575,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.74,,,,,,,fee schedule,18.8,40.71,APC Hyqvia 100mg immuneglobulin,J1575,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.8,,,,,,,fee schedule,18.8,40.71,APC "Inj, panzyga, 500 mg",J1576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.9,,,,,,,fee schedule,73.83,163.74, "Inj, panzyga, 500 mg",J1576,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,115.9,,,,,,,fee schedule,73.83,163.74, "Inj, panzyga, 500 mg",J1576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.44,,,,,,,fee schedule,73.83,163.74, "Inj, panzyga, 500 mg",J1576,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,163.74,,,,,,,fee schedule,73.83,163.74, "Inj, panzyga, 500 mg",J1576,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.78,,,,,,,fee schedule,73.83,163.74,APC "Inj, panzyga, 500 mg",J1576,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77.52,,,,,,,fee schedule,73.83,163.74,APC "Inj, panzyga, 500 mg",J1576,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.83,,,,,,,fee schedule,73.83,163.74,APC Garamycin gentamicin inj,J1580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.08,,,,,,,fee schedule,4.08,4.96, Garamycin gentamicin inj,J1580,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.08,,,,,,,fee schedule,4.08,4.96, Garamycin gentamicin inj,J1580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.13,,,,,,,fee schedule,4.08,4.96, Garamycin gentamicin inj,J1580,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.96,,,,,,,fee schedule,4.08,4.96, Injection glatiramer acetate,J1595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,119.15,,,,,,,fee schedule,119.15,142.99, Injection glatiramer acetate,J1595,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.99,,,,,,,fee schedule,119.15,142.99, "Inj, glycopyrrolate, 0.1 mg",J1596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.68,,,,,,,fee schedule,0.68,1.03, "Inj, glycopyrrolate, 0.1 mg",J1596,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.68,,,,,,,fee schedule,0.68,1.03, "Inj, glycopyrrolate, 0.1 mg",J1596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.86,,,,,,,fee schedule,0.68,1.03, "Inj, glycopyrrolate, 0.1 mg",J1596,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.03,,,,,,,fee schedule,0.68,1.03, "Inj glycopyrrolate, glyrx-pf",J1597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.05,,,,,,,fee schedule,3.05,3.66, "Inj glycopyrrolate, glyrx-pf",J1597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.66,,,,,,,fee schedule,3.05,3.66, Inj glycopyrrolate fres kabi,J1598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.89,,,,,,,fee schedule,2.5,3.01, Inj glycopyrrolate fres kabi,J1598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.89,,,,,,,fee schedule,2.5,3.01, Inj glycopyrrolate fres kabi,J1598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.5,,,,,,,fee schedule,2.5,3.01, Inj glycopyrrolate fres kabi,J1598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.01,,,,,,,fee schedule,2.5,3.01, "Ivig non-lyophilized, NOS",J1599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,284.05,,,,,,,fee schedule,284.05,340.89, "Ivig non-lyophilized, NOS",J1599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,340.89,,,,,,,fee schedule,284.05,340.89, Gold sodium thiomaleate inj,J1600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.35,,,,,,,fee schedule,56.35,67.63, Gold sodium thiomaleate inj,J1600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.63,,,,,,,fee schedule,56.35,67.63, Golimumab for iv use 1mg,J1602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.16,,,,,,,fee schedule,11.29,24.76, Golimumab for iv use 1mg,J1602,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.16,,,,,,,fee schedule,11.29,24.76, Golimumab for iv use 1mg,J1602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.63,,,,,,,fee schedule,11.29,24.76, Golimumab for iv use 1mg,J1602,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.76,,,,,,,fee schedule,11.29,24.76, Golimumab for iv use 1mg,J1602,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.74,,,,,,,fee schedule,11.29,24.76,APC Golimumab for iv use 1mg,J1602,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.85,,,,,,,fee schedule,11.29,24.76,APC Golimumab for iv use 1mg,J1602,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.29,,,,,,,fee schedule,11.29,24.76,APC Glucagon hydrochloride/1 mg,J1610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,304.77,,,,,,,fee schedule,146.33,409.24, Glucagon hydrochloride/1 mg,J1610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,304.77,,,,,,,fee schedule,146.33,409.24, Glucagon hydrochloride/1 mg,J1610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,341,,,,,,,fee schedule,146.33,409.24, Glucagon hydrochloride/1 mg,J1610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,409.24,,,,,,,fee schedule,146.33,409.24, Glucagon hydrochloride/1 mg,J1610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.19,,,,,,,fee schedule,146.33,409.24,APC Glucagon hydrochloride/1 mg,J1610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,153.65,,,,,,,fee schedule,146.33,409.24,APC Glucagon hydrochloride/1 mg,J1610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,146.33,,,,,,,fee schedule,146.33,409.24,APC "Inj glucagon hcl, fresenius",J1611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,225.52,,,,,,,fee schedule,135,334.18, "Inj glucagon hcl, fresenius",J1611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,225.52,,,,,,,fee schedule,135,334.18, "Inj glucagon hcl, fresenius",J1611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,278.46,,,,,,,fee schedule,135,334.18, "Inj glucagon hcl, fresenius",J1611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,334.18,,,,,,,fee schedule,135,334.18, "Inj glucagon hcl, fresenius",J1611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,140.4,,,,,,,fee schedule,135,334.18,APC "Inj glucagon hcl, fresenius",J1611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,141.75,,,,,,,fee schedule,135,334.18,APC "Inj glucagon hcl, fresenius",J1611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,135,,,,,,,fee schedule,135,334.18,APC Inj glucagon (gvoke) 0.01 mg,J1612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.8,,,,,,,fee schedule,2.37,5.76, Inj glucagon (gvoke) 0.01 mg,J1612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.76,,,,,,,fee schedule,2.37,5.76, Inj glucagon (gvoke) 0.01 mg,J1612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.46,,,,,,,fee schedule,2.37,5.76,APC Inj glucagon (gvoke) 0.01 mg,J1612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.48,,,,,,,fee schedule,2.37,5.76,APC Inj glucagon (gvoke) 0.01 mg,J1612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.37,,,,,,,fee schedule,2.37,5.76,APC Granisetron hcl injection,J1626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.35,,,,,,,fee schedule,0.34,0.4, Granisetron hcl injection,J1626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.35,,,,,,,fee schedule,0.34,0.4, Granisetron hcl injection,J1626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.34,,,,,,,fee schedule,0.34,0.4, Granisetron hcl injection,J1626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.4,,,,,,,fee schedule,0.34,0.4, "Inj, granisetron, xr, 0.1 mg",J1627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.72,,,,,,,fee schedule,3.88,9.62, "Inj, granisetron, xr, 0.1 mg",J1627,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.72,,,,,,,fee schedule,3.88,9.62, "Inj, granisetron, xr, 0.1 mg",J1627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.02,,,,,,,fee schedule,3.88,9.62, "Inj, granisetron, xr, 0.1 mg",J1627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.62,,,,,,,fee schedule,3.88,9.62, "Inj, granisetron, xr, 0.1 mg",J1627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.03,,,,,,,fee schedule,3.88,9.62,APC "Inj, granisetron, xr, 0.1 mg",J1627,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.07,,,,,,,fee schedule,3.88,9.62,APC "Inj, granisetron, xr, 0.1 mg",J1627,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.88,,,,,,,fee schedule,3.88,9.62,APC "Inj., guselkumab, 1 mg",J1628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.54,,,,,,,fee schedule,67.81,170.4, "Inj., guselkumab, 1 mg",J1628,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,116.54,,,,,,,fee schedule,67.81,170.4, "Inj., guselkumab, 1 mg",J1628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,141.99,,,,,,,fee schedule,67.81,170.4, "Inj., guselkumab, 1 mg",J1628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.4,,,,,,,fee schedule,67.81,170.4, "Inj., guselkumab, 1 mg",J1628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,70.53,,,,,,,fee schedule,67.81,170.4,APC "Inj., guselkumab, 1 mg",J1628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,71.2,,,,,,,fee schedule,67.81,170.4,APC "Inj., guselkumab, 1 mg",J1628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,67.81,,,,,,,fee schedule,67.81,170.4,APC Haloperidol injection,J1630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.3,,,,,,,fee schedule,1.3,1.79, Haloperidol injection,J1630,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.3,,,,,,,fee schedule,1.3,1.79, Haloperidol injection,J1630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.5,,,,,,,fee schedule,1.3,1.79, Haloperidol injection,J1630,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.79,,,,,,,fee schedule,1.3,1.79, Haloperidol decanoate inj,J1631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.29,,,,,,,fee schedule,7.29,9.87, Haloperidol decanoate inj,J1631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.29,,,,,,,fee schedule,7.29,9.87, Haloperidol decanoate inj,J1631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.22,,,,,,,fee schedule,7.29,9.87, Haloperidol decanoate inj,J1631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.87,,,,,,,fee schedule,7.29,9.87, "Inj., brexanolone, 1 mg",J1632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,142.03,,,,,,,fee schedule,142.03,170.45, "Inj., brexanolone, 1 mg",J1632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.45,,,,,,,fee schedule,142.03,170.45, "Hemin, 1 mg",J1640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.18,,,,,,,fee schedule,35.31,76.67, "Hemin, 1 mg",J1640,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.18,,,,,,,fee schedule,35.31,76.67, "Hemin, 1 mg",J1640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.88,,,,,,,fee schedule,35.31,76.67, "Hemin, 1 mg",J1640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.67,,,,,,,fee schedule,35.31,76.67, "Hemin, 1 mg",J1640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.72,,,,,,,fee schedule,35.31,76.67,APC "Hemin, 1 mg",J1640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.07,,,,,,,fee schedule,35.31,76.67,APC "Hemin, 1 mg",J1640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.31,,,,,,,fee schedule,35.31,76.67,APC Inj heparin sodium per 10 u,J1642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.03,,,,,,,fee schedule,0.03,0.04, Inj heparin sodium per 10 u,J1642,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.03,,,,,,,fee schedule,0.03,0.04, Inj heparin sodium per 10 u,J1642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.04,,,,,,,fee schedule,0.03,0.04, Inj heparin sodium per 10 u,J1642,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.04,,,,,,,fee schedule,0.03,0.04, "Inj heparin, pfizer, 1000u",J1643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.69,,,,,,,fee schedule,4.69,6.75, "Inj heparin, pfizer, 1000u",J1643,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.69,,,,,,,fee schedule,4.69,6.75, "Inj heparin, pfizer, 1000u",J1643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.63,,,,,,,fee schedule,4.69,6.75, "Inj heparin, pfizer, 1000u",J1643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.75,,,,,,,fee schedule,4.69,6.75, Inj heparin sodium per 1000u,J1644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.35,,,,,,,fee schedule,0.35,0.47, Inj heparin sodium per 1000u,J1644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.35,,,,,,,fee schedule,0.35,0.47, Inj heparin sodium per 1000u,J1644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.39,,,,,,,fee schedule,0.35,0.47, Inj heparin sodium per 1000u,J1644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.47,,,,,,,fee schedule,0.35,0.47, Dalteparin sodium,J1645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.08,,,,,,,fee schedule,28.08,37.1, Dalteparin sodium,J1645,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.08,,,,,,,fee schedule,28.08,37.1, Dalteparin sodium,J1645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.91,,,,,,,fee schedule,28.08,37.1, Dalteparin sodium,J1645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,37.1,,,,,,,fee schedule,28.08,37.1, Inj enoxaparin sodium,J1650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.89,,,,,,,fee schedule,0.89,1.32, Inj enoxaparin sodium,J1650,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.89,,,,,,,fee schedule,0.89,1.32, Inj enoxaparin sodium,J1650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.1,,,,,,,fee schedule,0.89,1.32, Inj enoxaparin sodium,J1650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.32,,,,,,,fee schedule,0.89,1.32, Fondaparinux sodium,J1652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.12,,,,,,,fee schedule,1.12,1.61, Fondaparinux sodium,J1652,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.12,,,,,,,fee schedule,1.12,1.61, Fondaparinux sodium,J1652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.35,,,,,,,fee schedule,1.12,1.61, Fondaparinux sodium,J1652,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.61,,,,,,,fee schedule,1.12,1.61, Tinzaparin sodium injection,J1655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.52,,,,,,,fee schedule,6.52,7.83, Tinzaparin sodium injection,J1655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.83,,,,,,,fee schedule,6.52,7.83, Tetanus immune globulin inj,J1670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,898.23,,,,,,,fee schedule,558.12,1330.1, Tetanus immune globulin inj,J1670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,898.23,,,,,,,fee schedule,558.12,1330.1, Tetanus immune globulin inj,J1670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1108.32,,,,,,,fee schedule,558.12,1330.1, Tetanus immune globulin inj,J1670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1330.1,,,,,,,fee schedule,558.12,1330.1, Tetanus immune globulin inj,J1670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,580.44,,,,,,,fee schedule,558.12,1330.1,APC Tetanus immune globulin inj,J1670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,586.02,,,,,,,fee schedule,558.12,1330.1,APC Tetanus immune globulin inj,J1670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,558.12,,,,,,,fee schedule,558.12,1330.1,APC Histrelin acetate,J1675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.53,,,,,,,fee schedule,1.53,1.84, Histrelin acetate,J1675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.84,,,,,,,fee schedule,1.53,1.84, Hydrocortisone acetate inj,J1700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.21,,,,,,,fee schedule,1.21,1.46, Hydrocortisone acetate inj,J1700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.46,,,,,,,fee schedule,1.21,1.46, Hydrocortisone sodium ph inj,J1710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.75,,,,,,,fee schedule,8.75,10.5, Hydrocortisone sodium ph inj,J1710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.5,,,,,,,fee schedule,8.75,10.5, Hydrocortisone sodium succ i,J1720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33,,,,,,,fee schedule,33,47.8, Hydrocortisone sodium succ i,J1720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33,,,,,,,fee schedule,33,47.8, Hydrocortisone sodium succ i,J1720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.83,,,,,,,fee schedule,33,47.8, Hydrocortisone sodium succ i,J1720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.8,,,,,,,fee schedule,33,47.8, Inj hydroxyprogst capoat nos,J1729,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26,,,,,,,fee schedule,26,31.2, Inj hydroxyprogst capoat nos,J1729,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,31.2,,,,,,,fee schedule,26,31.2, Inj. meloxicam 1 mg,J1738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.98,,,,,,,fee schedule,5.98,7.18, Inj. meloxicam 1 mg,J1738,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.18,,,,,,,fee schedule,5.98,7.18, Ibandronate sodium injection,J1740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.95,,,,,,,fee schedule,47.95,64.17, Ibandronate sodium injection,J1740,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.95,,,,,,,fee schedule,47.95,64.17, Ibandronate sodium injection,J1740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.47,,,,,,,fee schedule,47.95,64.17, Ibandronate sodium injection,J1740,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.17,,,,,,,fee schedule,47.95,64.17, Ibuprofen injection,J1741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.74,,,,,,,fee schedule,4.74,6.95, Ibuprofen injection,J1741,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.74,,,,,,,fee schedule,4.74,6.95, Ibuprofen injection,J1741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.79,,,,,,,fee schedule,4.74,6.95, Ibuprofen injection,J1741,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.95,,,,,,,fee schedule,4.74,6.95, Ibutilide fumarate injection,J1742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,580.53,,,,,,,fee schedule,219.22,696.7, Ibutilide fumarate injection,J1742,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,696.7,,,,,,,fee schedule,219.22,696.7, Ibutilide fumarate injection,J1742,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,227.98,,,,,,,fee schedule,219.22,696.7,APC Ibutilide fumarate injection,J1742,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,230.18,,,,,,,fee schedule,219.22,696.7,APC Ibutilide fumarate injection,J1742,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,219.22,,,,,,,fee schedule,219.22,696.7,APC Idursulfase injection,J1743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,869.45,,,,,,,fee schedule,558.22,1252.63, Idursulfase injection,J1743,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,869.45,,,,,,,fee schedule,558.22,1252.63, Idursulfase injection,J1743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1043.76,,,,,,,fee schedule,558.22,1252.63, Idursulfase injection,J1743,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1252.63,,,,,,,fee schedule,558.22,1252.63, Idursulfase injection,J1743,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,580.55,,,,,,,fee schedule,558.22,1252.63,APC Idursulfase injection,J1743,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,586.13,,,,,,,fee schedule,558.22,1252.63,APC Idursulfase injection,J1743,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,558.22,,,,,,,fee schedule,558.22,1252.63,APC Icatibant injection,J1744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.96,,,,,,,fee schedule,88.96,106.77, Icatibant injection,J1744,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,106.77,,,,,,,fee schedule,88.96,106.77, Infliximab not biosimil 10mg,J1745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.53,,,,,,,fee schedule,31.04,69.73, Infliximab not biosimil 10mg,J1745,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.53,,,,,,,fee schedule,31.04,69.73, Infliximab not biosimil 10mg,J1745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.11,,,,,,,fee schedule,31.04,69.73, Infliximab not biosimil 10mg,J1745,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.73,,,,,,,fee schedule,31.04,69.73, Infliximab not biosimil 10mg,J1745,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.28,,,,,,,fee schedule,31.04,69.73,APC Infliximab not biosimil 10mg,J1745,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.59,,,,,,,fee schedule,31.04,69.73,APC Infliximab not biosimil 10mg,J1745,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.04,,,,,,,fee schedule,31.04,69.73,APC "Inj., ibalizumab-uiyk, 10 mg",J1746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.57,,,,,,,fee schedule,77.68,177.78, "Inj., ibalizumab-uiyk, 10 mg",J1746,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.57,,,,,,,fee schedule,77.68,177.78, "Inj., ibalizumab-uiyk, 10 mg",J1746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,148.14,,,,,,,fee schedule,77.68,177.78, "Inj., ibalizumab-uiyk, 10 mg",J1746,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,177.78,,,,,,,fee schedule,77.68,177.78, "Inj., ibalizumab-uiyk, 10 mg",J1746,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.78,,,,,,,fee schedule,77.68,177.78,APC "Inj., ibalizumab-uiyk, 10 mg",J1746,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,81.56,,,,,,,fee schedule,77.68,177.78,APC "Inj., ibalizumab-uiyk, 10 mg",J1746,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.68,,,,,,,fee schedule,77.68,177.78,APC "Inj, spesolimab-sbzo, 1 mg",J1747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,102.32,,,,,,,fee schedule,65.73,147.43, "Inj, spesolimab-sbzo, 1 mg",J1747,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,102.32,,,,,,,fee schedule,65.73,147.43, "Inj, spesolimab-sbzo, 1 mg",J1747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.85,,,,,,,fee schedule,65.73,147.43, "Inj, spesolimab-sbzo, 1 mg",J1747,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.43,,,,,,,fee schedule,65.73,147.43, "Inj, spesolimab-sbzo, 1 mg",J1747,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,68.36,,,,,,,fee schedule,65.73,147.43,APC "Inj, spesolimab-sbzo, 1 mg",J1747,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,69.01,,,,,,,fee schedule,65.73,147.43,APC "Inj, spesolimab-sbzo, 1 mg",J1747,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,65.73,,,,,,,fee schedule,65.73,147.43,APC "Inj, zymfentra, 10 mg",J1748,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,510.63,,,,,,,fee schedule,510.63,612.81, "Inj, zymfentra, 10 mg",J1748,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,612.81,,,,,,,fee schedule,510.63,612.81, "Inj, iloprost, 0.1 mcg",J1749,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.89,,,,,,,fee schedule,8.89,12.81, "Inj, iloprost, 0.1 mcg",J1749,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.89,,,,,,,fee schedule,8.89,12.81, "Inj, iloprost, 0.1 mcg",J1749,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.67,,,,,,,fee schedule,8.89,12.81, "Inj, iloprost, 0.1 mcg",J1749,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.81,,,,,,,fee schedule,8.89,12.81, Inj iron dextran,J1750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.07,,,,,,,fee schedule,18.1,40.62, Inj iron dextran,J1750,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.07,,,,,,,fee schedule,18.1,40.62, Inj iron dextran,J1750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.85,,,,,,,fee schedule,18.1,40.62, Inj iron dextran,J1750,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.62,,,,,,,fee schedule,18.1,40.62, Inj iron dextran,J1750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.83,,,,,,,fee schedule,18.1,40.62,APC Inj iron dextran,J1750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.01,,,,,,,fee schedule,18.1,40.62,APC Inj iron dextran,J1750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.1,,,,,,,fee schedule,18.1,40.62,APC Iron sucrose injection,J1756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.35,,,,,,,fee schedule,0.35,0.52, Iron sucrose injection,J1756,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.35,,,,,,,fee schedule,0.35,0.52, Iron sucrose injection,J1756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.43,,,,,,,fee schedule,0.35,0.52, Iron sucrose injection,J1756,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.52,,,,,,,fee schedule,0.35,0.52, Imuglucerase injection,J1786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.39,,,,,,,fee schedule,42.82,96.88, Imuglucerase injection,J1786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.39,,,,,,,fee schedule,42.82,96.88, Imuglucerase injection,J1786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.72,,,,,,,fee schedule,42.82,96.88, Imuglucerase injection,J1786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.88,,,,,,,fee schedule,42.82,96.88, Imuglucerase injection,J1786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.54,,,,,,,fee schedule,42.82,96.88,APC Imuglucerase injection,J1786,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.97,,,,,,,fee schedule,42.82,96.88,APC Imuglucerase injection,J1786,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.82,,,,,,,fee schedule,42.82,96.88,APC Droperidol injection,J1790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.35,,,,,,,fee schedule,8.35,17.11, Droperidol injection,J1790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.35,,,,,,,fee schedule,8.35,17.11, Droperidol injection,J1790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.26,,,,,,,fee schedule,8.35,17.11, Droperidol injection,J1790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.11,,,,,,,fee schedule,8.35,17.11, Propranolol injection,J1800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.58,,,,,,,fee schedule,18.58,22.3, Propranolol injection,J1800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.3,,,,,,,fee schedule,18.58,22.3, "Inj, esmolol hcl, 10mg",J1805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.45,,,,,,,fee schedule,0.41,0.49, "Inj, esmolol hcl, 10mg",J1805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.45,,,,,,,fee schedule,0.41,0.49, "Inj, esmolol hcl, 10mg",J1805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.41,,,,,,,fee schedule,0.41,0.49, "Inj, esmolol hcl, 10mg",J1805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.49,,,,,,,fee schedule,0.41,0.49, Inj esmolol hcl wg crit care,J1806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.64,,,,,,,fee schedule,0.64,0.99, Inj esmolol hcl wg crit care,J1806,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.64,,,,,,,fee schedule,0.64,0.99, Inj esmolol hcl wg crit care,J1806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.82,,,,,,,fee schedule,0.64,0.99, Inj esmolol hcl wg crit care,J1806,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.99,,,,,,,fee schedule,0.64,0.99, "Inj, ethacrynate sod, 1 mg",J1807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.44,,,,,,,fee schedule,18.27,86.94, "Inj, ethacrynate sod, 1 mg",J1807,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,86.94,,,,,,,fee schedule,18.27,86.94, "Inj, ethacrynate sod, 1 mg",J1807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19,,,,,,,fee schedule,18.27,86.94,APC "Inj, ethacrynate sod, 1 mg",J1807,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.18,,,,,,,fee schedule,18.27,86.94,APC "Inj, ethacrynate sod, 1 mg",J1807,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.27,,,,,,,fee schedule,18.27,86.94,APC "Inj, folic acid, 0.1 mg",J1808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.13, "Inj, folic acid, 0.1 mg",J1808,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.13, "Inj, folic acid, 0.1 mg",J1808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.08,0.13, "Inj, folic acid, 0.1 mg",J1808,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.08,0.13, "Inj, fosdenopterin, 0.1mg",J1809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.72,,,,,,,fee schedule,17.59,38.06, "Inj, fosdenopterin, 0.1mg",J1809,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.06,,,,,,,fee schedule,17.59,38.06, "Inj, fosdenopterin, 0.1mg",J1809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.29,,,,,,,fee schedule,17.59,38.06,APC "Inj, fosdenopterin, 0.1mg",J1809,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.47,,,,,,,fee schedule,17.59,38.06,APC "Inj, fosdenopterin, 0.1mg",J1809,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.59,,,,,,,fee schedule,17.59,38.06,APC Fiasp for insulin pump use,J1811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.08,,,,,,,fee schedule,12.08,18.5, Fiasp for insulin pump use,J1811,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.08,,,,,,,fee schedule,12.08,18.5, Fiasp for insulin pump use,J1811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.42,,,,,,,fee schedule,12.08,18.5, Fiasp for insulin pump use,J1811,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18.5,,,,,,,fee schedule,12.08,18.5, Inj. Insulin (fiasp),J1812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.77,,,,,,,fee schedule,2.77,3.32, Inj. Insulin (fiasp),J1812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.32,,,,,,,fee schedule,2.77,3.32, Lyumjev for insulin pump use,J1813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.78,,,,,,,fee schedule,23.78,33.91, Lyumjev for insulin pump use,J1813,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.78,,,,,,,fee schedule,23.78,33.91, Lyumjev for insulin pump use,J1813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.26,,,,,,,fee schedule,23.78,33.91, Lyumjev for insulin pump use,J1813,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.91,,,,,,,fee schedule,23.78,33.91, Inj. insulin (lyumjev),J1814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.62,,,,,,,fee schedule,2.62,3.14, Inj. insulin (lyumjev),J1814,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.14,,,,,,,fee schedule,2.62,3.14, Insulin injection,J1815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.43,,,,,,,fee schedule,0.43,0.52, Insulin injection,J1815,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.52,,,,,,,fee schedule,0.43,0.52, Insulin for insulin pump use,J1817,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.03,,,,,,,fee schedule,5.03,7.16, Insulin for insulin pump use,J1817,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.03,,,,,,,fee schedule,5.03,7.16, Insulin for insulin pump use,J1817,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.96,,,,,,,fee schedule,5.03,7.16, Insulin for insulin pump use,J1817,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.16,,,,,,,fee schedule,5.03,7.16, "Inj. inebilizumab-cdon, 1 mg",J1823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,769.64,,,,,,,fee schedule,495.54,1111.52, "Inj. inebilizumab-cdon, 1 mg",J1823,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,769.64,,,,,,,fee schedule,495.54,1111.52, "Inj. inebilizumab-cdon, 1 mg",J1823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,926.18,,,,,,,fee schedule,495.54,1111.52, "Inj. inebilizumab-cdon, 1 mg",J1823,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1111.52,,,,,,,fee schedule,495.54,1111.52, "Inj. inebilizumab-cdon, 1 mg",J1823,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,515.37,,,,,,,fee schedule,495.54,1111.52,APC "Inj. inebilizumab-cdon, 1 mg",J1823,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,520.32,,,,,,,fee schedule,495.54,1111.52,APC "Inj. inebilizumab-cdon, 1 mg",J1823,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,495.54,,,,,,,fee schedule,495.54,1111.52,APC Interferon Beta-1A inj,J1826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4116.73,,,,,,,fee schedule,4116.73,4940.52, Interferon Beta-1A inj,J1826,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4940.52,,,,,,,fee schedule,4116.73,4940.52, Interferon beta-1b / .25 MG,J1830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1354.6,,,,,,,fee schedule,1354.6,1625.66, Interferon beta-1b / .25 MG,J1830,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1625.66,,,,,,,fee schedule,1354.6,1625.66, "Injection, isavuconazonium",J1833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.02,,,,,,,fee schedule,1.01,2.42, "Injection, isavuconazonium",J1833,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.42,,,,,,,fee schedule,1.01,2.42, "Injection, isavuconazonium",J1833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.05,,,,,,,fee schedule,1.01,2.42,APC "Injection, isavuconazonium",J1833,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.06,,,,,,,fee schedule,1.01,2.42,APC "Injection, isavuconazonium",J1833,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.01,,,,,,,fee schedule,1.01,2.42,APC "Inj, isoniazid, 1 mg",J1834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.56,,,,,,,fee schedule,0.3,0.67, "Inj, isoniazid, 1 mg",J1834,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.67,,,,,,,fee schedule,0.3,0.67, "Inj, isoniazid, 1 mg",J1834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.32,,,,,,,fee schedule,0.3,0.67,APC "Inj, isoniazid, 1 mg",J1834,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.32,,,,,,,fee schedule,0.3,0.67,APC "Inj, isoniazid, 1 mg",J1834,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.3,,,,,,,fee schedule,0.3,0.67,APC "Inj, metronidazole, 10 mg",J1836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.05,,,,,,,fee schedule,0.05,0.07, "Inj, metronidazole, 10 mg",J1836,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.05,,,,,,,fee schedule,0.05,0.07, "Inj, metronidazole, 10 mg",J1836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.05,0.07, "Inj, metronidazole, 10 mg",J1836,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.05,0.07, Ketorolac tromethamine inj,J1885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.54,,,,,,,fee schedule,0.34,0.67, Ketorolac tromethamine inj,J1885,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.54,,,,,,,fee schedule,0.34,0.67, Ketorolac tromethamine inj,J1885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.56,,,,,,,fee schedule,0.34,0.67, Ketorolac tromethamine inj,J1885,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.67,,,,,,,fee schedule,0.34,0.67, Ketorolac tromethamine inj,J1885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.35,,,,,,,fee schedule,0.34,0.67,APC Ketorolac tromethamine inj,J1885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.36,,,,,,,fee schedule,0.34,0.67,APC Ketorolac tromethamine inj,J1885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.34,,,,,,,fee schedule,0.34,0.67,APC "Inj, labetalol hcl, 5mg",J1920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.61,,,,,,,fee schedule,0.61,0.76, "Inj, labetalol hcl, 5mg",J1920,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.61,,,,,,,fee schedule,0.61,0.76, "Inj, labetalol hcl, 5mg",J1920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.64,,,,,,,fee schedule,0.61,0.76, "Inj, labetalol hcl, 5mg",J1920,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.76,,,,,,,fee schedule,0.61,0.76, "Inj labetalol hcl hikma, 5mg",J1921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.15,,,,,,,fee schedule,2.15,3.1, "Inj labetalol hcl hikma, 5mg",J1921,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.15,,,,,,,fee schedule,2.15,3.1, "Inj labetalol hcl hikma, 5mg",J1921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.58,,,,,,,fee schedule,2.15,3.1, "Inj labetalol hcl hikma, 5mg",J1921,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.1,,,,,,,fee schedule,2.15,3.1, Lanreotide injection,J1930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.06,,,,,,,fee schedule,35.72,76.37, Lanreotide injection,J1930,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.06,,,,,,,fee schedule,35.72,76.37, Lanreotide injection,J1930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.64,,,,,,,fee schedule,35.72,76.37, Lanreotide injection,J1930,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.37,,,,,,,fee schedule,35.72,76.37, Lanreotide injection,J1930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.15,,,,,,,fee schedule,35.72,76.37,APC Lanreotide injection,J1930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.51,,,,,,,fee schedule,35.72,76.37,APC Lanreotide injection,J1930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.72,,,,,,,fee schedule,35.72,76.37,APC Laronidase injection,J1931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,62.07,,,,,,,fee schedule,39.95,89.43, Laronidase injection,J1931,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,62.07,,,,,,,fee schedule,39.95,89.43, Laronidase injection,J1931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,74.52,,,,,,,fee schedule,39.95,89.43, Laronidase injection,J1931,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.43,,,,,,,fee schedule,39.95,89.43, Laronidase injection,J1931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.55,,,,,,,fee schedule,39.95,89.43,APC Laronidase injection,J1931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.95,,,,,,,fee schedule,39.95,89.43,APC Laronidase injection,J1931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.95,,,,,,,fee schedule,39.95,89.43,APC "Inj, lanreotide, (cipla) 1mg",J1932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.07,,,,,,,fee schedule,32.19,66.93, "Inj, lanreotide, (cipla) 1mg",J1932,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,38.07,,,,,,,fee schedule,32.19,66.93, "Inj, lanreotide, (cipla) 1mg",J1932,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.77,,,,,,,fee schedule,32.19,66.93, "Inj, lanreotide, (cipla) 1mg",J1932,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.93,,,,,,,fee schedule,32.19,66.93, "Inj, lanreotide, (cipla) 1mg",J1932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.48,,,,,,,fee schedule,32.19,66.93,APC "Inj, lanreotide, (cipla) 1mg",J1932,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.8,,,,,,,fee schedule,32.19,66.93,APC "Inj, lanreotide, (cipla) 1mg",J1932,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.19,,,,,,,fee schedule,32.19,66.93,APC "Inj, furosemide, 1 mg",J1938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.03,,,,,,,fee schedule,0.03,0.04, "Inj, furosemide, 1 mg",J1938,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.03,,,,,,,fee schedule,0.03,0.04, "Inj, furosemide, 1 mg",J1938,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.04,,,,,,,fee schedule,0.03,0.04, "Inj, furosemide, 1 mg",J1938,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.04,,,,,,,fee schedule,0.03,0.04, "Inj, bumetanide, 0.5 mg",J1939,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.94,,,,,,,fee schedule,0.69,0.94, "Inj, bumetanide, 0.5 mg",J1939,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.94,,,,,,,fee schedule,0.69,0.94, "Inj, bumetanide, 0.5 mg",J1939,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.69,,,,,,,fee schedule,0.69,0.94, "Inj, bumetanide, 0.5 mg",J1939,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.83,,,,,,,fee schedule,0.69,0.94, "Inj, furoscix, 20 mg",J1941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,467.34,,,,,,,fee schedule,467.34,560.86, "Inj, furoscix, 20 mg",J1941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,560.86,,,,,,,fee schedule,467.34,560.86, "Inj., aristada initio, 1 mg",J1943,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.07,,,,,,,fee schedule,3.25,7.27, "Inj., aristada initio, 1 mg",J1943,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.07,,,,,,,fee schedule,3.25,7.27, "Inj., aristada initio, 1 mg",J1943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.06,,,,,,,fee schedule,3.25,7.27, "Inj., aristada initio, 1 mg",J1943,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.27,,,,,,,fee schedule,3.25,7.27, "Inj., aristada initio, 1 mg",J1943,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.38,,,,,,,fee schedule,3.25,7.27,APC "Inj., aristada initio, 1 mg",J1943,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.41,,,,,,,fee schedule,3.25,7.27,APC "Inj., aristada initio, 1 mg",J1943,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.25,,,,,,,fee schedule,3.25,7.27,APC Aripirazole lauroxil 1 mg,J1944,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.2,,,,,,,fee schedule,3.32,7.51, Aripirazole lauroxil 1 mg,J1944,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.2,,,,,,,fee schedule,3.32,7.51, Aripirazole lauroxil 1 mg,J1944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.26,,,,,,,fee schedule,3.32,7.51, Aripirazole lauroxil 1 mg,J1944,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.51,,,,,,,fee schedule,3.32,7.51, Aripirazole lauroxil 1 mg,J1944,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.45,,,,,,,fee schedule,3.32,7.51,APC Aripirazole lauroxil 1 mg,J1944,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.48,,,,,,,fee schedule,3.32,7.51,APC Aripirazole lauroxil 1 mg,J1944,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.32,,,,,,,fee schedule,3.32,7.51,APC Lepirudin,J1945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1066.34,,,,,,,fee schedule,1066.34,1279.72, Lepirudin,J1945,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1279.72,,,,,,,fee schedule,1066.34,1279.72, Leuprolide acetate /3.75 mg,J1950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2703.97,,,,,,,fee schedule,1765.57,3881.11, Leuprolide acetate /3.75 mg,J1950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2703.97,,,,,,,fee schedule,1765.57,3881.11, Leuprolide acetate /3.75 mg,J1950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3233.97,,,,,,,fee schedule,1765.57,3881.11, Leuprolide acetate /3.75 mg,J1950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3881.11,,,,,,,fee schedule,1765.57,3881.11, Leuprolide acetate /3.75 mg,J1950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1836.2,,,,,,,fee schedule,1765.57,3881.11,APC Leuprolide acetate /3.75 mg,J1950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1853.85,,,,,,,fee schedule,1765.57,3881.11,APC Leuprolide acetate /3.75 mg,J1950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1765.57,,,,,,,fee schedule,1765.57,3881.11,APC Inj fensolvi 0.25 mg,J1951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,218.59,,,,,,,fee schedule,140.71,316.24, Inj fensolvi 0.25 mg,J1951,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,218.59,,,,,,,fee schedule,140.71,316.24, Inj fensolvi 0.25 mg,J1951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,263.51,,,,,,,fee schedule,140.71,316.24, Inj fensolvi 0.25 mg,J1951,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,316.24,,,,,,,fee schedule,140.71,316.24, Inj fensolvi 0.25 mg,J1951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,146.34,,,,,,,fee schedule,140.71,316.24,APC Inj fensolvi 0.25 mg,J1951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,147.74,,,,,,,fee schedule,140.71,316.24,APC Inj fensolvi 0.25 mg,J1951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,140.71,,,,,,,fee schedule,140.71,316.24,APC "Leuprolide inj, camcevi, 1mg",J1952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,80.03,,,,,,,fee schedule,39.95,177.02, "Leuprolide inj, camcevi, 1mg",J1952,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,80.03,,,,,,,fee schedule,39.95,177.02, "Leuprolide inj, camcevi, 1mg",J1952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,147.5,,,,,,,fee schedule,39.95,177.02, "Leuprolide inj, camcevi, 1mg",J1952,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,177.02,,,,,,,fee schedule,39.95,177.02, "Leuprolide inj, camcevi, 1mg",J1952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.54,,,,,,,fee schedule,39.95,177.02,APC "Leuprolide inj, camcevi, 1mg",J1952,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.94,,,,,,,fee schedule,39.95,177.02,APC "Leuprolide inj, camcevi, 1mg",J1952,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.95,,,,,,,fee schedule,39.95,177.02,APC Levetiracetam injection,J1953,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Levetiracetam injection,J1953,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.07,,,,,,,fee schedule,0.07,0.09, Levetiracetam injection,J1953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Levetiracetam injection,J1953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.07,0.09, Leuprolide depot cipla 7.5mg,J1954,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,343.61,,,,,,,fee schedule,343.61,1585.06, Leuprolide depot cipla 7.5mg,J1954,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,343.61,,,,,,,fee schedule,343.61,1585.06, Leuprolide depot cipla 7.5mg,J1954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1320.77,,,,,,,fee schedule,343.61,1585.06, Leuprolide depot cipla 7.5mg,J1954,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1585.06,,,,,,,fee schedule,343.61,1585.06, Leuprolide depot cipla 7.5mg,J1954,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,721.3,,,,,,,fee schedule,343.61,1585.06,APC Leuprolide depot cipla 7.5mg,J1954,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,728.23,,,,,,,fee schedule,343.61,1585.06,APC Leuprolide depot cipla 7.5mg,J1954,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,693.56,,,,,,,fee schedule,343.61,1585.06,APC Inj levocarnitine per 1 gm,J1955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.82,,,,,,,fee schedule,37.82,52.96, Inj levocarnitine per 1 gm,J1955,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.82,,,,,,,fee schedule,37.82,52.96, Inj levocarnitine per 1 gm,J1955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.13,,,,,,,fee schedule,37.82,52.96, Inj levocarnitine per 1 gm,J1955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,52.96,,,,,,,fee schedule,37.82,52.96, Levofloxacin injection,J1956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.05,,,,,,,fee schedule,3.05,5.7, Levofloxacin injection,J1956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.05,,,,,,,fee schedule,3.05,5.7, Levofloxacin injection,J1956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.75,,,,,,,fee schedule,3.05,5.7, Levofloxacin injection,J1956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.7,,,,,,,fee schedule,3.05,5.7, "Inj, lenacapavir, 1 mg",J1961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.29,,,,,,,fee schedule,22.3,49.68, "Inj, lenacapavir, 1 mg",J1961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.29,,,,,,,fee schedule,22.3,49.68, "Inj, lenacapavir, 1 mg",J1961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.4,,,,,,,fee schedule,22.3,49.68, "Inj, lenacapavir, 1 mg",J1961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,49.68,,,,,,,fee schedule,22.3,49.68, "Inj, lenacapavir, 1 mg",J1961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.19,,,,,,,fee schedule,22.3,49.68,APC "Inj, lenacapavir, 1 mg",J1961,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.41,,,,,,,fee schedule,22.3,49.68,APC "Inj, lenacapavir, 1 mg",J1961,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.3,,,,,,,fee schedule,22.3,49.68,APC Hyoscyamine sulfate inj,J1980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,102.94,,,,,,,fee schedule,102.94,123.54, Hyoscyamine sulfate inj,J1980,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123.54,,,,,,,fee schedule,102.94,123.54, Chlordiazepoxide injection,J1990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.34,,,,,,,fee schedule,39.34,47.22, Chlordiazepoxide injection,J1990,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.22,,,,,,,fee schedule,39.34,47.22, "Inj, lidocaine in d5w, 1 mg",J2002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, lidocaine in d5w, 1 mg",J2002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, lidocaine in d5w, 1 mg",J2002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, lidocaine in d5w, 1 mg",J2002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, lidocaine hcl, 1 mg",J2003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, lidocaine hcl, 1 mg",J2003,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, lidocaine w epinephrine",J2004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, lidocaine w epinephrine",J2004,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Lincomycin injection,J2010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.73,,,,,,,fee schedule,8.41,10.09, Lincomycin injection,J2010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.73,,,,,,,fee schedule,8.41,10.09, Lincomycin injection,J2010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.41,,,,,,,fee schedule,8.41,10.09, Lincomycin injection,J2010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.09,,,,,,,fee schedule,8.41,10.09, Linezolid injection,J2020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.4,,,,,,,fee schedule,5.4,8.01, Linezolid injection,J2020,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.4,,,,,,,fee schedule,5.4,8.01, Linezolid injection,J2020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.67,,,,,,,fee schedule,5.4,8.01, Linezolid injection,J2020,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.01,,,,,,,fee schedule,5.4,8.01, "Inj, linezolid (hospira)",J2021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.87,,,,,,,fee schedule,9.87,14.22, "Inj, linezolid (hospira)",J2021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.87,,,,,,,fee schedule,9.87,14.22, "Inj, linezolid (hospira)",J2021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.85,,,,,,,fee schedule,9.87,14.22, "Inj, linezolid (hospira)",J2021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.22,,,,,,,fee schedule,9.87,14.22, Lorazepam injection,J2060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.05,,,,,,,fee schedule,2.05,3.1, Lorazepam injection,J2060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.05,,,,,,,fee schedule,2.05,3.1, Lorazepam injection,J2060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.58,,,,,,,fee schedule,2.05,3.1, Lorazepam injection,J2060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.1,,,,,,,fee schedule,2.05,3.1, Loxapine for inhalation 1 mg,J2062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.6,,,,,,,fee schedule,28.6,34.32, Loxapine for inhalation 1 mg,J2062,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.32,,,,,,,fee schedule,28.6,34.32, Mannitol injection,J2150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.48,,,,,,,fee schedule,3.48,3.48, Mannitol injection,J2150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.48,,,,,,,fee schedule,3.48,3.48, "Inj, mannitol, 250 mg",J2151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.11,0.13, "Inj, mannitol, 250 mg",J2151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.11,0.13, Mecasermin injection,J2170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,700.84,,,,,,,fee schedule,700.84,841.08, Mecasermin injection,J2170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,841.08,,,,,,,fee schedule,700.84,841.08, Meperidine hydrochl /100 MG,J2175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.44,,,,,,,fee schedule,24.44,35.19, Meperidine hydrochl /100 MG,J2175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,24.44,,,,,,,fee schedule,24.44,35.19, Meperidine hydrochl /100 MG,J2175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.32,,,,,,,fee schedule,24.44,35.19, Meperidine hydrochl /100 MG,J2175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.19,,,,,,,fee schedule,24.44,35.19, Meperidine/promethazine inj,J2180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.08,,,,,,,fee schedule,7.08,8.5, Meperidine/promethazine inj,J2180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.5,,,,,,,fee schedule,7.08,8.5, "Injection, mepolizumab, 1mg",J2182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.76,,,,,,,fee schedule,31.82,70.14, "Injection, mepolizumab, 1mg",J2182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.76,,,,,,,fee schedule,31.82,70.14, "Injection, mepolizumab, 1mg",J2182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.44,,,,,,,fee schedule,31.82,70.14, "Injection, mepolizumab, 1mg",J2182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.14,,,,,,,fee schedule,31.82,70.14, "Injection, mepolizumab, 1mg",J2182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.1,,,,,,,fee schedule,31.82,70.14,APC "Injection, mepolizumab, 1mg",J2182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.41,,,,,,,fee schedule,31.82,70.14,APC "Injection, mepolizumab, 1mg",J2182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.82,,,,,,,fee schedule,31.82,70.14,APC Inj meropenem (wg crit care),J2183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.52,,,,,,,fee schedule,2.52,3.63, Inj meropenem (wg crit care),J2183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.52,,,,,,,fee schedule,2.52,3.63, Inj meropenem (wg crit care),J2183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.03,,,,,,,fee schedule,2.52,3.63, Inj meropenem (wg crit care),J2183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.63,,,,,,,fee schedule,2.52,3.63, "Inj, meropenem (b. braun)",J2184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.23,,,,,,,fee schedule,3.23,4.64, "Inj, meropenem (b. braun)",J2184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.23,,,,,,,fee schedule,3.23,4.64, "Inj, meropenem (b. braun)",J2184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.87,,,,,,,fee schedule,3.23,4.64, "Inj, meropenem (b. braun)",J2184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.64,,,,,,,fee schedule,3.23,4.64, Meropenem,J2185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.68,,,,,,,fee schedule,0.68,0.94, Meropenem,J2185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.68,,,,,,,fee schedule,0.68,0.94, Meropenem,J2185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.78,,,,,,,fee schedule,0.68,0.94, Meropenem,J2185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.94,,,,,,,fee schedule,0.68,0.94, "Inj., meropenem, vaborbactam",J2186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.24,,,,,,,fee schedule,2.17,5.09, "Inj., meropenem, vaborbactam",J2186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.09,,,,,,,fee schedule,2.17,5.09, "Inj., meropenem, vaborbactam",J2186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.26,,,,,,,fee schedule,2.17,5.09,APC "Inj., meropenem, vaborbactam",J2186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.28,,,,,,,fee schedule,2.17,5.09,APC "Inj., meropenem, vaborbactam",J2186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.17,,,,,,,fee schedule,2.17,5.09,APC Methylergonovin maleate inj,J2210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.34,,,,,,,fee schedule,34.34,46.47, Methylergonovin maleate inj,J2210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.34,,,,,,,fee schedule,34.34,46.47, Methylergonovin maleate inj,J2210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.73,,,,,,,fee schedule,34.34,46.47, Methylergonovin maleate inj,J2210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,46.47,,,,,,,fee schedule,34.34,46.47, Methylnaltrexone injection,J2212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.71,,,,,,,fee schedule,2.71,3.25, Methylnaltrexone injection,J2212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.25,,,,,,,fee schedule,2.71,3.25, "Inj, micafungin (baxter)",J2246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.79,,,,,,,fee schedule,0.79,1.1, "Inj, micafungin (baxter)",J2246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.79,,,,,,,fee schedule,0.79,1.1, "Inj, micafungin (baxter)",J2246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.92,,,,,,,fee schedule,0.79,1.1, "Inj, micafungin (baxter)",J2246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.1,,,,,,,fee schedule,0.79,1.1, "Inj, micafungin (par pharm)",J2247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.56,,,,,,,fee schedule,0.56,0.83, "Inj, micafungin (par pharm)",J2247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.56,,,,,,,fee schedule,0.56,0.83, "Inj, micafungin (par pharm)",J2247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.69,,,,,,,fee schedule,0.56,0.83, "Inj, micafungin (par pharm)",J2247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.83,,,,,,,fee schedule,0.56,0.83, Micafungin sodium injection,J2248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.48,,,,,,,fee schedule,0.48,0.58, Micafungin sodium injection,J2248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.48,,,,,,,fee schedule,0.48,0.58, Micafungin sodium injection,J2248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.49,,,,,,,fee schedule,0.48,0.58, Micafungin sodium injection,J2248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.58,,,,,,,fee schedule,0.48,0.58, "Inj, remimazolam, 1 mg",J2249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.19,,,,,,,fee schedule,4.19,5.02, "Inj, remimazolam, 1 mg",J2249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.02,,,,,,,fee schedule,4.19,5.02, Inj midazolam hydrochloride,J2250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.25,,,,,,,fee schedule,0.25,0.34, Inj midazolam hydrochloride,J2250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.25,,,,,,,fee schedule,0.25,0.34, Inj midazolam hydrochloride,J2250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.28,,,,,,,fee schedule,0.25,0.34, Inj midazolam hydrochloride,J2250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.34,,,,,,,fee schedule,0.25,0.34, Inj midazolam (wg crit care),J2251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.26,,,,,,,fee schedule,0.26,0.45, Inj midazolam (wg crit care),J2251,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.26,,,,,,,fee schedule,0.26,0.45, Inj midazolam (wg crit care),J2251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.37,,,,,,,fee schedule,0.26,0.45, Inj midazolam (wg crit care),J2251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.45,,,,,,,fee schedule,0.26,0.45, Inj midazolam in 0.8% nacl,J2252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.13,,,,,,,fee schedule,0.13,0.16, Inj midazolam in 0.8% nacl,J2252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.16,,,,,,,fee schedule,0.13,0.16, Inj milrinone lactate / 5 mg,J2260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.18,,,,,,,fee schedule,2.18,3.25, Inj milrinone lactate / 5 mg,J2260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.18,,,,,,,fee schedule,2.18,3.25, Inj milrinone lactate / 5 mg,J2260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.71,,,,,,,fee schedule,2.18,3.25, Inj milrinone lactate / 5 mg,J2260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.25,,,,,,,fee schedule,2.18,3.25, Minocycline hydrochloride,J2265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.93,,,,,,,fee schedule,2.66,5.92, Minocycline hydrochloride,J2265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.92,,,,,,,fee schedule,2.66,5.92, Minocycline hydrochloride,J2265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.77,,,,,,,fee schedule,2.66,5.92,APC Minocycline hydrochloride,J2265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.8,,,,,,,fee schedule,2.66,5.92,APC Minocycline hydrochloride,J2265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.66,,,,,,,fee schedule,2.66,5.92,APC "Inj, mirikizumab-mrkz, 1 mg",J2267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,75.14,,,,,,,fee schedule,42.09,96.56, "Inj, mirikizumab-mrkz, 1 mg",J2267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,75.14,,,,,,,fee schedule,42.09,96.56, "Inj, mirikizumab-mrkz, 1 mg",J2267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,80.46,,,,,,,fee schedule,42.09,96.56, "Inj, mirikizumab-mrkz, 1 mg",J2267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,96.56,,,,,,,fee schedule,42.09,96.56, "Inj, mirikizumab-mrkz, 1 mg",J2267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.78,,,,,,,fee schedule,42.09,96.56,APC "Inj, mirikizumab-mrkz, 1 mg",J2267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.2,,,,,,,fee schedule,42.09,96.56,APC "Inj, mirikizumab-mrkz, 1 mg",J2267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.09,,,,,,,fee schedule,42.09,96.56,APC Morphine sulfate injection,J2270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.08,,,,,,,fee schedule,4.07,7.08, Morphine sulfate injection,J2270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.08,,,,,,,fee schedule,4.07,7.08, Morphine sulfate injection,J2270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.07,,,,,,,fee schedule,4.07,7.08, Morphine sulfate injection,J2270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.89,,,,,,,fee schedule,4.07,7.08, "Inj, morphine (fresenius)",J2272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.66,,,,,,,fee schedule,12.66,19.63, "Inj, morphine (fresenius)",J2272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.66,,,,,,,fee schedule,12.66,19.63, "Inj, morphine (fresenius)",J2272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.35,,,,,,,fee schedule,12.66,19.63, "Inj, morphine (fresenius)",J2272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.63,,,,,,,fee schedule,12.66,19.63, In morphine preservativ free,J2274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.8,,,,,,,fee schedule,16.8,27.03, In morphine preservativ free,J2274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.8,,,,,,,fee schedule,16.8,27.03, In morphine preservativ free,J2274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.52,,,,,,,fee schedule,16.8,27.03, In morphine preservativ free,J2274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.03,,,,,,,fee schedule,16.8,27.03, "Inj, motixafortide, 0.25 mg",J2277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.25,,,,,,,fee schedule,26.48,56.57, "Inj, motixafortide, 0.25 mg",J2277,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.25,,,,,,,fee schedule,26.48,56.57, "Inj, motixafortide, 0.25 mg",J2277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.14,,,,,,,fee schedule,26.48,56.57, "Inj, motixafortide, 0.25 mg",J2277,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.57,,,,,,,fee schedule,26.48,56.57, "Inj, motixafortide, 0.25 mg",J2277,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.54,,,,,,,fee schedule,26.48,56.57,APC "Inj, motixafortide, 0.25 mg",J2277,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.8,,,,,,,fee schedule,26.48,56.57,APC "Inj, motixafortide, 0.25 mg",J2277,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.48,,,,,,,fee schedule,26.48,56.57,APC Ziconotide injection,J2278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.77,,,,,,,fee schedule,10.46,22.74, Ziconotide injection,J2278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.77,,,,,,,fee schedule,10.46,22.74, Ziconotide injection,J2278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.95,,,,,,,fee schedule,10.46,22.74, Ziconotide injection,J2278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.74,,,,,,,fee schedule,10.46,22.74, Ziconotide injection,J2278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.88,,,,,,,fee schedule,10.46,22.74,APC Ziconotide injection,J2278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.99,,,,,,,fee schedule,10.46,22.74,APC Ziconotide injection,J2278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.46,,,,,,,fee schedule,10.46,22.74,APC "Inj, moxifloxacin 100 mg",J2280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.56,,,,,,,fee schedule,13.56,20.21, "Inj, moxifloxacin 100 mg",J2280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13.56,,,,,,,fee schedule,13.56,20.21, "Inj, moxifloxacin 100 mg",J2280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.84,,,,,,,fee schedule,13.56,20.21, "Inj, moxifloxacin 100 mg",J2280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.21,,,,,,,fee schedule,13.56,20.21, Inj moxifloxacin (fres kabi),J2281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.08,,,,,,,fee schedule,12.08,16.62, Inj moxifloxacin (fres kabi),J2281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.08,,,,,,,fee schedule,12.08,16.62, Inj moxifloxacin (fres kabi),J2281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.85,,,,,,,fee schedule,12.08,16.62, Inj moxifloxacin (fres kabi),J2281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.62,,,,,,,fee schedule,12.08,16.62, "Inj, nafcillin sodium, 20 mg",J2290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.11, "Inj, nafcillin sodium, 20 mg",J2290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.11, "Inj, nafcillin sodium, 20 mg",J2290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.08,0.11, "Inj, nafcillin sodium, 20 mg",J2290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.08,0.11, "Inj, nafcillin (baxter) 20mg",J2291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.28,,,,,,,fee schedule,0.28,0.34, "Inj, nafcillin (baxter) 20mg",J2291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.34,,,,,,,fee schedule,0.28,0.34, Inj nalbuphine hydrochloride,J2300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.48,,,,,,,fee schedule,5.48,8.3, Inj nalbuphine hydrochloride,J2300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.48,,,,,,,fee schedule,5.48,8.3, Inj nalbuphine hydrochloride,J2300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.92,,,,,,,fee schedule,5.48,8.3, Inj nalbuphine hydrochloride,J2300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.3,,,,,,,fee schedule,5.48,8.3, "Inj, nitroglycerin, 5 mg",J2305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.21,,,,,,,fee schedule,2.21,3.34, "Inj, nitroglycerin, 5 mg",J2305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.21,,,,,,,fee schedule,2.21,3.34, "Inj, nitroglycerin, 5 mg",J2305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.78,,,,,,,fee schedule,2.21,3.34, "Inj, nitroglycerin, 5 mg",J2305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.34,,,,,,,fee schedule,2.21,3.34, "Inj naloxone hcl nos, 0.01mg",J2312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.1,,,,,,,fee schedule,0.1,0.18, "Inj naloxone hcl nos, 0.01mg",J2312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.1,,,,,,,fee schedule,0.1,0.18, "Inj naloxone hcl nos, 0.01mg",J2312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.15,,,,,,,fee schedule,0.1,0.18, "Inj naloxone hcl nos, 0.01mg",J2312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.18,,,,,,,fee schedule,0.1,0.18, "Inj, naloxone (zimhi) 0.01mg",J2313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.04, "Inj, naloxone (zimhi) 0.01mg",J2313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.04, "Inj, naloxone (zimhi) 0.01mg",J2313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.04,,,,,,,fee schedule,0.02,0.04, "Inj, naloxone (zimhi) 0.01mg",J2313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.04,,,,,,,fee schedule,0.02,0.04, "Naltrexone, depot form",J2315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.6,,,,,,,fee schedule,4.25,9.51, "Naltrexone, depot form",J2315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.6,,,,,,,fee schedule,4.25,9.51, "Naltrexone, depot form",J2315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.92,,,,,,,fee schedule,4.25,9.51, "Naltrexone, depot form",J2315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.51,,,,,,,fee schedule,4.25,9.51, "Naltrexone, depot form",J2315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.42,,,,,,,fee schedule,4.25,9.51,APC "Naltrexone, depot form",J2315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.46,,,,,,,fee schedule,4.25,9.51,APC "Naltrexone, depot form",J2315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.25,,,,,,,fee schedule,4.25,9.51,APC Nandrolone decanoate 50 MG,J2320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.01,,,,,,,fee schedule,7.01,8.41, Nandrolone decanoate 50 MG,J2320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.41,,,,,,,fee schedule,7.01,8.41, Natalizumab injection,J2323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.55,,,,,,,fee schedule,24.32,53.83, Natalizumab injection,J2323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.55,,,,,,,fee schedule,24.32,53.83, Natalizumab injection,J2323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.86,,,,,,,fee schedule,24.32,53.83, Natalizumab injection,J2323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.83,,,,,,,fee schedule,24.32,53.83, Natalizumab injection,J2323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.29,,,,,,,fee schedule,24.32,53.83,APC Natalizumab injection,J2323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.54,,,,,,,fee schedule,24.32,53.83,APC Natalizumab injection,J2323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.32,,,,,,,fee schedule,24.32,53.83,APC Nesiritide injection,J2325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,112.61,,,,,,,fee schedule,112.61,135.14, Nesiritide injection,J2325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,135.14,,,,,,,fee schedule,112.61,135.14, "Inj, nusinersen, 0.1mg",J2326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2324.18,,,,,,,fee schedule,1285.78,2789.26, "Inj, nusinersen, 0.1mg",J2326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2789.26,,,,,,,fee schedule,1285.78,2789.26, "Inj, nusinersen, 0.1mg",J2326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1337.21,,,,,,,fee schedule,1285.78,2789.26,APC "Inj, nusinersen, 0.1mg",J2326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1350.07,,,,,,,fee schedule,1285.78,2789.26,APC "Inj, nusinersen, 0.1mg",J2326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1285.78,,,,,,,fee schedule,1285.78,2789.26,APC Inj risankizumab-rzaa 1 mg,J2327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.1,,,,,,,fee schedule,14.6,33.51, Inj risankizumab-rzaa 1 mg,J2327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.1,,,,,,,fee schedule,14.6,33.51, Inj risankizumab-rzaa 1 mg,J2327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.92,,,,,,,fee schedule,14.6,33.51, Inj risankizumab-rzaa 1 mg,J2327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.51,,,,,,,fee schedule,14.6,33.51, Inj risankizumab-rzaa 1 mg,J2327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.18,,,,,,,fee schedule,14.6,33.51,APC Inj risankizumab-rzaa 1 mg,J2327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.33,,,,,,,fee schedule,14.6,33.51,APC Inj risankizumab-rzaa 1 mg,J2327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.6,,,,,,,fee schedule,14.6,33.51,APC "Inj ublituximab-xiiy, 1 mg",J2329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.92,,,,,,,fee schedule,68.75,158.69, "Inj ublituximab-xiiy, 1 mg",J2329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.92,,,,,,,fee schedule,68.75,158.69, "Inj ublituximab-xiiy, 1 mg",J2329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,132.23,,,,,,,fee schedule,68.75,158.69, "Inj ublituximab-xiiy, 1 mg",J2329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,158.69,,,,,,,fee schedule,68.75,158.69, "Inj ublituximab-xiiy, 1 mg",J2329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,71.5,,,,,,,fee schedule,68.75,158.69,APC "Inj ublituximab-xiiy, 1 mg",J2329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,72.18,,,,,,,fee schedule,68.75,158.69,APC "Inj ublituximab-xiiy, 1 mg",J2329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,68.75,,,,,,,fee schedule,68.75,158.69,APC "Injection, ocrelizumab, 1 mg",J2350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,92.93,,,,,,,fee schedule,59.6,133.26, "Injection, ocrelizumab, 1 mg",J2350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,92.93,,,,,,,fee schedule,59.6,133.26, "Injection, ocrelizumab, 1 mg",J2350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,111.04,,,,,,,fee schedule,59.6,133.26, "Injection, ocrelizumab, 1 mg",J2350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,133.26,,,,,,,fee schedule,59.6,133.26, "Injection, ocrelizumab, 1 mg",J2350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,61.98,,,,,,,fee schedule,59.6,133.26,APC "Injection, ocrelizumab, 1 mg",J2350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,62.58,,,,,,,fee schedule,59.6,133.26,APC "Injection, ocrelizumab, 1 mg",J2350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,59.6,,,,,,,fee schedule,59.6,133.26,APC Inj ocrelizumab 1mg hya-ocsq,J2351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,73.54,,,,,,,fee schedule,46.79,105.94, Inj ocrelizumab 1mg hya-ocsq,J2351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,73.54,,,,,,,fee schedule,46.79,105.94, Inj ocrelizumab 1mg hya-ocsq,J2351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.27,,,,,,,fee schedule,46.79,105.94, Inj ocrelizumab 1mg hya-ocsq,J2351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.94,,,,,,,fee schedule,46.79,105.94, Inj ocrelizumab 1mg hya-ocsq,J2351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.67,,,,,,,fee schedule,46.79,105.94,APC Inj ocrelizumab 1mg hya-ocsq,J2351,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.13,,,,,,,fee schedule,46.79,105.94,APC Inj ocrelizumab 1mg hya-ocsq,J2351,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.79,,,,,,,fee schedule,46.79,105.94,APC "Octreotide injection, depot",J2353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,330.31,,,,,,,fee schedule,188.35,456.63, "Octreotide injection, depot",J2353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,330.31,,,,,,,fee schedule,188.35,456.63, "Octreotide injection, depot",J2353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,380.49,,,,,,,fee schedule,188.35,456.63, "Octreotide injection, depot",J2353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,456.63,,,,,,,fee schedule,188.35,456.63, "Octreotide injection, depot",J2353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,195.88,,,,,,,fee schedule,188.35,456.63,APC "Octreotide injection, depot",J2353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,197.77,,,,,,,fee schedule,188.35,456.63,APC "Octreotide injection, depot",J2353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,188.35,,,,,,,fee schedule,188.35,456.63,APC "Octreotide inj, non-depot",J2354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.94,,,,,,,fee schedule,0.94,1.37, "Octreotide inj, non-depot",J2354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.94,,,,,,,fee schedule,0.94,1.37, "Octreotide inj, non-depot",J2354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.14,,,,,,,fee schedule,0.94,1.37, "Octreotide inj, non-depot",J2354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.37,,,,,,,fee schedule,0.94,1.37, Oprelvekin injection,J2355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,797.91,,,,,,,fee schedule,797.91,957.58, Oprelvekin injection,J2355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,957.58,,,,,,,fee schedule,797.91,957.58, "Inj tezepelumab-ekko, 1mg",J2356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.5,,,,,,,fee schedule,17.58,40.4, "Inj tezepelumab-ekko, 1mg",J2356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.5,,,,,,,fee schedule,17.58,40.4, "Inj tezepelumab-ekko, 1mg",J2356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.66,,,,,,,fee schedule,17.58,40.4, "Inj tezepelumab-ekko, 1mg",J2356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.4,,,,,,,fee schedule,17.58,40.4, "Inj tezepelumab-ekko, 1mg",J2356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.29,,,,,,,fee schedule,17.58,40.4,APC "Inj tezepelumab-ekko, 1mg",J2356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.46,,,,,,,fee schedule,17.58,40.4,APC "Inj tezepelumab-ekko, 1mg",J2356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.58,,,,,,,fee schedule,17.58,40.4,APC Omalizumab injection,J2357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.15,,,,,,,fee schedule,41.82,100.04, Omalizumab injection,J2357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.15,,,,,,,fee schedule,41.82,100.04, Omalizumab injection,J2357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.36,,,,,,,fee schedule,41.82,100.04, Omalizumab injection,J2357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.04,,,,,,,fee schedule,41.82,100.04, Omalizumab injection,J2357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.5,,,,,,,fee schedule,41.82,100.04,APC Omalizumab injection,J2357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.91,,,,,,,fee schedule,41.82,100.04,APC Omalizumab injection,J2357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.82,,,,,,,fee schedule,41.82,100.04,APC Olanzapine long-acting inj,J2358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.54,,,,,,,fee schedule,4.54,6.55, Olanzapine long-acting inj,J2358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.54,,,,,,,fee schedule,4.54,6.55, Olanzapine long-acting inj,J2358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.46,,,,,,,fee schedule,4.54,6.55, Olanzapine long-acting inj,J2358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.55,,,,,,,fee schedule,4.54,6.55, "Inj. olanzapine, 0.5mg",J2359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.42,,,,,,,fee schedule,1.42,1.95, "Inj. olanzapine, 0.5mg",J2359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.42,,,,,,,fee schedule,1.42,1.95, "Inj. olanzapine, 0.5mg",J2359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.63,,,,,,,fee schedule,1.42,1.95, "Inj. olanzapine, 0.5mg",J2359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.95,,,,,,,fee schedule,1.42,1.95, Orphenadrine injection,J2360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.7,,,,,,,fee schedule,14.7,25.1, Orphenadrine injection,J2360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.7,,,,,,,fee schedule,14.7,25.1, Orphenadrine injection,J2360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.91,,,,,,,fee schedule,14.7,25.1, Orphenadrine injection,J2360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,25.1,,,,,,,fee schedule,14.7,25.1, Inj phenylephrine hcl 20 mcg,J2371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.02, Inj phenylephrine hcl 20 mcg,J2371,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Inj phenylephrine hcl 20 mcg,J2371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, Inj phenylephrine hcl 20 mcg,J2371,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, biorphen, 20 micrograms",J2372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.26,,,,,,,fee schedule,0.26,0.38, "Inj, biorphen, 20 micrograms",J2372,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.26,,,,,,,fee schedule,0.26,0.38, "Inj, biorphen, 20 micrograms",J2372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.32,,,,,,,fee schedule,0.26,0.38, "Inj, biorphen, 20 micrograms",J2372,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.38,,,,,,,fee schedule,0.26,0.38, "Inj, immphentiv, 20 mcg",J2373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.2,,,,,,,fee schedule,0.2,0.31, "Inj, immphentiv, 20 mcg",J2373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.2,,,,,,,fee schedule,0.2,0.31, "Inj, immphentiv, 20 mcg",J2373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.26,,,,,,,fee schedule,0.2,0.31, "Inj, immphentiv, 20 mcg",J2373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.31,,,,,,,fee schedule,0.2,0.31, Chloroprocaine hcl injection,J2401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Chloroprocaine hcl injection,J2401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.07,,,,,,,fee schedule,0.07,0.09, Chloroprocaine hcl injection,J2401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.07,0.09, Chloroprocaine hcl injection,J2401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.07,0.09, Chloroprocaine (clorotekal),J2402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.58,,,,,,,fee schedule,0.58,0.7, Chloroprocaine (clorotekal),J2402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.7,,,,,,,fee schedule,0.58,0.7, "Chloroprocaine opht gel, 1mg",J2403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.94,,,,,,,fee schedule,0.94,1.3, "Chloroprocaine opht gel, 1mg",J2403,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.94,,,,,,,fee schedule,0.94,1.3, "Chloroprocaine opht gel, 1mg",J2403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.08,,,,,,,fee schedule,0.94,1.3, "Chloroprocaine opht gel, 1mg",J2403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.3,,,,,,,fee schedule,0.94,1.3, "Inj, nicardipine 0.1 mg",J2404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.13,,,,,,,fee schedule,0.13,0.16, "Inj, nicardipine 0.1 mg",J2404,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.13,,,,,,,fee schedule,0.13,0.16, "Inj, nicardipine 0.1 mg",J2404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.13,,,,,,,fee schedule,0.13,0.16, "Inj, nicardipine 0.1 mg",J2404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.16,,,,,,,fee schedule,0.13,0.16, Ondansetron hcl injection,J2405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.15,,,,,,,fee schedule,0.15,1.84, Ondansetron hcl injection,J2405,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.15,,,,,,,fee schedule,0.15,1.84, Ondansetron hcl injection,J2405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.53,,,,,,,fee schedule,0.15,1.84, Ondansetron hcl injection,J2405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.84,,,,,,,fee schedule,0.15,1.84, "Injection, oritavancin 10 mg",J2406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.45,,,,,,,fee schedule,43.72,95.28, "Injection, oritavancin 10 mg",J2406,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.45,,,,,,,fee schedule,43.72,95.28, "Injection, oritavancin 10 mg",J2406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.4,,,,,,,fee schedule,43.72,95.28, "Injection, oritavancin 10 mg",J2406,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.28,,,,,,,fee schedule,43.72,95.28, "Injection, oritavancin 10 mg",J2406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.47,,,,,,,fee schedule,43.72,95.28,APC "Injection, oritavancin 10 mg",J2406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,45.9,,,,,,,fee schedule,43.72,95.28,APC "Injection, oritavancin 10 mg",J2406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,43.72,,,,,,,fee schedule,43.72,95.28,APC "Injection, oritavancin",J2407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.4,,,,,,,fee schedule,28.57,64.33, "Injection, oritavancin",J2407,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.4,,,,,,,fee schedule,28.57,64.33, "Injection, oritavancin",J2407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.6,,,,,,,fee schedule,28.57,64.33, "Injection, oritavancin",J2407,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.33,,,,,,,fee schedule,28.57,64.33, "Injection, oritavancin",J2407,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.71,,,,,,,fee schedule,28.57,64.33,APC "Injection, oritavancin",J2407,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30,,,,,,,fee schedule,28.57,64.33,APC "Injection, oritavancin",J2407,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.57,,,,,,,fee schedule,28.57,64.33,APC Oxymorphone hcl injection,J2410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.33,,,,,,,fee schedule,5.33,6.39, Oxymorphone hcl injection,J2410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.39,,,,,,,fee schedule,5.33,6.39, Palifermin injection,J2425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.9,,,,,,,fee schedule,36.72,79.74, Palifermin injection,J2425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.9,,,,,,,fee schedule,36.72,79.74, Palifermin injection,J2425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.44,,,,,,,fee schedule,36.72,79.74, Palifermin injection,J2425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.74,,,,,,,fee schedule,36.72,79.74, Palifermin injection,J2425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.19,,,,,,,fee schedule,36.72,79.74,APC Palifermin injection,J2425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.55,,,,,,,fee schedule,36.72,79.74,APC Palifermin injection,J2425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.72,,,,,,,fee schedule,36.72,79.74,APC Paliperidone palmitate inj,J2426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.48,,,,,,,fee schedule,15.08,33.89, Paliperidone palmitate inj,J2426,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.48,,,,,,,fee schedule,15.08,33.89, Paliperidone palmitate inj,J2426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.24,,,,,,,fee schedule,15.08,33.89, Paliperidone palmitate inj,J2426,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.89,,,,,,,fee schedule,15.08,33.89, Paliperidone palmitate inj,J2426,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.68,,,,,,,fee schedule,15.08,33.89,APC Paliperidone palmitate inj,J2426,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.83,,,,,,,fee schedule,15.08,33.89,APC Paliperidone palmitate inj,J2426,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.08,,,,,,,fee schedule,15.08,33.89,APC "Inj, invega hafyera/trinza",J2427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.16,,,,,,,fee schedule,12.95,29.16, "Inj, invega hafyera/trinza",J2427,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.16,,,,,,,fee schedule,12.95,29.16, "Inj, invega hafyera/trinza",J2427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.3,,,,,,,fee schedule,12.95,29.16, "Inj, invega hafyera/trinza",J2427,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.16,,,,,,,fee schedule,12.95,29.16, "Inj, invega hafyera/trinza",J2427,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.47,,,,,,,fee schedule,12.95,29.16,APC "Inj, invega hafyera/trinza",J2427,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.6,,,,,,,fee schedule,12.95,29.16,APC "Inj, invega hafyera/trinza",J2427,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.95,,,,,,,fee schedule,12.95,29.16,APC "Inj, erzofri, 1 mg",J2428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.32,,,,,,,fee schedule,14.49,37.59, "Inj, erzofri, 1 mg",J2428,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,37.59,,,,,,,fee schedule,14.49,37.59, "Inj, erzofri, 1 mg",J2428,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.07,,,,,,,fee schedule,14.49,37.59,APC "Inj, erzofri, 1 mg",J2428,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.22,,,,,,,fee schedule,14.49,37.59,APC "Inj, erzofri, 1 mg",J2428,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.49,,,,,,,fee schedule,14.49,37.59,APC Pamidronate disodium /30 mg,J2430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.37,,,,,,,fee schedule,17.37,21.62, Pamidronate disodium /30 mg,J2430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.37,,,,,,,fee schedule,17.37,21.62, Pamidronate disodium /30 mg,J2430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.02,,,,,,,fee schedule,17.37,21.62, Pamidronate disodium /30 mg,J2430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.62,,,,,,,fee schedule,17.37,21.62, Papaverin hcl injection,J2440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,71.49,,,,,,,fee schedule,71.49,85.79, Papaverin hcl injection,J2440,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,85.79,,,,,,,fee schedule,71.49,85.79, Oxytetracycline injection,J2460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.76,,,,,,,fee schedule,1.76,2.11, Oxytetracycline injection,J2460,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.11,,,,,,,fee schedule,1.76,2.11, "Inj, palonosetron (avyxa)",J2468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.58,,,,,,,fee schedule,55.29,130.63, "Inj, palonosetron (avyxa)",J2468,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.58,,,,,,,fee schedule,55.29,130.63, "Inj, palonosetron (avyxa)",J2468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,108.85,,,,,,,fee schedule,55.29,130.63, "Inj, palonosetron (avyxa)",J2468,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,130.63,,,,,,,fee schedule,55.29,130.63, "Inj, palonosetron (avyxa)",J2468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.5,,,,,,,fee schedule,55.29,130.63,APC "Inj, palonosetron (avyxa)",J2468,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.05,,,,,,,fee schedule,55.29,130.63,APC "Inj, palonosetron (avyxa)",J2468,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.29,,,,,,,fee schedule,55.29,130.63,APC Palonosetron hcl,J2469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.69,,,,,,,fee schedule,0.64,0.76, Palonosetron hcl,J2469,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.69,,,,,,,fee schedule,0.64,0.76, Palonosetron hcl,J2469,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.64,,,,,,,fee schedule,0.64,0.76, Palonosetron hcl,J2469,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.76,,,,,,,fee schedule,0.64,0.76, Inj pantoprazole sodium 40mg,J2470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.61,,,,,,,fee schedule,3.61,4.33, Inj pantoprazole sodium 40mg,J2470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.33,,,,,,,fee schedule,3.61,4.33, Inj pantoprazole(hikma) 40mg,J2471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.39,,,,,,,fee schedule,12.39,14.87, Inj pantoprazole(hikma) 40mg,J2471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.87,,,,,,,fee schedule,12.39,14.87, "Inj, pantoprazole sodium chl",J2472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.8,,,,,,,fee schedule,16.8,20.16, "Inj, pantoprazole sodium chl",J2472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.16,,,,,,,fee schedule,16.8,20.16, Paricalcitol,J2501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.04,,,,,,,fee schedule,1.04,2.13, Paricalcitol,J2501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.04,,,,,,,fee schedule,1.04,2.13, Paricalcitol,J2501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.78,,,,,,,fee schedule,1.04,2.13, Paricalcitol,J2501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.13,,,,,,,fee schedule,1.04,2.13, "Inj, pasireotide long acting",J2502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,877.6,,,,,,,fee schedule,596.3,1285.15, "Inj, pasireotide long acting",J2502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,877.6,,,,,,,fee schedule,596.3,1285.15, "Inj, pasireotide long acting",J2502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1070.86,,,,,,,fee schedule,596.3,1285.15, "Inj, pasireotide long acting",J2502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1285.15,,,,,,,fee schedule,596.3,1285.15, "Inj, pasireotide long acting",J2502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,620.15,,,,,,,fee schedule,596.3,1285.15,APC "Inj, pasireotide long acting",J2502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,626.12,,,,,,,fee schedule,596.3,1285.15,APC "Inj, pasireotide long acting",J2502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,596.3,,,,,,,fee schedule,596.3,1285.15,APC "Pegademase bovine, 25 iu",J2504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,687.72,,,,,,,fee schedule,687.72,825.33, "Pegademase bovine, 25 iu",J2504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,825.33,,,,,,,fee schedule,687.72,825.33, Inj pegfilgrast ex bio 0.5mg,J2506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,90.9,,,,,,,fee schedule,90.9,200.39, Inj pegfilgrast ex bio 0.5mg,J2506,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,90.9,,,,,,,fee schedule,90.9,200.39, Inj pegfilgrast ex bio 0.5mg,J2506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,166.98,,,,,,,fee schedule,90.9,200.39, Inj pegfilgrast ex bio 0.5mg,J2506,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.39,,,,,,,fee schedule,90.9,200.39, Inj pegfilgrast ex bio 0.5mg,J2506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,132.47,,,,,,,fee schedule,90.9,200.39,APC Inj pegfilgrast ex bio 0.5mg,J2506,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,133.75,,,,,,,fee schedule,90.9,200.39,APC Inj pegfilgrast ex bio 0.5mg,J2506,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,127.38,,,,,,,fee schedule,90.9,200.39,APC Pegloticase injection,J2507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5664.27,,,,,,,fee schedule,3824.52,8211.24, Pegloticase injection,J2507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5664.27,,,,,,,fee schedule,3824.52,8211.24, Pegloticase injection,J2507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6842.09,,,,,,,fee schedule,3824.52,8211.24, Pegloticase injection,J2507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8211.24,,,,,,,fee schedule,3824.52,8211.24, Pegloticase injection,J2507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3977.5,,,,,,,fee schedule,3824.52,8211.24,APC Pegloticase injection,J2507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4015.75,,,,,,,fee schedule,3824.52,8211.24,APC Pegloticase injection,J2507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3824.52,,,,,,,fee schedule,3824.52,8211.24,APC Pegunigalsidase alfa-iwxj,J2508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,358.45,,,,,,,fee schedule,223.4,511.76, Pegunigalsidase alfa-iwxj,J2508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,358.45,,,,,,,fee schedule,223.4,511.76, Pegunigalsidase alfa-iwxj,J2508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,426.43,,,,,,,fee schedule,223.4,511.76, Pegunigalsidase alfa-iwxj,J2508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,511.76,,,,,,,fee schedule,223.4,511.76, Pegunigalsidase alfa-iwxj,J2508,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,232.34,,,,,,,fee schedule,223.4,511.76,APC Pegunigalsidase alfa-iwxj,J2508,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,234.57,,,,,,,fee schedule,223.4,511.76,APC Pegunigalsidase alfa-iwxj,J2508,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,223.4,,,,,,,fee schedule,223.4,511.76,APC Penicillin g procaine inj,J2510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.6,,,,,,,fee schedule,87.6,105.13, Penicillin g procaine inj,J2510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.13,,,,,,,fee schedule,87.6,105.13, Pentastarch 10% solution,J2513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.77,,,,,,,fee schedule,23.77,28.53, Pentastarch 10% solution,J2513,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.53,,,,,,,fee schedule,23.77,28.53, Pentobarbital sodium inj,J2515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,100.68,,,,,,,fee schedule,36.84,120.83, Pentobarbital sodium inj,J2515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,120.83,,,,,,,fee schedule,36.84,120.83, Pentobarbital sodium inj,J2515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.31,,,,,,,fee schedule,36.84,120.83,APC Pentobarbital sodium inj,J2515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.68,,,,,,,fee schedule,36.84,120.83,APC Pentobarbital sodium inj,J2515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,36.84,120.83,APC Penicillin g potassium inj,J2540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.37,,,,,,,fee schedule,1.37,1.77, Penicillin g potassium inj,J2540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.37,,,,,,,fee schedule,1.37,1.77, Penicillin g potassium inj,J2540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.48,,,,,,,fee schedule,1.37,1.77, Penicillin g potassium inj,J2540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.77,,,,,,,fee schedule,1.37,1.77, Piperacillin/tazobactam,J2543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.73,,,,,,,fee schedule,1.73,2.4, Piperacillin/tazobactam,J2543,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.73,,,,,,,fee schedule,1.73,2.4, Piperacillin/tazobactam,J2543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2,,,,,,,fee schedule,1.73,2.4, Piperacillin/tazobactam,J2543,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.4,,,,,,,fee schedule,1.73,2.4, Pentamidine non-comp unit,J2545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.22,,,,,,,fee schedule,128.22,156.4, Pentamidine non-comp unit,J2545,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.22,,,,,,,fee schedule,128.22,156.4, Pentamidine non-comp unit,J2545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,130.33,,,,,,,fee schedule,128.22,156.4, Pentamidine non-comp unit,J2545,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,156.4,,,,,,,fee schedule,128.22,156.4, "Injection, peramivir",J2547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.03,,,,,,,fee schedule,1.68,3.63, "Injection, peramivir",J2547,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.63,,,,,,,fee schedule,1.68,3.63, "Injection, peramivir",J2547,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.75,,,,,,,fee schedule,1.68,3.63,APC "Injection, peramivir",J2547,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.76,,,,,,,fee schedule,1.68,3.63,APC "Injection, peramivir",J2547,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.68,,,,,,,fee schedule,1.68,3.63,APC Promethazine hcl injection,J2550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.46,,,,,,,fee schedule,4.46,6.62, Promethazine hcl injection,J2550,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.46,,,,,,,fee schedule,4.46,6.62, Promethazine hcl injection,J2550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.51,,,,,,,fee schedule,4.46,6.62, Promethazine hcl injection,J2550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.62,,,,,,,fee schedule,4.46,6.62, Phenobarbital sodium inj,J2560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.59,,,,,,,fee schedule,42.59,67.67, Phenobarbital sodium inj,J2560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.59,,,,,,,fee schedule,42.59,67.67, Phenobarbital sodium inj,J2560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.39,,,,,,,fee schedule,42.59,67.67, Phenobarbital sodium inj,J2560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.67,,,,,,,fee schedule,42.59,67.67, "Inj, sezaby, 1 mg",J2561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.54,,,,,,,fee schedule,1.13,3.05, "Inj, sezaby, 1 mg",J2561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.05,,,,,,,fee schedule,1.13,3.05, "Inj, sezaby, 1 mg",J2561,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.18,,,,,,,fee schedule,1.13,3.05,APC "Inj, sezaby, 1 mg",J2561,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.19,,,,,,,fee schedule,1.13,3.05,APC "Inj, sezaby, 1 mg",J2561,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.13,,,,,,,fee schedule,1.13,3.05,APC Plerixafor injection,J2562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,185.97,,,,,,,fee schedule,32.74,185.97, Plerixafor injection,J2562,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,185.97,,,,,,,fee schedule,32.74,185.97, Plerixafor injection,J2562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.34,,,,,,,fee schedule,32.74,185.97, Plerixafor injection,J2562,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.82,,,,,,,fee schedule,32.74,185.97, Plerixafor injection,J2562,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.05,,,,,,,fee schedule,32.74,185.97,APC Plerixafor injection,J2562,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34.38,,,,,,,fee schedule,32.74,185.97,APC Plerixafor injection,J2562,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.74,,,,,,,fee schedule,32.74,185.97,APC Oxytocin injection,J2590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.67,,,,,,,fee schedule,2.67,3.21, Oxytocin injection,J2590,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.21,,,,,,,fee schedule,2.67,3.21, Inj desmopressin acetate,J2597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.06,,,,,,,fee schedule,6.06,7.9, Inj desmopressin acetate,J2597,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.06,,,,,,,fee schedule,6.06,7.9, Inj desmopressin acetate,J2597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.58,,,,,,,fee schedule,6.06,7.9, Inj desmopressin acetate,J2597,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.9,,,,,,,fee schedule,6.06,7.9, "Inj, vasopressin, 1 unit",J2598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.95,,,,,,,fee schedule,1.74,2.09, "Inj, vasopressin, 1 unit",J2598,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.95,,,,,,,fee schedule,1.74,2.09, "Inj, vasopressin, 1 unit",J2598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.74,,,,,,,fee schedule,1.74,2.09, "Inj, vasopressin, 1 unit",J2598,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.09,,,,,,,fee schedule,1.74,2.09, Inj vasopressin (am reg) 1 u,J2599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.74,,,,,,,fee schedule,0.74,1.37, Inj vasopressin (am reg) 1 u,J2599,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.74,,,,,,,fee schedule,0.74,1.37, Inj vasopressin (am reg) 1 u,J2599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.14,,,,,,,fee schedule,0.74,1.37, Inj vasopressin (am reg) 1 u,J2599,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.37,,,,,,,fee schedule,0.74,1.37, "Inj, vasopressin (baxter)",J2601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.57,,,,,,,fee schedule,1.53,4.57, "Inj, vasopressin (baxter)",J2601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.57,,,,,,,fee schedule,1.53,4.57, "Inj, vasopressin (baxter)",J2601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.76,,,,,,,fee schedule,1.53,4.57, "Inj, vasopressin (baxter)",J2601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.51,,,,,,,fee schedule,1.53,4.57, "Inj, vasopressin (baxter)",J2601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.59,,,,,,,fee schedule,1.53,4.57,APC "Inj, vasopressin (baxter)",J2601,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.61,,,,,,,fee schedule,1.53,4.57,APC "Inj, vasopressin (baxter)",J2601,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.53,,,,,,,fee schedule,1.53,4.57,APC Prednisolone acetate inj,J2650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.97,,,,,,,fee schedule,0.97,1.17, Prednisolone acetate inj,J2650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.17,,,,,,,fee schedule,0.97,1.17, Totazoline hcl injection,J2670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.43,,,,,,,fee schedule,6.43,7.72, Totazoline hcl injection,J2670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.72,,,,,,,fee schedule,6.43,7.72, Inj progesterone per 50 MG,J2675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.97,,,,,,,fee schedule,0.97,1.57, Inj progesterone per 50 MG,J2675,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.97,,,,,,,fee schedule,0.97,1.57, Inj progesterone per 50 MG,J2675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.31,,,,,,,fee schedule,0.97,1.57, Inj progesterone per 50 MG,J2675,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.57,,,,,,,fee schedule,0.97,1.57, Inj fluphenazine hcl 1.25 mg,J2679,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.57,,,,,,,fee schedule,11.57,16.46, Inj fluphenazine hcl 1.25 mg,J2679,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.57,,,,,,,fee schedule,11.57,16.46, Inj fluphenazine hcl 1.25 mg,J2679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.72,,,,,,,fee schedule,11.57,16.46, Inj fluphenazine hcl 1.25 mg,J2679,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.46,,,,,,,fee schedule,11.57,16.46, Fluphenazine decanoate 25 MG,J2680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.73,,,,,,,fee schedule,11.73,16.37, Fluphenazine decanoate 25 MG,J2680,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.73,,,,,,,fee schedule,11.73,16.37, Fluphenazine decanoate 25 MG,J2680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.64,,,,,,,fee schedule,11.73,16.37, Fluphenazine decanoate 25 MG,J2680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.37,,,,,,,fee schedule,11.73,16.37, Procainamide hcl injection,J2690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,302.48,,,,,,,fee schedule,214.81,660.99, Procainamide hcl injection,J2690,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,302.48,,,,,,,fee schedule,214.81,660.99, Procainamide hcl injection,J2690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,550.78,,,,,,,fee schedule,214.81,660.99, Procainamide hcl injection,J2690,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,660.99,,,,,,,fee schedule,214.81,660.99, Procainamide hcl injection,J2690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,223.4,,,,,,,fee schedule,214.81,660.99,APC Procainamide hcl injection,J2690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,225.55,,,,,,,fee schedule,214.81,660.99,APC Procainamide hcl injection,J2690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,214.81,,,,,,,fee schedule,214.81,660.99,APC Oxacillin sodium injeciton,J2700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.29,,,,,,,fee schedule,1.29,1.77, Oxacillin sodium injeciton,J2700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.29,,,,,,,fee schedule,1.29,1.77, Oxacillin sodium injeciton,J2700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.48,,,,,,,fee schedule,1.29,1.77, Oxacillin sodium injeciton,J2700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.77,,,,,,,fee schedule,1.29,1.77, "Inj, propofol, 10 mg",J2704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.13,,,,,,,fee schedule,0.13,0.2, "Inj, propofol, 10 mg",J2704,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.13,,,,,,,fee schedule,0.13,0.2, "Inj, propofol, 10 mg",J2704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.17,,,,,,,fee schedule,0.13,0.2, "Inj, propofol, 10 mg",J2704,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.2,,,,,,,fee schedule,0.13,0.2, Neostigmine methylslfte inj,J2710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.44,,,,,,,fee schedule,1.44,1.73, Neostigmine methylslfte inj,J2710,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.73,,,,,,,fee schedule,1.44,1.73, Inj protamine sulfate/10 MG,J2720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.54,,,,,,,fee schedule,2.54,3.9, Inj protamine sulfate/10 MG,J2720,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.54,,,,,,,fee schedule,2.54,3.9, Inj protamine sulfate/10 MG,J2720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.25,,,,,,,fee schedule,2.54,3.9, Inj protamine sulfate/10 MG,J2720,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.9,,,,,,,fee schedule,2.54,3.9, Protein C concentrate,J2724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,23.4,,,,,,,fee schedule,15.05,33.73, Protein C concentrate,J2724,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,23.4,,,,,,,fee schedule,15.05,33.73, Protein C concentrate,J2724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,15.05,33.73, Protein C concentrate,J2724,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.73,,,,,,,fee schedule,15.05,33.73, Protein C concentrate,J2724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15.65,,,,,,,fee schedule,15.05,33.73,APC Protein C concentrate,J2724,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15.8,,,,,,,fee schedule,15.05,33.73,APC Protein C concentrate,J2724,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15.05,,,,,,,fee schedule,15.05,33.73,APC Inj protirelin per 250 mcg,J2725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.71,,,,,,,fee schedule,40.71,48.85, Inj protirelin per 250 mcg,J2725,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.85,,,,,,,fee schedule,40.71,48.85, Pralidoxime chloride inj,J2730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,165.28,,,,,,,fee schedule,165.28,198.35, Pralidoxime chloride inj,J2730,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,198.35,,,,,,,fee schedule,165.28,198.35, Phentolaine mesylate inj,J2760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,679.47,,,,,,,fee schedule,257.45,969.02, Phentolaine mesylate inj,J2760,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,679.47,,,,,,,fee schedule,257.45,969.02, Phentolaine mesylate inj,J2760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,807.45,,,,,,,fee schedule,257.45,969.02, Phentolaine mesylate inj,J2760,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,969.02,,,,,,,fee schedule,257.45,969.02, Phentolaine mesylate inj,J2760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,267.75,,,,,,,fee schedule,257.45,969.02,APC Phentolaine mesylate inj,J2760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,270.32,,,,,,,fee schedule,257.45,969.02,APC Phentolaine mesylate inj,J2760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,257.45,,,,,,,fee schedule,257.45,969.02,APC Metoclopramide hcl injection,J2765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.55,,,,,,,fee schedule,1.55,2.44, Metoclopramide hcl injection,J2765,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.55,,,,,,,fee schedule,1.55,2.44, Metoclopramide hcl injection,J2765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.04,,,,,,,fee schedule,1.55,2.44, Metoclopramide hcl injection,J2765,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.44,,,,,,,fee schedule,1.55,2.44, Quinupristin/dalfopristin,J2770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,888.39,,,,,,,fee schedule,888.39,1066.17, Quinupristin/dalfopristin,J2770,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1066.17,,,,,,,fee schedule,888.39,1066.17, "Inj, faricimab-svoa, 0.1mg",J2777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,53.67,,,,,,,fee schedule,32.87,75.99, "Inj, faricimab-svoa, 0.1mg",J2777,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,53.67,,,,,,,fee schedule,32.87,75.99, "Inj, faricimab-svoa, 0.1mg",J2777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.32,,,,,,,fee schedule,32.87,75.99, "Inj, faricimab-svoa, 0.1mg",J2777,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75.99,,,,,,,fee schedule,32.87,75.99, "Inj, faricimab-svoa, 0.1mg",J2777,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.18,,,,,,,fee schedule,32.87,75.99,APC "Inj, faricimab-svoa, 0.1mg",J2777,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34.51,,,,,,,fee schedule,32.87,75.99,APC "Inj, faricimab-svoa, 0.1mg",J2777,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.87,,,,,,,fee schedule,32.87,75.99,APC Ranibizumab injection,J2778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,141.82,,,,,,,fee schedule,67.85,193.75, Ranibizumab injection,J2778,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.82,,,,,,,fee schedule,67.85,193.75, Ranibizumab injection,J2778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,161.44,,,,,,,fee schedule,67.85,193.75, Ranibizumab injection,J2778,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,193.75,,,,,,,fee schedule,67.85,193.75, Ranibizumab injection,J2778,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,70.57,,,,,,,fee schedule,67.85,193.75,APC Ranibizumab injection,J2778,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,71.25,,,,,,,fee schedule,67.85,193.75,APC Ranibizumab injection,J2778,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,67.85,,,,,,,fee schedule,67.85,193.75,APC "Inj, susvimo 0.1 mg",J2779,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,122.08,,,,,,,fee schedule,76.2,177.04, "Inj, susvimo 0.1 mg",J2779,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.08,,,,,,,fee schedule,76.2,177.04, "Inj, susvimo 0.1 mg",J2779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,147.52,,,,,,,fee schedule,76.2,177.04, "Inj, susvimo 0.1 mg",J2779,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,177.04,,,,,,,fee schedule,76.2,177.04, "Inj, susvimo 0.1 mg",J2779,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79.25,,,,,,,fee schedule,76.2,177.04,APC "Inj, susvimo 0.1 mg",J2779,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80.01,,,,,,,fee schedule,76.2,177.04,APC "Inj, susvimo 0.1 mg",J2779,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,76.2,,,,,,,fee schedule,76.2,177.04,APC "Inj, pegcetacoplan, 1mg",J2781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,220.9,,,,,,,fee schedule,147.81,312.18, "Inj, pegcetacoplan, 1mg",J2781,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,220.9,,,,,,,fee schedule,147.81,312.18, "Inj, pegcetacoplan, 1mg",J2781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,260.13,,,,,,,fee schedule,147.81,312.18, "Inj, pegcetacoplan, 1mg",J2781,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,312.18,,,,,,,fee schedule,147.81,312.18, "Inj, pegcetacoplan, 1mg",J2781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,153.72,,,,,,,fee schedule,147.81,312.18,APC "Inj, pegcetacoplan, 1mg",J2781,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,155.2,,,,,,,fee schedule,147.81,312.18,APC "Inj, pegcetacoplan, 1mg",J2781,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.81,,,,,,,fee schedule,147.81,312.18,APC Inj avacincaptad pegol 0.1mg,J2782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,164.84,,,,,,,fee schedule,103.4,235.78, Inj avacincaptad pegol 0.1mg,J2782,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,164.84,,,,,,,fee schedule,103.4,235.78, Inj avacincaptad pegol 0.1mg,J2782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,196.47,,,,,,,fee schedule,103.4,235.78, Inj avacincaptad pegol 0.1mg,J2782,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,235.78,,,,,,,fee schedule,103.4,235.78, Inj avacincaptad pegol 0.1mg,J2782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,107.54,,,,,,,fee schedule,103.4,235.78,APC Inj avacincaptad pegol 0.1mg,J2782,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,108.57,,,,,,,fee schedule,103.4,235.78,APC Inj avacincaptad pegol 0.1mg,J2782,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,103.4,,,,,,,fee schedule,103.4,235.78,APC Rasburicase,J2783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,586.03,,,,,,,fee schedule,382.19,846.78, Rasburicase,J2783,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,586.03,,,,,,,fee schedule,382.19,846.78, Rasburicase,J2783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,705.58,,,,,,,fee schedule,382.19,846.78, Rasburicase,J2783,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,846.78,,,,,,,fee schedule,382.19,846.78, Rasburicase,J2783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,397.47,,,,,,,fee schedule,382.19,846.78,APC Rasburicase,J2783,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,401.3,,,,,,,fee schedule,382.19,846.78,APC Rasburicase,J2783,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,382.19,,,,,,,fee schedule,382.19,846.78,APC Regadenoson injection,J2785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.5,,,,,,,fee schedule,4.5,6.77, Regadenoson injection,J2785,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.5,,,,,,,fee schedule,4.5,6.77, Regadenoson injection,J2785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.64,,,,,,,fee schedule,4.5,6.77, Regadenoson injection,J2785,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.77,,,,,,,fee schedule,4.5,6.77, "Injection, reslizumab, 1mg",J2786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.47,,,,,,,fee schedule,11.53,24.56, "Injection, reslizumab, 1mg",J2786,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.47,,,,,,,fee schedule,11.53,24.56, "Injection, reslizumab, 1mg",J2786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.47,,,,,,,fee schedule,11.53,24.56, "Injection, reslizumab, 1mg",J2786,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.56,,,,,,,fee schedule,11.53,24.56, "Injection, reslizumab, 1mg",J2786,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.99,,,,,,,fee schedule,11.53,24.56,APC "Injection, reslizumab, 1mg",J2786,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.11,,,,,,,fee schedule,11.53,24.56,APC "Injection, reslizumab, 1mg",J2786,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.53,,,,,,,fee schedule,11.53,24.56,APC Riboflavin 5?phos opth<=3ml,J2787,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4346.55,,,,,,,fee schedule,4346.55,5216.32, Riboflavin 5?phos opth<=3ml,J2787,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5216.32,,,,,,,fee schedule,4346.55,5216.32, Rho d immune globulin 50 mcg,J2788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.36,,,,,,,fee schedule,43.36,57.4, Rho d immune globulin 50 mcg,J2788,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.36,,,,,,,fee schedule,43.36,57.4, Rho d immune globulin 50 mcg,J2788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.83,,,,,,,fee schedule,43.36,57.4, Rho d immune globulin 50 mcg,J2788,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.4,,,,,,,fee schedule,43.36,57.4, Rho d immune globulin inj,J2790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.3,,,,,,,fee schedule,128.3,185.2, Rho d immune globulin inj,J2790,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.3,,,,,,,fee schedule,128.3,185.2, Rho d immune globulin inj,J2790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,154.32,,,,,,,fee schedule,128.3,185.2, Rho d immune globulin inj,J2790,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,185.2,,,,,,,fee schedule,128.3,185.2, Rhophylac injection,J2791,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.74,,,,,,,fee schedule,7.74,10.9, Rhophylac injection,J2791,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.74,,,,,,,fee schedule,7.74,10.9, Rhophylac injection,J2791,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.08,,,,,,,fee schedule,7.74,10.9, Rhophylac injection,J2791,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.9,,,,,,,fee schedule,7.74,10.9, "Rho(D) immune globulin h, sd",J2792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.9,,,,,,,fee schedule,34.26,57.11, "Rho(D) immune globulin h, sd",J2792,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.9,,,,,,,fee schedule,34.26,57.11, "Rho(D) immune globulin h, sd",J2792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.58,,,,,,,fee schedule,34.26,57.11, "Rho(D) immune globulin h, sd",J2792,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.11,,,,,,,fee schedule,34.26,57.11, "Rho(D) immune globulin h, sd",J2792,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.63,,,,,,,fee schedule,34.26,57.11,APC "Rho(D) immune globulin h, sd",J2792,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.97,,,,,,,fee schedule,34.26,57.11,APC "Rho(D) immune globulin h, sd",J2792,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.26,,,,,,,fee schedule,34.26,57.11,APC Rilonacept injection,J2793,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.66,,,,,,,fee schedule,51.66,62, Rilonacept injection,J2793,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,62,,,,,,,fee schedule,51.66,62, "Risperidone, long acting",J2794,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.03,,,,,,,fee schedule,10.8,24.63, "Risperidone, long acting",J2794,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.03,,,,,,,fee schedule,10.8,24.63, "Risperidone, long acting",J2794,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.52,,,,,,,fee schedule,10.8,24.63, "Risperidone, long acting",J2794,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.63,,,,,,,fee schedule,10.8,24.63, "Risperidone, long acting",J2794,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.23,,,,,,,fee schedule,10.8,24.63,APC "Risperidone, long acting",J2794,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.34,,,,,,,fee schedule,10.8,24.63,APC "Risperidone, long acting",J2794,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.8,,,,,,,fee schedule,10.8,24.63,APC Ropivacaine HCl injection,J2795,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.1,,,,,,,fee schedule,0.09,0.11, Ropivacaine HCl injection,J2795,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.1,,,,,,,fee schedule,0.09,0.11, Ropivacaine HCl injection,J2795,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.09,0.11, Ropivacaine HCl injection,J2795,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.09,0.11, "Inj., rolapitant, 0.5 mg",J2797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.68,,,,,,,fee schedule,1.68,2.02, "Inj., rolapitant, 0.5 mg",J2797,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.02,,,,,,,fee schedule,1.68,2.02, "Inj., perseris, 0.5 mg",J2798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,18.89,,,,,,,fee schedule,12.17,27.23, "Inj., perseris, 0.5 mg",J2798,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.89,,,,,,,fee schedule,12.17,27.23, "Inj., perseris, 0.5 mg",J2798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.69,,,,,,,fee schedule,12.17,27.23, "Inj., perseris, 0.5 mg",J2798,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.23,,,,,,,fee schedule,12.17,27.23, "Inj., perseris, 0.5 mg",J2798,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.66,,,,,,,fee schedule,12.17,27.23,APC "Inj., perseris, 0.5 mg",J2798,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.78,,,,,,,fee schedule,12.17,27.23,APC "Inj., perseris, 0.5 mg",J2798,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.17,,,,,,,fee schedule,12.17,27.23,APC "Inj, uzedy, 1 mg",J2799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.04,,,,,,,fee schedule,25.16,56.16, "Inj, uzedy, 1 mg",J2799,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.04,,,,,,,fee schedule,25.16,56.16, "Inj, uzedy, 1 mg",J2799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.8,,,,,,,fee schedule,25.16,56.16, "Inj, uzedy, 1 mg",J2799,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.16,,,,,,,fee schedule,25.16,56.16, "Inj, uzedy, 1 mg",J2799,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.16,,,,,,,fee schedule,25.16,56.16,APC "Inj, uzedy, 1 mg",J2799,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.41,,,,,,,fee schedule,25.16,56.16,APC "Inj, uzedy, 1 mg",J2799,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.16,,,,,,,fee schedule,25.16,56.16,APC Methocarbamol injection,J2800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.46,,,,,,,fee schedule,7.46,10.74, Methocarbamol injection,J2800,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.46,,,,,,,fee schedule,7.46,10.74, Methocarbamol injection,J2800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.95,,,,,,,fee schedule,7.46,10.74, Methocarbamol injection,J2800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.74,,,,,,,fee schedule,7.46,10.74, "Inj, rykindo, 0.5 mg",J2801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.44,,,,,,,fee schedule,13.03,28.13, "Inj, rykindo, 0.5 mg",J2801,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.13,,,,,,,fee schedule,13.03,28.13, "Inj, rykindo, 0.5 mg",J2801,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.55,,,,,,,fee schedule,13.03,28.13,APC "Inj, rykindo, 0.5 mg",J2801,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.68,,,,,,,fee schedule,13.03,28.13,APC "Inj, rykindo, 0.5 mg",J2801,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.03,,,,,,,fee schedule,13.03,28.13,APC "Inj, romiplostim 1 microgram",J2802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.11,,,,,,,fee schedule,11.11,24.7, "Inj, romiplostim 1 microgram",J2802,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.11,,,,,,,fee schedule,11.11,24.7, "Inj, romiplostim 1 microgram",J2802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.58,,,,,,,fee schedule,11.11,24.7, "Inj, romiplostim 1 microgram",J2802,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.7,,,,,,,fee schedule,11.11,24.7, "Inj, romiplostim 1 microgram",J2802,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.55,,,,,,,fee schedule,11.11,24.7,APC "Inj, romiplostim 1 microgram",J2802,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.66,,,,,,,fee schedule,11.11,24.7,APC "Inj, romiplostim 1 microgram",J2802,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.11,,,,,,,fee schedule,11.11,24.7,APC "Inj, rifampin, 1 mg",J2804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.25,,,,,,,fee schedule,0.25,0.31, "Inj, rifampin, 1 mg",J2804,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.25,,,,,,,fee schedule,0.25,0.31, "Inj, rifampin, 1 mg",J2804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.26,,,,,,,fee schedule,0.25,0.31, "Inj, rifampin, 1 mg",J2804,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.31,,,,,,,fee schedule,0.25,0.31, Sincalide injection,J2805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,211.66,,,,,,,fee schedule,211.66,276.7, Sincalide injection,J2805,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,211.66,,,,,,,fee schedule,211.66,276.7, Sincalide injection,J2805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,230.56,,,,,,,fee schedule,211.66,276.7, Sincalide injection,J2805,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,276.7,,,,,,,fee schedule,211.66,276.7, Inj theophylline per 40 MG,J2810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.77,,,,,,,fee schedule,0.77,0.92, Inj theophylline per 40 MG,J2810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.92,,,,,,,fee schedule,0.77,0.92, Sargramostim injection,J2820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87.32,,,,,,,fee schedule,61.89,112.98, Sargramostim injection,J2820,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87.32,,,,,,,fee schedule,61.89,112.98, Sargramostim injection,J2820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.14,,,,,,,fee schedule,61.89,112.98, Sargramostim injection,J2820,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,112.98,,,,,,,fee schedule,61.89,112.98, Sargramostim injection,J2820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.36,,,,,,,fee schedule,61.89,112.98,APC Sargramostim injection,J2820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.98,,,,,,,fee schedule,61.89,112.98,APC Sargramostim injection,J2820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.89,,,,,,,fee schedule,61.89,112.98,APC Inj sebelipase alfa 1 mg,J2840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,973.21,,,,,,,fee schedule,540.17,1167.95, Inj sebelipase alfa 1 mg,J2840,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1167.95,,,,,,,fee schedule,540.17,1167.95, Inj sebelipase alfa 1 mg,J2840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,561.78,,,,,,,fee schedule,540.17,1167.95,APC Inj sebelipase alfa 1 mg,J2840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,567.18,,,,,,,fee schedule,540.17,1167.95,APC Inj sebelipase alfa 1 mg,J2840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,540.17,,,,,,,fee schedule,540.17,1167.95,APC Inj secretin synthetic human,J2850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.76,,,,,,,fee schedule,40.23,94.52, Inj secretin synthetic human,J2850,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.52,,,,,,,fee schedule,40.23,94.52, Inj secretin synthetic human,J2850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.84,,,,,,,fee schedule,40.23,94.52,APC Inj secretin synthetic human,J2850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.24,,,,,,,fee schedule,40.23,94.52,APC Inj secretin synthetic human,J2850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.23,,,,,,,fee schedule,40.23,94.52,APC "Injection, siltuximab",J2860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,252.1,,,,,,,fee schedule,174.08,371.96, "Injection, siltuximab",J2860,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,252.1,,,,,,,fee schedule,174.08,371.96, "Injection, siltuximab",J2860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,309.94,,,,,,,fee schedule,174.08,371.96, "Injection, siltuximab",J2860,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,371.96,,,,,,,fee schedule,174.08,371.96, "Injection, siltuximab",J2860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.04,,,,,,,fee schedule,174.08,371.96,APC "Injection, siltuximab",J2860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,182.78,,,,,,,fee schedule,174.08,371.96,APC "Injection, siltuximab",J2860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.08,,,,,,,fee schedule,174.08,371.96,APC Inj sulfameth/trim 5 mg/1 mg,J2865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.11, Inj sulfameth/trim 5 mg/1 mg,J2865,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.11, Inj sulfameth/trim 5 mg/1 mg,J2865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.08,0.11, Inj sulfameth/trim 5 mg/1 mg,J2865,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.08,0.11, Aurothioglucose injeciton,J2910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.79,,,,,,,fee schedule,45.79,54.95, Aurothioglucose injeciton,J2910,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.95,,,,,,,fee schedule,45.79,54.95, Na ferric gluconate complex,J2916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.4,,,,,,,fee schedule,3.4,4.53, Na ferric gluconate complex,J2916,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.4,,,,,,,fee schedule,3.4,4.53, Na ferric gluconate complex,J2916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.78,,,,,,,fee schedule,3.4,4.53, Na ferric gluconate complex,J2916,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.53,,,,,,,fee schedule,3.4,4.53, "Inj, methylpred sod succ 5mg",J2919,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.4,,,,,,,fee schedule,0.39,0.47, "Inj, methylpred sod succ 5mg",J2919,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.4,,,,,,,fee schedule,0.39,0.47, "Inj, methylpred sod succ 5mg",J2919,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.39,,,,,,,fee schedule,0.39,0.47, "Inj, methylpred sod succ 5mg",J2919,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.47,,,,,,,fee schedule,0.39,0.47, Somatrem injection,J2940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.04,,,,,,,fee schedule,79.04,94.86, Somatrem injection,J2940,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.86,,,,,,,fee schedule,79.04,94.86, Somatropin injection,J2941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,296.35,,,,,,,fee schedule,296.35,355.65, Somatropin injection,J2941,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,355.65,,,,,,,fee schedule,296.35,355.65, Reteplase injection,J2993,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5759.23,,,,,,,fee schedule,2904.58,6911.69, Reteplase injection,J2993,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6911.69,,,,,,,fee schedule,2904.58,6911.69, Reteplase injection,J2993,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3020.76,,,,,,,fee schedule,2904.58,6911.69,APC Reteplase injection,J2993,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3049.8,,,,,,,fee schedule,2904.58,6911.69,APC Reteplase injection,J2993,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2904.58,,,,,,,fee schedule,2904.58,6911.69,APC Inj streptokinase /250000 IU,J2995,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,148.59,,,,,,,fee schedule,148.59,178.32, Inj streptokinase /250000 IU,J2995,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,178.32,,,,,,,fee schedule,148.59,178.32, Alteplase recombinant,J2997,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,146.55,,,,,,,fee schedule,95.09,211.85, Alteplase recombinant,J2997,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,146.55,,,,,,,fee schedule,95.09,211.85, Alteplase recombinant,J2997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,176.53,,,,,,,fee schedule,95.09,211.85, Alteplase recombinant,J2997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,211.85,,,,,,,fee schedule,95.09,211.85, Alteplase recombinant,J2997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,98.89,,,,,,,fee schedule,95.09,211.85,APC Alteplase recombinant,J2997,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,99.84,,,,,,,fee schedule,95.09,211.85,APC Alteplase recombinant,J2997,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,95.09,,,,,,,fee schedule,95.09,211.85,APC Inj plasminogen tvmh 1mg,J2998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,76.09,,,,,,,fee schedule,38.39,91.31, Inj plasminogen tvmh 1mg,J2998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.31,,,,,,,fee schedule,38.39,91.31, Inj plasminogen tvmh 1mg,J2998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.93,,,,,,,fee schedule,38.39,91.31,APC Inj plasminogen tvmh 1mg,J2998,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.31,,,,,,,fee schedule,38.39,91.31,APC Inj plasminogen tvmh 1mg,J2998,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.39,,,,,,,fee schedule,38.39,91.31,APC Streptomycin injection,J3000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.81,,,,,,,fee schedule,48.81,82.3, Streptomycin injection,J3000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.81,,,,,,,fee schedule,48.81,82.3, Streptomycin injection,J3000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.57,,,,,,,fee schedule,48.81,82.3, Streptomycin injection,J3000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.3,,,,,,,fee schedule,48.81,82.3, Fentanyl citrate injeciton,J3010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.5,,,,,,,fee schedule,1.5,2.47, Fentanyl citrate injeciton,J3010,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.5,,,,,,,fee schedule,1.5,2.47, Fentanyl citrate injeciton,J3010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.06,,,,,,,fee schedule,1.5,2.47, Fentanyl citrate injeciton,J3010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.47,,,,,,,fee schedule,1.5,2.47, Sumatriptan succinate / 6 MG,J3030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.54,,,,,,,fee schedule,70.54,84.65, Sumatriptan succinate / 6 MG,J3030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,84.65,,,,,,,fee schedule,70.54,84.65, "Inj., fremanezumab-vfrm 1 mg",J3031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.41,,,,,,,fee schedule,6.41,7.69, "Inj., fremanezumab-vfrm 1 mg",J3031,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.69,,,,,,,fee schedule,6.41,7.69, Inj. eptinezumab-jjmr 1 mg,J3032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.89,,,,,,,fee schedule,20.55,44.79, Inj. eptinezumab-jjmr 1 mg,J3032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.89,,,,,,,fee schedule,20.55,44.79, Inj. eptinezumab-jjmr 1 mg,J3032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.32,,,,,,,fee schedule,20.55,44.79, Inj. eptinezumab-jjmr 1 mg,J3032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.79,,,,,,,fee schedule,20.55,44.79, Inj. eptinezumab-jjmr 1 mg,J3032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.37,,,,,,,fee schedule,20.55,44.79,APC Inj. eptinezumab-jjmr 1 mg,J3032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.57,,,,,,,fee schedule,20.55,44.79,APC Inj. eptinezumab-jjmr 1 mg,J3032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.55,,,,,,,fee schedule,20.55,44.79,APC Inj talquetamab-tgvs 0.25 mg,J3055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,112.7,,,,,,,fee schedule,74.88,162.89, Inj talquetamab-tgvs 0.25 mg,J3055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,112.7,,,,,,,fee schedule,74.88,162.89, Inj talquetamab-tgvs 0.25 mg,J3055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,135.73,,,,,,,fee schedule,74.88,162.89, Inj talquetamab-tgvs 0.25 mg,J3055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,162.89,,,,,,,fee schedule,74.88,162.89, Inj talquetamab-tgvs 0.25 mg,J3055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.87,,,,,,,fee schedule,74.88,162.89,APC Inj talquetamab-tgvs 0.25 mg,J3055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.62,,,,,,,fee schedule,74.88,162.89,APC Inj talquetamab-tgvs 0.25 mg,J3055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.88,,,,,,,fee schedule,74.88,162.89,APC "Inj, taliglucerace alfa 10 u",J3060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,63.92,,,,,,,fee schedule,40.66,92.21, "Inj, taliglucerace alfa 10 u",J3060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,63.92,,,,,,,fee schedule,40.66,92.21, "Inj, taliglucerace alfa 10 u",J3060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,76.83,,,,,,,fee schedule,40.66,92.21, "Inj, taliglucerace alfa 10 u",J3060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,92.21,,,,,,,fee schedule,40.66,92.21, "Inj, taliglucerace alfa 10 u",J3060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42.28,,,,,,,fee schedule,40.66,92.21,APC "Inj, taliglucerace alfa 10 u",J3060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.69,,,,,,,fee schedule,40.66,92.21,APC "Inj, taliglucerace alfa 10 u",J3060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.66,,,,,,,fee schedule,40.66,92.21,APC Pentazocine injection,J3070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,202.58,,,,,,,fee schedule,202.58,243.12, Pentazocine injection,J3070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,243.12,,,,,,,fee schedule,202.58,243.12, Inj tedizolid phosphate,J3090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.97,,,,,,,fee schedule,1.96,4.4, Inj tedizolid phosphate,J3090,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.97,,,,,,,fee schedule,1.96,4.4, Inj tedizolid phosphate,J3090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.66,,,,,,,fee schedule,1.96,4.4, Inj tedizolid phosphate,J3090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.4,,,,,,,fee schedule,1.96,4.4, Inj tedizolid phosphate,J3090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.04,,,,,,,fee schedule,1.96,4.4,APC Inj tedizolid phosphate,J3090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.06,,,,,,,fee schedule,1.96,4.4,APC Inj tedizolid phosphate,J3090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.96,,,,,,,fee schedule,1.96,4.4,APC Telavancin injection,J3095,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.62,,,,,,,fee schedule,7.03,15.95, Telavancin injection,J3095,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.62,,,,,,,fee schedule,7.03,15.95, Telavancin injection,J3095,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.29,,,,,,,fee schedule,7.03,15.95, Telavancin injection,J3095,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.95,,,,,,,fee schedule,7.03,15.95, Telavancin injection,J3095,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.31,,,,,,,fee schedule,7.03,15.95,APC Telavancin injection,J3095,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.38,,,,,,,fee schedule,7.03,15.95,APC Telavancin injection,J3095,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.03,,,,,,,fee schedule,7.03,15.95,APC Tenecteplase injection,J3101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,267.65,,,,,,,fee schedule,197.44,386.29, Tenecteplase injection,J3101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,267.65,,,,,,,fee schedule,197.44,386.29, Tenecteplase injection,J3101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,321.88,,,,,,,fee schedule,197.44,386.29, Tenecteplase injection,J3101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,386.29,,,,,,,fee schedule,197.44,386.29, Tenecteplase injection,J3101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,205.34,,,,,,,fee schedule,197.44,386.29,APC Tenecteplase injection,J3101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,207.31,,,,,,,fee schedule,197.44,386.29,APC Tenecteplase injection,J3101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,197.44,,,,,,,fee schedule,197.44,386.29,APC Terbutaline sulfate inj,J3105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.27,,,,,,,fee schedule,4.27,16.58, Terbutaline sulfate inj,J3105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.27,,,,,,,fee schedule,4.27,16.58, Terbutaline sulfate inj,J3105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.81,,,,,,,fee schedule,4.27,16.58, Terbutaline sulfate inj,J3105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.58,,,,,,,fee schedule,4.27,16.58, Teriparatide injection,J3110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.48,,,,,,,fee schedule,88.48,106.18, Teriparatide injection,J3110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,106.18,,,,,,,fee schedule,88.48,106.18, Inj. romosozumab-aqqg 1 mg,J3111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,18.68,,,,,,,fee schedule,12.19,27.07, Inj. romosozumab-aqqg 1 mg,J3111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.68,,,,,,,fee schedule,12.19,27.07, Inj. romosozumab-aqqg 1 mg,J3111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.56,,,,,,,fee schedule,12.19,27.07, Inj. romosozumab-aqqg 1 mg,J3111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.07,,,,,,,fee schedule,12.19,27.07, Inj. romosozumab-aqqg 1 mg,J3111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.67,,,,,,,fee schedule,12.19,27.07,APC Inj. romosozumab-aqqg 1 mg,J3111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.8,,,,,,,fee schedule,12.19,27.07,APC Inj. romosozumab-aqqg 1 mg,J3111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.19,,,,,,,fee schedule,12.19,27.07,APC Inj testostero enanthate 1mg,J3121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.08,0.11, Inj testostero enanthate 1mg,J3121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.08,0.11, Inj testostero enanthate 1mg,J3121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.08,0.11, Inj testostero enanthate 1mg,J3121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.08,0.11, Testosterone undecanoate 1mg,J3145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.1,,,,,,,fee schedule,2.13,4.64, Testosterone undecanoate 1mg,J3145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.1,,,,,,,fee schedule,2.13,4.64, Testosterone undecanoate 1mg,J3145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.87,,,,,,,fee schedule,2.13,4.64, Testosterone undecanoate 1mg,J3145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.64,,,,,,,fee schedule,2.13,4.64, Testosterone undecanoate 1mg,J3145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.22,,,,,,,fee schedule,2.13,4.64,APC Testosterone undecanoate 1mg,J3145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.24,,,,,,,fee schedule,2.13,4.64,APC Testosterone undecanoate 1mg,J3145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.13,,,,,,,fee schedule,2.13,4.64,APC Chlorpromazine hcl injection,J3230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.14,,,,,,,fee schedule,42.14,56.68, Chlorpromazine hcl injection,J3230,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.14,,,,,,,fee schedule,42.14,56.68, Chlorpromazine hcl injection,J3230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.23,,,,,,,fee schedule,42.14,56.68, Chlorpromazine hcl injection,J3230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.68,,,,,,,fee schedule,42.14,56.68, Thyrotropin injection,J3240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3289.47,,,,,,,fee schedule,2125.34,4746.91, Thyrotropin injection,J3240,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3289.47,,,,,,,fee schedule,2125.34,4746.91, Thyrotropin injection,J3240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3955.4,,,,,,,fee schedule,2125.34,4746.91, Thyrotropin injection,J3240,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4746.91,,,,,,,fee schedule,2125.34,4746.91, Thyrotropin injection,J3240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2210.35,,,,,,,fee schedule,2125.34,4746.91,APC Thyrotropin injection,J3240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2231.6,,,,,,,fee schedule,2125.34,4746.91,APC Thyrotropin injection,J3240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2125.34,,,,,,,fee schedule,2125.34,4746.91,APC Inj. teprotumumab-trbw 10 mg,J3241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,558.95,,,,,,,fee schedule,367.91,805.66, Inj. teprotumumab-trbw 10 mg,J3241,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,558.95,,,,,,,fee schedule,367.91,805.66, Inj. teprotumumab-trbw 10 mg,J3241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,671.33,,,,,,,fee schedule,367.91,805.66, Inj. teprotumumab-trbw 10 mg,J3241,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,805.66,,,,,,,fee schedule,367.91,805.66, Inj. teprotumumab-trbw 10 mg,J3241,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,382.62,,,,,,,fee schedule,367.91,805.66,APC Inj. teprotumumab-trbw 10 mg,J3241,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,386.3,,,,,,,fee schedule,367.91,805.66,APC Inj. teprotumumab-trbw 10 mg,J3241,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,367.91,,,,,,,fee schedule,367.91,805.66,APC Tigecycline injection,J3243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.79,,,,,,,fee schedule,0.71,0.85, Tigecycline injection,J3243,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.79,,,,,,,fee schedule,0.71,0.85, Tigecycline injection,J3243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.71,,,,,,,fee schedule,0.71,0.85, Tigecycline injection,J3243,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.85,,,,,,,fee schedule,0.71,0.85, Inj. tigecycline (accord),J3244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.77,,,,,,,fee schedule,4.77,5.72, Inj. tigecycline (accord),J3244,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.72,,,,,,,fee schedule,4.77,5.72, "Inj., tildrakizumab, 1 mg",J3245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,196.5,,,,,,,fee schedule,118.2,285.87, "Inj., tildrakizumab, 1 mg",J3245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,196.5,,,,,,,fee schedule,118.2,285.87, "Inj., tildrakizumab, 1 mg",J3245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,238.2,,,,,,,fee schedule,118.2,285.87, "Inj., tildrakizumab, 1 mg",J3245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,285.87,,,,,,,fee schedule,118.2,285.87, "Inj., tildrakizumab, 1 mg",J3245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,122.93,,,,,,,fee schedule,118.2,285.87,APC "Inj., tildrakizumab, 1 mg",J3245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,124.11,,,,,,,fee schedule,118.2,285.87,APC "Inj., tildrakizumab, 1 mg",J3245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,118.2,,,,,,,fee schedule,118.2,285.87,APC Tirofiban hcl,J3246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.33,,,,,,,fee schedule,5.33,7.81, Tirofiban hcl,J3246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.33,,,,,,,fee schedule,5.33,7.81, Tirofiban hcl,J3246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.5,,,,,,,fee schedule,5.33,7.81, Tirofiban hcl,J3246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.81,,,,,,,fee schedule,5.33,7.81, Inj secukinumab intrav 1mg,J3247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.77,,,,,,,fee schedule,18.04,40.02, Inj secukinumab intrav 1mg,J3247,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.77,,,,,,,fee schedule,18.04,40.02, Inj secukinumab intrav 1mg,J3247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.34,,,,,,,fee schedule,18.04,40.02, Inj secukinumab intrav 1mg,J3247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.02,,,,,,,fee schedule,18.04,40.02, Inj secukinumab intrav 1mg,J3247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.76,,,,,,,fee schedule,18.04,40.02,APC Inj secukinumab intrav 1mg,J3247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18.94,,,,,,,fee schedule,18.04,40.02,APC Inj secukinumab intrav 1mg,J3247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.04,,,,,,,fee schedule,18.04,40.02,APC Trimethobenzamide hcl inj,J3250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.13,,,,,,,fee schedule,83.13,128.99, Trimethobenzamide hcl inj,J3250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.13,,,,,,,fee schedule,83.13,128.99, Trimethobenzamide hcl inj,J3250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,107.49,,,,,,,fee schedule,83.13,128.99, Trimethobenzamide hcl inj,J3250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,128.99,,,,,,,fee schedule,83.13,128.99, Tobramycin sulfate injection,J3260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.83,,,,,,,fee schedule,3.83,5.32, Tobramycin sulfate injection,J3260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.83,,,,,,,fee schedule,3.83,5.32, Tobramycin sulfate injection,J3260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.43,,,,,,,fee schedule,3.83,5.32, Tobramycin sulfate injection,J3260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.32,,,,,,,fee schedule,3.83,5.32, Tocilizumab injection,J3262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.01,,,,,,,fee schedule,5.53,12.81, Tocilizumab injection,J3262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.01,,,,,,,fee schedule,5.53,12.81, Tocilizumab injection,J3262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.67,,,,,,,fee schedule,5.53,12.81, Tocilizumab injection,J3262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.81,,,,,,,fee schedule,5.53,12.81, Tocilizumab injection,J3262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.75,,,,,,,fee schedule,5.53,12.81,APC Tocilizumab injection,J3262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.81,,,,,,,fee schedule,5.53,12.81,APC Tocilizumab injection,J3262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.53,,,,,,,fee schedule,5.53,12.81,APC "Inj, toripalimab-tpzi, 1 mg",J3263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,61.48,,,,,,,fee schedule,39.99,88.4, "Inj, toripalimab-tpzi, 1 mg",J3263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,61.48,,,,,,,fee schedule,39.99,88.4, "Inj, toripalimab-tpzi, 1 mg",J3263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,73.66,,,,,,,fee schedule,39.99,88.4, "Inj, toripalimab-tpzi, 1 mg",J3263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.4,,,,,,,fee schedule,39.99,88.4, "Inj, toripalimab-tpzi, 1 mg",J3263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.59,,,,,,,fee schedule,39.99,88.4,APC "Inj, toripalimab-tpzi, 1 mg",J3263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41.99,,,,,,,fee schedule,39.99,88.4,APC "Inj, toripalimab-tpzi, 1 mg",J3263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,39.99,,,,,,,fee schedule,39.99,88.4,APC Injection torsemide 10 mg/ml,J3265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.09,,,,,,,fee schedule,4.09,4.91, Injection torsemide 10 mg/ml,J3265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.91,,,,,,,fee schedule,4.09,4.91, Thiethylperazine maleate inj,J3280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.9,,,,,,,fee schedule,8.9,10.68, Thiethylperazine maleate inj,J3280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.68,,,,,,,fee schedule,8.9,10.68, Treprostinil injection,J3285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.36,,,,,,,fee schedule,55.18,122.71, Treprostinil injection,J3285,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.36,,,,,,,fee schedule,55.18,122.71, Treprostinil injection,J3285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,102.25,,,,,,,fee schedule,55.18,122.71, Treprostinil injection,J3285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,122.71,,,,,,,fee schedule,55.18,122.71, Treprostinil injection,J3285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.39,,,,,,,fee schedule,55.18,122.71,APC Treprostinil injection,J3285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,57.94,,,,,,,fee schedule,55.18,122.71,APC Treprostinil injection,J3285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.18,,,,,,,fee schedule,55.18,122.71,APC "Inj, tranexamic acid 5 mg",J3290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.06,0.07, "Inj, tranexamic acid 5 mg",J3290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.06,0.07, Inj xipere 1 mg,J3299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,74.71,,,,,,,fee schedule,47.78,107.6, Inj xipere 1 mg,J3299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,74.71,,,,,,,fee schedule,47.78,107.6, Inj xipere 1 mg,J3299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,89.66,,,,,,,fee schedule,47.78,107.6, Inj xipere 1 mg,J3299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,107.6,,,,,,,fee schedule,47.78,107.6, Inj xipere 1 mg,J3299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,49.69,,,,,,,fee schedule,47.78,107.6,APC Inj xipere 1 mg,J3299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50.17,,,,,,,fee schedule,47.78,107.6,APC Inj xipere 1 mg,J3299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.78,,,,,,,fee schedule,47.78,107.6,APC Triamcinolone A inj PRS-free,J3300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.15,,,,,,,fee schedule,18.78,54.95, Triamcinolone A inj PRS-free,J3300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,38.15,,,,,,,fee schedule,18.78,54.95, Triamcinolone A inj PRS-free,J3300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.79,,,,,,,fee schedule,18.78,54.95, Triamcinolone A inj PRS-free,J3300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.95,,,,,,,fee schedule,18.78,54.95, Triamcinolone A inj PRS-free,J3300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.53,,,,,,,fee schedule,18.78,54.95,APC Triamcinolone A inj PRS-free,J3300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.72,,,,,,,fee schedule,18.78,54.95,APC Triamcinolone A inj PRS-free,J3300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.78,,,,,,,fee schedule,18.78,54.95,APC Triamcinolone acet inj nos,J3301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.34,,,,,,,fee schedule,1.34,1.88, Triamcinolone acet inj nos,J3301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.34,,,,,,,fee schedule,1.34,1.88, Triamcinolone acet inj nos,J3301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.57,,,,,,,fee schedule,1.34,1.88, Triamcinolone acet inj nos,J3301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.88,,,,,,,fee schedule,1.34,1.88, Triamcinolone diacetate inj,J3302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.52,,,,,,,fee schedule,0.52,0.63, Triamcinolone diacetate inj,J3302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.63,,,,,,,fee schedule,0.52,0.63, Triamcinolone hexacetonl inj,J3303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.49,,,,,,,fee schedule,15.49,18.59, Triamcinolone hexacetonl inj,J3303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18.59,,,,,,,fee schedule,15.49,18.59, Inj triamcinolone ace xr 1mg,J3304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.35,,,,,,,fee schedule,18.64,41.05, Inj triamcinolone ace xr 1mg,J3304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.35,,,,,,,fee schedule,18.64,41.05, Inj triamcinolone ace xr 1mg,J3304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.2,,,,,,,fee schedule,18.64,41.05, Inj triamcinolone ace xr 1mg,J3304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.05,,,,,,,fee schedule,18.64,41.05, Inj triamcinolone ace xr 1mg,J3304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.38,,,,,,,fee schedule,18.64,41.05,APC Inj triamcinolone ace xr 1mg,J3304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.57,,,,,,,fee schedule,18.64,41.05,APC Inj triamcinolone ace xr 1mg,J3304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.64,,,,,,,fee schedule,18.64,41.05,APC Perphenazine injeciton,J3310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.92,,,,,,,fee schedule,11.92,14.31, Perphenazine injeciton,J3310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.31,,,,,,,fee schedule,11.92,14.31, Triptorelin pamoate,J3315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,765.7,,,,,,,fee schedule,469.38,1065.07, Triptorelin pamoate,J3315,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,765.7,,,,,,,fee schedule,469.38,1065.07, Triptorelin pamoate,J3315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,887.48,,,,,,,fee schedule,469.38,1065.07, Triptorelin pamoate,J3315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1065.07,,,,,,,fee schedule,469.38,1065.07, Triptorelin pamoate,J3315,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,488.15,,,,,,,fee schedule,469.38,1065.07,APC Triptorelin pamoate,J3315,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,492.84,,,,,,,fee schedule,469.38,1065.07,APC Triptorelin pamoate,J3315,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,469.38,,,,,,,fee schedule,469.38,1065.07,APC "Inj., triptorelin xr 3.75 mg",J3316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5872.83,,,,,,,fee schedule,3723.76,8562.16, "Inj., triptorelin xr 3.75 mg",J3316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5872.83,,,,,,,fee schedule,3723.76,8562.16, "Inj., triptorelin xr 3.75 mg",J3316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7134.5,,,,,,,fee schedule,3723.76,8562.16, "Inj., triptorelin xr 3.75 mg",J3316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8562.16,,,,,,,fee schedule,3723.76,8562.16, "Inj., triptorelin xr 3.75 mg",J3316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3872.71,,,,,,,fee schedule,3723.76,8562.16,APC "Inj., triptorelin xr 3.75 mg",J3316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3909.94,,,,,,,fee schedule,3723.76,8562.16,APC "Inj., triptorelin xr 3.75 mg",J3316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3723.76,,,,,,,fee schedule,3723.76,8562.16,APC Spectinomycn di-hcl inj,J3320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.22,,,,,,,fee schedule,56.22,67.47, Spectinomycn di-hcl inj,J3320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.47,,,,,,,fee schedule,56.22,67.47, Urea injection,J3350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,141.2,,,,,,,fee schedule,141.2,169.46, Urea injection,J3350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,169.46,,,,,,,fee schedule,141.2,169.46, "Urofollitropin, 75 iu",J3355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,118.55,,,,,,,fee schedule,118.55,142.27, "Urofollitropin, 75 iu",J3355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,142.27,,,,,,,fee schedule,118.55,142.27, "Ustekinumab sub cu inj, 1 mg",J3357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,540.31,,,,,,,fee schedule,540.31,648.43, "Ustekinumab sub cu inj, 1 mg",J3357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,648.43,,,,,,,fee schedule,540.31,648.43, "Ustekinumab, iv inject, 1 mg",J3358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.69,,,,,,,fee schedule,11.62,29.14, "Ustekinumab, iv inject, 1 mg",J3358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.69,,,,,,,fee schedule,11.62,29.14, "Ustekinumab, iv inject, 1 mg",J3358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.28,,,,,,,fee schedule,11.62,29.14, "Ustekinumab, iv inject, 1 mg",J3358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.14,,,,,,,fee schedule,11.62,29.14, "Ustekinumab, iv inject, 1 mg",J3358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.09,,,,,,,fee schedule,11.62,29.14,APC "Ustekinumab, iv inject, 1 mg",J3358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.21,,,,,,,fee schedule,11.62,29.14,APC "Ustekinumab, iv inject, 1 mg",J3358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.62,,,,,,,fee schedule,11.62,29.14,APC Diazepam injection,J3360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.6,,,,,,,fee schedule,9.6,16.49, Diazepam injection,J3360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.6,,,,,,,fee schedule,9.6,16.49, Diazepam injection,J3360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.74,,,,,,,fee schedule,9.6,16.49, Diazepam injection,J3360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,16.49,,,,,,,fee schedule,9.6,16.49, Urokinase 5000 IU injection,J3364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.12,,,,,,,fee schedule,17.12,20.55, Urokinase 5000 IU injection,J3364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.55,,,,,,,fee schedule,17.12,20.55, "Urokinase 250,000 IU inj",J3365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,855.5,,,,,,,fee schedule,855.5,1026.69, "Urokinase 250,000 IU inj",J3365,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1026.69,,,,,,,fee schedule,855.5,1026.69, "Inj, vancomycin hcl, 10 mg",J3373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.05,,,,,,,fee schedule,0.05,0.07, "Inj, vancomycin hcl, 10 mg",J3373,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.05,,,,,,,fee schedule,0.05,0.07, "Inj, vancomycin hcl, 10 mg",J3373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.06,,,,,,,fee schedule,0.05,0.07, "Inj, vancomycin hcl, 10 mg",J3373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.07,,,,,,,fee schedule,0.05,0.07, "Inj, vancomycin (mylan) 10mg",J3374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.18,,,,,,,fee schedule,0.18,0.27, "Inj, vancomycin (mylan) 10mg",J3374,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.18,,,,,,,fee schedule,0.18,0.27, "Inj, vancomycin (mylan) 10mg",J3374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.22,,,,,,,fee schedule,0.18,0.27, "Inj, vancomycin (mylan) 10mg",J3374,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.27,,,,,,,fee schedule,0.18,0.27, Inj vancomycin (xellia) 10mg,J3375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.21,,,,,,,fee schedule,0.21,0.31, Inj vancomycin (xellia) 10mg,J3375,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.21,,,,,,,fee schedule,0.21,0.31, Inj vancomycin (xellia) 10mg,J3375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.26,,,,,,,fee schedule,0.21,0.31, Inj vancomycin (xellia) 10mg,J3375,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.31,,,,,,,fee schedule,0.21,0.31, "Injection, vedolizumab",J3380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.34,,,,,,,fee schedule,20.98,47.8, "Injection, vedolizumab",J3380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.34,,,,,,,fee schedule,20.98,47.8, "Injection, vedolizumab",J3380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.83,,,,,,,fee schedule,20.98,47.8, "Injection, vedolizumab",J3380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.8,,,,,,,fee schedule,20.98,47.8, "Injection, vedolizumab",J3380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.82,,,,,,,fee schedule,20.98,47.8,APC "Injection, vedolizumab",J3380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.03,,,,,,,fee schedule,20.98,47.8,APC "Injection, vedolizumab",J3380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.98,,,,,,,fee schedule,20.98,47.8,APC Velaglucerase alfa,J3385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,591.79,,,,,,,fee schedule,388.16,855.39, Velaglucerase alfa,J3385,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,591.79,,,,,,,fee schedule,388.16,855.39, Velaglucerase alfa,J3385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,712.76,,,,,,,fee schedule,388.16,855.39, Velaglucerase alfa,J3385,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,855.39,,,,,,,fee schedule,388.16,855.39, Velaglucerase alfa,J3385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,403.68,,,,,,,fee schedule,388.16,855.39,APC Velaglucerase alfa,J3385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,407.56,,,,,,,fee schedule,388.16,855.39,APC Velaglucerase alfa,J3385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,388.16,,,,,,,fee schedule,388.16,855.39,APC Verteporfin injection,J3396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.99,,,,,,,fee schedule,11.57,25.88, Verteporfin injection,J3396,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.99,,,,,,,fee schedule,11.57,25.88, Verteporfin injection,J3396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.57,,,,,,,fee schedule,11.57,25.88, Verteporfin injection,J3396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,25.88,,,,,,,fee schedule,11.57,25.88, Verteporfin injection,J3396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.04,,,,,,,fee schedule,11.57,25.88,APC Verteporfin injection,J3396,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.15,,,,,,,fee schedule,11.57,25.88,APC Verteporfin injection,J3396,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.57,,,,,,,fee schedule,11.57,25.88,APC "Inj., vestronidase alfa-vjbk",J3397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,517.77,,,,,,,fee schedule,280.15,621.38, "Inj., vestronidase alfa-vjbk",J3397,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,621.38,,,,,,,fee schedule,280.15,621.38, "Inj., vestronidase alfa-vjbk",J3397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,291.36,,,,,,,fee schedule,280.15,621.38,APC "Inj., vestronidase alfa-vjbk",J3397,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,294.16,,,,,,,fee schedule,280.15,621.38,APC "Inj., vestronidase alfa-vjbk",J3397,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,280.15,,,,,,,fee schedule,280.15,621.38,APC Triflupromazine hcl inj,J3400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.65,,,,,,,fee schedule,20.65,24.79, Triflupromazine hcl inj,J3400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.79,,,,,,,fee schedule,20.65,24.79, "Vyjuvek 5x10^9pfu/ml, 0.1 ml",J3401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1614.38,,,,,,,fee schedule,1004.58,2263.64, "Vyjuvek 5x10^9pfu/ml, 0.1 ml",J3401,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1614.38,,,,,,,fee schedule,1004.58,2263.64, "Vyjuvek 5x10^9pfu/ml, 0.1 ml",J3401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1886.19,,,,,,,fee schedule,1004.58,2263.64, "Vyjuvek 5x10^9pfu/ml, 0.1 ml",J3401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2263.64,,,,,,,fee schedule,1004.58,2263.64, "Vyjuvek 5x10^9pfu/ml, 0.1 ml",J3401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1044.77,,,,,,,fee schedule,1004.58,2263.64,APC "Vyjuvek 5x10^9pfu/ml, 0.1 ml",J3401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1054.81,,,,,,,fee schedule,1004.58,2263.64,APC "Vyjuvek 5x10^9pfu/ml, 0.1 ml",J3401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1004.58,,,,,,,fee schedule,1004.58,2263.64,APC Hydroxyzine hcl injection,J3410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.35,,,,,,,fee schedule,26.35,34.32, Hydroxyzine hcl injection,J3410,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.35,,,,,,,fee schedule,26.35,34.32, Hydroxyzine hcl injection,J3410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.6,,,,,,,fee schedule,26.35,34.32, Hydroxyzine hcl injection,J3410,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.32,,,,,,,fee schedule,26.35,34.32, Thiamine hcl 100 mg,J3411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.79,,,,,,,fee schedule,2.79,4.08, Thiamine hcl 100 mg,J3411,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.79,,,,,,,fee schedule,2.79,4.08, Thiamine hcl 100 mg,J3411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.4,,,,,,,fee schedule,2.79,4.08, Thiamine hcl 100 mg,J3411,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.08,,,,,,,fee schedule,2.79,4.08, Pyridoxine hcl 100 mg,J3415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.92,,,,,,,fee schedule,11.31,19.92, Pyridoxine hcl 100 mg,J3415,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.92,,,,,,,fee schedule,11.31,19.92, Pyridoxine hcl 100 mg,J3415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11.31,,,,,,,fee schedule,11.31,19.92, Pyridoxine hcl 100 mg,J3415,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13.57,,,,,,,fee schedule,11.31,19.92, Vitamin b12 injection,J3420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.47,,,,,,,fee schedule,1.47,2.24, Vitamin b12 injection,J3420,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.47,,,,,,,fee schedule,1.47,2.24, Vitamin b12 injection,J3420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.87,,,,,,,fee schedule,1.47,2.24, Vitamin b12 injection,J3420,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.24,,,,,,,fee schedule,1.47,2.24, Inj hydroxocobalamin iv 25mg,J3424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10,,,,,,,fee schedule,5.44,12, Inj hydroxocobalamin iv 25mg,J3424,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12,,,,,,,fee schedule,5.44,12, Inj hydroxocobalamin iv 25mg,J3424,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.66,,,,,,,fee schedule,5.44,12,APC Inj hydroxocobalamin iv 25mg,J3424,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.72,,,,,,,fee schedule,5.44,12,APC Inj hydroxocobalamin iv 25mg,J3424,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.44,,,,,,,fee schedule,5.44,12,APC "Inj, hydroxocobalamin",J3425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, hydroxocobalamin",J3425,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, hydroxocobalamin",J3425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, "Inj, hydroxocobalamin",J3425,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Vitamin k phytonadione inj,J3430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.42,,,,,,,fee schedule,4.42,6.12, Vitamin k phytonadione inj,J3430,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.42,,,,,,,fee schedule,4.42,6.12, Vitamin k phytonadione inj,J3430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.1,,,,,,,fee schedule,4.42,6.12, Vitamin k phytonadione inj,J3430,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.12,,,,,,,fee schedule,4.42,6.12, "Injection, voriconazole",J3465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.2,,,,,,,fee schedule,1.2,1.73, "Injection, voriconazole",J3465,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.2,,,,,,,fee schedule,1.2,1.73, "Injection, voriconazole",J3465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.44,,,,,,,fee schedule,1.2,1.73, "Injection, voriconazole",J3465,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.73,,,,,,,fee schedule,1.2,1.73, Hyaluronidase injection,J3470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.12,,,,,,,fee schedule,49.12,72.27, Hyaluronidase injection,J3470,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.12,,,,,,,fee schedule,49.12,72.27, Hyaluronidase injection,J3470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.22,,,,,,,fee schedule,49.12,72.27, Hyaluronidase injection,J3470,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.27,,,,,,,fee schedule,49.12,72.27, "Ovine, up to 999 usp units",J3471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.78,,,,,,,fee schedule,0.78,1.12, "Ovine, up to 999 usp units",J3471,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.78,,,,,,,fee schedule,0.78,1.12, "Ovine, up to 999 usp units",J3471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.93,,,,,,,fee schedule,0.78,1.12, "Ovine, up to 999 usp units",J3471,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.12,,,,,,,fee schedule,0.78,1.12, "Ovine, 1000 USP units",J3472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,257.55,,,,,,,fee schedule,257.55,309.09, "Ovine, 1000 USP units",J3472,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,309.09,,,,,,,fee schedule,257.55,309.09, Hyaluronidase recombinant,J3473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.56,,,,,,,fee schedule,0.56,0.81, Hyaluronidase recombinant,J3473,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.56,,,,,,,fee schedule,0.56,0.81, Hyaluronidase recombinant,J3473,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.67,,,,,,,fee schedule,0.56,0.81, Hyaluronidase recombinant,J3473,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.81,,,,,,,fee schedule,0.56,0.81, Inj magnesium sulfate,J3475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.78,,,,,,,fee schedule,0.78,1.08, Inj magnesium sulfate,J3475,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.78,,,,,,,fee schedule,0.78,1.08, Inj magnesium sulfate,J3475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.9,,,,,,,fee schedule,0.78,1.08, Inj magnesium sulfate,J3475,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.08,,,,,,,fee schedule,0.78,1.08, Inj potassium chloride,J3480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.26,,,,,,,fee schedule,0.21,0.26, Inj potassium chloride,J3480,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.26,,,,,,,fee schedule,0.21,0.26, Inj potassium chloride,J3480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.21,,,,,,,fee schedule,0.21,0.26, Inj potassium chloride,J3480,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.25,,,,,,,fee schedule,0.21,0.26, Zidovudine,J3485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.36,,,,,,,fee schedule,1.51,3.39, Zidovudine,J3485,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.36,,,,,,,fee schedule,1.51,3.39, Zidovudine,J3485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.82,,,,,,,fee schedule,1.51,3.39, Zidovudine,J3485,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.39,,,,,,,fee schedule,1.51,3.39, Zidovudine,J3485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.57,,,,,,,fee schedule,1.51,3.39,APC Zidovudine,J3485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.59,,,,,,,fee schedule,1.51,3.39,APC Zidovudine,J3485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.51,,,,,,,fee schedule,1.51,3.39,APC Ziprasidone mesylate,J3486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.88,,,,,,,fee schedule,4.88,15.32, Ziprasidone mesylate,J3486,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.88,,,,,,,fee schedule,4.88,15.32, Ziprasidone mesylate,J3486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.77,,,,,,,fee schedule,4.88,15.32, Ziprasidone mesylate,J3486,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.32,,,,,,,fee schedule,4.88,15.32, Zoledronic acid 1mg,J3489,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.1,,,,,,,fee schedule,8.1,11.35, Zoledronic acid 1mg,J3489,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.1,,,,,,,fee schedule,8.1,11.35, Zoledronic acid 1mg,J3489,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.46,,,,,,,fee schedule,8.1,11.35, Zoledronic acid 1mg,J3489,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.35,,,,,,,fee schedule,8.1,11.35, Edetate disodium per 150 mg,J3520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.37,,,,,,,fee schedule,2.37,2.85, Edetate disodium per 150 mg,J3520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.85,,,,,,,fee schedule,2.37,2.85, Normal saline solution infus,J7030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.55,,,,,,,fee schedule,3.55,4.37, Normal saline solution infus,J7030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.55,,,,,,,fee schedule,3.55,4.37, Normal saline solution infus,J7030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.64,,,,,,,fee schedule,3.55,4.37, Normal saline solution infus,J7030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.37,,,,,,,fee schedule,3.55,4.37, Normal saline solution infus,J7040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.15,,,,,,,fee schedule,2.15,2.83, Normal saline solution infus,J7040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.15,,,,,,,fee schedule,2.15,2.83, Normal saline solution infus,J7040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.35,,,,,,,fee schedule,2.15,2.83, Normal saline solution infus,J7040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.83,,,,,,,fee schedule,2.15,2.83, 5% dextrose/normal saline,J7042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.11,,,,,,,fee schedule,2.11,3.16, 5% dextrose/normal saline,J7042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.11,,,,,,,fee schedule,2.11,3.16, 5% dextrose/normal saline,J7042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.64,,,,,,,fee schedule,2.11,3.16, 5% dextrose/normal saline,J7042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.16,,,,,,,fee schedule,2.11,3.16, Normal saline solution infus,J7050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.11,,,,,,,fee schedule,1.11,1.46, Normal saline solution infus,J7050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.11,,,,,,,fee schedule,1.11,1.46, Normal saline solution infus,J7050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.21,,,,,,,fee schedule,1.11,1.46, Normal saline solution infus,J7050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.46,,,,,,,fee schedule,1.11,1.46, 5% dextrose/water,J7060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.15,,,,,,,fee schedule,3.15,4.06, 5% dextrose/water,J7060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.15,,,,,,,fee schedule,3.15,4.06, 5% dextrose/water,J7060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.38,,,,,,,fee schedule,3.15,4.06, 5% dextrose/water,J7060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.06,,,,,,,fee schedule,3.15,4.06, D5w infusion,J7070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.74,,,,,,,fee schedule,4.74,6.98, D5w infusion,J7070,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.74,,,,,,,fee schedule,4.74,6.98, D5w infusion,J7070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.81,,,,,,,fee schedule,4.74,6.98, D5w infusion,J7070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.98,,,,,,,fee schedule,4.74,6.98, Dextran 40 infusion,J7100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,126.89,,,,,,,fee schedule,126.89,152.28, Dextran 40 infusion,J7100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.28,,,,,,,fee schedule,126.89,152.28, Dextran 75 infusion,J7110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.14,,,,,,,fee schedule,27.14,32.57, Dextran 75 infusion,J7110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.57,,,,,,,fee schedule,27.14,32.57, Ringers lactate infusion,J7120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.83,,,,,,,fee schedule,3.83,5.41, Ringers lactate infusion,J7120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.83,,,,,,,fee schedule,3.83,5.41, Ringers lactate infusion,J7120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.5,,,,,,,fee schedule,3.83,5.41, Ringers lactate infusion,J7120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.41,,,,,,,fee schedule,3.83,5.41, 5% dextrose in lac ringers,J7121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.21,,,,,,,fee schedule,15.21,18.26, 5% dextrose in lac ringers,J7121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18.26,,,,,,,fee schedule,15.21,18.26, Hypertonic saline sol,J7131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.32,,,,,,,fee schedule,0.32,0.38, Hypertonic saline sol,J7131,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.38,,,,,,,fee schedule,0.32,0.38, "Inj, human-lans, per i.u",J7165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6,,,,,,,fee schedule,1.72,7.2, "Inj, human-lans, per i.u",J7165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.2,,,,,,,fee schedule,1.72,7.2, "Inj, human-lans, per i.u",J7165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.78,,,,,,,fee schedule,1.72,7.2,APC "Inj, human-lans, per i.u",J7165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.8,,,,,,,fee schedule,1.72,7.2,APC "Inj, human-lans, per i.u",J7165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.72,,,,,,,fee schedule,1.72,7.2,APC Prothrombin complex kcentra,J7168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.68,,,,,,,fee schedule,2.05,6.82, Prothrombin complex kcentra,J7168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.82,,,,,,,fee schedule,2.05,6.82, Prothrombin complex kcentra,J7168,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.14,,,,,,,fee schedule,2.05,6.82,APC Prothrombin complex kcentra,J7168,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.16,,,,,,,fee schedule,2.05,6.82,APC Prothrombin complex kcentra,J7168,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.05,,,,,,,fee schedule,2.05,6.82,APC "Inj andexxa, 10 mg",J7169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,238.3,,,,,,,fee schedule,131.16,285.98, "Inj andexxa, 10 mg",J7169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,285.98,,,,,,,fee schedule,131.16,285.98, "Inj andexxa, 10 mg",J7169,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,136.41,,,,,,,fee schedule,131.16,285.98,APC "Inj andexxa, 10 mg",J7169,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,137.72,,,,,,,fee schedule,131.16,285.98,APC "Inj andexxa, 10 mg",J7169,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,131.16,,,,,,,fee schedule,131.16,285.98,APC "Inj., emicizumab-kxwh 0.5 mg",J7170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.4,,,,,,,fee schedule,55.64,125.83, "Inj., emicizumab-kxwh 0.5 mg",J7170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.4,,,,,,,fee schedule,55.64,125.83, "Inj., emicizumab-kxwh 0.5 mg",J7170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,104.85,,,,,,,fee schedule,55.64,125.83, "Inj., emicizumab-kxwh 0.5 mg",J7170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,125.83,,,,,,,fee schedule,55.64,125.83, "Inj., emicizumab-kxwh 0.5 mg",J7170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.87,,,,,,,fee schedule,55.64,125.83,APC "Inj., emicizumab-kxwh 0.5 mg",J7170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.42,,,,,,,fee schedule,55.64,125.83,APC "Inj., emicizumab-kxwh 0.5 mg",J7170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.64,,,,,,,fee schedule,55.64,125.83,APC "Inj, adzynma, 10 iu",J7171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,55.39,,,,,,,fee schedule,35.58,79.83, "Inj, adzynma, 10 iu",J7171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,55.39,,,,,,,fee schedule,35.58,79.83, "Inj, adzynma, 10 iu",J7171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,66.52,,,,,,,fee schedule,35.58,79.83, "Inj, adzynma, 10 iu",J7171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,79.83,,,,,,,fee schedule,35.58,79.83, "Inj, adzynma, 10 iu",J7171,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37,,,,,,,fee schedule,35.58,79.83,APC "Inj, adzynma, 10 iu",J7171,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.35,,,,,,,fee schedule,35.58,79.83,APC "Inj, adzynma, 10 iu",J7171,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.58,,,,,,,fee schedule,35.58,79.83,APC "Inj marstacim-hncq, 0.5 mg",J7172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.94,,,,,,,fee schedule,50.19,114.62, "Inj marstacim-hncq, 0.5 mg",J7172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.94,,,,,,,fee schedule,50.19,114.62, "Inj marstacim-hncq, 0.5 mg",J7172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.51,,,,,,,fee schedule,50.19,114.62, "Inj marstacim-hncq, 0.5 mg",J7172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,114.62,,,,,,,fee schedule,50.19,114.62, "Inj marstacim-hncq, 0.5 mg",J7172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.2,,,,,,,fee schedule,50.19,114.62,APC "Inj marstacim-hncq, 0.5 mg",J7172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.7,,,,,,,fee schedule,50.19,114.62,APC "Inj marstacim-hncq, 0.5 mg",J7172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.19,,,,,,,fee schedule,50.19,114.62,APC "Inj. concizumab-mtci, 0.5 mg",J7173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,161.5,,,,,,,fee schedule,83.47,193.82, "Inj. concizumab-mtci, 0.5 mg",J7173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,193.82,,,,,,,fee schedule,83.47,193.82, "Inj. concizumab-mtci, 0.5 mg",J7173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,86.81,,,,,,,fee schedule,83.47,193.82,APC "Inj. concizumab-mtci, 0.5 mg",J7173,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,87.65,,,,,,,fee schedule,83.47,193.82,APC "Inj. concizumab-mtci, 0.5 mg",J7173,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,83.47,,,,,,,fee schedule,83.47,193.82,APC Injection fitusiran 0.04 mg,J7174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,246.15,,,,,,,fee schedule,132.63,295.4, Injection fitusiran 0.04 mg,J7174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,295.4,,,,,,,fee schedule,132.63,295.4, Injection fitusiran 0.04 mg,J7174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,137.93,,,,,,,fee schedule,132.63,295.4,APC Injection fitusiran 0.04 mg,J7174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,139.26,,,,,,,fee schedule,132.63,295.4,APC Injection fitusiran 0.04 mg,J7174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,132.63,,,,,,,fee schedule,132.63,295.4,APC "Inj, factor x, (human), 1iu",J7175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.43,,,,,,,fee schedule,9.95,21.94, "Inj, factor x, (human), 1iu",J7175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.43,,,,,,,fee schedule,9.95,21.94, "Inj, factor x, (human), 1iu",J7175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.28,,,,,,,fee schedule,9.95,21.94, "Inj, factor x, (human), 1iu",J7175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.94,,,,,,,fee schedule,9.95,21.94, "Inj, factor x, (human), 1iu",J7175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.35,,,,,,,fee schedule,9.95,21.94,APC "Inj, factor x, (human), 1iu",J7175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.45,,,,,,,fee schedule,9.95,21.94,APC "Inj, factor x, (human), 1iu",J7175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.95,,,,,,,fee schedule,9.95,21.94,APC "Inj., fibryga, 1 mg",J7177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.88,,,,,,,fee schedule,1.24,2.76, "Inj., fibryga, 1 mg",J7177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.88,,,,,,,fee schedule,1.24,2.76, "Inj., fibryga, 1 mg",J7177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.3,,,,,,,fee schedule,1.24,2.76, "Inj., fibryga, 1 mg",J7177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.76,,,,,,,fee schedule,1.24,2.76, "Inj., fibryga, 1 mg",J7177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.29,,,,,,,fee schedule,1.24,2.76,APC "Inj., fibryga, 1 mg",J7177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.3,,,,,,,fee schedule,1.24,2.76,APC "Inj., fibryga, 1 mg",J7177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.24,,,,,,,fee schedule,1.24,2.76,APC Human fibrinogen conc inj,J7178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.36,,,,,,,fee schedule,1.52,3.41, Human fibrinogen conc inj,J7178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.36,,,,,,,fee schedule,1.52,3.41, Human fibrinogen conc inj,J7178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.84,,,,,,,fee schedule,1.52,3.41, Human fibrinogen conc inj,J7178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.41,,,,,,,fee schedule,1.52,3.41, Human fibrinogen conc inj,J7178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.58,,,,,,,fee schedule,1.52,3.41,APC Human fibrinogen conc inj,J7178,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.6,,,,,,,fee schedule,1.52,3.41,APC Human fibrinogen conc inj,J7178,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.52,,,,,,,fee schedule,1.52,3.41,APC Vonvendi inj 1 iu vwf:rco,J7179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.87,,,,,,,fee schedule,1.83,4.15, Vonvendi inj 1 iu vwf:rco,J7179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.87,,,,,,,fee schedule,1.83,4.15, Vonvendi inj 1 iu vwf:rco,J7179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.46,,,,,,,fee schedule,1.83,4.15, Vonvendi inj 1 iu vwf:rco,J7179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.15,,,,,,,fee schedule,1.83,4.15, Vonvendi inj 1 iu vwf:rco,J7179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.9,,,,,,,fee schedule,1.83,4.15,APC Vonvendi inj 1 iu vwf:rco,J7179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.92,,,,,,,fee schedule,1.83,4.15,APC Vonvendi inj 1 iu vwf:rco,J7179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.83,,,,,,,fee schedule,1.83,4.15,APC Factor XIII anti-hem factor,J7180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.78,,,,,,,fee schedule,10.78,24.13, Factor XIII anti-hem factor,J7180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.78,,,,,,,fee schedule,10.78,24.13, Factor XIII anti-hem factor,J7180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.11,,,,,,,fee schedule,10.78,24.13, Factor XIII anti-hem factor,J7180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.13,,,,,,,fee schedule,10.78,24.13, Factor XIII anti-hem factor,J7180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.21,,,,,,,fee schedule,10.78,24.13,APC Factor XIII anti-hem factor,J7180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.32,,,,,,,fee schedule,10.78,24.13,APC Factor XIII anti-hem factor,J7180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.78,,,,,,,fee schedule,10.78,24.13,APC Factor xiii recomb a-subunit,J7181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.48,,,,,,,fee schedule,18.33,40.73, Factor xiii recomb a-subunit,J7181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.48,,,,,,,fee schedule,18.33,40.73, Factor xiii recomb a-subunit,J7181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,33.94,,,,,,,fee schedule,18.33,40.73, Factor xiii recomb a-subunit,J7181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,40.73,,,,,,,fee schedule,18.33,40.73, Factor xiii recomb a-subunit,J7181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.06,,,,,,,fee schedule,18.33,40.73,APC Factor xiii recomb a-subunit,J7181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.25,,,,,,,fee schedule,18.33,40.73,APC Factor xiii recomb a-subunit,J7181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.33,,,,,,,fee schedule,18.33,40.73,APC Factor viii recomb novoeight,J7182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.36,,,,,,,fee schedule,1.41,3.45, Factor viii recomb novoeight,J7182,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.36,,,,,,,fee schedule,1.41,3.45, Factor viii recomb novoeight,J7182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.88,,,,,,,fee schedule,1.41,3.45, Factor viii recomb novoeight,J7182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.45,,,,,,,fee schedule,1.41,3.45, Factor viii recomb novoeight,J7182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.47,,,,,,,fee schedule,1.41,3.45,APC Factor viii recomb novoeight,J7182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.48,,,,,,,fee schedule,1.41,3.45,APC Factor viii recomb novoeight,J7182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.41,,,,,,,fee schedule,1.41,3.45,APC Wilate injection,J7183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.98,,,,,,,fee schedule,1.32,2.89, Wilate injection,J7183,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.98,,,,,,,fee schedule,1.32,2.89, Wilate injection,J7183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.41,,,,,,,fee schedule,1.32,2.89, Wilate injection,J7183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.89,,,,,,,fee schedule,1.32,2.89, Wilate injection,J7183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.37,,,,,,,fee schedule,1.32,2.89,APC Wilate injection,J7183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.39,,,,,,,fee schedule,1.32,2.89,APC Wilate injection,J7183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.32,,,,,,,fee schedule,1.32,2.89,APC Xyntha inj,J7185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.39,,,,,,,fee schedule,1.49,3.75, Xyntha inj,J7185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.39,,,,,,,fee schedule,1.49,3.75, Xyntha inj,J7185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.12,,,,,,,fee schedule,1.49,3.75, Xyntha inj,J7185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.75,,,,,,,fee schedule,1.49,3.75, Xyntha inj,J7185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.55,,,,,,,fee schedule,1.49,3.75,APC Xyntha inj,J7185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.57,,,,,,,fee schedule,1.49,3.75,APC Xyntha inj,J7185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.49,,,,,,,fee schedule,1.49,3.75,APC Antihemophilic viii/vwf comp,J7186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.91,,,,,,,fee schedule,1.25,2.78, Antihemophilic viii/vwf comp,J7186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.91,,,,,,,fee schedule,1.25,2.78, Antihemophilic viii/vwf comp,J7186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.32,,,,,,,fee schedule,1.25,2.78, Antihemophilic viii/vwf comp,J7186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.78,,,,,,,fee schedule,1.25,2.78, Antihemophilic viii/vwf comp,J7186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.3,,,,,,,fee schedule,1.25,2.78,APC Antihemophilic viii/vwf comp,J7186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.31,,,,,,,fee schedule,1.25,2.78,APC Antihemophilic viii/vwf comp,J7186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.25,,,,,,,fee schedule,1.25,2.78,APC "Humate-P, inj",J7187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.31,,,,,,,fee schedule,1.49,3.34, "Humate-P, inj",J7187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.31,,,,,,,fee schedule,1.49,3.34, "Humate-P, inj",J7187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.78,,,,,,,fee schedule,1.49,3.34, "Humate-P, inj",J7187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.34,,,,,,,fee schedule,1.49,3.34, "Humate-P, inj",J7187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.55,,,,,,,fee schedule,1.49,3.34,APC "Humate-P, inj",J7187,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.57,,,,,,,fee schedule,1.49,3.34,APC "Humate-P, inj",J7187,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.49,,,,,,,fee schedule,1.49,3.34,APC Factor viii recomb obizur,J7188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.03,,,,,,,fee schedule,3.24,7.24, Factor viii recomb obizur,J7188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.03,,,,,,,fee schedule,3.24,7.24, Factor viii recomb obizur,J7188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.04,,,,,,,fee schedule,3.24,7.24, Factor viii recomb obizur,J7188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.24,,,,,,,fee schedule,3.24,7.24, Factor viii recomb obizur,J7188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.37,,,,,,,fee schedule,3.24,7.24,APC Factor viii recomb obizur,J7188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.4,,,,,,,fee schedule,3.24,7.24,APC Factor viii recomb obizur,J7188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.24,,,,,,,fee schedule,3.24,7.24,APC Factor viia,J7189,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.13,,,,,,,fee schedule,2.64,5.94, Factor viia,J7189,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.13,,,,,,,fee schedule,2.64,5.94, Factor viia,J7189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.95,,,,,,,fee schedule,2.64,5.94, Factor viia,J7189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.94,,,,,,,fee schedule,2.64,5.94, Factor viia,J7189,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.75,,,,,,,fee schedule,2.64,5.94,APC Factor viia,J7189,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.77,,,,,,,fee schedule,2.64,5.94,APC Factor viia,J7189,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.64,,,,,,,fee schedule,2.64,5.94,APC Factor viii,J7190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.77,,,,,,,fee schedule,1.39,2.44, Factor viii,J7190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.77,,,,,,,fee schedule,1.39,2.44, Factor viii,J7190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.04,,,,,,,fee schedule,1.39,2.44, Factor viii,J7190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.44,,,,,,,fee schedule,1.39,2.44, Factor viii,J7190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.45,,,,,,,fee schedule,1.39,2.44,APC Factor viii,J7190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.46,,,,,,,fee schedule,1.39,2.44,APC Factor viii,J7190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.39,,,,,,,fee schedule,1.39,2.44,APC Factor viii recombinant nos,J7192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.39,,,,,,,fee schedule,1.57,3.61, Factor viii recombinant nos,J7192,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.39,,,,,,,fee schedule,1.57,3.61, Factor viii recombinant nos,J7192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.01,,,,,,,fee schedule,1.57,3.61, Factor viii recombinant nos,J7192,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.61,,,,,,,fee schedule,1.57,3.61, Factor viii recombinant nos,J7192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.63,,,,,,,fee schedule,1.57,3.61,APC Factor viii recombinant nos,J7192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.65,,,,,,,fee schedule,1.57,3.61,APC Factor viii recombinant nos,J7192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.57,,,,,,,fee schedule,1.57,3.61,APC Factor ix non-recombinant,J7193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.08,,,,,,,fee schedule,1.37,3.14, Factor ix non-recombinant,J7193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.08,,,,,,,fee schedule,1.37,3.14, Factor ix non-recombinant,J7193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.62,,,,,,,fee schedule,1.37,3.14, Factor ix non-recombinant,J7193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.14,,,,,,,fee schedule,1.37,3.14, Factor ix non-recombinant,J7193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.42,,,,,,,fee schedule,1.37,3.14,APC Factor ix non-recombinant,J7193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.44,,,,,,,fee schedule,1.37,3.14,APC Factor ix non-recombinant,J7193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.37,,,,,,,fee schedule,1.37,3.14,APC Factor ix complex,J7194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.66,,,,,,,fee schedule,1.7,3.81, Factor ix complex,J7194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.66,,,,,,,fee schedule,1.7,3.81, Factor ix complex,J7194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.18,,,,,,,fee schedule,1.7,3.81, Factor ix complex,J7194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.81,,,,,,,fee schedule,1.7,3.81, Factor ix complex,J7194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.77,,,,,,,fee schedule,1.7,3.81,APC Factor ix complex,J7194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.79,,,,,,,fee schedule,1.7,3.81,APC Factor ix complex,J7194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.7,,,,,,,fee schedule,1.7,3.81,APC Factor ix recombinant nos,J7195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.92,,,,,,,fee schedule,1.84,4.15, Factor ix recombinant nos,J7195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.92,,,,,,,fee schedule,1.84,4.15, Factor ix recombinant nos,J7195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.46,,,,,,,fee schedule,1.84,4.15, Factor ix recombinant nos,J7195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.15,,,,,,,fee schedule,1.84,4.15, Factor ix recombinant nos,J7195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.91,,,,,,,fee schedule,1.84,4.15,APC Factor ix recombinant nos,J7195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.93,,,,,,,fee schedule,1.84,4.15,APC Factor ix recombinant nos,J7195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.84,,,,,,,fee schedule,1.84,4.15,APC Antithrombin recombinant,J7196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,267.85,,,,,,,fee schedule,267.85,321.44, Antithrombin recombinant,J7196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,321.44,,,,,,,fee schedule,267.85,321.44, Antithrombin iii injection,J7197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.35,,,,,,,fee schedule,4.1,9.2, Antithrombin iii injection,J7197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.35,,,,,,,fee schedule,4.1,9.2, Antithrombin iii injection,J7197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.66,,,,,,,fee schedule,4.1,9.2, Antithrombin iii injection,J7197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.2,,,,,,,fee schedule,4.1,9.2, Antithrombin iii injection,J7197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.26,,,,,,,fee schedule,4.1,9.2,APC Antithrombin iii injection,J7197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.3,,,,,,,fee schedule,4.1,9.2,APC Antithrombin iii injection,J7197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.1,,,,,,,fee schedule,4.1,9.2,APC Anti-inhibitor,J7198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.81,,,,,,,fee schedule,2.42,5.41, Anti-inhibitor,J7198,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.81,,,,,,,fee schedule,2.42,5.41, Anti-inhibitor,J7198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.5,,,,,,,fee schedule,2.42,5.41, Anti-inhibitor,J7198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.41,,,,,,,fee schedule,2.42,5.41, Anti-inhibitor,J7198,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.51,,,,,,,fee schedule,2.42,5.41,APC Anti-inhibitor,J7198,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.54,,,,,,,fee schedule,2.42,5.41,APC Anti-inhibitor,J7198,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.42,,,,,,,fee schedule,2.42,5.41,APC Factor ix recombinan rixubis,J7200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.44,,,,,,,fee schedule,1.74,3.79, Factor ix recombinan rixubis,J7200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.44,,,,,,,fee schedule,1.74,3.79, Factor ix recombinan rixubis,J7200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.16,,,,,,,fee schedule,1.74,3.79, Factor ix recombinan rixubis,J7200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.79,,,,,,,fee schedule,1.74,3.79, Factor ix recombinan rixubis,J7200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.81,,,,,,,fee schedule,1.74,3.79,APC Factor ix recombinan rixubis,J7200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.83,,,,,,,fee schedule,1.74,3.79,APC Factor ix recombinan rixubis,J7200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.74,,,,,,,fee schedule,1.74,3.79,APC Factor ix alprolix recomb,J7201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.64,,,,,,,fee schedule,3.58,8.05, Factor ix alprolix recomb,J7201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.64,,,,,,,fee schedule,3.58,8.05, Factor ix alprolix recomb,J7201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.71,,,,,,,fee schedule,3.58,8.05, Factor ix alprolix recomb,J7201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.05,,,,,,,fee schedule,3.58,8.05, Factor ix alprolix recomb,J7201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.72,,,,,,,fee schedule,3.58,8.05,APC Factor ix alprolix recomb,J7201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.76,,,,,,,fee schedule,3.58,8.05,APC Factor ix alprolix recomb,J7201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.58,,,,,,,fee schedule,3.58,8.05,APC Factor ix idelvion inj,J7202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.32,,,,,,,fee schedule,5.32,11.93, Factor ix idelvion inj,J7202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.32,,,,,,,fee schedule,5.32,11.93, Factor ix idelvion inj,J7202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.94,,,,,,,fee schedule,5.32,11.93, Factor ix idelvion inj,J7202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.93,,,,,,,fee schedule,5.32,11.93, Factor ix idelvion inj,J7202,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.53,,,,,,,fee schedule,5.32,11.93,APC Factor ix idelvion inj,J7202,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.58,,,,,,,fee schedule,5.32,11.93,APC Factor ix idelvion inj,J7202,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.32,,,,,,,fee schedule,5.32,11.93,APC Factor ix recomb gly rebinyn,J7203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.13,,,,,,,fee schedule,4.5,10, Factor ix recomb gly rebinyn,J7203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.13,,,,,,,fee schedule,4.5,10, Factor ix recomb gly rebinyn,J7203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.34,,,,,,,fee schedule,4.5,10, Factor ix recomb gly rebinyn,J7203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10,,,,,,,fee schedule,4.5,10, Factor ix recomb gly rebinyn,J7203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.68,,,,,,,fee schedule,4.5,10,APC Factor ix recomb gly rebinyn,J7203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.72,,,,,,,fee schedule,4.5,10,APC Factor ix recomb gly rebinyn,J7203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.5,,,,,,,fee schedule,4.5,10,APC Inj recombin esperoct per iu,J7204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.51,,,,,,,fee schedule,2.22,4.98, Inj recombin esperoct per iu,J7204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.51,,,,,,,fee schedule,2.22,4.98, Inj recombin esperoct per iu,J7204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.15,,,,,,,fee schedule,2.22,4.98, Inj recombin esperoct per iu,J7204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.98,,,,,,,fee schedule,2.22,4.98, Inj recombin esperoct per iu,J7204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.31,,,,,,,fee schedule,2.22,4.98,APC Inj recombin esperoct per iu,J7204,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.34,,,,,,,fee schedule,2.22,4.98,APC Inj recombin esperoct per iu,J7204,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.22,,,,,,,fee schedule,2.22,4.98,APC Factor viii fc fusion recomb,J7205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.76,,,,,,,fee schedule,2.46,5.45, Factor viii fc fusion recomb,J7205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.76,,,,,,,fee schedule,2.46,5.45, Factor viii fc fusion recomb,J7205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.54,,,,,,,fee schedule,2.46,5.45, Factor viii fc fusion recomb,J7205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.45,,,,,,,fee schedule,2.46,5.45, Factor viii fc fusion recomb,J7205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.56,,,,,,,fee schedule,2.46,5.45,APC Factor viii fc fusion recomb,J7205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.59,,,,,,,fee schedule,2.46,5.45,APC Factor viii fc fusion recomb,J7205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.46,,,,,,,fee schedule,2.46,5.45,APC Factor viii pegylated recomb,J7207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.35,,,,,,,fee schedule,2.14,4.71, Factor viii pegylated recomb,J7207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.35,,,,,,,fee schedule,2.14,4.71, Factor viii pegylated recomb,J7207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.92,,,,,,,fee schedule,2.14,4.71, Factor viii pegylated recomb,J7207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.71,,,,,,,fee schedule,2.14,4.71, Factor viii pegylated recomb,J7207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.23,,,,,,,fee schedule,2.14,4.71,APC Factor viii pegylated recomb,J7207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.25,,,,,,,fee schedule,2.14,4.71,APC Factor viii pegylated recomb,J7207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.14,,,,,,,fee schedule,2.14,4.71,APC Inj. jivi 1 iu,J7208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.13,,,,,,,fee schedule,2.66,5.94, Inj. jivi 1 iu,J7208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.13,,,,,,,fee schedule,2.66,5.94, Inj. jivi 1 iu,J7208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.95,,,,,,,fee schedule,2.66,5.94, Inj. jivi 1 iu,J7208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.94,,,,,,,fee schedule,2.66,5.94, Inj. jivi 1 iu,J7208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.76,,,,,,,fee schedule,2.66,5.94,APC Inj. jivi 1 iu,J7208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.79,,,,,,,fee schedule,2.66,5.94,APC Inj. jivi 1 iu,J7208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.66,,,,,,,fee schedule,2.66,5.94,APC Factor viii nuwiq recomb 1iu,J7209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.83,,,,,,,fee schedule,1.18,2.51, Factor viii nuwiq recomb 1iu,J7209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.83,,,,,,,fee schedule,1.18,2.51, Factor viii nuwiq recomb 1iu,J7209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.09,,,,,,,fee schedule,1.18,2.51, Factor viii nuwiq recomb 1iu,J7209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.51,,,,,,,fee schedule,1.18,2.51, Factor viii nuwiq recomb 1iu,J7209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.23,,,,,,,fee schedule,1.18,2.51,APC Factor viii nuwiq recomb 1iu,J7209,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.24,,,,,,,fee schedule,1.18,2.51,APC Factor viii nuwiq recomb 1iu,J7209,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.18,,,,,,,fee schedule,1.18,2.51,APC "Inj, afstyla, 1 i.u.",J7210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.46,,,,,,,fee schedule,1.57,3.52, "Inj, afstyla, 1 i.u.",J7210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.46,,,,,,,fee schedule,1.57,3.52, "Inj, afstyla, 1 i.u.",J7210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.93,,,,,,,fee schedule,1.57,3.52, "Inj, afstyla, 1 i.u.",J7210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.52,,,,,,,fee schedule,1.57,3.52, "Inj, afstyla, 1 i.u.",J7210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.63,,,,,,,fee schedule,1.57,3.52,APC "Inj, afstyla, 1 i.u.",J7210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.65,,,,,,,fee schedule,1.57,3.52,APC "Inj, afstyla, 1 i.u.",J7210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.57,,,,,,,fee schedule,1.57,3.52,APC "Inj, kovaltry, 1 i.u.",J7211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.46,,,,,,,fee schedule,1.56,3.52, "Inj, kovaltry, 1 i.u.",J7211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.46,,,,,,,fee schedule,1.56,3.52, "Inj, kovaltry, 1 i.u.",J7211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.93,,,,,,,fee schedule,1.56,3.52, "Inj, kovaltry, 1 i.u.",J7211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.52,,,,,,,fee schedule,1.56,3.52, "Inj, kovaltry, 1 i.u.",J7211,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.63,,,,,,,fee schedule,1.56,3.52,APC "Inj, kovaltry, 1 i.u.",J7211,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.64,,,,,,,fee schedule,1.56,3.52,APC "Inj, kovaltry, 1 i.u.",J7211,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.56,,,,,,,fee schedule,1.56,3.52,APC Factor viia recomb sevenfact,J7212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.73,,,,,,,fee schedule,2.2,5.32, Factor viia recomb sevenfact,J7212,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.73,,,,,,,fee schedule,2.2,5.32, Factor viia recomb sevenfact,J7212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.43,,,,,,,fee schedule,2.2,5.32, Factor viia recomb sevenfact,J7212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.32,,,,,,,fee schedule,2.2,5.32, Factor viia recomb sevenfact,J7212,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.29,,,,,,,fee schedule,2.2,5.32,APC Factor viia recomb sevenfact,J7212,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.31,,,,,,,fee schedule,2.2,5.32,APC Factor viia recomb sevenfact,J7212,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.2,,,,,,,fee schedule,2.2,5.32,APC "Inj, ixinity, 1 i.u.",J7213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.97,,,,,,,fee schedule,1.97,4.28, "Inj, ixinity, 1 i.u.",J7213,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.97,,,,,,,fee schedule,1.97,4.28, "Inj, ixinity, 1 i.u.",J7213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.57,,,,,,,fee schedule,1.97,4.28, "Inj, ixinity, 1 i.u.",J7213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.28,,,,,,,fee schedule,1.97,4.28, "Inj, ixinity, 1 i.u.",J7213,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.05,,,,,,,fee schedule,1.97,4.28,APC "Inj, ixinity, 1 i.u.",J7213,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.07,,,,,,,fee schedule,1.97,4.28,APC "Inj, ixinity, 1 i.u.",J7213,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.97,,,,,,,fee schedule,1.97,4.28,APC Altuviiio per factor viii iu,J7214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.28,,,,,,,fee schedule,4.49,10.45, Altuviiio per factor viii iu,J7214,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.28,,,,,,,fee schedule,4.49,10.45, Altuviiio per factor viii iu,J7214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.71,,,,,,,fee schedule,4.49,10.45, Altuviiio per factor viii iu,J7214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.45,,,,,,,fee schedule,4.49,10.45, Altuviiio per factor viii iu,J7214,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.67,,,,,,,fee schedule,4.49,10.45,APC Altuviiio per factor viii iu,J7214,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.72,,,,,,,fee schedule,4.49,10.45,APC Altuviiio per factor viii iu,J7214,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.49,,,,,,,fee schedule,4.49,10.45,APC Seg acet and eth estr yearly,J7294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4614.49,,,,,,,fee schedule,4614.49,5537.88, Seg acet and eth estr yearly,J7294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5537.88,,,,,,,fee schedule,4614.49,5537.88, Eth estr and eton monthly,J7295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,215.93,,,,,,,fee schedule,215.93,259.13, Eth estr and eton monthly,J7295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,259.13,,,,,,,fee schedule,215.93,259.13, "Kyleena, 19.5 mg",J7296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2315.56,,,,,,,fee schedule,2315.56,2778.92, "Kyleena, 19.5 mg",J7296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2778.92,,,,,,,fee schedule,2315.56,2778.92, "Liletta, 52 mg",J7297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1776.24,,,,,,,fee schedule,1776.24,2131.68, "Liletta, 52 mg",J7297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2131.68,,,,,,,fee schedule,1776.24,2131.68, "Mirena, 52 mg",J7298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2315.56,,,,,,,fee schedule,2315.56,2778.92, "Mirena, 52 mg",J7298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2778.92,,,,,,,fee schedule,2315.56,2778.92, Intraut copper contraceptive,J7300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2170.1,,,,,,,fee schedule,2170.1,2604.35, Intraut copper contraceptive,J7300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2604.35,,,,,,,fee schedule,2170.1,2604.35, "Skyla, 13.5 mg",J7301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1928.08,,,,,,,fee schedule,1928.08,2313.9, "Skyla, 13.5 mg",J7301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2313.9,,,,,,,fee schedule,1928.08,2313.9, Levonorgestrel implant sys,J7306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,597.18,,,,,,,fee schedule,597.18,716.68, Levonorgestrel implant sys,J7306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,716.68,,,,,,,fee schedule,597.18,716.68, Etonogestrel implant system,J7307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2315.56,,,,,,,fee schedule,2315.56,2778.92, Etonogestrel implant system,J7307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2778.92,,,,,,,fee schedule,2315.56,2778.92, Aminolevulinic acid hcl top,J7308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,613.11,,,,,,,fee schedule,390.02,879.46, Aminolevulinic acid hcl top,J7308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,613.11,,,,,,,fee schedule,390.02,879.46, Aminolevulinic acid hcl top,J7308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,732.82,,,,,,,fee schedule,390.02,879.46, Aminolevulinic acid hcl top,J7308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,879.46,,,,,,,fee schedule,390.02,879.46, Aminolevulinic acid hcl top,J7308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,405.62,,,,,,,fee schedule,390.02,879.46,APC Aminolevulinic acid hcl top,J7308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,409.52,,,,,,,fee schedule,390.02,879.46,APC Aminolevulinic acid hcl top,J7308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,390.02,,,,,,,fee schedule,390.02,879.46,APC "Methyl aminolevulinate, top",J7309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,156.42,,,,,,,fee schedule,156.42,187.72, "Methyl aminolevulinate, top",J7309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,187.72,,,,,,,fee schedule,156.42,187.72, Ganciclovir long act implant,J7310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31698.24,,,,,,,fee schedule,31698.24,38041.28, Ganciclovir long act implant,J7310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38041.28,,,,,,,fee schedule,31698.24,38041.28, Fluocinolone acetonide implt,J7311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,528.87,,,,,,,fee schedule,338.79,763.32, Fluocinolone acetonide implt,J7311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,528.87,,,,,,,fee schedule,338.79,763.32, Fluocinolone acetonide implt,J7311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,636.04,,,,,,,fee schedule,338.79,763.32, Fluocinolone acetonide implt,J7311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,763.32,,,,,,,fee schedule,338.79,763.32, Fluocinolone acetonide implt,J7311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,352.34,,,,,,,fee schedule,338.79,763.32,APC Fluocinolone acetonide implt,J7311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,355.73,,,,,,,fee schedule,338.79,763.32,APC Fluocinolone acetonide implt,J7311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,338.79,,,,,,,fee schedule,338.79,763.32,APC Dexamethasone intra implant,J7312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,319.54,,,,,,,fee schedule,203.79,458.94, Dexamethasone intra implant,J7312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,319.54,,,,,,,fee schedule,203.79,458.94, Dexamethasone intra implant,J7312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,382.42,,,,,,,fee schedule,203.79,458.94, Dexamethasone intra implant,J7312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,458.94,,,,,,,fee schedule,203.79,458.94, Dexamethasone intra implant,J7312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,211.94,,,,,,,fee schedule,203.79,458.94,APC Dexamethasone intra implant,J7312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,213.98,,,,,,,fee schedule,203.79,458.94,APC Dexamethasone intra implant,J7312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,203.79,,,,,,,fee schedule,203.79,458.94,APC Fluocinol acet intravit imp,J7313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,774.87,,,,,,,fee schedule,509.81,1117.33, Fluocinol acet intravit imp,J7313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,774.87,,,,,,,fee schedule,509.81,1117.33, Fluocinol acet intravit imp,J7313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,931.02,,,,,,,fee schedule,509.81,1117.33, Fluocinol acet intravit imp,J7313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1117.33,,,,,,,fee schedule,509.81,1117.33, Fluocinol acet intravit imp,J7313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,530.2,,,,,,,fee schedule,509.81,1117.33,APC Fluocinol acet intravit imp,J7313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,535.3,,,,,,,fee schedule,509.81,1117.33,APC Fluocinol acet intravit imp,J7313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,509.81,,,,,,,fee schedule,509.81,1117.33,APC "Inj., yutiq, 0.01 mg",J7314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,829.03,,,,,,,fee schedule,529.89,1188.54, "Inj., yutiq, 0.01 mg",J7314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,829.03,,,,,,,fee schedule,529.89,1188.54, "Inj., yutiq, 0.01 mg",J7314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,990.36,,,,,,,fee schedule,529.89,1188.54, "Inj., yutiq, 0.01 mg",J7314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1188.54,,,,,,,fee schedule,529.89,1188.54, "Inj., yutiq, 0.01 mg",J7314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,551.08,,,,,,,fee schedule,529.89,1188.54,APC "Inj., yutiq, 0.01 mg",J7314,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,556.38,,,,,,,fee schedule,529.89,1188.54,APC "Inj., yutiq, 0.01 mg",J7314,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,529.89,,,,,,,fee schedule,529.89,1188.54,APC Ophthalmic mitomycin,J7315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,819.74,,,,,,,fee schedule,819.74,983.78, Ophthalmic mitomycin,J7315,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,983.78,,,,,,,fee schedule,819.74,983.78, "Inj, ocriplasmin, 0.125 mg",J7316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1956.71,,,,,,,fee schedule,1956.71,2348.26, "Inj, ocriplasmin, 0.125 mg",J7316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2348.26,,,,,,,fee schedule,1956.71,2348.26, "Inj, durolane 1 mg",J7318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.41,,,,,,,fee schedule,6.73,15.19, "Inj, durolane 1 mg",J7318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.41,,,,,,,fee schedule,6.73,15.19, "Inj, durolane 1 mg",J7318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.65,,,,,,,fee schedule,6.73,15.19, "Inj, durolane 1 mg",J7318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.19,,,,,,,fee schedule,6.73,15.19, "Inj, durolane 1 mg",J7318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7,,,,,,,fee schedule,6.73,15.19,APC "Inj, durolane 1 mg",J7318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.07,,,,,,,fee schedule,6.73,15.19,APC "Inj, durolane 1 mg",J7318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.73,,,,,,,fee schedule,6.73,15.19,APC "Genvisc 850, inj, 1mg",J7320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.37,,,,,,,fee schedule,3.68,12.94, "Genvisc 850, inj, 1mg",J7320,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.37,,,,,,,fee schedule,3.68,12.94, "Genvisc 850, inj, 1mg",J7320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.78,,,,,,,fee schedule,3.68,12.94, "Genvisc 850, inj, 1mg",J7320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.94,,,,,,,fee schedule,3.68,12.94, "Genvisc 850, inj, 1mg",J7320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.82,,,,,,,fee schedule,3.68,12.94,APC "Genvisc 850, inj, 1mg",J7320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.86,,,,,,,fee schedule,3.68,12.94,APC "Genvisc 850, inj, 1mg",J7320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.68,,,,,,,fee schedule,3.68,12.94,APC Hyalgan/supartz inj per dose,J7321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.23,,,,,,,fee schedule,114.23,160.42, Hyalgan/supartz inj per dose,J7321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.23,,,,,,,fee schedule,114.23,160.42, Hyalgan/supartz inj per dose,J7321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.67,,,,,,,fee schedule,114.23,160.42, Hyalgan/supartz inj per dose,J7321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,160.42,,,,,,,fee schedule,114.23,160.42, Hymovis injection 1 mg,J7322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.14,,,,,,,fee schedule,18.13,39.52, Hymovis injection 1 mg,J7322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.14,,,,,,,fee schedule,18.13,39.52, Hymovis injection 1 mg,J7322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.93,,,,,,,fee schedule,18.13,39.52, Hymovis injection 1 mg,J7322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.52,,,,,,,fee schedule,18.13,39.52, Hymovis injection 1 mg,J7322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18.86,,,,,,,fee schedule,18.13,39.52,APC Hymovis injection 1 mg,J7322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.04,,,,,,,fee schedule,18.13,39.52,APC Hymovis injection 1 mg,J7322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.13,,,,,,,fee schedule,18.13,39.52,APC Euflexxa inj per dose,J7323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,178.2,,,,,,,fee schedule,105.58,252.23, Euflexxa inj per dose,J7323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,178.2,,,,,,,fee schedule,105.58,252.23, Euflexxa inj per dose,J7323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,210.17,,,,,,,fee schedule,105.58,252.23, Euflexxa inj per dose,J7323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,252.23,,,,,,,fee schedule,105.58,252.23, Euflexxa inj per dose,J7323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,109.8,,,,,,,fee schedule,105.58,252.23,APC Euflexxa inj per dose,J7323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,110.86,,,,,,,fee schedule,105.58,252.23,APC Euflexxa inj per dose,J7323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,105.58,,,,,,,fee schedule,105.58,252.23,APC Orthovisc inj per dose,J7324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,152.08,,,,,,,fee schedule,109.09,256.91, Orthovisc inj per dose,J7324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,152.08,,,,,,,fee schedule,109.09,256.91, Orthovisc inj per dose,J7324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,214.08,,,,,,,fee schedule,109.09,256.91, Orthovisc inj per dose,J7324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,256.91,,,,,,,fee schedule,109.09,256.91, Orthovisc inj per dose,J7324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,113.46,,,,,,,fee schedule,109.09,256.91,APC Orthovisc inj per dose,J7324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,114.55,,,,,,,fee schedule,109.09,256.91,APC Orthovisc inj per dose,J7324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,109.09,,,,,,,fee schedule,109.09,256.91,APC Synvisc or Synvisc-One,J7325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.16,,,,,,,fee schedule,6.96,17.83, Synvisc or Synvisc-One,J7325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.16,,,,,,,fee schedule,6.96,17.83, Synvisc or Synvisc-One,J7325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.86,,,,,,,fee schedule,6.96,17.83, Synvisc or Synvisc-One,J7325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.83,,,,,,,fee schedule,6.96,17.83, Synvisc or Synvisc-One,J7325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.24,,,,,,,fee schedule,6.96,17.83,APC Synvisc or Synvisc-One,J7325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.31,,,,,,,fee schedule,6.96,17.83,APC Synvisc or Synvisc-One,J7325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.96,,,,,,,fee schedule,6.96,17.83,APC Gel-one,J7326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,815.69,,,,,,,fee schedule,526.79,1187.13, Gel-one,J7326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,815.69,,,,,,,fee schedule,526.79,1187.13, Gel-one,J7326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,989.19,,,,,,,fee schedule,526.79,1187.13, Gel-one,J7326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1187.13,,,,,,,fee schedule,526.79,1187.13, Gel-one,J7326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,547.86,,,,,,,fee schedule,526.79,1187.13,APC Gel-one,J7326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,553.13,,,,,,,fee schedule,526.79,1187.13,APC Gel-one,J7326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,526.79,,,,,,,fee schedule,526.79,1187.13,APC Monovisc inj per dose,J7327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,822.79,,,,,,,fee schedule,655.34,1427.87, Monovisc inj per dose,J7327,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,822.79,,,,,,,fee schedule,655.34,1427.87, Monovisc inj per dose,J7327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1189.79,,,,,,,fee schedule,655.34,1427.87, Monovisc inj per dose,J7327,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1427.87,,,,,,,fee schedule,655.34,1427.87, Monovisc inj per dose,J7327,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,681.55,,,,,,,fee schedule,655.34,1427.87,APC Monovisc inj per dose,J7327,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,688.1,,,,,,,fee schedule,655.34,1427.87,APC Monovisc inj per dose,J7327,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,655.34,,,,,,,fee schedule,655.34,1427.87,APC Gel-syn injection 0.1 mg,J7328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.02,,,,,,,fee schedule,0.68,1.57, Gel-syn injection 0.1 mg,J7328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.02,,,,,,,fee schedule,0.68,1.57, Gel-syn injection 0.1 mg,J7328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.31,,,,,,,fee schedule,0.68,1.57, Gel-syn injection 0.1 mg,J7328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.57,,,,,,,fee schedule,0.68,1.57, Gel-syn injection 0.1 mg,J7328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.71,,,,,,,fee schedule,0.68,1.57,APC Gel-syn injection 0.1 mg,J7328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.71,,,,,,,fee schedule,0.68,1.57,APC Gel-syn injection 0.1 mg,J7328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.68,,,,,,,fee schedule,0.68,1.57,APC "Inj, trivisc 1 mg",J7329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.48,,,,,,,fee schedule,3.27,10.52, "Inj, trivisc 1 mg",J7329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.48,,,,,,,fee schedule,3.27,10.52, "Inj, trivisc 1 mg",J7329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.77,,,,,,,fee schedule,3.27,10.52, "Inj, trivisc 1 mg",J7329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.52,,,,,,,fee schedule,3.27,10.52, "Inj, trivisc 1 mg",J7329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.4,,,,,,,fee schedule,3.27,10.52,APC "Inj, trivisc 1 mg",J7329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.44,,,,,,,fee schedule,3.27,10.52,APC "Inj, trivisc 1 mg",J7329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.27,,,,,,,fee schedule,3.27,10.52,APC Cultured chondrocytes implnt,J7330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133011.31,,,,,,,fee schedule,133011.31,159627.81, Cultured chondrocytes implnt,J7330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,159627.81,,,,,,,fee schedule,133011.31,159627.81, "Synojoynt, inj., 1 mg",J7331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.75,,,,,,,fee schedule,6.78,8.75, "Synojoynt, inj., 1 mg",J7331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.75,,,,,,,fee schedule,6.78,8.75, "Synojoynt, inj., 1 mg",J7331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.78,,,,,,,fee schedule,6.78,8.75, "Synojoynt, inj., 1 mg",J7331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.14,,,,,,,fee schedule,6.78,8.75, "Inj., triluron, 1 mg",J7332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.82,,,,,,,fee schedule,10.54,23.04, "Inj., triluron, 1 mg",J7332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.82,,,,,,,fee schedule,10.54,23.04, "Inj., triluron, 1 mg",J7332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.19,,,,,,,fee schedule,10.54,23.04, "Inj., triluron, 1 mg",J7332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.04,,,,,,,fee schedule,10.54,23.04, "Inj., triluron, 1 mg",J7332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.97,,,,,,,fee schedule,10.54,23.04,APC "Inj., triluron, 1 mg",J7332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.07,,,,,,,fee schedule,10.54,23.04,APC "Inj., triluron, 1 mg",J7332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.54,,,,,,,fee schedule,10.54,23.04,APC Capsaicin 8% patch,J7336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.26,,,,,,,fee schedule,3.42,7.67, Capsaicin 8% patch,J7336,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.26,,,,,,,fee schedule,3.42,7.67, Capsaicin 8% patch,J7336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.39,,,,,,,fee schedule,3.42,7.67, Capsaicin 8% patch,J7336,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.67,,,,,,,fee schedule,3.42,7.67, Capsaicin 8% patch,J7336,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.56,,,,,,,fee schedule,3.42,7.67,APC Capsaicin 8% patch,J7336,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.59,,,,,,,fee schedule,3.42,7.67,APC Capsaicin 8% patch,J7336,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.42,,,,,,,fee schedule,3.42,7.67,APC Carbidopa levodopa ent 100ml,J7340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,378.48,,,,,,,fee schedule,244.04,546.42, Carbidopa levodopa ent 100ml,J7340,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,378.48,,,,,,,fee schedule,244.04,546.42, Carbidopa levodopa ent 100ml,J7340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,455.31,,,,,,,fee schedule,244.04,546.42, Carbidopa levodopa ent 100ml,J7340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,546.42,,,,,,,fee schedule,244.04,546.42, Carbidopa levodopa ent 100ml,J7340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,253.8,,,,,,,fee schedule,244.04,546.42,APC Carbidopa levodopa ent 100ml,J7340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,256.24,,,,,,,fee schedule,244.04,546.42,APC Carbidopa levodopa ent 100ml,J7340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,244.04,,,,,,,fee schedule,244.04,546.42,APC Ciprofloxacin otic susp 6 mg,J7342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.98,,,,,,,fee schedule,53.98,64.78, Ciprofloxacin otic susp 6 mg,J7342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.78,,,,,,,fee schedule,53.98,64.78, "Aminolevulinic acid, 10% gel",J7345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.82,,,,,,,fee schedule,1.77,4.01, "Aminolevulinic acid, 10% gel",J7345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.82,,,,,,,fee schedule,1.77,4.01, "Aminolevulinic acid, 10% gel",J7345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.35,,,,,,,fee schedule,1.77,4.01, "Aminolevulinic acid, 10% gel",J7345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.01,,,,,,,fee schedule,1.77,4.01, "Aminolevulinic acid, 10% gel",J7345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.84,,,,,,,fee schedule,1.77,4.01,APC "Aminolevulinic acid, 10% gel",J7345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.86,,,,,,,fee schedule,1.77,4.01,APC "Aminolevulinic acid, 10% gel",J7345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.77,,,,,,,fee schedule,1.77,4.01,APC Inj bimatoprost itc imp 1mcg,J7351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,330.56,,,,,,,fee schedule,214.02,479.64, Inj bimatoprost itc imp 1mcg,J7351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,330.56,,,,,,,fee schedule,214.02,479.64, Inj bimatoprost itc imp 1mcg,J7351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,399.67,,,,,,,fee schedule,214.02,479.64, Inj bimatoprost itc imp 1mcg,J7351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,479.64,,,,,,,fee schedule,214.02,479.64, Inj bimatoprost itc imp 1mcg,J7351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,222.58,,,,,,,fee schedule,214.02,479.64,APC Inj bimatoprost itc imp 1mcg,J7351,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,224.72,,,,,,,fee schedule,214.02,479.64,APC Inj bimatoprost itc imp 1mcg,J7351,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,214.02,,,,,,,fee schedule,214.02,479.64,APC "Afamelanotide implant, 1 mg",J7352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6006.2,,,,,,,fee schedule,2943.42,7208.08, "Afamelanotide implant, 1 mg",J7352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7208.08,,,,,,,fee schedule,2943.42,7208.08, "Afamelanotide implant, 1 mg",J7352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3061.16,,,,,,,fee schedule,2943.42,7208.08,APC "Afamelanotide implant, 1 mg",J7352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3090.59,,,,,,,fee schedule,2943.42,7208.08,APC "Afamelanotide implant, 1 mg",J7352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2943.42,,,,,,,fee schedule,2943.42,7208.08,APC Anacaulase-bcdb 8.8% gel 1 g,J7353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,109.19,,,,,,,fee schedule,109.19,131.04, Anacaulase-bcdb 8.8% gel 1 g,J7353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,131.04,,,,,,,fee schedule,109.19,131.04, "Cantharidin top, applicator",J7354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1042.29,,,,,,,fee schedule,667.07,1468.63, "Cantharidin top, applicator",J7354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1042.29,,,,,,,fee schedule,667.07,1468.63, "Cantharidin top, applicator",J7354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1223.75,,,,,,,fee schedule,667.07,1468.63, "Cantharidin top, applicator",J7354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1468.63,,,,,,,fee schedule,667.07,1468.63, "Cantharidin top, applicator",J7354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,693.76,,,,,,,fee schedule,667.07,1468.63,APC "Cantharidin top, applicator",J7354,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,700.43,,,,,,,fee schedule,667.07,1468.63,APC "Cantharidin top, applicator",J7354,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,667.07,,,,,,,fee schedule,667.07,1468.63,APC Inj travoprost intra impl,J7355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,303.93,,,,,,,fee schedule,196.88,303.93, Inj travoprost intra impl,J7355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,303.93,,,,,,,fee schedule,196.88,303.93, Inj travoprost intra impl,J7355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,204.75,,,,,,,fee schedule,196.88,303.93,APC Inj travoprost intra impl,J7355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,206.72,,,,,,,fee schedule,196.88,303.93,APC Inj travoprost intra impl,J7355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,196.88,,,,,,,fee schedule,196.88,303.93,APC Inj foscarb/foslevodopa 5 mg,J7356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.33,,,,,,,fee schedule,1.33,1.59, Inj foscarb/foslevodopa 5 mg,J7356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.59,,,,,,,fee schedule,1.33,1.59, Mometasone sinus sinuva,J7402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,17.66,,,,,,,fee schedule,11.34,25.44, Mometasone sinus sinuva,J7402,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.66,,,,,,,fee schedule,11.34,25.44, Mometasone sinus sinuva,J7402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.19,,,,,,,fee schedule,11.34,25.44, Mometasone sinus sinuva,J7402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,25.44,,,,,,,fee schedule,11.34,25.44, Mometasone sinus sinuva,J7402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.8,,,,,,,fee schedule,11.34,25.44,APC Mometasone sinus sinuva,J7402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.91,,,,,,,fee schedule,11.34,25.44,APC Mometasone sinus sinuva,J7402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.34,,,,,,,fee schedule,11.34,25.44,APC Azathioprine oral 50mg,J7500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.33,,,,,,,fee schedule,0.11,3.33, Azathioprine oral 50mg,J7500,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.33,,,,,,,fee schedule,0.11,3.33, Azathioprine oral 50mg,J7500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.11,,,,,,,fee schedule,0.11,3.33, Azathioprine oral 50mg,J7500,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.13,,,,,,,fee schedule,0.11,3.33, Azathioprine parenteral,J7501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,476.6,,,,,,,fee schedule,254.76,571.97, Azathioprine parenteral,J7501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,571.97,,,,,,,fee schedule,254.76,571.97, Azathioprine parenteral,J7501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,264.95,,,,,,,fee schedule,254.76,571.97,APC Azathioprine parenteral,J7501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.5,,,,,,,fee schedule,254.76,571.97,APC Azathioprine parenteral,J7501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,254.76,,,,,,,fee schedule,254.76,571.97,APC Cyclosporine oral 100 mg,J7502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.22,,,,,,,fee schedule,3.22,4.58, Cyclosporine oral 100 mg,J7502,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.22,,,,,,,fee schedule,3.22,4.58, Cyclosporine oral 100 mg,J7502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.81,,,,,,,fee schedule,3.22,4.58, Cyclosporine oral 100 mg,J7502,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.58,,,,,,,fee schedule,3.22,4.58, Tacrol envarsus ex rel oral,J7503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.85,,,,,,,fee schedule,2.85,4.1, Tacrol envarsus ex rel oral,J7503,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.85,,,,,,,fee schedule,2.85,4.1, Tacrol envarsus ex rel oral,J7503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.42,,,,,,,fee schedule,2.85,4.1, Tacrol envarsus ex rel oral,J7503,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.1,,,,,,,fee schedule,2.85,4.1, Lymphocyte immune globulin,J7504,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7803.43,,,,,,,fee schedule,5292.43,11518.01, Lymphocyte immune globulin,J7504,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7803.43,,,,,,,fee schedule,5292.43,11518.01, Lymphocyte immune globulin,J7504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9597.48,,,,,,,fee schedule,5292.43,11518.01, Lymphocyte immune globulin,J7504,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11518.01,,,,,,,fee schedule,5292.43,11518.01, Lymphocyte immune globulin,J7504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5504.13,,,,,,,fee schedule,5292.43,11518.01,APC Lymphocyte immune globulin,J7504,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5557.05,,,,,,,fee schedule,5292.43,11518.01,APC Lymphocyte immune globulin,J7504,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5292.43,,,,,,,fee schedule,5292.43,11518.01,APC Tacrolimus imme rel oral 1mg,J7507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.25,,,,,,,fee schedule,0.25,0.38, Tacrolimus imme rel oral 1mg,J7507,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.25,,,,,,,fee schedule,0.25,0.38, Tacrolimus imme rel oral 1mg,J7507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.32,,,,,,,fee schedule,0.25,0.38, Tacrolimus imme rel oral 1mg,J7507,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.38,,,,,,,fee schedule,0.25,0.38, Tacrol astagraf ex rel oral,J7508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.91,,,,,,,fee schedule,0.91,1.32, Tacrol astagraf ex rel oral,J7508,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.91,,,,,,,fee schedule,0.91,1.32, Tacrol astagraf ex rel oral,J7508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.1,,,,,,,fee schedule,0.91,1.32, Tacrol astagraf ex rel oral,J7508,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.32,,,,,,,fee schedule,0.91,1.32, Methylprednisolone oral,J7509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.36,,,,,,,fee schedule,0.21,0.36, Methylprednisolone oral,J7509,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.36,,,,,,,fee schedule,0.21,0.36, Methylprednisolone oral,J7509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.21,,,,,,,fee schedule,0.21,0.36, Methylprednisolone oral,J7509,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.25,,,,,,,fee schedule,0.21,0.36, Prednisolone oral per 5 mg,J7510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.43,,,,,,,fee schedule,0.43,0.52, Prednisolone oral per 5 mg,J7510,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.43,,,,,,,fee schedule,0.43,0.52, Prednisolone oral per 5 mg,J7510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.43,,,,,,,fee schedule,0.43,0.52, Prednisolone oral per 5 mg,J7510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.52,,,,,,,fee schedule,0.43,0.52, Antithymocyte globuln rabbit,J7511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1550.98,,,,,,,fee schedule,1023.12,2241.59, Antithymocyte globuln rabbit,J7511,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1550.98,,,,,,,fee schedule,1023.12,2241.59, Antithymocyte globuln rabbit,J7511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1867.82,,,,,,,fee schedule,1023.12,2241.59, Antithymocyte globuln rabbit,J7511,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2241.59,,,,,,,fee schedule,1023.12,2241.59, Antithymocyte globuln rabbit,J7511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1064.05,,,,,,,fee schedule,1023.12,2241.59,APC Antithymocyte globuln rabbit,J7511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1074.28,,,,,,,fee schedule,1023.12,2241.59,APC Antithymocyte globuln rabbit,J7511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1023.12,,,,,,,fee schedule,1023.12,2241.59,APC Prednisone ir or dr oral 1mg,J7512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.02, Prednisone ir or dr oral 1mg,J7512,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Prednisone ir or dr oral 1mg,J7512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, Prednisone ir or dr oral 1mg,J7512,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Mycophenol (myhibbin) 100 mg,J7514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.17,,,,,,,fee schedule,4.17,5, Mycophenol (myhibbin) 100 mg,J7514,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5,,,,,,,fee schedule,4.17,5, Cyclosporine oral 25 mg,J7515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.2,,,,,,,fee schedule,1.2,1.79, Cyclosporine oral 25 mg,J7515,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.2,,,,,,,fee schedule,1.2,1.79, Cyclosporine oral 25 mg,J7515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.5,,,,,,,fee schedule,1.2,1.79, Cyclosporine oral 25 mg,J7515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.79,,,,,,,fee schedule,1.2,1.79, Cyclosporin parenteral 250mg,J7516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.14,,,,,,,fee schedule,113.14,162.8, Cyclosporin parenteral 250mg,J7516,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.14,,,,,,,fee schedule,113.14,162.8, Cyclosporin parenteral 250mg,J7516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,135.65,,,,,,,fee schedule,113.14,162.8, Cyclosporin parenteral 250mg,J7516,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,162.8,,,,,,,fee schedule,113.14,162.8, Mycophenolate mofetil oral,J7517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.25,,,,,,,fee schedule,0.25,0.36, Mycophenolate mofetil oral,J7517,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.25,,,,,,,fee schedule,0.25,0.36, Mycophenolate mofetil oral,J7517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.3,,,,,,,fee schedule,0.25,0.36, Mycophenolate mofetil oral,J7517,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.36,,,,,,,fee schedule,0.25,0.36, Mycophenolic acid,J7518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.58,,,,,,,fee schedule,0.58,0.76, Mycophenolic acid,J7518,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.58,,,,,,,fee schedule,0.58,0.76, Mycophenolic acid,J7518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.64,,,,,,,fee schedule,0.58,0.76, Mycophenolic acid,J7518,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.76,,,,,,,fee schedule,0.58,0.76, Inj. mycophenolate mofetil,J7519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.64,,,,,,,fee schedule,0.64,0.81, Inj. mycophenolate mofetil,J7519,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.64,,,,,,,fee schedule,0.64,0.81, Inj. mycophenolate mofetil,J7519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.67,,,,,,,fee schedule,0.64,0.81, Inj. mycophenolate mofetil,J7519,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.81,,,,,,,fee schedule,0.64,0.81, "Sirolimus, oral",J7520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.49,,,,,,,fee schedule,1.49,1.95, "Sirolimus, oral",J7520,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.49,,,,,,,fee schedule,1.49,1.95, "Sirolimus, oral",J7520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.63,,,,,,,fee schedule,1.49,1.95, "Sirolimus, oral",J7520,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.95,,,,,,,fee schedule,1.49,1.95, Tacrolim granules oral susp,J7521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.95,,,,,,,fee schedule,1.95,2.94, Tacrolim granules oral susp,J7521,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.95,,,,,,,fee schedule,1.95,2.94, Tacrolim granules oral susp,J7521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.45,,,,,,,fee schedule,1.95,2.94, Tacrolim granules oral susp,J7521,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.94,,,,,,,fee schedule,1.95,2.94, Tacrolimus injection,J7525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,408.19,,,,,,,fee schedule,259.96,590.25, Tacrolimus injection,J7525,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,408.19,,,,,,,fee schedule,259.96,590.25, Tacrolimus injection,J7525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,491.83,,,,,,,fee schedule,259.96,590.25, Tacrolimus injection,J7525,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,590.25,,,,,,,fee schedule,259.96,590.25, Tacrolimus injection,J7525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,270.35,,,,,,,fee schedule,259.96,590.25,APC Tacrolimus injection,J7525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,272.95,,,,,,,fee schedule,259.96,590.25,APC Tacrolimus injection,J7525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,259.96,,,,,,,fee schedule,259.96,590.25,APC Oral everolimus,J7527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.09,,,,,,,fee schedule,2.56,3.09, Oral everolimus,J7527,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.09,,,,,,,fee schedule,2.56,3.09, Oral everolimus,J7527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.56,,,,,,,fee schedule,2.56,3.09, Oral everolimus,J7527,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.07,,,,,,,fee schedule,2.56,3.09, Ensifentrine inh 3 mg,J7601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.13,,,,,,,fee schedule,81.13,116.91, Ensifentrine inh 3 mg,J7601,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81.13,,,,,,,fee schedule,81.13,116.91, Ensifentrine inh 3 mg,J7601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,97.41,,,,,,,fee schedule,81.13,116.91, Ensifentrine inh 3 mg,J7601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,116.91,,,,,,,fee schedule,81.13,116.91, Arformoterol non-comp unit,J7605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.24,,,,,,,fee schedule,1.24,1.59, Arformoterol non-comp unit,J7605,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.24,,,,,,,fee schedule,1.24,1.59, Arformoterol non-comp unit,J7605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.33,,,,,,,fee schedule,1.24,1.59, Arformoterol non-comp unit,J7605,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.59,,,,,,,fee schedule,1.24,1.59, "Formoterol fumarate, inh",J7606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.05,,,,,,,fee schedule,3.05,6.12, "Formoterol fumarate, inh",J7606,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.05,,,,,,,fee schedule,3.05,6.12, "Formoterol fumarate, inh",J7606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.1,,,,,,,fee schedule,3.05,6.12, "Formoterol fumarate, inh",J7606,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.12,,,,,,,fee schedule,3.05,6.12, Acetylcysteine non-comp unit,J7608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,13.84,,,,,,,fee schedule,13.84,19.42, Acetylcysteine non-comp unit,J7608,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,13.84,,,,,,,fee schedule,13.84,19.42, Acetylcysteine non-comp unit,J7608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.19,,,,,,,fee schedule,13.84,19.42, Acetylcysteine non-comp unit,J7608,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.42,,,,,,,fee schedule,13.84,19.42, Albuterol comp unit,J7609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.95,,,,,,,fee schedule,0.95,1.14, Albuterol comp unit,J7609,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.14,,,,,,,fee schedule,0.95,1.14, Albuterol comp con,J7610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.3,,,,,,,fee schedule,2.3,2.76, Albuterol comp con,J7610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.76,,,,,,,fee schedule,2.3,2.76, Albuterol non-comp con,J7611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.25,,,,,,,fee schedule,0.25,0.38, Albuterol non-comp con,J7611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.25,,,,,,,fee schedule,0.25,0.38, Albuterol non-comp con,J7611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.32,,,,,,,fee schedule,0.25,0.38, Albuterol non-comp con,J7611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.38,,,,,,,fee schedule,0.25,0.38, Levalbuterol non-comp con,J7612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.46,,,,,,,fee schedule,0.46,0.61, Levalbuterol non-comp con,J7612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.46,,,,,,,fee schedule,0.46,0.61, Levalbuterol non-comp con,J7612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.5,,,,,,,fee schedule,0.46,0.61, Levalbuterol non-comp con,J7612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.61,,,,,,,fee schedule,0.46,0.61, Albuterol non-comp unit,J7613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.12,,,,,,,fee schedule,0.12,0.18, Albuterol non-comp unit,J7613,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.12,,,,,,,fee schedule,0.12,0.18, Albuterol non-comp unit,J7613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.15,,,,,,,fee schedule,0.12,0.18, Albuterol non-comp unit,J7613,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.18,,,,,,,fee schedule,0.12,0.18, Levalbuterol non-comp unit,J7614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.13,,,,,,,fee schedule,0.13,0.2, Levalbuterol non-comp unit,J7614,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.13,,,,,,,fee schedule,0.13,0.2, Levalbuterol non-comp unit,J7614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.17,,,,,,,fee schedule,0.13,0.2, Levalbuterol non-comp unit,J7614,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.2,,,,,,,fee schedule,0.13,0.2, Levalbuterol comp unit,J7615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.69,,,,,,,fee schedule,2.69,3.23, Levalbuterol comp unit,J7615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.23,,,,,,,fee schedule,2.69,3.23, Albuterol ipratrop non-comp,J7620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.31,,,,,,,fee schedule,0.31,0.45, Albuterol ipratrop non-comp,J7620,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.31,,,,,,,fee schedule,0.31,0.45, Albuterol ipratrop non-comp,J7620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.37,,,,,,,fee schedule,0.31,0.45, Albuterol ipratrop non-comp,J7620,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.45,,,,,,,fee schedule,0.31,0.45, Budesonide non-comp unit,J7626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.98,,,,,,,fee schedule,1.98,3.03, Budesonide non-comp unit,J7626,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.98,,,,,,,fee schedule,1.98,3.03, Budesonide non-comp unit,J7626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.52,,,,,,,fee schedule,1.98,3.03, Budesonide non-comp unit,J7626,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.03,,,,,,,fee schedule,1.98,3.03, Budesonide comp unit,J7627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.58,,,,,,,fee schedule,0.58,0.7, Budesonide comp unit,J7627,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.7,,,,,,,fee schedule,0.58,0.7, Bitolterol mesylate comp con,J7628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.41,,,,,,,fee schedule,0.41,0.49, Bitolterol mesylate comp con,J7628,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.49,,,,,,,fee schedule,0.41,0.49, Cromolyn sodium noncomp unit,J7631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.45,,,,,,,fee schedule,0.45,0.99, Cromolyn sodium noncomp unit,J7631,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.45,,,,,,,fee schedule,0.45,0.99, Cromolyn sodium noncomp unit,J7631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.82,,,,,,,fee schedule,0.45,0.99, Cromolyn sodium noncomp unit,J7631,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.99,,,,,,,fee schedule,0.45,0.99, Cromolyn sodium comp unit,J7632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.5,,,,,,,fee schedule,0.5,0.61, Cromolyn sodium comp unit,J7632,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.61,,,,,,,fee schedule,0.5,0.61, Budesonide non-comp con,J7633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.01,,,,,,,fee schedule,9.01,10.81, Budesonide non-comp con,J7633,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.81,,,,,,,fee schedule,9.01,10.81, Dornase alfa non-comp unit,J7639,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,85.85,,,,,,,fee schedule,85.85,123.72, Dornase alfa non-comp unit,J7639,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.85,,,,,,,fee schedule,85.85,123.72, Dornase alfa non-comp unit,J7639,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,103.09,,,,,,,fee schedule,85.85,123.72, Dornase alfa non-comp unit,J7639,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123.72,,,,,,,fee schedule,85.85,123.72, Formoterol comp unit,J7640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.23,,,,,,,fee schedule,3.23,3.88, Formoterol comp unit,J7640,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.88,,,,,,,fee schedule,3.23,3.88, Flunisolide comp unit,J7641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.92,,,,,,,fee schedule,15.92,19.11, Flunisolide comp unit,J7641,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.11,,,,,,,fee schedule,15.92,19.11, Glycopyrrolate comp unit,J7643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.42,,,,,,,fee schedule,1.42,1.7, Glycopyrrolate comp unit,J7643,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.7,,,,,,,fee schedule,1.42,1.7, Ipratropium bromide non-comp,J7644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.61,,,,,,,fee schedule,0.61,0.87, Ipratropium bromide non-comp,J7644,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.61,,,,,,,fee schedule,0.61,0.87, Ipratropium bromide non-comp,J7644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.73,,,,,,,fee schedule,0.61,0.87, Ipratropium bromide non-comp,J7644,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.87,,,,,,,fee schedule,0.61,0.87, Ipratropium bromide comp,J7645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.09,,,,,,,fee schedule,0.09,0.11, Ipratropium bromide comp,J7645,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.11,,,,,,,fee schedule,0.09,0.11, Mannitol for inhaler,J7665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.54,,,,,,,fee schedule,12.54,15.05, Mannitol for inhaler,J7665,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.05,,,,,,,fee schedule,12.54,15.05, Metaproterenol non-comp unit,J7669,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.8,,,,,,,fee schedule,0.8,0.96, Metaproterenol non-comp unit,J7669,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.96,,,,,,,fee schedule,0.8,0.96, "Methacholine chloride, neb",J7674,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.69,,,,,,,fee schedule,2.69,3.95, "Methacholine chloride, neb",J7674,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.69,,,,,,,fee schedule,2.69,3.95, "Methacholine chloride, neb",J7674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.29,,,,,,,fee schedule,2.69,3.95, "Methacholine chloride, neb",J7674,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.95,,,,,,,fee schedule,2.69,3.95, Revefenacin inh non-com 1mcg,J7677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.3,,,,,,,fee schedule,0.3,0.43, Revefenacin inh non-com 1mcg,J7677,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.3,,,,,,,fee schedule,0.3,0.43, Revefenacin inh non-com 1mcg,J7677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.36,,,,,,,fee schedule,0.3,0.43, Revefenacin inh non-com 1mcg,J7677,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.43,,,,,,,fee schedule,0.3,0.43, Terbutaline sulf comp con,J7680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.04,,,,,,,fee schedule,20.04,24.04, Terbutaline sulf comp con,J7680,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.04,,,,,,,fee schedule,20.04,24.04, Terbutaline sulf comp unit,J7681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.04,,,,,,,fee schedule,20.04,24.04, Terbutaline sulf comp unit,J7681,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.04,,,,,,,fee schedule,20.04,24.04, Tobramycin non-comp unit,J7682,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.51,,,,,,,fee schedule,22.51,36.38, Tobramycin non-comp unit,J7682,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.51,,,,,,,fee schedule,22.51,36.38, Tobramycin non-comp unit,J7682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,30.32,,,,,,,fee schedule,22.51,36.38, Tobramycin non-comp unit,J7682,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,36.38,,,,,,,fee schedule,22.51,36.38, Triamcinolone comp con,J7683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.2,,,,,,,fee schedule,7.2,8.64, Triamcinolone comp con,J7683,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.64,,,,,,,fee schedule,7.2,8.64, Tobramycin comp unit,J7685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,91.99,,,,,,,fee schedule,91.99,110.4, Tobramycin comp unit,J7685,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,110.4,,,,,,,fee schedule,91.99,110.4, "Treprostinil, non-comp unit",J7686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1245.52,,,,,,,fee schedule,1245.52,1785.63, "Treprostinil, non-comp unit",J7686,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1245.52,,,,,,,fee schedule,1245.52,1785.63, "Treprostinil, non-comp unit",J7686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1487.89,,,,,,,fee schedule,1245.52,1785.63, "Treprostinil, non-comp unit",J7686,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1785.63,,,,,,,fee schedule,1245.52,1785.63, Oral aprepitant,J8501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.22,,,,,,,fee schedule,4.22,6.12, Oral aprepitant,J8501,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.22,,,,,,,fee schedule,4.22,6.12, Oral aprepitant,J8501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.1,,,,,,,fee schedule,4.22,6.12, Oral aprepitant,J8501,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.12,,,,,,,fee schedule,4.22,6.12, Oral busulfan,J8510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,261.87,,,,,,,fee schedule,10.12,314.27, Oral busulfan,J8510,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,314.27,,,,,,,fee schedule,10.12,314.27, Oral busulfan,J8510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.52,,,,,,,fee schedule,10.12,314.27,APC Oral busulfan,J8510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.63,,,,,,,fee schedule,10.12,314.27,APC Oral busulfan,J8510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.12,,,,,,,fee schedule,10.12,314.27,APC "Cabergoline, oral 0.25mg",J8515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.99,,,,,,,fee schedule,2.99,3.59, "Cabergoline, oral 0.25mg",J8515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.59,,,,,,,fee schedule,2.99,3.59, "Capecitabine, oral, 50 mg",J8522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.08,,,,,,,fee schedule,0.03,0.09, "Capecitabine, oral, 50 mg",J8522,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.08,,,,,,,fee schedule,0.03,0.09, "Capecitabine, oral, 50 mg",J8522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.07,,,,,,,fee schedule,0.03,0.09, "Capecitabine, oral, 50 mg",J8522,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.09,,,,,,,fee schedule,0.03,0.09, "Capecitabine, oral, 50 mg",J8522,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.03,,,,,,,fee schedule,0.03,0.09,APC "Capecitabine, oral, 50 mg",J8522,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.03,,,,,,,fee schedule,0.03,0.09,APC "Capecitabine, oral, 50 mg",J8522,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.03,,,,,,,fee schedule,0.03,0.09,APC Cyclophosphamide oral 25 MG,J8530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.09,,,,,,,fee schedule,2.06,3.09, Cyclophosphamide oral 25 MG,J8530,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.09,,,,,,,fee schedule,2.06,3.09, Cyclophosphamide oral 25 MG,J8530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.06,,,,,,,fee schedule,2.06,3.09, Cyclophosphamide oral 25 MG,J8530,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.47,,,,,,,fee schedule,2.06,3.09, Oral dexamethasone,J8540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.03,,,,,,,fee schedule,0.03,0.04, Oral dexamethasone,J8540,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.03,,,,,,,fee schedule,0.03,0.04, Oral dexamethasone,J8540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.04,,,,,,,fee schedule,0.03,0.04, Oral dexamethasone,J8540,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.04,,,,,,,fee schedule,0.03,0.04, "Oral, hemady, 0.25 mg",J8541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.69,,,,,,,fee schedule,0.69,0.83, "Oral, hemady, 0.25 mg",J8541,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.83,,,,,,,fee schedule,0.69,0.83, Etoposide oral 50 mg,J8560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,117.93,,,,,,,fee schedule,86.84,173.74, Etoposide oral 50 mg,J8560,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,117.93,,,,,,,fee schedule,86.84,173.74, Etoposide oral 50 mg,J8560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,144.77,,,,,,,fee schedule,86.84,173.74, Etoposide oral 50 mg,J8560,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,173.74,,,,,,,fee schedule,86.84,173.74, Etoposide oral 50 mg,J8560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,90.31,,,,,,,fee schedule,86.84,173.74,APC Etoposide oral 50 mg,J8560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,91.18,,,,,,,fee schedule,86.84,173.74,APC Etoposide oral 50 mg,J8560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,86.84,,,,,,,fee schedule,86.84,173.74,APC Gefitinib oral,J8565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,267.29,,,,,,,fee schedule,267.29,320.77, Gefitinib oral,J8565,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,320.77,,,,,,,fee schedule,267.29,320.77, Melphalan oral 2 MG,J8600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.46,,,,,,,fee schedule,17.46,20.95, Melphalan oral 2 MG,J8600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.95,,,,,,,fee schedule,17.46,20.95, Methotrexate oral 2.5 MG,J8610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.31,,,,,,,fee schedule,0.31,0.43, Methotrexate oral 2.5 MG,J8610,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.31,,,,,,,fee schedule,0.31,0.43, Methotrexate oral 2.5 MG,J8610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.36,,,,,,,fee schedule,0.31,0.43, Methotrexate oral 2.5 MG,J8610,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.43,,,,,,,fee schedule,0.31,0.43, Oral methotrexate (jylamvo),J8611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.84,,,,,,,fee schedule,18.71,41.43, Oral methotrexate (jylamvo),J8611,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.84,,,,,,,fee schedule,18.71,41.43, Oral methotrexate (jylamvo),J8611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.52,,,,,,,fee schedule,18.71,41.43, Oral methotrexate (jylamvo),J8611,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.43,,,,,,,fee schedule,18.71,41.43, Oral methotrexate (jylamvo),J8611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.46,,,,,,,fee schedule,18.71,41.43,APC Oral methotrexate (jylamvo),J8611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.65,,,,,,,fee schedule,18.71,41.43,APC Oral methotrexate (jylamvo),J8611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.71,,,,,,,fee schedule,18.71,41.43,APC Oral methotrexate (xatmep),J8612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,35.28,,,,,,,fee schedule,22.3,50.87, Oral methotrexate (xatmep),J8612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,35.28,,,,,,,fee schedule,22.3,50.87, Oral methotrexate (xatmep),J8612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.39,,,,,,,fee schedule,22.3,50.87, Oral methotrexate (xatmep),J8612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.87,,,,,,,fee schedule,22.3,50.87, Oral methotrexate (xatmep),J8612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.19,,,,,,,fee schedule,22.3,50.87,APC Oral methotrexate (xatmep),J8612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.41,,,,,,,fee schedule,22.3,50.87,APC Oral methotrexate (xatmep),J8612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.3,,,,,,,fee schedule,22.3,50.87,APC Nabilone oral,J8650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,74.72,,,,,,,fee schedule,74.72,89.68, Nabilone oral,J8650,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.68,,,,,,,fee schedule,74.72,89.68, Netupitant palonosetron oral,J8655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,637.46,,,,,,,fee schedule,397.79,948.54, Netupitant palonosetron oral,J8655,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,637.46,,,,,,,fee schedule,397.79,948.54, Netupitant palonosetron oral,J8655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,790.38,,,,,,,fee schedule,397.79,948.54, Netupitant palonosetron oral,J8655,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,948.54,,,,,,,fee schedule,397.79,948.54, Netupitant palonosetron oral,J8655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,413.7,,,,,,,fee schedule,397.79,948.54,APC Netupitant palonosetron oral,J8655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,417.68,,,,,,,fee schedule,397.79,948.54,APC Netupitant palonosetron oral,J8655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,397.79,,,,,,,fee schedule,397.79,948.54,APC "Rolapitant, oral, 1mg",J8670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.43,,,,,,,fee schedule,2.43,4.17, "Rolapitant, oral, 1mg",J8670,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.43,,,,,,,fee schedule,2.43,4.17, "Rolapitant, oral, 1mg",J8670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.48,,,,,,,fee schedule,2.43,4.17, "Rolapitant, oral, 1mg",J8670,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.17,,,,,,,fee schedule,2.43,4.17, Temozolomide,J8700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.56,,,,,,,fee schedule,0.56,1.01, Temozolomide,J8700,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.56,,,,,,,fee schedule,0.56,1.01, Temozolomide,J8700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.84,,,,,,,fee schedule,0.56,1.01, Temozolomide,J8700,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.01,,,,,,,fee schedule,0.56,1.01, Topotecan oral,J8705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,194.42,,,,,,,fee schedule,125.22,279.99, Topotecan oral,J8705,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,194.42,,,,,,,fee schedule,125.22,279.99, Topotecan oral,J8705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,233.31,,,,,,,fee schedule,125.22,279.99, Topotecan oral,J8705,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,279.99,,,,,,,fee schedule,125.22,279.99, Topotecan oral,J8705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,130.23,,,,,,,fee schedule,125.22,279.99,APC Topotecan oral,J8705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,131.49,,,,,,,fee schedule,125.22,279.99,APC Topotecan oral,J8705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,125.22,,,,,,,fee schedule,125.22,279.99,APC Doxorubicin hcl injection,J9000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.24,,,,,,,fee schedule,4.24,6.77, Doxorubicin hcl injection,J9000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.24,,,,,,,fee schedule,4.24,6.77, Doxorubicin hcl injection,J9000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.64,,,,,,,fee schedule,4.24,6.77, Doxorubicin hcl injection,J9000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.77,,,,,,,fee schedule,4.24,6.77, "Datopotamab deruxtecan, 1 mg",J9011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,96.37,,,,,,,fee schedule,51.52,115.65, "Datopotamab deruxtecan, 1 mg",J9011,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,115.65,,,,,,,fee schedule,51.52,115.65, "Datopotamab deruxtecan, 1 mg",J9011,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.58,,,,,,,fee schedule,51.52,115.65,APC "Datopotamab deruxtecan, 1 mg",J9011,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.09,,,,,,,fee schedule,51.52,115.65,APC "Datopotamab deruxtecan, 1 mg",J9011,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.52,,,,,,,fee schedule,51.52,115.65,APC Aldesleukin injection,J9015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11552.66,,,,,,,fee schedule,3338.87,13864.43, Aldesleukin injection,J9015,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13864.43,,,,,,,fee schedule,3338.87,13864.43, Aldesleukin injection,J9015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3472.42,,,,,,,fee schedule,3338.87,13864.43,APC Aldesleukin injection,J9015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3505.81,,,,,,,fee schedule,3338.87,13864.43,APC Aldesleukin injection,J9015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3338.87,,,,,,,fee schedule,3338.87,13864.43,APC Arsenic trioxide injection,J9017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.12,,,,,,,fee schedule,9.12,18.28, Arsenic trioxide injection,J9017,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.12,,,,,,,fee schedule,9.12,18.28, Arsenic trioxide injection,J9017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.23,,,,,,,fee schedule,9.12,18.28, Arsenic trioxide injection,J9017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18.28,,,,,,,fee schedule,9.12,18.28, Erwinaze injection,J9019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,768.44,,,,,,,fee schedule,768.44,922.21, Erwinaze injection,J9019,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,922.21,,,,,,,fee schedule,768.44,922.21, "Inj, aspara, rylaze, 0.1 mg",J9021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.08,,,,,,,fee schedule,56.29,124.42, "Inj, aspara, rylaze, 0.1 mg",J9021,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.08,,,,,,,fee schedule,56.29,124.42, "Inj, aspara, rylaze, 0.1 mg",J9021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,103.67,,,,,,,fee schedule,56.29,124.42, "Inj, aspara, rylaze, 0.1 mg",J9021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,124.42,,,,,,,fee schedule,56.29,124.42, "Inj, aspara, rylaze, 0.1 mg",J9021,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.54,,,,,,,fee schedule,56.29,124.42,APC "Inj, aspara, rylaze, 0.1 mg",J9021,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.1,,,,,,,fee schedule,56.29,124.42,APC "Inj, aspara, rylaze, 0.1 mg",J9021,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.29,,,,,,,fee schedule,56.29,124.42,APC "Inj, atezolizumab,10 mg",J9022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,141.69,,,,,,,fee schedule,94,204.88, "Inj, atezolizumab,10 mg",J9022,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,141.69,,,,,,,fee schedule,94,204.88, "Inj, atezolizumab,10 mg",J9022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,170.71,,,,,,,fee schedule,94,204.88, "Inj, atezolizumab,10 mg",J9022,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,204.88,,,,,,,fee schedule,94,204.88, "Inj, atezolizumab,10 mg",J9022,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,97.76,,,,,,,fee schedule,94,204.88,APC "Inj, atezolizumab,10 mg",J9022,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,98.7,,,,,,,fee schedule,94,204.88,APC "Inj, atezolizumab,10 mg",J9022,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,94,,,,,,,fee schedule,94,204.88,APC "Injection, avelumab, 10 mg",J9023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.12,,,,,,,fee schedule,105.54,224.5, "Injection, avelumab, 10 mg",J9023,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,156.12,,,,,,,fee schedule,105.54,224.5, "Injection, avelumab, 10 mg",J9023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,187.07,,,,,,,fee schedule,105.54,224.5, "Injection, avelumab, 10 mg",J9023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,224.5,,,,,,,fee schedule,105.54,224.5, "Injection, avelumab, 10 mg",J9023,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,109.77,,,,,,,fee schedule,105.54,224.5,APC "Injection, avelumab, 10 mg",J9023,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,110.82,,,,,,,fee schedule,105.54,224.5,APC "Injection, avelumab, 10 mg",J9023,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,105.54,,,,,,,fee schedule,105.54,224.5,APC Inj atezolizumb 5mg hya-tqjs,J9024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,49.24,,,,,,,fee schedule,31.95,70.83, Inj atezolizumb 5mg hya-tqjs,J9024,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,49.24,,,,,,,fee schedule,31.95,70.83, Inj atezolizumb 5mg hya-tqjs,J9024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,59.02,,,,,,,fee schedule,31.95,70.83, Inj atezolizumb 5mg hya-tqjs,J9024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.83,,,,,,,fee schedule,31.95,70.83, Inj atezolizumb 5mg hya-tqjs,J9024,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.22,,,,,,,fee schedule,31.95,70.83,APC Inj atezolizumb 5mg hya-tqjs,J9024,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.54,,,,,,,fee schedule,31.95,70.83,APC Inj atezolizumb 5mg hya-tqjs,J9024,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.95,,,,,,,fee schedule,31.95,70.83,APC Azacitidine injection,J9025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.33,,,,,,,fee schedule,0.33,1.28, Azacitidine injection,J9025,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.33,,,,,,,fee schedule,0.33,1.28, Azacitidine injection,J9025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.07,,,,,,,fee schedule,0.33,1.28, Azacitidine injection,J9025,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.28,,,,,,,fee schedule,0.33,1.28, "Inj, tarlatamab-dlle, 1 mg",J9026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2439.97,,,,,,,fee schedule,1567.72,3509.49, "Inj, tarlatamab-dlle, 1 mg",J9026,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2439.97,,,,,,,fee schedule,1567.72,3509.49, "Inj, tarlatamab-dlle, 1 mg",J9026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2924.31,,,,,,,fee schedule,1567.72,3509.49, "Inj, tarlatamab-dlle, 1 mg",J9026,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3509.49,,,,,,,fee schedule,1567.72,3509.49, "Inj, tarlatamab-dlle, 1 mg",J9026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1630.43,,,,,,,fee schedule,1567.72,3509.49,APC "Inj, tarlatamab-dlle, 1 mg",J9026,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1646.1,,,,,,,fee schedule,1567.72,3509.49,APC "Inj, tarlatamab-dlle, 1 mg",J9026,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1567.72,,,,,,,fee schedule,1567.72,3509.49,APC Clofarabine injection,J9027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.9,,,,,,,fee schedule,7.83,22.9, Clofarabine injection,J9027,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.9,,,,,,,fee schedule,7.83,22.9, Clofarabine injection,J9027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.83,,,,,,,fee schedule,7.83,22.9, Clofarabine injection,J9027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.4,,,,,,,fee schedule,7.83,22.9, Clofarabine injection,J9027,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.37,,,,,,,fee schedule,7.83,22.9,APC Clofarabine injection,J9027,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.48,,,,,,,fee schedule,7.83,22.9,APC Clofarabine injection,J9027,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.94,,,,,,,fee schedule,7.83,22.9,APC "Inj, nogapendekin pmln, 1mcg",J9028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,146.5,,,,,,,fee schedule,94.6,212.32, "Inj, nogapendekin pmln, 1mcg",J9028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,146.5,,,,,,,fee schedule,94.6,212.32, "Inj, nogapendekin pmln, 1mcg",J9028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,176.92,,,,,,,fee schedule,94.6,212.32, "Inj, nogapendekin pmln, 1mcg",J9028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,212.32,,,,,,,fee schedule,94.6,212.32, "Inj, nogapendekin pmln, 1mcg",J9028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,98.38,,,,,,,fee schedule,94.6,212.32,APC "Inj, nogapendekin pmln, 1mcg",J9028,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,99.33,,,,,,,fee schedule,94.6,212.32,APC "Inj, nogapendekin pmln, 1mcg",J9028,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,94.6,,,,,,,fee schedule,94.6,212.32,APC "Inj, adstiladrin, per tx dos",J9029,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,98737.02,,,,,,,fee schedule,64282.3,136598.7, "Inj, adstiladrin, per tx dos",J9029,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98737.02,,,,,,,fee schedule,64282.3,136598.7, "Inj, adstiladrin, per tx dos",J9029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,113822.1,,,,,,,fee schedule,64282.3,136598.7, "Inj, adstiladrin, per tx dos",J9029,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,136598.7,,,,,,,fee schedule,64282.3,136598.7, "Inj, adstiladrin, per tx dos",J9029,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66853.59,,,,,,,fee schedule,64282.3,136598.7,APC "Inj, adstiladrin, per tx dos",J9029,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67496.41,,,,,,,fee schedule,64282.3,136598.7,APC "Inj, adstiladrin, per tx dos",J9029,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64282.3,,,,,,,fee schedule,64282.3,136598.7,APC Bcg live intravesical 1mg,J9030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.87,,,,,,,fee schedule,3.39,7.31, Bcg live intravesical 1mg,J9030,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.87,,,,,,,fee schedule,3.39,7.31, Bcg live intravesical 1mg,J9030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.09,,,,,,,fee schedule,3.39,7.31, Bcg live intravesical 1mg,J9030,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.31,,,,,,,fee schedule,3.39,7.31, Bcg live intravesical 1mg,J9030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.53,,,,,,,fee schedule,3.39,7.31,APC Bcg live intravesical 1mg,J9030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.56,,,,,,,fee schedule,3.39,7.31,APC Bcg live intravesical 1mg,J9030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.39,,,,,,,fee schedule,3.39,7.31,APC "Injection, belinostat, 10mg",J9032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81,,,,,,,fee schedule,53.11,117.69, "Injection, belinostat, 10mg",J9032,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,81,,,,,,,fee schedule,53.11,117.69, "Injection, belinostat, 10mg",J9032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.07,,,,,,,fee schedule,53.11,117.69, "Injection, belinostat, 10mg",J9032,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,117.69,,,,,,,fee schedule,53.11,117.69, "Injection, belinostat, 10mg",J9032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,55.24,,,,,,,fee schedule,53.11,117.69,APC "Injection, belinostat, 10mg",J9032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,55.77,,,,,,,fee schedule,53.11,117.69,APC "Injection, belinostat, 10mg",J9032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,53.11,,,,,,,fee schedule,53.11,117.69,APC "Inj., treanda 1 mg",J9033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.89,,,,,,,fee schedule,2.16,4.22, "Inj., treanda 1 mg",J9033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.89,,,,,,,fee schedule,2.16,4.22, "Inj., treanda 1 mg",J9033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.51,,,,,,,fee schedule,2.16,4.22, "Inj., treanda 1 mg",J9033,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.22,,,,,,,fee schedule,2.16,4.22, "Inj., treanda 1 mg",J9033,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.25,,,,,,,fee schedule,2.16,4.22,APC "Inj., treanda 1 mg",J9033,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.27,,,,,,,fee schedule,2.16,4.22,APC "Inj., treanda 1 mg",J9033,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.16,,,,,,,fee schedule,2.16,4.22,APC "Inj., bendeka 1 mg",J9034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,20.43,,,,,,,fee schedule,12.9,30.26, "Inj., bendeka 1 mg",J9034,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,20.43,,,,,,,fee schedule,12.9,30.26, "Inj., bendeka 1 mg",J9034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,25.21,,,,,,,fee schedule,12.9,30.26, "Inj., bendeka 1 mg",J9034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.26,,,,,,,fee schedule,12.9,30.26, "Inj., bendeka 1 mg",J9034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13.42,,,,,,,fee schedule,12.9,30.26,APC "Inj., bendeka 1 mg",J9034,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13.55,,,,,,,fee schedule,12.9,30.26,APC "Inj., bendeka 1 mg",J9034,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12.9,,,,,,,fee schedule,12.9,30.26,APC Bevacizumab injection,J9035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,113.7,,,,,,,fee schedule,74.36,164.19, Bevacizumab injection,J9035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,113.7,,,,,,,fee schedule,74.36,164.19, Bevacizumab injection,J9035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,136.81,,,,,,,fee schedule,74.36,164.19, Bevacizumab injection,J9035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,164.19,,,,,,,fee schedule,74.36,164.19, Bevacizumab injection,J9035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.33,,,,,,,fee schedule,74.36,164.19,APC Bevacizumab injection,J9035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.07,,,,,,,fee schedule,74.36,164.19,APC Bevacizumab injection,J9035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.36,,,,,,,fee schedule,74.36,164.19,APC Inj. belrapzo/bendamustine,J9036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,18.66,,,,,,,fee schedule,13.94,27.54, Inj. belrapzo/bendamustine,J9036,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.66,,,,,,,fee schedule,13.94,27.54, Inj. belrapzo/bendamustine,J9036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.95,,,,,,,fee schedule,13.94,27.54, Inj. belrapzo/bendamustine,J9036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,27.54,,,,,,,fee schedule,13.94,27.54, Inj. belrapzo/bendamustine,J9036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.5,,,,,,,fee schedule,13.94,27.54,APC Inj. belrapzo/bendamustine,J9036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.64,,,,,,,fee schedule,13.94,27.54,APC Inj. belrapzo/bendamustine,J9036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.94,,,,,,,fee schedule,13.94,27.54,APC Inj axatilimab-csfr 0.1 mg,J9038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,104.01,,,,,,,fee schedule,55.65,124.82, Inj axatilimab-csfr 0.1 mg,J9038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,124.82,,,,,,,fee schedule,55.65,124.82, Inj axatilimab-csfr 0.1 mg,J9038,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.88,,,,,,,fee schedule,55.65,124.82,APC Inj axatilimab-csfr 0.1 mg,J9038,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.43,,,,,,,fee schedule,55.65,124.82,APC Inj axatilimab-csfr 0.1 mg,J9038,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.65,,,,,,,fee schedule,55.65,124.82,APC "Injection, blinatumomab",J9039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,254.05,,,,,,,fee schedule,163.96,368.41, "Injection, blinatumomab",J9039,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,254.05,,,,,,,fee schedule,163.96,368.41, "Injection, blinatumomab",J9039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,306.98,,,,,,,fee schedule,163.96,368.41, "Injection, blinatumomab",J9039,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,368.41,,,,,,,fee schedule,163.96,368.41, "Injection, blinatumomab",J9039,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,170.52,,,,,,,fee schedule,163.96,368.41,APC "Injection, blinatumomab",J9039,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,172.16,,,,,,,fee schedule,163.96,368.41,APC "Injection, blinatumomab",J9039,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,163.96,,,,,,,fee schedule,163.96,368.41,APC Bleomycin sulfate injection,J9040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.54,,,,,,,fee schedule,32.54,48.27, Bleomycin sulfate injection,J9040,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.54,,,,,,,fee schedule,32.54,48.27, Bleomycin sulfate injection,J9040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.22,,,,,,,fee schedule,32.54,48.27, Bleomycin sulfate injection,J9040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.27,,,,,,,fee schedule,32.54,48.27, Bortezomib injection,J9041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.48,,,,,,,fee schedule,2.48,6.26, Bortezomib injection,J9041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.48,,,,,,,fee schedule,2.48,6.26, Bortezomib injection,J9041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.21,,,,,,,fee schedule,2.48,6.26, Bortezomib injection,J9041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.26,,,,,,,fee schedule,2.48,6.26, Brentuximab vedotin inj,J9042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,402.4,,,,,,,fee schedule,268.73,580.13, Brentuximab vedotin inj,J9042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,402.4,,,,,,,fee schedule,268.73,580.13, Brentuximab vedotin inj,J9042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,483.4,,,,,,,fee schedule,268.73,580.13, Brentuximab vedotin inj,J9042,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,580.13,,,,,,,fee schedule,268.73,580.13, Brentuximab vedotin inj,J9042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,279.48,,,,,,,fee schedule,268.73,580.13,APC Brentuximab vedotin inj,J9042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,282.16,,,,,,,fee schedule,268.73,580.13,APC Brentuximab vedotin inj,J9042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,268.73,,,,,,,fee schedule,268.73,580.13,APC Cabazitaxel injection,J9043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,353.51,,,,,,,fee schedule,231.05,509.79, Cabazitaxel injection,J9043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,353.51,,,,,,,fee schedule,231.05,509.79, Cabazitaxel injection,J9043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,424.79,,,,,,,fee schedule,231.05,509.79, Cabazitaxel injection,J9043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,509.79,,,,,,,fee schedule,231.05,509.79, Cabazitaxel injection,J9043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,240.29,,,,,,,fee schedule,231.05,509.79,APC Cabazitaxel injection,J9043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,242.6,,,,,,,fee schedule,231.05,509.79,APC Cabazitaxel injection,J9043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,231.05,,,,,,,fee schedule,231.05,509.79,APC Carboplatin injection,J9045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.28,,,,,,,fee schedule,3.28,5.54, Carboplatin injection,J9045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.28,,,,,,,fee schedule,3.28,5.54, Carboplatin injection,J9045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.62,,,,,,,fee schedule,3.28,5.54, Carboplatin injection,J9045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.54,,,,,,,fee schedule,3.28,5.54, "Inj, bortezomib, dr. reddy's",J9046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.32,,,,,,,fee schedule,3.46,104.79, "Inj, bortezomib, dr. reddy's",J9046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,104.79,,,,,,,fee schedule,3.46,104.79, "Inj, bortezomib, dr. reddy's",J9046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.6,,,,,,,fee schedule,3.46,104.79,APC "Inj, bortezomib, dr. reddy's",J9046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.63,,,,,,,fee schedule,3.46,104.79,APC "Inj, bortezomib, dr. reddy's",J9046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.46,,,,,,,fee schedule,3.46,104.79,APC "Injection, carfilzomib, 1 mg",J9047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,85.75,,,,,,,fee schedule,56.24,124.82, "Injection, carfilzomib, 1 mg",J9047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.75,,,,,,,fee schedule,56.24,124.82, "Injection, carfilzomib, 1 mg",J9047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,104.01,,,,,,,fee schedule,56.24,124.82, "Injection, carfilzomib, 1 mg",J9047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,124.82,,,,,,,fee schedule,56.24,124.82, "Injection, carfilzomib, 1 mg",J9047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.49,,,,,,,fee schedule,56.24,124.82,APC "Injection, carfilzomib, 1 mg",J9047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.05,,,,,,,fee schedule,56.24,124.82,APC "Injection, carfilzomib, 1 mg",J9047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.24,,,,,,,fee schedule,56.24,124.82,APC "Inj, bortezomib freseniuskab",J9048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.32,,,,,,,fee schedule,6.97,104.79, "Inj, bortezomib freseniuskab",J9048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,104.79,,,,,,,fee schedule,6.97,104.79, "Inj, bortezomib freseniuskab",J9048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7.25,,,,,,,fee schedule,6.97,104.79,APC "Inj, bortezomib freseniuskab",J9048,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7.32,,,,,,,fee schedule,6.97,104.79,APC "Inj, bortezomib freseniuskab",J9048,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.97,,,,,,,fee schedule,6.97,104.79,APC "Inj, bortezomib, hospira",J9049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.41,,,,,,,fee schedule,2.41,3.3, "Inj, bortezomib, hospira",J9049,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.41,,,,,,,fee schedule,2.41,3.3, "Inj, bortezomib, hospira",J9049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.75,,,,,,,fee schedule,2.41,3.3, "Inj, bortezomib, hospira",J9049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.3,,,,,,,fee schedule,2.41,3.3, Carmustine injection,J9050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,270.29,,,,,,,fee schedule,241.8,534.87, Carmustine injection,J9050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,270.29,,,,,,,fee schedule,241.8,534.87, Carmustine injection,J9050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,445.68,,,,,,,fee schedule,241.8,534.87, Carmustine injection,J9050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,534.87,,,,,,,fee schedule,241.8,534.87, Carmustine injection,J9050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,251.48,,,,,,,fee schedule,241.8,534.87,APC Carmustine injection,J9050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,253.89,,,,,,,fee schedule,241.8,534.87,APC Carmustine injection,J9050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,241.8,,,,,,,fee schedule,241.8,534.87,APC "Inj, bortezomib (maia)",J9051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.52,,,,,,,fee schedule,6.52,7.83, "Inj, bortezomib (maia)",J9051,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.83,,,,,,,fee schedule,6.52,7.83, "Inj, carmustine (accord)",J9052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,467.06,,,,,,,fee schedule,467.06,560.53, "Inj, carmustine (accord)",J9052,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,560.53,,,,,,,fee schedule,467.06,560.53, Inj bortezomib boruzu 0.1 mg,J9054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.87,,,,,,,fee schedule,25.41,58.65, Inj bortezomib boruzu 0.1 mg,J9054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,58.65,,,,,,,fee schedule,25.41,58.65, Inj bortezomib boruzu 0.1 mg,J9054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.43,,,,,,,fee schedule,25.41,58.65,APC Inj bortezomib boruzu 0.1 mg,J9054,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.68,,,,,,,fee schedule,25.41,58.65,APC Inj bortezomib boruzu 0.1 mg,J9054,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.41,,,,,,,fee schedule,25.41,58.65,APC Cetuximab injection,J9055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,122.15,,,,,,,fee schedule,80.46,175.78, Cetuximab injection,J9055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.15,,,,,,,fee schedule,80.46,175.78, Cetuximab injection,J9055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.47,,,,,,,fee schedule,80.46,175.78, Cetuximab injection,J9055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,175.78,,,,,,,fee schedule,80.46,175.78, Cetuximab injection,J9055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,83.68,,,,,,,fee schedule,80.46,175.78,APC Cetuximab injection,J9055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,84.48,,,,,,,fee schedule,80.46,175.78,APC Cetuximab injection,J9055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,80.46,,,,,,,fee schedule,80.46,175.78,APC "Inj, bendamustine, 1 mg",J9056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.68,,,,,,,fee schedule,31.74,66.95, "Inj, bendamustine, 1 mg",J9056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.68,,,,,,,fee schedule,31.74,66.95, "Inj, bendamustine, 1 mg",J9056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.79,,,,,,,fee schedule,31.74,66.95, "Inj, bendamustine, 1 mg",J9056,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.95,,,,,,,fee schedule,31.74,66.95, "Inj, bendamustine, 1 mg",J9056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.01,,,,,,,fee schedule,31.74,66.95,APC "Inj, bendamustine, 1 mg",J9056,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.32,,,,,,,fee schedule,31.74,66.95,APC "Inj, bendamustine, 1 mg",J9056,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.74,,,,,,,fee schedule,31.74,66.95,APC "Inj., copanlisib, 1 mg",J9057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,166.92,,,,,,,fee schedule,166.92,200.32, "Inj., copanlisib, 1 mg",J9057,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.32,,,,,,,fee schedule,166.92,200.32, Cisplatin 10 mg injection,J9060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.04,,,,,,,fee schedule,3.04,5.14, Cisplatin 10 mg injection,J9060,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.04,,,,,,,fee schedule,3.04,5.14, Cisplatin 10 mg injection,J9060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.28,,,,,,,fee schedule,3.04,5.14, Cisplatin 10 mg injection,J9060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.14,,,,,,,fee schedule,3.04,5.14, "Inj, amivantamab-vmjw",J9061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.57,,,,,,,fee schedule,22.63,50.56, "Inj, amivantamab-vmjw",J9061,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.57,,,,,,,fee schedule,22.63,50.56, "Inj, amivantamab-vmjw",J9061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.13,,,,,,,fee schedule,22.63,50.56, "Inj, amivantamab-vmjw",J9061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.56,,,,,,,fee schedule,22.63,50.56, "Inj, amivantamab-vmjw",J9061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.54,,,,,,,fee schedule,22.63,50.56,APC "Inj, amivantamab-vmjw",J9061,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23.76,,,,,,,fee schedule,22.63,50.56,APC "Inj, amivantamab-vmjw",J9061,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.63,,,,,,,fee schedule,22.63,50.56,APC "Inj, elahere, 1 mg",J9063,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108.21,,,,,,,fee schedule,71.13,155.87, "Inj, elahere, 1 mg",J9063,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,108.21,,,,,,,fee schedule,71.13,155.87, "Inj, elahere, 1 mg",J9063,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129.88,,,,,,,fee schedule,71.13,155.87, "Inj, elahere, 1 mg",J9063,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.87,,,,,,,fee schedule,71.13,155.87, "Inj, elahere, 1 mg",J9063,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.97,,,,,,,fee schedule,71.13,155.87,APC "Inj, elahere, 1 mg",J9063,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,74.68,,,,,,,fee schedule,71.13,155.87,APC "Inj, elahere, 1 mg",J9063,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,71.13,,,,,,,fee schedule,71.13,155.87,APC Inj cladribine per 1 mg,J9065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.15,,,,,,,fee schedule,8.73,23.96, Inj cladribine per 1 mg,J9065,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.15,,,,,,,fee schedule,8.73,23.96, Inj cladribine per 1 mg,J9065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.96,,,,,,,fee schedule,8.73,23.96, Inj cladribine per 1 mg,J9065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.96,,,,,,,fee schedule,8.73,23.96, Inj cladribine per 1 mg,J9065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.08,,,,,,,fee schedule,8.73,23.96,APC Inj cladribine per 1 mg,J9065,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.16,,,,,,,fee schedule,8.73,23.96,APC Inj cladribine per 1 mg,J9065,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.73,,,,,,,fee schedule,8.73,23.96,APC Inj cyclophosphamd auromedic,J9071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.22,,,,,,,fee schedule,0.52,1.41, Inj cyclophosphamd auromedic,J9071,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.22,,,,,,,fee schedule,0.52,1.41, Inj cyclophosphamd auromedic,J9071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.18,,,,,,,fee schedule,0.52,1.41, Inj cyclophosphamd auromedic,J9071,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.41,,,,,,,fee schedule,0.52,1.41, Inj cyclophosphamd auromedic,J9071,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.54,,,,,,,fee schedule,0.52,1.41,APC Inj cyclophosphamd auromedic,J9071,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.54,,,,,,,fee schedule,0.52,1.41,APC Inj cyclophosphamd auromedic,J9071,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.52,,,,,,,fee schedule,0.52,1.41,APC Inj cyclophos dr.reddy's 5mg,J9072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,14.01,,,,,,,fee schedule,9.1,20.41, Inj cyclophos dr.reddy's 5mg,J9072,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,14.01,,,,,,,fee schedule,9.1,20.41, Inj cyclophos dr.reddy's 5mg,J9072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.01,,,,,,,fee schedule,9.1,20.41, Inj cyclophos dr.reddy's 5mg,J9072,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.41,,,,,,,fee schedule,9.1,20.41, Inj cyclophos dr.reddy's 5mg,J9072,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.47,,,,,,,fee schedule,9.1,20.41,APC Inj cyclophos dr.reddy's 5mg,J9072,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.56,,,,,,,fee schedule,9.1,20.41,APC Inj cyclophos dr.reddy's 5mg,J9072,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.1,,,,,,,fee schedule,9.1,20.41,APC Inj cyclophosphamd (ingenus),J9073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.8,,,,,,,fee schedule,0.5,1.8, Inj cyclophosphamd (ingenus),J9073,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.8,,,,,,,fee schedule,0.5,1.8, Inj cyclophosphamd (ingenus),J9073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.46,,,,,,,fee schedule,0.5,1.8, Inj cyclophosphamd (ingenus),J9073,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.75,,,,,,,fee schedule,0.5,1.8, Inj cyclophosphamd (ingenus),J9073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.52,,,,,,,fee schedule,0.5,1.8,APC Inj cyclophosphamd (ingenus),J9073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.53,,,,,,,fee schedule,0.5,1.8,APC Inj cyclophosphamd (ingenus),J9073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.5,,,,,,,fee schedule,0.5,1.8,APC "Inj, cyclophosphamd, sandoz",J9074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.55,,,,,,,fee schedule,3.65,8.84, "Inj, cyclophosphamd, sandoz",J9074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.55,,,,,,,fee schedule,3.65,8.84, "Inj, cyclophosphamd, sandoz",J9074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.36,,,,,,,fee schedule,3.65,8.84, "Inj, cyclophosphamd, sandoz",J9074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.84,,,,,,,fee schedule,3.65,8.84, "Inj, cyclophosphamd, sandoz",J9074,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.8,,,,,,,fee schedule,3.65,8.84,APC "Inj, cyclophosphamd, sandoz",J9074,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.84,,,,,,,fee schedule,3.65,8.84,APC "Inj, cyclophosphamd, sandoz",J9074,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.65,,,,,,,fee schedule,3.65,8.84,APC "Inj, cyclophosphamide, nos",J9075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.97,,,,,,,fee schedule,0.77,1.08, "Inj, cyclophosphamide, nos",J9075,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.97,,,,,,,fee schedule,0.77,1.08, "Inj, cyclophosphamide, nos",J9075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.9,,,,,,,fee schedule,0.77,1.08, "Inj, cyclophosphamide, nos",J9075,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.08,,,,,,,fee schedule,0.77,1.08, "Inj, cyclophosphamide, nos",J9075,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.8,,,,,,,fee schedule,0.77,1.08,APC "Inj, cyclophosphamide, nos",J9075,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.81,,,,,,,fee schedule,0.77,1.08,APC "Inj, cyclophosphamide, nos",J9075,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.77,,,,,,,fee schedule,0.77,1.08,APC "Inj, cyclophos (baxter) 5mg",J9076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.82,,,,,,,fee schedule,3.72,11.24, "Inj, cyclophos (baxter) 5mg",J9076,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.82,,,,,,,fee schedule,3.72,11.24, "Inj, cyclophos (baxter) 5mg",J9076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.36,,,,,,,fee schedule,3.72,11.24, "Inj, cyclophos (baxter) 5mg",J9076,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.24,,,,,,,fee schedule,3.72,11.24, "Inj, cyclophos (baxter) 5mg",J9076,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.87,,,,,,,fee schedule,3.72,11.24,APC "Inj, cyclophos (baxter) 5mg",J9076,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.91,,,,,,,fee schedule,3.72,11.24,APC "Inj, cyclophos (baxter) 5mg",J9076,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.72,,,,,,,fee schedule,3.72,11.24,APC Cytarabine liposome inj,J9098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1174.42,,,,,,,fee schedule,1174.42,1409.43, Cytarabine liposome inj,J9098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1409.43,,,,,,,fee schedule,1174.42,1409.43, Cytarabine hcl 100 mg inj,J9100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.25,,,,,,,fee schedule,1.25,1.86, Cytarabine hcl 100 mg inj,J9100,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.25,,,,,,,fee schedule,1.25,1.86, Cytarabine hcl 100 mg inj,J9100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.55,,,,,,,fee schedule,1.25,1.86, Cytarabine hcl 100 mg inj,J9100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.86,,,,,,,fee schedule,1.25,1.86, Inj. calaspargase pegol-mknl,J9118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,127.5,,,,,,,fee schedule,82.08,184.08, Inj. calaspargase pegol-mknl,J9118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,127.5,,,,,,,fee schedule,82.08,184.08, Inj. calaspargase pegol-mknl,J9118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,153.39,,,,,,,fee schedule,82.08,184.08, Inj. calaspargase pegol-mknl,J9118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,184.08,,,,,,,fee schedule,82.08,184.08, Inj. calaspargase pegol-mknl,J9118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,85.36,,,,,,,fee schedule,82.08,184.08,APC Inj. calaspargase pegol-mknl,J9118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,86.18,,,,,,,fee schedule,82.08,184.08,APC Inj. calaspargase pegol-mknl,J9118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,82.08,,,,,,,fee schedule,82.08,184.08,APC "Inj., cemiplimab-rwlc, 1 mg",J9119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.67,,,,,,,fee schedule,29.76,65.7, "Inj., cemiplimab-rwlc, 1 mg",J9119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.67,,,,,,,fee schedule,29.76,65.7, "Inj., cemiplimab-rwlc, 1 mg",J9119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.74,,,,,,,fee schedule,29.76,65.7, "Inj., cemiplimab-rwlc, 1 mg",J9119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.7,,,,,,,fee schedule,29.76,65.7, "Inj., cemiplimab-rwlc, 1 mg",J9119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.95,,,,,,,fee schedule,29.76,65.7,APC "Inj., cemiplimab-rwlc, 1 mg",J9119,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.25,,,,,,,fee schedule,29.76,65.7,APC "Inj., cemiplimab-rwlc, 1 mg",J9119,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.76,,,,,,,fee schedule,29.76,65.7,APC Dactinomycin injection,J9120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,471.54,,,,,,,fee schedule,337.67,736.47, Dactinomycin injection,J9120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,471.54,,,,,,,fee schedule,337.67,736.47, Dactinomycin injection,J9120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,613.67,,,,,,,fee schedule,337.67,736.47, Dactinomycin injection,J9120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,736.47,,,,,,,fee schedule,337.67,736.47, Dactinomycin injection,J9120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,351.18,,,,,,,fee schedule,337.67,736.47,APC Dactinomycin injection,J9120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,354.55,,,,,,,fee schedule,337.67,736.47,APC Dactinomycin injection,J9120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,337.67,,,,,,,fee schedule,337.67,736.47,APC Dacarbazine 100 mg inj,J9130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.94,,,,,,,fee schedule,5.94,7.74, Dacarbazine 100 mg inj,J9130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.94,,,,,,,fee schedule,5.94,7.74, Dacarbazine 100 mg inj,J9130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.45,,,,,,,fee schedule,5.94,7.74, Dacarbazine 100 mg inj,J9130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.74,,,,,,,fee schedule,5.94,7.74, "Daratumumab, hyaluronidase",J9144,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,85.09,,,,,,,fee schedule,55.03,124.64, "Daratumumab, hyaluronidase",J9144,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,85.09,,,,,,,fee schedule,55.03,124.64, "Daratumumab, hyaluronidase",J9144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,103.86,,,,,,,fee schedule,55.03,124.64, "Daratumumab, hyaluronidase",J9144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,124.64,,,,,,,fee schedule,55.03,124.64, "Daratumumab, hyaluronidase",J9144,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,57.23,,,,,,,fee schedule,55.03,124.64,APC "Daratumumab, hyaluronidase",J9144,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,57.78,,,,,,,fee schedule,55.03,124.64,APC "Daratumumab, hyaluronidase",J9144,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,55.03,,,,,,,fee schedule,55.03,124.64,APC "Injection, daratumumab 10 mg",J9145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,108.7,,,,,,,fee schedule,70.77,160.08, "Injection, daratumumab 10 mg",J9145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,108.7,,,,,,,fee schedule,70.77,160.08, "Injection, daratumumab 10 mg",J9145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.39,,,,,,,fee schedule,70.77,160.08, "Injection, daratumumab 10 mg",J9145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,160.08,,,,,,,fee schedule,70.77,160.08, "Injection, daratumumab 10 mg",J9145,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.6,,,,,,,fee schedule,70.77,160.08,APC "Injection, daratumumab 10 mg",J9145,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,74.31,,,,,,,fee schedule,70.77,160.08,APC "Injection, daratumumab 10 mg",J9145,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.77,,,,,,,fee schedule,70.77,160.08,APC Daunorubicin injection,J9150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.76,,,,,,,fee schedule,30.76,48.67, Daunorubicin injection,J9150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.76,,,,,,,fee schedule,30.76,48.67, Daunorubicin injection,J9150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,40.56,,,,,,,fee schedule,30.76,48.67, Daunorubicin injection,J9150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,48.67,,,,,,,fee schedule,30.76,48.67, Daunorubicin citrate inj,J9151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,107.77,,,,,,,fee schedule,107.77,129.33, Daunorubicin citrate inj,J9151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,129.33,,,,,,,fee schedule,107.77,129.33, "Inj daunorubicin, cytarabine",J9153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,397.07,,,,,,,fee schedule,261.2,574.41, "Inj daunorubicin, cytarabine",J9153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,397.07,,,,,,,fee schedule,261.2,574.41, "Inj daunorubicin, cytarabine",J9153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,478.63,,,,,,,fee schedule,261.2,574.41, "Inj daunorubicin, cytarabine",J9153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,574.41,,,,,,,fee schedule,261.2,574.41, "Inj daunorubicin, cytarabine",J9153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,271.64,,,,,,,fee schedule,261.2,574.41,APC "Inj daunorubicin, cytarabine",J9153,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,274.25,,,,,,,fee schedule,261.2,574.41,APC "Inj daunorubicin, cytarabine",J9153,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,261.2,,,,,,,fee schedule,261.2,574.41,APC Degarelix injection,J9155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6.78,,,,,,,fee schedule,4.46,9.98, Degarelix injection,J9155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6.78,,,,,,,fee schedule,4.46,9.98, Degarelix injection,J9155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.32,,,,,,,fee schedule,4.46,9.98, Degarelix injection,J9155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.98,,,,,,,fee schedule,4.46,9.98, Degarelix injection,J9155,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.64,,,,,,,fee schedule,4.46,9.98,APC Degarelix injection,J9155,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.68,,,,,,,fee schedule,4.46,9.98,APC Degarelix injection,J9155,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.46,,,,,,,fee schedule,4.46,9.98,APC Docetaxel injection,J9171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.59,,,,,,,fee schedule,0.59,1.35, Docetaxel injection,J9171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.59,,,,,,,fee schedule,0.59,1.35, Docetaxel injection,J9171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.12,,,,,,,fee schedule,0.59,1.35, Docetaxel injection,J9171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.35,,,,,,,fee schedule,0.59,1.35, "Docetaxel (ingenus), 1 mg",J9172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.4,,,,,,,fee schedule,50.61,113.9, "Docetaxel (ingenus), 1 mg",J9172,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.4,,,,,,,fee schedule,50.61,113.9, "Docetaxel (ingenus), 1 mg",J9172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.91,,,,,,,fee schedule,50.61,113.9, "Docetaxel (ingenus), 1 mg",J9172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,113.9,,,,,,,fee schedule,50.61,113.9, "Docetaxel (ingenus), 1 mg",J9172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.63,,,,,,,fee schedule,50.61,113.9,APC "Docetaxel (ingenus), 1 mg",J9172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.14,,,,,,,fee schedule,50.61,113.9,APC "Docetaxel (ingenus), 1 mg",J9172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.61,,,,,,,fee schedule,50.61,113.9,APC "Inj., durvalumab, 10 mg",J9173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,132.69,,,,,,,fee schedule,86.15,190.92, "Inj., durvalumab, 10 mg",J9173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,132.69,,,,,,,fee schedule,86.15,190.92, "Inj., durvalumab, 10 mg",J9173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,159.09,,,,,,,fee schedule,86.15,190.92, "Inj., durvalumab, 10 mg",J9173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,190.92,,,,,,,fee schedule,86.15,190.92, "Inj., durvalumab, 10 mg",J9173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,89.59,,,,,,,fee schedule,86.15,190.92,APC "Inj., durvalumab, 10 mg",J9173,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,90.45,,,,,,,fee schedule,86.15,190.92,APC "Inj., durvalumab, 10 mg",J9173,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,86.15,,,,,,,fee schedule,86.15,190.92,APC "Inj, docetaxel (beizray) 1mg",J9174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.32,,,,,,,fee schedule,46.09,102.39, "Inj, docetaxel (beizray) 1mg",J9174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,102.39,,,,,,,fee schedule,46.09,102.39, "Inj, docetaxel (beizray) 1mg",J9174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,47.94,,,,,,,fee schedule,46.09,102.39,APC "Inj, docetaxel (beizray) 1mg",J9174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48.4,,,,,,,fee schedule,46.09,102.39,APC "Inj, docetaxel (beizray) 1mg",J9174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,46.09,,,,,,,fee schedule,46.09,102.39,APC Elliotts b solution per ml,J9175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.44,,,,,,,fee schedule,19.44,23.33, Elliotts b solution per ml,J9175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.33,,,,,,,fee schedule,19.44,23.33, "Injection, elotuzumab, 1mg",J9176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.26,,,,,,,fee schedule,8.04,17.7, "Injection, elotuzumab, 1mg",J9176,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.26,,,,,,,fee schedule,8.04,17.7, "Injection, elotuzumab, 1mg",J9176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.75,,,,,,,fee schedule,8.04,17.7, "Injection, elotuzumab, 1mg",J9176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.7,,,,,,,fee schedule,8.04,17.7, "Injection, elotuzumab, 1mg",J9176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.36,,,,,,,fee schedule,8.04,17.7,APC "Injection, elotuzumab, 1mg",J9176,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.44,,,,,,,fee schedule,8.04,17.7,APC "Injection, elotuzumab, 1mg",J9176,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.04,,,,,,,fee schedule,8.04,17.7,APC Inj enfort vedo-ejfv 0.25mg,J9177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.07,,,,,,,fee schedule,36.71,82.41, Inj enfort vedo-ejfv 0.25mg,J9177,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.07,,,,,,,fee schedule,36.71,82.41, Inj enfort vedo-ejfv 0.25mg,J9177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.67,,,,,,,fee schedule,36.71,82.41, Inj enfort vedo-ejfv 0.25mg,J9177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.41,,,,,,,fee schedule,36.71,82.41, Inj enfort vedo-ejfv 0.25mg,J9177,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.18,,,,,,,fee schedule,36.71,82.41,APC Inj enfort vedo-ejfv 0.25mg,J9177,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.54,,,,,,,fee schedule,36.71,82.41,APC Inj enfort vedo-ejfv 0.25mg,J9177,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.71,,,,,,,fee schedule,36.71,82.41,APC "Inj, epirubicin hcl, 2 mg",J9178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.48,,,,,,,fee schedule,2.48,4.73, "Inj, epirubicin hcl, 2 mg",J9178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.48,,,,,,,fee schedule,2.48,4.73, "Inj, epirubicin hcl, 2 mg",J9178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.94,,,,,,,fee schedule,2.48,4.73, "Inj, epirubicin hcl, 2 mg",J9178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.73,,,,,,,fee schedule,2.48,4.73, Eribulin mesylate injection,J9179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,162.79,,,,,,,fee schedule,76.76,200.39, Eribulin mesylate injection,J9179,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,162.79,,,,,,,fee schedule,76.76,200.39, Eribulin mesylate injection,J9179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,166.98,,,,,,,fee schedule,76.76,200.39, Eribulin mesylate injection,J9179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.39,,,,,,,fee schedule,76.76,200.39, Eribulin mesylate injection,J9179,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79.83,,,,,,,fee schedule,76.76,200.39,APC Eribulin mesylate injection,J9179,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80.59,,,,,,,fee schedule,76.76,200.39,APC Eribulin mesylate injection,J9179,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,76.76,,,,,,,fee schedule,76.76,200.39,APC Etoposide injection,J9181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.03,,,,,,,fee schedule,1.76,2.11, Etoposide injection,J9181,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.03,,,,,,,fee schedule,1.76,2.11, Etoposide injection,J9181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.76,,,,,,,fee schedule,1.76,2.11, Etoposide injection,J9181,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.11,,,,,,,fee schedule,1.76,2.11, Fludarabine phosphate inj,J9185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.52,,,,,,,fee schedule,111.52,152.97, Fludarabine phosphate inj,J9185,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.52,,,,,,,fee schedule,111.52,152.97, Fludarabine phosphate inj,J9185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,127.47,,,,,,,fee schedule,111.52,152.97, Fludarabine phosphate inj,J9185,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,152.97,,,,,,,fee schedule,111.52,152.97, Fluorouracil injection,J9190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.67,,,,,,,fee schedule,2.67,4.46, Fluorouracil injection,J9190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.67,,,,,,,fee schedule,2.67,4.46, Fluorouracil injection,J9190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.72,,,,,,,fee schedule,2.67,4.46, Fluorouracil injection,J9190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.46,,,,,,,fee schedule,2.67,4.46, Inj gemcitabine hcl (accord),J9196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.23,,,,,,,fee schedule,8.23,11.87, Inj gemcitabine hcl (accord),J9196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.23,,,,,,,fee schedule,8.23,11.87, Inj gemcitabine hcl (accord),J9196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.89,,,,,,,fee schedule,8.23,11.87, Inj gemcitabine hcl (accord),J9196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.87,,,,,,,fee schedule,8.23,11.87, "Inj. infugem, 100 mg",J9198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.44,,,,,,,fee schedule,72.44,86.94, "Inj. infugem, 100 mg",J9198,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,86.94,,,,,,,fee schedule,72.44,86.94, Floxuridine injection,J9200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6421.85,,,,,,,fee schedule,4250.97,9259.15, Floxuridine injection,J9200,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6421.85,,,,,,,fee schedule,4250.97,9259.15, Floxuridine injection,J9200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7715.27,,,,,,,fee schedule,4250.97,9259.15, Floxuridine injection,J9200,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9259.15,,,,,,,fee schedule,4250.97,9259.15, Floxuridine injection,J9200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4421.01,,,,,,,fee schedule,4250.97,9259.15,APC Floxuridine injection,J9200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4463.52,,,,,,,fee schedule,4250.97,9259.15,APC Floxuridine injection,J9200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4250.97,,,,,,,fee schedule,4250.97,9259.15,APC Gemcitabine hcl injection,J9201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4.6,,,,,,,fee schedule,4.6,7.02, Gemcitabine hcl injection,J9201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4.6,,,,,,,fee schedule,4.6,7.02, Gemcitabine hcl injection,J9201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.85,,,,,,,fee schedule,4.6,7.02, Gemcitabine hcl injection,J9201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.02,,,,,,,fee schedule,4.6,7.02, Goserelin acetate implant,J9202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1142.79,,,,,,,fee schedule,1142.79,1645.62, Goserelin acetate implant,J9202,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1142.79,,,,,,,fee schedule,1142.79,1645.62, Goserelin acetate implant,J9202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1371.23,,,,,,,fee schedule,1142.79,1645.62, Goserelin acetate implant,J9202,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1645.62,,,,,,,fee schedule,1142.79,1645.62, Gemtuzumab ozogamicin 0.1 mg,J9203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,368.31,,,,,,,fee schedule,240.16,530.74, Gemtuzumab ozogamicin 0.1 mg,J9203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,368.31,,,,,,,fee schedule,240.16,530.74, Gemtuzumab ozogamicin 0.1 mg,J9203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,442.24,,,,,,,fee schedule,240.16,530.74, Gemtuzumab ozogamicin 0.1 mg,J9203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,530.74,,,,,,,fee schedule,240.16,530.74, Gemtuzumab ozogamicin 0.1 mg,J9203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,249.77,,,,,,,fee schedule,240.16,530.74,APC Gemtuzumab ozogamicin 0.1 mg,J9203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,252.17,,,,,,,fee schedule,240.16,530.74,APC Gemtuzumab ozogamicin 0.1 mg,J9203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,240.16,,,,,,,fee schedule,240.16,530.74,APC "Inj mogamulizumab-kpkc, 1 mg",J9204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,386.81,,,,,,,fee schedule,253.47,557.39, "Inj mogamulizumab-kpkc, 1 mg",J9204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,386.81,,,,,,,fee schedule,253.47,557.39, "Inj mogamulizumab-kpkc, 1 mg",J9204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,464.45,,,,,,,fee schedule,253.47,557.39, "Inj mogamulizumab-kpkc, 1 mg",J9204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,557.39,,,,,,,fee schedule,253.47,557.39, "Inj mogamulizumab-kpkc, 1 mg",J9204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,263.61,,,,,,,fee schedule,253.47,557.39,APC "Inj mogamulizumab-kpkc, 1 mg",J9204,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,266.14,,,,,,,fee schedule,253.47,557.39,APC "Inj mogamulizumab-kpkc, 1 mg",J9204,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,253.47,,,,,,,fee schedule,253.47,557.39,APC Inj irinotecan liposome 1 mg,J9205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.57,,,,,,,fee schedule,66.37,148.04, Inj irinotecan liposome 1 mg,J9205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.57,,,,,,,fee schedule,66.37,148.04, Inj irinotecan liposome 1 mg,J9205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,123.35,,,,,,,fee schedule,66.37,148.04, Inj irinotecan liposome 1 mg,J9205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,148.04,,,,,,,fee schedule,66.37,148.04, Inj irinotecan liposome 1 mg,J9205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,69.03,,,,,,,fee schedule,66.37,148.04,APC Inj irinotecan liposome 1 mg,J9205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,66.37,148.04,APC Inj irinotecan liposome 1 mg,J9205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,66.37,,,,,,,fee schedule,66.37,148.04,APC Irinotecan injection,J9206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.18,,,,,,,fee schedule,2.18,3.93, Irinotecan injection,J9206,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.18,,,,,,,fee schedule,2.18,3.93, Irinotecan injection,J9206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.27,,,,,,,fee schedule,2.18,3.93, Irinotecan injection,J9206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.93,,,,,,,fee schedule,2.18,3.93, Ixabepilone injection,J9207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,215.85,,,,,,,fee schedule,139.75,312.25, Ixabepilone injection,J9207,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,215.85,,,,,,,fee schedule,139.75,312.25, Ixabepilone injection,J9207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,260.18,,,,,,,fee schedule,139.75,312.25, Ixabepilone injection,J9207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,312.25,,,,,,,fee schedule,139.75,312.25, Ixabepilone injection,J9207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,145.34,,,,,,,fee schedule,139.75,312.25,APC Ixabepilone injection,J9207,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,146.74,,,,,,,fee schedule,139.75,312.25,APC Ixabepilone injection,J9207,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,139.75,,,,,,,fee schedule,139.75,312.25,APC Ifosfamide injection,J9208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.58,,,,,,,fee schedule,36.58,56.52, Ifosfamide injection,J9208,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.58,,,,,,,fee schedule,36.58,56.52, Ifosfamide injection,J9208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,47.1,,,,,,,fee schedule,36.58,56.52, Ifosfamide injection,J9208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.52,,,,,,,fee schedule,36.58,56.52, Mesna injection,J9209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.08,,,,,,,fee schedule,2.08,4.17, Mesna injection,J9209,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.08,,,,,,,fee schedule,2.08,4.17, Mesna injection,J9209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.48,,,,,,,fee schedule,2.08,4.17, Mesna injection,J9209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.17,,,,,,,fee schedule,2.08,4.17, "Inj., emapalumab-lzsg, 1 mg",J9210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,594.07,,,,,,,fee schedule,384.14,863.22, "Inj., emapalumab-lzsg, 1 mg",J9210,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,594.07,,,,,,,fee schedule,384.14,863.22, "Inj., emapalumab-lzsg, 1 mg",J9210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,719.28,,,,,,,fee schedule,384.14,863.22, "Inj., emapalumab-lzsg, 1 mg",J9210,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,863.22,,,,,,,fee schedule,384.14,863.22, "Inj., emapalumab-lzsg, 1 mg",J9210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,399.5,,,,,,,fee schedule,384.14,863.22,APC "Inj., emapalumab-lzsg, 1 mg",J9210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,403.34,,,,,,,fee schedule,384.14,863.22,APC "Inj., emapalumab-lzsg, 1 mg",J9210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,384.14,,,,,,,fee schedule,384.14,863.22,APC Idarubicin hcl injection,J9211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.67,,,,,,,fee schedule,57.67,82.25, Idarubicin hcl injection,J9211,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.67,,,,,,,fee schedule,57.67,82.25, Idarubicin hcl injection,J9211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.54,,,,,,,fee schedule,57.67,82.25, Idarubicin hcl injection,J9211,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.25,,,,,,,fee schedule,57.67,82.25, Interferon alfacon-1 inj,J9212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.24,,,,,,,fee schedule,12.24,14.69, Interferon alfacon-1 inj,J9212,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14.69,,,,,,,fee schedule,12.24,14.69, Interferon alfa-2a inj,J9213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.96,,,,,,,fee schedule,53.96,64.76, Interferon alfa-2a inj,J9213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.76,,,,,,,fee schedule,53.96,64.76, Interferon alfa-2b inj,J9214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.59,,,,,,,fee schedule,58.59,70.32, Interferon alfa-2b inj,J9214,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,70.32,,,,,,,fee schedule,58.59,70.32, Interferon alfa-n3 inj,J9215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.42,,,,,,,fee schedule,57.42,68.9, Interferon alfa-n3 inj,J9215,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,68.9,,,,,,,fee schedule,57.42,68.9, Interferon gamma 1-b inj,J9216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16127.3,,,,,,,fee schedule,16127.3,19354.49, Interferon gamma 1-b inj,J9216,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19354.49,,,,,,,fee schedule,16127.3,19354.49, Leuprolide acetate suspnsion,J9217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,241.92,,,,,,,fee schedule,176.2,395.78, Leuprolide acetate suspnsion,J9217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,241.92,,,,,,,fee schedule,176.2,395.78, Leuprolide acetate suspnsion,J9217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,329.79,,,,,,,fee schedule,176.2,395.78, Leuprolide acetate suspnsion,J9217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,395.78,,,,,,,fee schedule,176.2,395.78, Leuprolide acetate suspnsion,J9217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,183.25,,,,,,,fee schedule,176.2,395.78,APC Leuprolide acetate suspnsion,J9217,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,185.01,,,,,,,fee schedule,176.2,395.78,APC Leuprolide acetate suspnsion,J9217,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,176.2,,,,,,,fee schedule,176.2,395.78,APC Leuprolide acetate injeciton,J9218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,96.1,,,,,,,fee schedule,96.1,115.34, Leuprolide acetate injeciton,J9218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,115.34,,,,,,,fee schedule,96.1,115.34, Leuprolide acetate implant,J9219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9008.24,,,,,,,fee schedule,9008.24,10810.86, Leuprolide acetate implant,J9219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10810.86,,,,,,,fee schedule,9008.24,10810.86, Indigotindisulfonate sod 1mg,J9220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.06,,,,,,,fee schedule,9.3,22.88, Indigotindisulfonate sod 1mg,J9220,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.88,,,,,,,fee schedule,9.3,22.88, Indigotindisulfonate sod 1mg,J9220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.67,,,,,,,fee schedule,9.3,22.88,APC Indigotindisulfonate sod 1mg,J9220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.77,,,,,,,fee schedule,9.3,22.88,APC Indigotindisulfonate sod 1mg,J9220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.3,,,,,,,fee schedule,9.3,22.88,APC "Inj. lurbinectedin, 0.1 mg",J9223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,320.86,,,,,,,fee schedule,212.1,464.59, "Inj. lurbinectedin, 0.1 mg",J9223,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,320.86,,,,,,,fee schedule,212.1,464.59, "Inj. lurbinectedin, 0.1 mg",J9223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,387.13,,,,,,,fee schedule,212.1,464.59, "Inj. lurbinectedin, 0.1 mg",J9223,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,464.59,,,,,,,fee schedule,212.1,464.59, "Inj. lurbinectedin, 0.1 mg",J9223,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,220.58,,,,,,,fee schedule,212.1,464.59,APC "Inj. lurbinectedin, 0.1 mg",J9223,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,222.7,,,,,,,fee schedule,212.1,464.59,APC "Inj. lurbinectedin, 0.1 mg",J9223,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,212.1,,,,,,,fee schedule,212.1,464.59,APC Vantas implant,J9225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9291.43,,,,,,,fee schedule,9291.43,11150.72, Vantas implant,J9225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11150.72,,,,,,,fee schedule,9291.43,11150.72, Supprelin LA implant,J9226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70919.48,,,,,,,fee schedule,41173.43,100981.32, Supprelin LA implant,J9226,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70919.48,,,,,,,fee schedule,41173.43,100981.32, Supprelin LA implant,J9226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84143.59,,,,,,,fee schedule,41173.43,100981.32, Supprelin LA implant,J9226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100981.32,,,,,,,fee schedule,41173.43,100981.32, Supprelin LA implant,J9226,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42820.36,,,,,,,fee schedule,41173.43,100981.32,APC Supprelin LA implant,J9226,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43232.1,,,,,,,fee schedule,41173.43,100981.32,APC Supprelin LA implant,J9226,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41173.43,,,,,,,fee schedule,41173.43,100981.32,APC Inj. isatuximab-irfc 10 mg,J9227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.98,,,,,,,fee schedule,83.58,183.7, Inj. isatuximab-irfc 10 mg,J9227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.98,,,,,,,fee schedule,83.58,183.7, Inj. isatuximab-irfc 10 mg,J9227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,153.07,,,,,,,fee schedule,83.58,183.7, Inj. isatuximab-irfc 10 mg,J9227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,183.7,,,,,,,fee schedule,83.58,183.7, Inj. isatuximab-irfc 10 mg,J9227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,86.92,,,,,,,fee schedule,83.58,183.7,APC Inj. isatuximab-irfc 10 mg,J9227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,87.76,,,,,,,fee schedule,83.58,183.7,APC Inj. isatuximab-irfc 10 mg,J9227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,83.58,,,,,,,fee schedule,83.58,183.7,APC Ipilimumab injection,J9228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,285.5,,,,,,,fee schedule,187.17,411.55, Ipilimumab injection,J9228,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,285.5,,,,,,,fee schedule,187.17,411.55, Ipilimumab injection,J9228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,342.92,,,,,,,fee schedule,187.17,411.55, Ipilimumab injection,J9228,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,411.55,,,,,,,fee schedule,187.17,411.55, Ipilimumab injection,J9228,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,194.65,,,,,,,fee schedule,187.17,411.55,APC Ipilimumab injection,J9228,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,196.52,,,,,,,fee schedule,187.17,411.55,APC Ipilimumab injection,J9228,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,187.17,,,,,,,fee schedule,187.17,411.55,APC Inj inotuzumab ozogam 0.1 mg,J9229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4199.79,,,,,,,fee schedule,2816.77,6051.73, Inj inotuzumab ozogam 0.1 mg,J9229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4199.79,,,,,,,fee schedule,2816.77,6051.73, Inj inotuzumab ozogam 0.1 mg,J9229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5042.66,,,,,,,fee schedule,2816.77,6051.73, Inj inotuzumab ozogam 0.1 mg,J9229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6051.73,,,,,,,fee schedule,2816.77,6051.73, Inj inotuzumab ozogam 0.1 mg,J9229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2929.44,,,,,,,fee schedule,2816.77,6051.73,APC Inj inotuzumab ozogam 0.1 mg,J9229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2957.61,,,,,,,fee schedule,2816.77,6051.73,APC Inj inotuzumab ozogam 0.1 mg,J9229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2816.77,,,,,,,fee schedule,2816.77,6051.73,APC Mechlorethamine hcl inj,J9230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,601.29,,,,,,,fee schedule,601.29,721.62, Mechlorethamine hcl inj,J9230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,721.62,,,,,,,fee schedule,601.29,721.62, Inj melphalan hydrochl 50 MG,J9245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,168.17,,,,,,,fee schedule,120.67,215.1, Inj melphalan hydrochl 50 MG,J9245,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,168.17,,,,,,,fee schedule,120.67,215.1, Inj melphalan hydrochl 50 MG,J9245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,179.24,,,,,,,fee schedule,120.67,215.1, Inj melphalan hydrochl 50 MG,J9245,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,215.1,,,,,,,fee schedule,120.67,215.1, Inj melphalan hydrochl 50 MG,J9245,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.49,,,,,,,fee schedule,120.67,215.1,APC Inj melphalan hydrochl 50 MG,J9245,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.7,,,,,,,fee schedule,120.67,215.1,APC Inj melphalan hydrochl 50 MG,J9245,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.67,,,,,,,fee schedule,120.67,215.1,APC "Inj., evomela, 1 mg",J9246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,27.04,,,,,,,fee schedule,19.43,41.5, "Inj., evomela, 1 mg",J9246,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.04,,,,,,,fee schedule,19.43,41.5, "Inj., evomela, 1 mg",J9246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.58,,,,,,,fee schedule,19.43,41.5, "Inj., evomela, 1 mg",J9246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.5,,,,,,,fee schedule,19.43,41.5, "Inj., evomela, 1 mg",J9246,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.21,,,,,,,fee schedule,19.43,41.5,APC "Inj., evomela, 1 mg",J9246,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20.4,,,,,,,fee schedule,19.43,41.5,APC "Inj., evomela, 1 mg",J9246,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19.43,,,,,,,fee schedule,19.43,41.5,APC Inj melphalan (hepzato) 1 mg,J9248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1226.28,,,,,,,fee schedule,795,1783.19, Inj melphalan (hepzato) 1 mg,J9248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1226.28,,,,,,,fee schedule,795,1783.19, Inj melphalan (hepzato) 1 mg,J9248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1485.86,,,,,,,fee schedule,795,1783.19, Inj melphalan (hepzato) 1 mg,J9248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1783.19,,,,,,,fee schedule,795,1783.19, Inj melphalan (hepzato) 1 mg,J9248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,826.8,,,,,,,fee schedule,795,1783.19,APC Inj melphalan (hepzato) 1 mg,J9248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,834.75,,,,,,,fee schedule,795,1783.19,APC Inj melphalan (hepzato) 1 mg,J9248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,795,,,,,,,fee schedule,795,1783.19,APC "Inj, melphalan (apotex) 1 mg",J9249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.49,,,,,,,fee schedule,64.78,139.81, "Inj, melphalan (apotex) 1 mg",J9249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,139.81,,,,,,,fee schedule,64.78,139.81, "Inj, melphalan (apotex) 1 mg",J9249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,67.37,,,,,,,fee schedule,64.78,139.81,APC "Inj, melphalan (apotex) 1 mg",J9249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.02,,,,,,,fee schedule,64.78,139.81,APC "Inj, melphalan (apotex) 1 mg",J9249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.78,,,,,,,fee schedule,64.78,139.81,APC Methotrexate sodium inj,J9260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.51,,,,,,,fee schedule,3.51,6.33, Methotrexate sodium inj,J9260,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.51,,,,,,,fee schedule,3.51,6.33, Methotrexate sodium inj,J9260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.27,,,,,,,fee schedule,3.51,6.33, Methotrexate sodium inj,J9260,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.33,,,,,,,fee schedule,3.51,6.33, Nelarabine injection,J9261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,98.65,,,,,,,fee schedule,52.71,179.13, Nelarabine injection,J9261,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98.65,,,,,,,fee schedule,52.71,179.13, Nelarabine injection,J9261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,149.26,,,,,,,fee schedule,52.71,179.13, Nelarabine injection,J9261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,179.13,,,,,,,fee schedule,52.71,179.13, Nelarabine injection,J9261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,54.82,,,,,,,fee schedule,52.71,179.13,APC Nelarabine injection,J9261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,55.34,,,,,,,fee schedule,52.71,179.13,APC Nelarabine injection,J9261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,52.71,,,,,,,fee schedule,52.71,179.13,APC "Inj, omacetaxine mep, 0.01mg",J9262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.25,,,,,,,fee schedule,7.25,8.7, "Inj, omacetaxine mep, 0.01mg",J9262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8.7,,,,,,,fee schedule,7.25,8.7, Oxaliplatin,J9263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.15,,,,,,,fee schedule,0.15,0.18, Oxaliplatin,J9263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.15,,,,,,,fee schedule,0.15,0.18, Oxaliplatin,J9263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.15,,,,,,,fee schedule,0.15,0.18, Oxaliplatin,J9263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.18,,,,,,,fee schedule,0.15,0.18, Paclitaxel protein bound,J9264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,18.88,,,,,,,fee schedule,6.02,23.64, Paclitaxel protein bound,J9264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.88,,,,,,,fee schedule,6.02,23.64, Paclitaxel protein bound,J9264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.7,,,,,,,fee schedule,6.02,23.64, Paclitaxel protein bound,J9264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.64,,,,,,,fee schedule,6.02,23.64, Paclitaxel protein bound,J9264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.26,,,,,,,fee schedule,6.02,23.64,APC Paclitaxel protein bound,J9264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.32,,,,,,,fee schedule,6.02,23.64,APC Paclitaxel protein bound,J9264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.02,,,,,,,fee schedule,6.02,23.64,APC Pegaspargase injection,J9266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44245,,,,,,,fee schedule,28424.06,63755.17, Pegaspargase injection,J9266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44245,,,,,,,fee schedule,28424.06,63755.17, Pegaspargase injection,J9266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53124.57,,,,,,,fee schedule,28424.06,63755.17, Pegaspargase injection,J9266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63755.17,,,,,,,fee schedule,28424.06,63755.17, Pegaspargase injection,J9266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29561.02,,,,,,,fee schedule,28424.06,63755.17,APC Pegaspargase injection,J9266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29845.26,,,,,,,fee schedule,28424.06,63755.17,APC Pegaspargase injection,J9266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28424.06,,,,,,,fee schedule,28424.06,63755.17,APC Paclitaxel injection,J9267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.17,,,,,,,fee schedule,0.17,0.31, Paclitaxel injection,J9267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.17,,,,,,,fee schedule,0.17,0.31, Paclitaxel injection,J9267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.26,,,,,,,fee schedule,0.17,0.31, Paclitaxel injection,J9267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.31,,,,,,,fee schedule,0.17,0.31, Pentostatin injection,J9268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3959.84,,,,,,,fee schedule,2626.33,5850.1, Pentostatin injection,J9268,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3959.84,,,,,,,fee schedule,2626.33,5850.1, Pentostatin injection,J9268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4874.65,,,,,,,fee schedule,2626.33,5850.1, Pentostatin injection,J9268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5850.1,,,,,,,fee schedule,2626.33,5850.1, Pentostatin injection,J9268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2731.38,,,,,,,fee schedule,2626.33,5850.1,APC Pentostatin injection,J9268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2757.64,,,,,,,fee schedule,2626.33,5850.1,APC Pentostatin injection,J9268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2626.33,,,,,,,fee schedule,2626.33,5850.1,APC Inj. tagraxofusp-erzs 10 mcg,J9269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,542.65,,,,,,,fee schedule,357.28,800.59, Inj. tagraxofusp-erzs 10 mcg,J9269,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,542.65,,,,,,,fee schedule,357.28,800.59, Inj. tagraxofusp-erzs 10 mcg,J9269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,667.1,,,,,,,fee schedule,357.28,800.59, Inj. tagraxofusp-erzs 10 mcg,J9269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,800.59,,,,,,,fee schedule,357.28,800.59, Inj. tagraxofusp-erzs 10 mcg,J9269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,371.57,,,,,,,fee schedule,357.28,800.59,APC Inj. tagraxofusp-erzs 10 mcg,J9269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,375.14,,,,,,,fee schedule,357.28,800.59,APC Inj. tagraxofusp-erzs 10 mcg,J9269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,357.28,,,,,,,fee schedule,357.28,800.59,APC Inj pembrolizumab,J9271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,91.16,,,,,,,fee schedule,61.25,135.23, Inj pembrolizumab,J9271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.16,,,,,,,fee schedule,61.25,135.23, Inj pembrolizumab,J9271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,112.68,,,,,,,fee schedule,61.25,135.23, Inj pembrolizumab,J9271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,135.23,,,,,,,fee schedule,61.25,135.23, Inj pembrolizumab,J9271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,63.7,,,,,,,fee schedule,61.25,135.23,APC Inj pembrolizumab,J9271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.31,,,,,,,fee schedule,61.25,135.23,APC Inj pembrolizumab,J9271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.25,,,,,,,fee schedule,61.25,135.23,APC "Inj, dostarlimab-gxly, 10 mg",J9272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,379.53,,,,,,,fee schedule,247.08,546.64, "Inj, dostarlimab-gxly, 10 mg",J9272,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,379.53,,,,,,,fee schedule,247.08,546.64, "Inj, dostarlimab-gxly, 10 mg",J9272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,455.49,,,,,,,fee schedule,247.08,546.64, "Inj, dostarlimab-gxly, 10 mg",J9272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,546.64,,,,,,,fee schedule,247.08,546.64, "Inj, dostarlimab-gxly, 10 mg",J9272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,256.97,,,,,,,fee schedule,247.08,546.64,APC "Inj, dostarlimab-gxly, 10 mg",J9272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,259.44,,,,,,,fee schedule,247.08,546.64,APC "Inj, dostarlimab-gxly, 10 mg",J9272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,247.08,,,,,,,fee schedule,247.08,546.64,APC "Inj tisotu vedotin-tftv, 1mg",J9273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,293.65,,,,,,,fee schedule,196.12,423.39, "Inj tisotu vedotin-tftv, 1mg",J9273,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,293.65,,,,,,,fee schedule,196.12,423.39, "Inj tisotu vedotin-tftv, 1mg",J9273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,352.79,,,,,,,fee schedule,196.12,423.39, "Inj tisotu vedotin-tftv, 1mg",J9273,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,423.39,,,,,,,fee schedule,196.12,423.39, "Inj tisotu vedotin-tftv, 1mg",J9273,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,203.97,,,,,,,fee schedule,196.12,423.39,APC "Inj tisotu vedotin-tftv, 1mg",J9273,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,205.93,,,,,,,fee schedule,196.12,423.39,APC "Inj tisotu vedotin-tftv, 1mg",J9273,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,196.12,,,,,,,fee schedule,196.12,423.39,APC "Inj, tebentafusp-tebn, 1 mcg",J9274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,337.92,,,,,,,fee schedule,222.49,486.93, "Inj, tebentafusp-tebn, 1 mcg",J9274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,337.92,,,,,,,fee schedule,222.49,486.93, "Inj, tebentafusp-tebn, 1 mcg",J9274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,405.74,,,,,,,fee schedule,222.49,486.93, "Inj, tebentafusp-tebn, 1 mcg",J9274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,486.93,,,,,,,fee schedule,222.49,486.93, "Inj, tebentafusp-tebn, 1 mcg",J9274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,231.39,,,,,,,fee schedule,222.49,486.93,APC "Inj, tebentafusp-tebn, 1 mcg",J9274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,233.62,,,,,,,fee schedule,222.49,486.93,APC "Inj, tebentafusp-tebn, 1 mcg",J9274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,222.49,,,,,,,fee schedule,222.49,486.93,APC "Inj cosibelimab-ipdl, 2 mg",J9275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.23,,,,,,,fee schedule,22.92,49.48, "Inj cosibelimab-ipdl, 2 mg",J9275,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,49.48,,,,,,,fee schedule,22.92,49.48, "Inj cosibelimab-ipdl, 2 mg",J9275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23.84,,,,,,,fee schedule,22.92,49.48,APC "Inj cosibelimab-ipdl, 2 mg",J9275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.07,,,,,,,fee schedule,22.92,49.48,APC "Inj cosibelimab-ipdl, 2 mg",J9275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22.92,,,,,,,fee schedule,22.92,49.48,APC "Inj zanidatamab-hrii, 2 mg",J9276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,39.04,,,,,,,fee schedule,25,56.19, "Inj zanidatamab-hrii, 2 mg",J9276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,39.04,,,,,,,fee schedule,25,56.19, "Inj zanidatamab-hrii, 2 mg",J9276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.82,,,,,,,fee schedule,25,56.19, "Inj zanidatamab-hrii, 2 mg",J9276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.19,,,,,,,fee schedule,25,56.19, "Inj zanidatamab-hrii, 2 mg",J9276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26,,,,,,,fee schedule,25,56.19,APC "Inj zanidatamab-hrii, 2 mg",J9276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.25,,,,,,,fee schedule,25,56.19,APC "Inj zanidatamab-hrii, 2 mg",J9276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25,,,,,,,fee schedule,25,56.19,APC Mitomycin injection,J9280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.01,,,,,,,fee schedule,28.46,45.65, Mitomycin injection,J9280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.01,,,,,,,fee schedule,28.46,45.65, Mitomycin injection,J9280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.03,,,,,,,fee schedule,28.46,45.65, Mitomycin injection,J9280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.65,,,,,,,fee schedule,28.46,45.65, Mitomycin injection,J9280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.6,,,,,,,fee schedule,28.46,45.65,APC Mitomycin injection,J9280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.88,,,,,,,fee schedule,28.46,45.65,APC Mitomycin injection,J9280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.46,,,,,,,fee schedule,28.46,45.65,APC Mitomycin instillation,J9281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,494.09,,,,,,,fee schedule,323.17,714.46, Mitomycin instillation,J9281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,494.09,,,,,,,fee schedule,323.17,714.46, Mitomycin instillation,J9281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,595.33,,,,,,,fee schedule,323.17,714.46, Mitomycin instillation,J9281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,714.46,,,,,,,fee schedule,323.17,714.46, Mitomycin instillation,J9281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,336.1,,,,,,,fee schedule,323.17,714.46,APC Mitomycin instillation,J9281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,339.33,,,,,,,fee schedule,323.17,714.46,APC Mitomycin instillation,J9281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,323.17,,,,,,,fee schedule,323.17,714.46,APC "Inj, olaratumab, 10 mg",J9285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,97.32,,,,,,,fee schedule,97.32,116.79, "Inj, olaratumab, 10 mg",J9285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,116.79,,,,,,,fee schedule,97.32,116.79, "Inj glofitamab gxbm, 2.5 mg",J9286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4312.67,,,,,,,fee schedule,2840.68,6208.35, "Inj glofitamab gxbm, 2.5 mg",J9286,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4312.67,,,,,,,fee schedule,2840.68,6208.35, "Inj glofitamab gxbm, 2.5 mg",J9286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5173.17,,,,,,,fee schedule,2840.68,6208.35, "Inj glofitamab gxbm, 2.5 mg",J9286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6208.35,,,,,,,fee schedule,2840.68,6208.35, "Inj glofitamab gxbm, 2.5 mg",J9286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2954.3,,,,,,,fee schedule,2840.68,6208.35,APC "Inj glofitamab gxbm, 2.5 mg",J9286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2982.71,,,,,,,fee schedule,2840.68,6208.35,APC "Inj glofitamab gxbm, 2.5 mg",J9286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2840.68,,,,,,,fee schedule,2840.68,6208.35,APC Inj nivolumab 2 mg hyaluron,J9289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.14,,,,,,,fee schedule,27.73,61.37, Inj nivolumab 2 mg hyaluron,J9289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.37,,,,,,,fee schedule,27.73,61.37, Inj nivolumab 2 mg hyaluron,J9289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.84,,,,,,,fee schedule,27.73,61.37,APC Inj nivolumab 2 mg hyaluron,J9289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.12,,,,,,,fee schedule,27.73,61.37,APC Inj nivolumab 2 mg hyaluron,J9289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.73,,,,,,,fee schedule,27.73,61.37,APC "Inj, pemetrexed (avyxa) 10mg",J9292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.64,,,,,,,fee schedule,82.02,184.69, "Inj, pemetrexed (avyxa) 10mg",J9292,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.64,,,,,,,fee schedule,82.02,184.69, "Inj, pemetrexed (avyxa) 10mg",J9292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,153.89,,,,,,,fee schedule,82.02,184.69, "Inj, pemetrexed (avyxa) 10mg",J9292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,184.69,,,,,,,fee schedule,82.02,184.69, "Inj, pemetrexed (avyxa) 10mg",J9292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,85.3,,,,,,,fee schedule,82.02,184.69,APC "Inj, pemetrexed (avyxa) 10mg",J9292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,86.12,,,,,,,fee schedule,82.02,184.69,APC "Inj, pemetrexed (avyxa) 10mg",J9292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,82.02,,,,,,,fee schedule,82.02,184.69,APC Mitoxantrone hydrochl / 5 MG,J9293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.07,,,,,,,fee schedule,38.61,53.56, Mitoxantrone hydrochl / 5 MG,J9293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.07,,,,,,,fee schedule,38.61,53.56, Mitoxantrone hydrochl / 5 MG,J9293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44.63,,,,,,,fee schedule,38.61,53.56, Mitoxantrone hydrochl / 5 MG,J9293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53.56,,,,,,,fee schedule,38.61,53.56, Mitoxantrone hydrochl / 5 MG,J9293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,40.16,,,,,,,fee schedule,38.61,53.56,APC Mitoxantrone hydrochl / 5 MG,J9293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.54,,,,,,,fee schedule,38.61,53.56,APC Mitoxantrone hydrochl / 5 MG,J9293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.61,,,,,,,fee schedule,38.61,53.56,APC "Inj pemetrexed, hospira 10mg",J9294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.67,,,,,,,fee schedule,5.2,7.96, "Inj pemetrexed, hospira 10mg",J9294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.67,,,,,,,fee schedule,5.2,7.96, "Inj pemetrexed, hospira 10mg",J9294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.63,,,,,,,fee schedule,5.2,7.96, "Inj pemetrexed, hospira 10mg",J9294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.96,,,,,,,fee schedule,5.2,7.96, "Inj pemetrexed, hospira 10mg",J9294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.41,,,,,,,fee schedule,5.2,7.96,APC "Inj pemetrexed, hospira 10mg",J9294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.46,,,,,,,fee schedule,5.2,7.96,APC "Inj pemetrexed, hospira 10mg",J9294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.2,,,,,,,fee schedule,5.2,7.96,APC "Injection, necitumumab, 1 mg",J9295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.93,,,,,,,fee schedule,5.73,12.85, "Injection, necitumumab, 1 mg",J9295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.93,,,,,,,fee schedule,5.73,12.85, "Injection, necitumumab, 1 mg",J9295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.71,,,,,,,fee schedule,5.73,12.85, "Injection, necitumumab, 1 mg",J9295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.85,,,,,,,fee schedule,5.73,12.85, "Injection, necitumumab, 1 mg",J9295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.96,,,,,,,fee schedule,5.73,12.85,APC "Injection, necitumumab, 1 mg",J9295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.02,,,,,,,fee schedule,5.73,12.85,APC "Injection, necitumumab, 1 mg",J9295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.73,,,,,,,fee schedule,5.73,12.85,APC Inj pemetrexed (accord) 10mg,J9296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.15,,,,,,,fee schedule,9.66,21.85, Inj pemetrexed (accord) 10mg,J9296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,15.15,,,,,,,fee schedule,9.66,21.85, Inj pemetrexed (accord) 10mg,J9296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.2,,,,,,,fee schedule,9.66,21.85, Inj pemetrexed (accord) 10mg,J9296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.85,,,,,,,fee schedule,9.66,21.85, Inj pemetrexed (accord) 10mg,J9296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.04,,,,,,,fee schedule,9.66,21.85,APC Inj pemetrexed (accord) 10mg,J9296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.14,,,,,,,fee schedule,9.66,21.85,APC Inj pemetrexed (accord) 10mg,J9296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.66,,,,,,,fee schedule,9.66,21.85,APC Inj pemetrexed (sandoz) 10mg,J9297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.88,,,,,,,fee schedule,1.88,3.93, Inj pemetrexed (sandoz) 10mg,J9297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.88,,,,,,,fee schedule,1.88,3.93, Inj pemetrexed (sandoz) 10mg,J9297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.27,,,,,,,fee schedule,1.88,3.93, Inj pemetrexed (sandoz) 10mg,J9297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.93,,,,,,,fee schedule,1.88,3.93, Inj nivol relatlimab 3mg/1mg,J9298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,307.66,,,,,,,fee schedule,201.76,443.73, Inj nivol relatlimab 3mg/1mg,J9298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,307.66,,,,,,,fee schedule,201.76,443.73, Inj nivol relatlimab 3mg/1mg,J9298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,369.74,,,,,,,fee schedule,201.76,443.73, Inj nivol relatlimab 3mg/1mg,J9298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,443.73,,,,,,,fee schedule,201.76,443.73, Inj nivol relatlimab 3mg/1mg,J9298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.83,,,,,,,fee schedule,201.76,443.73,APC Inj nivol relatlimab 3mg/1mg,J9298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.84,,,,,,,fee schedule,201.76,443.73,APC Inj nivol relatlimab 3mg/1mg,J9298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.76,,,,,,,fee schedule,201.76,443.73,APC "Injection, nivolumab",J9299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.36,,,,,,,fee schedule,33.62,73.93, "Injection, nivolumab",J9299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.36,,,,,,,fee schedule,33.62,73.93, "Injection, nivolumab",J9299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.6,,,,,,,fee schedule,33.62,73.93, "Injection, nivolumab",J9299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.93,,,,,,,fee schedule,33.62,73.93, "Injection, nivolumab",J9299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.97,,,,,,,fee schedule,33.62,73.93,APC "Injection, nivolumab",J9299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.31,,,,,,,fee schedule,33.62,73.93,APC "Injection, nivolumab",J9299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.62,,,,,,,fee schedule,33.62,73.93,APC Obinutuzumab inj,J9301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,122.13,,,,,,,fee schedule,81.81,177.2, Obinutuzumab inj,J9301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,122.13,,,,,,,fee schedule,81.81,177.2, Obinutuzumab inj,J9301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,147.65,,,,,,,fee schedule,81.81,177.2, Obinutuzumab inj,J9301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,177.2,,,,,,,fee schedule,81.81,177.2, Obinutuzumab inj,J9301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,85.08,,,,,,,fee schedule,81.81,177.2,APC Obinutuzumab inj,J9301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,85.9,,,,,,,fee schedule,81.81,177.2,APC Obinutuzumab inj,J9301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,81.81,,,,,,,fee schedule,81.81,177.2,APC Ofatumumab injection,J9302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,115.02,,,,,,,fee schedule,62.23,138.03, Ofatumumab injection,J9302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,138.03,,,,,,,fee schedule,62.23,138.03, Ofatumumab injection,J9302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,64.72,,,,,,,fee schedule,62.23,138.03,APC Ofatumumab injection,J9302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.35,,,,,,,fee schedule,62.23,138.03,APC Ofatumumab injection,J9302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.23,,,,,,,fee schedule,62.23,138.03,APC Panitumumab injection,J9303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,268.59,,,,,,,fee schedule,174.39,388.11, Panitumumab injection,J9303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,268.59,,,,,,,fee schedule,174.39,388.11, Panitumumab injection,J9303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,323.39,,,,,,,fee schedule,174.39,388.11, Panitumumab injection,J9303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,388.11,,,,,,,fee schedule,174.39,388.11, Panitumumab injection,J9303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,181.36,,,,,,,fee schedule,174.39,388.11,APC Panitumumab injection,J9303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,183.11,,,,,,,fee schedule,174.39,388.11,APC Panitumumab injection,J9303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,174.39,,,,,,,fee schedule,174.39,388.11,APC "Inj. pemetrexed, 10 mg",J9304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.64,,,,,,,fee schedule,7.99,103.9, "Inj. pemetrexed, 10 mg",J9304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.64,,,,,,,fee schedule,7.99,103.9, "Inj. pemetrexed, 10 mg",J9304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.57,,,,,,,fee schedule,7.99,103.9, "Inj. pemetrexed, 10 mg",J9304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,103.9,,,,,,,fee schedule,7.99,103.9, "Inj. pemetrexed, 10 mg",J9304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.31,,,,,,,fee schedule,7.99,103.9,APC "Inj. pemetrexed, 10 mg",J9304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.39,,,,,,,fee schedule,7.99,103.9,APC "Inj. pemetrexed, 10 mg",J9304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.99,,,,,,,fee schedule,7.99,103.9,APC Pemetrexed injection,J9305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.81,,,,,,,fee schedule,4.04,9.78, Pemetrexed injection,J9305,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.81,,,,,,,fee schedule,4.04,9.78, Pemetrexed injection,J9305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.15,,,,,,,fee schedule,4.04,9.78, Pemetrexed injection,J9305,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.78,,,,,,,fee schedule,4.04,9.78, Pemetrexed injection,J9305,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.2,,,,,,,fee schedule,4.04,9.78,APC Pemetrexed injection,J9305,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.24,,,,,,,fee schedule,4.04,9.78,APC Pemetrexed injection,J9305,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.04,,,,,,,fee schedule,4.04,9.78,APC "Injection, pertuzumab, 1 mg",J9306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,26.3,,,,,,,fee schedule,17.02,38.18, "Injection, pertuzumab, 1 mg",J9306,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,26.3,,,,,,,fee schedule,17.02,38.18, "Injection, pertuzumab, 1 mg",J9306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.81,,,,,,,fee schedule,17.02,38.18, "Injection, pertuzumab, 1 mg",J9306,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.18,,,,,,,fee schedule,17.02,38.18, "Injection, pertuzumab, 1 mg",J9306,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,17.7,,,,,,,fee schedule,17.02,38.18,APC "Injection, pertuzumab, 1 mg",J9306,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17.87,,,,,,,fee schedule,17.02,38.18,APC "Injection, pertuzumab, 1 mg",J9306,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17.02,,,,,,,fee schedule,17.02,38.18,APC Pralatrexate injection,J9307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,605.25,,,,,,,fee schedule,392.72,880.67, Pralatrexate injection,J9307,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,605.25,,,,,,,fee schedule,392.72,880.67, Pralatrexate injection,J9307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,733.83,,,,,,,fee schedule,392.72,880.67, Pralatrexate injection,J9307,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,880.67,,,,,,,fee schedule,392.72,880.67, Pralatrexate injection,J9307,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,408.43,,,,,,,fee schedule,392.72,880.67,APC Pralatrexate injection,J9307,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,412.35,,,,,,,fee schedule,392.72,880.67,APC Pralatrexate injection,J9307,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,392.72,,,,,,,fee schedule,392.72,880.67,APC "Injection, ramucirumab",J9308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,115.9,,,,,,,fee schedule,75.47,166.79, "Injection, ramucirumab",J9308,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,115.9,,,,,,,fee schedule,75.47,166.79, "Injection, ramucirumab",J9308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,138.98,,,,,,,fee schedule,75.47,166.79, "Injection, ramucirumab",J9308,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,166.79,,,,,,,fee schedule,75.47,166.79, "Injection, ramucirumab",J9308,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,78.49,,,,,,,fee schedule,75.47,166.79,APC "Injection, ramucirumab",J9308,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,79.25,,,,,,,fee schedule,75.47,166.79,APC "Injection, ramucirumab",J9308,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,75.47,,,,,,,fee schedule,75.47,166.79,APC "Inj, polatuzumab vedotin 1mg",J9309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,212.06,,,,,,,fee schedule,137.23,306.55, "Inj, polatuzumab vedotin 1mg",J9309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,212.06,,,,,,,fee schedule,137.23,306.55, "Inj, polatuzumab vedotin 1mg",J9309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,255.44,,,,,,,fee schedule,137.23,306.55, "Inj, polatuzumab vedotin 1mg",J9309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,306.55,,,,,,,fee schedule,137.23,306.55, "Inj, polatuzumab vedotin 1mg",J9309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.72,,,,,,,fee schedule,137.23,306.55,APC "Inj, polatuzumab vedotin 1mg",J9309,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,144.09,,,,,,,fee schedule,137.23,306.55,APC "Inj, polatuzumab vedotin 1mg",J9309,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137.23,,,,,,,fee schedule,137.23,306.55,APC "Inj rituximab, hyaluronidase",J9311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,57.54,,,,,,,fee schedule,36.28,82.3, "Inj rituximab, hyaluronidase",J9311,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,57.54,,,,,,,fee schedule,36.28,82.3, "Inj rituximab, hyaluronidase",J9311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.57,,,,,,,fee schedule,36.28,82.3, "Inj rituximab, hyaluronidase",J9311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,82.3,,,,,,,fee schedule,36.28,82.3, "Inj rituximab, hyaluronidase",J9311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.73,,,,,,,fee schedule,36.28,82.3,APC "Inj rituximab, hyaluronidase",J9311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.1,,,,,,,fee schedule,36.28,82.3,APC "Inj rituximab, hyaluronidase",J9311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.28,,,,,,,fee schedule,36.28,82.3,APC "Inj., rituximab, 10 mg",J9312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,118.19,,,,,,,fee schedule,74.16,168.72, "Inj., rituximab, 10 mg",J9312,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,118.19,,,,,,,fee schedule,74.16,168.72, "Inj., rituximab, 10 mg",J9312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,140.59,,,,,,,fee schedule,74.16,168.72, "Inj., rituximab, 10 mg",J9312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,168.72,,,,,,,fee schedule,74.16,168.72, "Inj., rituximab, 10 mg",J9312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.12,,,,,,,fee schedule,74.16,168.72,APC "Inj., rituximab, 10 mg",J9312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77.87,,,,,,,fee schedule,74.16,168.72,APC "Inj., rituximab, 10 mg",J9312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.16,,,,,,,fee schedule,74.16,168.72,APC "Inj., lumoxiti, 0.01 mg",J9313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.07,,,,,,,fee schedule,23.39,50.49, "Inj., lumoxiti, 0.01 mg",J9313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.49,,,,,,,fee schedule,23.39,50.49, "Inj., lumoxiti, 0.01 mg",J9313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.33,,,,,,,fee schedule,23.39,50.49,APC "Inj., lumoxiti, 0.01 mg",J9313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.56,,,,,,,fee schedule,23.39,50.49,APC "Inj., lumoxiti, 0.01 mg",J9313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.39,,,,,,,fee schedule,23.39,50.49,APC Inj pemetrexed (teva) 10mg,J9314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.91,,,,,,,fee schedule,5.91,34.86, Inj pemetrexed (teva) 10mg,J9314,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.91,,,,,,,fee schedule,5.91,34.86, Inj pemetrexed (teva) 10mg,J9314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.04,,,,,,,fee schedule,5.91,34.86, Inj pemetrexed (teva) 10mg,J9314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.86,,,,,,,fee schedule,5.91,34.86, Inj pemetrexed (teva) 10mg,J9314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.43,,,,,,,fee schedule,5.91,34.86,APC Inj pemetrexed (teva) 10mg,J9314,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.54,,,,,,,fee schedule,5.91,34.86,APC Inj pemetrexed (teva) 10mg,J9314,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.99,,,,,,,fee schedule,5.91,34.86,APC "Pertuzu, trastuzu, 10 mg",J9316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,98.67,,,,,,,fee schedule,60.22,139.29, "Pertuzu, trastuzu, 10 mg",J9316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98.67,,,,,,,fee schedule,60.22,139.29, "Pertuzu, trastuzu, 10 mg",J9316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.06,,,,,,,fee schedule,60.22,139.29, "Pertuzu, trastuzu, 10 mg",J9316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,139.29,,,,,,,fee schedule,60.22,139.29, "Pertuzu, trastuzu, 10 mg",J9316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,62.63,,,,,,,fee schedule,60.22,139.29,APC "Pertuzu, trastuzu, 10 mg",J9316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,63.24,,,,,,,fee schedule,60.22,139.29,APC "Pertuzu, trastuzu, 10 mg",J9316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,60.22,,,,,,,fee schedule,60.22,139.29,APC Sacituzumab govitecan-hziy,J9317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,56.45,,,,,,,fee schedule,36.8,81.38, Sacituzumab govitecan-hziy,J9317,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,56.45,,,,,,,fee schedule,36.8,81.38, Sacituzumab govitecan-hziy,J9317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,67.81,,,,,,,fee schedule,36.8,81.38, Sacituzumab govitecan-hziy,J9317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,81.38,,,,,,,fee schedule,36.8,81.38, Sacituzumab govitecan-hziy,J9317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.27,,,,,,,fee schedule,36.8,81.38,APC Sacituzumab govitecan-hziy,J9317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.64,,,,,,,fee schedule,36.8,81.38,APC Sacituzumab govitecan-hziy,J9317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.8,,,,,,,fee schedule,36.8,81.38,APC Inj romidepsin non-lyo 0.1mg,J9318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.39,,,,,,,fee schedule,28.52,63.97, Inj romidepsin non-lyo 0.1mg,J9318,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.39,,,,,,,fee schedule,28.52,63.97, Inj romidepsin non-lyo 0.1mg,J9318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,53.3,,,,,,,fee schedule,28.52,63.97, Inj romidepsin non-lyo 0.1mg,J9318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.97,,,,,,,fee schedule,28.52,63.97, Inj romidepsin non-lyo 0.1mg,J9318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.66,,,,,,,fee schedule,28.52,63.97,APC Inj romidepsin non-lyo 0.1mg,J9318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.94,,,,,,,fee schedule,28.52,63.97,APC Inj romidepsin non-lyo 0.1mg,J9318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.52,,,,,,,fee schedule,28.52,63.97,APC Inj romidepsin lyophil 0.1mg,J9319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.38,,,,,,,fee schedule,30.8,69.04, Inj romidepsin lyophil 0.1mg,J9319,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.38,,,,,,,fee schedule,30.8,69.04, Inj romidepsin lyophil 0.1mg,J9319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.53,,,,,,,fee schedule,30.8,69.04, Inj romidepsin lyophil 0.1mg,J9319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.04,,,,,,,fee schedule,30.8,69.04, Inj romidepsin lyophil 0.1mg,J9319,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.03,,,,,,,fee schedule,30.8,69.04,APC Inj romidepsin lyophil 0.1mg,J9319,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.34,,,,,,,fee schedule,30.8,69.04,APC Inj romidepsin lyophil 0.1mg,J9319,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.8,,,,,,,fee schedule,30.8,69.04,APC Streptozocin injection,J9320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2478.29,,,,,,,fee schedule,2478.29,2974.22, Streptozocin injection,J9320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2974.22,,,,,,,fee schedule,2478.29,2974.22, Inj epcoritamab-bysp 0.16 mg,J9321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,86.64,,,,,,,fee schedule,56.92,125.25, Inj epcoritamab-bysp 0.16 mg,J9321,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,86.64,,,,,,,fee schedule,56.92,125.25, Inj epcoritamab-bysp 0.16 mg,J9321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,104.36,,,,,,,fee schedule,56.92,125.25, Inj epcoritamab-bysp 0.16 mg,J9321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,125.25,,,,,,,fee schedule,56.92,125.25, Inj epcoritamab-bysp 0.16 mg,J9321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,59.19,,,,,,,fee schedule,56.92,125.25,APC Inj epcoritamab-bysp 0.16 mg,J9321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.76,,,,,,,fee schedule,56.92,125.25,APC Inj epcoritamab-bysp 0.16 mg,J9321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.92,,,,,,,fee schedule,56.92,125.25,APC Inj pemetrexed (bluepoint),J9322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,17.36,,,,,,,fee schedule,10.6,20.84, Inj pemetrexed (bluepoint),J9322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.84,,,,,,,fee schedule,10.6,20.84, Inj pemetrexed (bluepoint),J9322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.02,,,,,,,fee schedule,10.6,20.84,APC Inj pemetrexed (bluepoint),J9322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.13,,,,,,,fee schedule,10.6,20.84,APC Inj pemetrexed (bluepoint),J9322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.6,,,,,,,fee schedule,10.6,20.84,APC Inj pemetrexed ditromethamin,J9323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.1,,,,,,,fee schedule,0.22,16.1, Inj pemetrexed ditromethamin,J9323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.1,,,,,,,fee schedule,0.22,16.1, Inj pemetrexed ditromethamin,J9323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.22,,,,,,,fee schedule,0.22,16.1, Inj pemetrexed ditromethamin,J9323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.27,,,,,,,fee schedule,0.22,16.1, "Inj, pemrydi rtu, 10 mg",J9324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,124.69,,,,,,,fee schedule,70.48,170.04, "Inj, pemrydi rtu, 10 mg",J9324,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,124.69,,,,,,,fee schedule,70.48,170.04, "Inj, pemrydi rtu, 10 mg",J9324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,141.69,,,,,,,fee schedule,70.48,170.04, "Inj, pemrydi rtu, 10 mg",J9324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.04,,,,,,,fee schedule,70.48,170.04, "Inj, pemrydi rtu, 10 mg",J9324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.3,,,,,,,fee schedule,70.48,170.04,APC "Inj, pemrydi rtu, 10 mg",J9324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,74,,,,,,,fee schedule,70.48,170.04,APC "Inj, pemrydi rtu, 10 mg",J9324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.48,,,,,,,fee schedule,70.48,170.04,APC Inj talimogene laherparepvec,J9325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,114.48,,,,,,,fee schedule,73.94,165.85, Inj talimogene laherparepvec,J9325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,114.48,,,,,,,fee schedule,73.94,165.85, Inj talimogene laherparepvec,J9325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,138.19,,,,,,,fee schedule,73.94,165.85, Inj talimogene laherparepvec,J9325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,165.85,,,,,,,fee schedule,73.94,165.85, Inj talimogene laherparepvec,J9325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.9,,,,,,,fee schedule,73.94,165.85,APC Inj talimogene laherparepvec,J9325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77.64,,,,,,,fee schedule,73.94,165.85,APC Inj talimogene laherparepvec,J9325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.94,,,,,,,fee schedule,73.94,165.85,APC Temozolomide injection,J9328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.19,,,,,,,fee schedule,10.4,23.3, Temozolomide injection,J9328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.19,,,,,,,fee schedule,10.4,23.3, Temozolomide injection,J9328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.42,,,,,,,fee schedule,10.4,23.3, Temozolomide injection,J9328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.3,,,,,,,fee schedule,10.4,23.3, Temozolomide injection,J9328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.81,,,,,,,fee schedule,10.4,23.3,APC Temozolomide injection,J9328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.92,,,,,,,fee schedule,10.4,23.3,APC Temozolomide injection,J9328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.4,,,,,,,fee schedule,10.4,23.3,APC "Inj, tislelizumab-jsgr",J9329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,89.38,,,,,,,fee schedule,58.27,128.86, "Inj, tislelizumab-jsgr",J9329,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,89.38,,,,,,,fee schedule,58.27,128.86, "Inj, tislelizumab-jsgr",J9329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,107.37,,,,,,,fee schedule,58.27,128.86, "Inj, tislelizumab-jsgr",J9329,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,128.86,,,,,,,fee schedule,58.27,128.86, "Inj, tislelizumab-jsgr",J9329,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,60.6,,,,,,,fee schedule,58.27,128.86,APC "Inj, tislelizumab-jsgr",J9329,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61.18,,,,,,,fee schedule,58.27,128.86,APC "Inj, tislelizumab-jsgr",J9329,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58.27,,,,,,,fee schedule,58.27,128.86,APC Temsirolimus injection,J9330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.26,,,,,,,fee schedule,30.08,59.91, Temsirolimus injection,J9330,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.26,,,,,,,fee schedule,30.08,59.91, Temsirolimus injection,J9330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,49.92,,,,,,,fee schedule,30.08,59.91, Temsirolimus injection,J9330,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.91,,,,,,,fee schedule,30.08,59.91, Temsirolimus injection,J9330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.28,,,,,,,fee schedule,30.08,59.91,APC Temsirolimus injection,J9330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.58,,,,,,,fee schedule,30.08,59.91,APC Temsirolimus injection,J9330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.08,,,,,,,fee schedule,30.08,59.91,APC Inj sirolimus prot part 1 mg,J9331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,131.57,,,,,,,fee schedule,87.11,189.69, Inj sirolimus prot part 1 mg,J9331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,131.57,,,,,,,fee schedule,87.11,189.69, Inj sirolimus prot part 1 mg,J9331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,158.06,,,,,,,fee schedule,87.11,189.69, Inj sirolimus prot part 1 mg,J9331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,189.69,,,,,,,fee schedule,87.11,189.69, Inj sirolimus prot part 1 mg,J9331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,90.59,,,,,,,fee schedule,87.11,189.69,APC Inj sirolimus prot part 1 mg,J9331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,91.47,,,,,,,fee schedule,87.11,189.69,APC Inj sirolimus prot part 1 mg,J9331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,87.11,,,,,,,fee schedule,87.11,189.69,APC Inj efgartigimod 2mg,J9332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,50.06,,,,,,,fee schedule,32.61,72.11, Inj efgartigimod 2mg,J9332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.06,,,,,,,fee schedule,32.61,72.11, Inj efgartigimod 2mg,J9332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.09,,,,,,,fee schedule,32.61,72.11, Inj efgartigimod 2mg,J9332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.11,,,,,,,fee schedule,32.61,72.11, Inj efgartigimod 2mg,J9332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.91,,,,,,,fee schedule,32.61,72.11,APC Inj efgartigimod 2mg,J9332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34.24,,,,,,,fee schedule,32.61,72.11,APC Inj efgartigimod 2mg,J9332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.61,,,,,,,fee schedule,32.61,72.11,APC Inj ronzanolixizum-noli 1 mg,J9333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,36.05,,,,,,,fee schedule,23.4,51.97, Inj ronzanolixizum-noli 1 mg,J9333,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.05,,,,,,,fee schedule,23.4,51.97, Inj ronzanolixizum-noli 1 mg,J9333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,43.3,,,,,,,fee schedule,23.4,51.97, Inj ronzanolixizum-noli 1 mg,J9333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.97,,,,,,,fee schedule,23.4,51.97, Inj ronzanolixizum-noli 1 mg,J9333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.33,,,,,,,fee schedule,23.4,51.97,APC Inj ronzanolixizum-noli 1 mg,J9333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.57,,,,,,,fee schedule,23.4,51.97,APC Inj ronzanolixizum-noli 1 mg,J9333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.4,,,,,,,fee schedule,23.4,51.97,APC Inj efgart-alfa 2mg hya-qvfc,J9334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.44,,,,,,,fee schedule,34.33,76.02, Inj efgart-alfa 2mg hya-qvfc,J9334,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.44,,,,,,,fee schedule,34.33,76.02, Inj efgart-alfa 2mg hya-qvfc,J9334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.34,,,,,,,fee schedule,34.33,76.02, Inj efgart-alfa 2mg hya-qvfc,J9334,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.02,,,,,,,fee schedule,34.33,76.02, Inj efgart-alfa 2mg hya-qvfc,J9334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.7,,,,,,,fee schedule,34.33,76.02,APC Inj efgart-alfa 2mg hya-qvfc,J9334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.04,,,,,,,fee schedule,34.33,76.02,APC Inj efgart-alfa 2mg hya-qvfc,J9334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.33,,,,,,,fee schedule,34.33,76.02,APC Inj thiotepa (tepylute) 1 mg,J9341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.8,,,,,,,fee schedule,70.8,84.96, Inj thiotepa (tepylute) 1 mg,J9341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,84.96,,,,,,,fee schedule,70.8,84.96, Inj thiotepa nos 1 mg,J9342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.04,,,,,,,fee schedule,5.74,23.64, Inj thiotepa nos 1 mg,J9342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.04,,,,,,,fee schedule,5.74,23.64, Inj thiotepa nos 1 mg,J9342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,19.7,,,,,,,fee schedule,5.74,23.64, Inj thiotepa nos 1 mg,J9342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,23.64,,,,,,,fee schedule,5.74,23.64, Inj thiotepa nos 1 mg,J9342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.97,,,,,,,fee schedule,5.74,23.64,APC Inj thiotepa nos 1 mg,J9342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.02,,,,,,,fee schedule,5.74,23.64,APC Inj thiotepa nos 1 mg,J9342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.74,,,,,,,fee schedule,5.74,23.64,APC "Inj, retifanlimab-dlwr, 1 mg",J9345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.66,,,,,,,fee schedule,30.4,68.55, "Inj, retifanlimab-dlwr, 1 mg",J9345,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.66,,,,,,,fee schedule,30.4,68.55, "Inj, retifanlimab-dlwr, 1 mg",J9345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,57.12,,,,,,,fee schedule,30.4,68.55, "Inj, retifanlimab-dlwr, 1 mg",J9345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,68.55,,,,,,,fee schedule,30.4,68.55, "Inj, retifanlimab-dlwr, 1 mg",J9345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.62,,,,,,,fee schedule,30.4,68.55,APC "Inj, retifanlimab-dlwr, 1 mg",J9345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.92,,,,,,,fee schedule,30.4,68.55,APC "Inj, retifanlimab-dlwr, 1 mg",J9345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,30.4,,,,,,,fee schedule,30.4,68.55,APC "Inj, tremelimumab-actl, 1 mg",J9347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,219.73,,,,,,,fee schedule,143.23,316.04, "Inj, tremelimumab-actl, 1 mg",J9347,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,219.73,,,,,,,fee schedule,143.23,316.04, "Inj, tremelimumab-actl, 1 mg",J9347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,263.34,,,,,,,fee schedule,143.23,316.04, "Inj, tremelimumab-actl, 1 mg",J9347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,316.04,,,,,,,fee schedule,143.23,316.04, "Inj, tremelimumab-actl, 1 mg",J9347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,148.96,,,,,,,fee schedule,143.23,316.04,APC "Inj, tremelimumab-actl, 1 mg",J9347,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,150.39,,,,,,,fee schedule,143.23,316.04,APC "Inj, tremelimumab-actl, 1 mg",J9347,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,143.23,,,,,,,fee schedule,143.23,316.04,APC "Inj. naxitamab-gqgk, 1 mg",J9348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1067.68,,,,,,,fee schedule,686.09,1538.7, "Inj. naxitamab-gqgk, 1 mg",J9348,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1067.68,,,,,,,fee schedule,686.09,1538.7, "Inj. naxitamab-gqgk, 1 mg",J9348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1282.13,,,,,,,fee schedule,686.09,1538.7, "Inj. naxitamab-gqgk, 1 mg",J9348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1538.7,,,,,,,fee schedule,686.09,1538.7, "Inj. naxitamab-gqgk, 1 mg",J9348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,713.54,,,,,,,fee schedule,686.09,1538.7,APC "Inj. naxitamab-gqgk, 1 mg",J9348,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,720.4,,,,,,,fee schedule,686.09,1538.7,APC "Inj. naxitamab-gqgk, 1 mg",J9348,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,686.09,,,,,,,fee schedule,686.09,1538.7,APC "Inj., tafasitamab-cxix",J9349,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,21.91,,,,,,,fee schedule,14.17,32.1, "Inj., tafasitamab-cxix",J9349,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.91,,,,,,,fee schedule,14.17,32.1, "Inj., tafasitamab-cxix",J9349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,26.75,,,,,,,fee schedule,14.17,32.1, "Inj., tafasitamab-cxix",J9349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.1,,,,,,,fee schedule,14.17,32.1, "Inj., tafasitamab-cxix",J9349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.73,,,,,,,fee schedule,14.17,32.1,APC "Inj., tafasitamab-cxix",J9349,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.87,,,,,,,fee schedule,14.17,32.1,APC "Inj., tafasitamab-cxix",J9349,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.17,,,,,,,fee schedule,14.17,32.1,APC "Inj mosunetuzumab-axgb, 1 mg",J9350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1016.07,,,,,,,fee schedule,654.54,1468.34, "Inj mosunetuzumab-axgb, 1 mg",J9350,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1016.07,,,,,,,fee schedule,654.54,1468.34, "Inj mosunetuzumab-axgb, 1 mg",J9350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1223.5,,,,,,,fee schedule,654.54,1468.34, "Inj mosunetuzumab-axgb, 1 mg",J9350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1468.34,,,,,,,fee schedule,654.54,1468.34, "Inj mosunetuzumab-axgb, 1 mg",J9350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,680.72,,,,,,,fee schedule,654.54,1468.34,APC "Inj mosunetuzumab-axgb, 1 mg",J9350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,687.27,,,,,,,fee schedule,654.54,1468.34,APC "Inj mosunetuzumab-axgb, 1 mg",J9350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,654.54,,,,,,,fee schedule,654.54,1468.34,APC Topotecan injection,J9351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.1,,,,,,,fee schedule,2.1,5.7, Topotecan injection,J9351,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.1,,,,,,,fee schedule,2.1,5.7, Topotecan injection,J9351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.75,,,,,,,fee schedule,2.1,5.7, Topotecan injection,J9351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.7,,,,,,,fee schedule,2.1,5.7, Injection trabectedin 0.1mg,J9352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,596.28,,,,,,,fee schedule,391.07,877.17, Injection trabectedin 0.1mg,J9352,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,596.28,,,,,,,fee schedule,391.07,877.17, Injection trabectedin 0.1mg,J9352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,730.91,,,,,,,fee schedule,391.07,877.17, Injection trabectedin 0.1mg,J9352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,877.17,,,,,,,fee schedule,391.07,877.17, Injection trabectedin 0.1mg,J9352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,406.71,,,,,,,fee schedule,391.07,877.17,APC Injection trabectedin 0.1mg,J9352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,410.62,,,,,,,fee schedule,391.07,877.17,APC Injection trabectedin 0.1mg,J9352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,391.07,,,,,,,fee schedule,391.07,877.17,APC "Inj. margetuximab-cmkb, 5 mg",J9353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,78.52,,,,,,,fee schedule,53.27,117.74, "Inj. margetuximab-cmkb, 5 mg",J9353,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,78.52,,,,,,,fee schedule,53.27,117.74, "Inj. margetuximab-cmkb, 5 mg",J9353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.1,,,,,,,fee schedule,53.27,117.74, "Inj. margetuximab-cmkb, 5 mg",J9353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,117.74,,,,,,,fee schedule,53.27,117.74, "Inj. margetuximab-cmkb, 5 mg",J9353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,55.4,,,,,,,fee schedule,53.27,117.74,APC "Inj. margetuximab-cmkb, 5 mg",J9353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,55.94,,,,,,,fee schedule,53.27,117.74,APC "Inj. margetuximab-cmkb, 5 mg",J9353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,53.27,,,,,,,fee schedule,53.27,117.74,APC "Inj, ado-trastuzumab emt 1mg",J9354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,65.14,,,,,,,fee schedule,42.2,94.56, "Inj, ado-trastuzumab emt 1mg",J9354,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,65.14,,,,,,,fee schedule,42.2,94.56, "Inj, ado-trastuzumab emt 1mg",J9354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,78.8,,,,,,,fee schedule,42.2,94.56, "Inj, ado-trastuzumab emt 1mg",J9354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,94.56,,,,,,,fee schedule,42.2,94.56, "Inj, ado-trastuzumab emt 1mg",J9354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.89,,,,,,,fee schedule,42.2,94.56,APC "Inj, ado-trastuzumab emt 1mg",J9354,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.31,,,,,,,fee schedule,42.2,94.56,APC "Inj, ado-trastuzumab emt 1mg",J9354,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.2,,,,,,,fee schedule,42.2,94.56,APC Trastuzumab injection,J9355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,118.59,,,,,,,fee schedule,73.42,168.27, Trastuzumab injection,J9355,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,118.59,,,,,,,fee schedule,73.42,168.27, Trastuzumab injection,J9355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,140.21,,,,,,,fee schedule,73.42,168.27, Trastuzumab injection,J9355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,168.27,,,,,,,fee schedule,73.42,168.27, Trastuzumab injection,J9355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.36,,,,,,,fee schedule,73.42,168.27,APC Trastuzumab injection,J9355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77.1,,,,,,,fee schedule,73.42,168.27,APC Trastuzumab injection,J9355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.42,,,,,,,fee schedule,73.42,168.27,APC "Inj. herceptin hylecta, 10mg",J9356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,98.03,,,,,,,fee schedule,59.91,137.81, "Inj. herceptin hylecta, 10mg",J9356,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,98.03,,,,,,,fee schedule,59.91,137.81, "Inj. herceptin hylecta, 10mg",J9356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,114.83,,,,,,,fee schedule,59.91,137.81, "Inj. herceptin hylecta, 10mg",J9356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,137.81,,,,,,,fee schedule,59.91,137.81, "Inj. herceptin hylecta, 10mg",J9356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,62.31,,,,,,,fee schedule,59.91,137.81,APC "Inj. herceptin hylecta, 10mg",J9356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,62.9,,,,,,,fee schedule,59.91,137.81,APC "Inj. herceptin hylecta, 10mg",J9356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,59.91,,,,,,,fee schedule,59.91,137.81,APC Valrubicin injection,J9357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2143.1,,,,,,,fee schedule,1270.52,2968.27, Valrubicin injection,J9357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2143.1,,,,,,,fee schedule,1270.52,2968.27, Valrubicin injection,J9357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2473.34,,,,,,,fee schedule,1270.52,2968.27, Valrubicin injection,J9357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2968.27,,,,,,,fee schedule,1270.52,2968.27, Valrubicin injection,J9357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1321.34,,,,,,,fee schedule,1270.52,2968.27,APC Valrubicin injection,J9357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1334.05,,,,,,,fee schedule,1270.52,2968.27,APC Valrubicin injection,J9357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1270.52,,,,,,,fee schedule,1270.52,2968.27,APC Inj fam-trastu deru-nxki 1mg,J9358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.7,,,,,,,fee schedule,31.26,67.25, Inj fam-trastu deru-nxki 1mg,J9358,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.7,,,,,,,fee schedule,31.26,67.25, Inj fam-trastu deru-nxki 1mg,J9358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.03,,,,,,,fee schedule,31.26,67.25, Inj fam-trastu deru-nxki 1mg,J9358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.25,,,,,,,fee schedule,31.26,67.25, Inj fam-trastu deru-nxki 1mg,J9358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.51,,,,,,,fee schedule,31.26,67.25,APC Inj fam-trastu deru-nxki 1mg,J9358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.83,,,,,,,fee schedule,31.26,67.25,APC Inj fam-trastu deru-nxki 1mg,J9358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.26,,,,,,,fee schedule,31.26,67.25,APC Inj lon tesirin-lpyl 0.075mg,J9359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,337.38,,,,,,,fee schedule,221.49,486.51, Inj lon tesirin-lpyl 0.075mg,J9359,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,337.38,,,,,,,fee schedule,221.49,486.51, Inj lon tesirin-lpyl 0.075mg,J9359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,405.39,,,,,,,fee schedule,221.49,486.51, Inj lon tesirin-lpyl 0.075mg,J9359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,486.51,,,,,,,fee schedule,221.49,486.51, Inj lon tesirin-lpyl 0.075mg,J9359,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,230.35,,,,,,,fee schedule,221.49,486.51,APC Inj lon tesirin-lpyl 0.075mg,J9359,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,232.57,,,,,,,fee schedule,221.49,486.51,APC Inj lon tesirin-lpyl 0.075mg,J9359,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,221.49,,,,,,,fee schedule,221.49,486.51,APC Vinblastine sulfate inj,J9360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,8.23,,,,,,,fee schedule,8.23,11.89, Vinblastine sulfate inj,J9360,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,8.23,,,,,,,fee schedule,8.23,11.89, Vinblastine sulfate inj,J9360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.91,,,,,,,fee schedule,8.23,11.89, Vinblastine sulfate inj,J9360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.89,,,,,,,fee schedule,8.23,11.89, "Inj, efbemalenograstim alfa-",J9361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,219.23,,,,,,,fee schedule,219.23,263.1, "Inj, efbemalenograstim alfa-",J9361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,263.1,,,,,,,fee schedule,219.23,263.1, Vincristine sulfate 1 MG inj,J9370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.24,,,,,,,fee schedule,12.24,18.44, Vincristine sulfate 1 MG inj,J9370,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.24,,,,,,,fee schedule,12.24,18.44, Vincristine sulfate 1 MG inj,J9370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.36,,,,,,,fee schedule,12.24,18.44, Vincristine sulfate 1 MG inj,J9370,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18.44,,,,,,,fee schedule,12.24,18.44, "Inj pozelimab-bbfg, 1 mg",J9376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.98,,,,,,,fee schedule,91.73,197.99, "Inj pozelimab-bbfg, 1 mg",J9376,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.99,,,,,,,fee schedule,91.73,197.99, "Inj pozelimab-bbfg, 1 mg",J9376,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.4,,,,,,,fee schedule,91.73,197.99,APC "Inj pozelimab-bbfg, 1 mg",J9376,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.32,,,,,,,fee schedule,91.73,197.99,APC "Inj pozelimab-bbfg, 1 mg",J9376,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.73,,,,,,,fee schedule,91.73,197.99,APC Inj teclistamab cqyv 0.5 mg,J9380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,51.78,,,,,,,fee schedule,34.5,75.3, Inj teclistamab cqyv 0.5 mg,J9380,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,51.78,,,,,,,fee schedule,34.5,75.3, Inj teclistamab cqyv 0.5 mg,J9380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.74,,,,,,,fee schedule,34.5,75.3, Inj teclistamab cqyv 0.5 mg,J9380,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75.3,,,,,,,fee schedule,34.5,75.3, Inj teclistamab cqyv 0.5 mg,J9380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.5,75.3,APC Inj teclistamab cqyv 0.5 mg,J9380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.23,,,,,,,fee schedule,34.5,75.3,APC Inj teclistamab cqyv 0.5 mg,J9380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.5,,,,,,,fee schedule,34.5,75.3,APC Inj teplizumab mzwv 5 mcg,J9381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,58.61,,,,,,,fee schedule,38.39,84.47, Inj teplizumab mzwv 5 mcg,J9381,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,58.61,,,,,,,fee schedule,38.39,84.47, Inj teplizumab mzwv 5 mcg,J9381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.39,,,,,,,fee schedule,38.39,84.47, Inj teplizumab mzwv 5 mcg,J9381,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,84.47,,,,,,,fee schedule,38.39,84.47, Inj teplizumab mzwv 5 mcg,J9381,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.93,,,,,,,fee schedule,38.39,84.47,APC Inj teplizumab mzwv 5 mcg,J9381,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.31,,,,,,,fee schedule,38.39,84.47,APC Inj teplizumab mzwv 5 mcg,J9381,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.39,,,,,,,fee schedule,38.39,84.47,APC Inj zenocutuzumab-zbco 1 mg,J9382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.51,,,,,,,fee schedule,33.57,73.82, Inj zenocutuzumab-zbco 1 mg,J9382,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,73.82,,,,,,,fee schedule,33.57,73.82, Inj zenocutuzumab-zbco 1 mg,J9382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,34.91,,,,,,,fee schedule,33.57,73.82,APC Inj zenocutuzumab-zbco 1 mg,J9382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.25,,,,,,,fee schedule,33.57,73.82,APC Inj zenocutuzumab-zbco 1 mg,J9382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,33.57,,,,,,,fee schedule,33.57,73.82,APC Vinorelbine tartrate inj,J9390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.05,,,,,,,fee schedule,3.05,17.23, Vinorelbine tartrate inj,J9390,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.05,,,,,,,fee schedule,3.05,17.23, Vinorelbine tartrate inj,J9390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.35,,,,,,,fee schedule,3.05,17.23, Vinorelbine tartrate inj,J9390,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.23,,,,,,,fee schedule,3.05,17.23, "Inj, fulvestrant (teva)",J9393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.13,,,,,,,fee schedule,38.13,45.76, "Inj, fulvestrant (teva)",J9393,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.76,,,,,,,fee schedule,38.13,45.76, "Inj, fulvestrant (teva)",J9393,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.34,,,,,,,fee schedule,38.13,45.76,APC "Inj, fulvestrant (teva)",J9393,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.75,,,,,,,fee schedule,38.13,45.76,APC "Inj, fulvestrant (teva)",J9393,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.67,,,,,,,fee schedule,38.13,45.76,APC "Inj, fulvestrant (fresenius)",J9394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5.16,,,,,,,fee schedule,5.16,60.05, "Inj, fulvestrant (fresenius)",J9394,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5.16,,,,,,,fee schedule,5.16,60.05, "Inj, fulvestrant (fresenius)",J9394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.03,,,,,,,fee schedule,5.16,60.05, "Inj, fulvestrant (fresenius)",J9394,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.05,,,,,,,fee schedule,5.16,60.05, "Inj, fulvestrant (fresenius)",J9394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.2,,,,,,,fee schedule,5.16,60.05,APC "Inj, fulvestrant (fresenius)",J9394,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.47,,,,,,,fee schedule,5.16,60.05,APC "Inj, fulvestrant (fresenius)",J9394,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.11,,,,,,,fee schedule,5.16,60.05,APC "Injection, Fulvestrant",J9395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,10.86,,,,,,,fee schedule,10.86,15.1, "Injection, Fulvestrant",J9395,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.86,,,,,,,fee schedule,10.86,15.1, "Injection, Fulvestrant",J9395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.58,,,,,,,fee schedule,10.86,15.1, "Injection, Fulvestrant",J9395,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.1,,,,,,,fee schedule,10.86,15.1, "Inj, ziv-aflibercept, 1mg",J9400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,12.42,,,,,,,fee schedule,8.61,17.67, "Inj, ziv-aflibercept, 1mg",J9400,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,12.42,,,,,,,fee schedule,8.61,17.67, "Inj, ziv-aflibercept, 1mg",J9400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.73,,,,,,,fee schedule,8.61,17.67, "Inj, ziv-aflibercept, 1mg",J9400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.67,,,,,,,fee schedule,8.61,17.67, "Inj, ziv-aflibercept, 1mg",J9400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.95,,,,,,,fee schedule,8.61,17.67,APC "Inj, ziv-aflibercept, 1mg",J9400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.04,,,,,,,fee schedule,8.61,17.67,APC "Inj, ziv-aflibercept, 1mg",J9400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.61,,,,,,,fee schedule,8.61,17.67,APC Porfimer sodium injection,J9600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,44462.5,,,,,,,fee schedule,44462.5,53359.76, Porfimer sodium injection,J9600,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,53359.76,,,,,,,fee schedule,44462.5,53359.76, Cranial cervical orthosis,L0112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1746.01,,,,,,,fee schedule,1678.86,1762.8,APC Cranial cervical orthosis,L0112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1762.8,,,,,,,fee schedule,1678.86,1762.8,APC Cranial cervical orthosis,L0112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1678.86,,,,,,,fee schedule,1678.86,1762.8,APC Cranial cervical torticollis,L0113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,355.75,,,,,,,fee schedule,342.07,359.17,APC Cranial cervical torticollis,L0113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,359.17,,,,,,,fee schedule,342.07,359.17,APC Cranial cervical torticollis,L0113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,342.07,,,,,,,fee schedule,342.07,359.17,APC Cerv flex n/adj foam pre ots,L0120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.42,,,,,,,fee schedule,32.13,33.74,APC Cerv flex n/adj foam pre ots,L0120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.74,,,,,,,fee schedule,32.13,33.74,APC Cerv flex n/adj foam pre ots,L0120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,32.13,,,,,,,fee schedule,32.13,33.74,APC Flex thermoplastic collar mo,L0130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,236.2,,,,,,,fee schedule,227.12,238.48,APC Flex thermoplastic collar mo,L0130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,238.48,,,,,,,fee schedule,227.12,238.48,APC Flex thermoplastic collar mo,L0130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,227.12,,,,,,,fee schedule,227.12,238.48,APC Cervical semi-rigid adjustab,L0140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,78.11,,,,,,,fee schedule,75.11,78.87,APC Cervical semi-rigid adjustab,L0140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.87,,,,,,,fee schedule,75.11,78.87,APC Cervical semi-rigid adjustab,L0140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,75.11,,,,,,,fee schedule,75.11,78.87,APC Cerv semi-rig adj molded chn,L0150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,143.29,,,,,,,fee schedule,137.78,144.67,APC Cerv semi-rig adj molded chn,L0150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,144.67,,,,,,,fee schedule,137.78,144.67,APC Cerv semi-rig adj molded chn,L0150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137.78,,,,,,,fee schedule,137.78,144.67,APC Cerv sr wire occ/man pre ots,L0160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,187.18,,,,,,,fee schedule,179.98,188.98,APC Cerv sr wire occ/man pre ots,L0160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,188.98,,,,,,,fee schedule,179.98,188.98,APC Cerv sr wire occ/man pre ots,L0160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,179.98,,,,,,,fee schedule,179.98,188.98,APC Cervical collar molded to pt,L0170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,770.72,,,,,,,fee schedule,741.08,778.13,APC Cervical collar molded to pt,L0170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,778.13,,,,,,,fee schedule,741.08,778.13,APC Cervical collar molded to pt,L0170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,741.08,,,,,,,fee schedule,741.08,778.13,APC Cerv col sr foam 2pc pre ots,L0172,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,167.11,,,,,,,fee schedule,160.68,168.71,APC Cerv col sr foam 2pc pre ots,L0172,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,168.71,,,,,,,fee schedule,160.68,168.71,APC Cerv col sr foam 2pc pre ots,L0172,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,160.68,,,,,,,fee schedule,160.68,168.71,APC Cerv sr 2pc thor ext pre ots,L0174,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,328.3,,,,,,,fee schedule,315.67,331.45,APC Cerv sr 2pc thor ext pre ots,L0174,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,331.45,,,,,,,fee schedule,315.67,331.45,APC Cerv sr 2pc thor ext pre ots,L0174,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,315.67,,,,,,,fee schedule,315.67,331.45,APC Cer post col occ/man sup adj,L0180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,455.23,,,,,,,fee schedule,437.72,459.61,APC Cer post col occ/man sup adj,L0180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,459.61,,,,,,,fee schedule,437.72,459.61,APC Cer post col occ/man sup adj,L0180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,437.72,,,,,,,fee schedule,437.72,459.61,APC Cerv collar supp adj cerv ba,L0190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,592,,,,,,,fee schedule,569.23,597.69,APC Cerv collar supp adj cerv ba,L0190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,597.69,,,,,,,fee schedule,569.23,597.69,APC Cerv collar supp adj cerv ba,L0190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,569.23,,,,,,,fee schedule,569.23,597.69,APC Cerv col supp adj bar & thor,L0200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,617.16,,,,,,,fee schedule,593.42,623.09,APC Cerv col supp adj bar & thor,L0200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,623.09,,,,,,,fee schedule,593.42,623.09,APC Cerv col supp adj bar & thor,L0200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,593.42,,,,,,,fee schedule,593.42,623.09,APC Thor rib belt custom fabrica,L0220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,168.53,,,,,,,fee schedule,162.05,170.15,APC Thor rib belt custom fabrica,L0220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,170.15,,,,,,,fee schedule,162.05,170.15,APC Thor rib belt custom fabrica,L0220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,162.05,,,,,,,fee schedule,162.05,170.15,APC Tlso flex trunk/thor pre ots,L0450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,132.4,,,,,,,fee schedule,127.31,133.68,APC Tlso flex trunk/thor pre ots,L0450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,133.68,,,,,,,fee schedule,127.31,133.68,APC Tlso flex trunk/thor pre ots,L0450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,127.31,,,,,,,fee schedule,127.31,133.68,APC Tlso trnk sj-t9 pre cst,L0454,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,432.65,,,,,,,fee schedule,416.01,436.81,APC Tlso trnk sj-t9 pre cst,L0454,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,436.81,,,,,,,fee schedule,416.01,436.81,APC Tlso trnk sj-t9 pre cst,L0454,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.01,,,,,,,fee schedule,416.01,436.81,APC Tlso flex trnk sj-t9 pre ots,L0455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.79,,,,,,,fee schedule,236.34,248.16,APC Tlso flex trnk sj-t9 pre ots,L0455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.16,,,,,,,fee schedule,236.34,248.16,APC Tlso flex trnk sj-t9 pre ots,L0455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,236.34,,,,,,,fee schedule,236.34,248.16,APC Tlso flex trnk sj-ss pre cst,L0456,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1240.71,,,,,,,fee schedule,1192.99,1252.64,APC Tlso flex trnk sj-ss pre cst,L0456,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1252.64,,,,,,,fee schedule,1192.99,1252.64,APC Tlso flex trnk sj-ss pre cst,L0456,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1192.99,,,,,,,fee schedule,1192.99,1252.64,APC Tlso flex trnk sj-ss pre ots,L0457,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,704.86,,,,,,,fee schedule,677.75,711.64,APC Tlso flex trnk sj-ss pre ots,L0457,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,711.64,,,,,,,fee schedule,677.75,711.64,APC Tlso flex trnk sj-ss pre ots,L0457,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,677.75,,,,,,,fee schedule,677.75,711.64,APC TLSO 2Mod symphis-xipho pre,L0458,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1112.54,,,,,,,fee schedule,1069.75,1123.24,APC TLSO 2Mod symphis-xipho pre,L0458,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1123.24,,,,,,,fee schedule,1069.75,1123.24,APC TLSO 2Mod symphis-xipho pre,L0458,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1069.75,,,,,,,fee schedule,1069.75,1123.24,APC Tlso 2 shl symphys-stern cst,L0460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1252.24,,,,,,,fee schedule,1204.08,1264.28,APC Tlso 2 shl symphys-stern cst,L0460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1264.28,,,,,,,fee schedule,1204.08,1264.28,APC Tlso 2 shl symphys-stern cst,L0460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1204.08,,,,,,,fee schedule,1204.08,1264.28,APC TLSO 3Mod sacro-scap pre,L0462,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1557.6,,,,,,,fee schedule,1497.69,1572.57,APC TLSO 3Mod sacro-scap pre,L0462,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1572.57,,,,,,,fee schedule,1497.69,1572.57,APC TLSO 3Mod sacro-scap pre,L0462,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1497.69,,,,,,,fee schedule,1497.69,1572.57,APC TLSO 4Mod sacro-scap pre,L0464,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1854.29,,,,,,,fee schedule,1782.97,1872.12,APC TLSO 4Mod sacro-scap pre,L0464,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1872.12,,,,,,,fee schedule,1782.97,1872.12,APC TLSO 4Mod sacro-scap pre,L0464,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1782.97,,,,,,,fee schedule,1782.97,1872.12,APC Tlso r fram soft ant pre cst,L0466,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,450.69,,,,,,,fee schedule,433.36,455.03,APC Tlso r fram soft ant pre cst,L0466,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,455.03,,,,,,,fee schedule,433.36,455.03,APC Tlso r fram soft ant pre cst,L0466,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,433.36,,,,,,,fee schedule,433.36,455.03,APC Tlso r fram soft pre ots,L0467,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,275.66,,,,,,,fee schedule,265.06,278.31,APC Tlso r fram soft pre ots,L0467,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,278.31,,,,,,,fee schedule,265.06,278.31,APC Tlso r fram soft pre ots,L0467,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,265.06,,,,,,,fee schedule,265.06,278.31,APC Tlso rig fram pelvic pre cst,L0468,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,597.1,,,,,,,fee schedule,574.13,602.84,APC Tlso rig fram pelvic pre cst,L0468,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,602.84,,,,,,,fee schedule,574.13,602.84,APC Tlso rig fram pelvic pre cst,L0468,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,574.13,,,,,,,fee schedule,574.13,602.84,APC Tlso rig fram pelvic pre ots,L0469,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,351.24,,,,,,,fee schedule,337.73,354.62,APC Tlso rig fram pelvic pre ots,L0469,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,354.62,,,,,,,fee schedule,337.73,354.62,APC Tlso rig fram pelvic pre ots,L0469,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,337.73,,,,,,,fee schedule,337.73,354.62,APC TLSO rigid frame pre subclav,L0470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,761.92,,,,,,,fee schedule,732.62,769.25,APC TLSO rigid frame pre subclav,L0470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,769.25,,,,,,,fee schedule,732.62,769.25,APC TLSO rigid frame pre subclav,L0470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,732.62,,,,,,,fee schedule,732.62,769.25,APC TLSO rigid frame hyperex pre,L0472,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,483.23,,,,,,,fee schedule,464.64,487.87,APC TLSO rigid frame hyperex pre,L0472,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,487.87,,,,,,,fee schedule,464.64,487.87,APC TLSO rigid frame hyperex pre,L0472,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,464.64,,,,,,,fee schedule,464.64,487.87,APC TLSO rigid plastic custom fa,L0480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1701.72,,,,,,,fee schedule,1636.27,1718.08,APC TLSO rigid plastic custom fa,L0480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1718.08,,,,,,,fee schedule,1636.27,1718.08,APC TLSO rigid plastic custom fa,L0480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1636.27,,,,,,,fee schedule,1636.27,1718.08,APC TLSO rigid lined custom fab,L0482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1976.62,,,,,,,fee schedule,1900.6,1995.63,APC TLSO rigid lined custom fab,L0482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1995.63,,,,,,,fee schedule,1900.6,1995.63,APC TLSO rigid lined custom fab,L0482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1900.6,,,,,,,fee schedule,1900.6,1995.63,APC TLSO rigid plastic cust fab,L0484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2123.83,,,,,,,fee schedule,2042.14,2144.25,APC TLSO rigid plastic cust fab,L0484,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2144.25,,,,,,,fee schedule,2042.14,2144.25,APC TLSO rigid plastic cust fab,L0484,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2042.14,,,,,,,fee schedule,2042.14,2144.25,APC TLSO rigidlined cust fab two,L0486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2253.26,,,,,,,fee schedule,2166.6,2274.93,APC TLSO rigidlined cust fab two,L0486,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2274.93,,,,,,,fee schedule,2166.6,2274.93,APC TLSO rigidlined cust fab two,L0486,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2166.6,,,,,,,fee schedule,2166.6,2274.93,APC TLSO rigid lined pre one pie,L0488,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1252.24,,,,,,,fee schedule,1204.08,1264.28,APC TLSO rigid lined pre one pie,L0488,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1264.28,,,,,,,fee schedule,1204.08,1264.28,APC TLSO rigid lined pre one pie,L0488,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1204.08,,,,,,,fee schedule,1204.08,1264.28,APC TLSO rigid plastic pre one,L0490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,352.9,,,,,,,fee schedule,339.33,356.3,APC TLSO rigid plastic pre one,L0490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,356.3,,,,,,,fee schedule,339.33,356.3,APC TLSO rigid plastic pre one,L0490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,339.33,,,,,,,fee schedule,339.33,356.3,APC TLSO 2 piece rigid shell,L0491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,958.07,,,,,,,fee schedule,921.22,967.28,APC TLSO 2 piece rigid shell,L0491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,967.28,,,,,,,fee schedule,921.22,967.28,APC TLSO 2 piece rigid shell,L0491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,921.22,,,,,,,fee schedule,921.22,967.28,APC TLSO 3 piece rigid shell,L0492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,630.09,,,,,,,fee schedule,605.86,636.15,APC TLSO 3 piece rigid shell,L0492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,636.15,,,,,,,fee schedule,605.86,636.15,APC TLSO 3 piece rigid shell,L0492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,605.86,,,,,,,fee schedule,605.86,636.15,APC Sio flex pelvic/sacr pre ots,L0621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,69.8,,,,,,,fee schedule,67.12,70.48,APC Sio flex pelvic/sacr pre ots,L0621,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,70.48,,,,,,,fee schedule,67.12,70.48,APC Sio flex pelvic/sacr pre ots,L0621,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,67.12,,,,,,,fee schedule,67.12,70.48,APC Sio flex pelvisacral custom,L0622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,360.94,,,,,,,fee schedule,347.06,364.41,APC Sio flex pelvisacral custom,L0622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,364.41,,,,,,,fee schedule,347.06,364.41,APC Sio flex pelvisacral custom,L0622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,347.06,,,,,,,fee schedule,347.06,364.41,APC Sio rig pnl pelv/sac pre ots,L0623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.13,,,,,,,fee schedule,120.32,126.34,APC Sio rig pnl pelv/sac pre ots,L0623,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.34,,,,,,,fee schedule,120.32,126.34,APC Sio rig pnl pelv/sac pre ots,L0623,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.32,,,,,,,fee schedule,120.32,126.34,APC Lo flex l1-below l5 pre ots,L0625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.05,,,,,,,fee schedule,37.55,39.43,APC Lo flex l1-below l5 pre ots,L0625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.43,,,,,,,fee schedule,37.55,39.43,APC Lo flex l1-below l5 pre ots,L0625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.55,,,,,,,fee schedule,37.55,39.43,APC Lo sag rig pnl stays pre cst,L0626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,97.22,,,,,,,fee schedule,93.48,98.15,APC Lo sag rig pnl stays pre cst,L0626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,98.15,,,,,,,fee schedule,93.48,98.15,APC Lo sag rig pnl stays pre cst,L0626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,93.48,,,,,,,fee schedule,93.48,98.15,APC Lo sag ri an/pos pnl pre cst,L0627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,512.8,,,,,,,fee schedule,493.08,517.73,APC Lo sag ri an/pos pnl pre cst,L0627,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,517.73,,,,,,,fee schedule,493.08,517.73,APC Lo sag ri an/pos pnl pre cst,L0627,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,493.08,,,,,,,fee schedule,493.08,517.73,APC Lso flex no ri stays pre ots,L0628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,59.47,,,,,,,fee schedule,57.18,60.04,APC Lso flex no ri stays pre ots,L0628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,60.04,,,,,,,fee schedule,57.18,60.04,APC Lso flex no ri stays pre ots,L0628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,57.18,,,,,,,fee schedule,57.18,60.04,APC Lso r post pnl sj-t9 pre cst,L0630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,202.03,,,,,,,fee schedule,194.26,203.97,APC Lso r post pnl sj-t9 pre cst,L0630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,203.97,,,,,,,fee schedule,194.26,203.97,APC Lso r post pnl sj-t9 pre cst,L0630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,194.26,,,,,,,fee schedule,194.26,203.97,APC Lso sag r an/pos pnl pre cst,L0631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1280.64,,,,,,,fee schedule,1231.38,1292.95,APC Lso sag r an/pos pnl pre cst,L0631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1292.95,,,,,,,fee schedule,1231.38,1292.95,APC Lso sag r an/pos pnl pre cst,L0631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1231.38,,,,,,,fee schedule,1231.38,1292.95,APC Lso sc r pos/lat pnl pre cst,L0633,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,357.73,,,,,,,fee schedule,343.97,361.17,APC Lso sc r pos/lat pnl pre cst,L0633,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,361.17,,,,,,,fee schedule,343.97,361.17,APC Lso sc r pos/lat pnl pre cst,L0633,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,343.97,,,,,,,fee schedule,343.97,361.17,APC Lso sagit rigid panel prefab,L0635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1143.93,,,,,,,fee schedule,1099.93,1154.93,APC Lso sagit rigid panel prefab,L0635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1154.93,,,,,,,fee schedule,1099.93,1154.93,APC Lso sagit rigid panel prefab,L0635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1099.93,,,,,,,fee schedule,1099.93,1154.93,APC Lso sagittal rigid panel cus,L0636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1693.44,,,,,,,fee schedule,1628.31,1709.73,APC Lso sagittal rigid panel cus,L0636,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1709.73,,,,,,,fee schedule,1628.31,1709.73,APC Lso sagittal rigid panel cus,L0636,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1628.31,,,,,,,fee schedule,1628.31,1709.73,APC Lso sc r ant/pos pnl pre cst,L0637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1340.14,,,,,,,fee schedule,1288.6,1353.03,APC Lso sc r ant/pos pnl pre cst,L0637,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1353.03,,,,,,,fee schedule,1288.6,1353.03,APC Lso sc r ant/pos pnl pre cst,L0637,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1288.6,,,,,,,fee schedule,1288.6,1353.03,APC Lso sag-coronal panel custom,L0638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1645.3,,,,,,,fee schedule,1582.02,1661.12,APC Lso sag-coronal panel custom,L0638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1661.12,,,,,,,fee schedule,1582.02,1661.12,APC Lso sag-coronal panel custom,L0638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1582.02,,,,,,,fee schedule,1582.02,1661.12,APC Lso s/c shell/panel prefab,L0639,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1340.14,,,,,,,fee schedule,1288.6,1353.03,APC Lso s/c shell/panel prefab,L0639,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1353.03,,,,,,,fee schedule,1288.6,1353.03,APC Lso s/c shell/panel prefab,L0639,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1288.6,,,,,,,fee schedule,1288.6,1353.03,APC Lso s/c shell/panel custom,L0640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1305.4,,,,,,,fee schedule,1255.19,1317.95,APC Lso s/c shell/panel custom,L0640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1317.95,,,,,,,fee schedule,1255.19,1317.95,APC Lso s/c shell/panel custom,L0640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1255.19,,,,,,,fee schedule,1255.19,1317.95,APC Lo rig pos pnl l1-l5 pre ots,L0641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,55.26,,,,,,,fee schedule,53.13,55.79,APC Lo rig pos pnl l1-l5 pre ots,L0641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,55.79,,,,,,,fee schedule,53.13,55.79,APC Lo rig pos pnl l1-l5 pre ots,L0641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,53.13,,,,,,,fee schedule,53.13,55.79,APC Lo sag ri an/pos pnl pre ots,L0642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,291.39,,,,,,,fee schedule,280.18,294.19,APC Lo sag ri an/pos pnl pre ots,L0642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,294.19,,,,,,,fee schedule,280.18,294.19,APC Lo sag ri an/pos pnl pre ots,L0642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,280.18,,,,,,,fee schedule,280.18,294.19,APC Lso sag ctr rigi pos pre ots,L0643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,114.8,,,,,,,fee schedule,110.38,115.9,APC Lso sag ctr rigi pos pre ots,L0643,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,115.9,,,,,,,fee schedule,110.38,115.9,APC Lso sag ctr rigi pos pre ots,L0643,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,110.38,,,,,,,fee schedule,110.38,115.9,APC Lso sag r an/pos pnl pre ots,L0648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,727.7,,,,,,,fee schedule,699.71,734.7,APC Lso sag r an/pos pnl pre ots,L0648,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,734.7,,,,,,,fee schedule,699.71,734.7,APC Lso sag r an/pos pnl pre ots,L0648,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,699.71,,,,,,,fee schedule,699.71,734.7,APC Lso sc r pos/lat pnl pre ots,L0649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,203.28,,,,,,,fee schedule,195.46,205.23,APC Lso sc r pos/lat pnl pre ots,L0649,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,205.23,,,,,,,fee schedule,195.46,205.23,APC Lso sc r pos/lat pnl pre ots,L0649,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,195.46,,,,,,,fee schedule,195.46,205.23,APC Lso sc r ant/pos pnl pre ots,L0650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,841.99,,,,,,,fee schedule,809.61,850.09,APC Lso sc r ant/pos pnl pre ots,L0650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,850.09,,,,,,,fee schedule,809.61,850.09,APC Lso sc r ant/pos pnl pre ots,L0650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,809.61,,,,,,,fee schedule,809.61,850.09,APC LSO sag-co shell pnl pre ots,L0651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,841.99,,,,,,,fee schedule,809.61,850.09,APC LSO sag-co shell pnl pre ots,L0651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,850.09,,,,,,,fee schedule,809.61,850.09,APC LSO sag-co shell pnl pre ots,L0651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,809.61,,,,,,,fee schedule,809.61,850.09,APC Ctlso a-p-l control molded,L0700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2443.11,,,,,,,fee schedule,2349.14,2466.6,APC Ctlso a-p-l control molded,L0700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2466.6,,,,,,,fee schedule,2349.14,2466.6,APC Ctlso a-p-l control molded,L0700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2349.14,,,,,,,fee schedule,2349.14,2466.6,APC Ctlso a-p-l control w/ inter,L0710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2495.94,,,,,,,fee schedule,2399.94,2519.94,APC Ctlso a-p-l control w/ inter,L0710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2519.94,,,,,,,fee schedule,2399.94,2519.94,APC Ctlso a-p-l control w/ inter,L0710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2399.94,,,,,,,fee schedule,2399.94,2519.94,APC Ctlso a-p-l control custom,L0720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2309.52,,,,,,,fee schedule,2220.69,2331.72,APC Ctlso a-p-l control custom,L0720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2331.72,,,,,,,fee schedule,2220.69,2331.72,APC Ctlso a-p-l control custom,L0720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2220.69,,,,,,,fee schedule,2220.69,2331.72,APC Halo cervical into jckt vest,L0810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3121.49,,,,,,,fee schedule,3001.43,3151.5,APC Halo cervical into jckt vest,L0810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3151.5,,,,,,,fee schedule,3001.43,3151.5,APC Halo cervical into jckt vest,L0810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3001.43,,,,,,,fee schedule,3001.43,3151.5,APC Halo cervical into body jack,L0820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2801.73,,,,,,,fee schedule,2693.97,2828.67,APC Halo cervical into body jack,L0820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2828.67,,,,,,,fee schedule,2693.97,2828.67,APC Halo cervical into body jack,L0820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2693.97,,,,,,,fee schedule,2693.97,2828.67,APC Halo cerv into milwaukee typ,L0830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3948.47,,,,,,,fee schedule,3796.61,3986.44,APC Halo cerv into milwaukee typ,L0830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3986.44,,,,,,,fee schedule,3796.61,3986.44,APC Halo cerv into milwaukee typ,L0830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3796.61,,,,,,,fee schedule,3796.61,3986.44,APC MRI compatible system,L0859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1645.5,,,,,,,fee schedule,1582.21,1661.32,APC MRI compatible system,L0859,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1661.32,,,,,,,fee schedule,1582.21,1661.32,APC MRI compatible system,L0859,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1582.21,,,,,,,fee schedule,1582.21,1661.32,APC Halo repl liner/interface,L0861,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,268.87,,,,,,,fee schedule,258.53,271.46,APC Halo repl liner/interface,L0861,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,271.46,,,,,,,fee schedule,258.53,271.46,APC Halo repl liner/interface,L0861,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,258.53,,,,,,,fee schedule,258.53,271.46,APC Tlso corset front,L0970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,160.7,,,,,,,fee schedule,154.52,162.25,APC Tlso corset front,L0970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,162.25,,,,,,,fee schedule,154.52,162.25,APC Tlso corset front,L0970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,154.52,,,,,,,fee schedule,154.52,162.25,APC Lso corset front,L0972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,144.34,,,,,,,fee schedule,138.79,145.73,APC Lso corset front,L0972,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,145.73,,,,,,,fee schedule,138.79,145.73,APC Lso corset front,L0972,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,138.79,,,,,,,fee schedule,138.79,145.73,APC Tlso full corset,L0974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,214.34,,,,,,,fee schedule,206.1,216.4,APC Tlso full corset,L0974,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,216.4,,,,,,,fee schedule,206.1,216.4,APC Tlso full corset,L0974,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,206.1,,,,,,,fee schedule,206.1,216.4,APC Lso full corset,L0976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,191.1,,,,,,,fee schedule,183.75,192.94,APC Lso full corset,L0976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,192.94,,,,,,,fee schedule,183.75,192.94,APC Lso full corset,L0976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,183.75,,,,,,,fee schedule,183.75,192.94,APC Axillary crutch extension,L0978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,252.23,,,,,,,fee schedule,242.53,254.66,APC Axillary crutch extension,L0978,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,254.66,,,,,,,fee schedule,242.53,254.66,APC Axillary crutch extension,L0978,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,242.53,,,,,,,fee schedule,242.53,254.66,APC Peroneal straps pair pre ots,L0980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.53,,,,,,,fee schedule,26.47,27.79,APC Peroneal straps pair pre ots,L0980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.79,,,,,,,fee schedule,26.47,27.79,APC Peroneal straps pair pre ots,L0980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.47,,,,,,,fee schedule,26.47,27.79,APC Stocking sup grips 4 pre ots,L0982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.46,,,,,,,fee schedule,18.71,19.65,APC Stocking sup grips 4 pre ots,L0982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.65,,,,,,,fee schedule,18.71,19.65,APC Stocking sup grips 4 pre ots,L0982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.71,,,,,,,fee schedule,18.71,19.65,APC Protect body sock ea pre ots,L0984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.78,,,,,,,fee schedule,77.67,81.55,APC Protect body sock ea pre ots,L0984,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,81.55,,,,,,,fee schedule,77.67,81.55,APC Protect body sock ea pre ots,L0984,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.67,,,,,,,fee schedule,77.67,81.55,APC Ctlso milwauke initial model,L1000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2451.17,,,,,,,fee schedule,2356.89,2474.73,APC Ctlso milwauke initial model,L1000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2474.73,,,,,,,fee schedule,2356.89,2474.73,APC Ctlso milwauke initial model,L1000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2356.89,,,,,,,fee schedule,2356.89,2474.73,APC Tension based scoliosis orth,L1005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3992.77,,,,,,,fee schedule,3839.2,4031.16,APC Tension based scoliosis orth,L1005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4031.16,,,,,,,fee schedule,3839.2,4031.16,APC Tension based scoliosis orth,L1005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3839.2,,,,,,,fee schedule,3839.2,4031.16,APC Ctlso axilla sling,L1010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.2,,,,,,,fee schedule,77.12,80.98,APC Ctlso axilla sling,L1010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80.98,,,,,,,fee schedule,77.12,80.98,APC Ctlso axilla sling,L1010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.12,,,,,,,fee schedule,77.12,80.98,APC Kyphosis pad,L1020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,103.3,,,,,,,fee schedule,99.33,104.3,APC Kyphosis pad,L1020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,104.3,,,,,,,fee schedule,99.33,104.3,APC Kyphosis pad,L1020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,99.33,,,,,,,fee schedule,99.33,104.3,APC Kyphosis pad floating,L1025,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,197.18,,,,,,,fee schedule,189.6,199.08,APC Kyphosis pad floating,L1025,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,199.08,,,,,,,fee schedule,189.6,199.08,APC Kyphosis pad floating,L1025,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,189.6,,,,,,,fee schedule,189.6,199.08,APC Lumbar bolster pad,L1030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.02,,,,,,,fee schedule,73.1,76.76,APC Lumbar bolster pad,L1030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,76.76,,,,,,,fee schedule,73.1,76.76,APC Lumbar bolster pad,L1030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.1,,,,,,,fee schedule,73.1,76.76,APC Lumbar or lumbar rib pad,L1040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,99.51,,,,,,,fee schedule,95.68,100.46,APC Lumbar or lumbar rib pad,L1040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,100.46,,,,,,,fee schedule,95.68,100.46,APC Lumbar or lumbar rib pad,L1040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,95.68,,,,,,,fee schedule,95.68,100.46,APC Sternal pad,L1050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.93,,,,,,,fee schedule,115.32,121.09,APC Sternal pad,L1050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,121.09,,,,,,,fee schedule,115.32,121.09,APC Sternal pad,L1050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,115.32,,,,,,,fee schedule,115.32,121.09,APC Thoracic pad,L1060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,143.85,,,,,,,fee schedule,138.32,145.24,APC Thoracic pad,L1060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,145.24,,,,,,,fee schedule,138.32,145.24,APC Thoracic pad,L1060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,138.32,,,,,,,fee schedule,138.32,145.24,APC Trapezius sling,L1070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,140.46,,,,,,,fee schedule,135.06,141.81,APC Trapezius sling,L1070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,141.81,,,,,,,fee schedule,135.06,141.81,APC Trapezius sling,L1070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,135.06,,,,,,,fee schedule,135.06,141.81,APC Outrigger,L1080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79,,,,,,,fee schedule,75.96,79.76,APC Outrigger,L1080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,79.76,,,,,,,fee schedule,75.96,79.76,APC Outrigger,L1080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,75.96,,,,,,,fee schedule,75.96,79.76,APC Outrigger bil w/ vert extens,L1085,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,213.75,,,,,,,fee schedule,205.53,215.81,APC Outrigger bil w/ vert extens,L1085,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,215.81,,,,,,,fee schedule,205.53,215.81,APC Outrigger bil w/ vert extens,L1085,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,205.53,,,,,,,fee schedule,205.53,215.81,APC Lumbar sling,L1090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,141.4,,,,,,,fee schedule,135.96,142.76,APC Lumbar sling,L1090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,142.76,,,,,,,fee schedule,135.96,142.76,APC Lumbar sling,L1090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,135.96,,,,,,,fee schedule,135.96,142.76,APC Ring flange plastic/leather,L1100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,225.82,,,,,,,fee schedule,217.13,227.99,APC Ring flange plastic/leather,L1100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,227.99,,,,,,,fee schedule,217.13,227.99,APC Ring flange plastic/leather,L1100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,217.13,,,,,,,fee schedule,217.13,227.99,APC Ring flange plas/leather mol,L1110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,305.23,,,,,,,fee schedule,293.49,308.16,APC Ring flange plas/leather mol,L1110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,308.16,,,,,,,fee schedule,293.49,308.16,APC Ring flange plas/leather mol,L1110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,293.49,,,,,,,fee schedule,293.49,308.16,APC Covers for upright each,L1120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,51.62,,,,,,,fee schedule,49.63,52.11,APC Covers for upright each,L1120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.11,,,,,,,fee schedule,49.63,52.11,APC Covers for upright each,L1120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,49.63,,,,,,,fee schedule,49.63,52.11,APC Furnsh initial orthosis only,L1200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1872.49,,,,,,,fee schedule,1800.47,1890.49,APC Furnsh initial orthosis only,L1200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1890.49,,,,,,,fee schedule,1800.47,1890.49,APC Furnsh initial orthosis only,L1200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1800.47,,,,,,,fee schedule,1800.47,1890.49,APC Lateral thoracic extension,L1210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,312.71,,,,,,,fee schedule,300.68,315.71,APC Lateral thoracic extension,L1210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,315.71,,,,,,,fee schedule,300.68,315.71,APC Lateral thoracic extension,L1210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,300.68,,,,,,,fee schedule,300.68,315.71,APC Anterior thoracic extension,L1220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,298.73,,,,,,,fee schedule,287.24,301.6,APC Anterior thoracic extension,L1220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,301.6,,,,,,,fee schedule,287.24,301.6,APC Anterior thoracic extension,L1220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,287.24,,,,,,,fee schedule,287.24,301.6,APC Milwaukee type superstructur,L1230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,765.72,,,,,,,fee schedule,736.27,773.08,APC Milwaukee type superstructur,L1230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,773.08,,,,,,,fee schedule,736.27,773.08,APC Milwaukee type superstructur,L1230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,736.27,,,,,,,fee schedule,736.27,773.08,APC Lumbar derotation pad,L1240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,103.51,,,,,,,fee schedule,99.53,104.51,APC Lumbar derotation pad,L1240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,104.51,,,,,,,fee schedule,99.53,104.51,APC Lumbar derotation pad,L1240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,99.53,,,,,,,fee schedule,99.53,104.51,APC Anterior asis pad,L1250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,103.51,,,,,,,fee schedule,99.53,104.51,APC Anterior asis pad,L1250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,104.51,,,,,,,fee schedule,99.53,104.51,APC Anterior asis pad,L1250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,99.53,,,,,,,fee schedule,99.53,104.51,APC Anterior thoracic derotation,L1260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,105.7,,,,,,,fee schedule,101.63,106.71,APC Anterior thoracic derotation,L1260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,106.71,,,,,,,fee schedule,101.63,106.71,APC Anterior thoracic derotation,L1260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,101.63,,,,,,,fee schedule,101.63,106.71,APC Abdominal pad,L1270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,107.36,,,,,,,fee schedule,103.23,108.39,APC Abdominal pad,L1270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,108.39,,,,,,,fee schedule,103.23,108.39,APC Abdominal pad,L1270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,103.23,,,,,,,fee schedule,103.23,108.39,APC Rib gusset (elastic) each,L1280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,123.5,,,,,,,fee schedule,118.75,124.69,APC Rib gusset (elastic) each,L1280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,124.69,,,,,,,fee schedule,118.75,124.69,APC Rib gusset (elastic) each,L1280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,118.75,,,,,,,fee schedule,118.75,124.69,APC Lateral trochanteric pad,L1290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,97.76,,,,,,,fee schedule,94,98.7,APC Lateral trochanteric pad,L1290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,98.7,,,,,,,fee schedule,94,98.7,APC Lateral trochanteric pad,L1290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,94,,,,,,,fee schedule,94,98.7,APC Body jacket mold to patient,L1300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2201.27,,,,,,,fee schedule,2116.61,2222.44,APC Body jacket mold to patient,L1300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2222.44,,,,,,,fee schedule,2116.61,2222.44,APC Body jacket mold to patient,L1300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2116.61,,,,,,,fee schedule,2116.61,2222.44,APC Post-operative body jacket,L1310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2261.82,,,,,,,fee schedule,2174.83,2283.57,APC Post-operative body jacket,L1310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2283.57,,,,,,,fee schedule,2174.83,2283.57,APC Post-operative body jacket,L1310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2174.83,,,,,,,fee schedule,2174.83,2283.57,APC Ho flex frejka w/cov pre cst,L1600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,154,,,,,,,fee schedule,148.08,155.48,APC Ho flex frejka w/cov pre cst,L1600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,155.48,,,,,,,fee schedule,148.08,155.48,APC Ho flex frejka w/cov pre cst,L1600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,148.08,,,,,,,fee schedule,148.08,155.48,APC Ho frejka cov only pre cst,L1610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,67.96,,,,,,,fee schedule,65.35,68.62,APC Ho frejka cov only pre cst,L1610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.62,,,,,,,fee schedule,65.35,68.62,APC Ho frejka cov only pre cst,L1610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,65.35,,,,,,,fee schedule,65.35,68.62,APC Ho flex pavlik harns pre cst,L1620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.47,,,,,,,fee schedule,185.07,194.32,APC Ho flex pavlik harns pre cst,L1620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.32,,,,,,,fee schedule,185.07,194.32,APC Ho flex pavlik harns pre cst,L1620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,185.07,,,,,,,fee schedule,185.07,194.32,APC Abduct control hip semi-flex,L1630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,202.51,,,,,,,fee schedule,194.72,204.46,APC Abduct control hip semi-flex,L1630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,204.46,,,,,,,fee schedule,194.72,204.46,APC Abduct control hip semi-flex,L1630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,194.72,,,,,,,fee schedule,194.72,204.46,APC Pelv band/spread bar thigh c,L1640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,616.44,,,,,,,fee schedule,592.73,622.37,APC Pelv band/spread bar thigh c,L1640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,622.37,,,,,,,fee schedule,592.73,622.37,APC Pelv band/spread bar thigh c,L1640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,592.73,,,,,,,fee schedule,592.73,622.37,APC HO abduction hip adjustable,L1650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,311.95,,,,,,,fee schedule,299.95,314.95,APC HO abduction hip adjustable,L1650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,314.95,,,,,,,fee schedule,299.95,314.95,APC HO abduction hip adjustable,L1650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,299.95,,,,,,,fee schedule,299.95,314.95,APC HO bi thighcuffs w sprdr bar,L1652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,444.66,,,,,,,fee schedule,427.56,448.94,APC HO bi thighcuffs w sprdr bar,L1652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,448.94,,,,,,,fee schedule,427.56,448.94,APC HO bi thighcuffs w sprdr bar,L1652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,427.56,,,,,,,fee schedule,427.56,448.94,APC HO abduction static plastic,L1660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,204.53,,,,,,,fee schedule,196.66,206.49,APC HO abduction static plastic,L1660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,206.49,,,,,,,fee schedule,196.66,206.49,APC HO abduction static plastic,L1660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,196.66,,,,,,,fee schedule,196.66,206.49,APC Pelvic & hip control thigh c,L1680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1456.11,,,,,,,fee schedule,1400.11,1470.12,APC Pelvic & hip control thigh c,L1680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1470.12,,,,,,,fee schedule,1400.11,1470.12,APC Pelvic & hip control thigh c,L1680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1400.11,,,,,,,fee schedule,1400.11,1470.12,APC Ho bilateral hip abduction,L1681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2744.33,,,,,,,fee schedule,2638.78,2770.72,APC Ho bilateral hip abduction,L1681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2770.72,,,,,,,fee schedule,2638.78,2770.72,APC Ho bilateral hip abduction,L1681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2638.78,,,,,,,fee schedule,2638.78,2770.72,APC Post-op hip abduct custom fa,L1685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1486.05,,,,,,,fee schedule,1428.89,1500.33,APC Post-op hip abduct custom fa,L1685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1500.33,,,,,,,fee schedule,1428.89,1500.33,APC Post-op hip abduct custom fa,L1685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1428.89,,,,,,,fee schedule,1428.89,1500.33,APC HO post-op hip abduction,L1686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1372.17,,,,,,,fee schedule,1319.39,1385.36,APC HO post-op hip abduction,L1686,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1385.36,,,,,,,fee schedule,1319.39,1385.36,APC HO post-op hip abduction,L1686,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1319.39,,,,,,,fee schedule,1319.39,1385.36,APC Combination bilateral HO,L1690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2412.32,,,,,,,fee schedule,2319.54,2435.52,APC Combination bilateral HO,L1690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2435.52,,,,,,,fee schedule,2319.54,2435.52,APC Combination bilateral HO,L1690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2319.54,,,,,,,fee schedule,2319.54,2435.52,APC Leg perthes orth toronto typ,L1700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1825.03,,,,,,,fee schedule,1754.84,1842.58,APC Leg perthes orth toronto typ,L1700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1842.58,,,,,,,fee schedule,1754.84,1842.58,APC Leg perthes orth toronto typ,L1700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1754.84,,,,,,,fee schedule,1754.84,1842.58,APC Legg perthes orth newington,L1710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2136.4,,,,,,,fee schedule,2054.23,2156.94,APC Legg perthes orth newington,L1710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2156.94,,,,,,,fee schedule,2054.23,2156.94,APC Legg perthes orth newington,L1710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2054.23,,,,,,,fee schedule,2054.23,2156.94,APC Legg perthes orthosis trilat,L1720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1574.78,,,,,,,fee schedule,1514.21,1589.92,APC Legg perthes orthosis trilat,L1720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1589.92,,,,,,,fee schedule,1514.21,1589.92,APC Legg perthes orthosis trilat,L1720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1514.21,,,,,,,fee schedule,1514.21,1589.92,APC Legg perthes orth scottish r,L1730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1352.58,,,,,,,fee schedule,1300.56,1365.59,APC Legg perthes orth scottish r,L1730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1365.59,,,,,,,fee schedule,1300.56,1365.59,APC Legg perthes orth scottish r,L1730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1300.56,,,,,,,fee schedule,1300.56,1365.59,APC Legg perthes patten bottom t,L1755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2146.47,,,,,,,fee schedule,2063.91,2167.11,APC Legg perthes patten bottom t,L1755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2167.11,,,,,,,fee schedule,2063.91,2167.11,APC Legg perthes patten bottom t,L1755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2063.91,,,,,,,fee schedule,2063.91,2167.11,APC Ko elastic with joints,L1810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,117.7,,,,,,,fee schedule,113.17,118.83,APC Ko elastic with joints,L1810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,118.83,,,,,,,fee schedule,113.17,118.83,APC Ko elastic with joints,L1810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,113.17,,,,,,,fee schedule,113.17,118.83,APC Ko elastic w/joints pre ots,L1812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.74,,,,,,,fee schedule,77.63,81.51,APC Ko elastic w/joints pre ots,L1812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,81.51,,,,,,,fee schedule,77.63,81.51,APC Ko elastic w/joints pre ots,L1812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.63,,,,,,,fee schedule,77.63,81.51,APC Ko elas w/ condyle pads & jo,L1820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.33,,,,,,,fee schedule,175.32,184.09,APC Ko elas w/ condyle pads & jo,L1820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.09,,,,,,,fee schedule,175.32,184.09,APC Ko elas w/ condyle pads & jo,L1820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.32,,,,,,,fee schedule,175.32,184.09,APC Ko immob canvas long pre ots,L1830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.74,,,,,,,fee schedule,69.94,73.44,APC Ko immob canvas long pre ots,L1830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.44,,,,,,,fee schedule,69.94,73.44,APC Ko immob canvas long pre ots,L1830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.94,,,,,,,fee schedule,69.94,73.44,APC Knee orth pos locking joint,L1831,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,367.16,,,,,,,fee schedule,353.04,370.69,APC Knee orth pos locking joint,L1831,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,370.69,,,,,,,fee schedule,353.04,370.69,APC Knee orth pos locking joint,L1831,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,353.04,,,,,,,fee schedule,353.04,370.69,APC Ko adj jnt pos r sup pre cst,L1832,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,845.2,,,,,,,fee schedule,812.69,853.32,APC Ko adj jnt pos r sup pre cst,L1832,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,853.32,,,,,,,fee schedule,812.69,853.32,APC Ko adj jnt pos r sup pre cst,L1832,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,812.69,,,,,,,fee schedule,812.69,853.32,APC Ko adj jnt pos r sup pre ots,L1833,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,524.02,,,,,,,fee schedule,503.87,529.06,APC Ko adj jnt pos r sup pre ots,L1833,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,529.06,,,,,,,fee schedule,503.87,529.06,APC Ko adj jnt pos r sup pre ots,L1833,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,503.87,,,,,,,fee schedule,503.87,529.06,APC Ko w/0 joint rigid molded to,L1834,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,927.7,,,,,,,fee schedule,892.02,936.62,APC Ko w/0 joint rigid molded to,L1834,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,936.62,,,,,,,fee schedule,892.02,936.62,APC Ko w/0 joint rigid molded to,L1834,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,892.02,,,,,,,fee schedule,892.02,936.62,APC Ko rigid w/o joints pre ots,L1836,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,102.86,,,,,,,fee schedule,98.9,103.84,APC Ko rigid w/o joints pre ots,L1836,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,103.85,,,,,,,fee schedule,98.9,103.84,APC Ko rigid w/o joints pre ots,L1836,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,98.9,,,,,,,fee schedule,98.9,103.84,APC Ko derot ant cruciate custom,L1840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1235.73,,,,,,,fee schedule,1188.2,1247.61,APC Ko derot ant cruciate custom,L1840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1247.61,,,,,,,fee schedule,1188.2,1247.61,APC Ko derot ant cruciate custom,L1840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1188.2,,,,,,,fee schedule,1188.2,1247.61,APC Ko single upright pre cst,L1843,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1119.31,,,,,,,fee schedule,1076.26,1130.07,APC Ko single upright pre cst,L1843,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1130.07,,,,,,,fee schedule,1076.26,1130.07,APC Ko single upright pre cst,L1843,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1076.26,,,,,,,fee schedule,1076.26,1130.07,APC Ko w/adj jt rot cntrl molded,L1844,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1940.13,,,,,,,fee schedule,1865.51,1958.79,APC Ko w/adj jt rot cntrl molded,L1844,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1958.79,,,,,,,fee schedule,1865.51,1958.79,APC Ko w/adj jt rot cntrl molded,L1844,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1865.51,,,,,,,fee schedule,1865.51,1958.79,APC Ko double upright pre cst,L1845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1161.56,,,,,,,fee schedule,1116.88,1172.72,APC Ko double upright pre cst,L1845,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1172.72,,,,,,,fee schedule,1116.88,1172.72,APC Ko double upright pre cst,L1845,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1116.88,,,,,,,fee schedule,1116.88,1172.72,APC Ko w adj flex/ext rotat mold,L1846,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1424.14,,,,,,,fee schedule,1369.37,1437.84,APC Ko w adj flex/ext rotat mold,L1846,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1437.84,,,,,,,fee schedule,1369.37,1437.84,APC Ko w adj flex/ext rotat mold,L1846,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1369.37,,,,,,,fee schedule,1369.37,1437.84,APC Ko dbl upright w/air pre cst,L1847,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,717.52,,,,,,,fee schedule,689.92,724.42,APC Ko dbl upright w/air pre cst,L1847,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,724.42,,,,,,,fee schedule,689.92,724.42,APC Ko dbl upright w/air pre cst,L1847,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,689.92,,,,,,,fee schedule,689.92,724.42,APC Ko dbl upright w/air pre ots,L1848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,717.52,,,,,,,fee schedule,689.92,724.42,APC Ko dbl upright w/air pre ots,L1848,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,724.42,,,,,,,fee schedule,689.92,724.42,APC Ko dbl upright w/air pre ots,L1848,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,689.92,,,,,,,fee schedule,689.92,724.42,APC Ko swedish type pre ots,L1850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,236.91,,,,,,,fee schedule,227.8,239.19,APC Ko swedish type pre ots,L1850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,239.19,,,,,,,fee schedule,227.8,239.19,APC Ko swedish type pre ots,L1850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,227.8,,,,,,,fee schedule,227.8,239.19,APC Ko single upright prefab ots,L1851,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,691.66,,,,,,,fee schedule,665.06,698.31,APC Ko single upright prefab ots,L1851,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,698.31,,,,,,,fee schedule,665.06,698.31,APC Ko single upright prefab ots,L1851,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,665.06,,,,,,,fee schedule,665.06,698.31,APC Ko double upright prefab ots,L1852,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,659.84,,,,,,,fee schedule,634.46,666.18,APC Ko double upright prefab ots,L1852,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,666.18,,,,,,,fee schedule,634.46,666.18,APC Ko double upright prefab ots,L1852,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,634.46,,,,,,,fee schedule,634.46,666.18,APC Ko supracondylar socket mold,L1860,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1282.39,,,,,,,fee schedule,1233.07,1294.72,APC Ko supracondylar socket mold,L1860,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1294.72,,,,,,,fee schedule,1233.07,1294.72,APC Ko supracondylar socket mold,L1860,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1233.07,,,,,,,fee schedule,1233.07,1294.72,APC Afo sprng wir drsflx calf bd,L1900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,322.41,,,,,,,fee schedule,310.01,325.51,APC Afo sprng wir drsflx calf bd,L1900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,325.51,,,,,,,fee schedule,310.01,325.51,APC Afo sprng wir drsflx calf bd,L1900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,310.01,,,,,,,fee schedule,310.01,325.51,APC Afo ankle gauntlet pre ots,L1902,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,111.4,,,,,,,fee schedule,107.12,112.48,APC Afo ankle gauntlet pre ots,L1902,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,112.48,,,,,,,fee schedule,107.12,112.48,APC Afo ankle gauntlet pre ots,L1902,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,107.12,,,,,,,fee schedule,107.12,112.48,APC Afo molded ankle gauntlet,L1904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,669.96,,,,,,,fee schedule,644.19,676.4,APC Afo molded ankle gauntlet,L1904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,676.4,,,,,,,fee schedule,644.19,676.4,APC Afo molded ankle gauntlet,L1904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,644.19,,,,,,,fee schedule,644.19,676.4,APC Afo multilig ank sup pre ots,L1906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,143.73,,,,,,,fee schedule,138.2,145.11,APC Afo multilig ank sup pre ots,L1906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,145.11,,,,,,,fee schedule,138.2,145.11,APC Afo multilig ank sup pre ots,L1906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,138.2,,,,,,,fee schedule,138.2,145.11,APC AFO supramalleolar custom,L1907,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,701.95,,,,,,,fee schedule,674.95,708.7,APC AFO supramalleolar custom,L1907,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,708.7,,,,,,,fee schedule,674.95,708.7,APC AFO supramalleolar custom,L1907,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,674.95,,,,,,,fee schedule,674.95,708.7,APC Afo sing bar clasp attach sh,L1910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,326.38,,,,,,,fee schedule,313.83,329.52,APC Afo sing bar clasp attach sh,L1910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,329.52,,,,,,,fee schedule,313.83,329.52,APC Afo sing bar clasp attach sh,L1910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,313.83,,,,,,,fee schedule,313.83,329.52,APC Afo sing upright w/ adjust s,L1920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,417.8,,,,,,,fee schedule,401.73,421.82,APC Afo sing upright w/ adjust s,L1920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,421.82,,,,,,,fee schedule,401.73,421.82,APC Afo sing upright w/ adjust s,L1920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,401.73,,,,,,,fee schedule,401.73,421.82,APC Afo plastic,L1930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,282.71,,,,,,,fee schedule,271.84,285.43,APC Afo plastic,L1930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,285.43,,,,,,,fee schedule,271.84,285.43,APC Afo plastic,L1930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,271.84,,,,,,,fee schedule,271.84,285.43,APC Afo rig ant tib prefab TCF/=,L1932,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1113.21,,,,,,,fee schedule,1070.39,1123.91,APC Afo rig ant tib prefab TCF/=,L1932,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1123.91,,,,,,,fee schedule,1070.39,1123.91,APC Afo rig ant tib prefab TCF/=,L1932,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1070.39,,,,,,,fee schedule,1070.39,1123.91,APC Afo rig ant tib tcf/= ots,L1933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1113.21,,,,,,,fee schedule,1070.39,1123.91,APC Afo rig ant tib tcf/= ots,L1933,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1123.91,,,,,,,fee schedule,1070.39,1123.91,APC Afo rig ant tib tcf/= ots,L1933,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1070.39,,,,,,,fee schedule,1070.39,1123.91,APC Afo molded to patient plasti,L1940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,591.03,,,,,,,fee schedule,568.3,596.72,APC Afo molded to patient plasti,L1940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,596.72,,,,,,,fee schedule,568.3,596.72,APC Afo molded to patient plasti,L1940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,568.3,,,,,,,fee schedule,568.3,596.72,APC Afo molded plas rig ant tib,L1945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1413.04,,,,,,,fee schedule,1358.69,1426.62,APC Afo molded plas rig ant tib,L1945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1426.62,,,,,,,fee schedule,1358.69,1426.62,APC Afo molded plas rig ant tib,L1945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1358.69,,,,,,,fee schedule,1358.69,1426.62,APC Afo spiral molded to pt plas,L1950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,936.9,,,,,,,fee schedule,900.87,945.91,APC Afo spiral molded to pt plas,L1950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,945.91,,,,,,,fee schedule,900.87,945.91,APC Afo spiral molded to pt plas,L1950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,900.87,,,,,,,fee schedule,900.87,945.91,APC AFO spiral prefabricated,L1951,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1047.66,,,,,,,fee schedule,1007.37,1057.74,APC AFO spiral prefabricated,L1951,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1057.74,,,,,,,fee schedule,1007.37,1057.74,APC AFO spiral prefabricated,L1951,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1007.37,,,,,,,fee schedule,1007.37,1057.74,APC Afo spiral prefab ots,L1952,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1047.66,,,,,,,fee schedule,1007.37,1057.74,APC Afo spiral prefab ots,L1952,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1057.74,,,,,,,fee schedule,1007.37,1057.74,APC Afo spiral prefab ots,L1952,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1007.37,,,,,,,fee schedule,1007.37,1057.74,APC Afo pos solid ank plastic mo,L1960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,706.64,,,,,,,fee schedule,679.46,713.43,APC Afo pos solid ank plastic mo,L1960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,713.43,,,,,,,fee schedule,679.46,713.43,APC Afo pos solid ank plastic mo,L1960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,679.46,,,,,,,fee schedule,679.46,713.43,APC Afo plastic molded w/ankle j,L1970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,850.39,,,,,,,fee schedule,817.68,858.56,APC Afo plastic molded w/ankle j,L1970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,858.56,,,,,,,fee schedule,817.68,858.56,APC Afo plastic molded w/ankle j,L1970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,817.68,,,,,,,fee schedule,817.68,858.56,APC "AFO w/ankle joint, prefab",L1971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,584.72,,,,,,,fee schedule,562.23,590.34,APC "AFO w/ankle joint, prefab",L1971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,590.34,,,,,,,fee schedule,562.23,590.34,APC "AFO w/ankle joint, prefab",L1971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,562.23,,,,,,,fee schedule,562.23,590.34,APC Afo sing solid stirrup calf,L1980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,438.6,,,,,,,fee schedule,421.73,442.82,APC Afo sing solid stirrup calf,L1980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,442.82,,,,,,,fee schedule,421.73,442.82,APC Afo sing solid stirrup calf,L1980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,421.73,,,,,,,fee schedule,421.73,442.82,APC Afo doub solid stirrup calf,L1990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,532.71,,,,,,,fee schedule,512.22,537.83,APC Afo doub solid stirrup calf,L1990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,537.83,,,,,,,fee schedule,512.22,537.83,APC Afo doub solid stirrup calf,L1990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,512.22,,,,,,,fee schedule,512.22,537.83,APC Kafo sing fre stirr thi/calf,L2000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1262.06,,,,,,,fee schedule,1213.52,1274.2,APC Kafo sing fre stirr thi/calf,L2000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1274.2,,,,,,,fee schedule,1213.52,1274.2,APC Kafo sing fre stirr thi/calf,L2000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1213.52,,,,,,,fee schedule,1213.52,1274.2,APC KAFO sng/dbl mechanical act,L2005,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5111.82,,,,,,,fee schedule,4915.21,5160.97,APC KAFO sng/dbl mechanical act,L2005,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5160.97,,,,,,,fee schedule,4915.21,5160.97,APC KAFO sng/dbl mechanical act,L2005,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4915.21,,,,,,,fee schedule,4915.21,5160.97,APC Kafo sng solid stirrup w/o j,L2010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1177.34,,,,,,,fee schedule,1132.06,1188.66,APC Kafo sng solid stirrup w/o j,L2010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1188.66,,,,,,,fee schedule,1132.06,1188.66,APC Kafo sng solid stirrup w/o j,L2010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1132.06,,,,,,,fee schedule,1132.06,1188.66,APC Kafo dbl solid stirrup band/,L2020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1482.42,,,,,,,fee schedule,1425.4,1496.67,APC Kafo dbl solid stirrup band/,L2020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1496.67,,,,,,,fee schedule,1425.4,1496.67,APC Kafo dbl solid stirrup band/,L2020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1425.4,,,,,,,fee schedule,1425.4,1496.67,APC Kafo dbl solid stirrup w/o j,L2030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1345.7,,,,,,,fee schedule,1293.94,1358.64,APC Kafo dbl solid stirrup w/o j,L2030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1358.64,,,,,,,fee schedule,1293.94,1358.64,APC Kafo dbl solid stirrup w/o j,L2030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1293.94,,,,,,,fee schedule,1293.94,1358.64,APC Kafo pla sin up w/wo k/a cus,L2034,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2541.75,,,,,,,fee schedule,2443.99,2566.19,APC Kafo pla sin up w/wo k/a cus,L2034,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2566.19,,,,,,,fee schedule,2443.99,2566.19,APC Kafo pla sin up w/wo k/a cus,L2034,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2443.99,,,,,,,fee schedule,2443.99,2566.19,APC KAFO plastic pediatric size,L2035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,218.29,,,,,,,fee schedule,209.89,220.38,APC KAFO plastic pediatric size,L2035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,220.38,,,,,,,fee schedule,209.89,220.38,APC KAFO plastic pediatric size,L2035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.89,,,,,,,fee schedule,209.89,220.38,APC Kafo plas doub free knee mol,L2036,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2297.73,,,,,,,fee schedule,2209.36,2319.83,APC Kafo plas doub free knee mol,L2036,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2319.83,,,,,,,fee schedule,2209.36,2319.83,APC Kafo plas doub free knee mol,L2036,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2209.36,,,,,,,fee schedule,2209.36,2319.83,APC Kafo plas sing free knee mol,L2037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2143.66,,,,,,,fee schedule,2061.21,2164.27,APC Kafo plas sing free knee mol,L2037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2164.27,,,,,,,fee schedule,2061.21,2164.27,APC Kafo plas sing free knee mol,L2037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2061.21,,,,,,,fee schedule,2061.21,2164.27,APC Kafo w/o joint multi-axis an,L2038,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2177.61,,,,,,,fee schedule,2093.86,2198.55,APC Kafo w/o joint multi-axis an,L2038,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2198.55,,,,,,,fee schedule,2093.86,2198.55,APC Kafo w/o joint multi-axis an,L2038,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2093.86,,,,,,,fee schedule,2093.86,2198.55,APC Hkafo torsion bil rot straps,L2040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,264.11,,,,,,,fee schedule,253.95,266.65,APC Hkafo torsion bil rot straps,L2040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,266.65,,,,,,,fee schedule,253.95,266.65,APC Hkafo torsion bil rot straps,L2040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,253.95,,,,,,,fee schedule,253.95,266.65,APC Hkafo torsion cable hip pelv,L2050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,569.29,,,,,,,fee schedule,547.39,574.76,APC Hkafo torsion cable hip pelv,L2050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,574.76,,,,,,,fee schedule,547.39,574.76,APC Hkafo torsion cable hip pelv,L2050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,547.39,,,,,,,fee schedule,547.39,574.76,APC Hkafo torsion ball bearing j,L2060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,693.86,,,,,,,fee schedule,667.17,700.53,APC Hkafo torsion ball bearing j,L2060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,700.53,,,,,,,fee schedule,667.17,700.53,APC Hkafo torsion ball bearing j,L2060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,667.17,,,,,,,fee schedule,667.17,700.53,APC Hkafo torsion unilat rot str,L2070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,178.18,,,,,,,fee schedule,171.33,179.9,APC Hkafo torsion unilat rot str,L2070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,179.9,,,,,,,fee schedule,171.33,179.9,APC Hkafo torsion unilat rot str,L2070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,171.33,,,,,,,fee schedule,171.33,179.9,APC Hkafo unilat torsion cable,L2080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,429.85,,,,,,,fee schedule,413.32,433.99,APC Hkafo unilat torsion cable,L2080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,433.99,,,,,,,fee schedule,413.32,433.99,APC Hkafo unilat torsion cable,L2080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,413.32,,,,,,,fee schedule,413.32,433.99,APC Hkafo unilat torsion ball br,L2090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,524.04,,,,,,,fee schedule,503.88,529.07,APC Hkafo unilat torsion ball br,L2090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,529.07,,,,,,,fee schedule,503.88,529.07,APC Hkafo unilat torsion ball br,L2090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,503.88,,,,,,,fee schedule,503.88,529.07,APC Afo tib fx cast plaster mold,L2106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,812.56,,,,,,,fee schedule,781.31,820.38,APC Afo tib fx cast plaster mold,L2106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,820.38,,,,,,,fee schedule,781.31,820.38,APC Afo tib fx cast plaster mold,L2106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,781.31,,,,,,,fee schedule,781.31,820.38,APC Afo tib fx cast molded to pt,L2108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1414.82,,,,,,,fee schedule,1360.4,1428.42,APC Afo tib fx cast molded to pt,L2108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1428.42,,,,,,,fee schedule,1360.4,1428.42,APC Afo tib fx cast molded to pt,L2108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1360.4,,,,,,,fee schedule,1360.4,1428.42,APC Afo tibial fracture soft,L2112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,650.75,,,,,,,fee schedule,625.72,657.01,APC Afo tibial fracture soft,L2112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,657.01,,,,,,,fee schedule,625.72,657.01,APC Afo tibial fracture soft,L2112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,625.72,,,,,,,fee schedule,625.72,657.01,APC Afo tib fx semi-rigid,L2114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,816.21,,,,,,,fee schedule,784.82,824.06,APC Afo tib fx semi-rigid,L2114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,824.06,,,,,,,fee schedule,784.82,824.06,APC Afo tib fx semi-rigid,L2114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,784.82,,,,,,,fee schedule,784.82,824.06,APC Afo tibial fracture rigid,L2116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,939.13,,,,,,,fee schedule,903.01,948.16,APC Afo tibial fracture rigid,L2116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,948.16,,,,,,,fee schedule,903.01,948.16,APC Afo tibial fracture rigid,L2116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,903.01,,,,,,,fee schedule,903.01,948.16,APC Kafo fem fx cast thermoplas,L2126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1570.99,,,,,,,fee schedule,1510.57,1586.1,APC Kafo fem fx cast thermoplas,L2126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1586.1,,,,,,,fee schedule,1510.57,1586.1,APC Kafo fem fx cast thermoplas,L2126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1510.57,,,,,,,fee schedule,1510.57,1586.1,APC Kafo fem fx cast molded to p,L2128,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2224.62,,,,,,,fee schedule,2139.06,2246.01,APC Kafo fem fx cast molded to p,L2128,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2246.01,,,,,,,fee schedule,2139.06,2246.01,APC Kafo fem fx cast molded to p,L2128,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2139.06,,,,,,,fee schedule,2139.06,2246.01,APC Kafo femoral fx cast soft,L2132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1206.12,,,,,,,fee schedule,1159.73,1217.72,APC Kafo femoral fx cast soft,L2132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1217.72,,,,,,,fee schedule,1159.73,1217.72,APC Kafo femoral fx cast soft,L2132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1159.73,,,,,,,fee schedule,1159.73,1217.72,APC Kafo fem fx cast semi-rigid,L2134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1287.02,,,,,,,fee schedule,1237.52,1299.4,APC Kafo fem fx cast semi-rigid,L2134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1299.4,,,,,,,fee schedule,1237.52,1299.4,APC Kafo fem fx cast semi-rigid,L2134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1237.52,,,,,,,fee schedule,1237.52,1299.4,APC Kafo femoral fx cast rigid,L2136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1536.14,,,,,,,fee schedule,1477.06,1550.91,APC Kafo femoral fx cast rigid,L2136,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1550.91,,,,,,,fee schedule,1477.06,1550.91,APC Kafo femoral fx cast rigid,L2136,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1477.06,,,,,,,fee schedule,1477.06,1550.91,APC Plas shoe insert w ank joint,L2180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,143.34,,,,,,,fee schedule,137.83,144.72,APC Plas shoe insert w ank joint,L2180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,144.72,,,,,,,fee schedule,137.83,144.72,APC Plas shoe insert w ank joint,L2180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137.83,,,,,,,fee schedule,137.83,144.72,APC Drop lock knee,L2182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,118.78,,,,,,,fee schedule,114.21,119.92,APC Drop lock knee,L2182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,119.92,,,,,,,fee schedule,114.21,119.92,APC Drop lock knee,L2182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,114.21,,,,,,,fee schedule,114.21,119.92,APC Limited motion knee joint,L2184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,162.38,,,,,,,fee schedule,156.13,163.94,APC Limited motion knee joint,L2184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,163.94,,,,,,,fee schedule,156.13,163.94,APC Limited motion knee joint,L2184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.13,,,,,,,fee schedule,156.13,163.94,APC Adj motion knee jnt lerman t,L2186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,225.22,,,,,,,fee schedule,216.56,227.39,APC Adj motion knee jnt lerman t,L2186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,227.39,,,,,,,fee schedule,216.56,227.39,APC Adj motion knee jnt lerman t,L2186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,216.56,,,,,,,fee schedule,216.56,227.39,APC Quadrilateral brim,L2188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,431.31,,,,,,,fee schedule,414.72,435.46,APC Quadrilateral brim,L2188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,435.46,,,,,,,fee schedule,414.72,435.46,APC Quadrilateral brim,L2188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,414.72,,,,,,,fee schedule,414.72,435.46,APC Waist belt,L2190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,111.44,,,,,,,fee schedule,107.15,112.51,APC Waist belt,L2190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,112.51,,,,,,,fee schedule,107.15,112.51,APC Waist belt,L2190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,107.15,,,,,,,fee schedule,107.15,112.51,APC Pelvic band & belt thigh fla,L2192,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,489.37,,,,,,,fee schedule,470.55,494.08,APC Pelvic band & belt thigh fla,L2192,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,494.08,,,,,,,fee schedule,470.55,494.08,APC Pelvic band & belt thigh fla,L2192,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,470.55,,,,,,,fee schedule,470.55,494.08,APC Limited ankle motion ea jnt,L2200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,56.82,,,,,,,fee schedule,54.63,57.36,APC Limited ankle motion ea jnt,L2200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,57.36,,,,,,,fee schedule,54.63,57.36,APC Limited ankle motion ea jnt,L2200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,54.63,,,,,,,fee schedule,54.63,57.36,APC Dorsiflexion assist each joi,L2210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.25,,,,,,,fee schedule,79.09,83.04,APC Dorsiflexion assist each joi,L2210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,83.04,,,,,,,fee schedule,79.09,83.04,APC Dorsiflexion assist each joi,L2210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79.09,,,,,,,fee schedule,79.09,83.04,APC Dorsi & plantar flex ass/res,L2220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,97.86,,,,,,,fee schedule,94.1,98.8,APC Dorsi & plantar flex ass/res,L2220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,98.8,,,,,,,fee schedule,94.1,98.8,APC Dorsi & plantar flex ass/res,L2220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,94.1,,,,,,,fee schedule,94.1,98.8,APC Split flat caliper stirr & p,L2230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,91.7,,,,,,,fee schedule,88.17,92.58,APC Split flat caliper stirr & p,L2230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92.58,,,,,,,fee schedule,88.17,92.58,APC Split flat caliper stirr & p,L2230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,88.17,,,,,,,fee schedule,88.17,92.58,APC "Rocker bottom, contact AFO",L2232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,124.16,,,,,,,fee schedule,119.38,125.35,APC "Rocker bottom, contact AFO",L2232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,125.35,,,,,,,fee schedule,119.38,125.35,APC "Rocker bottom, contact AFO",L2232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,119.38,,,,,,,fee schedule,119.38,125.35,APC Round caliper and plate atta,L2240,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,113.51,,,,,,,fee schedule,109.14,114.6,APC Round caliper and plate atta,L2240,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,114.6,,,,,,,fee schedule,109.14,114.6,APC Round caliper and plate atta,L2240,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,109.14,,,,,,,fee schedule,109.14,114.6,APC Foot plate molded stirrup at,L2250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.16,,,,,,,fee schedule,442.46,464.58,APC Foot plate molded stirrup at,L2250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.58,,,,,,,fee schedule,442.46,464.58,APC Foot plate molded stirrup at,L2250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.46,,,,,,,fee schedule,442.46,464.58,APC Reinforced solid stirrup,L2260,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,239.56,,,,,,,fee schedule,230.35,241.87,APC Reinforced solid stirrup,L2260,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,241.87,,,,,,,fee schedule,230.35,241.87,APC Reinforced solid stirrup,L2260,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,230.35,,,,,,,fee schedule,230.35,241.87,APC Long tongue stirrup,L2265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,140.74,,,,,,,fee schedule,135.33,142.1,APC Long tongue stirrup,L2265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,142.1,,,,,,,fee schedule,135.33,142.1,APC Long tongue stirrup,L2265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,135.33,,,,,,,fee schedule,135.33,142.1,APC Varus/valgus strap padded/li,L2270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,65.98,,,,,,,fee schedule,63.44,66.61,APC Varus/valgus strap padded/li,L2270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,66.61,,,,,,,fee schedule,63.44,66.61,APC Varus/valgus strap padded/li,L2270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,63.44,,,,,,,fee schedule,63.44,66.61,APC Plastic mod low ext pad/line,L2275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,155.57,,,,,,,fee schedule,149.59,157.07,APC Plastic mod low ext pad/line,L2275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,157.07,,,,,,,fee schedule,149.59,157.07,APC Plastic mod low ext pad/line,L2275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,149.59,,,,,,,fee schedule,149.59,157.07,APC Molded inner boot,L2280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,544.02,,,,,,,fee schedule,523.1,549.26,APC Molded inner boot,L2280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,549.26,,,,,,,fee schedule,523.1,549.26,APC Molded inner boot,L2280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,523.1,,,,,,,fee schedule,523.1,549.26,APC Abduction bar jointed adjust,L2300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,341.13,,,,,,,fee schedule,328.01,344.41,APC Abduction bar jointed adjust,L2300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,344.41,,,,,,,fee schedule,328.01,344.41,APC Abduction bar jointed adjust,L2300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,328.01,,,,,,,fee schedule,328.01,344.41,APC Abduction bar-straight,L2310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,170.82,,,,,,,fee schedule,164.25,172.46,APC Abduction bar-straight,L2310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,172.46,,,,,,,fee schedule,164.25,172.46,APC Abduction bar-straight,L2310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,164.25,,,,,,,fee schedule,164.25,172.46,APC Non-molded lacer,L2320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,245.9,,,,,,,fee schedule,236.44,248.26,APC Non-molded lacer,L2320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,248.26,,,,,,,fee schedule,236.44,248.26,APC Non-molded lacer,L2320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,236.44,,,,,,,fee schedule,236.44,248.26,APC Lacer molded to patient mode,L2330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,514.72,,,,,,,fee schedule,494.92,519.67,APC Lacer molded to patient mode,L2330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,519.67,,,,,,,fee schedule,494.92,519.67,APC Lacer molded to patient mode,L2330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,494.92,,,,,,,fee schedule,494.92,519.67,APC Anterior swing band,L2335,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,317.78,,,,,,,fee schedule,305.56,320.84,APC Anterior swing band,L2335,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,320.84,,,,,,,fee schedule,305.56,320.84,APC Anterior swing band,L2335,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,305.56,,,,,,,fee schedule,305.56,320.84,APC Pre-tibial shell molded to p,L2340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,687.97,,,,,,,fee schedule,661.51,694.59,APC Pre-tibial shell molded to p,L2340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,694.59,,,,,,,fee schedule,661.51,694.59,APC Pre-tibial shell molded to p,L2340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,661.51,,,,,,,fee schedule,661.51,694.59,APC Prosthetic type socket molde,L2350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1188.18,,,,,,,fee schedule,1142.48,1199.6,APC Prosthetic type socket molde,L2350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1199.6,,,,,,,fee schedule,1142.48,1199.6,APC Prosthetic type socket molde,L2350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1142.48,,,,,,,fee schedule,1142.48,1199.6,APC Extended steel shank,L2360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,61.83,,,,,,,fee schedule,59.45,62.42,APC Extended steel shank,L2360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,62.42,,,,,,,fee schedule,59.45,62.42,APC Extended steel shank,L2360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,59.45,,,,,,,fee schedule,59.45,62.42,APC Patten bottom,L2370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,400.67,,,,,,,fee schedule,385.26,404.52,APC Patten bottom,L2370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,404.52,,,,,,,fee schedule,385.26,404.52,APC Patten bottom,L2370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,385.26,,,,,,,fee schedule,385.26,404.52,APC Torsion ank & half solid sti,L2375,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,169.24,,,,,,,fee schedule,162.73,170.87,APC Torsion ank & half solid sti,L2375,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,170.87,,,,,,,fee schedule,162.73,170.87,APC Torsion ank & half solid sti,L2375,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,162.73,,,,,,,fee schedule,162.73,170.87,APC Torsion straight knee joint,L2380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,147.13,,,,,,,fee schedule,141.47,148.54,APC Torsion straight knee joint,L2380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,148.54,,,,,,,fee schedule,141.47,148.54,APC Torsion straight knee joint,L2380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,141.47,,,,,,,fee schedule,141.47,148.54,APC Straight knee joint heavy du,L2385,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,160.08,,,,,,,fee schedule,153.92,161.62,APC Straight knee joint heavy du,L2385,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,161.62,,,,,,,fee schedule,153.92,161.62,APC Straight knee joint heavy du,L2385,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,153.92,,,,,,,fee schedule,153.92,161.62,APC Add le poly knee custom kafo,L2387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,230.63,,,,,,,fee schedule,221.76,232.85,APC Add le poly knee custom kafo,L2387,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,232.85,,,,,,,fee schedule,221.76,232.85,APC Add le poly knee custom kafo,L2387,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,221.76,,,,,,,fee schedule,221.76,232.85,APC Offset knee joint each,L2390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,134.05,,,,,,,fee schedule,128.89,135.33,APC Offset knee joint each,L2390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.33,,,,,,,fee schedule,128.89,135.33,APC Offset knee joint each,L2390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.89,,,,,,,fee schedule,128.89,135.33,APC Offset knee joint heavy duty,L2395,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,186.99,,,,,,,fee schedule,179.8,188.79,APC Offset knee joint heavy duty,L2395,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,188.79,,,,,,,fee schedule,179.8,188.79,APC Offset knee joint heavy duty,L2395,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,179.8,,,,,,,fee schedule,179.8,188.79,APC Suspension sleeve lower ext,L2397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,145.67,,,,,,,fee schedule,140.07,147.07,APC Suspension sleeve lower ext,L2397,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,147.07,,,,,,,fee schedule,140.07,147.07,APC Suspension sleeve lower ext,L2397,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,140.07,,,,,,,fee schedule,140.07,147.07,APC Knee joint drop lock ea jnt,L2405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,108.75,,,,,,,fee schedule,104.57,109.8,APC Knee joint drop lock ea jnt,L2405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,109.8,,,,,,,fee schedule,104.57,109.8,APC Knee joint drop lock ea jnt,L2405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,104.57,,,,,,,fee schedule,104.57,109.8,APC Knee joint cam lock each joi,L2415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,151.52,,,,,,,fee schedule,145.69,152.97,APC Knee joint cam lock each joi,L2415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,152.97,,,,,,,fee schedule,145.69,152.97,APC Knee joint cam lock each joi,L2415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,145.69,,,,,,,fee schedule,145.69,152.97,APC Knee disc/dial lock/adj flex,L2425,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,178.81,,,,,,,fee schedule,171.93,180.53,APC Knee disc/dial lock/adj flex,L2425,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,180.53,,,,,,,fee schedule,171.93,180.53,APC Knee disc/dial lock/adj flex,L2425,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,171.93,,,,,,,fee schedule,171.93,180.53,APC Knee jnt ratchet lock ea jnt,L2430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,178.81,,,,,,,fee schedule,171.93,180.53,APC Knee jnt ratchet lock ea jnt,L2430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,180.53,,,,,,,fee schedule,171.93,180.53,APC Knee jnt ratchet lock ea jnt,L2430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,171.93,,,,,,,fee schedule,171.93,180.53,APC Knee lift loop drop lock rin,L2492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,162.35,,,,,,,fee schedule,156.11,163.92,APC Knee lift loop drop lock rin,L2492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,163.92,,,,,,,fee schedule,156.11,163.92,APC Knee lift loop drop lock rin,L2492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.11,,,,,,,fee schedule,156.11,163.92,APC Thi/glut/ischia wgt bearing,L2500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,388.4,,,,,,,fee schedule,373.46,392.13,APC Thi/glut/ischia wgt bearing,L2500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,392.13,,,,,,,fee schedule,373.46,392.13,APC Thi/glut/ischia wgt bearing,L2500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,373.46,,,,,,,fee schedule,373.46,392.13,APC Th/wght bear quad-lat brim m,L2510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,871.44,,,,,,,fee schedule,837.92,879.82,APC Th/wght bear quad-lat brim m,L2510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,879.82,,,,,,,fee schedule,837.92,879.82,APC Th/wght bear quad-lat brim m,L2510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,837.92,,,,,,,fee schedule,837.92,879.82,APC Th/wght bear quad-lat brim c,L2520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,574.85,,,,,,,fee schedule,552.74,580.38,APC Th/wght bear quad-lat brim c,L2520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,580.38,,,,,,,fee schedule,552.74,580.38,APC Th/wght bear quad-lat brim c,L2520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,552.74,,,,,,,fee schedule,552.74,580.38,APC Th/wght bear nar m-l brim mo,L2525,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1550.93,,,,,,,fee schedule,1491.28,1565.84,APC Th/wght bear nar m-l brim mo,L2525,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1565.84,,,,,,,fee schedule,1491.28,1565.84,APC Th/wght bear nar m-l brim mo,L2525,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1491.28,,,,,,,fee schedule,1491.28,1565.84,APC Th/wght bear nar m-l brim cu,L2526,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,885.06,,,,,,,fee schedule,851.02,893.57,APC Th/wght bear nar m-l brim cu,L2526,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,893.57,,,,,,,fee schedule,851.02,893.57,APC Th/wght bear nar m-l brim cu,L2526,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,851.02,,,,,,,fee schedule,851.02,893.57,APC Thigh/wght bear lacer non-mo,L2530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,280.79,,,,,,,fee schedule,269.99,283.49,APC Thigh/wght bear lacer non-mo,L2530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,283.49,,,,,,,fee schedule,269.99,283.49,APC Thigh/wght bear lacer non-mo,L2530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,269.99,,,,,,,fee schedule,269.99,283.49,APC Thigh/wght bear lacer molded,L2540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,505.26,,,,,,,fee schedule,485.83,510.12,APC Thigh/wght bear lacer molded,L2540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,510.12,,,,,,,fee schedule,485.83,510.12,APC Thigh/wght bear lacer molded,L2540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,485.83,,,,,,,fee schedule,485.83,510.12,APC Thigh/wght bear high roll cu,L2550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,343.24,,,,,,,fee schedule,330.04,346.54,APC Thigh/wght bear high roll cu,L2550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.54,,,,,,,fee schedule,330.04,346.54,APC Thigh/wght bear high roll cu,L2550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,330.04,,,,,,,fee schedule,330.04,346.54,APC Hip clevis type 2 posit jnt,L2570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,569.23,,,,,,,fee schedule,547.34,574.71,APC Hip clevis type 2 posit jnt,L2570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,574.71,,,,,,,fee schedule,547.34,574.71,APC Hip clevis type 2 posit jnt,L2570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,547.34,,,,,,,fee schedule,547.34,574.71,APC Pelvic control pelvic sling,L2580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,554.65,,,,,,,fee schedule,533.32,559.99,APC Pelvic control pelvic sling,L2580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,559.99,,,,,,,fee schedule,533.32,559.99,APC Pelvic control pelvic sling,L2580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,533.32,,,,,,,fee schedule,533.32,559.99,APC Hip clevis/thrust bearing fr,L2600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,303.73,,,,,,,fee schedule,292.05,306.65,APC Hip clevis/thrust bearing fr,L2600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,306.65,,,,,,,fee schedule,292.05,306.65,APC Hip clevis/thrust bearing fr,L2600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,292.05,,,,,,,fee schedule,292.05,306.65,APC Hip clevis/thrust bearing lo,L2610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,321.7,,,,,,,fee schedule,309.33,324.8,APC Hip clevis/thrust bearing lo,L2610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,324.8,,,,,,,fee schedule,309.33,324.8,APC Hip clevis/thrust bearing lo,L2610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,309.33,,,,,,,fee schedule,309.33,324.8,APC Pelvic control hip heavy dut,L2620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,361.73,,,,,,,fee schedule,347.82,365.21,APC Pelvic control hip heavy dut,L2620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,365.21,,,,,,,fee schedule,347.82,365.21,APC Pelvic control hip heavy dut,L2620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,347.82,,,,,,,fee schedule,347.82,365.21,APC Hip joint adjustable flexion,L2622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,410.09,,,,,,,fee schedule,394.32,414.04,APC Hip joint adjustable flexion,L2622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,414.04,,,,,,,fee schedule,394.32,414.04,APC Hip joint adjustable flexion,L2622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,394.32,,,,,,,fee schedule,394.32,414.04,APC Hip adj flex ext abduct cont,L2624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,395.74,,,,,,,fee schedule,380.52,399.55,APC Hip adj flex ext abduct cont,L2624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,399.55,,,,,,,fee schedule,380.52,399.55,APC Hip adj flex ext abduct cont,L2624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,380.52,,,,,,,fee schedule,380.52,399.55,APC Plastic mold recipro hip & c,L2627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2159.47,,,,,,,fee schedule,2076.41,2180.23,APC Plastic mold recipro hip & c,L2627,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2180.23,,,,,,,fee schedule,2076.41,2180.23,APC Plastic mold recipro hip & c,L2627,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2076.41,,,,,,,fee schedule,2076.41,2180.23,APC Metal frame recipro hip & ca,L2628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2124.15,,,,,,,fee schedule,2042.45,2144.57,APC Metal frame recipro hip & ca,L2628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2144.57,,,,,,,fee schedule,2042.45,2144.57,APC Metal frame recipro hip & ca,L2628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2042.45,,,,,,,fee schedule,2042.45,2144.57,APC Pelvic control band & belt u,L2630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,295.93,,,,,,,fee schedule,284.55,298.78,APC Pelvic control band & belt u,L2630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,298.78,,,,,,,fee schedule,284.55,298.78,APC Pelvic control band & belt u,L2630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,284.55,,,,,,,fee schedule,284.55,298.78,APC Pelvic control band & belt b,L2640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,401.62,,,,,,,fee schedule,386.17,405.48,APC Pelvic control band & belt b,L2640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,405.48,,,,,,,fee schedule,386.17,405.48,APC Pelvic control band & belt b,L2640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,386.17,,,,,,,fee schedule,386.17,405.48,APC Pelv & thor control gluteal,L2650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,171,,,,,,,fee schedule,164.42,172.64,APC Pelv & thor control gluteal,L2650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,172.64,,,,,,,fee schedule,164.42,172.64,APC Pelv & thor control gluteal,L2650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,164.42,,,,,,,fee schedule,164.42,172.64,APC Thoracic control thoracic ba,L2660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,222.74,,,,,,,fee schedule,214.17,224.88,APC Thoracic control thoracic ba,L2660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,224.88,,,,,,,fee schedule,214.17,224.88,APC Thoracic control thoracic ba,L2660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,214.17,,,,,,,fee schedule,214.17,224.88,APC Thorac cont paraspinal uprig,L2670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,216,,,,,,,fee schedule,207.69,218.07,APC Thorac cont paraspinal uprig,L2670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,218.07,,,,,,,fee schedule,207.69,218.07,APC Thorac cont paraspinal uprig,L2670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,207.69,,,,,,,fee schedule,207.69,218.07,APC Thorac cont lat support upri,L2680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,200.08,,,,,,,fee schedule,192.38,202,APC Thorac cont lat support upri,L2680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,202,,,,,,,fee schedule,192.38,202,APC Thorac cont lat support upri,L2680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,192.38,,,,,,,fee schedule,192.38,202,APC Plating chrome/nickel pr bar,L2750,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,99.89,,,,,,,fee schedule,96.05,100.85,APC Plating chrome/nickel pr bar,L2750,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,100.85,,,,,,,fee schedule,96.05,100.85,APC Plating chrome/nickel pr bar,L2750,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,96.05,,,,,,,fee schedule,96.05,100.85,APC Carbon graphite lamination,L2755,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,162.97,,,,,,,fee schedule,156.7,164.54,APC Carbon graphite lamination,L2755,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,164.54,,,,,,,fee schedule,156.7,164.54,APC Carbon graphite lamination,L2755,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.7,,,,,,,fee schedule,156.7,164.54,APC Extension per extension per,L2760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.61,,,,,,,fee schedule,69.82,73.31,APC Extension per extension per,L2760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.31,,,,,,,fee schedule,69.82,73.31,APC Extension per extension per,L2760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.82,,,,,,,fee schedule,69.82,73.31,APC Ortho sidebar disconnect,L2768,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,162.51,,,,,,,fee schedule,156.26,164.07,APC Ortho sidebar disconnect,L2768,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,164.07,,,,,,,fee schedule,156.26,164.07,APC Ortho sidebar disconnect,L2768,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,156.26,,,,,,,fee schedule,156.26,164.07,APC Non-corrosive finish,L2780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.88,,,,,,,fee schedule,77.77,81.66,APC Non-corrosive finish,L2780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,81.66,,,,,,,fee schedule,77.77,81.66,APC Non-corrosive finish,L2780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.77,,,,,,,fee schedule,77.77,81.66,APC Drop lock retainer each,L2785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.03,,,,,,,fee schedule,36.57,38.4,APC Drop lock retainer each,L2785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.4,,,,,,,fee schedule,36.57,38.4,APC Drop lock retainer each,L2785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.57,,,,,,,fee schedule,36.57,38.4,APC Knee control full kneecap,L2795,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,103.15,,,,,,,fee schedule,99.18,104.14,APC Knee control full kneecap,L2795,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,104.14,,,,,,,fee schedule,99.18,104.14,APC Knee control full kneecap,L2795,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,99.18,,,,,,,fee schedule,99.18,104.14,APC Knee cap medial or lateral p,L2800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.55,,,,,,,fee schedule,152.45,160.07,APC Knee cap medial or lateral p,L2800,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,160.07,,,,,,,fee schedule,152.45,160.07,APC Knee cap medial or lateral p,L2800,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.45,,,,,,,fee schedule,152.45,160.07,APC Knee control condylar pad,L2810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,124.46,,,,,,,fee schedule,119.67,125.65,APC Knee control condylar pad,L2810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,125.65,,,,,,,fee schedule,119.67,125.65,APC Knee control condylar pad,L2810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,119.67,,,,,,,fee schedule,119.67,125.65,APC Soft interface below knee se,L2820,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,103.78,,,,,,,fee schedule,99.79,104.78,APC Soft interface below knee se,L2820,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,104.78,,,,,,,fee schedule,99.79,104.78,APC Soft interface below knee se,L2820,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,99.79,,,,,,,fee schedule,99.79,104.78,APC Soft interface above knee se,L2830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,112.28,,,,,,,fee schedule,107.96,113.36,APC Soft interface above knee se,L2830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,113.36,,,,,,,fee schedule,107.96,113.36,APC Soft interface above knee se,L2830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,107.96,,,,,,,fee schedule,107.96,113.36,APC Tibial length sock fx or equ,L2840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.37,,,,,,,fee schedule,63.82,67.01,APC Tibial length sock fx or equ,L2840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.01,,,,,,,fee schedule,63.82,67.01,APC Tibial length sock fx or equ,L2840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,63.82,,,,,,,fee schedule,63.82,67.01,APC Femoral lgth sock fx or equa,L2850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,74,,,,,,,fee schedule,71.15,74.71,APC Femoral lgth sock fx or equa,L2850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,74.71,,,,,,,fee schedule,71.15,74.71,APC Femoral lgth sock fx or equa,L2850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,71.15,,,,,,,fee schedule,71.15,74.71,APC Ft insert ucb berkeley shell,L3000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,391.87,,,,,,,fee schedule,376.8,395.64,APC Ft insert ucb berkeley shell,L3000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,395.64,,,,,,,fee schedule,376.8,395.64,APC Ft insert ucb berkeley shell,L3000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,376.8,,,,,,,fee schedule,376.8,395.64,APC Foot insert remov molded spe,L3001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,165.01,,,,,,,fee schedule,158.66,166.59,APC Foot insert remov molded spe,L3001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.59,,,,,,,fee schedule,158.66,166.59,APC Foot insert remov molded spe,L3001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.66,,,,,,,fee schedule,158.66,166.59,APC Foot insert plastazote or eq,L3002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,201.48,,,,,,,fee schedule,193.73,203.42,APC Foot insert plastazote or eq,L3002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,203.42,,,,,,,fee schedule,193.73,203.42,APC Foot insert plastazote or eq,L3002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.73,,,,,,,fee schedule,193.73,203.42,APC Foot insert silicone gel eac,L3003,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,217.4,,,,,,,fee schedule,209.04,219.49,APC Foot insert silicone gel eac,L3003,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,219.49,,,,,,,fee schedule,209.04,219.49,APC Foot insert silicone gel eac,L3003,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.04,,,,,,,fee schedule,209.04,219.49,APC Foot longitudinal arch suppo,L3010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,217.4,,,,,,,fee schedule,209.04,219.49,APC Foot longitudinal arch suppo,L3010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,219.49,,,,,,,fee schedule,209.04,219.49,APC Foot longitudinal arch suppo,L3010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,209.04,,,,,,,fee schedule,209.04,219.49,APC Foot longitud/metatarsal sup,L3020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,247.49,,,,,,,fee schedule,237.97,249.87,APC Foot longitud/metatarsal sup,L3020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,249.87,,,,,,,fee schedule,237.97,249.87,APC Foot longitud/metatarsal sup,L3020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,237.97,,,,,,,fee schedule,237.97,249.87,APC Foot arch support remov prem,L3030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.21,,,,,,,fee schedule,91.55,96.13,APC Foot arch support remov prem,L3030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.13,,,,,,,fee schedule,91.55,96.13,APC Foot arch support remov prem,L3030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.55,,,,,,,fee schedule,91.55,96.13,APC Foot lamin/prepreg composite,L3031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.8,,,,,,,fee schedule,146.92,154.27,APC Foot lamin/prepreg composite,L3031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.27,,,,,,,fee schedule,146.92,154.27,APC Foot lamin/prepreg composite,L3031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,146.92,,,,,,,fee schedule,146.92,154.27,APC Ft arch suprt premold longit,L3040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.71,,,,,,,fee schedule,56.45,59.27,APC Ft arch suprt premold longit,L3040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.27,,,,,,,fee schedule,56.45,59.27,APC Ft arch suprt premold longit,L3040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.45,,,,,,,fee schedule,56.45,59.27,APC Foot arch supp premold metat,L3050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.71,,,,,,,fee schedule,56.45,59.27,APC Foot arch supp premold metat,L3050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.27,,,,,,,fee schedule,56.45,59.27,APC Foot arch supp premold metat,L3050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.45,,,,,,,fee schedule,56.45,59.27,APC Foot arch supp longitud/meta,L3060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,91.99,,,,,,,fee schedule,88.45,92.87,APC Foot arch supp longitud/meta,L3060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92.87,,,,,,,fee schedule,88.45,92.87,APC Foot arch supp longitud/meta,L3060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,88.45,,,,,,,fee schedule,88.45,92.87,APC Arch suprt att to sho longit,L3070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.63,,,,,,,fee schedule,38.11,40.02,APC Arch suprt att to sho longit,L3070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.02,,,,,,,fee schedule,38.11,40.02,APC Arch suprt att to sho longit,L3070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.11,,,,,,,fee schedule,38.11,40.02,APC Arch supp att to shoe metata,L3080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.63,,,,,,,fee schedule,38.11,40.02,APC Arch supp att to shoe metata,L3080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.02,,,,,,,fee schedule,38.11,40.02,APC Arch supp att to shoe metata,L3080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.11,,,,,,,fee schedule,38.11,40.02,APC Arch supp att to shoe long/m,L3090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.78,,,,,,,fee schedule,48.83,51.27,APC Arch supp att to shoe long/m,L3090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.27,,,,,,,fee schedule,48.83,51.27,APC Arch supp att to shoe long/m,L3090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.83,,,,,,,fee schedule,48.83,51.27,APC Hallus-valgus nt dyn pre ots,L3100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.93,,,,,,,fee schedule,51.86,54.45,APC Hallus-valgus nt dyn pre ots,L3100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.45,,,,,,,fee schedule,51.86,54.45,APC Hallus-valgus nt dyn pre ots,L3100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.86,,,,,,,fee schedule,51.86,54.45,APC Abduction rotation bar shoe,L3140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,111.07,,,,,,,fee schedule,106.8,112.14,APC Abduction rotation bar shoe,L3140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,112.14,,,,,,,fee schedule,106.8,112.14,APC Abduction rotation bar shoe,L3140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,106.8,,,,,,,fee schedule,106.8,112.14,APC Abduct rotation bar w/o shoe,L3150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,101.54,,,,,,,fee schedule,97.63,102.51,APC Abduct rotation bar w/o shoe,L3150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,102.51,,,,,,,fee schedule,97.63,102.51,APC Abduct rotation bar w/o shoe,L3150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,97.63,,,,,,,fee schedule,97.63,102.51,APC Foot plas heel stabi pre ots,L3170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,63.48,,,,,,,fee schedule,61.04,64.09,APC Foot plas heel stabi pre ots,L3170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.09,,,,,,,fee schedule,61.04,64.09,APC Foot plas heel stabi pre ots,L3170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.04,,,,,,,fee schedule,61.04,64.09,APC Woman's shoe oxford brace,L3224,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79.5,,,,,,,fee schedule,76.44,80.26,APC Woman's shoe oxford brace,L3224,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80.26,,,,,,,fee schedule,76.44,80.26,APC Woman's shoe oxford brace,L3224,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,76.44,,,,,,,fee schedule,76.44,80.26,APC Man's shoe oxford brace,L3225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,81.63,,,,,,,fee schedule,78.49,82.41,APC Man's shoe oxford brace,L3225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,82.41,,,,,,,fee schedule,78.49,82.41,APC Man's shoe oxford brace,L3225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,78.49,,,,,,,fee schedule,78.49,82.41,APC Sho lift taper to metatarsal,L3300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,65.05,,,,,,,fee schedule,62.55,65.68,APC Sho lift taper to metatarsal,L3300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,65.68,,,,,,,fee schedule,62.55,65.68,APC Sho lift taper to metatarsal,L3300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,62.55,,,,,,,fee schedule,62.55,65.68,APC Shoe lift elev heel/sole neo,L3310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,101.54,,,,,,,fee schedule,97.63,102.51,APC Shoe lift elev heel/sole neo,L3310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,102.51,,,,,,,fee schedule,97.63,102.51,APC Shoe lift elev heel/sole neo,L3310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,97.63,,,,,,,fee schedule,97.63,102.51,APC Lifts elevation metal extens,L3330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,706.01,,,,,,,fee schedule,678.86,712.8,APC Lifts elevation metal extens,L3330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,712.8,,,,,,,fee schedule,678.86,712.8,APC Lifts elevation metal extens,L3330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,678.86,,,,,,,fee schedule,678.86,712.8,APC Shoe lifts tapered to one-ha,L3332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,91.99,,,,,,,fee schedule,88.45,92.87,APC Shoe lifts tapered to one-ha,L3332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92.87,,,,,,,fee schedule,88.45,92.87,APC Shoe lifts tapered to one-ha,L3332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,88.45,,,,,,,fee schedule,88.45,92.87,APC Shoe lifts elevation heel /i,L3334,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,47.61,,,,,,,fee schedule,45.78,48.07,APC Shoe lifts elevation heel /i,L3334,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48.07,,,,,,,fee schedule,45.78,48.07,APC Shoe lifts elevation heel /i,L3334,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,45.78,,,,,,,fee schedule,45.78,48.07,APC Shoe wedge sach,L3340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.35,,,,,,,fee schedule,102.26,107.37,APC Shoe wedge sach,L3340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.37,,,,,,,fee schedule,102.26,107.37,APC Shoe wedge sach,L3340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.26,,,,,,,fee schedule,102.26,107.37,APC Shoe heel wedge,L3350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.58,,,,,,,fee schedule,27.48,28.85,APC Shoe heel wedge,L3350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.85,,,,,,,fee schedule,27.48,28.85,APC Shoe heel wedge,L3350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.48,,,,,,,fee schedule,27.48,28.85,APC Shoe sole wedge outside sole,L3360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44.43,,,,,,,fee schedule,42.72,44.86,APC Shoe sole wedge outside sole,L3360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44.86,,,,,,,fee schedule,42.72,44.86,APC Shoe sole wedge outside sole,L3360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42.72,,,,,,,fee schedule,42.72,44.86,APC Shoe sole wedge between sole,L3370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,61.84,,,,,,,fee schedule,59.46,62.43,APC Shoe sole wedge between sole,L3370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,62.43,,,,,,,fee schedule,59.46,62.43,APC Shoe sole wedge between sole,L3370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,59.46,,,,,,,fee schedule,59.46,62.43,APC Shoe clubfoot wedge,L3380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,61.84,,,,,,,fee schedule,59.46,62.43,APC Shoe clubfoot wedge,L3380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,62.43,,,,,,,fee schedule,59.46,62.43,APC Shoe clubfoot wedge,L3380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,59.46,,,,,,,fee schedule,59.46,62.43,APC Shoe outflare wedge,L3390,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,61.84,,,,,,,fee schedule,59.46,62.43,APC Shoe outflare wedge,L3390,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,62.43,,,,,,,fee schedule,59.46,62.43,APC Shoe outflare wedge,L3390,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,59.46,,,,,,,fee schedule,59.46,62.43,APC Shoe metatarsal bar wedge ro,L3400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.78,,,,,,,fee schedule,48.83,51.27,APC Shoe metatarsal bar wedge ro,L3400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.27,,,,,,,fee schedule,48.83,51.27,APC Shoe metatarsal bar wedge ro,L3400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.83,,,,,,,fee schedule,48.83,51.27,APC Shoe metatarsal bar between,L3410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,115.8,,,,,,,fee schedule,111.35,116.92,APC Shoe metatarsal bar between,L3410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,116.92,,,,,,,fee schedule,111.35,116.92,APC Shoe metatarsal bar between,L3410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,111.35,,,,,,,fee schedule,111.35,116.92,APC Full sole/heel wedge btween,L3420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,68.24,,,,,,,fee schedule,65.62,68.9,APC Full sole/heel wedge btween,L3420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68.9,,,,,,,fee schedule,65.62,68.9,APC Full sole/heel wedge btween,L3420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,65.62,,,,,,,fee schedule,65.62,68.9,APC Sho heel count plast reinfor,L3430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.91,,,,,,,fee schedule,192.22,201.83,APC Sho heel count plast reinfor,L3430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.83,,,,,,,fee schedule,192.22,201.83,APC Sho heel count plast reinfor,L3430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,192.22,,,,,,,fee schedule,192.22,201.83,APC Heel leather reinforced,L3440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.21,,,,,,,fee schedule,91.55,96.13,APC Heel leather reinforced,L3440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.13,,,,,,,fee schedule,91.55,96.13,APC Heel leather reinforced,L3440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.55,,,,,,,fee schedule,91.55,96.13,APC Shoe heel sach cushion type,L3450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,131.71,,,,,,,fee schedule,126.64,132.97,APC Shoe heel sach cushion type,L3450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,132.97,,,,,,,fee schedule,126.64,132.97,APC Shoe heel sach cushion type,L3450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,126.64,,,,,,,fee schedule,126.64,132.97,APC Shoe heel new leather standa,L3455,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.78,,,,,,,fee schedule,48.83,51.27,APC Shoe heel new leather standa,L3455,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.27,,,,,,,fee schedule,48.83,51.27,APC Shoe heel new leather standa,L3455,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.83,,,,,,,fee schedule,48.83,51.27,APC Shoe heel new rubber standar,L3460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42.81,,,,,,,fee schedule,41.16,43.22,APC Shoe heel new rubber standar,L3460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.22,,,,,,,fee schedule,41.16,43.22,APC Shoe heel new rubber standar,L3460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.16,,,,,,,fee schedule,41.16,43.22,APC Shoe heel thomas with wedge,L3465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.97,,,,,,,fee schedule,70.16,73.67,APC Shoe heel thomas with wedge,L3465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.67,,,,,,,fee schedule,70.16,73.67,APC Shoe heel thomas with wedge,L3465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.16,,,,,,,fee schedule,70.16,73.67,APC Shoe heel thomas extend to b,L3470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.73,,,,,,,fee schedule,74.74,78.48,APC Shoe heel thomas extend to b,L3470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.48,,,,,,,fee schedule,74.74,78.48,APC Shoe heel thomas extend to b,L3470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.74,,,,,,,fee schedule,74.74,78.48,APC Shoe heel pad & depress for,L3480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.73,,,,,,,fee schedule,74.74,78.48,APC Shoe heel pad & depress for,L3480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.48,,,,,,,fee schedule,74.74,78.48,APC Shoe heel pad & depress for,L3480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.74,,,,,,,fee schedule,74.74,78.48,APC Ortho shoe add leather insol,L3500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Ortho shoe add leather insol,L3500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Ortho shoe add leather insol,L3500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC Orthopedic shoe add rub insl,L3510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.49,,,,,,,fee schedule,35.09,36.84,APC Orthopedic shoe add rub insl,L3510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.84,,,,,,,fee schedule,35.09,36.84,APC Orthopedic shoe add rub insl,L3510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.09,,,,,,,fee schedule,35.09,36.84,APC O shoe add felt w leath insl,L3520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.63,,,,,,,fee schedule,38.11,40.02,APC O shoe add felt w leath insl,L3520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.02,,,,,,,fee schedule,38.11,40.02,APC O shoe add felt w leath insl,L3520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.11,,,,,,,fee schedule,38.11,40.02,APC Ortho shoe add half sole,L3530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.63,,,,,,,fee schedule,38.11,40.02,APC Ortho shoe add half sole,L3530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.02,,,,,,,fee schedule,38.11,40.02,APC Ortho shoe add half sole,L3530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.11,,,,,,,fee schedule,38.11,40.02,APC Ortho shoe add full sole,L3540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,63.48,,,,,,,fee schedule,61.04,64.09,APC Ortho shoe add full sole,L3540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64.09,,,,,,,fee schedule,61.04,64.09,APC Ortho shoe add full sole,L3540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,61.04,,,,,,,fee schedule,61.04,64.09,APC O shoe add standard toe tap,L3550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.08,,,,,,,fee schedule,10.65,11.18,APC O shoe add standard toe tap,L3550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.18,,,,,,,fee schedule,10.65,11.18,APC O shoe add standard toe tap,L3550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.65,,,,,,,fee schedule,10.65,11.18,APC O shoe add horseshoe toe tap,L3560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.58,,,,,,,fee schedule,27.48,28.85,APC O shoe add horseshoe toe tap,L3560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.85,,,,,,,fee schedule,27.48,28.85,APC O shoe add horseshoe toe tap,L3560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.48,,,,,,,fee schedule,27.48,28.85,APC O shoe add instep extension,L3570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,106.35,,,,,,,fee schedule,102.26,107.37,APC O shoe add instep extension,L3570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107.37,,,,,,,fee schedule,102.26,107.37,APC O shoe add instep extension,L3570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,102.26,,,,,,,fee schedule,102.26,107.37,APC O shoe add instep velcro clo,L3580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.92,,,,,,,fee schedule,77.81,81.7,APC O shoe add instep velcro clo,L3580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,81.7,,,,,,,fee schedule,77.81,81.7,APC O shoe add instep velcro clo,L3580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.81,,,,,,,fee schedule,77.81,81.7,APC O shoe convert to sof counte,L3590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.63,,,,,,,fee schedule,64.07,67.27,APC O shoe convert to sof counte,L3590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.27,,,,,,,fee schedule,64.07,67.27,APC O shoe convert to sof counte,L3590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.07,,,,,,,fee schedule,64.07,67.27,APC Ortho shoe add march bar,L3595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.34,,,,,,,fee schedule,50.33,52.85,APC Ortho shoe add march bar,L3595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.85,,,,,,,fee schedule,50.33,52.85,APC Ortho shoe add march bar,L3595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.33,,,,,,,fee schedule,50.33,52.85,APC Trans shoe calip plate exist,L3600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.21,,,,,,,fee schedule,91.55,96.13,APC Trans shoe calip plate exist,L3600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.13,,,,,,,fee schedule,91.55,96.13,APC Trans shoe calip plate exist,L3600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.55,,,,,,,fee schedule,91.55,96.13,APC Trans shoe caliper plate new,L3610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.33,,,,,,,fee schedule,120.51,126.54,APC Trans shoe caliper plate new,L3610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.54,,,,,,,fee schedule,120.51,126.54,APC Trans shoe caliper plate new,L3610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.51,,,,,,,fee schedule,120.51,126.54,APC Trans shoe solid stirrup exi,L3620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.21,,,,,,,fee schedule,91.55,96.13,APC Trans shoe solid stirrup exi,L3620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.13,,,,,,,fee schedule,91.55,96.13,APC Trans shoe solid stirrup exi,L3620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.55,,,,,,,fee schedule,91.55,96.13,APC Trans shoe solid stirrup new,L3630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,125.33,,,,,,,fee schedule,120.51,126.54,APC Trans shoe solid stirrup new,L3630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,126.54,,,,,,,fee schedule,120.51,126.54,APC Trans shoe solid stirrup new,L3630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,120.51,,,,,,,fee schedule,120.51,126.54,APC Shoe dennis browne splint bo,L3640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.93,,,,,,,fee schedule,51.86,54.45,APC Shoe dennis browne splint bo,L3640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.45,,,,,,,fee schedule,51.86,54.45,APC Shoe dennis browne splint bo,L3640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.86,,,,,,,fee schedule,51.86,54.45,APC So 8 abd restraint pre ots,L3650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,79.47,,,,,,,fee schedule,76.41,80.23,APC So 8 abd restraint pre ots,L3650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80.23,,,,,,,fee schedule,76.41,80.23,APC So 8 abd restraint pre ots,L3650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,76.41,,,,,,,fee schedule,76.41,80.23,APC So 8 ab rstr can/web pre ots,L3660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,120.19,,,,,,,fee schedule,115.57,121.35,APC So 8 ab rstr can/web pre ots,L3660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,121.35,,,,,,,fee schedule,115.57,121.35,APC So 8 ab rstr can/web pre ots,L3660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,115.57,,,,,,,fee schedule,115.57,121.35,APC So acro/clav can web pre ots,L3670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,158.84,,,,,,,fee schedule,152.73,160.37,APC So acro/clav can web pre ots,L3670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,160.37,,,,,,,fee schedule,152.73,160.37,APC So acro/clav can web pre ots,L3670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,152.73,,,,,,,fee schedule,152.73,160.37,APC SO cap design w/o jnts CF,L3671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1023.03,,,,,,,fee schedule,983.68,1032.86,APC SO cap design w/o jnts CF,L3671,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1032.86,,,,,,,fee schedule,983.68,1032.86,APC SO cap design w/o jnts CF,L3671,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,983.68,,,,,,,fee schedule,983.68,1032.86,APC SO airplane w/wo joint CF,L3674,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1341.98,,,,,,,fee schedule,1290.37,1354.89,APC SO airplane w/wo joint CF,L3674,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1354.89,,,,,,,fee schedule,1290.37,1354.89,APC SO airplane w/wo joint CF,L3674,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1290.37,,,,,,,fee schedule,1290.37,1354.89,APC So vest canvas/web pre ots,L3675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,199.24,,,,,,,fee schedule,191.58,201.16,APC So vest canvas/web pre ots,L3675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,201.16,,,,,,,fee schedule,191.58,201.16,APC So vest canvas/web pre ots,L3675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,191.58,,,,,,,fee schedule,191.58,201.16,APC EO w/o joints CF,L3702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,327.82,,,,,,,fee schedule,315.21,330.97,APC EO w/o joints CF,L3702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,330.97,,,,,,,fee schedule,315.21,330.97,APC EO w/o joints CF,L3702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,315.21,,,,,,,fee schedule,315.21,330.97,APC Eo elas w/metal jnts pre ots,L3710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,182.75,,,,,,,fee schedule,175.72,184.51,APC Eo elas w/metal jnts pre ots,L3710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,184.51,,,,,,,fee schedule,175.72,184.51,APC Eo elas w/metal jnts pre ots,L3710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,175.72,,,,,,,fee schedule,175.72,184.51,APC Forearm/arm cuffs free motio,L3720,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,815.42,,,,,,,fee schedule,784.06,823.26,APC Forearm/arm cuffs free motio,L3720,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,823.26,,,,,,,fee schedule,784.06,823.26,APC Forearm/arm cuffs free motio,L3720,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,784.06,,,,,,,fee schedule,784.06,823.26,APC Forearm/arm cuffs ext/flex a,L3730,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1054.21,,,,,,,fee schedule,1013.66,1064.34,APC Forearm/arm cuffs ext/flex a,L3730,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1064.34,,,,,,,fee schedule,1013.66,1064.34,APC Forearm/arm cuffs ext/flex a,L3730,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1013.66,,,,,,,fee schedule,1013.66,1064.34,APC Cuffs adj lock w/ active con,L3740,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1249.85,,,,,,,fee schedule,1201.78,1261.87,APC Cuffs adj lock w/ active con,L3740,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1261.87,,,,,,,fee schedule,1201.78,1261.87,APC Cuffs adj lock w/ active con,L3740,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1201.78,,,,,,,fee schedule,1201.78,1261.87,APC "EO withjoint, Prefabricated",L3760,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,567.74,,,,,,,fee schedule,545.9,573.2,APC "EO withjoint, Prefabricated",L3760,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,573.2,,,,,,,fee schedule,545.9,573.2,APC "EO withjoint, Prefabricated",L3760,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,545.9,,,,,,,fee schedule,545.9,573.2,APC "Eo, adj lock joint prefab ot",L3761,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,567.74,,,,,,,fee schedule,545.9,573.2,APC "Eo, adj lock joint prefab ot",L3761,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,573.2,,,,,,,fee schedule,545.9,573.2,APC "Eo, adj lock joint prefab ot",L3761,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,545.9,,,,,,,fee schedule,545.9,573.2,APC Eo rigid w/o joints pre ots,L3762,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,122.08,,,,,,,fee schedule,117.38,123.25,APC Eo rigid w/o joints pre ots,L3762,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,123.25,,,,,,,fee schedule,117.38,123.25,APC Eo rigid w/o joints pre ots,L3762,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,117.38,,,,,,,fee schedule,117.38,123.25,APC EWHO rigid w/o jnts CF,L3763,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,796.93,,,,,,,fee schedule,766.28,804.59,APC EWHO rigid w/o jnts CF,L3763,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,804.59,,,,,,,fee schedule,766.28,804.59,APC EWHO rigid w/o jnts CF,L3763,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,766.28,,,,,,,fee schedule,766.28,804.59,APC EWHO w/joint(s) CF,L3764,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1040.18,,,,,,,fee schedule,1000.17,1050.18,APC EWHO w/joint(s) CF,L3764,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1050.18,,,,,,,fee schedule,1000.17,1050.18,APC EWHO w/joint(s) CF,L3764,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1000.17,,,,,,,fee schedule,1000.17,1050.18,APC EWHFO rigid w/o jnts CF,L3765,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1455.75,,,,,,,fee schedule,1399.76,1469.75,APC EWHFO rigid w/o jnts CF,L3765,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1469.75,,,,,,,fee schedule,1399.76,1469.75,APC EWHFO rigid w/o jnts CF,L3765,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1399.76,,,,,,,fee schedule,1399.76,1469.75,APC EWHFO w/joint(s) CF,L3766,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1541.53,,,,,,,fee schedule,1482.24,1556.35,APC EWHFO w/joint(s) CF,L3766,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1556.35,,,,,,,fee schedule,1482.24,1556.35,APC EWHFO w/joint(s) CF,L3766,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1482.24,,,,,,,fee schedule,1482.24,1556.35,APC WHFO w/joint(s) custom fab,L3806,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,515.73,,,,,,,fee schedule,495.89,520.68,APC WHFO w/joint(s) custom fab,L3806,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,520.68,,,,,,,fee schedule,495.89,520.68,APC WHFO w/joint(s) custom fab,L3806,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,495.89,,,,,,,fee schedule,495.89,520.68,APC Whfo w/o joints pre cst,L3807,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,283.89,,,,,,,fee schedule,272.97,286.62,APC Whfo w/o joints pre cst,L3807,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,286.62,,,,,,,fee schedule,272.97,286.62,APC Whfo w/o joints pre cst,L3807,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,272.97,,,,,,,fee schedule,272.97,286.62,APC "WHFO, rigid w/o joints",L3808,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,424.55,,,,,,,fee schedule,408.22,428.63,APC "WHFO, rigid w/o joints",L3808,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,428.63,,,,,,,fee schedule,408.22,428.63,APC "WHFO, rigid w/o joints",L3808,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,408.22,,,,,,,fee schedule,408.22,428.63,APC Whfo w/o joints pre ots,L3809,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,283.89,,,,,,,fee schedule,272.97,286.62,APC Whfo w/o joints pre ots,L3809,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,286.62,,,,,,,fee schedule,272.97,286.62,APC Whfo w/o joints pre ots,L3809,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,272.97,,,,,,,fee schedule,272.97,286.62,APC Hinge extension/flex wrist/f,L3900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1655.42,,,,,,,fee schedule,1591.75,1671.34,APC Hinge extension/flex wrist/f,L3900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1671.34,,,,,,,fee schedule,1591.75,1671.34,APC Hinge extension/flex wrist/f,L3900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1591.75,,,,,,,fee schedule,1591.75,1671.34,APC Hinge ext/flex wrist finger,L3901,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1879.92,,,,,,,fee schedule,1807.62,1898,APC Hinge ext/flex wrist finger,L3901,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1898,,,,,,,fee schedule,1807.62,1898,APC Hinge ext/flex wrist finger,L3901,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1807.62,,,,,,,fee schedule,1807.62,1898,APC Whfo electric custom fitted,L3904,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3424.68,,,,,,,fee schedule,3292.96,3457.61,APC Whfo electric custom fitted,L3904,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3457.61,,,,,,,fee schedule,3292.96,3457.61,APC Whfo electric custom fitted,L3904,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3292.96,,,,,,,fee schedule,3292.96,3457.61,APC Who w/nontorsion jnt(s) cf,L3905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1125.92,,,,,,,fee schedule,1082.62,1136.75,APC Who w/nontorsion jnt(s) cf,L3905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1136.75,,,,,,,fee schedule,1082.62,1136.75,APC Who w/nontorsion jnt(s) cf,L3905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1082.62,,,,,,,fee schedule,1082.62,1136.75,APC Who w/o joints cf,L3906,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,499.89,,,,,,,fee schedule,480.66,504.69,APC Who w/o joints cf,L3906,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,504.69,,,,,,,fee schedule,480.66,504.69,APC Who w/o joints cf,L3906,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,480.66,,,,,,,fee schedule,480.66,504.69,APC Who cock-up nonmolde pre ots,L3908,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,78.67,,,,,,,fee schedule,75.64,79.42,APC Who cock-up nonmolde pre ots,L3908,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,79.42,,,,,,,fee schedule,75.64,79.42,APC Who cock-up nonmolde pre ots,L3908,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,75.64,,,,,,,fee schedule,75.64,79.42,APC Hfo flexion glove pre ots,L3912,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,136.28,,,,,,,fee schedule,131.04,137.59,APC Hfo flexion glove pre ots,L3912,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,137.59,,,,,,,fee schedule,131.04,137.59,APC Hfo flexion glove pre ots,L3912,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,131.04,,,,,,,fee schedule,131.04,137.59,APC HFO w/o joints CF,L3913,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,307.49,,,,,,,fee schedule,295.66,310.44,APC HFO w/o joints CF,L3913,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,310.44,,,,,,,fee schedule,295.66,310.44,APC HFO w/o joints CF,L3913,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.66,,,,,,,fee schedule,295.66,310.44,APC Who nontorsion jnts pre cst,L3915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,603.49,,,,,,,fee schedule,580.28,609.29,APC Who nontorsion jnts pre cst,L3915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,609.29,,,,,,,fee schedule,580.28,609.29,APC Who nontorsion jnts pre cst,L3915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,580.28,,,,,,,fee schedule,580.28,609.29,APC Who nontorsion jnts pre ots,L3916,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,603.49,,,,,,,fee schedule,580.28,609.29,APC Who nontorsion jnts pre ots,L3916,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,609.29,,,,,,,fee schedule,580.28,609.29,APC Who nontorsion jnts pre ots,L3916,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,580.28,,,,,,,fee schedule,580.28,609.29,APC Metacarp fx orthosis pre cst,L3917,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.98,,,,,,,fee schedule,115.37,121.14,APC Metacarp fx orthosis pre cst,L3917,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,121.14,,,,,,,fee schedule,115.37,121.14,APC Metacarp fx orthosis pre cst,L3917,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,115.37,,,,,,,fee schedule,115.37,121.14,APC Metacarp fx orthosis pre ots,L3918,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.98,,,,,,,fee schedule,115.37,121.14,APC Metacarp fx orthosis pre ots,L3918,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,121.14,,,,,,,fee schedule,115.37,121.14,APC Metacarp fx orthosis pre ots,L3918,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,115.37,,,,,,,fee schedule,115.37,121.14,APC HO w/o joints CF,L3919,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,307.49,,,,,,,fee schedule,295.66,310.44,APC HO w/o joints CF,L3919,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,310.44,,,,,,,fee schedule,295.66,310.44,APC HO w/o joints CF,L3919,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,295.66,,,,,,,fee schedule,295.66,310.44,APC HFO w/joint(s) CF,L3921,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,364.69,,,,,,,fee schedule,350.66,368.19,APC HFO w/joint(s) CF,L3921,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,368.19,,,,,,,fee schedule,350.66,368.19,APC HFO w/joint(s) CF,L3921,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,350.66,,,,,,,fee schedule,350.66,368.19,APC Hfo without joints pre cst,L3923,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,109.58,,,,,,,fee schedule,105.37,110.64,APC Hfo without joints pre cst,L3923,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,110.64,,,,,,,fee schedule,105.37,110.64,APC Hfo without joints pre cst,L3923,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,105.37,,,,,,,fee schedule,105.37,110.64,APC Hfo without joints pre ots,L3924,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,109.58,,,,,,,fee schedule,105.37,110.64,APC Hfo without joints pre ots,L3924,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,110.64,,,,,,,fee schedule,105.37,110.64,APC Hfo without joints pre ots,L3924,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,105.37,,,,,,,fee schedule,105.37,110.64,APC Fo pip dip jnt/sprng pre ots,L3925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.77,,,,,,,fee schedule,56.51,59.34,APC Fo pip dip jnt/sprng pre ots,L3925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.34,,,,,,,fee schedule,56.51,59.34,APC Fo pip dip jnt/sprng pre ots,L3925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.51,,,,,,,fee schedule,56.51,59.34,APC Fo pip dip no jt spr pre ots,L3927,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.7,,,,,,,fee schedule,38.17,40.08,APC Fo pip dip no jt spr pre ots,L3927,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40.08,,,,,,,fee schedule,38.17,40.08,APC Fo pip dip no jt spr pre ots,L3927,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,38.17,,,,,,,fee schedule,38.17,40.08,APC Hfo nontorsion jnts pre cst,L3929,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,104.12,,,,,,,fee schedule,100.12,105.13,APC Hfo nontorsion jnts pre cst,L3929,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,105.13,,,,,,,fee schedule,100.12,105.13,APC Hfo nontorsion jnts pre cst,L3929,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,100.12,,,,,,,fee schedule,100.12,105.13,APC Hfo nontorsion jnts pre ots,L3930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,104.12,,,,,,,fee schedule,100.12,105.13,APC Hfo nontorsion jnts pre ots,L3930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,105.13,,,,,,,fee schedule,100.12,105.13,APC Hfo nontorsion jnts pre ots,L3930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,100.12,,,,,,,fee schedule,100.12,105.13,APC WHFO nontorsion joint prefab,L3931,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,213.24,,,,,,,fee schedule,205.04,215.29,APC WHFO nontorsion joint prefab,L3931,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,215.29,,,,,,,fee schedule,205.04,215.29,APC WHFO nontorsion joint prefab,L3931,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,205.04,,,,,,,fee schedule,205.04,215.29,APC FO w/o joints CF,L3933,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,242.21,,,,,,,fee schedule,232.89,244.53,APC FO w/o joints CF,L3933,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,244.53,,,,,,,fee schedule,232.89,244.53,APC FO w/o joints CF,L3933,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,232.89,,,,,,,fee schedule,232.89,244.53,APC FO nontorsion joint CF,L3935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,250.8,,,,,,,fee schedule,241.15,253.21,APC FO nontorsion joint CF,L3935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,253.21,,,,,,,fee schedule,241.15,253.21,APC FO nontorsion joint CF,L3935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,241.15,,,,,,,fee schedule,241.15,253.21,APC Sewho airplan desig abdu pos,L3960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,860.25,,,,,,,fee schedule,827.16,868.52,APC Sewho airplan desig abdu pos,L3960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,868.52,,,,,,,fee schedule,827.16,868.52,APC Sewho airplan desig abdu pos,L3960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,827.16,,,,,,,fee schedule,827.16,868.52,APC Sewho cap design w/o jnts cf,L3961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1907.45,,,,,,,fee schedule,1834.09,1925.79,APC Sewho cap design w/o jnts cf,L3961,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1925.79,,,,,,,fee schedule,1834.09,1925.79,APC Sewho cap design w/o jnts cf,L3961,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1834.09,,,,,,,fee schedule,1834.09,1925.79,APC Sewho erbs palsey design abd,L3962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,839.07,,,,,,,fee schedule,806.8,847.14,APC Sewho erbs palsey design abd,L3962,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,847.14,,,,,,,fee schedule,806.8,847.14,APC Sewho erbs palsey design abd,L3962,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,806.8,,,,,,,fee schedule,806.8,847.14,APC Sewho airplane w/o jnts cf,L3967,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2252.08,,,,,,,fee schedule,2165.46,2273.73,APC Sewho airplane w/o jnts cf,L3967,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2273.73,,,,,,,fee schedule,2165.46,2273.73,APC Sewho airplane w/o jnts cf,L3967,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2165.46,,,,,,,fee schedule,2165.46,2273.73,APC Sewho cap design w/jnt(s) cf,L3971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2137.75,,,,,,,fee schedule,2055.53,2158.31,APC Sewho cap design w/jnt(s) cf,L3971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2158.31,,,,,,,fee schedule,2055.53,2158.31,APC Sewho cap design w/jnt(s) cf,L3971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2055.53,,,,,,,fee schedule,2055.53,2158.31,APC Sewho airplane w/jnt(s) cf,L3973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2252.08,,,,,,,fee schedule,2165.46,2273.73,APC Sewho airplane w/jnt(s) cf,L3973,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2273.73,,,,,,,fee schedule,2165.46,2273.73,APC Sewho airplane w/jnt(s) cf,L3973,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2165.46,,,,,,,fee schedule,2165.46,2273.73,APC Sewhfo cap design w/o jnt cf,L3975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1907.45,,,,,,,fee schedule,1834.09,1925.79,APC Sewhfo cap design w/o jnt cf,L3975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1925.79,,,,,,,fee schedule,1834.09,1925.79,APC Sewhfo cap design w/o jnt cf,L3975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1834.09,,,,,,,fee schedule,1834.09,1925.79,APC Sewhfo airplane w/o jnts cf,L3976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1907.45,,,,,,,fee schedule,1834.09,1925.79,APC Sewhfo airplane w/o jnts cf,L3976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1925.79,,,,,,,fee schedule,1834.09,1925.79,APC Sewhfo airplane w/o jnts cf,L3976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1834.09,,,,,,,fee schedule,1834.09,1925.79,APC Sewhfo cap desgn w/jnt(s) cf,L3977,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2137.75,,,,,,,fee schedule,2055.53,2158.31,APC Sewhfo cap desgn w/jnt(s) cf,L3977,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2158.31,,,,,,,fee schedule,2055.53,2158.31,APC Sewhfo cap desgn w/jnt(s) cf,L3977,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2055.53,,,,,,,fee schedule,2055.53,2158.31,APC Sewhfo airplane w/jnt(s) cf,L3978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2252.08,,,,,,,fee schedule,2165.46,2273.73,APC Sewhfo airplane w/jnt(s) cf,L3978,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2273.73,,,,,,,fee schedule,2165.46,2273.73,APC Sewhfo airplane w/jnt(s) cf,L3978,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2165.46,,,,,,,fee schedule,2165.46,2273.73,APC Up ext fx orthos humeral nos,L3980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,374.47,,,,,,,fee schedule,360.07,378.07,APC Up ext fx orthos humeral nos,L3980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,378.07,,,,,,,fee schedule,360.07,378.07,APC Up ext fx orthos humeral nos,L3980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,360.07,,,,,,,fee schedule,360.07,378.07,APC Ue fx orth shoul cap forearm,L3981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1142.78,,,,,,,fee schedule,1098.83,1153.77,APC Ue fx orth shoul cap forearm,L3981,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1153.77,,,,,,,fee schedule,1098.83,1153.77,APC Ue fx orth shoul cap forearm,L3981,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1098.83,,,,,,,fee schedule,1098.83,1153.77,APC Upper ext fx orthosis rad/ul,L3982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,436.57,,,,,,,fee schedule,419.78,440.77,APC Upper ext fx orthosis rad/ul,L3982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,440.77,,,,,,,fee schedule,419.78,440.77,APC Upper ext fx orthosis rad/ul,L3982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,419.78,,,,,,,fee schedule,419.78,440.77,APC Upper ext fx orthosis wrist,L3984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,402.51,,,,,,,fee schedule,387.03,406.38,APC Upper ext fx orthosis wrist,L3984,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,406.38,,,,,,,fee schedule,387.03,406.38,APC Upper ext fx orthosis wrist,L3984,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,387.03,,,,,,,fee schedule,387.03,406.38,APC Sock fracture or equal each,L3995,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,41.71,,,,,,,fee schedule,40.11,42.12,APC Sock fracture or equal each,L3995,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.12,,,,,,,fee schedule,40.11,42.12,APC Sock fracture or equal each,L3995,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.11,,,,,,,fee schedule,40.11,42.12,APC Repl girdle milwaukee orth,L4000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1645.17,,,,,,,fee schedule,1581.89,1660.98,APC Repl girdle milwaukee orth,L4000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1660.98,,,,,,,fee schedule,1581.89,1660.98,APC Repl girdle milwaukee orth,L4000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1581.89,,,,,,,fee schedule,1581.89,1660.98,APC Replace trilateral socket br,L4010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,802.04,,,,,,,fee schedule,771.19,809.75,APC Replace trilateral socket br,L4010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,809.75,,,,,,,fee schedule,771.19,809.75,APC Replace trilateral socket br,L4010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,771.19,,,,,,,fee schedule,771.19,809.75,APC Replace quadlat socket brim,L4020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1121.68,,,,,,,fee schedule,1078.54,1132.47,APC Replace quadlat socket brim,L4020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1132.47,,,,,,,fee schedule,1078.54,1132.47,APC Replace quadlat socket brim,L4020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1078.54,,,,,,,fee schedule,1078.54,1132.47,APC Replace socket brim cust fit,L4030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,603.38,,,,,,,fee schedule,580.17,609.18,APC Replace socket brim cust fit,L4030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,609.18,,,,,,,fee schedule,580.17,609.18,APC Replace socket brim cust fit,L4030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,580.17,,,,,,,fee schedule,580.17,609.18,APC Replace molded thigh lacer,L4040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,492.37,,,,,,,fee schedule,473.43,497.1,APC Replace molded thigh lacer,L4040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,497.1,,,,,,,fee schedule,473.43,497.1,APC Replace molded thigh lacer,L4040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,473.43,,,,,,,fee schedule,473.43,497.1,APC Replace non-molded thigh lac,L4045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,392.02,,,,,,,fee schedule,376.94,395.79,APC Replace non-molded thigh lac,L4045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,395.79,,,,,,,fee schedule,376.94,395.79,APC Replace non-molded thigh lac,L4045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,376.94,,,,,,,fee schedule,376.94,395.79,APC Replace molded calf lacer,L4050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,493.38,,,,,,,fee schedule,474.4,498.12,APC Replace molded calf lacer,L4050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,498.12,,,,,,,fee schedule,474.4,498.12,APC Replace molded calf lacer,L4050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,474.4,,,,,,,fee schedule,474.4,498.12,APC Replace non-molded calf lace,L4055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,319.49,,,,,,,fee schedule,307.2,322.56,APC Replace non-molded calf lace,L4055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,322.56,,,,,,,fee schedule,307.2,322.56,APC Replace non-molded calf lace,L4055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,307.2,,,,,,,fee schedule,307.2,322.56,APC Replace high roll cuff,L4060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,379.8,,,,,,,fee schedule,365.19,383.45,APC Replace high roll cuff,L4060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,383.45,,,,,,,fee schedule,365.19,383.45,APC Replace high roll cuff,L4060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,365.19,,,,,,,fee schedule,365.19,383.45,APC Replace prox & dist upright,L4070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,336.33,,,,,,,fee schedule,323.39,339.56,APC Replace prox & dist upright,L4070,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,339.56,,,,,,,fee schedule,323.39,339.56,APC Replace prox & dist upright,L4070,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,323.39,,,,,,,fee schedule,323.39,339.56,APC Repl met band kafo-afo prox,L4080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,137.97,,,,,,,fee schedule,132.66,139.29,APC Repl met band kafo-afo prox,L4080,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,139.29,,,,,,,fee schedule,132.66,139.29,APC Repl met band kafo-afo prox,L4080,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,132.66,,,,,,,fee schedule,132.66,139.29,APC Repl met band kafo-afo calf/,L4090,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,108.86,,,,,,,fee schedule,104.67,109.9,APC Repl met band kafo-afo calf/,L4090,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,109.9,,,,,,,fee schedule,104.67,109.9,APC Repl met band kafo-afo calf/,L4090,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,104.67,,,,,,,fee schedule,104.67,109.9,APC Repl leath cuff kafo prox th,L4100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,142.95,,,,,,,fee schedule,137.45,144.32,APC Repl leath cuff kafo prox th,L4100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,144.32,,,,,,,fee schedule,137.45,144.32,APC Repl leath cuff kafo prox th,L4100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,137.45,,,,,,,fee schedule,137.45,144.32,APC Repl leath cuff kafo-afo cal,L4110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,107.67,,,,,,,fee schedule,103.53,108.71,APC Repl leath cuff kafo-afo cal,L4110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,108.71,,,,,,,fee schedule,103.53,108.71,APC Repl leath cuff kafo-afo cal,L4110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,103.53,,,,,,,fee schedule,103.53,108.71,APC Replace pretibial shell,L4130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,603.82,,,,,,,fee schedule,580.6,609.63,APC Replace pretibial shell,L4130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,609.63,,,,,,,fee schedule,580.6,609.63,APC Replace pretibial shell,L4130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,580.6,,,,,,,fee schedule,580.6,609.63,APC Ortho dvc repair per 15 min,L4205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31.12,,,,,,,fee schedule,29.92,31.42,APC Ortho dvc repair per 15 min,L4205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.42,,,,,,,fee schedule,29.92,31.42,APC Ortho dvc repair per 15 min,L4205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.92,,,,,,,fee schedule,29.92,31.42,APC Ankle control ortho pre ots,L4350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,119.62,,,,,,,fee schedule,115.02,120.77,APC Ankle control ortho pre ots,L4350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,120.77,,,,,,,fee schedule,115.02,120.77,APC Ankle control ortho pre ots,L4350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,115.02,,,,,,,fee schedule,115.02,120.77,APC Pneumat walking boot pre cst,L4360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,367.73,,,,,,,fee schedule,353.59,371.27,APC Pneumat walking boot pre cst,L4360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,371.27,,,,,,,fee schedule,353.59,371.27,APC Pneumat walking boot pre cst,L4360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,353.59,,,,,,,fee schedule,353.59,371.27,APC Pneuma/vac walk boot pre ots,L4361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,367.73,,,,,,,fee schedule,353.59,371.27,APC Pneuma/vac walk boot pre ots,L4361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,371.27,,,,,,,fee schedule,353.59,371.27,APC Pneuma/vac walk boot pre ots,L4361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,353.59,,,,,,,fee schedule,353.59,371.27,APC Pneum full leg splnt pre ots,L4370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,243.17,,,,,,,fee schedule,233.82,245.51,APC Pneum full leg splnt pre ots,L4370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,245.51,,,,,,,fee schedule,233.82,245.51,APC Pneum full leg splnt pre ots,L4370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,233.82,,,,,,,fee schedule,233.82,245.51,APC Non-pneum walk boot pre cst,L4386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,197.77,,,,,,,fee schedule,190.16,199.67,APC Non-pneum walk boot pre cst,L4386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,199.67,,,,,,,fee schedule,190.16,199.67,APC Non-pneum walk boot pre cst,L4386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,190.16,,,,,,,fee schedule,190.16,199.67,APC Non-pneum walk boot pre ots,L4387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,197.77,,,,,,,fee schedule,190.16,199.67,APC Non-pneum walk boot pre ots,L4387,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,199.67,,,,,,,fee schedule,190.16,199.67,APC Non-pneum walk boot pre ots,L4387,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,190.16,,,,,,,fee schedule,190.16,199.67,APC Replace AFO soft interface,L4392,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.35,,,,,,,fee schedule,28.22,29.63,APC Replace AFO soft interface,L4392,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.63,,,,,,,fee schedule,28.22,29.63,APC Replace AFO soft interface,L4392,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.22,,,,,,,fee schedule,28.22,29.63,APC Replace foot drop spint,L4394,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.4,,,,,,,fee schedule,20.58,21.61,APC Replace foot drop spint,L4394,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.61,,,,,,,fee schedule,20.58,21.61,APC Replace foot drop spint,L4394,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.58,,,,,,,fee schedule,20.58,21.61,APC Static or dynami afo pre cst,L4396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.31,,,,,,,fee schedule,201.26,211.32,APC Static or dynami afo pre cst,L4396,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.32,,,,,,,fee schedule,201.26,211.32,APC Static or dynami afo pre cst,L4396,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.26,,,,,,,fee schedule,201.26,211.32,APC Static or dynami afo pre ots,L4397,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,209.31,,,,,,,fee schedule,201.26,211.32,APC Static or dynami afo pre ots,L4397,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,211.32,,,,,,,fee schedule,201.26,211.32,APC Static or dynami afo pre ots,L4397,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,201.26,,,,,,,fee schedule,201.26,211.32,APC Foot drop splint pre ots,L4398,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,96.38,,,,,,,fee schedule,92.67,97.3,APC Foot drop splint pre ots,L4398,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,97.3,,,,,,,fee schedule,92.67,97.3,APC Foot drop splint pre ots,L4398,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,92.67,,,,,,,fee schedule,92.67,97.3,APC "Afo, walk boot type, cus fab",L4631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1989.15,,,,,,,fee schedule,1912.64,2008.27,APC "Afo, walk boot type, cus fab",L4631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2008.27,,,,,,,fee schedule,1912.64,2008.27,APC "Afo, walk boot type, cus fab",L4631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1912.64,,,,,,,fee schedule,1912.64,2008.27,APC Sho insert w arch toe filler,L5000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,709.62,,,,,,,fee schedule,682.33,716.45,APC Sho insert w arch toe filler,L5000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,716.45,,,,,,,fee schedule,682.33,716.45,APC Sho insert w arch toe filler,L5000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,682.33,,,,,,,fee schedule,682.33,716.45,APC Mold socket ank hgt w/ toe f,L5010,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1550.07,,,,,,,fee schedule,1490.45,1564.97,APC Mold socket ank hgt w/ toe f,L5010,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1564.97,,,,,,,fee schedule,1490.45,1564.97,APC Mold socket ank hgt w/ toe f,L5010,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1490.45,,,,,,,fee schedule,1490.45,1564.97,APC Tibial tubercle hgt w/ toe f,L5020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2523.2,,,,,,,fee schedule,2426.15,2547.46,APC Tibial tubercle hgt w/ toe f,L5020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2547.46,,,,,,,fee schedule,2426.15,2547.46,APC Tibial tubercle hgt w/ toe f,L5020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2426.15,,,,,,,fee schedule,2426.15,2547.46,APC Ank symes mold sckt sach ft,L5050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2921.97,,,,,,,fee schedule,2809.59,2950.07,APC Ank symes mold sckt sach ft,L5050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2950.07,,,,,,,fee schedule,2809.59,2950.07,APC Ank symes mold sckt sach ft,L5050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2809.59,,,,,,,fee schedule,2809.59,2950.07,APC Symes met fr leath socket ar,L5060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3516.64,,,,,,,fee schedule,3381.38,3550.45,APC Symes met fr leath socket ar,L5060,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3550.45,,,,,,,fee schedule,3381.38,3550.45,APC Symes met fr leath socket ar,L5060,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3381.38,,,,,,,fee schedule,3381.38,3550.45,APC Molded socket shin sach foot,L5100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3043.91,,,,,,,fee schedule,2926.84,3073.18,APC Molded socket shin sach foot,L5100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3073.18,,,,,,,fee schedule,2926.84,3073.18,APC Molded socket shin sach foot,L5100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2926.84,,,,,,,fee schedule,2926.84,3073.18,APC Plast socket jts/thgh lacer,L5105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4831.35,,,,,,,fee schedule,4645.53,4877.81,APC Plast socket jts/thgh lacer,L5105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4877.81,,,,,,,fee schedule,4645.53,4877.81,APC Plast socket jts/thgh lacer,L5105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4645.53,,,,,,,fee schedule,4645.53,4877.81,APC Mold sckt ext knee shin sach,L5150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4471.15,,,,,,,fee schedule,4299.18,4514.14,APC Mold sckt ext knee shin sach,L5150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4514.14,,,,,,,fee schedule,4299.18,4514.14,APC Mold sckt ext knee shin sach,L5150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4299.18,,,,,,,fee schedule,4299.18,4514.14,APC Mold socket bent knee shin s,L5160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4863.16,,,,,,,fee schedule,4676.12,4909.93,APC Mold socket bent knee shin s,L5160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4909.93,,,,,,,fee schedule,4676.12,4909.93,APC Mold socket bent knee shin s,L5160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4676.12,,,,,,,fee schedule,4676.12,4909.93,APC Kne sing axis fric shin sach,L5200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4236.24,,,,,,,fee schedule,4073.31,4276.98,APC Kne sing axis fric shin sach,L5200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4276.98,,,,,,,fee schedule,4073.31,4276.98,APC Kne sing axis fric shin sach,L5200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4073.31,,,,,,,fee schedule,4073.31,4276.98,APC No knee/ankle joints w/ ft b,L5210,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3089.56,,,,,,,fee schedule,2970.73,3119.27,APC No knee/ankle joints w/ ft b,L5210,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3119.27,,,,,,,fee schedule,2970.73,3119.27,APC No knee/ankle joints w/ ft b,L5210,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2970.73,,,,,,,fee schedule,2970.73,3119.27,APC No knee joint with artic ali,L5220,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3511.85,,,,,,,fee schedule,3376.78,3545.62,APC No knee joint with artic ali,L5220,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3545.62,,,,,,,fee schedule,3376.78,3545.62,APC No knee joint with artic ali,L5220,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3376.78,,,,,,,fee schedule,3376.78,3545.62,APC Fem focal defic constant fri,L5230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4843.53,,,,,,,fee schedule,4657.24,4890.1,APC Fem focal defic constant fri,L5230,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4890.1,,,,,,,fee schedule,4657.24,4890.1,APC Fem focal defic constant fri,L5230,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4657.24,,,,,,,fee schedule,4657.24,4890.1,APC Hip canad sing axi cons fric,L5250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6606.15,,,,,,,fee schedule,6352.07,6669.67,APC Hip canad sing axi cons fric,L5250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6669.67,,,,,,,fee schedule,6352.07,6669.67,APC Hip canad sing axi cons fric,L5250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6352.07,,,,,,,fee schedule,6352.07,6669.67,APC Tilt table locking hip sing,L5270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6548.28,,,,,,,fee schedule,6296.42,6611.24,APC Tilt table locking hip sing,L5270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6611.24,,,,,,,fee schedule,6296.42,6611.24,APC Tilt table locking hip sing,L5270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6296.42,,,,,,,fee schedule,6296.42,6611.24,APC Hemipelvect canad sing axis,L5280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6482.8,,,,,,,fee schedule,6233.46,6545.13,APC Hemipelvect canad sing axis,L5280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6545.13,,,,,,,fee schedule,6233.46,6545.13,APC Hemipelvect canad sing axis,L5280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6233.46,,,,,,,fee schedule,6233.46,6545.13,APC Bk mold socket sach ft endo,L5301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2923.34,,,,,,,fee schedule,2810.9,2951.44,APC Bk mold socket sach ft endo,L5301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2951.44,,,,,,,fee schedule,2810.9,2951.44,APC Bk mold socket sach ft endo,L5301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2810.9,,,,,,,fee schedule,2810.9,2951.44,APC "Knee disart, SACH ft, endo",L5312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4199.7,,,,,,,fee schedule,4038.17,4240.08,APC "Knee disart, SACH ft, endo",L5312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4240.08,,,,,,,fee schedule,4038.17,4240.08,APC "Knee disart, SACH ft, endo",L5312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4038.17,,,,,,,fee schedule,4038.17,4240.08,APC Ak open end sach,L5321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4184.68,,,,,,,fee schedule,4023.73,4224.92,APC Ak open end sach,L5321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4224.92,,,,,,,fee schedule,4023.73,4224.92,APC Ak open end sach,L5321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4023.73,,,,,,,fee schedule,4023.73,4224.92,APC Hip disart canadian sach ft,L5331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5921.48,,,,,,,fee schedule,5693.73,5978.42,APC Hip disart canadian sach ft,L5331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5978.42,,,,,,,fee schedule,5693.73,5978.42,APC Hip disart canadian sach ft,L5331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5693.73,,,,,,,fee schedule,5693.73,5978.42,APC Hemipelvectomy canadian sach,L5341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6434.79,,,,,,,fee schedule,6187.3,6496.66,APC Hemipelvectomy canadian sach,L5341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6496.67,,,,,,,fee schedule,6187.3,6496.66,APC Hemipelvectomy canadian sach,L5341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6187.3,,,,,,,fee schedule,6187.3,6496.66,APC Postop dress & 1 cast chg bk,L5400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1532.37,,,,,,,fee schedule,1473.43,1547.1,APC Postop dress & 1 cast chg bk,L5400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1547.1,,,,,,,fee schedule,1473.43,1547.1,APC Postop dress & 1 cast chg bk,L5400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1473.43,,,,,,,fee schedule,1473.43,1547.1,APC Postop dsg bk ea add cast ch,L5410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,671.36,,,,,,,fee schedule,645.54,677.82,APC Postop dsg bk ea add cast ch,L5410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,677.82,,,,,,,fee schedule,645.54,677.82,APC Postop dsg bk ea add cast ch,L5410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,645.54,,,,,,,fee schedule,645.54,677.82,APC Postop dsg & 1 cast chg ak/d,L5420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1935.32,,,,,,,fee schedule,1860.88,1953.92,APC Postop dsg & 1 cast chg ak/d,L5420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1953.92,,,,,,,fee schedule,1860.88,1953.92,APC Postop dsg & 1 cast chg ak/d,L5420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1860.88,,,,,,,fee schedule,1860.88,1953.92,APC Postop dsg ak ea add cast ch,L5430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,854.28,,,,,,,fee schedule,821.42,862.49,APC Postop dsg ak ea add cast ch,L5430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,862.49,,,,,,,fee schedule,821.42,862.49,APC Postop dsg ak ea add cast ch,L5430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,821.42,,,,,,,fee schedule,821.42,862.49,APC Postop app non-wgt bear dsg,L5450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,546.49,,,,,,,fee schedule,525.47,551.74,APC Postop app non-wgt bear dsg,L5450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,551.74,,,,,,,fee schedule,525.47,551.74,APC Postop app non-wgt bear dsg,L5450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,525.47,,,,,,,fee schedule,525.47,551.74,APC Postop app non-wgt bear dsg,L5460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,805.48,,,,,,,fee schedule,774.5,813.22,APC Postop app non-wgt bear dsg,L5460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,813.22,,,,,,,fee schedule,774.5,813.22,APC Postop app non-wgt bear dsg,L5460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,774.5,,,,,,,fee schedule,774.5,813.22,APC Init bk ptb plaster direct,L5500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1635.22,,,,,,,fee schedule,1572.33,1650.95,APC Init bk ptb plaster direct,L5500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1650.95,,,,,,,fee schedule,1572.33,1650.95,APC Init bk ptb plaster direct,L5500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1572.33,,,,,,,fee schedule,1572.33,1650.95,APC Init ak ischal plstr direct,L5505,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2214.52,,,,,,,fee schedule,2129.35,2235.82,APC Init ak ischal plstr direct,L5505,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2235.82,,,,,,,fee schedule,2129.35,2235.82,APC Init ak ischal plstr direct,L5505,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2129.35,,,,,,,fee schedule,2129.35,2235.82,APC Prep BK ptb plaster molded,L5510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1853.63,,,,,,,fee schedule,1782.34,1871.46,APC Prep BK ptb plaster molded,L5510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1871.46,,,,,,,fee schedule,1782.34,1871.46,APC Prep BK ptb plaster molded,L5510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1782.34,,,,,,,fee schedule,1782.34,1871.46,APC Perp BK ptb thermopls direct,L5520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1830.95,,,,,,,fee schedule,1760.53,1848.56,APC Perp BK ptb thermopls direct,L5520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1848.56,,,,,,,fee schedule,1760.53,1848.56,APC Perp BK ptb thermopls direct,L5520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1760.53,,,,,,,fee schedule,1760.53,1848.56,APC Prep BK ptb thermopls molded,L5530,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2317.62,,,,,,,fee schedule,2228.48,2339.9,APC Prep BK ptb thermopls molded,L5530,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2339.9,,,,,,,fee schedule,2228.48,2339.9,APC Prep BK ptb thermopls molded,L5530,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2228.48,,,,,,,fee schedule,2228.48,2339.9,APC Prep BK ptb open end socket,L5535,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2283.99,,,,,,,fee schedule,2196.14,2305.95,APC Prep BK ptb open end socket,L5535,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2305.95,,,,,,,fee schedule,2196.14,2305.95,APC Prep BK ptb open end socket,L5535,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2196.14,,,,,,,fee schedule,2196.14,2305.95,APC Prep BK ptb laminated socket,L5540,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2411.78,,,,,,,fee schedule,2319.02,2434.97,APC Prep BK ptb laminated socket,L5540,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2434.97,,,,,,,fee schedule,2319.02,2434.97,APC Prep BK ptb laminated socket,L5540,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2319.02,,,,,,,fee schedule,2319.02,2434.97,APC Prep AK ischial plast molded,L5560,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2474.61,,,,,,,fee schedule,2379.43,2498.4,APC Prep AK ischial plast molded,L5560,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2498.4,,,,,,,fee schedule,2379.43,2498.4,APC Prep AK ischial plast molded,L5560,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2379.43,,,,,,,fee schedule,2379.43,2498.4,APC Prep AK ischial direct form,L5570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2572.71,,,,,,,fee schedule,2473.76,2597.45,APC Prep AK ischial direct form,L5570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2597.45,,,,,,,fee schedule,2473.76,2597.45,APC Prep AK ischial direct form,L5570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2473.76,,,,,,,fee schedule,2473.76,2597.45,APC Prep AK ischial thermo mold,L5580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3003.46,,,,,,,fee schedule,2887.94,3032.34,APC Prep AK ischial thermo mold,L5580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3032.34,,,,,,,fee schedule,2887.94,3032.34,APC Prep AK ischial thermo mold,L5580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2887.94,,,,,,,fee schedule,2887.94,3032.34,APC Prep AK ischial open end,L5585,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3257.6,,,,,,,fee schedule,3132.31,3288.93,APC Prep AK ischial open end,L5585,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3288.93,,,,,,,fee schedule,3132.31,3288.93,APC Prep AK ischial open end,L5585,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3132.31,,,,,,,fee schedule,3132.31,3288.93,APC Prep AK ischial laminated,L5590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3060.73,,,,,,,fee schedule,2943.01,3090.16,APC Prep AK ischial laminated,L5590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3090.16,,,,,,,fee schedule,2943.01,3090.16,APC Prep AK ischial laminated,L5590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2943.01,,,,,,,fee schedule,2943.01,3090.16,APC Hip disartic sach thermopls,L5595,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5379.93,,,,,,,fee schedule,5173.01,5431.66,APC Hip disartic sach thermopls,L5595,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5431.66,,,,,,,fee schedule,5173.01,5431.66,APC Hip disartic sach thermopls,L5595,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5173.01,,,,,,,fee schedule,5173.01,5431.66,APC Hip disart sach laminat mold,L5600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5868.02,,,,,,,fee schedule,5642.33,5924.45,APC Hip disart sach laminat mold,L5600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5924.45,,,,,,,fee schedule,5642.33,5924.45,APC Hip disart sach laminat mold,L5600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5642.33,,,,,,,fee schedule,5642.33,5924.45,APC Above knee hydracadence,L5610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2636.05,,,,,,,fee schedule,2534.66,2661.39,APC Above knee hydracadence,L5610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2661.39,,,,,,,fee schedule,2534.66,2661.39,APC Above knee hydracadence,L5610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2534.66,,,,,,,fee schedule,2534.66,2661.39,APC Ak 4 bar link w/fric swing,L5611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2051.37,,,,,,,fee schedule,1972.47,2071.09,APC Ak 4 bar link w/fric swing,L5611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2071.09,,,,,,,fee schedule,1972.47,2071.09,APC Ak 4 bar link w/fric swing,L5611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1972.47,,,,,,,fee schedule,1972.47,2071.09,APC Ak 4 bar ling w/hydraul swig,L5613,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3120.27,,,,,,,fee schedule,3000.26,3150.27,APC Ak 4 bar ling w/hydraul swig,L5613,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3150.27,,,,,,,fee schedule,3000.26,3150.27,APC Ak 4 bar ling w/hydraul swig,L5613,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3000.26,,,,,,,fee schedule,3000.26,3150.27,APC 4-bar link above knee w/swng,L5614,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2109.18,,,,,,,fee schedule,2028.06,2129.46,APC 4-bar link above knee w/swng,L5614,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2129.46,,,,,,,fee schedule,2028.06,2129.46,APC 4-bar link above knee w/swng,L5614,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2028.06,,,,,,,fee schedule,2028.06,2129.46,APC Ak 4 bar link hydl swg/stanc,L5615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7106.98,,,,,,,fee schedule,6833.63,7175.31,APC Ak 4 bar link hydl swg/stanc,L5615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7175.31,,,,,,,fee schedule,6833.63,7175.31,APC Ak 4 bar link hydl swg/stanc,L5615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6833.63,,,,,,,fee schedule,6833.63,7175.31,APC Ak univ multiplex sys frict,L5616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1729.23,,,,,,,fee schedule,1662.72,1745.86,APC Ak univ multiplex sys frict,L5616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1745.86,,,,,,,fee schedule,1662.72,1745.86,APC Ak univ multiplex sys frict,L5616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1662.72,,,,,,,fee schedule,1662.72,1745.86,APC AK/BK self-aligning unit ea,L5617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,699.32,,,,,,,fee schedule,672.42,706.04,APC AK/BK self-aligning unit ea,L5617,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,706.04,,,,,,,fee schedule,672.42,706.04,APC AK/BK self-aligning unit ea,L5617,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,672.42,,,,,,,fee schedule,672.42,706.04,APC Test socket symes,L5618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,402.88,,,,,,,fee schedule,387.38,406.75,APC Test socket symes,L5618,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,406.75,,,,,,,fee schedule,387.38,406.75,APC Test socket symes,L5618,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,387.38,,,,,,,fee schedule,387.38,406.75,APC Test socket below knee,L5620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,353.97,,,,,,,fee schedule,340.36,357.38,APC Test socket below knee,L5620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,357.38,,,,,,,fee schedule,340.36,357.38,APC Test socket below knee,L5620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,340.36,,,,,,,fee schedule,340.36,357.38,APC Test socket knee disarticula,L5622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,540.58,,,,,,,fee schedule,519.79,545.78,APC Test socket knee disarticula,L5622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,545.78,,,,,,,fee schedule,519.79,545.78,APC Test socket knee disarticula,L5622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,519.79,,,,,,,fee schedule,519.79,545.78,APC Test socket above knee,L5624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,515.78,,,,,,,fee schedule,495.94,520.74,APC Test socket above knee,L5624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,520.74,,,,,,,fee schedule,495.94,520.74,APC Test socket above knee,L5624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,495.94,,,,,,,fee schedule,495.94,520.74,APC Test socket hip disarticulat,L5626,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,725,,,,,,,fee schedule,697.12,731.98,APC Test socket hip disarticulat,L5626,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,731.98,,,,,,,fee schedule,697.12,731.98,APC Test socket hip disarticulat,L5626,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,697.12,,,,,,,fee schedule,697.12,731.98,APC Test socket hemipelvectomy,L5628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,686.67,,,,,,,fee schedule,660.26,693.27,APC Test socket hemipelvectomy,L5628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,693.27,,,,,,,fee schedule,660.26,693.27,APC Test socket hemipelvectomy,L5628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,660.26,,,,,,,fee schedule,660.26,693.27,APC Below knee acrylic socket,L5629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,524.38,,,,,,,fee schedule,504.21,529.42,APC Below knee acrylic socket,L5629,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,529.42,,,,,,,fee schedule,504.21,529.42,APC Below knee acrylic socket,L5629,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,504.21,,,,,,,fee schedule,504.21,529.42,APC Syme typ expandabl wall sckt,L5630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,571.42,,,,,,,fee schedule,549.44,576.91,APC Syme typ expandabl wall sckt,L5630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,576.91,,,,,,,fee schedule,549.44,576.91,APC Syme typ expandabl wall sckt,L5630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,549.44,,,,,,,fee schedule,549.44,576.91,APC Ak/knee disartic acrylic soc,L5631,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,683.31,,,,,,,fee schedule,657.03,689.88,APC Ak/knee disartic acrylic soc,L5631,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,689.88,,,,,,,fee schedule,657.03,689.88,APC Ak/knee disartic acrylic soc,L5631,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,657.03,,,,,,,fee schedule,657.03,689.88,APC Symes type ptb brim design s,L5632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,282.7,,,,,,,fee schedule,271.83,285.42,APC Symes type ptb brim design s,L5632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,285.42,,,,,,,fee schedule,271.83,285.42,APC Symes type ptb brim design s,L5632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,271.83,,,,,,,fee schedule,271.83,285.42,APC Symes type poster opening so,L5634,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,387.3,,,,,,,fee schedule,372.4,391.02,APC Symes type poster opening so,L5634,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,391.02,,,,,,,fee schedule,372.4,391.02,APC Symes type poster opening so,L5634,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,372.4,,,,,,,fee schedule,372.4,391.02,APC Symes type medial opening so,L5636,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,324.42,,,,,,,fee schedule,311.94,327.54,APC Symes type medial opening so,L5636,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,327.54,,,,,,,fee schedule,311.94,327.54,APC Symes type medial opening so,L5636,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,311.94,,,,,,,fee schedule,311.94,327.54,APC Below knee total contact,L5637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,433.35,,,,,,,fee schedule,416.68,437.51,APC Below knee total contact,L5637,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,437.51,,,,,,,fee schedule,416.68,437.51,APC Below knee total contact,L5637,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,416.68,,,,,,,fee schedule,416.68,437.51,APC Below knee leather socket,L5638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,619.62,,,,,,,fee schedule,595.79,625.58,APC Below knee leather socket,L5638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,625.58,,,,,,,fee schedule,595.79,625.58,APC Below knee leather socket,L5638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,595.79,,,,,,,fee schedule,595.79,625.58,APC Below knee wood socket,L5639,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1453.61,,,,,,,fee schedule,1397.7,1467.58,APC Below knee wood socket,L5639,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1467.58,,,,,,,fee schedule,1397.7,1467.58,APC Below knee wood socket,L5639,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1397.7,,,,,,,fee schedule,1397.7,1467.58,APC Knee disarticulat leather so,L5640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,885.02,,,,,,,fee schedule,850.98,893.53,APC Knee disarticulat leather so,L5640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,893.53,,,,,,,fee schedule,850.98,893.53,APC Knee disarticulat leather so,L5640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,850.98,,,,,,,fee schedule,850.98,893.53,APC Above knee leather socket,L5642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,792.32,,,,,,,fee schedule,761.85,799.94,APC Above knee leather socket,L5642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,799.94,,,,,,,fee schedule,761.85,799.94,APC Above knee leather socket,L5642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,761.85,,,,,,,fee schedule,761.85,799.94,APC Hip flex inner socket ext fr,L5643,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1981.68,,,,,,,fee schedule,1905.46,2000.73,APC Hip flex inner socket ext fr,L5643,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2000.73,,,,,,,fee schedule,1905.46,2000.73,APC Hip flex inner socket ext fr,L5643,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1905.46,,,,,,,fee schedule,1905.46,2000.73,APC Above knee wood socket,L5644,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,752.01,,,,,,,fee schedule,723.09,759.24,APC Above knee wood socket,L5644,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,759.24,,,,,,,fee schedule,723.09,759.24,APC Above knee wood socket,L5644,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,723.09,,,,,,,fee schedule,723.09,759.24,APC Bk flex inner socket ext fra,L5645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1015.88,,,,,,,fee schedule,976.81,1025.65,APC Bk flex inner socket ext fra,L5645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1025.65,,,,,,,fee schedule,976.81,1025.65,APC Bk flex inner socket ext fra,L5645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,976.81,,,,,,,fee schedule,976.81,1025.65,APC Below knee cushion socket,L5646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,697.6,,,,,,,fee schedule,670.77,704.31,APC Below knee cushion socket,L5646,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,704.31,,,,,,,fee schedule,670.77,704.31,APC Below knee cushion socket,L5646,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,670.77,,,,,,,fee schedule,670.77,704.31,APC Below knee suction socket,L5647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1012.79,,,,,,,fee schedule,973.84,1022.53,APC Below knee suction socket,L5647,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1022.53,,,,,,,fee schedule,973.84,1022.53,APC Below knee suction socket,L5647,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,973.84,,,,,,,fee schedule,973.84,1022.53,APC Above knee cushion socket,L5648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,838.25,,,,,,,fee schedule,806.01,846.31,APC Above knee cushion socket,L5648,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,846.31,,,,,,,fee schedule,806.01,846.31,APC Above knee cushion socket,L5648,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,806.01,,,,,,,fee schedule,806.01,846.31,APC Isch containmt/narrow m-l so,L5649,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2544.83,,,,,,,fee schedule,2446.95,2569.3,APC Isch containmt/narrow m-l so,L5649,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2569.3,,,,,,,fee schedule,2446.95,2569.3,APC Isch containmt/narrow m-l so,L5649,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2446.95,,,,,,,fee schedule,2446.95,2569.3,APC Tot contact ak/knee disart s,L5650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,621.57,,,,,,,fee schedule,597.66,627.54,APC Tot contact ak/knee disart s,L5650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,627.54,,,,,,,fee schedule,597.66,627.54,APC Tot contact ak/knee disart s,L5650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,597.66,,,,,,,fee schedule,597.66,627.54,APC Ak flex inner socket ext fra,L5651,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1529.03,,,,,,,fee schedule,1470.22,1543.73,APC Ak flex inner socket ext fra,L5651,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1543.73,,,,,,,fee schedule,1470.22,1543.73,APC Ak flex inner socket ext fra,L5651,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1470.22,,,,,,,fee schedule,1470.22,1543.73,APC Suction susp ak/knee disart,L5652,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,555.1,,,,,,,fee schedule,533.75,560.44,APC Suction susp ak/knee disart,L5652,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,560.44,,,,,,,fee schedule,533.75,560.44,APC Suction susp ak/knee disart,L5652,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,533.75,,,,,,,fee schedule,533.75,560.44,APC Knee disart expand wall sock,L5653,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,741.01,,,,,,,fee schedule,712.51,748.14,APC Knee disart expand wall sock,L5653,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,748.14,,,,,,,fee schedule,712.51,748.14,APC Knee disart expand wall sock,L5653,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,712.51,,,,,,,fee schedule,712.51,748.14,APC Socket insert symes,L5654,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,422.26,,,,,,,fee schedule,406.02,426.32,APC Socket insert symes,L5654,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,426.32,,,,,,,fee schedule,406.02,426.32,APC Socket insert symes,L5654,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,406.02,,,,,,,fee schedule,406.02,426.32,APC Socket insert below knee,L5655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,357.51,,,,,,,fee schedule,343.76,360.95,APC Socket insert below knee,L5655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,360.95,,,,,,,fee schedule,343.76,360.95,APC Socket insert below knee,L5655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,343.76,,,,,,,fee schedule,343.76,360.95,APC Socket insert knee articulat,L5656,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,503.63,,,,,,,fee schedule,484.26,508.47,APC Socket insert knee articulat,L5656,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,508.47,,,,,,,fee schedule,484.26,508.47,APC Socket insert knee articulat,L5656,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,484.26,,,,,,,fee schedule,484.26,508.47,APC Socket insert above knee,L5658,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,490.46,,,,,,,fee schedule,471.6,495.18,APC Socket insert above knee,L5658,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,495.18,,,,,,,fee schedule,471.6,495.18,APC Socket insert above knee,L5658,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,471.6,,,,,,,fee schedule,471.6,495.18,APC Multi-durometer symes,L5661,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,852.31,,,,,,,fee schedule,819.53,860.51,APC Multi-durometer symes,L5661,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,860.51,,,,,,,fee schedule,819.53,860.51,APC Multi-durometer symes,L5661,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,819.53,,,,,,,fee schedule,819.53,860.51,APC Multi-durometer below knee,L5665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,651.91,,,,,,,fee schedule,626.84,658.18,APC Multi-durometer below knee,L5665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,658.18,,,,,,,fee schedule,626.84,658.18,APC Multi-durometer below knee,L5665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,626.84,,,,,,,fee schedule,626.84,658.18,APC Below knee cuff suspension,L5666,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,96.88,,,,,,,fee schedule,93.15,97.81,APC Below knee cuff suspension,L5666,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,97.81,,,,,,,fee schedule,93.15,97.81,APC Below knee cuff suspension,L5666,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,93.15,,,,,,,fee schedule,93.15,97.81,APC Bk molded distal cushion,L5668,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,129.34,,,,,,,fee schedule,124.37,130.59,APC Bk molded distal cushion,L5668,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,130.59,,,,,,,fee schedule,124.37,130.59,APC Bk molded distal cushion,L5668,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,124.37,,,,,,,fee schedule,124.37,130.59,APC Bk molded supracondylar susp,L5670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,393.75,,,,,,,fee schedule,378.61,397.54,APC Bk molded supracondylar susp,L5670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,397.54,,,,,,,fee schedule,378.61,397.54,APC Bk molded supracondylar susp,L5670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,378.61,,,,,,,fee schedule,378.61,397.54,APC Bk/ak locking mechanism,L5671,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,633.32,,,,,,,fee schedule,608.96,639.41,APC Bk/ak locking mechanism,L5671,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,639.41,,,,,,,fee schedule,608.96,639.41,APC Bk/ak locking mechanism,L5671,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.96,,,,,,,fee schedule,608.96,639.41,APC Bk removable medial brim sus,L5672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,481.1,,,,,,,fee schedule,462.6,485.73,APC Bk removable medial brim sus,L5672,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,485.73,,,,,,,fee schedule,462.6,485.73,APC Bk removable medial brim sus,L5672,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,462.6,,,,,,,fee schedule,462.6,485.73,APC Socket insert w lock mech,L5673,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,894.5,,,,,,,fee schedule,860.1,903.1,APC Socket insert w lock mech,L5673,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,903.1,,,,,,,fee schedule,860.1,903.1,APC Socket insert w lock mech,L5673,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,860.1,,,,,,,fee schedule,860.1,903.1,APC Bk knee joints single axis p,L5676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,461.38,,,,,,,fee schedule,443.63,465.81,APC Bk knee joints single axis p,L5676,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,465.81,,,,,,,fee schedule,443.63,465.81,APC Bk knee joints single axis p,L5676,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,443.63,,,,,,,fee schedule,443.63,465.81,APC Bk knee joints polycentric p,L5677,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,627.76,,,,,,,fee schedule,603.62,633.8,APC Bk knee joints polycentric p,L5677,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,633.8,,,,,,,fee schedule,603.62,633.8,APC Bk knee joints polycentric p,L5677,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,603.62,,,,,,,fee schedule,603.62,633.8,APC Bk joint covers pair,L5678,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50.55,,,,,,,fee schedule,48.61,51.04,APC Bk joint covers pair,L5678,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51.04,,,,,,,fee schedule,48.61,51.04,APC Bk joint covers pair,L5678,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48.61,,,,,,,fee schedule,48.61,51.04,APC Socket insert w/o lock mech,L5679,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,745.41,,,,,,,fee schedule,716.74,752.58,APC Socket insert w/o lock mech,L5679,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,752.58,,,,,,,fee schedule,716.74,752.58,APC Socket insert w/o lock mech,L5679,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,716.74,,,,,,,fee schedule,716.74,752.58,APC Bk thigh lacer non-molded,L5680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,440.96,,,,,,,fee schedule,424,445.2,APC Bk thigh lacer non-molded,L5680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,445.2,,,,,,,fee schedule,424,445.2,APC Bk thigh lacer non-molded,L5680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,424,,,,,,,fee schedule,424,445.2,APC Intl custm cong/latyp insert,L5681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1644.14,,,,,,,fee schedule,1580.9,1659.94,APC Intl custm cong/latyp insert,L5681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1659.95,,,,,,,fee schedule,1580.9,1659.94,APC Intl custm cong/latyp insert,L5681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1580.9,,,,,,,fee schedule,1580.9,1659.94,APC Bk thigh lacer glut/ischia m,L5682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,796.26,,,,,,,fee schedule,765.63,803.91,APC Bk thigh lacer glut/ischia m,L5682,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,803.91,,,,,,,fee schedule,765.63,803.91,APC Bk thigh lacer glut/ischia m,L5682,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,765.63,,,,,,,fee schedule,765.63,803.91,APC Initial custom socket insert,L5683,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1644.14,,,,,,,fee schedule,1580.9,1659.94,APC Initial custom socket insert,L5683,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1659.95,,,,,,,fee schedule,1580.9,1659.94,APC Initial custom socket insert,L5683,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1580.9,,,,,,,fee schedule,1580.9,1659.94,APC Bk fork strap,L5684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,61.29,,,,,,,fee schedule,58.93,61.88,APC Bk fork strap,L5684,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61.88,,,,,,,fee schedule,58.93,61.88,APC Bk fork strap,L5684,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,58.93,,,,,,,fee schedule,58.93,61.88,APC Below knee sus/seal sleeve,L5685,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,160.1,,,,,,,fee schedule,153.94,161.64,APC Below knee sus/seal sleeve,L5685,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,161.64,,,,,,,fee schedule,153.94,161.64,APC Below knee sus/seal sleeve,L5685,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,153.94,,,,,,,fee schedule,153.94,161.64,APC Bk back check,L5686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.66,,,,,,,fee schedule,79.48,83.45,APC Bk back check,L5686,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,83.45,,,,,,,fee schedule,79.48,83.45,APC Bk back check,L5686,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79.48,,,,,,,fee schedule,79.48,83.45,APC Bk waist belt webbing,L5688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,77.77,,,,,,,fee schedule,74.78,78.52,APC Bk waist belt webbing,L5688,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,78.52,,,,,,,fee schedule,74.78,78.52,APC Bk waist belt webbing,L5688,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,74.78,,,,,,,fee schedule,74.78,78.52,APC Bk waist belt padded and lin,L5690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,150.59,,,,,,,fee schedule,144.8,152.04,APC Bk waist belt padded and lin,L5690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,152.04,,,,,,,fee schedule,144.8,152.04,APC Bk waist belt padded and lin,L5690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,144.8,,,,,,,fee schedule,144.8,152.04,APC Ak pelvic control belt light,L5692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,174.79,,,,,,,fee schedule,168.07,176.47,APC Ak pelvic control belt light,L5692,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,176.47,,,,,,,fee schedule,168.07,176.47,APC Ak pelvic control belt light,L5692,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,168.07,,,,,,,fee schedule,168.07,176.47,APC Ak pelvic control belt pad/l,L5694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,230.98,,,,,,,fee schedule,222.1,233.2,APC Ak pelvic control belt pad/l,L5694,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,233.2,,,,,,,fee schedule,222.1,233.2,APC Ak pelvic control belt pad/l,L5694,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,222.1,,,,,,,fee schedule,222.1,233.2,APC Ak sleeve susp neoprene/equa,L5695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,242.3,,,,,,,fee schedule,232.98,244.63,APC Ak sleeve susp neoprene/equa,L5695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,244.63,,,,,,,fee schedule,232.98,244.63,APC Ak sleeve susp neoprene/equa,L5695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,232.98,,,,,,,fee schedule,232.98,244.63,APC Ak/knee disartic pelvic join,L5696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,264.8,,,,,,,fee schedule,254.62,267.35,APC Ak/knee disartic pelvic join,L5696,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,267.35,,,,,,,fee schedule,254.62,267.35,APC Ak/knee disartic pelvic join,L5696,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,254.62,,,,,,,fee schedule,254.62,267.35,APC Ak/knee disartic pelvic band,L5697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,107.57,,,,,,,fee schedule,103.43,108.6,APC Ak/knee disartic pelvic band,L5697,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,108.6,,,,,,,fee schedule,103.43,108.6,APC Ak/knee disartic pelvic band,L5697,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,103.43,,,,,,,fee schedule,103.43,108.6,APC Ak/knee disartic silesian ba,L5698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,133.79,,,,,,,fee schedule,128.64,135.07,APC Ak/knee disartic silesian ba,L5698,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,135.07,,,,,,,fee schedule,128.64,135.07,APC Ak/knee disartic silesian ba,L5698,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,128.64,,,,,,,fee schedule,128.64,135.07,APC Shoulder harness,L5699,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,237.39,,,,,,,fee schedule,228.26,239.67,APC Shoulder harness,L5699,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,239.67,,,,,,,fee schedule,228.26,239.67,APC Shoulder harness,L5699,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,228.26,,,,,,,fee schedule,228.26,239.67,APC Replace socket below knee,L5700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3668.04,,,,,,,fee schedule,3526.96,3703.31,APC Replace socket below knee,L5700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3703.31,,,,,,,fee schedule,3526.96,3703.31,APC Replace socket below knee,L5700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3526.96,,,,,,,fee schedule,3526.96,3703.31,APC Replace socket above knee,L5701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4550.53,,,,,,,fee schedule,4375.51,4594.29,APC Replace socket above knee,L5701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4594.29,,,,,,,fee schedule,4375.51,4594.29,APC Replace socket above knee,L5701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4375.51,,,,,,,fee schedule,4375.51,4594.29,APC Replace socket hip,L5702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5735.28,,,,,,,fee schedule,5514.69,5790.42,APC Replace socket hip,L5702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5790.42,,,,,,,fee schedule,5514.69,5790.42,APC Replace socket hip,L5702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5514.69,,,,,,,fee schedule,5514.69,5790.42,APC Symes ankle w/o (sach) foot,L5703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2663.4,,,,,,,fee schedule,2560.96,2689.01,APC Symes ankle w/o (sach) foot,L5703,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2689.01,,,,,,,fee schedule,2560.96,2689.01,APC Symes ankle w/o (sach) foot,L5703,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2560.96,,,,,,,fee schedule,2560.96,2689.01,APC Custom shape cover bk,L5704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,747.9,,,,,,,fee schedule,719.13,755.09,APC Custom shape cover bk,L5704,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,755.09,,,,,,,fee schedule,719.13,755.09,APC Custom shape cover bk,L5704,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,719.13,,,,,,,fee schedule,719.13,755.09,APC Custom shape cover ak,L5705,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1371.2,,,,,,,fee schedule,1318.46,1384.38,APC Custom shape cover ak,L5705,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1384.38,,,,,,,fee schedule,1318.46,1384.38,APC Custom shape cover ak,L5705,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1318.46,,,,,,,fee schedule,1318.46,1384.38,APC Custom shape cvr knee disart,L5706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1337.43,,,,,,,fee schedule,1285.99,1350.29,APC Custom shape cvr knee disart,L5706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1350.29,,,,,,,fee schedule,1285.99,1350.29,APC Custom shape cvr knee disart,L5706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1285.99,,,,,,,fee schedule,1285.99,1350.29,APC Custom shape cvr hip disart,L5707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1796.82,,,,,,,fee schedule,1727.71,1814.1,APC Custom shape cvr hip disart,L5707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1814.1,,,,,,,fee schedule,1727.71,1814.1,APC Custom shape cvr hip disart,L5707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1727.71,,,,,,,fee schedule,1727.71,1814.1,APC Kne-shin exo sng axi mnl loc,L5710,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,457.92,,,,,,,fee schedule,440.31,462.33,APC Kne-shin exo sng axi mnl loc,L5710,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.33,,,,,,,fee schedule,440.31,462.33,APC Kne-shin exo sng axi mnl loc,L5710,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.31,,,,,,,fee schedule,440.31,462.33,APC Knee-shin exo mnl lock ultra,L5711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,694.67,,,,,,,fee schedule,667.95,701.35,APC Knee-shin exo mnl lock ultra,L5711,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,701.35,,,,,,,fee schedule,667.95,701.35,APC Knee-shin exo mnl lock ultra,L5711,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,667.95,,,,,,,fee schedule,667.95,701.35,APC Knee-shin exo frict swg & st,L5712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,548.62,,,,,,,fee schedule,527.52,553.9,APC Knee-shin exo frict swg & st,L5712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,553.9,,,,,,,fee schedule,527.52,553.9,APC Knee-shin exo frict swg & st,L5712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,527.52,,,,,,,fee schedule,527.52,553.9,APC Knee-shin exo variable frict,L5714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,565.77,,,,,,,fee schedule,544.01,571.21,APC Knee-shin exo variable frict,L5714,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,571.21,,,,,,,fee schedule,544.01,571.21,APC Knee-shin exo variable frict,L5714,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,544.01,,,,,,,fee schedule,544.01,571.21,APC Knee-shin exo mech stance ph,L5716,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,927.97,,,,,,,fee schedule,892.28,936.89,APC Knee-shin exo mech stance ph,L5716,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,936.89,,,,,,,fee schedule,892.28,936.89,APC Knee-shin exo mech stance ph,L5716,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,892.28,,,,,,,fee schedule,892.28,936.89,APC Knee-shin exo frct swg & sta,L5718,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1159.87,,,,,,,fee schedule,1115.26,1171.02,APC Knee-shin exo frct swg & sta,L5718,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1171.02,,,,,,,fee schedule,1115.26,1171.02,APC Knee-shin exo frct swg & sta,L5718,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1115.26,,,,,,,fee schedule,1115.26,1171.02,APC Knee-shin pneum swg frct exo,L5722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1210.36,,,,,,,fee schedule,1163.81,1222,APC Knee-shin pneum swg frct exo,L5722,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1222,,,,,,,fee schedule,1163.81,1222,APC Knee-shin pneum swg frct exo,L5722,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1163.81,,,,,,,fee schedule,1163.81,1222,APC Knee-shin exo fluid swing ph,L5724,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1921.82,,,,,,,fee schedule,1847.9,1940.3,APC Knee-shin exo fluid swing ph,L5724,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1940.3,,,,,,,fee schedule,1847.9,1940.3,APC Knee-shin exo fluid swing ph,L5724,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1847.9,,,,,,,fee schedule,1847.9,1940.3,APC Knee-shin ext jnts fld swg e,L5726,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2523.55,,,,,,,fee schedule,2426.49,2547.81,APC Knee-shin ext jnts fld swg e,L5726,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2547.81,,,,,,,fee schedule,2426.49,2547.81,APC Knee-shin ext jnts fld swg e,L5726,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2426.49,,,,,,,fee schedule,2426.49,2547.81,APC Knee-shin fluid swg & stance,L5728,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3144,,,,,,,fee schedule,3023.08,3174.23,APC Knee-shin fluid swg & stance,L5728,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3174.23,,,,,,,fee schedule,3023.08,3174.23,APC Knee-shin fluid swg & stance,L5728,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3023.08,,,,,,,fee schedule,3023.08,3174.23,APC Knee-shin pneum/hydra pneum,L5780,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1515.88,,,,,,,fee schedule,1457.58,1530.46,APC Knee-shin pneum/hydra pneum,L5780,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1530.46,,,,,,,fee schedule,1457.58,1530.46,APC Knee-shin pneum/hydra pneum,L5780,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1457.58,,,,,,,fee schedule,1457.58,1530.46,APC Lower limb pros vacuum pump,L5781,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5001.12,,,,,,,fee schedule,4808.77,5049.21,APC Lower limb pros vacuum pump,L5781,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5049.21,,,,,,,fee schedule,4808.77,5049.21,APC Lower limb pros vacuum pump,L5781,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4808.77,,,,,,,fee schedule,4808.77,5049.21,APC HD low limb pros vacuum pump,L5782,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5272.3,,,,,,,fee schedule,5069.52,5323,APC HD low limb pros vacuum pump,L5782,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5323,,,,,,,fee schedule,5069.52,5323,APC HD low limb pros vacuum pump,L5782,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5069.52,,,,,,,fee schedule,5069.52,5323,APC Add low ext mec limb vol sys,L5783,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3276.07,,,,,,,fee schedule,3150.07,3307.57,APC Add low ext mec limb vol sys,L5783,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3307.57,,,,,,,fee schedule,3150.07,3307.57,APC Add low ext mec limb vol sys,L5783,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3150.07,,,,,,,fee schedule,3150.07,3307.57,APC Exoskeletal bk ultralt mater,L5785,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,661.5,,,,,,,fee schedule,636.06,667.86,APC Exoskeletal bk ultralt mater,L5785,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,667.86,,,,,,,fee schedule,636.06,667.86,APC Exoskeletal bk ultralt mater,L5785,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,636.06,,,,,,,fee schedule,636.06,667.86,APC Exoskeletal ak ultra-light m,L5790,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,915.47,,,,,,,fee schedule,880.26,924.27,APC Exoskeletal ak ultra-light m,L5790,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,924.27,,,,,,,fee schedule,880.26,924.27,APC Exoskeletal ak ultra-light m,L5790,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,880.26,,,,,,,fee schedule,880.26,924.27,APC Exoskel hip ultra-light mate,L5795,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1367.04,,,,,,,fee schedule,1314.46,1380.18,APC Exoskel hip ultra-light mate,L5795,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1380.18,,,,,,,fee schedule,1314.46,1380.18,APC Exoskel hip ultra-light mate,L5795,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1314.46,,,,,,,fee schedule,1314.46,1380.18,APC Endoskel knee-shin mnl lock,L5810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,635.96,,,,,,,fee schedule,611.5,642.08,APC Endoskel knee-shin mnl lock,L5810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,642.08,,,,,,,fee schedule,611.5,642.08,APC Endoskel knee-shin mnl lock,L5810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,611.5,,,,,,,fee schedule,611.5,642.08,APC Endo knee-shin mnl lck ultra,L5811,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,928.57,,,,,,,fee schedule,892.86,937.5,APC Endo knee-shin mnl lck ultra,L5811,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,937.5,,,,,,,fee schedule,892.86,937.5,APC Endo knee-shin mnl lck ultra,L5811,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,892.86,,,,,,,fee schedule,892.86,937.5,APC Endo knee-shin frct swg & st,L5812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,719.74,,,,,,,fee schedule,692.06,726.66,APC Endo knee-shin frct swg & st,L5812,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,726.66,,,,,,,fee schedule,692.06,726.66,APC Endo knee-shin frct swg & st,L5812,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,692.06,,,,,,,fee schedule,692.06,726.66,APC Endo knee-shin hydral swg ph,L5814,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4641.98,,,,,,,fee schedule,4463.44,4686.61,APC Endo knee-shin hydral swg ph,L5814,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4686.61,,,,,,,fee schedule,4463.44,4686.61,APC Endo knee-shin hydral swg ph,L5814,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4463.44,,,,,,,fee schedule,4463.44,4686.61,APC Endo knee-shin polyc mch sta,L5816,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1082.81,,,,,,,fee schedule,1041.16,1093.22,APC Endo knee-shin polyc mch sta,L5816,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1093.22,,,,,,,fee schedule,1041.16,1093.22,APC Endo knee-shin polyc mch sta,L5816,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1041.16,,,,,,,fee schedule,1041.16,1093.22,APC Endo knee-shin frct swg & st,L5818,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1222.7,,,,,,,fee schedule,1175.67,1234.45,APC Endo knee-shin frct swg & st,L5818,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1234.45,,,,,,,fee schedule,1175.67,1234.45,APC Endo knee-shin frct swg & st,L5818,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1175.67,,,,,,,fee schedule,1175.67,1234.45,APC Endo knee-shin pneum swg frc,L5822,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2372.14,,,,,,,fee schedule,2280.9,2394.95,APC Endo knee-shin pneum swg frc,L5822,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2394.95,,,,,,,fee schedule,2280.9,2394.95,APC Endo knee-shin pneum swg frc,L5822,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2280.9,,,,,,,fee schedule,2280.9,2394.95,APC Endo knee-shin fluid swing p,L5824,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1952.56,,,,,,,fee schedule,1877.46,1971.33,APC Endo knee-shin fluid swing p,L5824,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1971.33,,,,,,,fee schedule,1877.46,1971.33,APC Endo knee-shin fluid swing p,L5824,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1877.46,,,,,,,fee schedule,1877.46,1971.33,APC Miniature knee joint,L5826,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3942.39,,,,,,,fee schedule,3790.76,3980.3,APC Miniature knee joint,L5826,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3980.3,,,,,,,fee schedule,3790.76,3980.3,APC Miniature knee joint,L5826,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3790.76,,,,,,,fee schedule,3790.76,3980.3,APC Endo knee shin single axis,L5827,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7306.36,,,,,,,fee schedule,7025.35,7376.62,APC Endo knee shin single axis,L5827,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7376.62,,,,,,,fee schedule,7025.35,7376.62,APC Endo knee shin single axis,L5827,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7025.35,,,,,,,fee schedule,7025.35,7376.62,APC Endo knee-shin fluid swg/sta,L5828,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3721.97,,,,,,,fee schedule,3578.82,3757.76,APC Endo knee-shin fluid swg/sta,L5828,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3757.76,,,,,,,fee schedule,3578.82,3757.76,APC Endo knee-shin fluid swg/sta,L5828,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3578.82,,,,,,,fee schedule,3578.82,3757.76,APC Endo knee-shin pneum/swg pha,L5830,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2644.64,,,,,,,fee schedule,2542.92,2670.07,APC Endo knee-shin pneum/swg pha,L5830,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2670.07,,,,,,,fee schedule,2542.92,2670.07,APC Endo knee-shin pneum/swg pha,L5830,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2542.92,,,,,,,fee schedule,2542.92,2670.07,APC Multi-axial knee/shin system,L5840,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4663.48,,,,,,,fee schedule,4484.12,4708.33,APC Multi-axial knee/shin system,L5840,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4708.33,,,,,,,fee schedule,4484.12,4708.33,APC Multi-axial knee/shin system,L5840,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4484.12,,,,,,,fee schedule,4484.12,4708.33,APC Addition endoskletl knee-shi,L5841,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3175.27,,,,,,,fee schedule,3053.14,3205.8,APC Addition endoskletl knee-shi,L5841,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3205.8,,,,,,,fee schedule,3053.14,3205.8,APC Addition endoskletl knee-shi,L5841,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3053.14,,,,,,,fee schedule,3053.14,3205.8,APC Knee-shin sys stance flexion,L5845,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2240.32,,,,,,,fee schedule,2154.15,2261.86,APC Knee-shin sys stance flexion,L5845,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2261.86,,,,,,,fee schedule,2154.15,2261.86,APC Knee-shin sys stance flexion,L5845,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2154.15,,,,,,,fee schedule,2154.15,2261.86,APC Knee-shin sys hydraul stance,L5848,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1344.08,,,,,,,fee schedule,1292.38,1357,APC Knee-shin sys hydraul stance,L5848,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1357,,,,,,,fee schedule,1292.38,1357,APC Knee-shin sys hydraul stance,L5848,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1292.38,,,,,,,fee schedule,1292.38,1357,APC Endo ak/hip knee extens assi,L5850,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,169.1,,,,,,,fee schedule,162.6,170.73,APC Endo ak/hip knee extens assi,L5850,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,170.73,,,,,,,fee schedule,162.6,170.73,APC Endo ak/hip knee extens assi,L5850,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,162.6,,,,,,,fee schedule,162.6,170.73,APC Mech hip extension assist,L5855,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,393.21,,,,,,,fee schedule,378.09,396.99,APC Mech hip extension assist,L5855,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,396.99,,,,,,,fee schedule,378.09,396.99,APC Mech hip extension assist,L5855,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,378.09,,,,,,,fee schedule,378.09,396.99,APC Elec knee-shin swing/stance,L5856,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30005.28,,,,,,,fee schedule,28851.23,30293.79,APC Elec knee-shin swing/stance,L5856,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30293.79,,,,,,,fee schedule,28851.23,30293.79,APC Elec knee-shin swing/stance,L5856,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28851.23,,,,,,,fee schedule,28851.23,30293.79,APC Elec knee-shin swing only,L5857,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10647.05,,,,,,,fee schedule,10237.55,10749.43,APC Elec knee-shin swing only,L5857,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10749.43,,,,,,,fee schedule,10237.55,10749.43,APC Elec knee-shin swing only,L5857,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10237.55,,,,,,,fee schedule,10237.55,10749.43,APC Stance phase only,L5858,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23229.93,,,,,,,fee schedule,22336.47,23453.29,APC Stance phase only,L5858,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23453.29,,,,,,,fee schedule,22336.47,23453.29,APC Stance phase only,L5858,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22336.47,,,,,,,fee schedule,22336.47,23453.29,APC Knee-shin pro flex/ext cont,L5859,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18135.42,,,,,,,fee schedule,17437.9,18309.79,APC Knee-shin pro flex/ext cont,L5859,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18309.8,,,,,,,fee schedule,17437.9,18309.79,APC Knee-shin pro flex/ext cont,L5859,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17437.9,,,,,,,fee schedule,17437.9,18309.79,APC Endo below knee alignable sy,L5910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,464.4,,,,,,,fee schedule,446.54,468.87,APC Endo below knee alignable sy,L5910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,468.87,,,,,,,fee schedule,446.54,468.87,APC Endo below knee alignable sy,L5910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,446.54,,,,,,,fee schedule,446.54,468.87,APC Endo ak/hip alignable system,L5920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,675.56,,,,,,,fee schedule,649.58,682.06,APC Endo ak/hip alignable system,L5920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,682.06,,,,,,,fee schedule,649.58,682.06,APC Endo ak/hip alignable system,L5920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,649.58,,,,,,,fee schedule,649.58,682.06,APC Above knee manual lock,L5925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,427.81,,,,,,,fee schedule,411.36,431.93,APC Above knee manual lock,L5925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,431.93,,,,,,,fee schedule,411.36,431.93,APC Above knee manual lock,L5925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,411.36,,,,,,,fee schedule,411.36,431.93,APC Endoskel posit rotat unit,L5926,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,729.52,,,,,,,fee schedule,701.46,736.53,APC Endoskel posit rotat unit,L5926,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,736.53,,,,,,,fee schedule,701.46,736.53,APC Endoskel posit rotat unit,L5926,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,701.46,,,,,,,fee schedule,701.46,736.53,APC High activity knee frame,L5930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4207.12,,,,,,,fee schedule,4045.31,4247.58,APC High activity knee frame,L5930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4247.58,,,,,,,fee schedule,4045.31,4247.58,APC High activity knee frame,L5930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4045.31,,,,,,,fee schedule,4045.31,4247.58,APC Endo bk ultra-light material,L5940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,638.66,,,,,,,fee schedule,614.1,644.8,APC Endo bk ultra-light material,L5940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,644.81,,,,,,,fee schedule,614.1,644.8,APC Endo bk ultra-light material,L5940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,614.1,,,,,,,fee schedule,614.1,644.8,APC Endo ak ultra-light material,L5950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1078.92,,,,,,,fee schedule,1037.42,1089.29,APC Endo ak ultra-light material,L5950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1089.29,,,,,,,fee schedule,1037.42,1089.29,APC Endo ak ultra-light material,L5950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1037.42,,,,,,,fee schedule,1037.42,1089.29,APC Endo hip ultra-light materia,L5960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1292.38,,,,,,,fee schedule,1242.67,1304.8,APC Endo hip ultra-light materia,L5960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1304.8,,,,,,,fee schedule,1242.67,1304.8,APC Endo hip ultra-light materia,L5960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1242.67,,,,,,,fee schedule,1242.67,1304.8,APC "Endo poly hip, pneu/hyd/rot",L5961,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5792.46,,,,,,,fee schedule,5569.67,5848.15,APC "Endo poly hip, pneu/hyd/rot",L5961,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5848.15,,,,,,,fee schedule,5569.67,5848.15,APC "Endo poly hip, pneu/hyd/rot",L5961,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5569.67,,,,,,,fee schedule,5569.67,5848.15,APC Below knee flex cover system,L5962,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,748.38,,,,,,,fee schedule,719.6,755.58,APC Below knee flex cover system,L5962,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,755.58,,,,,,,fee schedule,719.6,755.58,APC Below knee flex cover system,L5962,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,719.6,,,,,,,fee schedule,719.6,755.58,APC Above knee flex cover system,L5964,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1340.52,,,,,,,fee schedule,1288.96,1353.41,APC Above knee flex cover system,L5964,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1353.41,,,,,,,fee schedule,1288.96,1353.41,APC Above knee flex cover system,L5964,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1288.96,,,,,,,fee schedule,1288.96,1353.41,APC Hip flexible cover system,L5966,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1726.81,,,,,,,fee schedule,1660.39,1743.41,APC Hip flexible cover system,L5966,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1743.41,,,,,,,fee schedule,1660.39,1743.41,APC Hip flexible cover system,L5966,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1660.39,,,,,,,fee schedule,1660.39,1743.41,APC Multiaxial ankle w dorsiflex,L5968,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4542.1,,,,,,,fee schedule,4367.4,4585.77,APC Multiaxial ankle w dorsiflex,L5968,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4585.77,,,,,,,fee schedule,4367.4,4585.77,APC Multiaxial ankle w dorsiflex,L5968,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4367.4,,,,,,,fee schedule,4367.4,4585.77,APC Foot external keel sach foot,L5970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,279.51,,,,,,,fee schedule,268.76,282.2,APC Foot external keel sach foot,L5970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,282.2,,,,,,,fee schedule,268.76,282.2,APC Foot external keel sach foot,L5970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,268.76,,,,,,,fee schedule,268.76,282.2,APC "SACH foot, replacement",L5971,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,279.51,,,,,,,fee schedule,268.76,282.2,APC "SACH foot, replacement",L5971,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,282.2,,,,,,,fee schedule,268.76,282.2,APC "SACH foot, replacement",L5971,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,268.76,,,,,,,fee schedule,268.76,282.2,APC Flexible keel foot,L5972,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,448.72,,,,,,,fee schedule,431.46,453.03,APC Flexible keel foot,L5972,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,453.03,,,,,,,fee schedule,431.46,453.03,APC Flexible keel foot,L5972,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,431.46,,,,,,,fee schedule,431.46,453.03,APC Ank-foot sys dors-plant flex,L5973,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21882.64,,,,,,,fee schedule,21041,22093.05,APC Ank-foot sys dors-plant flex,L5973,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22093.05,,,,,,,fee schedule,21041,22093.05,APC Ank-foot sys dors-plant flex,L5973,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21041,,,,,,,fee schedule,21041,22093.05,APC Foot single axis ankle/foot,L5974,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,378.58,,,,,,,fee schedule,364.02,382.22,APC Foot single axis ankle/foot,L5974,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,382.22,,,,,,,fee schedule,364.02,382.22,APC Foot single axis ankle/foot,L5974,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,364.02,,,,,,,fee schedule,364.02,382.22,APC Combo ankle/foot prosthesis,L5975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,579.44,,,,,,,fee schedule,557.15,585.01,APC Combo ankle/foot prosthesis,L5975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,585.01,,,,,,,fee schedule,557.15,585.01,APC Combo ankle/foot prosthesis,L5975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,557.15,,,,,,,fee schedule,557.15,585.01,APC Energy storing foot,L5976,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,713.03,,,,,,,fee schedule,685.61,719.89,APC Energy storing foot,L5976,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,719.89,,,,,,,fee schedule,685.61,719.89,APC Energy storing foot,L5976,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,685.61,,,,,,,fee schedule,685.61,719.89,APC Ft prosth multiaxial ankl/ft,L5978,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,371.56,,,,,,,fee schedule,357.27,375.13,APC Ft prosth multiaxial ankl/ft,L5978,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,375.13,,,,,,,fee schedule,357.27,375.13,APC Ft prosth multiaxial ankl/ft,L5978,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,357.27,,,,,,,fee schedule,357.27,375.13,APC Multi-axial ankle/ft prosth,L5979,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2981.53,,,,,,,fee schedule,2866.86,3010.2,APC Multi-axial ankle/ft prosth,L5979,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3010.2,,,,,,,fee schedule,2866.86,3010.2,APC Multi-axial ankle/ft prosth,L5979,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2866.86,,,,,,,fee schedule,2866.86,3010.2,APC Flex foot system,L5980,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4720.72,,,,,,,fee schedule,4539.15,4766.11,APC Flex foot system,L5980,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4766.11,,,,,,,fee schedule,4539.15,4766.11,APC Flex foot system,L5980,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4539.15,,,,,,,fee schedule,4539.15,4766.11,APC Flex-walk sys low ext prosth,L5981,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4080.43,,,,,,,fee schedule,3923.49,4119.66,APC Flex-walk sys low ext prosth,L5981,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4119.66,,,,,,,fee schedule,3923.49,4119.66,APC Flex-walk sys low ext prosth,L5981,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3923.49,,,,,,,fee schedule,3923.49,4119.66,APC Exoskeletal axial rotation u,L5982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,736.06,,,,,,,fee schedule,707.75,743.14,APC Exoskeletal axial rotation u,L5982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,743.14,,,,,,,fee schedule,707.75,743.14,APC Exoskeletal axial rotation u,L5982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,707.75,,,,,,,fee schedule,707.75,743.14,APC Endoskeletal axial rotation,L5984,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,729.52,,,,,,,fee schedule,701.46,736.53,APC Endoskeletal axial rotation,L5984,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,736.53,,,,,,,fee schedule,701.46,736.53,APC Endoskeletal axial rotation,L5984,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,701.46,,,,,,,fee schedule,701.46,736.53,APC Lwr ext dynamic prosth pylon,L5985,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,352.97,,,,,,,fee schedule,339.39,356.36,APC Lwr ext dynamic prosth pylon,L5985,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,356.36,,,,,,,fee schedule,339.39,356.36,APC Lwr ext dynamic prosth pylon,L5985,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,339.39,,,,,,,fee schedule,339.39,356.36,APC Multi-axial rotation unit,L5986,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,811.1,,,,,,,fee schedule,779.9,818.9,APC Multi-axial rotation unit,L5986,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,818.9,,,,,,,fee schedule,779.9,818.9,APC Multi-axial rotation unit,L5986,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,779.9,,,,,,,fee schedule,779.9,818.9,APC Shank ft w vert load pylon,L5987,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8991.54,,,,,,,fee schedule,8645.71,9078,APC Shank ft w vert load pylon,L5987,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9078,,,,,,,fee schedule,8645.71,9078,APC Shank ft w vert load pylon,L5987,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8645.71,,,,,,,fee schedule,8645.71,9078,APC Vertical shock reducing pylo,L5988,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2496.98,,,,,,,fee schedule,2400.94,2520.99,APC Vertical shock reducing pylo,L5988,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2520.99,,,,,,,fee schedule,2400.94,2520.99,APC Vertical shock reducing pylo,L5988,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2400.94,,,,,,,fee schedule,2400.94,2520.99,APC User adjustable heel height,L5990,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2267.63,,,,,,,fee schedule,2180.41,2289.43,APC User adjustable heel height,L5990,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2289.43,,,,,,,fee schedule,2180.41,2289.43,APC User adjustable heel height,L5990,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2180.41,,,,,,,fee schedule,2180.41,2289.43,APC Low pros ext osseo connector,L5991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12225.24,,,,,,,fee schedule,11755.04,12342.79,APC Low pros ext osseo connector,L5991,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12342.79,,,,,,,fee schedule,11755.04,12342.79,APC Low pros ext osseo connector,L5991,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11755.04,,,,,,,fee schedule,11755.04,12342.79,APC Part hand myo exclu term dev,L6026,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5384.3,,,,,,,fee schedule,5177.21,5436.07,APC Part hand myo exclu term dev,L6026,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5436.07,,,,,,,fee schedule,5177.21,5436.07,APC Part hand myo exclu term dev,L6026,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5177.21,,,,,,,fee schedule,5177.21,5436.07,APC Wrst MLd sck flx hng tri pad,L6050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2418.62,,,,,,,fee schedule,2325.6,2441.88,APC Wrst MLd sck flx hng tri pad,L6050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2441.88,,,,,,,fee schedule,2325.6,2441.88,APC Wrst MLd sck flx hng tri pad,L6050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2325.6,,,,,,,fee schedule,2325.6,2441.88,APC Wrst mold sock w/exp interfa,L6055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3844.51,,,,,,,fee schedule,3696.64,3881.47,APC Wrst mold sock w/exp interfa,L6055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3881.47,,,,,,,fee schedule,3696.64,3881.47,APC Wrst mold sock w/exp interfa,L6055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3696.64,,,,,,,fee schedule,3696.64,3881.47,APC Elb mold sock flex hinge pad,L6100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2450.44,,,,,,,fee schedule,2356.19,2474,APC Elb mold sock flex hinge pad,L6100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2474,,,,,,,fee schedule,2356.19,2474,APC Elb mold sock flex hinge pad,L6100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2356.19,,,,,,,fee schedule,2356.19,2474,APC Elbow mold sock suspension t,L6110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2599.11,,,,,,,fee schedule,2499.14,2624.1,APC Elbow mold sock suspension t,L6110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2624.1,,,,,,,fee schedule,2499.14,2624.1,APC Elbow mold sock suspension t,L6110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2499.14,,,,,,,fee schedule,2499.14,2624.1,APC Elbow mold doub splt soc ste,L6120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3028.89,,,,,,,fee schedule,2912.39,3058.01,APC Elbow mold doub splt soc ste,L6120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3058.01,,,,,,,fee schedule,2912.39,3058.01,APC Elbow mold doub splt soc ste,L6120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2912.39,,,,,,,fee schedule,2912.39,3058.01,APC Elbow stump activated lock h,L6130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3295.99,,,,,,,fee schedule,3169.22,3327.68,APC Elbow stump activated lock h,L6130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3327.68,,,,,,,fee schedule,3169.22,3327.68,APC Elbow stump activated lock h,L6130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3169.22,,,,,,,fee schedule,3169.22,3327.68,APC Elbow mold outsid lock hinge,L6200,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3473.44,,,,,,,fee schedule,3339.85,3506.84,APC Elbow mold outsid lock hinge,L6200,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3506.84,,,,,,,fee schedule,3339.85,3506.84,APC Elbow mold outsid lock hinge,L6200,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3339.85,,,,,,,fee schedule,3339.85,3506.84,APC Elbow molded w/ expand inter,L6205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5788.11,,,,,,,fee schedule,5565.49,5843.76,APC Elbow molded w/ expand inter,L6205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5843.76,,,,,,,fee schedule,5565.49,5843.76,APC Elbow molded w/ expand inter,L6205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5565.49,,,,,,,fee schedule,5565.49,5843.76,APC Elbow inter loc elbow forarm,L6250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3419.02,,,,,,,fee schedule,3287.52,3451.9,APC Elbow inter loc elbow forarm,L6250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3451.9,,,,,,,fee schedule,3287.52,3451.9,APC Elbow inter loc elbow forarm,L6250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3287.52,,,,,,,fee schedule,3287.52,3451.9,APC Shlder disart int lock elbow,L6300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4743.53,,,,,,,fee schedule,4561.09,4789.14,APC Shlder disart int lock elbow,L6300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4789.14,,,,,,,fee schedule,4561.09,4789.14,APC Shlder disart int lock elbow,L6300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4561.09,,,,,,,fee schedule,4561.09,4789.14,APC Shoulder passive restor comp,L6310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3900.94,,,,,,,fee schedule,3750.9,3938.44,APC Shoulder passive restor comp,L6310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3938.44,,,,,,,fee schedule,3750.9,3938.44,APC Shoulder passive restor comp,L6310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3750.9,,,,,,,fee schedule,3750.9,3938.44,APC Shoulder passive restor cap,L6320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2175.84,,,,,,,fee schedule,2092.15,2196.76,APC Shoulder passive restor cap,L6320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2196.76,,,,,,,fee schedule,2092.15,2196.76,APC Shoulder passive restor cap,L6320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2092.15,,,,,,,fee schedule,2092.15,2196.76,APC Thoracic intern lock elbow,L6350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4987.1,,,,,,,fee schedule,4795.29,5035.05,APC Thoracic intern lock elbow,L6350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5035.05,,,,,,,fee schedule,4795.29,5035.05,APC Thoracic intern lock elbow,L6350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4795.29,,,,,,,fee schedule,4795.29,5035.05,APC Thoracic passive restor comp,L6360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4094.14,,,,,,,fee schedule,3936.67,4133.5,APC Thoracic passive restor comp,L6360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4133.5,,,,,,,fee schedule,3936.67,4133.5,APC Thoracic passive restor comp,L6360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3936.67,,,,,,,fee schedule,3936.67,4133.5,APC Thoracic passive restor cap,L6370,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3082.23,,,,,,,fee schedule,2963.68,3111.86,APC Thoracic passive restor cap,L6370,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3111.86,,,,,,,fee schedule,2963.68,3111.86,APC Thoracic passive restor cap,L6370,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2963.68,,,,,,,fee schedule,2963.68,3111.86,APC Postop dsg cast chg wrst/elb,L6380,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1664.68,,,,,,,fee schedule,1600.65,1680.68,APC Postop dsg cast chg wrst/elb,L6380,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1680.68,,,,,,,fee schedule,1600.65,1680.68,APC Postop dsg cast chg wrst/elb,L6380,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1600.65,,,,,,,fee schedule,1600.65,1680.68,APC Postop dsg cast chg elb dis/,L6382,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1992.02,,,,,,,fee schedule,1915.4,2011.17,APC Postop dsg cast chg elb dis/,L6382,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2011.17,,,,,,,fee schedule,1915.4,2011.17,APC Postop dsg cast chg elb dis/,L6382,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1915.4,,,,,,,fee schedule,1915.4,2011.17,APC Postop dsg cast chg shlder/t,L6384,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2430.83,,,,,,,fee schedule,2337.34,2454.21,APC Postop dsg cast chg shlder/t,L6384,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2454.21,,,,,,,fee schedule,2337.34,2454.21,APC Postop dsg cast chg shlder/t,L6384,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2337.34,,,,,,,fee schedule,2337.34,2454.21,APC Postop ea cast chg & realign,L6386,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,582.93,,,,,,,fee schedule,560.51,588.54,APC Postop ea cast chg & realign,L6386,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,588.54,,,,,,,fee schedule,560.51,588.54,APC Postop ea cast chg & realign,L6386,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,560.51,,,,,,,fee schedule,560.51,588.54,APC Postop applicat rigid dsg on,L6388,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,559.74,,,,,,,fee schedule,538.21,565.12,APC Postop applicat rigid dsg on,L6388,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,565.12,,,,,,,fee schedule,538.21,565.12,APC Postop applicat rigid dsg on,L6388,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,538.21,,,,,,,fee schedule,538.21,565.12,APC Below elbow prosth tiss shap,L6400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2960.6,,,,,,,fee schedule,2846.73,2989.07,APC Below elbow prosth tiss shap,L6400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2989.07,,,,,,,fee schedule,2846.73,2989.07,APC Below elbow prosth tiss shap,L6400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2846.73,,,,,,,fee schedule,2846.73,2989.07,APC Elb disart prosth tiss shap,L6450,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3925.44,,,,,,,fee schedule,3774.46,3963.18,APC Elb disart prosth tiss shap,L6450,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3963.18,,,,,,,fee schedule,3774.46,3963.18,APC Elb disart prosth tiss shap,L6450,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3774.46,,,,,,,fee schedule,3774.46,3963.18,APC Above elbow prosth tiss shap,L6500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3928.64,,,,,,,fee schedule,3777.54,3966.42,APC Above elbow prosth tiss shap,L6500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3966.42,,,,,,,fee schedule,3777.54,3966.42,APC Above elbow prosth tiss shap,L6500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3777.54,,,,,,,fee schedule,3777.54,3966.42,APC Shldr disar prosth tiss shap,L6550,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4855.09,,,,,,,fee schedule,4668.36,4901.78,APC Shldr disar prosth tiss shap,L6550,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4901.78,,,,,,,fee schedule,4668.36,4901.78,APC Shldr disar prosth tiss shap,L6550,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4668.36,,,,,,,fee schedule,4668.36,4901.78,APC Scap thorac prosth tiss shap,L6570,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5890.89,,,,,,,fee schedule,5664.32,5947.54,APC Scap thorac prosth tiss shap,L6570,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5947.54,,,,,,,fee schedule,5664.32,5947.54,APC Scap thorac prosth tiss shap,L6570,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5664.32,,,,,,,fee schedule,5664.32,5947.54,APC Wrist/elbow bowden cable mol,L6580,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2056.3,,,,,,,fee schedule,1977.21,2076.07,APC Wrist/elbow bowden cable mol,L6580,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2076.07,,,,,,,fee schedule,1977.21,2076.07,APC Wrist/elbow bowden cable mol,L6580,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1977.21,,,,,,,fee schedule,1977.21,2076.07,APC Wrist/elbow bowden cbl dir f,L6582,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1752.34,,,,,,,fee schedule,1684.94,1769.19,APC Wrist/elbow bowden cbl dir f,L6582,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1769.19,,,,,,,fee schedule,1684.94,1769.19,APC Wrist/elbow bowden cbl dir f,L6582,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1684.94,,,,,,,fee schedule,1684.94,1769.19,APC Elbow fair lead cable molded,L6584,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2838.49,,,,,,,fee schedule,2729.32,2865.79,APC Elbow fair lead cable molded,L6584,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2865.79,,,,,,,fee schedule,2729.32,2865.79,APC Elbow fair lead cable molded,L6584,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2729.32,,,,,,,fee schedule,2729.32,2865.79,APC Elbow fair lead cable dir fo,L6586,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2483.08,,,,,,,fee schedule,2387.58,2506.96,APC Elbow fair lead cable dir fo,L6586,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2506.96,,,,,,,fee schedule,2387.58,2506.96,APC Elbow fair lead cable dir fo,L6586,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2387.58,,,,,,,fee schedule,2387.58,2506.96,APC Shdr fair lead cable molded,L6588,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4098.99,,,,,,,fee schedule,3941.34,4138.41,APC Shdr fair lead cable molded,L6588,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4138.41,,,,,,,fee schedule,3941.34,4138.41,APC Shdr fair lead cable molded,L6588,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3941.34,,,,,,,fee schedule,3941.34,4138.41,APC Shdr fair lead cable direct,L6590,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3749.43,,,,,,,fee schedule,3605.22,3785.48,APC Shdr fair lead cable direct,L6590,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3785.48,,,,,,,fee schedule,3605.22,3785.48,APC Shdr fair lead cable direct,L6590,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3605.22,,,,,,,fee schedule,3605.22,3785.48,APC Polycentric hinge pair,L6600,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,252.99,,,,,,,fee schedule,243.26,255.42,APC Polycentric hinge pair,L6600,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,255.42,,,,,,,fee schedule,243.26,255.42,APC Polycentric hinge pair,L6600,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,243.26,,,,,,,fee schedule,243.26,255.42,APC Single pivot hinge pair,L6605,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,236.15,,,,,,,fee schedule,227.07,238.42,APC Single pivot hinge pair,L6605,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,238.42,,,,,,,fee schedule,227.07,238.42,APC Single pivot hinge pair,L6605,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,227.07,,,,,,,fee schedule,227.07,238.42,APC Flexible metal hinge pair,L6610,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,211.98,,,,,,,fee schedule,203.83,214.02,APC Flexible metal hinge pair,L6610,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,214.02,,,,,,,fee schedule,203.83,214.02,APC Flexible metal hinge pair,L6610,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,203.83,,,,,,,fee schedule,203.83,214.02,APC "Additional switch, ext power",L6611,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,514.64,,,,,,,fee schedule,494.85,519.59,APC "Additional switch, ext power",L6611,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,519.59,,,,,,,fee schedule,494.85,519.59,APC "Additional switch, ext power",L6611,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,494.85,,,,,,,fee schedule,494.85,519.59,APC Disconnect locking wrist uni,L6615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,261.39,,,,,,,fee schedule,251.34,263.91,APC Disconnect locking wrist uni,L6615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,263.91,,,,,,,fee schedule,251.34,263.91,APC Disconnect locking wrist uni,L6615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,251.34,,,,,,,fee schedule,251.34,263.91,APC Disconnect insert locking wr,L6616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,110.12,,,,,,,fee schedule,105.88,111.17,APC Disconnect insert locking wr,L6616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,111.17,,,,,,,fee schedule,105.88,111.17,APC Disconnect insert locking wr,L6616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,105.88,,,,,,,fee schedule,105.88,111.17,APC Flexion/extension wrist unit,L6620,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,410.22,,,,,,,fee schedule,394.44,414.16,APC Flexion/extension wrist unit,L6620,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,414.16,,,,,,,fee schedule,394.44,414.16,APC Flexion/extension wrist unit,L6620,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,394.44,,,,,,,fee schedule,394.44,414.16,APC Flex/ext wrist w/wo friction,L6621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2858.94,,,,,,,fee schedule,2748.98,2886.43,APC Flex/ext wrist w/wo friction,L6621,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2886.43,,,,,,,fee schedule,2748.98,2886.43,APC Flex/ext wrist w/wo friction,L6621,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2748.98,,,,,,,fee schedule,2748.98,2886.43,APC Spring-ass rot wrst w/ latch,L6623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,939.01,,,,,,,fee schedule,902.89,948.03,APC Spring-ass rot wrst w/ latch,L6623,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,948.03,,,,,,,fee schedule,902.89,948.03,APC Spring-ass rot wrst w/ latch,L6623,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,902.89,,,,,,,fee schedule,902.89,948.03,APC Flex/ext/rotation wrist unit,L6624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4707.32,,,,,,,fee schedule,4526.27,4752.58,APC Flex/ext/rotation wrist unit,L6624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4752.58,,,,,,,fee schedule,4526.27,4752.58,APC Flex/ext/rotation wrist unit,L6624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4526.27,,,,,,,fee schedule,4526.27,4752.58,APC Rotation wrst w/ cable lock,L6625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,683.29,,,,,,,fee schedule,657.01,689.86,APC Rotation wrst w/ cable lock,L6625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,689.86,,,,,,,fee schedule,657.01,689.86,APC Rotation wrst w/ cable lock,L6625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,657.01,,,,,,,fee schedule,657.01,689.86,APC Quick disconn hook adapter o,L6628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,698.28,,,,,,,fee schedule,671.42,704.99,APC Quick disconn hook adapter o,L6628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,704.99,,,,,,,fee schedule,671.42,704.99,APC Quick disconn hook adapter o,L6628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,671.42,,,,,,,fee schedule,671.42,704.99,APC Lamination collar w/ couplin,L6629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,186.27,,,,,,,fee schedule,179.11,188.07,APC Lamination collar w/ couplin,L6629,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,188.07,,,,,,,fee schedule,179.11,188.07,APC Lamination collar w/ couplin,L6629,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,179.11,,,,,,,fee schedule,179.11,188.07,APC Stainless steel any wrist,L6630,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,274.4,,,,,,,fee schedule,263.85,277.04,APC Stainless steel any wrist,L6630,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,277.04,,,,,,,fee schedule,263.85,277.04,APC Stainless steel any wrist,L6630,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,263.85,,,,,,,fee schedule,263.85,277.04,APC Latex suspension sleeve each,L6632,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,91.53,,,,,,,fee schedule,88.01,92.41,APC Latex suspension sleeve each,L6632,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92.41,,,,,,,fee schedule,88.01,92.41,APC Latex suspension sleeve each,L6632,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,88.01,,,,,,,fee schedule,88.01,92.41,APC Lift assist for elbow,L6635,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,254.17,,,,,,,fee schedule,244.39,256.61,APC Lift assist for elbow,L6635,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,256.61,,,,,,,fee schedule,244.39,256.61,APC Lift assist for elbow,L6635,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,244.39,,,,,,,fee schedule,244.39,256.61,APC Nudge control elbow lock,L6637,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,527.59,,,,,,,fee schedule,507.3,532.66,APC Nudge control elbow lock,L6637,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,532.67,,,,,,,fee schedule,507.3,532.66,APC Nudge control elbow lock,L6637,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,507.3,,,,,,,fee schedule,507.3,532.66,APC Elec lock on manual pw elbow,L6638,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3125.71,,,,,,,fee schedule,3005.49,3155.76,APC Elec lock on manual pw elbow,L6638,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3155.76,,,,,,,fee schedule,3005.49,3155.76,APC Elec lock on manual pw elbow,L6638,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3005.49,,,,,,,fee schedule,3005.49,3155.76,APC Shoulder abduction joint pai,L6640,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,360.04,,,,,,,fee schedule,346.19,363.5,APC Shoulder abduction joint pai,L6640,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,363.5,,,,,,,fee schedule,346.19,363.5,APC Shoulder abduction joint pai,L6640,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,346.19,,,,,,,fee schedule,346.19,363.5,APC Excursion amplifier pulley t,L6641,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,239.28,,,,,,,fee schedule,230.08,241.58,APC Excursion amplifier pulley t,L6641,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,241.58,,,,,,,fee schedule,230.08,241.58,APC Excursion amplifier pulley t,L6641,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,230.08,,,,,,,fee schedule,230.08,241.58,APC Excursion amplifier lever ty,L6642,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,340.69,,,,,,,fee schedule,327.59,343.97,APC Excursion amplifier lever ty,L6642,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,343.97,,,,,,,fee schedule,327.59,343.97,APC Excursion amplifier lever ty,L6642,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,327.59,,,,,,,fee schedule,327.59,343.97,APC Shoulder flexion-abduction j,L6645,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,413.73,,,,,,,fee schedule,397.82,417.71,APC Shoulder flexion-abduction j,L6645,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,417.71,,,,,,,fee schedule,397.82,417.71,APC Shoulder flexion-abduction j,L6645,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,397.82,,,,,,,fee schedule,397.82,417.71,APC Multipo locking shoulder jnt,L6646,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3942.23,,,,,,,fee schedule,3790.61,3980.14,APC Multipo locking shoulder jnt,L6646,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3980.14,,,,,,,fee schedule,3790.61,3980.14,APC Multipo locking shoulder jnt,L6646,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3790.61,,,,,,,fee schedule,3790.61,3980.14,APC Shoulder lock actuator,L6647,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,649,,,,,,,fee schedule,624.04,655.24,APC Shoulder lock actuator,L6647,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,655.24,,,,,,,fee schedule,624.04,655.24,APC Shoulder lock actuator,L6647,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,624.04,,,,,,,fee schedule,624.04,655.24,APC Ext pwrd shlder lock/unlock,L6648,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4065.84,,,,,,,fee schedule,3909.46,4104.93,APC Ext pwrd shlder lock/unlock,L6648,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4104.93,,,,,,,fee schedule,3909.46,4104.93,APC Ext pwrd shlder lock/unlock,L6648,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3909.46,,,,,,,fee schedule,3909.46,4104.93,APC Shoulder universal joint,L6650,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,430.97,,,,,,,fee schedule,414.39,435.11,APC Shoulder universal joint,L6650,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,435.11,,,,,,,fee schedule,414.39,435.11,APC Shoulder universal joint,L6650,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,414.39,,,,,,,fee schedule,414.39,435.11,APC Standard control cable extra,L6655,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,95.65,,,,,,,fee schedule,91.97,96.57,APC Standard control cable extra,L6655,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,96.57,,,,,,,fee schedule,91.97,96.57,APC Standard control cable extra,L6655,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,91.97,,,,,,,fee schedule,91.97,96.57,APC Heavy duty control cable,L6660,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.86,,,,,,,fee schedule,112.37,117.99,APC Heavy duty control cable,L6660,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.99,,,,,,,fee schedule,112.37,117.99,APC Heavy duty control cable,L6660,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.37,,,,,,,fee schedule,112.37,117.99,APC Teflon or equal cable lining,L6665,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,66.82,,,,,,,fee schedule,64.25,67.46,APC Teflon or equal cable lining,L6665,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,67.46,,,,,,,fee schedule,64.25,67.46,APC Teflon or equal cable lining,L6665,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,64.25,,,,,,,fee schedule,64.25,67.46,APC Hook to hand cable adapter,L6670,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,63.35,,,,,,,fee schedule,60.91,63.96,APC Hook to hand cable adapter,L6670,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,63.96,,,,,,,fee schedule,60.91,63.96,APC Hook to hand cable adapter,L6670,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,60.91,,,,,,,fee schedule,60.91,63.96,APC Harness chest/shlder saddle,L6672,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,214.69,,,,,,,fee schedule,206.43,216.75,APC Harness chest/shlder saddle,L6672,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,216.75,,,,,,,fee schedule,206.43,216.75,APC Harness chest/shlder saddle,L6672,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,206.43,,,,,,,fee schedule,206.43,216.75,APC Harness figure of 8 sing con,L6675,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.9,,,,,,,fee schedule,147.02,154.37,APC Harness figure of 8 sing con,L6675,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.37,,,,,,,fee schedule,147.02,154.37,APC Harness figure of 8 sing con,L6675,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.02,,,,,,,fee schedule,147.02,154.37,APC Harness figure of 8 dual con,L6676,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,154.41,,,,,,,fee schedule,148.47,155.89,APC Harness figure of 8 dual con,L6676,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,155.89,,,,,,,fee schedule,148.47,155.89,APC Harness figure of 8 dual con,L6676,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,148.47,,,,,,,fee schedule,148.47,155.89,APC UE triple control harness,L6677,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,370.78,,,,,,,fee schedule,356.52,374.35,APC UE triple control harness,L6677,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,374.35,,,,,,,fee schedule,356.52,374.35,APC UE triple control harness,L6677,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,356.52,,,,,,,fee schedule,356.52,374.35,APC Test sock wrist disart/bel e,L6680,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,295.39,,,,,,,fee schedule,284.03,298.23,APC Test sock wrist disart/bel e,L6680,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,298.23,,,,,,,fee schedule,284.03,298.23,APC Test sock wrist disart/bel e,L6680,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,284.03,,,,,,,fee schedule,284.03,298.23,APC Test sock elbw disart/above,L6682,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,331.06,,,,,,,fee schedule,318.33,334.25,APC Test sock elbw disart/above,L6682,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,334.25,,,,,,,fee schedule,318.33,334.25,APC Test sock elbw disart/above,L6682,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,318.33,,,,,,,fee schedule,318.33,334.25,APC Test socket shldr disart/tho,L6684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,443.81,,,,,,,fee schedule,426.74,448.08,APC Test socket shldr disart/tho,L6684,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,448.08,,,,,,,fee schedule,426.74,448.08,APC Test socket shldr disart/tho,L6684,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,426.74,,,,,,,fee schedule,426.74,448.08,APC Suction socket,L6686,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,825.3,,,,,,,fee schedule,793.56,833.24,APC Suction socket,L6686,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,833.24,,,,,,,fee schedule,793.56,833.24,APC Suction socket,L6686,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,793.56,,,,,,,fee schedule,793.56,833.24,APC Frame typ socket bel elbow/w,L6687,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,734.41,,,,,,,fee schedule,706.16,741.47,APC Frame typ socket bel elbow/w,L6687,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,741.47,,,,,,,fee schedule,706.16,741.47,APC Frame typ socket bel elbow/w,L6687,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,706.16,,,,,,,fee schedule,706.16,741.47,APC Frame typ sock above elb/dis,L6688,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,710.41,,,,,,,fee schedule,683.09,717.24,APC Frame typ sock above elb/dis,L6688,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,717.24,,,,,,,fee schedule,683.09,717.24,APC Frame typ sock above elb/dis,L6688,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,683.09,,,,,,,fee schedule,683.09,717.24,APC Frame typ socket shoulder di,L6689,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,857.9,,,,,,,fee schedule,824.9,866.14,APC Frame typ socket shoulder di,L6689,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,866.14,,,,,,,fee schedule,824.9,866.14,APC Frame typ socket shoulder di,L6689,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,824.9,,,,,,,fee schedule,824.9,866.14,APC Frame typ sock interscap-tho,L6690,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,929.06,,,,,,,fee schedule,893.33,938,APC Frame typ sock interscap-tho,L6690,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,938,,,,,,,fee schedule,893.33,938,APC Frame typ sock interscap-tho,L6690,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,893.33,,,,,,,fee schedule,893.33,938,APC Removable insert each,L6691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,555.61,,,,,,,fee schedule,534.24,560.95,APC Removable insert each,L6691,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,560.95,,,,,,,fee schedule,534.24,560.95,APC Removable insert each,L6691,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,534.24,,,,,,,fee schedule,534.24,560.95,APC Silicone gel insert or equal,L6692,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,712.02,,,,,,,fee schedule,684.63,718.86,APC Silicone gel insert or equal,L6692,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,718.86,,,,,,,fee schedule,684.63,718.86,APC Silicone gel insert or equal,L6692,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,684.63,,,,,,,fee schedule,684.63,718.86,APC Lockingelbow forearm cntrbal,L6693,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3548.51,,,,,,,fee schedule,3412.03,3582.63,APC Lockingelbow forearm cntrbal,L6693,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3582.63,,,,,,,fee schedule,3412.03,3582.63,APC Lockingelbow forearm cntrbal,L6693,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3412.03,,,,,,,fee schedule,3412.03,3582.63,APC Elbow socket ins use w/lock,L6694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,894.5,,,,,,,fee schedule,860.1,903.1,APC Elbow socket ins use w/lock,L6694,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,903.1,,,,,,,fee schedule,860.1,903.1,APC Elbow socket ins use w/lock,L6694,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,860.1,,,,,,,fee schedule,860.1,903.1,APC Elbow socket ins use w/o lck,L6695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,745.41,,,,,,,fee schedule,716.74,752.58,APC Elbow socket ins use w/o lck,L6695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,752.58,,,,,,,fee schedule,716.74,752.58,APC Elbow socket ins use w/o lck,L6695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,716.74,,,,,,,fee schedule,716.74,752.58,APC Cus elbo skt in for con/atyp,L6696,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1644.14,,,,,,,fee schedule,1580.9,1659.94,APC Cus elbo skt in for con/atyp,L6696,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1659.95,,,,,,,fee schedule,1580.9,1659.94,APC Cus elbo skt in for con/atyp,L6696,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1580.9,,,,,,,fee schedule,1580.9,1659.94,APC Cus elbo skt in not con/atyp,L6697,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1644.14,,,,,,,fee schedule,1580.9,1659.94,APC Cus elbo skt in not con/atyp,L6697,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1659.95,,,,,,,fee schedule,1580.9,1659.94,APC Cus elbo skt in not con/atyp,L6697,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1580.9,,,,,,,fee schedule,1580.9,1659.94,APC Below/above elbow lock mech,L6698,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,633.32,,,,,,,fee schedule,608.96,639.41,APC Below/above elbow lock mech,L6698,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,639.41,,,,,,,fee schedule,608.96,639.41,APC Below/above elbow lock mech,L6698,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,608.96,,,,,,,fee schedule,608.96,639.41,APC Ue add ext power myoel,L6700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30690.6,,,,,,,fee schedule,29510.19,30985.7,APC Ue add ext power myoel,L6700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30985.7,,,,,,,fee schedule,29510.19,30985.7,APC Ue add ext power myoel,L6700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29510.19,,,,,,,fee schedule,29510.19,30985.7,APC "Term dev, passive hand mitt",L6703,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,450.29,,,,,,,fee schedule,432.97,454.62,APC "Term dev, passive hand mitt",L6703,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,454.62,,,,,,,fee schedule,432.97,454.62,APC "Term dev, passive hand mitt",L6703,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,432.97,,,,,,,fee schedule,432.97,454.62,APC "Term dev, sport/rec/work att",L6704,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,745.64,,,,,,,fee schedule,716.96,752.81,APC "Term dev, sport/rec/work att",L6704,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,752.81,,,,,,,fee schedule,716.96,752.81,APC "Term dev, sport/rec/work att",L6704,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,716.96,,,,,,,fee schedule,716.96,752.81,APC Term dev mech hook vol open,L6706,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,444.25,,,,,,,fee schedule,427.16,448.52,APC Term dev mech hook vol open,L6706,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,448.52,,,,,,,fee schedule,427.16,448.52,APC Term dev mech hook vol open,L6706,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,427.16,,,,,,,fee schedule,427.16,448.52,APC Term dev mech hook vol close,L6707,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1872.34,,,,,,,fee schedule,1800.33,1890.35,APC Term dev mech hook vol close,L6707,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1890.35,,,,,,,fee schedule,1800.33,1890.35,APC Term dev mech hook vol close,L6707,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1800.33,,,,,,,fee schedule,1800.33,1890.35,APC Term dev mech hand vol open,L6708,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1065.01,,,,,,,fee schedule,1024.05,1075.25,APC Term dev mech hand vol open,L6708,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1075.25,,,,,,,fee schedule,1024.05,1075.25,APC Term dev mech hand vol open,L6708,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1024.05,,,,,,,fee schedule,1024.05,1075.25,APC Term dev mech hand vol close,L6709,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1723.64,,,,,,,fee schedule,1657.35,1740.22,APC Term dev mech hand vol close,L6709,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1740.22,,,,,,,fee schedule,1657.35,1740.22,APC Term dev mech hand vol close,L6709,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1657.35,,,,,,,fee schedule,1657.35,1740.22,APC "Ped term dev, hook, vol open",L6711,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,840.32,,,,,,,fee schedule,808,848.4,APC "Ped term dev, hook, vol open",L6711,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,848.4,,,,,,,fee schedule,808,848.4,APC "Ped term dev, hook, vol open",L6711,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,808,,,,,,,fee schedule,808,848.4,APC "Ped term dev, hook, vol clos",L6712,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1547.2,,,,,,,fee schedule,1487.69,1562.07,APC "Ped term dev, hook, vol clos",L6712,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1562.07,,,,,,,fee schedule,1487.69,1562.07,APC "Ped term dev, hook, vol clos",L6712,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1487.69,,,,,,,fee schedule,1487.69,1562.07,APC "Ped term dev, hand, vol open",L6713,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1952.79,,,,,,,fee schedule,1877.68,1971.56,APC "Ped term dev, hand, vol open",L6713,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1971.56,,,,,,,fee schedule,1877.68,1971.56,APC "Ped term dev, hand, vol open",L6713,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1877.68,,,,,,,fee schedule,1877.68,1971.56,APC "Ped term dev, hand, vol clos",L6714,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1653.96,,,,,,,fee schedule,1590.35,1669.87,APC "Ped term dev, hand, vol clos",L6714,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1669.87,,,,,,,fee schedule,1590.35,1669.87,APC "Ped term dev, hand, vol clos",L6714,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1590.35,,,,,,,fee schedule,1590.35,1669.87,APC "Term device, multi art digit",L6715,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3946.14,,,,,,,fee schedule,3794.37,3984.09,APC "Term device, multi art digit",L6715,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3984.09,,,,,,,fee schedule,3794.37,3984.09,APC "Term device, multi art digit",L6715,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3794.37,,,,,,,fee schedule,3794.37,3984.09,APC "Hook/hand, hvy dty, vol open",L6721,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2939.73,,,,,,,fee schedule,2826.66,2967.99,APC "Hook/hand, hvy dty, vol open",L6721,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2967.99,,,,,,,fee schedule,2826.66,2967.99,APC "Hook/hand, hvy dty, vol open",L6721,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2826.66,,,,,,,fee schedule,2826.66,2967.99,APC "Hook/hand, hvy dty, vol clos",L6722,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2534.28,,,,,,,fee schedule,2436.81,2558.65,APC "Hook/hand, hvy dty, vol clos",L6722,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2558.65,,,,,,,fee schedule,2436.81,2558.65,APC "Hook/hand, hvy dty, vol clos",L6722,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2436.81,,,,,,,fee schedule,2436.81,2558.65,APC Term dev modifier wrist unit,L6805,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,458.31,,,,,,,fee schedule,440.68,462.71,APC Term dev modifier wrist unit,L6805,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,462.71,,,,,,,fee schedule,440.68,462.71,APC Term dev modifier wrist unit,L6805,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,440.68,,,,,,,fee schedule,440.68,462.71,APC Term dev precision pinch dev,L6810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,249.82,,,,,,,fee schedule,240.21,252.22,APC Term dev precision pinch dev,L6810,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,252.22,,,,,,,fee schedule,240.21,252.22,APC Term dev precision pinch dev,L6810,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,240.21,,,,,,,fee schedule,240.21,252.22,APC Elec hand ind art digits,L6880,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29863.6,,,,,,,fee schedule,28715,30150.75,APC Elec hand ind art digits,L6880,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30150.75,,,,,,,fee schedule,28715,30150.75,APC Elec hand ind art digits,L6880,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28715,,,,,,,fee schedule,28715,30150.75,APC Term dev auto grasp feature,L6881,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5109.97,,,,,,,fee schedule,4913.43,5159.1,APC Term dev auto grasp feature,L6881,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5159.1,,,,,,,fee schedule,4913.43,5159.1,APC Term dev auto grasp feature,L6881,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4913.43,,,,,,,fee schedule,4913.43,5159.1,APC Microprocessor control uplmb,L6882,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3876.15,,,,,,,fee schedule,3727.07,3913.42,APC Microprocessor control uplmb,L6882,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3913.42,,,,,,,fee schedule,3727.07,3913.42,APC Microprocessor control uplmb,L6882,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3727.07,,,,,,,fee schedule,3727.07,3913.42,APC Replc sockt below e/w disa,L6883,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2020.44,,,,,,,fee schedule,1942.73,2039.87,APC Replc sockt below e/w disa,L6883,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2039.87,,,,,,,fee schedule,1942.73,2039.87,APC Replc sockt below e/w disa,L6883,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1942.73,,,,,,,fee schedule,1942.73,2039.87,APC Replc sockt above elbow disa,L6884,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2842.48,,,,,,,fee schedule,2733.15,2869.81,APC Replc sockt above elbow disa,L6884,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2869.81,,,,,,,fee schedule,2733.15,2869.81,APC Replc sockt above elbow disa,L6884,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2733.15,,,,,,,fee schedule,2733.15,2869.81,APC Replc sockt shldr dis/interc,L6885,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4094.14,,,,,,,fee schedule,3936.67,4133.5,APC Replc sockt shldr dis/interc,L6885,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4133.5,,,,,,,fee schedule,3936.67,4133.5,APC Replc sockt shldr dis/interc,L6885,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3936.67,,,,,,,fee schedule,3936.67,4133.5,APC Prefab glove for term device,L6890,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,216.56,,,,,,,fee schedule,208.23,218.64,APC Prefab glove for term device,L6890,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,218.64,,,,,,,fee schedule,208.23,218.64,APC Prefab glove for term device,L6890,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,208.23,,,,,,,fee schedule,208.23,218.64,APC Custom glove for term device,L6895,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,788.2,,,,,,,fee schedule,757.88,795.77,APC Custom glove for term device,L6895,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,795.77,,,,,,,fee schedule,757.88,795.77,APC Custom glove for term device,L6895,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,757.88,,,,,,,fee schedule,757.88,795.77,APC Hand restorat thumb/1 finger,L6900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2045.61,,,,,,,fee schedule,1966.93,2065.28,APC Hand restorat thumb/1 finger,L6900,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2065.28,,,,,,,fee schedule,1966.93,2065.28,APC Hand restorat thumb/1 finger,L6900,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1966.93,,,,,,,fee schedule,1966.93,2065.28,APC Hand restoration multiple fi,L6905,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2008.21,,,,,,,fee schedule,1930.97,2027.52,APC Hand restoration multiple fi,L6905,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2027.52,,,,,,,fee schedule,1930.97,2027.52,APC Hand restoration multiple fi,L6905,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1930.97,,,,,,,fee schedule,1930.97,2027.52,APC Hand restoration no fingers,L6910,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2061.56,,,,,,,fee schedule,1982.27,2081.38,APC Hand restoration no fingers,L6910,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2081.38,,,,,,,fee schedule,1982.27,2081.38,APC Hand restoration no fingers,L6910,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1982.27,,,,,,,fee schedule,1982.27,2081.38,APC Hand restoration replacmnt g,L6915,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,797.07,,,,,,,fee schedule,766.41,804.73,APC Hand restoration replacmnt g,L6915,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,804.73,,,,,,,fee schedule,766.41,804.73,APC Hand restoration replacmnt g,L6915,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,766.41,,,,,,,fee schedule,766.41,804.73,APC Wrist disarticul switch ctrl,L6920,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9814.26,,,,,,,fee schedule,9436.79,9908.63,APC Wrist disarticul switch ctrl,L6920,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9908.63,,,,,,,fee schedule,9436.79,9908.63,APC Wrist disarticul switch ctrl,L6920,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9436.79,,,,,,,fee schedule,9436.79,9908.63,APC Wrist disart myoelectronic c,L6925,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10759.27,,,,,,,fee schedule,10345.45,10862.72,APC Wrist disart myoelectronic c,L6925,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10862.72,,,,,,,fee schedule,10345.45,10862.72,APC Wrist disart myoelectronic c,L6925,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10345.45,,,,,,,fee schedule,10345.45,10862.72,APC Below elbow switch control,L6930,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9284.52,,,,,,,fee schedule,8927.42,9373.79,APC Below elbow switch control,L6930,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9373.79,,,,,,,fee schedule,8927.42,9373.79,APC Below elbow switch control,L6930,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8927.42,,,,,,,fee schedule,8927.42,9373.79,APC Below elbow myoelectronic ct,L6935,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10986.61,,,,,,,fee schedule,10564.05,11092.25,APC Below elbow myoelectronic ct,L6935,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11092.25,,,,,,,fee schedule,10564.05,11092.25,APC Below elbow myoelectronic ct,L6935,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10564.05,,,,,,,fee schedule,10564.05,11092.25,APC Elbow disarticulation switch,L6940,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12104.06,,,,,,,fee schedule,11638.52,12220.45,APC Elbow disarticulation switch,L6940,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12220.45,,,,,,,fee schedule,11638.52,12220.45,APC Elbow disarticulation switch,L6940,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11638.52,,,,,,,fee schedule,11638.52,12220.45,APC Elbow disart myoelectronic c,L6945,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,13538.15,,,,,,,fee schedule,13017.45,13668.32,APC Elbow disart myoelectronic c,L6945,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13668.32,,,,,,,fee schedule,13017.45,13668.32,APC Elbow disart myoelectronic c,L6945,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13017.45,,,,,,,fee schedule,13017.45,13668.32,APC Above elbow switch control,L6950,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12827.72,,,,,,,fee schedule,12334.35,12951.07,APC Above elbow switch control,L6950,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12951.07,,,,,,,fee schedule,12334.35,12951.07,APC Above elbow switch control,L6950,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12334.35,,,,,,,fee schedule,12334.35,12951.07,APC Above elbow myoelectronic ct,L6955,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15601,,,,,,,fee schedule,15000.96,15751.01,APC Above elbow myoelectronic ct,L6955,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15751.01,,,,,,,fee schedule,15000.96,15751.01,APC Above elbow myoelectronic ct,L6955,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15000.96,,,,,,,fee schedule,15000.96,15751.01,APC Shldr disartic switch contro,L6960,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,16562.82,,,,,,,fee schedule,15925.79,16722.08,APC Shldr disartic switch contro,L6960,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16722.08,,,,,,,fee schedule,15925.79,16722.08,APC Shldr disartic switch contro,L6960,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,15925.79,,,,,,,fee schedule,15925.79,16722.08,APC Shldr disartic myoelectronic,L6965,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18972.68,,,,,,,fee schedule,18242.96,19155.11,APC Shldr disartic myoelectronic,L6965,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19155.11,,,,,,,fee schedule,18242.96,19155.11,APC Shldr disartic myoelectronic,L6965,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18242.96,,,,,,,fee schedule,18242.96,19155.11,APC Interscapular-thor switch ct,L6970,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20391.83,,,,,,,fee schedule,19607.53,20587.91,APC Interscapular-thor switch ct,L6970,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20587.91,,,,,,,fee schedule,19607.53,20587.91,APC Interscapular-thor switch ct,L6970,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19607.53,,,,,,,fee schedule,19607.53,20587.91,APC Interscap-thor myoelectronic,L6975,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22512.84,,,,,,,fee schedule,21646.96,22729.31,APC Interscap-thor myoelectronic,L6975,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22729.31,,,,,,,fee schedule,21646.96,22729.31,APC Interscap-thor myoelectronic,L6975,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21646.96,,,,,,,fee schedule,21646.96,22729.31,APC Adult electric hand,L7007,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4618,,,,,,,fee schedule,4440.38,4662.4,APC Adult electric hand,L7007,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4662.4,,,,,,,fee schedule,4440.38,4662.4,APC Adult electric hand,L7007,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4440.38,,,,,,,fee schedule,4440.38,4662.4,APC Pediatric electric hand,L7008,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7801.5,,,,,,,fee schedule,7501.44,7876.51,APC Pediatric electric hand,L7008,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7876.51,,,,,,,fee schedule,7501.44,7876.51,APC Pediatric electric hand,L7008,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7501.44,,,,,,,fee schedule,7501.44,7876.51,APC Adult electric hook,L7009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4722.45,,,,,,,fee schedule,4540.82,4767.86,APC Adult electric hook,L7009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4767.86,,,,,,,fee schedule,4540.82,4767.86,APC Adult electric hook,L7009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4540.82,,,,,,,fee schedule,4540.82,4767.86,APC Prehensile actuator,L7040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3703.86,,,,,,,fee schedule,3561.4,3739.47,APC Prehensile actuator,L7040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3739.47,,,,,,,fee schedule,3561.4,3739.47,APC Prehensile actuator,L7040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3561.4,,,,,,,fee schedule,3561.4,3739.47,APC Pediatric electric hook,L7045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2057.94,,,,,,,fee schedule,1978.79,2077.73,APC Pediatric electric hook,L7045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2077.73,,,,,,,fee schedule,1978.79,2077.73,APC Pediatric electric hook,L7045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1978.79,,,,,,,fee schedule,1978.79,2077.73,APC Electronic elbow hosmer swit,L7170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7465.52,,,,,,,fee schedule,7178.38,7537.3,APC Electronic elbow hosmer swit,L7170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7537.3,,,,,,,fee schedule,7178.38,7537.3,APC Electronic elbow hosmer swit,L7170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7178.38,,,,,,,fee schedule,7178.38,7537.3,APC Electronic elbow sequential,L7180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,44455.16,,,,,,,fee schedule,42745.35,44882.62,APC Electronic elbow sequential,L7180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44882.62,,,,,,,fee schedule,42745.35,44882.62,APC Electronic elbow sequential,L7180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,42745.35,,,,,,,fee schedule,42745.35,44882.62,APC Electronic elbo simultaneous,L7181,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,50081.72,,,,,,,fee schedule,48155.5,50563.28,APC Electronic elbo simultaneous,L7181,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50563.28,,,,,,,fee schedule,48155.5,50563.28,APC Electronic elbo simultaneous,L7181,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,48155.5,,,,,,,fee schedule,48155.5,50563.28,APC Electron elbow adolescent sw,L7185,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,7643.46,,,,,,,fee schedule,7349.48,7716.95,APC Electron elbow adolescent sw,L7185,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7716.95,,,,,,,fee schedule,7349.48,7716.95,APC Electron elbow adolescent sw,L7185,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7349.48,,,,,,,fee schedule,7349.48,7716.95,APC Electron elbow child switch,L7186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11672.19,,,,,,,fee schedule,11223.26,11784.42,APC Electron elbow child switch,L7186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11784.42,,,,,,,fee schedule,11223.26,11784.42,APC Electron elbow child switch,L7186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11223.26,,,,,,,fee schedule,11223.26,11784.42,APC Elbow adolescent myoelectron,L7190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9951.49,,,,,,,fee schedule,9568.74,10047.18,APC Elbow adolescent myoelectron,L7190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10047.18,,,,,,,fee schedule,9568.74,10047.18,APC Elbow adolescent myoelectron,L7190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9568.74,,,,,,,fee schedule,9568.74,10047.18,APC Elbow child myoelectronic ct,L7191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12571.92,,,,,,,fee schedule,12088.38,12692.8,APC Elbow child myoelectronic ct,L7191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12692.8,,,,,,,fee schedule,12088.38,12692.8,APC Elbow child myoelectronic ct,L7191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,12088.38,,,,,,,fee schedule,12088.38,12692.8,APC Electronic wrist rotator any,L7259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5308.95,,,,,,,fee schedule,5104.76,5360,APC Electronic wrist rotator any,L7259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5360,,,,,,,fee schedule,5104.76,5360,APC Electronic wrist rotator any,L7259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5104.76,,,,,,,fee schedule,5104.76,5360,APC Six volt bat otto bock/eq ea,L7360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,380.44,,,,,,,fee schedule,365.81,384.1,APC Six volt bat otto bock/eq ea,L7360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,384.1,,,,,,,fee schedule,365.81,384.1,APC Six volt bat otto bock/eq ea,L7360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,365.81,,,,,,,fee schedule,365.81,384.1,APC Battery chrgr six volt otto,L7362,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,342.73,,,,,,,fee schedule,329.55,346.03,APC Battery chrgr six volt otto,L7362,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,346.03,,,,,,,fee schedule,329.55,346.03,APC Battery chrgr six volt otto,L7362,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,329.55,,,,,,,fee schedule,329.55,346.03,APC Twelve volt battery utah/equ,L7364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,633.51,,,,,,,fee schedule,609.14,639.6,APC Twelve volt battery utah/equ,L7364,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,639.6,,,,,,,fee schedule,609.14,639.6,APC Twelve volt battery utah/equ,L7364,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,609.14,,,,,,,fee schedule,609.14,639.6,APC Battery chrgr 12 volt utah/e,L7366,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,853.5,,,,,,,fee schedule,820.67,861.7,APC Battery chrgr 12 volt utah/e,L7366,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,861.7,,,,,,,fee schedule,820.67,861.7,APC Battery chrgr 12 volt utah/e,L7366,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,820.67,,,,,,,fee schedule,820.67,861.7,APC Replacemnt lithium ionbatter,L7367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,486.62,,,,,,,fee schedule,467.9,491.3,APC Replacemnt lithium ionbatter,L7367,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,491.3,,,,,,,fee schedule,467.9,491.3,APC Replacemnt lithium ionbatter,L7367,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,467.9,,,,,,,fee schedule,467.9,491.3,APC Lithium ion battery charger,L7368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,630.82,,,,,,,fee schedule,606.56,636.89,APC Lithium ion battery charger,L7368,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,636.89,,,,,,,fee schedule,606.56,636.89,APC Lithium ion battery charger,L7368,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,606.56,,,,,,,fee schedule,606.56,636.89,APC "Add ue prost be/wd, ultlite",L7400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,383.08,,,,,,,fee schedule,368.35,386.77,APC "Add ue prost be/wd, ultlite",L7400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,386.77,,,,,,,fee schedule,368.35,386.77,APC "Add ue prost be/wd, ultlite",L7400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,368.35,,,,,,,fee schedule,368.35,386.77,APC Add ue prost a/e ultlite mat,L7401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,428.89,,,,,,,fee schedule,412.39,433.01,APC Add ue prost a/e ultlite mat,L7401,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,433.01,,,,,,,fee schedule,412.39,433.01,APC Add ue prost a/e ultlite mat,L7401,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,412.39,,,,,,,fee schedule,412.39,433.01,APC Add ue prost s/d ultlite mat,L7402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,463.14,,,,,,,fee schedule,445.33,467.6,APC Add ue prost s/d ultlite mat,L7402,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,467.6,,,,,,,fee schedule,445.33,467.6,APC Add ue prost s/d ultlite mat,L7402,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,445.33,,,,,,,fee schedule,445.33,467.6,APC Add UE prost b/e acrylic,L7403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,460.28,,,,,,,fee schedule,442.58,464.71,APC Add UE prost b/e acrylic,L7403,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,464.71,,,,,,,fee schedule,442.58,464.71,APC Add UE prost b/e acrylic,L7403,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,442.58,,,,,,,fee schedule,442.58,464.71,APC Add UE prost a/e acrylic,L7404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,694.74,,,,,,,fee schedule,668.02,701.42,APC Add UE prost a/e acrylic,L7404,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,701.42,,,,,,,fee schedule,668.02,701.42,APC Add UE prost a/e acrylic,L7404,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,668.02,,,,,,,fee schedule,668.02,701.42,APC Add UE prost s/d acrylic,L7405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,908.6,,,,,,,fee schedule,873.65,917.33,APC Add UE prost s/d acrylic,L7405,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,917.33,,,,,,,fee schedule,873.65,917.33,APC Add UE prost s/d acrylic,L7405,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,873.65,,,,,,,fee schedule,873.65,917.33,APC Add to upp extr user adj mec,L7406,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3276.07,,,,,,,fee schedule,3150.07,3307.57,APC Add to upp extr user adj mec,L7406,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3307.57,,,,,,,fee schedule,3150.07,3307.57,APC Add to upp extr user adj mec,L7406,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3150.07,,,,,,,fee schedule,3150.07,3307.57,APC Repair prosthesis per 15 min,L7520,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,42.3,,,,,,,fee schedule,40.67,42.7,APC Repair prosthesis per 15 min,L7520,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42.7,,,,,,,fee schedule,40.67,42.7,APC Repair prosthesis per 15 min,L7520,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,40.67,,,,,,,fee schedule,40.67,42.7,APC Pros soc insert gasket/seal,L7700,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,183.48,,,,,,,fee schedule,176.42,185.24,APC Pros soc insert gasket/seal,L7700,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,185.24,,,,,,,fee schedule,176.42,185.24,APC Pros soc insert gasket/seal,L7700,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,176.42,,,,,,,fee schedule,176.42,185.24,APC Mastectomy bra,L8000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,46.49,,,,,,,fee schedule,44.7,46.94,APC Mastectomy bra,L8000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.94,,,,,,,fee schedule,44.7,46.94,APC Mastectomy bra,L8000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.7,,,,,,,fee schedule,44.7,46.94,APC Breast prosthesis bra & form,L8001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,156.8,,,,,,,fee schedule,150.77,158.31,APC Breast prosthesis bra & form,L8001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,158.31,,,,,,,fee schedule,150.77,158.31,APC Breast prosthesis bra & form,L8001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,150.77,,,,,,,fee schedule,150.77,158.31,APC Brst prsth bra & bilat form,L8002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,206.2,,,,,,,fee schedule,198.27,208.18,APC Brst prsth bra & bilat form,L8002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,208.18,,,,,,,fee schedule,198.27,208.18,APC Brst prsth bra & bilat form,L8002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,198.27,,,,,,,fee schedule,198.27,208.18,APC Ext breastprosthesis garment,L8015,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,74.93,,,,,,,fee schedule,72.05,75.65,APC Ext breastprosthesis garment,L8015,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75.65,,,,,,,fee schedule,72.05,75.65,APC Ext breastprosthesis garment,L8015,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,72.05,,,,,,,fee schedule,72.05,75.65,APC Mastectomy form,L8020,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,318.55,,,,,,,fee schedule,306.3,321.62,APC Mastectomy form,L8020,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,321.62,,,,,,,fee schedule,306.3,321.62,APC Mastectomy form,L8020,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,306.3,,,,,,,fee schedule,306.3,321.62,APC Breast prosthes w/o adhesive,L8030,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,412.28,,,,,,,fee schedule,396.42,416.24,APC Breast prosthes w/o adhesive,L8030,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,416.24,,,,,,,fee schedule,396.42,416.24,APC Breast prosthes w/o adhesive,L8030,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,396.42,,,,,,,fee schedule,396.42,416.24,APC Breast prosthesis w adhesive,L8031,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,412.28,,,,,,,fee schedule,396.42,416.24,APC Breast prosthesis w adhesive,L8031,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,416.24,,,,,,,fee schedule,396.42,416.24,APC Breast prosthesis w adhesive,L8031,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,396.42,,,,,,,fee schedule,396.42,416.24,APC Reusable nipple prosthesis,L8032,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,48.96,,,,,,,fee schedule,47.08,49.43,APC Reusable nipple prosthesis,L8032,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49.43,,,,,,,fee schedule,47.08,49.43,APC Reusable nipple prosthesis,L8032,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,47.08,,,,,,,fee schedule,47.08,49.43,APC Custom breast prosthesis,L8035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4579.23,,,,,,,fee schedule,4403.11,4623.27,APC Custom breast prosthesis,L8035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4623.27,,,,,,,fee schedule,4403.11,4623.27,APC Custom breast prosthesis,L8035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4403.11,,,,,,,fee schedule,4403.11,4623.27,APC Nasal prosthesis,L8040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3185.78,,,,,,,fee schedule,3063.25,3216.41,APC Nasal prosthesis,L8040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3216.41,,,,,,,fee schedule,3063.25,3216.41,APC Nasal prosthesis,L8040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3063.25,,,,,,,fee schedule,3063.25,3216.41,APC Midfacial prosthesis,L8041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3839.95,,,,,,,fee schedule,3692.26,3876.87,APC Midfacial prosthesis,L8041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3876.87,,,,,,,fee schedule,3692.26,3876.87,APC Midfacial prosthesis,L8041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3692.26,,,,,,,fee schedule,3692.26,3876.87,APC Orbital prosthesis,L8042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4314.54,,,,,,,fee schedule,4148.6,4356.03,APC Orbital prosthesis,L8042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4356.03,,,,,,,fee schedule,4148.6,4356.03,APC Orbital prosthesis,L8042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4148.6,,,,,,,fee schedule,4148.6,4356.03,APC Upper facial prosthesis,L8043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4832.35,,,,,,,fee schedule,4646.49,4878.81,APC Upper facial prosthesis,L8043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4878.81,,,,,,,fee schedule,4646.49,4878.81,APC Upper facial prosthesis,L8043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4646.49,,,,,,,fee schedule,4646.49,4878.81,APC Hemi-facial prosthesis,L8044,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5350.01,,,,,,,fee schedule,5144.24,5401.45,APC Hemi-facial prosthesis,L8044,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5401.45,,,,,,,fee schedule,5144.24,5401.45,APC Hemi-facial prosthesis,L8044,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5144.24,,,,,,,fee schedule,5144.24,5401.45,APC Auricular prosthesis,L8045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3734.75,,,,,,,fee schedule,3591.11,3770.67,APC Auricular prosthesis,L8045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3770.67,,,,,,,fee schedule,3591.11,3770.67,APC Auricular prosthesis,L8045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3591.11,,,,,,,fee schedule,3591.11,3770.67,APC Partial facial prosthesis,L8046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3451.6,,,,,,,fee schedule,3318.85,3484.79,APC Partial facial prosthesis,L8046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3484.79,,,,,,,fee schedule,3318.85,3484.79,APC Partial facial prosthesis,L8046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3318.85,,,,,,,fee schedule,3318.85,3484.79,APC Nasal septal prosthesis,L8047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1768.99,,,,,,,fee schedule,1700.95,1786,APC Nasal septal prosthesis,L8047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1786,,,,,,,fee schedule,1700.95,1786,APC Nasal septal prosthesis,L8047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1700.95,,,,,,,fee schedule,1700.95,1786,APC Truss single w/ standard pad,L8300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,107.41,,,,,,,fee schedule,103.28,108.44,APC Truss single w/ standard pad,L8300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,108.44,,,,,,,fee schedule,103.28,108.44,APC Truss single w/ standard pad,L8300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,103.28,,,,,,,fee schedule,103.28,108.44,APC Truss double w/ standard pad,L8310,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,169.57,,,,,,,fee schedule,163.05,171.2,APC Truss double w/ standard pad,L8310,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,171.2,,,,,,,fee schedule,163.05,171.2,APC Truss double w/ standard pad,L8310,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,163.05,,,,,,,fee schedule,163.05,171.2,APC Truss addition to std pad wa,L8320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,76.02,,,,,,,fee schedule,73.1,76.76,APC Truss addition to std pad wa,L8320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,76.76,,,,,,,fee schedule,73.1,76.76,APC Truss addition to std pad wa,L8320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,73.1,,,,,,,fee schedule,73.1,76.76,APC Truss add to std pad scrotal,L8330,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,62.86,,,,,,,fee schedule,60.44,63.46,APC Truss add to std pad scrotal,L8330,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,63.46,,,,,,,fee schedule,60.44,63.46,APC Truss add to std pad scrotal,L8330,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,60.44,,,,,,,fee schedule,60.44,63.46,APC Sheath below knee,L8400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.12,,,,,,,fee schedule,21.27,22.33,APC Sheath below knee,L8400,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.33,,,,,,,fee schedule,21.27,22.33,APC Sheath below knee,L8400,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.27,,,,,,,fee schedule,21.27,22.33,APC Sheath above knee,L8410,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.54,,,,,,,fee schedule,28.4,29.82,APC Sheath above knee,L8410,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.82,,,,,,,fee schedule,28.4,29.82,APC Sheath above knee,L8410,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.4,,,,,,,fee schedule,28.4,29.82,APC Sheath upper limb,L8415,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.05,,,,,,,fee schedule,27.93,29.33,APC Sheath upper limb,L8415,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.33,,,,,,,fee schedule,27.93,29.33,APC Sheath upper limb,L8415,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.93,,,,,,,fee schedule,27.93,29.33,APC Pros sheath/sock w gel cushn,L8417,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,93.93,,,,,,,fee schedule,90.32,94.84,APC Pros sheath/sock w gel cushn,L8417,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,94.84,,,,,,,fee schedule,90.32,94.84,APC Pros sheath/sock w gel cushn,L8417,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,90.32,,,,,,,fee schedule,90.32,94.84,APC Prosthetic sock multi ply BK,L8420,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.08,,,,,,,fee schedule,25.08,26.33,APC Prosthetic sock multi ply BK,L8420,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.33,,,,,,,fee schedule,25.08,26.33,APC Prosthetic sock multi ply BK,L8420,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.08,,,,,,,fee schedule,25.08,26.33,APC Prosthetic sock multi ply AK,L8430,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,28.18,,,,,,,fee schedule,27.1,28.46,APC Prosthetic sock multi ply AK,L8430,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.46,,,,,,,fee schedule,27.1,28.46,APC Prosthetic sock multi ply AK,L8430,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.1,,,,,,,fee schedule,27.1,28.46,APC Pros sock multi ply upper lm,L8435,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.77,,,,,,,fee schedule,25.74,27.03,APC Pros sock multi ply upper lm,L8435,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.03,,,,,,,fee schedule,25.74,27.03,APC Pros sock multi ply upper lm,L8435,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.74,,,,,,,fee schedule,25.74,27.03,APC Shrinker below knee,L8440,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.25,,,,,,,fee schedule,51.2,53.76,APC Shrinker below knee,L8440,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.76,,,,,,,fee schedule,51.2,53.76,APC Shrinker below knee,L8440,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.2,,,,,,,fee schedule,51.2,53.76,APC Shrinker above knee,L8460,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,84.85,,,,,,,fee schedule,81.59,85.67,APC Shrinker above knee,L8460,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,85.67,,,,,,,fee schedule,81.59,85.67,APC Shrinker above knee,L8460,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,81.59,,,,,,,fee schedule,81.59,85.67,APC Shrinker upper limb,L8465,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,75.12,,,,,,,fee schedule,72.23,75.84,APC Shrinker upper limb,L8465,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75.84,,,,,,,fee schedule,72.23,75.84,APC Shrinker upper limb,L8465,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,72.23,,,,,,,fee schedule,72.23,75.84,APC Pros sock single ply BK,L8470,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.5,,,,,,,fee schedule,8.17,8.58,APC Pros sock single ply BK,L8470,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.58,,,,,,,fee schedule,8.17,8.58,APC Pros sock single ply BK,L8470,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.17,,,,,,,fee schedule,8.17,8.58,APC Pros sock single ply AK,L8480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.72,,,,,,,fee schedule,11.27,11.83,APC Pros sock single ply AK,L8480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.83,,,,,,,fee schedule,11.27,11.83,APC Pros sock single ply AK,L8480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.27,,,,,,,fee schedule,11.27,11.83,APC Pros sock single ply upper l,L8485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.73,,,,,,,fee schedule,14.16,14.87,APC Pros sock single ply upper l,L8485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.87,,,,,,,fee schedule,14.16,14.87,APC Pros sock single ply upper l,L8485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.16,,,,,,,fee schedule,14.16,14.87,APC Artificial larynx,L8500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1120.36,,,,,,,fee schedule,1077.27,1131.13,APC Artificial larynx,L8500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1131.13,,,,,,,fee schedule,1077.27,1131.13,APC Artificial larynx,L8500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1077.27,,,,,,,fee schedule,1077.27,1131.13,APC Tracheostomy speaking valve,L8501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,153.8,,,,,,,fee schedule,147.88,155.27,APC Tracheostomy speaking valve,L8501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,155.27,,,,,,,fee schedule,147.88,155.27,APC Tracheostomy speaking valve,L8501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.88,,,,,,,fee schedule,147.88,155.27,APC Trach-esoph voice pros pt in,L8507,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,52.35,,,,,,,fee schedule,50.34,52.86,APC Trach-esoph voice pros pt in,L8507,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52.86,,,,,,,fee schedule,50.34,52.86,APC Trach-esoph voice pros pt in,L8507,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,50.34,,,,,,,fee schedule,50.34,52.86,APC Trach-esoph voice pros md in,L8509,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,136.49,,,,,,,fee schedule,131.24,137.8,APC Trach-esoph voice pros md in,L8509,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,137.8,,,,,,,fee schedule,131.24,137.8,APC Trach-esoph voice pros md in,L8509,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,131.24,,,,,,,fee schedule,131.24,137.8,APC Voice amplifier,L8510,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,315.84,,,,,,,fee schedule,303.69,318.87,APC Voice amplifier,L8510,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,318.87,,,,,,,fee schedule,303.69,318.87,APC Voice amplifier,L8510,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,303.69,,,,,,,fee schedule,303.69,318.87,APC Indwelling trach insert,L8511,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,90.91,,,,,,,fee schedule,87.41,91.78,APC Indwelling trach insert,L8511,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,91.78,,,,,,,fee schedule,87.41,91.78,APC Indwelling trach insert,L8511,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,87.41,,,,,,,fee schedule,87.41,91.78,APC Gel cap for trach voice pros,L8512,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.69,,,,,,,fee schedule,2.59,2.72,APC Gel cap for trach voice pros,L8512,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.72,,,,,,,fee schedule,2.59,2.72,APC Gel cap for trach voice pros,L8512,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.59,,,,,,,fee schedule,2.59,2.72,APC Trach pros cleaning device,L8513,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.49,,,,,,,fee schedule,6.24,6.55,APC Trach pros cleaning device,L8513,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.55,,,,,,,fee schedule,6.24,6.55,APC Trach pros cleaning device,L8513,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6.24,,,,,,,fee schedule,6.24,6.55,APC Repl trach puncture dilator,L8514,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,117.84,,,,,,,fee schedule,113.31,118.98,APC Repl trach puncture dilator,L8514,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,118.98,,,,,,,fee schedule,113.31,118.98,APC Repl trach puncture dilator,L8514,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,113.31,,,,,,,fee schedule,113.31,118.98,APC Gel cap app device for trach,L8515,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,78.87,,,,,,,fee schedule,75.84,79.63,APC Gel cap app device for trach,L8515,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,79.63,,,,,,,fee schedule,75.84,79.63,APC Gel cap app device for trach,L8515,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,75.84,,,,,,,fee schedule,75.84,79.63,APC Coch implant headset replace,L8615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,563.73,,,,,,,fee schedule,542.05,569.15,APC Coch implant headset replace,L8615,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,569.15,,,,,,,fee schedule,542.05,569.15,APC Coch implant headset replace,L8615,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,542.05,,,,,,,fee schedule,542.05,569.15,APC Coch implant microphone repl,L8616,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,131.31,,,,,,,fee schedule,126.26,132.57,APC Coch implant microphone repl,L8616,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,132.57,,,,,,,fee schedule,126.26,132.57,APC Coch implant microphone repl,L8616,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,126.26,,,,,,,fee schedule,126.26,132.57,APC Coch implant trans coil repl,L8617,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,114.68,,,,,,,fee schedule,110.27,115.78,APC Coch implant trans coil repl,L8617,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,115.78,,,,,,,fee schedule,110.27,115.78,APC Coch implant trans coil repl,L8617,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,110.27,,,,,,,fee schedule,110.27,115.78,APC Coch implant tran cable repl,L8618,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.76,,,,,,,fee schedule,31.5,33.08,APC Coch implant tran cable repl,L8618,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.08,,,,,,,fee schedule,31.5,33.08,APC Coch implant tran cable repl,L8618,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.5,,,,,,,fee schedule,31.5,33.08,APC Coch imp ext proc/contr rplc,L8619,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10658.34,,,,,,,fee schedule,10248.4,10760.82,APC Coch imp ext proc/contr rplc,L8619,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10760.82,,,,,,,fee schedule,10248.4,10760.82,APC Coch imp ext proc/contr rplc,L8619,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10248.4,,,,,,,fee schedule,10248.4,10760.82,APC Repl zinc air battery,L8621,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.78,,,,,,,fee schedule,0.75,0.79,APC Repl zinc air battery,L8621,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.79,,,,,,,fee schedule,0.75,0.79,APC Repl zinc air battery,L8621,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.75,,,,,,,fee schedule,0.75,0.79,APC Repl alkaline battery,L8622,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.41,,,,,,,fee schedule,0.39,0.41,APC Repl alkaline battery,L8622,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.41,,,,,,,fee schedule,0.39,0.41,APC Repl alkaline battery,L8622,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.39,,,,,,,fee schedule,0.39,0.41,APC "Lith ion batt cid,non-earlvl",L8623,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,80.86,,,,,,,fee schedule,77.75,81.64,APC "Lith ion batt cid,non-earlvl",L8623,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,81.64,,,,,,,fee schedule,77.75,81.64,APC "Lith ion batt cid,non-earlvl",L8623,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,77.75,,,,,,,fee schedule,77.75,81.64,APC "Lith ion batt cid, ear level",L8624,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,201.57,,,,,,,fee schedule,193.82,203.51,APC "Lith ion batt cid, ear level",L8624,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,203.51,,,,,,,fee schedule,193.82,203.51,APC "Lith ion batt cid, ear level",L8624,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,193.82,,,,,,,fee schedule,193.82,203.51,APC Charger coch impl/aoi battry,L8625,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,236.05,,,,,,,fee schedule,226.97,238.32,APC Charger coch impl/aoi battry,L8625,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,238.32,,,,,,,fee schedule,226.97,238.32,APC Charger coch impl/aoi battry,L8625,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,226.97,,,,,,,fee schedule,226.97,238.32,APC CID ext speech process repl,L8627,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9105.62,,,,,,,fee schedule,8755.4,9193.17,APC CID ext speech process repl,L8627,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9193.17,,,,,,,fee schedule,8755.4,9193.17,APC CID ext speech process repl,L8627,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8755.4,,,,,,,fee schedule,8755.4,9193.17,APC CID ext controller repl,L8628,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1552.65,,,,,,,fee schedule,1492.93,1567.58,APC CID ext controller repl,L8628,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1567.58,,,,,,,fee schedule,1492.93,1567.58,APC CID ext controller repl,L8628,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1492.93,,,,,,,fee schedule,1492.93,1567.58,APC CID transmit coil and cable,L8629,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,223.79,,,,,,,fee schedule,215.18,225.94,APC CID transmit coil and cable,L8629,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,225.94,,,,,,,fee schedule,215.18,225.94,APC CID transmit coil and cable,L8629,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,215.18,,,,,,,fee schedule,215.18,225.94,APC Pt prgrm for implt neurostim,L8681,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1373.55,,,,,,,fee schedule,1320.72,1386.76,APC Pt prgrm for implt neurostim,L8681,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1386.76,,,,,,,fee schedule,1320.72,1386.76,APC Pt prgrm for implt neurostim,L8681,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1320.72,,,,,,,fee schedule,1320.72,1386.76,APC Radiofq trsmtr for implt neu,L8683,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6586.36,,,,,,,fee schedule,6333.04,6649.69,APC Radiofq trsmtr for implt neu,L8683,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6649.69,,,,,,,fee schedule,6333.04,6649.69,APC Radiofq trsmtr for implt neu,L8683,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,6333.04,,,,,,,fee schedule,6333.04,6649.69,APC Radiof trsmtr implt scrl neu,L8684,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1011.06,,,,,,,fee schedule,972.17,1020.78,APC Radiof trsmtr implt scrl neu,L8684,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1020.78,,,,,,,fee schedule,972.17,1020.78,APC Radiof trsmtr implt scrl neu,L8684,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,972.17,,,,,,,fee schedule,972.17,1020.78,APC External recharg sys intern,L8689,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2156.03,,,,,,,fee schedule,2073.11,2176.77,APC External recharg sys intern,L8689,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2176.77,,,,,,,fee schedule,2073.11,2176.77,APC External recharg sys intern,L8689,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2073.11,,,,,,,fee schedule,2073.11,2176.77,APC Osseointegrated snd proc rpl,L8691,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2152.52,,,,,,,fee schedule,2069.73,2173.22,APC Osseointegrated snd proc rpl,L8691,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2173.22,,,,,,,fee schedule,2069.73,2173.22,APC Osseointegrated snd proc rpl,L8691,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2069.73,,,,,,,fee schedule,2069.73,2173.22,APC Aoi transducer/actuator repl,L8694,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1180.38,,,,,,,fee schedule,1134.98,1191.73,APC Aoi transducer/actuator repl,L8694,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1191.73,,,,,,,fee schedule,1134.98,1191.73,APC Aoi transducer/actuator repl,L8694,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1134.98,,,,,,,fee schedule,1134.98,1191.73,APC External recharg sys extern,L8695,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20.8,,,,,,,fee schedule,20,21,APC External recharg sys extern,L8695,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21,,,,,,,fee schedule,20,21,APC External recharg sys extern,L8695,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20,,,,,,,fee schedule,20,21,APC Pow ue rom dev ewh uprt cust,L8701,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36368.94,,,,,,,fee schedule,34970.13,36718.64,APC Pow ue rom dev ewh uprt cust,L8701,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36718.64,,,,,,,fee schedule,34970.13,36718.64,APC Pow ue rom dev ewh uprt cust,L8701,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34970.13,,,,,,,fee schedule,34970.13,36718.64,APC Pow ue rom dev ewhf uprt cus,L8702,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,71553.78,,,,,,,fee schedule,68801.71,72241.8,APC Pow ue rom dev ewhf uprt cus,L8702,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,72241.8,,,,,,,fee schedule,68801.71,72241.8,APC Pow ue rom dev ewhf uprt cus,L8702,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,68801.71,,,,,,,fee schedule,68801.71,72241.8,APC Cephalin floculation test,P2028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.86,,,,,,,fee schedule,4.95,22.36, Cephalin floculation test,P2028,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.36,,,,,,,fee schedule,4.95,22.36, Cephalin floculation test,P2028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.15,,,,,,,fee schedule,4.95,22.36,APC Cephalin floculation test,P2028,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.2,,,,,,,fee schedule,4.95,22.36,APC Cephalin floculation test,P2028,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.95,,,,,,,fee schedule,4.95,22.36,APC Congo red blood test,P2029,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.86,,,,,,,fee schedule,4.95,22.36, Congo red blood test,P2029,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.36,,,,,,,fee schedule,4.95,22.36, Congo red blood test,P2029,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.15,,,,,,,fee schedule,4.95,22.36,APC Congo red blood test,P2029,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.2,,,,,,,fee schedule,4.95,22.36,APC Congo red blood test,P2029,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.95,,,,,,,fee schedule,4.95,22.36,APC Hair analysis,P2031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.86,,,,,,,fee schedule,19.86,22.36, Hair analysis,P2031,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.36,,,,,,,fee schedule,19.86,22.36, Blood thymol turbidity,P2033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.86,,,,,,,fee schedule,4.95,22.36, Blood thymol turbidity,P2033,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.36,,,,,,,fee schedule,4.95,22.36, Blood thymol turbidity,P2033,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.15,,,,,,,fee schedule,4.95,22.36,APC Blood thymol turbidity,P2033,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.2,,,,,,,fee schedule,4.95,22.36,APC Blood thymol turbidity,P2033,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.95,,,,,,,fee schedule,4.95,22.36,APC Blood mucoprotein,P2038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.82,,,,,,,fee schedule,4.95,25.69, Blood mucoprotein,P2038,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,25.69,,,,,,,fee schedule,4.95,25.69, Blood mucoprotein,P2038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15.62,,,,,,,fee schedule,4.95,25.69, Blood mucoprotein,P2038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.85,,,,,,,fee schedule,4.95,25.69, Blood mucoprotein,P2038,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.15,,,,,,,fee schedule,4.95,25.69,APC Blood mucoprotein,P2038,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.2,,,,,,,fee schedule,4.95,25.69,APC Blood mucoprotein,P2038,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.95,,,,,,,fee schedule,4.95,25.69,APC Screen pap by tech w md supv,P3000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.97,,,,,,,fee schedule,18.54,64.29, Screen pap by tech w md supv,P3000,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,54.02,,,,,,,fee schedule,18.54,64.29, Screen pap by tech w md supv,P3000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,64.29, Screen pap by tech w md supv,P3000,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,64.29, Screen pap by tech w md supv,P3000,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,64.29,APC Screen pap by tech w md supv,P3000,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,64.29,APC Screen pap by tech w md supv,P3000,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,64.29,APC Rbc leukocytes reduced,P9016,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,192.31,,,,,,,fee schedule,184.91,194.16,APC Rbc leukocytes reduced,P9016,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,194.16,,,,,,,fee schedule,184.91,194.16,APC Rbc leukocytes reduced,P9016,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,184.91,,,,,,,fee schedule,184.91,194.16,APC Plate pheres leukoredu irrad,P9037,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,707.83,,,,,,,fee schedule,680.61,714.64,APC Plate pheres leukoredu irrad,P9037,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,714.64,,,,,,,fee schedule,680.61,714.64,APC Plate pheres leukoredu irrad,P9037,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,680.61,,,,,,,fee schedule,680.61,714.64,APC RBC leukoreduced irradiated,P9040,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,276.03,,,,,,,fee schedule,265.41,278.68,APC RBC leukoreduced irradiated,P9040,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,278.68,,,,,,,fee schedule,265.41,278.68,APC RBC leukoreduced irradiated,P9040,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,265.41,,,,,,,fee schedule,265.41,278.68,APC "Albumin (human),5%, 50ml",P9041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.52,,,,,,,fee schedule,10.62,75.03, "Albumin (human),5%, 50ml",P9041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.52,,,,,,,fee schedule,10.62,75.03, "Albumin (human),5%, 50ml",P9041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,62.52,,,,,,,fee schedule,10.62,75.03, "Albumin (human),5%, 50ml",P9041,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,75.03,,,,,,,fee schedule,10.62,75.03, "Albumin (human),5%, 50ml",P9041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,11.04,,,,,,,fee schedule,10.62,75.03,APC "Albumin (human),5%, 50ml",P9041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11.15,,,,,,,fee schedule,10.62,75.03,APC "Albumin (human),5%, 50ml",P9041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.62,,,,,,,fee schedule,10.62,75.03,APC "Plasma protein fract,5%,50ml",P9043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.93,,,,,,,fee schedule,8.11,51.52, "Plasma protein fract,5%,50ml",P9043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.52,,,,,,,fee schedule,8.11,51.52, "Plasma protein fract,5%,50ml",P9043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.43,,,,,,,fee schedule,8.11,51.52,APC "Plasma protein fract,5%,50ml",P9043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.52,,,,,,,fee schedule,8.11,51.52,APC "Plasma protein fract,5%,50ml",P9043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,8.11,,,,,,,fee schedule,8.11,51.52,APC "Albumin (human), 5%, 250 ml",P9045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.62,,,,,,,fee schedule,53.08,106.52, "Albumin (human), 5%, 250 ml",P9045,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.62,,,,,,,fee schedule,53.08,106.52, "Albumin (human), 5%, 250 ml",P9045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.76,,,,,,,fee schedule,53.08,106.52, "Albumin (human), 5%, 250 ml",P9045,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,106.52,,,,,,,fee schedule,53.08,106.52, "Albumin (human), 5%, 250 ml",P9045,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,55.2,,,,,,,fee schedule,53.08,106.52,APC "Albumin (human), 5%, 250 ml",P9045,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,55.73,,,,,,,fee schedule,53.08,106.52,APC "Albumin (human), 5%, 250 ml",P9045,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,53.08,,,,,,,fee schedule,53.08,106.52,APC "Albumin (human), 25%, 20 ml",P9046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,33.05,,,,,,,fee schedule,21.23,63.28, "Albumin (human), 25%, 20 ml",P9046,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,33.05,,,,,,,fee schedule,21.23,63.28, "Albumin (human), 25%, 20 ml",P9046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.72,,,,,,,fee schedule,21.23,63.28, "Albumin (human), 25%, 20 ml",P9046,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,63.28,,,,,,,fee schedule,21.23,63.28, "Albumin (human), 25%, 20 ml",P9046,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,22.08,,,,,,,fee schedule,21.23,63.28,APC "Albumin (human), 25%, 20 ml",P9046,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22.29,,,,,,,fee schedule,21.23,63.28,APC "Albumin (human), 25%, 20 ml",P9046,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,21.23,,,,,,,fee schedule,21.23,63.28,APC "Albumin (human), 25%, 50ml",P9047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.62,,,,,,,fee schedule,53.08,102.95, "Albumin (human), 25%, 50ml",P9047,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.62,,,,,,,fee schedule,53.08,102.95, "Albumin (human), 25%, 50ml",P9047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,85.79,,,,,,,fee schedule,53.08,102.95, "Albumin (human), 25%, 50ml",P9047,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,102.95,,,,,,,fee schedule,53.08,102.95, "Albumin (human), 25%, 50ml",P9047,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,55.2,,,,,,,fee schedule,53.08,102.95,APC "Albumin (human), 25%, 50ml",P9047,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,55.73,,,,,,,fee schedule,53.08,102.95,APC "Albumin (human), 25%, 50ml",P9047,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,53.08,,,,,,,fee schedule,53.08,102.95,APC "Plasmaprotein fract,5%,250ml",P9048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,100.83,,,,,,,fee schedule,35.32,121.01, "Plasmaprotein fract,5%,250ml",P9048,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,121.01,,,,,,,fee schedule,35.32,121.01, "Plasmaprotein fract,5%,250ml",P9048,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.73,,,,,,,fee schedule,35.32,121.01,APC "Plasmaprotein fract,5%,250ml",P9048,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.09,,,,,,,fee schedule,35.32,121.01,APC "Plasmaprotein fract,5%,250ml",P9048,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.32,,,,,,,fee schedule,35.32,121.01,APC "Platelets, pathogen reduced",P9073,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,631.73,,,,,,,fee schedule,607.43,637.8,APC "Platelets, pathogen reduced",P9073,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,637.8,,,,,,,fee schedule,607.43,637.8,APC "Platelets, pathogen reduced",P9073,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,607.43,,,,,,,fee schedule,607.43,637.8,APC Pathogen test for platelets,P9100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,99.44,,,,,,,fee schedule,69.69,113.64, Pathogen test for platelets,P9100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,113.64,,,,,,,fee schedule,69.69,113.64, Pathogen test for platelets,P9100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,72.48,,,,,,,fee schedule,69.69,113.64,APC Pathogen test for platelets,P9100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,73.17,,,,,,,fee schedule,69.69,113.64,APC Pathogen test for platelets,P9100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,69.69,,,,,,,fee schedule,69.69,113.64,APC Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,9.34,1866, Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,9.34,1866, Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.75,,,,,,,fee schedule,9.34,1866, Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.98,,,,,,,fee schedule,9.34,1866, Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,9.34,1866, Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,9.34,1866, Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,9.71,,,,,,,fee schedule,9.34,1866,APC Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9.81,,,,,,,fee schedule,9.34,1866,APC Catheterize for urine spec,P9612,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.34,,,,,,,fee schedule,9.34,1866,APC Urine specimen collect mult,P9615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,9.75,1866, Urine specimen collect mult,P9615,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,9.75,1866, Urine specimen collect mult,P9615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.75,,,,,,,fee schedule,9.75,1866, Urine specimen collect mult,P9615,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,10.98,,,,,,,fee schedule,9.75,1866, Urine specimen collect mult,P9615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.11,,,,,,,fee schedule,9.75,1866, Urine specimen collect mult,P9615,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,32.13,,,,,,,fee schedule,9.75,1866, Cardiokymography,Q0035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,272.48,,,,,,,fee schedule,44.12,312.03, Cardiokymography,Q0035,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,312.03,,,,,,,fee schedule,44.12,312.03, Cardiokymography,Q0035,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,45.89,,,,,,,fee schedule,44.12,312.03,APC Cardiokymography,Q0035,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46.33,,,,,,,fee schedule,44.12,312.03,APC Cardiokymography,Q0035,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,44.12,,,,,,,fee schedule,44.12,312.03,APC Obtaining screen pap smear,Q0091,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,35.54,,,,,,,fee schedule,34.17,35.88,APC Obtaining screen pap smear,Q0091,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35.88,,,,,,,fee schedule,34.17,35.88,APC Obtaining screen pap smear,Q0091,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.17,,,,,,,fee schedule,34.17,35.88,APC Wet mounts/ w preparations,Q0111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.37,,,,,,,fee schedule,18.54,64.29, Wet mounts/ w preparations,Q0111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,21.81,,,,,,,fee schedule,18.54,64.29, Wet mounts/ w preparations,Q0111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.25,,,,,,,fee schedule,18.54,64.29, Wet mounts/ w preparations,Q0111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,64.29,,,,,,,fee schedule,18.54,64.29, Wet mounts/ w preparations,Q0111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,19.28,,,,,,,fee schedule,18.54,64.29,APC Wet mounts/ w preparations,Q0111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19.47,,,,,,,fee schedule,18.54,64.29,APC Wet mounts/ w preparations,Q0111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,18.54,,,,,,,fee schedule,18.54,64.29,APC Potassium hydroxide preps,Q0112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,15.7,,,,,,,fee schedule,5.83,21.42, Potassium hydroxide preps,Q0112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,17.68,,,,,,,fee schedule,5.83,21.42, Potassium hydroxide preps,Q0112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.74,,,,,,,fee schedule,5.83,21.42, Potassium hydroxide preps,Q0112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,21.42,,,,,,,fee schedule,5.83,21.42, Potassium hydroxide preps,Q0112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,6.06,,,,,,,fee schedule,5.83,21.42,APC Potassium hydroxide preps,Q0112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6.12,,,,,,,fee schedule,5.83,21.42,APC Potassium hydroxide preps,Q0112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.83,,,,,,,fee schedule,5.83,21.42,APC Pinworm examinations,Q0113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,24.57,,,,,,,fee schedule,4.27,27.67, Pinworm examinations,Q0113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,27.67,,,,,,,fee schedule,4.27,27.67, Pinworm examinations,Q0113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,13.55,,,,,,,fee schedule,4.27,27.67, Pinworm examinations,Q0113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.48,,,,,,,fee schedule,4.27,27.67, Pinworm examinations,Q0113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.27,27.67,APC Pinworm examinations,Q0113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.48,,,,,,,fee schedule,4.27,27.67,APC Pinworm examinations,Q0113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.27,,,,,,,fee schedule,4.27,27.67,APC Fern test,Q0114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.47,,,,,,,fee schedule,9.74,36.56, Fern test,Q0114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,36.56,,,,,,,fee schedule,9.74,36.56, Fern test,Q0114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.24,,,,,,,fee schedule,9.74,36.56, Fern test,Q0114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.7,,,,,,,fee schedule,9.74,36.56, Fern test,Q0114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.13,,,,,,,fee schedule,9.74,36.56,APC Fern test,Q0114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.23,,,,,,,fee schedule,9.74,36.56,APC Fern test,Q0114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,9.74,,,,,,,fee schedule,9.74,36.56,APC Post-coital mucous exam,Q0115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.95,,,,,,,fee schedule,25,90.48, Post-coital mucous exam,Q0115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,50.62,,,,,,,fee schedule,25,90.48, Post-coital mucous exam,Q0115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.17,,,,,,,fee schedule,25,90.48, Post-coital mucous exam,Q0115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.48,,,,,,,fee schedule,25,90.48, Post-coital mucous exam,Q0115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26,,,,,,,fee schedule,25,90.48,APC Post-coital mucous exam,Q0115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26.25,,,,,,,fee schedule,25,90.48,APC Post-coital mucous exam,Q0115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25,,,,,,,fee schedule,25,90.48,APC "Ferumoxytol, non-esrd",Q0138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.48,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, non-esrd",Q0138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.48,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, non-esrd",Q0138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.6,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, non-esrd",Q0138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.72,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, non-esrd",Q0138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.24,,,,,,,fee schedule,0.23,0.72,APC "Ferumoxytol, non-esrd",Q0138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.24,,,,,,,fee schedule,0.23,0.72,APC "Ferumoxytol, non-esrd",Q0138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.23,,,,,,,fee schedule,0.23,0.72,APC "Ferumoxytol, esrd use",Q0139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.48,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, esrd use",Q0139,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.48,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, esrd use",Q0139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.6,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, esrd use",Q0139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.72,,,,,,,fee schedule,0.23,0.72, "Ferumoxytol, esrd use",Q0139,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.24,,,,,,,fee schedule,0.23,0.72,APC "Ferumoxytol, esrd use",Q0139,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.24,,,,,,,fee schedule,0.23,0.72,APC "Ferumoxytol, esrd use",Q0139,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.23,,,,,,,fee schedule,0.23,0.72,APC "Azithromycin dihydrate, oral",Q0144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.18,,,,,,,fee schedule,42.18,50.62, "Azithromycin dihydrate, oral",Q0144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.62,,,,,,,fee schedule,42.18,50.62, Dronabinol (syndros) 0.1 mg,Q0155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.19,,,,,,,fee schedule,6.19,7.42, Dronabinol (syndros) 0.1 mg,Q0155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.42,,,,,,,fee schedule,6.19,7.42, Chlorpromazine hcl 5mg oral,Q0161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.62,,,,,,,fee schedule,0.62,0.74, Chlorpromazine hcl 5mg oral,Q0161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.74,,,,,,,fee schedule,0.62,0.74, Ondansetron oral,Q0162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.02,,,,,,,fee schedule,0.02,0.02, Ondansetron oral,Q0162,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Ondansetron oral,Q0162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.02,,,,,,,fee schedule,0.02,0.02, Ondansetron oral,Q0162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.02,,,,,,,fee schedule,0.02,0.02, Diphenhydramine HCl 50mg,Q0163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.04,,,,,,,fee schedule,0.04,0.04, Diphenhydramine HCl 50mg,Q0163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.04,,,,,,,fee schedule,0.04,0.04, Prochlorperazine maleate 5mg,Q0164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.65,,,,,,,fee schedule,0.65,0.79, Prochlorperazine maleate 5mg,Q0164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.79,,,,,,,fee schedule,0.65,0.79, Granisetron HCl 1 mg oral,Q0166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.72,,,,,,,fee schedule,5.72,6.86, Granisetron HCl 1 mg oral,Q0166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.86,,,,,,,fee schedule,5.72,6.86, Dronabinol 2.5mg oral,Q0167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.61,,,,,,,fee schedule,2.52,3.03, Dronabinol 2.5mg oral,Q0167,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.61,,,,,,,fee schedule,2.52,3.03, Dronabinol 2.5mg oral,Q0167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.52,,,,,,,fee schedule,2.52,3.03, Dronabinol 2.5mg oral,Q0167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.03,,,,,,,fee schedule,2.52,3.03, Promethazine HCl 12.5mg oral,Q0169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.17,,,,,,,fee schedule,0.17,0.2, Promethazine HCl 12.5mg oral,Q0169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.2,,,,,,,fee schedule,0.17,0.2, Trimethobenzamide HCl 250mg,Q0173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.57,,,,,,,fee schedule,1.57,1.88, Trimethobenzamide HCl 250mg,Q0173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.88,,,,,,,fee schedule,1.57,1.88, Thiethylperazine maleate10mg,Q0174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.18,,,,,,,fee schedule,1.18,1.41, Thiethylperazine maleate10mg,Q0174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.41,,,,,,,fee schedule,1.18,1.41, Perphenazine 4mg oral,Q0175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.9,,,,,,,fee schedule,0.9,1.08, Perphenazine 4mg oral,Q0175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.08,,,,,,,fee schedule,0.9,1.08, Hydroxyzine pamoate 25mg,Q0177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.24,,,,,,,fee schedule,0.24,0.29, Hydroxyzine pamoate 25mg,Q0177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.29,,,,,,,fee schedule,0.24,0.29, Dolasetron mesylate oral,Q0180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,114.98,,,,,,,fee schedule,114.98,137.99, Dolasetron mesylate oral,Q0180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,137.99,,,,,,,fee schedule,114.98,137.99, "Inj, pemivibart, 4500 mg",Q0224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11268.26,,,,,,,fee schedule,11268.26,14528.31, "Inj, pemivibart, 4500 mg",Q0224,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11268.26,,,,,,,fee schedule,11268.26,14528.31, "Inj, pemivibart, 4500 mg",Q0224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12105.85,,,,,,,fee schedule,11268.26,14528.31, "Inj, pemivibart, 4500 mg",Q0224,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,14528.31,,,,,,,fee schedule,11268.26,14528.31, "Inj, monoclon antibody, 1 mg",Q0235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.35,,,,,,,fee schedule,9.35,11.22, "Inj, monoclon antibody, 1 mg",Q0235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,11.22,,,,,,,fee schedule,9.35,11.22, "Inj, tocilizumab-anoh, hospi",Q0237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.22,,,,,,,fee schedule,8.22,9.87, "Inj, tocilizumab-anoh, hospi",Q0237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.87,,,,,,,fee schedule,8.22,9.87, Tocilizumab for covid-19,Q0249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.78,,,,,,,fee schedule,11.78,15.19, Tocilizumab for covid-19,Q0249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.78,,,,,,,fee schedule,11.78,15.19, Tocilizumab for covid-19,Q0249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,12.65,,,,,,,fee schedule,11.78,15.19, Tocilizumab for covid-19,Q0249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,15.19,,,,,,,fee schedule,11.78,15.19, Pwr module pt cable lvad rpl,Q0477,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,969.69,,,,,,,fee schedule,932.39,979.01,APC Pwr module pt cable lvad rpl,Q0477,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,979.01,,,,,,,fee schedule,932.39,979.01,APC Pwr module pt cable lvad rpl,Q0477,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,932.39,,,,,,,fee schedule,932.39,979.01,APC "Power adapter, combo vad",Q0478,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,229.7,,,,,,,fee schedule,220.87,231.91,APC "Power adapter, combo vad",Q0478,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,231.91,,,,,,,fee schedule,220.87,231.91,APC "Power adapter, combo vad",Q0478,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,220.87,,,,,,,fee schedule,220.87,231.91,APC "Power module combo vad, rep",Q0479,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,15009.02,,,,,,,fee schedule,14431.75,15153.34,APC "Power module combo vad, rep",Q0479,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15153.34,,,,,,,fee schedule,14431.75,15153.34,APC "Power module combo vad, rep",Q0479,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14431.75,,,,,,,fee schedule,14431.75,15153.34,APC "driver pneumatic vad, rep",Q0480,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,112573.08,,,,,,,fee schedule,108243.35,113655.52,APC "driver pneumatic vad, rep",Q0480,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,113655.52,,,,,,,fee schedule,108243.35,113655.52,APC "driver pneumatic vad, rep",Q0480,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,108243.35,,,,,,,fee schedule,108243.35,113655.52,APC "microprcsr cu elec vad, rep",Q0481,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,18162.33,,,,,,,fee schedule,17463.78,18336.97,APC "microprcsr cu elec vad, rep",Q0481,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18336.97,,,,,,,fee schedule,17463.78,18336.97,APC "microprcsr cu elec vad, rep",Q0481,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,17463.78,,,,,,,fee schedule,17463.78,18336.97,APC "microprcsr cu combo vad, rep",Q0482,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5688.78,,,,,,,fee schedule,5469.98,5743.48,APC "microprcsr cu combo vad, rep",Q0482,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5743.48,,,,,,,fee schedule,5469.98,5743.48,APC "microprcsr cu combo vad, rep",Q0482,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5469.98,,,,,,,fee schedule,5469.98,5743.48,APC "monitor elec vad, rep",Q0483,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,23435.28,,,,,,,fee schedule,22533.92,23660.62,APC "monitor elec vad, rep",Q0483,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23660.62,,,,,,,fee schedule,22533.92,23660.62,APC "monitor elec vad, rep",Q0483,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,22533.92,,,,,,,fee schedule,22533.92,23660.62,APC monitor elec or comb vad rep,Q0484,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4551.06,,,,,,,fee schedule,4376.02,4594.82,APC monitor elec or comb vad rep,Q0484,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4594.82,,,,,,,fee schedule,4376.02,4594.82,APC monitor elec or comb vad rep,Q0484,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4376.02,,,,,,,fee schedule,4376.02,4594.82,APC "monitor cable elec vad, rep",Q0485,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,439.37,,,,,,,fee schedule,422.47,443.59,APC "monitor cable elec vad, rep",Q0485,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,443.59,,,,,,,fee schedule,422.47,443.59,APC "monitor cable elec vad, rep",Q0485,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,422.47,,,,,,,fee schedule,422.47,443.59,APC mon cable elec/pneum vad rep,Q0486,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,365.72,,,,,,,fee schedule,351.65,369.23,APC mon cable elec/pneum vad rep,Q0486,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,369.23,,,,,,,fee schedule,351.65,369.23,APC mon cable elec/pneum vad rep,Q0486,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,351.65,,,,,,,fee schedule,351.65,369.23,APC "leads any type vad, rep only",Q0487,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,426.66,,,,,,,fee schedule,410.25,430.76,APC "leads any type vad, rep only",Q0487,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,430.76,,,,,,,fee schedule,410.25,430.76,APC "leads any type vad, rep only",Q0487,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,410.25,,,,,,,fee schedule,410.25,430.76,APC "pwr pck base combo vad, rep",Q0489,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,20317.1,,,,,,,fee schedule,19535.67,20512.45,APC "pwr pck base combo vad, rep",Q0489,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20512.45,,,,,,,fee schedule,19535.67,20512.45,APC "pwr pck base combo vad, rep",Q0489,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,19535.67,,,,,,,fee schedule,19535.67,20512.45,APC "emr pwr source elec vad, rep",Q0490,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,878.83,,,,,,,fee schedule,845.03,887.28,APC "emr pwr source elec vad, rep",Q0490,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,887.28,,,,,,,fee schedule,845.03,887.28,APC "emr pwr source elec vad, rep",Q0490,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,845.03,,,,,,,fee schedule,845.03,887.28,APC emr pwr source combo vad rep,Q0491,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1381.62,,,,,,,fee schedule,1328.48,1394.9,APC emr pwr source combo vad rep,Q0491,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1394.9,,,,,,,fee schedule,1328.48,1394.9,APC emr pwr source combo vad rep,Q0491,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1328.48,,,,,,,fee schedule,1328.48,1394.9,APC "emr pwr cbl elec vad, rep",Q0492,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,111.29,,,,,,,fee schedule,107.01,112.36,APC "emr pwr cbl elec vad, rep",Q0492,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,112.36,,,,,,,fee schedule,107.01,112.36,APC "emr pwr cbl elec vad, rep",Q0492,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,107.01,,,,,,,fee schedule,107.01,112.36,APC "emr pwr cbl combo vad, rep",Q0493,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,316.96,,,,,,,fee schedule,304.77,320.01,APC "emr pwr cbl combo vad, rep",Q0493,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,320.01,,,,,,,fee schedule,304.77,320.01,APC "emr pwr cbl combo vad, rep",Q0493,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,304.77,,,,,,,fee schedule,304.77,320.01,APC "emr hd pmp elec/combo, rep",Q0494,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,268.22,,,,,,,fee schedule,257.9,270.8,APC "emr hd pmp elec/combo, rep",Q0494,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,270.8,,,,,,,fee schedule,257.9,270.8,APC "emr hd pmp elec/combo, rep",Q0494,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,257.9,,,,,,,fee schedule,257.9,270.8,APC "charger elec/combo vad, rep",Q0495,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5220.97,,,,,,,fee schedule,5020.16,5271.17,APC "charger elec/combo vad, rep",Q0495,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5271.17,,,,,,,fee schedule,5020.16,5271.17,APC "charger elec/combo vad, rep",Q0495,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5020.16,,,,,,,fee schedule,5020.16,5271.17,APC "battery elec/combo vad, rep",Q0496,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1873.89,,,,,,,fee schedule,1801.82,1891.91,APC "battery elec/combo vad, rep",Q0496,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1891.91,,,,,,,fee schedule,1801.82,1891.91,APC "battery elec/combo vad, rep",Q0496,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1801.82,,,,,,,fee schedule,1801.82,1891.91,APC "bat clps elec/comb vad, rep",Q0497,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,585.15,,,,,,,fee schedule,562.64,590.77,APC "bat clps elec/comb vad, rep",Q0497,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,590.77,,,,,,,fee schedule,562.64,590.77,APC "bat clps elec/comb vad, rep",Q0497,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,562.64,,,,,,,fee schedule,562.64,590.77,APC "holster elec/combo vad, rep",Q0498,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,642.05,,,,,,,fee schedule,617.36,648.23,APC "holster elec/combo vad, rep",Q0498,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,648.23,,,,,,,fee schedule,617.36,648.23,APC "holster elec/combo vad, rep",Q0498,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,617.36,,,,,,,fee schedule,617.36,648.23,APC belt/vest elec/combo vad rep,Q0499,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,208.6,,,,,,,fee schedule,200.58,210.61,APC belt/vest elec/combo vad rep,Q0499,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,210.61,,,,,,,fee schedule,200.58,210.61,APC belt/vest elec/combo vad rep,Q0499,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,200.58,,,,,,,fee schedule,200.58,210.61,APC "filters elec/combo vad, rep",Q0500,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,38.18,,,,,,,fee schedule,36.71,38.55,APC "filters elec/combo vad, rep",Q0500,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38.55,,,,,,,fee schedule,36.71,38.55,APC "filters elec/combo vad, rep",Q0500,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,36.71,,,,,,,fee schedule,36.71,38.55,APC "shwr cov elec/combo vad, rep",Q0501,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,638.3,,,,,,,fee schedule,613.75,644.44,APC "shwr cov elec/combo vad, rep",Q0501,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,644.44,,,,,,,fee schedule,613.75,644.44,APC "shwr cov elec/combo vad, rep",Q0501,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,613.75,,,,,,,fee schedule,613.75,644.44,APC "mobility cart pneum vad, rep",Q0502,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,812.65,,,,,,,fee schedule,781.39,820.46,APC "mobility cart pneum vad, rep",Q0502,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,820.46,,,,,,,fee schedule,781.39,820.46,APC "mobility cart pneum vad, rep",Q0502,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,781.39,,,,,,,fee schedule,781.39,820.46,APC battery pneum vad replacemnt,Q0503,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1625.35,,,,,,,fee schedule,1562.84,1640.98,APC battery pneum vad replacemnt,Q0503,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1640.98,,,,,,,fee schedule,1562.84,1640.98,APC battery pneum vad replacemnt,Q0503,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1562.84,,,,,,,fee schedule,1562.84,1640.98,APC "pwr adpt pneum vad, rep veh",Q0504,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,857.67,,,,,,,fee schedule,824.68,865.91,APC "pwr adpt pneum vad, rep veh",Q0504,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,865.91,,,,,,,fee schedule,824.68,865.91,APC "pwr adpt pneum vad, rep veh",Q0504,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,824.68,,,,,,,fee schedule,824.68,865.91,APC Lith-ion batt elec/pneum VAD,Q0506,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1067.6,,,,,,,fee schedule,1026.54,1077.87,APC Lith-ion batt elec/pneum VAD,Q0506,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1077.87,,,,,,,fee schedule,1026.54,1077.87,APC Lith-ion batt elec/pneum VAD,Q0506,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1026.54,,,,,,,fee schedule,1026.54,1077.87,APC Sermorelin acetate injection,Q0515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.36,,,,,,,fee schedule,3.36,4.04, Sermorelin acetate injection,Q0515,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4.04,,,,,,,fee schedule,3.36,4.04, Fosphenytoin inj pe,Q2009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.9,,,,,,,fee schedule,1.33,5.88, Fosphenytoin inj pe,Q2009,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.88,,,,,,,fee schedule,1.33,5.88, Fosphenytoin inj pe,Q2009,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.39,,,,,,,fee schedule,1.33,5.88,APC Fosphenytoin inj pe,Q2009,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.4,,,,,,,fee schedule,1.33,5.88,APC Fosphenytoin inj pe,Q2009,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.33,,,,,,,fee schedule,1.33,5.88,APC "Teniposide, 50 mg",Q2017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4758.23,,,,,,,fee schedule,4758.23,5710.39, "Teniposide, 50 mg",Q2017,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5710.39,,,,,,,fee schedule,4758.23,5710.39, "Inj, sculptra, 0.5mg",Q2028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.23,,,,,,,fee schedule,1.23,2.27, "Inj, sculptra, 0.5mg",Q2028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.48,,,,,,,fee schedule,1.23,2.27, "Inj, sculptra, 0.5mg",Q2028,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2.25,,,,,,,fee schedule,1.23,2.27,APC "Inj, sculptra, 0.5mg",Q2028,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2.27,,,,,,,fee schedule,1.23,2.27,APC "Inj, sculptra, 0.5mg",Q2028,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,2.16,,,,,,,fee schedule,1.23,2.27,APC "Afluria vacc, 3 yrs & >, im",Q2035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.22,,,,,,,fee schedule,22.22,26.67, "Afluria vacc, 3 yrs & >, im",Q2035,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.67,,,,,,,fee schedule,22.22,26.67, "Flulaval vacc, 3 yrs & >, im",Q2036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.02,,,,,,,fee schedule,16.02,19.22, "Flulaval vacc, 3 yrs & >, im",Q2036,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.22,,,,,,,fee schedule,16.02,19.22, "Fluvirin vacc, 3 yrs & >, im",Q2037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,32.74,,,,,,,fee schedule,32.74,39.3, "Fluvirin vacc, 3 yrs & >, im",Q2037,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,39.3,,,,,,,fee schedule,32.74,39.3, "Fluzone vacc, 3 yrs & >, im",Q2038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.37,,,,,,,fee schedule,22.37,26.85, "Fluzone vacc, 3 yrs & >, im",Q2038,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.85,,,,,,,fee schedule,22.37,26.85, Axicabtagene ciloleucel car+,Q2041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,829788.86,,,,,,,fee schedule,531849.12,829788.86, Axicabtagene ciloleucel car+,Q2041,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,829788.86,,,,,,,fee schedule,531849.12,829788.86, Axicabtagene ciloleucel car+,Q2041,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,553123.08,,,,,,,fee schedule,531849.12,829788.86,APC Axicabtagene ciloleucel car+,Q2041,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,558441.57,,,,,,,fee schedule,531849.12,829788.86,APC Axicabtagene ciloleucel car+,Q2041,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,531849.12,,,,,,,fee schedule,531849.12,829788.86,APC Tisagenlecleucel car-pos t,Q2042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,900222.23,,,,,,,fee schedule,614180.81,900222.23, Tisagenlecleucel car-pos t,Q2042,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,900222.23,,,,,,,fee schedule,614180.81,900222.23, Tisagenlecleucel car-pos t,Q2042,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,638748.04,,,,,,,fee schedule,614180.81,900222.23,APC Tisagenlecleucel car-pos t,Q2042,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,644889.85,,,,,,,fee schedule,614180.81,900222.23,APC Tisagenlecleucel car-pos t,Q2042,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,614180.81,,,,,,,fee schedule,614180.81,900222.23,APC Sipuleucel-t auto cd54+,Q2043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,87085.71,,,,,,,fee schedule,56269.19,123975.81, Sipuleucel-t auto cd54+,Q2043,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,87085.71,,,,,,,fee schedule,56269.19,123975.81, Sipuleucel-t auto cd54+,Q2043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,103303.97,,,,,,,fee schedule,56269.19,123975.81, Sipuleucel-t auto cd54+,Q2043,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,123975.81,,,,,,,fee schedule,56269.19,123975.81, Sipuleucel-t auto cd54+,Q2043,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58519.96,,,,,,,fee schedule,56269.19,123975.81,APC Sipuleucel-t auto cd54+,Q2043,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59082.65,,,,,,,fee schedule,56269.19,123975.81,APC Sipuleucel-t auto cd54+,Q2043,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56269.19,,,,,,,fee schedule,56269.19,123975.81,APC Imported Lipodox inj,Q2049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,950.26,,,,,,,fee schedule,298.74,1140.41, Imported Lipodox inj,Q2049,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1140.41,,,,,,,fee schedule,298.74,1140.41, Imported Lipodox inj,Q2049,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,310.69,,,,,,,fee schedule,298.74,1140.41,APC Imported Lipodox inj,Q2049,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,313.68,,,,,,,fee schedule,298.74,1140.41,APC Imported Lipodox inj,Q2049,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,298.74,,,,,,,fee schedule,298.74,1140.41,APC Doxorubicin inj 10mg,Q2050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,170.12,,,,,,,fee schedule,71.86,243.3, Doxorubicin inj 10mg,Q2050,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,170.12,,,,,,,fee schedule,71.86,243.3, Doxorubicin inj 10mg,Q2050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,202.73,,,,,,,fee schedule,71.86,243.3, Doxorubicin inj 10mg,Q2050,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,243.3,,,,,,,fee schedule,71.86,243.3, Doxorubicin inj 10mg,Q2050,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,74.74,,,,,,,fee schedule,71.86,243.3,APC Doxorubicin inj 10mg,Q2050,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75.45,,,,,,,fee schedule,71.86,243.3,APC Doxorubicin inj 10mg,Q2050,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,71.86,,,,,,,fee schedule,71.86,243.3,APC Brexucabtagene car pos t,Q2053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,762300,,,,,,,fee schedule,489290.6,762300, Brexucabtagene car pos t,Q2053,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,762300,,,,,,,fee schedule,489290.6,762300, Brexucabtagene car pos t,Q2053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,508862.23,,,,,,,fee schedule,489290.6,762300,APC Brexucabtagene car pos t,Q2053,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,513755.13,,,,,,,fee schedule,489290.6,762300,APC Brexucabtagene car pos t,Q2053,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,489290.6,,,,,,,fee schedule,489290.6,762300,APC Lisocabtagene mara car pos t,Q2054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,843112.1,,,,,,,fee schedule,562260.84,843112.1, Lisocabtagene mara car pos t,Q2054,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,843112.1,,,,,,,fee schedule,562260.84,843112.1, Lisocabtagene mara car pos t,Q2054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,584751.27,,,,,,,fee schedule,562260.84,843112.1,APC Lisocabtagene mara car pos t,Q2054,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,590373.88,,,,,,,fee schedule,562260.84,843112.1,APC Lisocabtagene mara car pos t,Q2054,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,562260.84,,,,,,,fee schedule,562260.84,843112.1,APC Idecabtagene vicleucel car,Q2055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,842528.05,,,,,,,fee schedule,559781.08,842528.05, Idecabtagene vicleucel car,Q2055,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,842528.05,,,,,,,fee schedule,559781.08,842528.05, Idecabtagene vicleucel car,Q2055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,582172.32,,,,,,,fee schedule,559781.08,842528.05,APC Idecabtagene vicleucel car,Q2055,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,587770.14,,,,,,,fee schedule,559781.08,842528.05,APC Idecabtagene vicleucel car,Q2055,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,559781.08,,,,,,,fee schedule,559781.08,842528.05,APC Ciltacabtagene car-pos t,Q2056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,861391.58,,,,,,,fee schedule,588494.81,861391.58, Ciltacabtagene car-pos t,Q2056,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,861391.58,,,,,,,fee schedule,588494.81,861391.58, Ciltacabtagene car-pos t,Q2056,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,612034.6,,,,,,,fee schedule,588494.81,861391.58,APC Ciltacabtagene car-pos t,Q2056,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,617919.55,,,,,,,fee schedule,588494.81,861391.58,APC Ciltacabtagene car-pos t,Q2056,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,588494.81,,,,,,,fee schedule,588494.81,861391.58,APC Afamitresgene autoleucel,Q2057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1199550,,,,,,,fee schedule,770620,1199550, Afamitresgene autoleucel,Q2057,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1199550,,,,,,,fee schedule,770620,1199550, Afamitresgene autoleucel,Q2057,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,801444.8,,,,,,,fee schedule,770620,1199550,APC Afamitresgene autoleucel,Q2057,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,809151,,,,,,,fee schedule,770620,1199550,APC Afamitresgene autoleucel,Q2057,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,770620,,,,,,,fee schedule,770620,1199550,APC Inj beta interferon im 1 mcg,Q3027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,137.22,,,,,,,fee schedule,137.22,164.68, Inj beta interferon im 1 mcg,Q3027,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,164.68,,,,,,,fee schedule,137.22,164.68, Inj beta interferon sq 1 mcg,Q3028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,79.36,,,,,,,fee schedule,79.36,95.24, Inj beta interferon sq 1 mcg,Q3028,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,95.24,,,,,,,fee schedule,79.36,95.24, Iloprost non-comp unit dose,Q4074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,247.37,,,,,,,fee schedule,247.37,356.46, Iloprost non-comp unit dose,Q4074,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,247.37,,,,,,,fee schedule,247.37,356.46, Iloprost non-comp unit dose,Q4074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,297.02,,,,,,,fee schedule,247.37,356.46, Iloprost non-comp unit dose,Q4074,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,356.46,,,,,,,fee schedule,247.37,356.46, "Epoetin alfa, 100 units ESRD",Q4081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.19,,,,,,,fee schedule,1.19,1.91, "Epoetin alfa, 100 units ESRD",Q4081,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.19,,,,,,,fee schedule,1.19,1.91, "Epoetin alfa, 100 units ESRD",Q4081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.59,,,,,,,fee schedule,1.19,1.91, "Epoetin alfa, 100 units ESRD",Q4081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.91,,,,,,,fee schedule,1.19,1.91, Apligraf,Q4101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.17,,,,,,,fee schedule,47.17,154.36, Apligraf,Q4101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.17,,,,,,,fee schedule,47.17,154.36, Apligraf,Q4101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.5,,,,,,,fee schedule,47.17,154.36, Apligraf,Q4101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.81,,,,,,,fee schedule,47.17,154.36, Apligraf,Q4101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,47.17,154.36,APC Apligraf,Q4101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,47.17,154.36,APC Apligraf,Q4101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,47.17,154.36,APC Oasis wound matrix,Q4102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,18.22,,,,,,,fee schedule,18.22,154.36, Oasis wound matrix,Q4102,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,18.22,,,,,,,fee schedule,18.22,154.36, Oasis wound matrix,Q4102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,22.2,,,,,,,fee schedule,18.22,154.36, Oasis wound matrix,Q4102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.65,,,,,,,fee schedule,18.22,154.36, Oasis wound matrix,Q4102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,18.22,154.36,APC Oasis wound matrix,Q4102,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,18.22,154.36,APC Oasis wound matrix,Q4102,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,18.22,154.36,APC Oasis burn matrix,Q4103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,19.27,,,,,,,fee schedule,19.27,154.36, Oasis burn matrix,Q4103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,19.27,,,,,,,fee schedule,19.27,154.36, Oasis burn matrix,Q4103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.34,,,,,,,fee schedule,19.27,154.36, Oasis burn matrix,Q4103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.02,,,,,,,fee schedule,19.27,154.36, Oasis burn matrix,Q4103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,19.27,154.36,APC Oasis burn matrix,Q4103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,19.27,154.36,APC Oasis burn matrix,Q4103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,19.27,154.36,APC Integra bmwd,Q4104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,83.69,,,,,,,fee schedule,83.69,154.36, Integra bmwd,Q4104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,83.69,,,,,,,fee schedule,83.69,154.36, Integra bmwd,Q4104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,95.32,,,,,,,fee schedule,83.69,154.36, Integra bmwd,Q4104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,114.39,,,,,,,fee schedule,83.69,154.36, Integra bmwd,Q4104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,83.69,154.36,APC Integra bmwd,Q4104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,83.69,154.36,APC Integra bmwd,Q4104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,83.69,154.36,APC Integra drt or omnigraft,Q4105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,40.61,,,,,,,fee schedule,40.61,154.36, Integra drt or omnigraft,Q4105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,40.61,,,,,,,fee schedule,40.61,154.36, Integra drt or omnigraft,Q4105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.35,,,,,,,fee schedule,40.61,154.36, Integra drt or omnigraft,Q4105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.43,,,,,,,fee schedule,40.61,154.36, Integra drt or omnigraft,Q4105,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,40.61,154.36,APC Integra drt or omnigraft,Q4105,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,40.61,154.36,APC Integra drt or omnigraft,Q4105,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,40.61,154.36,APC Dermagraft,Q4106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,83.99,,,,,,,fee schedule,83.99,100.8, Dermagraft,Q4106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,100.8,,,,,,,fee schedule,83.99,100.8, Graftjacket,Q4107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,160.66,,,,,,,fee schedule,147.01,192.81, Graftjacket,Q4107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,192.81,,,,,,,fee schedule,147.01,192.81, Graftjacket,Q4107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,192.81,APC Graftjacket,Q4107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,192.81,APC Graftjacket,Q4107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,192.81,APC Integra matrix,Q4108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.46,,,,,,,fee schedule,72.03,154.36, Integra matrix,Q4108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.46,,,,,,,fee schedule,72.03,154.36, Integra matrix,Q4108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,72.03,,,,,,,fee schedule,72.03,154.36, Integra matrix,Q4108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,86.45,,,,,,,fee schedule,72.03,154.36, Integra matrix,Q4108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,72.03,154.36,APC Integra matrix,Q4108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,72.03,154.36,APC Integra matrix,Q4108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,72.03,154.36,APC Primatrix,Q4110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,101.81,,,,,,,fee schedule,101.81,154.36, Primatrix,Q4110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,101.81,,,,,,,fee schedule,101.81,154.36, Primatrix,Q4110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,122.23,,,,,,,fee schedule,101.81,154.36, Primatrix,Q4110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,146.69,,,,,,,fee schedule,101.81,154.36, Primatrix,Q4110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,101.81,154.36,APC Primatrix,Q4110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,101.81,154.36,APC Primatrix,Q4110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,101.81,154.36,APC Gammagraft,Q4111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.07,,,,,,,fee schedule,11.07,154.36, Gammagraft,Q4111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.07,,,,,,,fee schedule,11.07,154.36, Gammagraft,Q4111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.71,,,,,,,fee schedule,11.07,154.36, Gammagraft,Q4111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.65,,,,,,,fee schedule,11.07,154.36, Gammagraft,Q4111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,11.07,154.36,APC Gammagraft,Q4111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,11.07,154.36,APC Gammagraft,Q4111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,11.07,154.36,APC Cymetra injectable,Q4112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1629.92,,,,,,,fee schedule,1629.92,1956.08, Cymetra injectable,Q4112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1956.08,,,,,,,fee schedule,1629.92,1956.08, Graftjacket xpress,Q4113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1425.82,,,,,,,fee schedule,1425.82,1711.14, Graftjacket xpress,Q4113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1711.14,,,,,,,fee schedule,1425.82,1711.14, Integra flowable wound matri,Q4114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2400.67,,,,,,,fee schedule,2400.67,3351.96, Integra flowable wound matri,Q4114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2400.67,,,,,,,fee schedule,2400.67,3351.96, Integra flowable wound matri,Q4114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2793.05,,,,,,,fee schedule,2400.67,3351.96, Integra flowable wound matri,Q4114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3351.96,,,,,,,fee schedule,2400.67,3351.96, Alloskin,Q4115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,22.54,,,,,,,fee schedule,22.54,154.36, Alloskin,Q4115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,22.54,,,,,,,fee schedule,22.54,154.36, Alloskin,Q4115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.04,,,,,,,fee schedule,22.54,154.36, Alloskin,Q4115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.84,,,,,,,fee schedule,22.54,154.36, Alloskin,Q4115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,22.54,154.36,APC Alloskin,Q4115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,22.54,154.36,APC Alloskin,Q4115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,22.54,154.36,APC Alloderm,Q4116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.14,,,,,,,fee schedule,58.14,154.36, Alloderm,Q4116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.78,,,,,,,fee schedule,58.14,154.36, Alloderm,Q4116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,58.14,154.36,APC Alloderm,Q4116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,58.14,154.36,APC Alloderm,Q4116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,58.14,154.36,APC Hyalomatrix,Q4117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.58,,,,,,,fee schedule,45.58,154.36, Hyalomatrix,Q4117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.71,,,,,,,fee schedule,45.58,154.36, Hyalomatrix,Q4117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,45.58,154.36,APC Hyalomatrix,Q4117,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,45.58,154.36,APC Hyalomatrix,Q4117,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,45.58,154.36,APC Matristem micromatrix,Q4118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.98,,,,,,,fee schedule,3.98,5.7, Matristem micromatrix,Q4118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.98,,,,,,,fee schedule,3.98,5.7, Matristem micromatrix,Q4118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.75,,,,,,,fee schedule,3.98,5.7, Matristem micromatrix,Q4118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.7,,,,,,,fee schedule,3.98,5.7, Theraskin,Q4121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,76.05,,,,,,,fee schedule,76.05,154.36, Theraskin,Q4121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,76.05,,,,,,,fee schedule,76.05,154.36, Theraskin,Q4121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,98.59,,,,,,,fee schedule,76.05,154.36, Theraskin,Q4121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,118.32,,,,,,,fee schedule,76.05,154.36, Theraskin,Q4121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,76.05,154.36,APC Theraskin,Q4121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,76.05,154.36,APC Theraskin,Q4121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,76.05,154.36,APC Dermacell,Q4122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,192.23,,,,,,,fee schedule,147.01,230.69, Dermacell,Q4122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,230.69,,,,,,,fee schedule,147.01,230.69, Dermacell,Q4122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,230.69,APC Dermacell,Q4122,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,230.69,APC Dermacell,Q4122,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,230.69,APC Alloskin,Q4123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,111.38,,,,,,,fee schedule,111.38,160.49, Alloskin,Q4123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,111.38,,,,,,,fee schedule,111.38,160.49, Alloskin,Q4123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,133.73,,,,,,,fee schedule,111.38,160.49, Alloskin,Q4123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,160.49,,,,,,,fee schedule,111.38,160.49, Alloskin,Q4123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,111.38,160.49,APC Alloskin,Q4123,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,111.38,160.49,APC Alloskin,Q4123,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,111.38,160.49,APC Oasis tri-layer wound matrix,Q4124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3.86,,,,,,,fee schedule,3.86,154.36, Oasis tri-layer wound matrix,Q4124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3.86,,,,,,,fee schedule,3.86,154.36, Oasis tri-layer wound matrix,Q4124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.65,,,,,,,fee schedule,3.86,154.36, Oasis tri-layer wound matrix,Q4124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.59,,,,,,,fee schedule,3.86,154.36, Oasis tri-layer wound matrix,Q4124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,3.86,154.36,APC Oasis tri-layer wound matrix,Q4124,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,3.86,154.36,APC Oasis tri-layer wound matrix,Q4124,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,3.86,154.36,APC Memoderm/derma/tranz/integup,Q4126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,93.11,,,,,,,fee schedule,93.11,154.36, Memoderm/derma/tranz/integup,Q4126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,93.11,,,,,,,fee schedule,93.11,154.36, Memoderm/derma/tranz/integup,Q4126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,116.64,,,,,,,fee schedule,93.11,154.36, Memoderm/derma/tranz/integup,Q4126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,139.99,,,,,,,fee schedule,93.11,154.36, Memoderm/derma/tranz/integup,Q4126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,93.11,154.36,APC Memoderm/derma/tranz/integup,Q4126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,93.11,154.36,APC Memoderm/derma/tranz/integup,Q4126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,93.11,154.36,APC Talymed,Q4127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,106.61,,,,,,,fee schedule,106.61,154.36, Talymed,Q4127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,106.61,,,,,,,fee schedule,106.61,154.36, Talymed,Q4127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,128.01,,,,,,,fee schedule,106.61,154.36, Talymed,Q4127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,153.62,,,,,,,fee schedule,106.61,154.36, Talymed,Q4127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,106.61,154.36,APC Talymed,Q4127,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,106.61,154.36,APC Talymed,Q4127,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,106.61,154.36,APC Flexhd/allopatchhd/matrixhd,Q4128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,47.78,,,,,,,fee schedule,47.78,154.36, Flexhd/allopatchhd/matrixhd,Q4128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,47.78,,,,,,,fee schedule,47.78,154.36, Flexhd/allopatchhd/matrixhd,Q4128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.9,,,,,,,fee schedule,47.78,154.36, Flexhd/allopatchhd/matrixhd,Q4128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.09,,,,,,,fee schedule,47.78,154.36, Flexhd/allopatchhd/matrixhd,Q4128,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,47.78,154.36,APC Flexhd/allopatchhd/matrixhd,Q4128,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,47.78,154.36,APC Flexhd/allopatchhd/matrixhd,Q4128,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,47.78,154.36,APC Grafix core,Q4132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,138.81,,,,,,,fee schedule,138.81,239.33, Grafix core,Q4132,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,138.81,,,,,,,fee schedule,138.81,239.33, Grafix core,Q4132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,199.42,,,,,,,fee schedule,138.81,239.33, Grafix core,Q4132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,239.33,,,,,,,fee schedule,138.81,239.33, Grafix core,Q4132,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,138.81,239.33,APC Grafix core,Q4132,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,138.81,239.33,APC Grafix core,Q4132,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,138.81,239.33,APC Grafix prime,Q4133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,211.98,,,,,,,fee schedule,147.01,311.19, Grafix prime,Q4133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,211.98,,,,,,,fee schedule,147.01,311.19, Grafix prime,Q4133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,259.31,,,,,,,fee schedule,147.01,311.19, Grafix prime,Q4133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,311.19,,,,,,,fee schedule,147.01,311.19, Grafix prime,Q4133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,311.19,APC Grafix prime,Q4133,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,311.19,APC Grafix prime,Q4133,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,311.19,APC hMatrix,Q4134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,302.93,,,,,,,fee schedule,147.01,363.55, hMatrix,Q4134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,363.55,,,,,,,fee schedule,147.01,363.55, hMatrix,Q4134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,363.55,APC hMatrix,Q4134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,363.55,APC hMatrix,Q4134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,363.55,APC "Amnioexcel or biodexcel, 1cm",Q4137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.77,,,,,,,fee schedule,147.01,228.16, "Amnioexcel or biodexcel, 1cm",Q4137,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,156.77,,,,,,,fee schedule,147.01,228.16, "Amnioexcel or biodexcel, 1cm",Q4137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,190.11,,,,,,,fee schedule,147.01,228.16, "Amnioexcel or biodexcel, 1cm",Q4137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,228.16,,,,,,,fee schedule,147.01,228.16, "Amnioexcel or biodexcel, 1cm",Q4137,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,228.16,APC "Amnioexcel or biodexcel, 1cm",Q4137,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,228.16,APC "Amnioexcel or biodexcel, 1cm",Q4137,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,228.16,APC "Biodfence dryflex, 1cm",Q4138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,156.29,,,,,,,fee schedule,147.01,220.06, "Biodfence dryflex, 1cm",Q4138,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,156.29,,,,,,,fee schedule,147.01,220.06, "Biodfence dryflex, 1cm",Q4138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,183.37,,,,,,,fee schedule,147.01,220.06, "Biodfence dryflex, 1cm",Q4138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,220.06,,,,,,,fee schedule,147.01,220.06, "Biodfence dryflex, 1cm",Q4138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,220.06,APC "Biodfence dryflex, 1cm",Q4138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,220.06,APC "Biodfence dryflex, 1cm",Q4138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,220.06,APC Biodfence 1cm,Q4140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,256.58,,,,,,,fee schedule,147.01,362.51, Biodfence 1cm,Q4140,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,256.58,,,,,,,fee schedule,147.01,362.51, Biodfence 1cm,Q4140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,302.07,,,,,,,fee schedule,147.01,362.51, Biodfence 1cm,Q4140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,362.51,,,,,,,fee schedule,147.01,362.51, Biodfence 1cm,Q4140,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,362.51,APC Biodfence 1cm,Q4140,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,362.51,APC Biodfence 1cm,Q4140,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,362.51,APC "Alloskin ac, 1 cm",Q4141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,100.78,,,,,,,fee schedule,100.78,239.93, "Alloskin ac, 1 cm",Q4141,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,100.78,,,,,,,fee schedule,100.78,239.93, "Alloskin ac, 1 cm",Q4141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,199.93,,,,,,,fee schedule,100.78,239.93, "Alloskin ac, 1 cm",Q4141,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,239.93,,,,,,,fee schedule,100.78,239.93, "Alloskin ac, 1 cm",Q4141,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,100.78,239.93,APC "Alloskin ac, 1 cm",Q4141,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,100.78,239.93,APC "Alloskin ac, 1 cm",Q4141,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,100.78,239.93,APC "Repriza, 1cm",Q4143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,52.8,,,,,,,fee schedule,52.8,154.36, "Repriza, 1cm",Q4143,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,52.8,,,,,,,fee schedule,52.8,154.36, "Repriza, 1cm",Q4143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,63.4,,,,,,,fee schedule,52.8,154.36, "Repriza, 1cm",Q4143,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,76.08,,,,,,,fee schedule,52.8,154.36, "Repriza, 1cm",Q4143,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,52.8,154.36,APC "Repriza, 1cm",Q4143,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,52.8,154.36,APC "Repriza, 1cm",Q4143,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,52.8,154.36,APC "Epifix, inj, 1mg",Q4145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.33,,,,,,,fee schedule,30.33,43.69, "Epifix, inj, 1mg",Q4145,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.33,,,,,,,fee schedule,30.33,43.69, "Epifix, inj, 1mg",Q4145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,36.41,,,,,,,fee schedule,30.33,43.69, "Epifix, inj, 1mg",Q4145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,43.69,,,,,,,fee schedule,30.33,43.69, Architect ecm px fx 1 sq cm,Q4147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,90.76,,,,,,,fee schedule,90.76,154.36, Architect ecm px fx 1 sq cm,Q4147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,108.92,,,,,,,fee schedule,90.76,154.36, Architect ecm px fx 1 sq cm,Q4147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,90.76,154.36,APC Architect ecm px fx 1 sq cm,Q4147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,90.76,154.36,APC Architect ecm px fx 1 sq cm,Q4147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,90.76,154.36,APC "Neox 1k, 1cm",Q4148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,196.23,,,,,,,fee schedule,147.01,277.68, "Neox 1k, 1cm",Q4148,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,196.23,,,,,,,fee schedule,147.01,277.68, "Neox 1k, 1cm",Q4148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,231.38,,,,,,,fee schedule,147.01,277.68, "Neox 1k, 1cm",Q4148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,277.68,,,,,,,fee schedule,147.01,277.68, "Neox 1k, 1cm",Q4148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,277.68,APC "Neox 1k, 1cm",Q4148,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,277.68,APC "Neox 1k, 1cm",Q4148,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,277.68,APC "Excellagen, 0.1 cc",Q4149,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,276.43,,,,,,,fee schedule,276.43,331.74, "Excellagen, 0.1 cc",Q4149,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,331.74,,,,,,,fee schedule,276.43,331.74, Allowrap ds or dry 1 sq cm,Q4150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,132.08,,,,,,,fee schedule,132.08,175.34, Allowrap ds or dry 1 sq cm,Q4150,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,132.08,,,,,,,fee schedule,132.08,175.34, Allowrap ds or dry 1 sq cm,Q4150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,146.1,,,,,,,fee schedule,132.08,175.34, Allowrap ds or dry 1 sq cm,Q4150,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,175.34,,,,,,,fee schedule,132.08,175.34, Allowrap ds or dry 1 sq cm,Q4150,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,132.08,175.34,APC Allowrap ds or dry 1 sq cm,Q4150,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,132.08,175.34,APC Allowrap ds or dry 1 sq cm,Q4150,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,132.08,175.34,APC "Amnioband, guardian 1 sq cm",Q4151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,213.56,,,,,,,fee schedule,147.01,302.56, "Amnioband, guardian 1 sq cm",Q4151,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,213.56,,,,,,,fee schedule,147.01,302.56, "Amnioband, guardian 1 sq cm",Q4151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,252.11,,,,,,,fee schedule,147.01,302.56, "Amnioband, guardian 1 sq cm",Q4151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,302.56,,,,,,,fee schedule,147.01,302.56, "Amnioband, guardian 1 sq cm",Q4151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,302.56,APC "Amnioband, guardian 1 sq cm",Q4151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,302.56,APC "Amnioband, guardian 1 sq cm",Q4151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,302.56,APC Dermapure 1 square cm,Q4152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,70.69,,,,,,,fee schedule,70.69,154.36, Dermapure 1 square cm,Q4152,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,70.69,,,,,,,fee schedule,70.69,154.36, Dermapure 1 square cm,Q4152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,94.78,,,,,,,fee schedule,70.69,154.36, Dermapure 1 square cm,Q4152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,113.74,,,,,,,fee schedule,70.69,154.36, Dermapure 1 square cm,Q4152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,70.69,154.36,APC Dermapure 1 square cm,Q4152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,70.69,154.36,APC Dermapure 1 square cm,Q4152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,70.69,154.36,APC "Dermavest, plurivest sq cm",Q4153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,169.04,,,,,,,fee schedule,147.01,309.38, "Dermavest, plurivest sq cm",Q4153,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,169.04,,,,,,,fee schedule,147.01,309.38, "Dermavest, plurivest sq cm",Q4153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,257.79,,,,,,,fee schedule,147.01,309.38, "Dermavest, plurivest sq cm",Q4153,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,309.38,,,,,,,fee schedule,147.01,309.38, "Dermavest, plurivest sq cm",Q4153,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,309.38,APC "Dermavest, plurivest sq cm",Q4153,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,309.38,APC "Dermavest, plurivest sq cm",Q4153,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,309.38,APC Biovance 1 square cm,Q4154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,222.37,,,,,,,fee schedule,147.01,295.85, Biovance 1 square cm,Q4154,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,222.37,,,,,,,fee schedule,147.01,295.85, Biovance 1 square cm,Q4154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,246.52,,,,,,,fee schedule,147.01,295.85, Biovance 1 square cm,Q4154,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,295.85,,,,,,,fee schedule,147.01,295.85, Biovance 1 square cm,Q4154,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,295.85,APC Biovance 1 square cm,Q4154,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,295.85,APC Biovance 1 square cm,Q4154,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,295.85,APC Neoxflo or clarixflo 1 mg,Q4155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,42.5,,,,,,,fee schedule,42.5,59.71, Neoxflo or clarixflo 1 mg,Q4155,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,42.5,,,,,,,fee schedule,42.5,59.71, Neoxflo or clarixflo 1 mg,Q4155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,49.75,,,,,,,fee schedule,42.5,59.71, Neoxflo or clarixflo 1 mg,Q4155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.71,,,,,,,fee schedule,42.5,59.71, Neox 100 1 square cm,Q4156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,103.27,,,,,,,fee schedule,103.27,154.36, Neox 100 1 square cm,Q4156,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.27,,,,,,,fee schedule,103.27,154.36, Neox 100 1 square cm,Q4156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,123.13,,,,,,,fee schedule,103.27,154.36, Neox 100 1 square cm,Q4156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,147.77,,,,,,,fee schedule,103.27,154.36, Neox 100 1 square cm,Q4156,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,103.27,154.36,APC Neox 100 1 square cm,Q4156,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,103.27,154.36,APC Neox 100 1 square cm,Q4156,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,103.27,154.36,APC Revitalon 1 square cm,Q4157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,332.92,,,,,,,fee schedule,147.01,399.55, Revitalon 1 square cm,Q4157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,399.55,,,,,,,fee schedule,147.01,399.55, Revitalon 1 square cm,Q4157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,399.55,APC Revitalon 1 square cm,Q4157,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,399.55,APC Revitalon 1 square cm,Q4157,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,399.55,APC Marigen 1 square cm,Q4158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,103.22,,,,,,,fee schedule,103.22,154.36, Marigen 1 square cm,Q4158,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,103.22,,,,,,,fee schedule,103.22,154.36, Marigen 1 square cm,Q4158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,125.73,,,,,,,fee schedule,103.22,154.36, Marigen 1 square cm,Q4158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,150.89,,,,,,,fee schedule,103.22,154.36, Marigen 1 square cm,Q4158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,103.22,154.36,APC Marigen 1 square cm,Q4158,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,103.22,154.36,APC Marigen 1 square cm,Q4158,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,103.22,154.36,APC Affinity1 square cm,Q4159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,366.07,,,,,,,fee schedule,147.01,459.73, Affinity1 square cm,Q4159,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,366.07,,,,,,,fee schedule,147.01,459.73, Affinity1 square cm,Q4159,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,383.07,,,,,,,fee schedule,147.01,459.73, Affinity1 square cm,Q4159,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,459.73,,,,,,,fee schedule,147.01,459.73, Affinity1 square cm,Q4159,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,459.73,APC Affinity1 square cm,Q4159,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,459.73,APC Affinity1 square cm,Q4159,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,459.73,APC Nushield 1 square cm,Q4160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,825,,,,,,,fee schedule,147.01,6245.36, Nushield 1 square cm,Q4160,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,825,,,,,,,fee schedule,147.01,6245.36, Nushield 1 square cm,Q4160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5204.01,,,,,,,fee schedule,147.01,6245.36, Nushield 1 square cm,Q4160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6245.36,,,,,,,fee schedule,147.01,6245.36, Nushield 1 square cm,Q4160,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6245.36,APC Nushield 1 square cm,Q4160,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6245.36,APC Nushield 1 square cm,Q4160,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6245.36,APC Bio-connekt per square cm,Q4161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2574.33,,,,,,,fee schedule,147.01,3567.58, Bio-connekt per square cm,Q4161,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2574.33,,,,,,,fee schedule,147.01,3567.58, Bio-connekt per square cm,Q4161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2972.72,,,,,,,fee schedule,147.01,3567.58, Bio-connekt per square cm,Q4161,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3567.58,,,,,,,fee schedule,147.01,3567.58, Bio-connekt per square cm,Q4161,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3567.58,APC Bio-connekt per square cm,Q4161,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3567.58,APC Bio-connekt per square cm,Q4161,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3567.58,APC Amnio bio and woundex flow,Q4162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3495.03,,,,,,,fee schedule,3495.03,4194.41, Amnio bio and woundex flow,Q4162,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4194.41,,,,,,,fee schedule,3495.03,4194.41, Amnio bio and woundex sq cm,Q4163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,283.59,,,,,,,fee schedule,147.01,408.63, Amnio bio and woundex sq cm,Q4163,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,283.59,,,,,,,fee schedule,147.01,408.63, Amnio bio and woundex sq cm,Q4163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,340.49,,,,,,,fee schedule,147.01,408.63, Amnio bio and woundex sq cm,Q4163,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,408.63,,,,,,,fee schedule,147.01,408.63, Amnio bio and woundex sq cm,Q4163,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,408.63,APC Amnio bio and woundex sq cm,Q4163,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,408.63,APC Amnio bio and woundex sq cm,Q4163,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,408.63,APC "Helicoll, per square cm",Q4164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2554.28,,,,,,,fee schedule,147.01,3680.61, "Helicoll, per square cm",Q4164,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2554.28,,,,,,,fee schedule,147.01,3680.61, "Helicoll, per square cm",Q4164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3066.9,,,,,,,fee schedule,147.01,3680.61, "Helicoll, per square cm",Q4164,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3680.61,,,,,,,fee schedule,147.01,3680.61, "Helicoll, per square cm",Q4164,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3680.61,APC "Helicoll, per square cm",Q4164,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3680.61,APC "Helicoll, per square cm",Q4164,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3680.61,APC "Keramatrix, per square cm",Q4165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.57,,,,,,,fee schedule,84.57,154.36, "Keramatrix, per square cm",Q4165,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,101.5,,,,,,,fee schedule,84.57,154.36, "Keramatrix, per square cm",Q4165,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,84.57,154.36,APC "Keramatrix, per square cm",Q4165,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,84.57,154.36,APC "Keramatrix, per square cm",Q4165,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,84.57,154.36,APC "Cytal, per square centimeter",Q4166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.46,,,,,,,fee schedule,32.46,154.36, "Cytal, per square centimeter",Q4166,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.46,,,,,,,fee schedule,32.46,154.36, "Cytal, per square centimeter",Q4166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.32,,,,,,,fee schedule,32.46,154.36, "Cytal, per square centimeter",Q4166,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.79,,,,,,,fee schedule,32.46,154.36, "Cytal, per square centimeter",Q4166,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,32.46,154.36,APC "Cytal, per square centimeter",Q4166,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,32.46,154.36,APC "Cytal, per square centimeter",Q4166,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,32.46,154.36,APC "Truskin, per sq centimeter",Q4167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,192.13,,,,,,,fee schedule,147.01,230.58, "Truskin, per sq centimeter",Q4167,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,230.58,,,,,,,fee schedule,147.01,230.58, "Truskin, per sq centimeter",Q4167,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,230.58,APC "Truskin, per sq centimeter",Q4167,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,230.58,APC "Truskin, per sq centimeter",Q4167,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,230.58,APC "Amnioband, 1 mg",Q4168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,31.87,,,,,,,fee schedule,31.87,38.24, "Amnioband, 1 mg",Q4168,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,38.24,,,,,,,fee schedule,31.87,38.24, "Artacent wound, per sq cm",Q4169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3456.55,,,,,,,fee schedule,147.01,4639.58, "Artacent wound, per sq cm",Q4169,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3456.55,,,,,,,fee schedule,147.01,4639.58, "Artacent wound, per sq cm",Q4169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3865.97,,,,,,,fee schedule,147.01,4639.58, "Artacent wound, per sq cm",Q4169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4639.58,,,,,,,fee schedule,147.01,4639.58, "Artacent wound, per sq cm",Q4169,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4639.58,APC "Artacent wound, per sq cm",Q4169,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4639.58,APC "Artacent wound, per sq cm",Q4169,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4639.58,APC "Cygnus, per sq cm",Q4170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.68,,,,,,,fee schedule,64.68,154.36, "Cygnus, per sq cm",Q4170,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.68,,,,,,,fee schedule,64.68,154.36, "Cygnus, per sq cm",Q4170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,73.47,,,,,,,fee schedule,64.68,154.36, "Cygnus, per sq cm",Q4170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,88.17,,,,,,,fee schedule,64.68,154.36, "Cygnus, per sq cm",Q4170,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,64.68,154.36,APC "Cygnus, per sq cm",Q4170,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,64.68,154.36,APC "Cygnus, per sq cm",Q4170,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,64.68,154.36,APC "Interfyl, 1 mg",Q4171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,16.52,,,,,,,fee schedule,16.52,22.63, "Interfyl, 1 mg",Q4171,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,16.52,,,,,,,fee schedule,16.52,22.63, "Interfyl, 1 mg",Q4171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.86,,,,,,,fee schedule,16.52,22.63, "Interfyl, 1 mg",Q4171,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.63,,,,,,,fee schedule,16.52,22.63, Palingen or palingen xplus,Q4173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,555.01,,,,,,,fee schedule,147.01,782.83, Palingen or palingen xplus,Q4173,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,555.01,,,,,,,fee schedule,147.01,782.83, Palingen or palingen xplus,Q4173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,652.3,,,,,,,fee schedule,147.01,782.83, Palingen or palingen xplus,Q4173,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,782.83,,,,,,,fee schedule,147.01,782.83, Palingen or palingen xplus,Q4173,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,782.83,APC Palingen or palingen xplus,Q4173,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,782.83,APC Palingen or palingen xplus,Q4173,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,782.83,APC Palingen or promatrx,Q4174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2373.44,,,,,,,fee schedule,2373.44,2848.39, Palingen or promatrx,Q4174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2848.39,,,,,,,fee schedule,2373.44,2848.39, Miroderm,Q4175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,105.4,,,,,,,fee schedule,105.4,205.32, Miroderm,Q4175,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,105.4,,,,,,,fee schedule,105.4,205.32, Miroderm,Q4175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,171.09,,,,,,,fee schedule,105.4,205.32, Miroderm,Q4175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,205.32,,,,,,,fee schedule,105.4,205.32, Miroderm,Q4175,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,105.4,205.32,APC Miroderm,Q4175,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,105.4,205.32,APC Miroderm,Q4175,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,105.4,205.32,APC "Neopatch, per sq centimeter",Q4176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,301.84,,,,,,,fee schedule,147.01,362.24, "Neopatch, per sq centimeter",Q4176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,362.24,,,,,,,fee schedule,147.01,362.24, "Neopatch, per sq centimeter",Q4176,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,362.24,APC "Neopatch, per sq centimeter",Q4176,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,362.24,APC "Neopatch, per sq centimeter",Q4176,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,362.24,APC "Floweramnioflo, 0.1 cc",Q4177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,285.96,,,,,,,fee schedule,285.96,343.18, "Floweramnioflo, 0.1 cc",Q4177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,343.18,,,,,,,fee schedule,285.96,343.18, "Floweramniopatch, per sq cm",Q4178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,144.94,,,,,,,fee schedule,144.94,200.55, "Floweramniopatch, per sq cm",Q4178,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,144.94,,,,,,,fee schedule,144.94,200.55, "Floweramniopatch, per sq cm",Q4178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,167.11,,,,,,,fee schedule,144.94,200.55, "Floweramniopatch, per sq cm",Q4178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,200.55,,,,,,,fee schedule,144.94,200.55, "Floweramniopatch, per sq cm",Q4178,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,144.94,200.55,APC "Floweramniopatch, per sq cm",Q4178,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,144.94,200.55,APC "Floweramniopatch, per sq cm",Q4178,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,144.94,200.55,APC "Revita, per sq cm",Q4180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1696.81,,,,,,,fee schedule,147.01,1696.81, "Revita, per sq cm",Q4180,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1696.81,,,,,,,fee schedule,147.01,1696.81, "Revita, per sq cm",Q4180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1226.29,,,,,,,fee schedule,147.01,1696.81, "Revita, per sq cm",Q4180,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1471.68,,,,,,,fee schedule,147.01,1696.81, "Revita, per sq cm",Q4180,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1696.81,APC "Revita, per sq cm",Q4180,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1696.81,APC "Revita, per sq cm",Q4180,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1696.81,APC "Transcyte, per sq centimeter",Q4182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,74.98,,,,,,,fee schedule,74.98,154.36, "Transcyte, per sq centimeter",Q4182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.99,,,,,,,fee schedule,74.98,154.36, "Transcyte, per sq centimeter",Q4182,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,74.98,154.36,APC "Transcyte, per sq centimeter",Q4182,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,74.98,154.36,APC "Transcyte, per sq centimeter",Q4182,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,74.98,154.36,APC "Surgigraft, 1 sq cm",Q4183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,158.87,,,,,,,fee schedule,147.01,190.66, "Surgigraft, 1 sq cm",Q4183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,190.66,,,,,,,fee schedule,147.01,190.66, "Surgigraft, 1 sq cm",Q4183,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,190.66,APC "Surgigraft, 1 sq cm",Q4183,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,190.66,APC "Surgigraft, 1 sq cm",Q4183,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,190.66,APC "Cellesta, 1 sq cm",Q4184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,124.59,,,,,,,fee schedule,124.59,179.53, "Cellesta, 1 sq cm",Q4184,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,124.59,,,,,,,fee schedule,124.59,179.53, "Cellesta, 1 sq cm",Q4184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,149.59,,,,,,,fee schedule,124.59,179.53, "Cellesta, 1 sq cm",Q4184,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,179.53,,,,,,,fee schedule,124.59,179.53, "Cellesta, 1 sq cm",Q4184,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,124.59,179.53,APC "Cellesta, 1 sq cm",Q4184,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,124.59,179.53,APC "Cellesta, 1 sq cm",Q4184,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,124.59,179.53,APC Epifix 1 sq cm,Q4186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,234,,,,,,,fee schedule,147.01,339.07, Epifix 1 sq cm,Q4186,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,234,,,,,,,fee schedule,147.01,339.07, Epifix 1 sq cm,Q4186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,282.54,,,,,,,fee schedule,147.01,339.07, Epifix 1 sq cm,Q4186,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,339.07,,,,,,,fee schedule,147.01,339.07, Epifix 1 sq cm,Q4186,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,339.07,APC Epifix 1 sq cm,Q4186,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,339.07,APC Epifix 1 sq cm,Q4186,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,339.07,APC Epicord 1 sq cm,Q4187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,376.5,,,,,,,fee schedule,147.01,550.21, Epicord 1 sq cm,Q4187,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,376.5,,,,,,,fee schedule,147.01,550.21, Epicord 1 sq cm,Q4187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,458.47,,,,,,,fee schedule,147.01,550.21, Epicord 1 sq cm,Q4187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,550.21,,,,,,,fee schedule,147.01,550.21, Epicord 1 sq cm,Q4187,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,550.21,APC Epicord 1 sq cm,Q4187,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,550.21,APC Epicord 1 sq cm,Q4187,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,550.21,APC Amnioarmor 1 sq cm,Q4188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,758.98,,,,,,,fee schedule,147.01,1093.66, Amnioarmor 1 sq cm,Q4188,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,758.98,,,,,,,fee schedule,147.01,1093.66, Amnioarmor 1 sq cm,Q4188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,911.31,,,,,,,fee schedule,147.01,1093.66, Amnioarmor 1 sq cm,Q4188,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1093.66,,,,,,,fee schedule,147.01,1093.66, Amnioarmor 1 sq cm,Q4188,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1093.66,APC Amnioarmor 1 sq cm,Q4188,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1093.66,APC Amnioarmor 1 sq cm,Q4188,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1093.66,APC "Artacent ac, 1 mg",Q4189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,39.75,,,,,,,fee schedule,39.75,47.71, "Artacent ac, 1 mg",Q4189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,47.71,,,,,,,fee schedule,39.75,47.71, Artacent ac 1 sq cm,Q4190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,201.45,,,,,,,fee schedule,147.01,251.93, Artacent ac 1 sq cm,Q4190,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,201.45,,,,,,,fee schedule,147.01,251.93, Artacent ac 1 sq cm,Q4190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,209.93,,,,,,,fee schedule,147.01,251.93, Artacent ac 1 sq cm,Q4190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,251.93,,,,,,,fee schedule,147.01,251.93, Artacent ac 1 sq cm,Q4190,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,251.93,APC Artacent ac 1 sq cm,Q4190,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,251.93,APC Artacent ac 1 sq cm,Q4190,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,251.93,APC Restorigin 1 sq cm,Q4191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1137,,,,,,,fee schedule,147.01,1469.84, Restorigin 1 sq cm,Q4191,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1137,,,,,,,fee schedule,147.01,1469.84, Restorigin 1 sq cm,Q4191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1224.76,,,,,,,fee schedule,147.01,1469.84, Restorigin 1 sq cm,Q4191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1469.84,,,,,,,fee schedule,147.01,1469.84, Restorigin 1 sq cm,Q4191,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1469.84,APC Restorigin 1 sq cm,Q4191,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1469.84,APC Restorigin 1 sq cm,Q4191,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1469.84,APC Coll-e-derm 1 sq cm,Q4193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2666.75,,,,,,,fee schedule,147.01,3124.77, Coll-e-derm 1 sq cm,Q4193,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2666.75,,,,,,,fee schedule,147.01,3124.77, Coll-e-derm 1 sq cm,Q4193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2603.74,,,,,,,fee schedule,147.01,3124.77, Coll-e-derm 1 sq cm,Q4193,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3124.77,,,,,,,fee schedule,147.01,3124.77, Coll-e-derm 1 sq cm,Q4193,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3124.77,APC Coll-e-derm 1 sq cm,Q4193,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3124.77,APC Coll-e-derm 1 sq cm,Q4193,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3124.77,APC Novachor 1 sq cm,Q4194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1117.3,,,,,,,fee schedule,147.01,1488.52, Novachor 1 sq cm,Q4194,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1117.3,,,,,,,fee schedule,147.01,1488.52, Novachor 1 sq cm,Q4194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1240.32,,,,,,,fee schedule,147.01,1488.52, Novachor 1 sq cm,Q4194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1488.52,,,,,,,fee schedule,147.01,1488.52, Novachor 1 sq cm,Q4194,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1488.52,APC Novachor 1 sq cm,Q4194,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1488.52,APC Novachor 1 sq cm,Q4194,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1488.52,APC Puraply 1 sq cm,Q4195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,167.99,,,,,,,fee schedule,147.01,219.68, Puraply 1 sq cm,Q4195,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,167.99,,,,,,,fee schedule,147.01,219.68, Puraply 1 sq cm,Q4195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,183.05,,,,,,,fee schedule,147.01,219.68, Puraply 1 sq cm,Q4195,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,219.68,,,,,,,fee schedule,147.01,219.68, Puraply 1 sq cm,Q4195,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,219.68,APC Puraply 1 sq cm,Q4195,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,219.68,APC Puraply 1 sq cm,Q4195,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,219.68,APC Puraply am 1 sq cm,Q4196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,153.38,,,,,,,fee schedule,147.01,226.61, Puraply am 1 sq cm,Q4196,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,153.38,,,,,,,fee schedule,147.01,226.61, Puraply am 1 sq cm,Q4196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,188.83,,,,,,,fee schedule,147.01,226.61, Puraply am 1 sq cm,Q4196,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,226.61,,,,,,,fee schedule,147.01,226.61, Puraply am 1 sq cm,Q4196,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,226.61,APC Puraply am 1 sq cm,Q4196,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,226.61,APC Puraply am 1 sq cm,Q4196,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,226.61,APC Puraply xt 1 sq cm,Q4197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,110.58,,,,,,,fee schedule,110.58,158.58, Puraply xt 1 sq cm,Q4197,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,110.58,,,,,,,fee schedule,110.58,158.58, Puraply xt 1 sq cm,Q4197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,132.14,,,,,,,fee schedule,110.58,158.58, Puraply xt 1 sq cm,Q4197,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,158.58,,,,,,,fee schedule,110.58,158.58, Puraply xt 1 sq cm,Q4197,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,110.58,158.58,APC Puraply xt 1 sq cm,Q4197,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,110.58,158.58,APC Puraply xt 1 sq cm,Q4197,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,110.58,158.58,APC "Cygnus matrix, per sq cm",Q4199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,202.75,,,,,,,fee schedule,147.01,249.31, "Cygnus matrix, per sq cm",Q4199,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,202.75,,,,,,,fee schedule,147.01,249.31, "Cygnus matrix, per sq cm",Q4199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,207.74,,,,,,,fee schedule,147.01,249.31, "Cygnus matrix, per sq cm",Q4199,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,249.31,,,,,,,fee schedule,147.01,249.31, "Cygnus matrix, per sq cm",Q4199,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,249.31,APC "Cygnus matrix, per sq cm",Q4199,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,249.31,APC "Cygnus matrix, per sq cm",Q4199,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,249.31,APC Matrion 1 sq cm,Q4201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,123.32,,,,,,,fee schedule,123.32,170.67, Matrion 1 sq cm,Q4201,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,123.32,,,,,,,fee schedule,123.32,170.67, Matrion 1 sq cm,Q4201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,142.21,,,,,,,fee schedule,123.32,170.67, Matrion 1 sq cm,Q4201,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170.67,,,,,,,fee schedule,123.32,170.67, Matrion 1 sq cm,Q4201,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,123.32,170.67,APC Matrion 1 sq cm,Q4201,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,123.32,170.67,APC Matrion 1 sq cm,Q4201,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,123.32,170.67,APC "Derma-gide, 1 sq cm",Q4203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1356.38,,,,,,,fee schedule,147.01,2361.63, "Derma-gide, 1 sq cm",Q4203,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1356.38,,,,,,,fee schedule,147.01,2361.63, "Derma-gide, 1 sq cm",Q4203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1967.85,,,,,,,fee schedule,147.01,2361.63, "Derma-gide, 1 sq cm",Q4203,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2361.63,,,,,,,fee schedule,147.01,2361.63, "Derma-gide, 1 sq cm",Q4203,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2361.63,APC "Derma-gide, 1 sq cm",Q4203,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2361.63,APC "Derma-gide, 1 sq cm",Q4203,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2361.63,APC Xwrap 1 sq cm,Q4204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5875.83,,,,,,,fee schedule,147.01,8281.47, Xwrap 1 sq cm,Q4204,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5875.83,,,,,,,fee schedule,147.01,8281.47, Xwrap 1 sq cm,Q4204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6900.61,,,,,,,fee schedule,147.01,8281.47, Xwrap 1 sq cm,Q4204,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8281.47,,,,,,,fee schedule,147.01,8281.47, Xwrap 1 sq cm,Q4204,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8281.47,APC Xwrap 1 sq cm,Q4204,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8281.47,APC Xwrap 1 sq cm,Q4204,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8281.47,APC Membrane graft or wrap sq cm,Q4205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1853.05,,,,,,,fee schedule,147.01,2775.22, Membrane graft or wrap sq cm,Q4205,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1853.05,,,,,,,fee schedule,147.01,2775.22, Membrane graft or wrap sq cm,Q4205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2312.48,,,,,,,fee schedule,147.01,2775.22, Membrane graft or wrap sq cm,Q4205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2775.22,,,,,,,fee schedule,147.01,2775.22, Membrane graft or wrap sq cm,Q4205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2775.22,APC Membrane graft or wrap sq cm,Q4205,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2775.22,APC Membrane graft or wrap sq cm,Q4205,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2775.22,APC Novafix per sq cm,Q4208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,762.55,,,,,,,fee schedule,147.01,915.14, Novafix per sq cm,Q4208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,915.14,,,,,,,fee schedule,147.01,915.14, Novafix per sq cm,Q4208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,915.14,APC Novafix per sq cm,Q4208,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,915.14,APC Novafix per sq cm,Q4208,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,915.14,APC "Ascent, 0.5 mg",Q4213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,109.52,,,,,,,fee schedule,109.52,131.44, "Ascent, 0.5 mg",Q4213,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,131.44,,,,,,,fee schedule,109.52,131.44, Woundfix biowound plus xplus,Q4217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,495,,,,,,,fee schedule,147.01,713.27, Woundfix biowound plus xplus,Q4217,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,495,,,,,,,fee schedule,147.01,713.27, Woundfix biowound plus xplus,Q4217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,594.34,,,,,,,fee schedule,147.01,713.27, Woundfix biowound plus xplus,Q4217,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,713.27,,,,,,,fee schedule,147.01,713.27, Woundfix biowound plus xplus,Q4217,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,713.27,APC Woundfix biowound plus xplus,Q4217,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,713.27,APC Woundfix biowound plus xplus,Q4217,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,713.27,APC Surgicord per sq cm,Q4218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,238.3,,,,,,,fee schedule,147.01,285.98, Surgicord per sq cm,Q4218,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,285.98,,,,,,,fee schedule,147.01,285.98, Surgicord per sq cm,Q4218,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,285.98,APC Surgicord per sq cm,Q4218,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,285.98,APC Surgicord per sq cm,Q4218,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,285.98,APC Surgigraft dual per sq cm,Q4219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1906.38,,,,,,,fee schedule,147.01,2287.86, Surgigraft dual per sq cm,Q4219,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2287.86,,,,,,,fee schedule,147.01,2287.86, Surgigraft dual per sq cm,Q4219,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2287.86,APC Surgigraft dual per sq cm,Q4219,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2287.86,APC Surgigraft dual per sq cm,Q4219,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2287.86,APC Amniowrap2 per sq cm,Q4221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3052.5,,,,,,,fee schedule,147.01,4398.52, Amniowrap2 per sq cm,Q4221,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3052.5,,,,,,,fee schedule,147.01,4398.52, Amniowrap2 per sq cm,Q4221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3665.11,,,,,,,fee schedule,147.01,4398.52, Amniowrap2 per sq cm,Q4221,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4398.52,,,,,,,fee schedule,147.01,4398.52, Amniowrap2 per sq cm,Q4221,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4398.52,APC Amniowrap2 per sq cm,Q4221,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4398.52,APC Amniowrap2 per sq cm,Q4221,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4398.52,APC "Progenamatrix, per sq cm",Q4222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,198.54,,,,,,,fee schedule,147.01,326.33, "Progenamatrix, per sq cm",Q4222,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,198.54,,,,,,,fee schedule,147.01,326.33, "Progenamatrix, per sq cm",Q4222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,271.92,,,,,,,fee schedule,147.01,326.33, "Progenamatrix, per sq cm",Q4222,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,326.33,,,,,,,fee schedule,147.01,326.33, "Progenamatrix, per sq cm",Q4222,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,326.33,APC "Progenamatrix, per sq cm",Q4222,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,326.33,APC "Progenamatrix, per sq cm",Q4222,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,326.33,APC "Amniobind, per sq cm",Q4225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2133.68,,,,,,,fee schedule,147.01,3201.77, "Amniobind, per sq cm",Q4225,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2133.68,,,,,,,fee schedule,147.01,3201.77, "Amniobind, per sq cm",Q4225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2667.9,,,,,,,fee schedule,147.01,3201.77, "Amniobind, per sq cm",Q4225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3201.77,,,,,,,fee schedule,147.01,3201.77, "Amniobind, per sq cm",Q4225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3201.77,APC "Amniobind, per sq cm",Q4225,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3201.77,APC "Amniobind, per sq cm",Q4225,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3201.77,APC Myown harv prep proc sq cm,Q4226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2287.66,,,,,,,fee schedule,2287.66,2745.43, Myown harv prep proc sq cm,Q4226,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2745.43,,,,,,,fee schedule,2287.66,2745.43, Amniocore per sq cm,Q4227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1814.04,,,,,,,fee schedule,147.01,2630.05, Amniocore per sq cm,Q4227,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1814.04,,,,,,,fee schedule,147.01,2630.05, Amniocore per sq cm,Q4227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2191.51,,,,,,,fee schedule,147.01,2630.05, Amniocore per sq cm,Q4227,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2630.05,,,,,,,fee schedule,147.01,2630.05, Amniocore per sq cm,Q4227,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2630.05,APC Amniocore per sq cm,Q4227,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2630.05,APC Amniocore per sq cm,Q4227,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2630.05,APC Cogenex amnio memb per sq cm,Q4229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,514.16,,,,,,,fee schedule,147.01,1034.83, Cogenex amnio memb per sq cm,Q4229,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,514.16,,,,,,,fee schedule,147.01,1034.83, Cogenex amnio memb per sq cm,Q4229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,862.28,,,,,,,fee schedule,147.01,1034.83, Cogenex amnio memb per sq cm,Q4229,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1034.83,,,,,,,fee schedule,147.01,1034.83, Cogenex amnio memb per sq cm,Q4229,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1034.83,APC Cogenex amnio memb per sq cm,Q4229,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1034.83,APC Cogenex amnio memb per sq cm,Q4229,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1034.83,APC "Corplex, per sq cm",Q4232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,202.54,,,,,,,fee schedule,147.01,245.47, "Corplex, per sq cm",Q4232,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,202.54,,,,,,,fee schedule,147.01,245.47, "Corplex, per sq cm",Q4232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,204.54,,,,,,,fee schedule,147.01,245.47, "Corplex, per sq cm",Q4232,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,245.47,,,,,,,fee schedule,147.01,245.47, "Corplex, per sq cm",Q4232,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,245.47,APC "Corplex, per sq cm",Q4232,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,245.47,APC "Corplex, per sq cm",Q4232,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,245.47,APC "Xcellerate, per sq cm",Q4234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,303.27,,,,,,,fee schedule,147.01,1242.49, "Xcellerate, per sq cm",Q4234,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,303.27,,,,,,,fee schedule,147.01,1242.49, "Xcellerate, per sq cm",Q4234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1035.31,,,,,,,fee schedule,147.01,1242.49, "Xcellerate, per sq cm",Q4234,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1242.49,,,,,,,fee schedule,147.01,1242.49, "Xcellerate, per sq cm",Q4234,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1242.49,APC "Xcellerate, per sq cm",Q4234,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1242.49,APC "Xcellerate, per sq cm",Q4234,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1242.49,APC Amniorepair or altiply sq cm,Q4235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,125.28,,,,,,,fee schedule,125.28,197.34, Amniorepair or altiply sq cm,Q4235,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,125.28,,,,,,,fee schedule,125.28,197.34, Amniorepair or altiply sq cm,Q4235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,164.43,,,,,,,fee schedule,125.28,197.34, Amniorepair or altiply sq cm,Q4235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,197.34,,,,,,,fee schedule,125.28,197.34, Amniorepair or altiply sq cm,Q4235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,125.28,197.34,APC Amniorepair or altiply sq cm,Q4235,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,125.28,197.34,APC Amniorepair or altiply sq cm,Q4235,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,125.28,197.34,APC Carepatch per sq cm,Q4236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,752.85,,,,,,,fee schedule,147.01,1008.03, Carepatch per sq cm,Q4236,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,752.85,,,,,,,fee schedule,147.01,1008.03, Carepatch per sq cm,Q4236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,839.95,,,,,,,fee schedule,147.01,1008.03, Carepatch per sq cm,Q4236,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1008.03,,,,,,,fee schedule,147.01,1008.03, Carepatch per sq cm,Q4236,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1008.03,APC Carepatch per sq cm,Q4236,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1008.03,APC Carepatch per sq cm,Q4236,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1008.03,APC "cryo-cord, per sq cm",Q4237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,793.33,,,,,,,fee schedule,147.01,952.09, "cryo-cord, per sq cm",Q4237,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,952.09,,,,,,,fee schedule,147.01,952.09, "cryo-cord, per sq cm",Q4237,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,952.09,APC "cryo-cord, per sq cm",Q4237,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,952.09,APC "cryo-cord, per sq cm",Q4237,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,952.09,APC "Derm-maxx, per sq cm",Q4238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2685.21,,,,,,,fee schedule,147.01,3257.4, "Derm-maxx, per sq cm",Q4238,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2685.21,,,,,,,fee schedule,147.01,3257.4, "Derm-maxx, per sq cm",Q4238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2714.26,,,,,,,fee schedule,147.01,3257.4, "Derm-maxx, per sq cm",Q4238,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3257.4,,,,,,,fee schedule,147.01,3257.4, "Derm-maxx, per sq cm",Q4238,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3257.4,APC "Derm-maxx, per sq cm",Q4238,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3257.4,APC "Derm-maxx, per sq cm",Q4238,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3257.4,APC Amnio-maxx or lite per sq cm,Q4239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3173.15,,,,,,,fee schedule,147.01,4267.58, Amnio-maxx or lite per sq cm,Q4239,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3173.15,,,,,,,fee schedule,147.01,4267.58, Amnio-maxx or lite per sq cm,Q4239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3556,,,,,,,fee schedule,147.01,4267.58, Amnio-maxx or lite per sq cm,Q4239,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4267.58,,,,,,,fee schedule,147.01,4267.58, Amnio-maxx or lite per sq cm,Q4239,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4267.58,APC Amnio-maxx or lite per sq cm,Q4239,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4267.58,APC Amnio-maxx or lite per sq cm,Q4239,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4267.58,APC "Coretext or protext, per cc",Q4246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7673.18,,,,,,,fee schedule,7673.18,9208.64, "Coretext or protext, per cc",Q4246,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9208.64,,,,,,,fee schedule,7673.18,9208.64, "Amniotext patch, per sq cm",Q4247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5846.23,,,,,,,fee schedule,147.01,7016.1, "Amniotext patch, per sq cm",Q4247,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7016.1,,,,,,,fee schedule,147.01,7016.1, "Amniotext patch, per sq cm",Q4247,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7016.1,APC "Amniotext patch, per sq cm",Q4247,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7016.1,APC "Amniotext patch, per sq cm",Q4247,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7016.1,APC Dermacyte Amn mem allo sq cm,Q4248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4396.62,,,,,,,fee schedule,147.01,4396.62, Dermacyte Amn mem allo sq cm,Q4248,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4396.62,,,,,,,fee schedule,147.01,4396.62, Dermacyte Amn mem allo sq cm,Q4248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1037.67,,,,,,,fee schedule,147.01,4396.62, Dermacyte Amn mem allo sq cm,Q4248,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1245.31,,,,,,,fee schedule,147.01,4396.62, Dermacyte Amn mem allo sq cm,Q4248,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4396.62,APC Dermacyte Amn mem allo sq cm,Q4248,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4396.62,APC Dermacyte Amn mem allo sq cm,Q4248,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4396.62,APC "Amniply, per sq cm",Q4249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2785.61,,,,,,,fee schedule,147.01,4418.46, "Amniply, per sq cm",Q4249,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2785.61,,,,,,,fee schedule,147.01,4418.46, "Amniply, per sq cm",Q4249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3681.72,,,,,,,fee schedule,147.01,4418.46, "Amniply, per sq cm",Q4249,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4418.46,,,,,,,fee schedule,147.01,4418.46, "Amniply, per sq cm",Q4249,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4418.46,APC "Amniply, per sq cm",Q4249,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4418.46,APC "Amniply, per sq cm",Q4249,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4418.46,APC AmnioAMP-MP per sq cm,Q4250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4516.73,,,,,,,fee schedule,147.01,6683.13, AmnioAMP-MP per sq cm,Q4250,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4516.73,,,,,,,fee schedule,147.01,6683.13, AmnioAMP-MP per sq cm,Q4250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5568.78,,,,,,,fee schedule,147.01,6683.13, AmnioAMP-MP per sq cm,Q4250,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6683.13,,,,,,,fee schedule,147.01,6683.13, AmnioAMP-MP per sq cm,Q4250,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6683.13,APC AmnioAMP-MP per sq cm,Q4250,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6683.13,APC AmnioAMP-MP per sq cm,Q4250,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6683.13,APC "Vim, per square centimeter",Q4251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,285.96,,,,,,,fee schedule,147.01,343.18, "Vim, per square centimeter",Q4251,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,343.18,,,,,,,fee schedule,147.01,343.18, "Vim, per square centimeter",Q4251,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,343.18,APC "Vim, per square centimeter",Q4251,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,343.18,APC "Vim, per square centimeter",Q4251,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,343.18,APC "Vendaje, per square centimet",Q4252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,82.5,,,,,,,fee schedule,82.5,154.36, "Vendaje, per square centimet",Q4252,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,82.5,,,,,,,fee schedule,82.5,154.36, "Vendaje, per square centimet",Q4252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,99.06,,,,,,,fee schedule,82.5,154.36, "Vendaje, per square centimet",Q4252,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,118.88,,,,,,,fee schedule,82.5,154.36, "Vendaje, per square centimet",Q4252,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,82.5,154.36,APC "Vendaje, per square centimet",Q4252,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,82.5,154.36,APC "Vendaje, per square centimet",Q4252,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,82.5,154.36,APC Zenith amniotic membrane psc,Q4253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,129.48,,,,,,,fee schedule,129.48,170, Zenith amniotic membrane psc,Q4253,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,129.48,,,,,,,fee schedule,129.48,170, Zenith amniotic membrane psc,Q4253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,141.65,,,,,,,fee schedule,129.48,170, Zenith amniotic membrane psc,Q4253,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,170,,,,,,,fee schedule,129.48,170, Zenith amniotic membrane psc,Q4253,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,129.48,170,APC Zenith amniotic membrane psc,Q4253,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,129.48,170,APC Zenith amniotic membrane psc,Q4253,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,129.48,170,APC Novafix dl per sq cm,Q4254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,762.55,,,,,,,fee schedule,147.01,915.14, Novafix dl per sq cm,Q4254,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,915.14,,,,,,,fee schedule,147.01,915.14, Novafix dl per sq cm,Q4254,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,915.14,APC Novafix dl per sq cm,Q4254,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,915.14,APC Novafix dl per sq cm,Q4254,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,915.14,APC "Mlg complet, per sq cm",Q4256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1265.85,,,,,,,fee schedule,147.01,1648.72, "Mlg complet, per sq cm",Q4256,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1265.85,,,,,,,fee schedule,147.01,1648.72, "Mlg complet, per sq cm",Q4256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1373.81,,,,,,,fee schedule,147.01,1648.72, "Mlg complet, per sq cm",Q4256,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1648.72,,,,,,,fee schedule,147.01,1648.72, "Mlg complet, per sq cm",Q4256,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1648.72,APC "Mlg complet, per sq cm",Q4256,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1648.72,APC "Mlg complet, per sq cm",Q4256,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1648.72,APC "Relese, per sq cm",Q4257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1015.94,,,,,,,fee schedule,147.01,2052.55, "Relese, per sq cm",Q4257,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1015.94,,,,,,,fee schedule,147.01,2052.55, "Relese, per sq cm",Q4257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1710.3,,,,,,,fee schedule,147.01,2052.55, "Relese, per sq cm",Q4257,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2052.55,,,,,,,fee schedule,147.01,2052.55, "Relese, per sq cm",Q4257,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2052.55,APC "Relese, per sq cm",Q4257,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2052.55,APC "Relese, per sq cm",Q4257,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2052.55,APC "Enverse, per sq cm",Q4258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,128.29,,,,,,,fee schedule,128.29,201.31, "Enverse, per sq cm",Q4258,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,128.29,,,,,,,fee schedule,128.29,201.31, "Enverse, per sq cm",Q4258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,167.74,,,,,,,fee schedule,128.29,201.31, "Enverse, per sq cm",Q4258,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,201.31,,,,,,,fee schedule,128.29,201.31, "Enverse, per sq cm",Q4258,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,128.29,201.31,APC "Enverse, per sq cm",Q4258,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,128.29,201.31,APC "Enverse, per sq cm",Q4258,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,128.29,201.31,APC Celera per sq cm,Q4259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1465.48,,,,,,,fee schedule,147.01,1600.38, Celera per sq cm,Q4259,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1465.48,,,,,,,fee schedule,147.01,1600.38, Celera per sq cm,Q4259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1333.53,,,,,,,fee schedule,147.01,1600.38, Celera per sq cm,Q4259,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1600.38,,,,,,,fee schedule,147.01,1600.38, Celera per sq cm,Q4259,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1600.38,APC Celera per sq cm,Q4259,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1600.38,APC Celera per sq cm,Q4259,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1600.38,APC "Tag, per square centimeter",Q4261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1149.92,,,,,,,fee schedule,147.01,1380.03, "Tag, per square centimeter",Q4261,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1380.03,,,,,,,fee schedule,147.01,1380.03, "Tag, per square centimeter",Q4261,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1380.03,APC "Tag, per square centimeter",Q4261,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1380.03,APC "Tag, per square centimeter",Q4261,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1380.03,APC "Dual layer impax, per sq cm",Q4262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,97.83,,,,,,,fee schedule,97.83,222.12, "Dual layer impax, per sq cm",Q4262,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,97.83,,,,,,,fee schedule,97.83,222.12, "Dual layer impax, per sq cm",Q4262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,185.09,,,,,,,fee schedule,97.83,222.12, "Dual layer impax, per sq cm",Q4262,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,222.12,,,,,,,fee schedule,97.83,222.12, "Dual layer impax, per sq cm",Q4262,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,97.83,222.12,APC "Dual layer impax, per sq cm",Q4262,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,97.83,222.12,APC "Dual layer impax, per sq cm",Q4262,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,97.83,222.12,APC "Surgraft tl, per sq cm",Q4263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2666.47,,,,,,,fee schedule,147.01,4072.79, "Surgraft tl, per sq cm",Q4263,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2666.47,,,,,,,fee schedule,147.01,4072.79, "Surgraft tl, per sq cm",Q4263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3393.69,,,,,,,fee schedule,147.01,4072.79, "Surgraft tl, per sq cm",Q4263,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4072.79,,,,,,,fee schedule,147.01,4072.79, "Surgraft tl, per sq cm",Q4263,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4072.79,APC "Surgraft tl, per sq cm",Q4263,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4072.79,APC "Surgraft tl, per sq cm",Q4263,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4072.79,APC "Cocoon membrane, per sq cm",Q4264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,580.44,,,,,,,fee schedule,147.01,836.39, "Cocoon membrane, per sq cm",Q4264,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,580.44,,,,,,,fee schedule,147.01,836.39, "Cocoon membrane, per sq cm",Q4264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,696.93,,,,,,,fee schedule,147.01,836.39, "Cocoon membrane, per sq cm",Q4264,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,836.39,,,,,,,fee schedule,147.01,836.39, "Cocoon membrane, per sq cm",Q4264,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,836.39,APC "Cocoon membrane, per sq cm",Q4264,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,836.39,APC "Cocoon membrane, per sq cm",Q4264,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,836.39,APC Neostim tl per sq cm,Q4265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2652.49,,,,,,,fee schedule,147.01,3109.81, Neostim tl per sq cm,Q4265,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2652.49,,,,,,,fee schedule,147.01,3109.81, Neostim tl per sq cm,Q4265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2591.28,,,,,,,fee schedule,147.01,3109.81, Neostim tl per sq cm,Q4265,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3109.81,,,,,,,fee schedule,147.01,3109.81, Neostim tl per sq cm,Q4265,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3109.81,APC Neostim tl per sq cm,Q4265,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3109.81,APC Neostim tl per sq cm,Q4265,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3109.81,APC Neostim per sq cm,Q4266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,872.59,,,,,,,fee schedule,147.01,1211.89, Neostim per sq cm,Q4266,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,872.59,,,,,,,fee schedule,147.01,1211.89, Neostim per sq cm,Q4266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1009.82,,,,,,,fee schedule,147.01,1211.89, Neostim per sq cm,Q4266,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1211.89,,,,,,,fee schedule,147.01,1211.89, Neostim per sq cm,Q4266,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1211.89,APC Neostim per sq cm,Q4266,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1211.89,APC Neostim per sq cm,Q4266,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1211.89,APC Neostim dl per sq cm,Q4267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,451.44,,,,,,,fee schedule,147.01,724.96, Neostim dl per sq cm,Q4267,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,451.44,,,,,,,fee schedule,147.01,724.96, Neostim dl per sq cm,Q4267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,604.08,,,,,,,fee schedule,147.01,724.96, Neostim dl per sq cm,Q4267,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,724.96,,,,,,,fee schedule,147.01,724.96, Neostim dl per sq cm,Q4267,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,724.96,APC Neostim dl per sq cm,Q4267,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,724.96,APC Neostim dl per sq cm,Q4267,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,724.96,APC Surgraft ft per sq cm,Q4268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,846.11,,,,,,,fee schedule,147.01,1015.43, Surgraft ft per sq cm,Q4268,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1015.43,,,,,,,fee schedule,147.01,1015.43, Surgraft ft per sq cm,Q4268,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1015.43,APC Surgraft ft per sq cm,Q4268,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1015.43,APC Surgraft ft per sq cm,Q4268,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1015.43,APC Surgraft xt per sq cm,Q4269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3373.47,,,,,,,fee schedule,147.01,4048.53, Surgraft xt per sq cm,Q4269,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4048.53,,,,,,,fee schedule,147.01,4048.53, Surgraft xt per sq cm,Q4269,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4048.53,APC Surgraft xt per sq cm,Q4269,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4048.53,APC Surgraft xt per sq cm,Q4269,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4048.53,APC Complete sl per sq cm,Q4270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5247,,,,,,,fee schedule,147.01,7446.42, Complete sl per sq cm,Q4270,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5247,,,,,,,fee schedule,147.01,7446.42, Complete sl per sq cm,Q4270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6204.8,,,,,,,fee schedule,147.01,7446.42, Complete sl per sq cm,Q4270,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7446.42,,,,,,,fee schedule,147.01,7446.42, Complete sl per sq cm,Q4270,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7446.42,APC Complete sl per sq cm,Q4270,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7446.42,APC Complete sl per sq cm,Q4270,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7446.42,APC Complete ft per sq cm,Q4271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1884.25,,,,,,,fee schedule,147.01,2560.03, Complete ft per sq cm,Q4271,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1884.25,,,,,,,fee schedule,147.01,2560.03, Complete ft per sq cm,Q4271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2133.16,,,,,,,fee schedule,147.01,2560.03, Complete ft per sq cm,Q4271,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2560.03,,,,,,,fee schedule,147.01,2560.03, Complete ft per sq cm,Q4271,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2560.03,APC Complete ft per sq cm,Q4271,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2560.03,APC Complete ft per sq cm,Q4271,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2560.03,APC "Esano a, per sq cm",Q4272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,556.03,,,,,,,fee schedule,147.01,667.29, "Esano a, per sq cm",Q4272,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,667.29,,,,,,,fee schedule,147.01,667.29, "Esano a, per sq cm",Q4272,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,667.29,APC "Esano a, per sq cm",Q4272,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,667.29,APC "Esano a, per sq cm",Q4272,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,667.29,APC "Esano ac, per sq cm",Q4274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2852.19,,,,,,,fee schedule,147.01,4220.2, "Esano ac, per sq cm",Q4274,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2852.19,,,,,,,fee schedule,147.01,4220.2, "Esano ac, per sq cm",Q4274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3516.52,,,,,,,fee schedule,147.01,4220.2, "Esano ac, per sq cm",Q4274,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4220.2,,,,,,,fee schedule,147.01,4220.2, "Esano ac, per sq cm",Q4274,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4220.2,APC "Esano ac, per sq cm",Q4274,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4220.2,APC "Esano ac, per sq cm",Q4274,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4220.2,APC "Esano aca, per sq cm",Q4275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4164.67,,,,,,,fee schedule,147.01,4164.67, "Esano aca, per sq cm",Q4275,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4164.67,,,,,,,fee schedule,147.01,4164.67, "Esano aca, per sq cm",Q4275,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4164.67,APC "Esano aca, per sq cm",Q4275,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4164.67,APC "Esano aca, per sq cm",Q4275,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4164.67,APC "Orion, per sq cm",Q4276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,406.68,,,,,,,fee schedule,147.01,609.6, "Orion, per sq cm",Q4276,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,406.68,,,,,,,fee schedule,147.01,609.6, "Orion, per sq cm",Q4276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,507.96,,,,,,,fee schedule,147.01,609.6, "Orion, per sq cm",Q4276,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,609.6,,,,,,,fee schedule,147.01,609.6, "Orion, per sq cm",Q4276,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,609.6,APC "Orion, per sq cm",Q4276,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,609.6,APC "Orion, per sq cm",Q4276,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,609.6,APC "Epieffect, per sq cm",Q4278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,412.68,,,,,,,fee schedule,147.01,472.26, "Epieffect, per sq cm",Q4278,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,412.68,,,,,,,fee schedule,147.01,472.26, "Epieffect, per sq cm",Q4278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,393.52,,,,,,,fee schedule,147.01,472.26, "Epieffect, per sq cm",Q4278,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,472.26,,,,,,,fee schedule,147.01,472.26, "Epieffect, per sq cm",Q4278,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,472.26,APC "Epieffect, per sq cm",Q4278,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,472.26,APC "Epieffect, per sq cm",Q4278,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,472.26,APC "Vendaje ac, per sq cm",Q4279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3712.5,,,,,,,fee schedule,147.01,4761.26, "Vendaje ac, per sq cm",Q4279,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3712.5,,,,,,,fee schedule,147.01,4761.26, "Vendaje ac, per sq cm",Q4279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3967.36,,,,,,,fee schedule,147.01,4761.26, "Vendaje ac, per sq cm",Q4279,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4761.26,,,,,,,fee schedule,147.01,4761.26, "Vendaje ac, per sq cm",Q4279,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4761.26,APC "Vendaje ac, per sq cm",Q4279,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4761.26,APC "Vendaje ac, per sq cm",Q4279,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4761.26,APC Xcell amnio matrix per sq cm,Q4280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4503.02,,,,,,,fee schedule,147.01,5284.17, Xcell amnio matrix per sq cm,Q4280,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4503.02,,,,,,,fee schedule,147.01,5284.17, Xcell amnio matrix per sq cm,Q4280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4403.08,,,,,,,fee schedule,147.01,5284.17, Xcell amnio matrix per sq cm,Q4280,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5284.17,,,,,,,fee schedule,147.01,5284.17, Xcell amnio matrix per sq cm,Q4280,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5284.17,APC Xcell amnio matrix per sq cm,Q4280,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5284.17,APC Xcell amnio matrix per sq cm,Q4280,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5284.17,APC Barrera slor dl per sq cm,Q4281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,846.86,,,,,,,fee schedule,147.01,922.23, Barrera slor dl per sq cm,Q4281,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,846.86,,,,,,,fee schedule,147.01,922.23, Barrera slor dl per sq cm,Q4281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,768.46,,,,,,,fee schedule,147.01,922.23, Barrera slor dl per sq cm,Q4281,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,922.23,,,,,,,fee schedule,147.01,922.23, Barrera slor dl per sq cm,Q4281,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,922.23,APC Barrera slor dl per sq cm,Q4281,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,922.23,APC Barrera slor dl per sq cm,Q4281,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,922.23,APC Cygnus dual per sq cm,Q4282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,524.21,,,,,,,fee schedule,147.01,755.02, Cygnus dual per sq cm,Q4282,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,524.21,,,,,,,fee schedule,147.01,755.02, Cygnus dual per sq cm,Q4282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,629.12,,,,,,,fee schedule,147.01,755.02, Cygnus dual per sq cm,Q4282,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,755.02,,,,,,,fee schedule,147.01,755.02, Cygnus dual per sq cm,Q4282,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,755.02,APC Cygnus dual per sq cm,Q4282,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,755.02,APC Cygnus dual per sq cm,Q4282,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,755.02,APC "Biovance tri or 3l, sq cm",Q4283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,711.86,,,,,,,fee schedule,147.01,1022.22, "Biovance tri or 3l, sq cm",Q4283,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,711.86,,,,,,,fee schedule,147.01,1022.22, "Biovance tri or 3l, sq cm",Q4283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,851.78,,,,,,,fee schedule,147.01,1022.22, "Biovance tri or 3l, sq cm",Q4283,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1022.22,,,,,,,fee schedule,147.01,1022.22, "Biovance tri or 3l, sq cm",Q4283,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1022.22,APC "Biovance tri or 3l, sq cm",Q4283,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1022.22,APC "Biovance tri or 3l, sq cm",Q4283,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1022.22,APC Nudyn dl or dl mesh pr sq cm,Q4285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,318.05,,,,,,,fee schedule,147.01,381.69, Nudyn dl or dl mesh pr sq cm,Q4285,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,381.69,,,,,,,fee schedule,147.01,381.69, Nudyn dl or dl mesh pr sq cm,Q4285,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,381.69,APC Nudyn dl or dl mesh pr sq cm,Q4285,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,381.69,APC Nudyn dl or dl mesh pr sq cm,Q4285,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,381.69,APC "Nudyn sl or slw, per sq cm",Q4286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,340.05,,,,,,,fee schedule,147.01,408.09, "Nudyn sl or slw, per sq cm",Q4286,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,408.09,,,,,,,fee schedule,147.01,408.09, "Nudyn sl or slw, per sq cm",Q4286,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,408.09,APC "Nudyn sl or slw, per sq cm",Q4286,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,408.09,APC "Nudyn sl or slw, per sq cm",Q4286,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,408.09,APC "Revoshield+ amnio, per sq cm",Q4289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2285.25,,,,,,,fee schedule,147.01,3416.18, "Revoshield+ amnio, per sq cm",Q4289,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2285.25,,,,,,,fee schedule,147.01,3416.18, "Revoshield+ amnio, per sq cm",Q4289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2846.56,,,,,,,fee schedule,147.01,3416.18, "Revoshield+ amnio, per sq cm",Q4289,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3416.18,,,,,,,fee schedule,147.01,3416.18, "Revoshield+ amnio, per sq cm",Q4289,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3416.18,APC "Revoshield+ amnio, per sq cm",Q4289,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3416.18,APC "Revoshield+ amnio, per sq cm",Q4289,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3416.18,APC Membrane wrap hydr per sq cm,Q4290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2902.61,,,,,,,fee schedule,147.01,4187.7, Membrane wrap hydr per sq cm,Q4290,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2902.61,,,,,,,fee schedule,147.01,4187.7, Membrane wrap hydr per sq cm,Q4290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3489.44,,,,,,,fee schedule,147.01,4187.7, Membrane wrap hydr per sq cm,Q4290,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4187.7,,,,,,,fee schedule,147.01,4187.7, Membrane wrap hydr per sq cm,Q4290,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4187.7,APC Membrane wrap hydr per sq cm,Q4290,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4187.7,APC Membrane wrap hydr per sq cm,Q4290,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4187.7,APC "Lamellas xt, per sq cm",Q4291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5547.57,,,,,,,fee schedule,147.01,6657.67, "Lamellas xt, per sq cm",Q4291,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6657.67,,,,,,,fee schedule,147.01,6657.67, "Lamellas xt, per sq cm",Q4291,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6657.67,APC "Lamellas xt, per sq cm",Q4291,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6657.67,APC "Lamellas xt, per sq cm",Q4291,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6657.67,APC "Lamellas, per sq cm",Q4292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2287.66,,,,,,,fee schedule,147.01,2745.43, "Lamellas, per sq cm",Q4292,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2745.43,,,,,,,fee schedule,147.01,2745.43, "Lamellas, per sq cm",Q4292,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2745.43,APC "Lamellas, per sq cm",Q4292,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2745.43,APC "Lamellas, per sq cm",Q4292,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2745.43,APC "Acesso dl, per sq cm",Q4293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2466.75,,,,,,,fee schedule,147.01,3554.48, "Acesso dl, per sq cm",Q4293,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2466.75,,,,,,,fee schedule,147.01,3554.48, "Acesso dl, per sq cm",Q4293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2961.8,,,,,,,fee schedule,147.01,3554.48, "Acesso dl, per sq cm",Q4293,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3554.48,,,,,,,fee schedule,147.01,3554.48, "Acesso dl, per sq cm",Q4293,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3554.48,APC "Acesso dl, per sq cm",Q4293,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3554.48,APC "Acesso dl, per sq cm",Q4293,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3554.48,APC "Amnio quad-core, per sq cm",Q4294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4537.5,,,,,,,fee schedule,147.01,7545.03, "Amnio quad-core, per sq cm",Q4294,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4537.5,,,,,,,fee schedule,147.01,7545.03, "Amnio quad-core, per sq cm",Q4294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6286.96,,,,,,,fee schedule,147.01,7545.03, "Amnio quad-core, per sq cm",Q4294,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7545.03,,,,,,,fee schedule,147.01,7545.03, "Amnio quad-core, per sq cm",Q4294,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7545.03,APC "Amnio quad-core, per sq cm",Q4294,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7545.03,APC "Amnio quad-core, per sq cm",Q4294,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7545.03,APC "Amnio tri-core, per sq cm",Q4295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3993,,,,,,,fee schedule,147.01,6516.92, "Amnio tri-core, per sq cm",Q4295,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3993,,,,,,,fee schedule,147.01,6516.92, "Amnio tri-core, per sq cm",Q4295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5430.29,,,,,,,fee schedule,147.01,6516.92, "Amnio tri-core, per sq cm",Q4295,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6516.92,,,,,,,fee schedule,147.01,6516.92, "Amnio tri-core, per sq cm",Q4295,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6516.92,APC "Amnio tri-core, per sq cm",Q4295,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6516.92,APC "Amnio tri-core, per sq cm",Q4295,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6516.92,APC "Rebound matrix, per sq cm",Q4296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2265.09,,,,,,,fee schedule,147.01,2265.09, "Rebound matrix, per sq cm",Q4296,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2265.09,,,,,,,fee schedule,147.01,2265.09, "Rebound matrix, per sq cm",Q4296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1567.1,,,,,,,fee schedule,147.01,2265.09, "Rebound matrix, per sq cm",Q4296,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1880.69,,,,,,,fee schedule,147.01,2265.09, "Rebound matrix, per sq cm",Q4296,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2265.09,APC "Rebound matrix, per sq cm",Q4296,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2265.09,APC "Rebound matrix, per sq cm",Q4296,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2265.09,APC "Emerge matrix, per sq cm",Q4297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2642.11,,,,,,,fee schedule,147.01,2921.06, "Emerge matrix, per sq cm",Q4297,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2642.11,,,,,,,fee schedule,147.01,2921.06, "Emerge matrix, per sq cm",Q4297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2434,,,,,,,fee schedule,147.01,2921.06, "Emerge matrix, per sq cm",Q4297,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2921.06,,,,,,,fee schedule,147.01,2921.06, "Emerge matrix, per sq cm",Q4297,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2921.06,APC "Emerge matrix, per sq cm",Q4297,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2921.06,APC "Emerge matrix, per sq cm",Q4297,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2921.06,APC "Amnicore pro, per sq cm",Q4298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3460.59,,,,,,,fee schedule,147.01,5908.4, "Amnicore pro, per sq cm",Q4298,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3460.59,,,,,,,fee schedule,147.01,5908.4, "Amnicore pro, per sq cm",Q4298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4923.23,,,,,,,fee schedule,147.01,5908.4, "Amnicore pro, per sq cm",Q4298,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5908.4,,,,,,,fee schedule,147.01,5908.4, "Amnicore pro, per sq cm",Q4298,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5908.4,APC "Amnicore pro, per sq cm",Q4298,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5908.4,APC "Amnicore pro, per sq cm",Q4298,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5908.4,APC "Amnicore pro+, per sq cm",Q4299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4446.75,,,,,,,fee schedule,147.01,7090.66, "Amnicore pro+, per sq cm",Q4299,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4446.75,,,,,,,fee schedule,147.01,7090.66, "Amnicore pro+, per sq cm",Q4299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5908.36,,,,,,,fee schedule,147.01,7090.66, "Amnicore pro+, per sq cm",Q4299,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7090.66,,,,,,,fee schedule,147.01,7090.66, "Amnicore pro+, per sq cm",Q4299,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7090.66,APC "Amnicore pro+, per sq cm",Q4299,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7090.66,APC "Amnicore pro+, per sq cm",Q4299,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7090.66,APC "Acesso tl, per sq cm",Q4300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3291.75,,,,,,,fee schedule,147.01,4761.31, "Acesso tl, per sq cm",Q4300,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3291.75,,,,,,,fee schedule,147.01,4761.31, "Acesso tl, per sq cm",Q4300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3967.4,,,,,,,fee schedule,147.01,4761.31, "Acesso tl, per sq cm",Q4300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4761.31,,,,,,,fee schedule,147.01,4761.31, "Acesso tl, per sq cm",Q4300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4761.31,APC "Acesso tl, per sq cm",Q4300,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4761.31,APC "Acesso tl, per sq cm",Q4300,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4761.31,APC "Activate matrix, per sq cm",Q4301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2811.75,,,,,,,fee schedule,147.01,4033.16, "Activate matrix, per sq cm",Q4301,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2811.75,,,,,,,fee schedule,147.01,4033.16, "Activate matrix, per sq cm",Q4301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3360.67,,,,,,,fee schedule,147.01,4033.16, "Activate matrix, per sq cm",Q4301,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4033.16,,,,,,,fee schedule,147.01,4033.16, "Activate matrix, per sq cm",Q4301,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4033.16,APC "Activate matrix, per sq cm",Q4301,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4033.16,APC "Activate matrix, per sq cm",Q4301,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4033.16,APC "Complete aca, per sq cm",Q4302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1979.39,,,,,,,fee schedule,147.01,2781.1, "Complete aca, per sq cm",Q4302,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1979.39,,,,,,,fee schedule,147.01,2781.1, "Complete aca, per sq cm",Q4302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2317.37,,,,,,,fee schedule,147.01,2781.1, "Complete aca, per sq cm",Q4302,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2781.1,,,,,,,fee schedule,147.01,2781.1, "Complete aca, per sq cm",Q4302,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2781.1,APC "Complete aca, per sq cm",Q4302,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2781.1,APC "Complete aca, per sq cm",Q4302,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2781.1,APC "Complete aa, per sq cm",Q4303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5242.64,,,,,,,fee schedule,147.01,7555.3, "Complete aa, per sq cm",Q4303,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5242.64,,,,,,,fee schedule,147.01,7555.3, "Complete aa, per sq cm",Q4303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6295.52,,,,,,,fee schedule,147.01,7555.3, "Complete aa, per sq cm",Q4303,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7555.3,,,,,,,fee schedule,147.01,7555.3, "Complete aa, per sq cm",Q4303,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7555.3,APC "Complete aa, per sq cm",Q4303,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7555.3,APC "Complete aa, per sq cm",Q4303,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7555.3,APC "Grafix plus, per sq cm",Q4304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,955.25,,,,,,,fee schedule,147.01,1003.65, "Grafix plus, per sq cm",Q4304,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,955.25,,,,,,,fee schedule,147.01,1003.65, "Grafix plus, per sq cm",Q4304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,836.3,,,,,,,fee schedule,147.01,1003.65, "Grafix plus, per sq cm",Q4304,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1003.65,,,,,,,fee schedule,147.01,1003.65, "Grafix plus, per sq cm",Q4304,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1003.65,APC "Grafix plus, per sq cm",Q4304,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1003.65,APC "Grafix plus, per sq cm",Q4304,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1003.65,APC "Via matrix, per sq cm",Q4309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2036.89,,,,,,,fee schedule,147.01,2036.89, "Via matrix, per sq cm",Q4309,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2036.89,,,,,,,fee schedule,147.01,2036.89, "Via matrix, per sq cm",Q4309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1644.78,,,,,,,fee schedule,147.01,2036.89, "Via matrix, per sq cm",Q4309,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1973.91,,,,,,,fee schedule,147.01,2036.89, "Via matrix, per sq cm",Q4309,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2036.89,APC "Via matrix, per sq cm",Q4309,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2036.89,APC "Via matrix, per sq cm",Q4309,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2036.89,APC "Procenta, per 100 mg",Q4310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2050.6,,,,,,,fee schedule,2050.6,3121.36, "Procenta, per 100 mg",Q4310,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2050.6,,,,,,,fee schedule,2050.6,3121.36, "Procenta, per 100 mg",Q4310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2600.9,,,,,,,fee schedule,2050.6,3121.36, "Procenta, per 100 mg",Q4310,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3121.36,,,,,,,fee schedule,2050.6,3121.36, "Acesso, per sq cm",Q4311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3971.63,,,,,,,fee schedule,147.01,4766.38, "Acesso, per sq cm",Q4311,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4766.38,,,,,,,fee schedule,147.01,4766.38, "Acesso, per sq cm",Q4311,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4766.38,APC "Acesso, per sq cm",Q4311,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4766.38,APC "Acesso, per sq cm",Q4311,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4766.38,APC "Acesso ac, per sq cm",Q4312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4507.58,,,,,,,fee schedule,147.01,5409.58, "Acesso ac, per sq cm",Q4312,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5409.58,,,,,,,fee schedule,147.01,5409.58, "Acesso ac, per sq cm",Q4312,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5409.58,APC "Acesso ac, per sq cm",Q4312,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5409.58,APC "Acesso ac, per sq cm",Q4312,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5409.58,APC "Dermabind fm, per sq cm",Q4313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5480.31,,,,,,,fee schedule,147.01,7429.98, "Dermabind fm, per sq cm",Q4313,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5480.31,,,,,,,fee schedule,147.01,7429.98, "Dermabind fm, per sq cm",Q4313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6191.1,,,,,,,fee schedule,147.01,7429.98, "Dermabind fm, per sq cm",Q4313,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7429.98,,,,,,,fee schedule,147.01,7429.98, "Dermabind fm, per sq cm",Q4313,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7429.98,APC "Dermabind fm, per sq cm",Q4313,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7429.98,APC "Dermabind fm, per sq cm",Q4313,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7429.98,APC "Reeva, per sq cm",Q4314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4358.51,,,,,,,fee schedule,147.01,5230.68, "Reeva, per sq cm",Q4314,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5230.68,,,,,,,fee schedule,147.01,5230.68, "Reeva, per sq cm",Q4314,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5230.68,APC "Reeva, per sq cm",Q4314,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5230.68,APC "Reeva, per sq cm",Q4314,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5230.68,APC "Amchoplast, per sq cm",Q4316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,6873.92,,,,,,,fee schedule,147.01,9483.34, "Amchoplast, per sq cm",Q4316,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,6873.92,,,,,,,fee schedule,147.01,9483.34, "Amchoplast, per sq cm",Q4316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7902.08,,,,,,,fee schedule,147.01,9483.34, "Amchoplast, per sq cm",Q4316,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9483.34,,,,,,,fee schedule,147.01,9483.34, "Amchoplast, per sq cm",Q4316,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,9483.34,APC "Amchoplast, per sq cm",Q4316,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,9483.34,APC "Amchoplast, per sq cm",Q4316,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,9483.34,APC "Vitograft, per sq cm",Q4317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8915.13,,,,,,,fee schedule,147.01,10699.11, "Vitograft, per sq cm",Q4317,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10699.11,,,,,,,fee schedule,147.01,10699.11, "Vitograft, per sq cm",Q4317,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,10699.11,APC "Vitograft, per sq cm",Q4317,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,10699.11,APC "Vitograft, per sq cm",Q4317,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,10699.11,APC "E-graft, per sq cm",Q4318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3169.36,,,,,,,fee schedule,147.01,3803.57, "E-graft, per sq cm",Q4318,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3803.57,,,,,,,fee schedule,147.01,3803.57, "E-graft, per sq cm",Q4318,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3803.57,APC "E-graft, per sq cm",Q4318,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3803.57,APC "E-graft, per sq cm",Q4318,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3803.57,APC "Sanograft, per sq cm",Q4319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5250.02,,,,,,,fee schedule,147.01,6300.59, "Sanograft, per sq cm",Q4319,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6300.59,,,,,,,fee schedule,147.01,6300.59, "Sanograft, per sq cm",Q4319,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6300.59,APC "Sanograft, per sq cm",Q4319,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6300.59,APC "Sanograft, per sq cm",Q4319,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6300.59,APC "Pellograft, per sq cm",Q4320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,192.56,,,,,,,fee schedule,147.01,231.1, "Pellograft, per sq cm",Q4320,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,231.1,,,,,,,fee schedule,147.01,231.1, "Pellograft, per sq cm",Q4320,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,231.1,APC "Pellograft, per sq cm",Q4320,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,231.1,APC "Pellograft, per sq cm",Q4320,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,231.1,APC "Renograft, per sq cm",Q4321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7132.1,,,,,,,fee schedule,147.01,8559.29, "Renograft, per sq cm",Q4321,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8559.29,,,,,,,fee schedule,147.01,8559.29, "Renograft, per sq cm",Q4321,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8559.29,APC "Renograft, per sq cm",Q4321,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8559.29,APC "Renograft, per sq cm",Q4321,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8559.29,APC "Caregraft, per sq cm",Q4322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2788.34,,,,,,,fee schedule,147.01,4094.87, "Caregraft, per sq cm",Q4322,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2788.34,,,,,,,fee schedule,147.01,4094.87, "Caregraft, per sq cm",Q4322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3412.08,,,,,,,fee schedule,147.01,4094.87, "Caregraft, per sq cm",Q4322,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4094.87,,,,,,,fee schedule,147.01,4094.87, "Caregraft, per sq cm",Q4322,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4094.87,APC "Caregraft, per sq cm",Q4322,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4094.87,APC "Caregraft, per sq cm",Q4322,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4094.87,APC "Alloply, per sq cm",Q4323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2450.94,,,,,,,fee schedule,147.01,3506.15, "Alloply, per sq cm",Q4323,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2450.94,,,,,,,fee schedule,147.01,3506.15, "Alloply, per sq cm",Q4323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2921.53,,,,,,,fee schedule,147.01,3506.15, "Alloply, per sq cm",Q4323,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3506.15,,,,,,,fee schedule,147.01,3506.15, "Alloply, per sq cm",Q4323,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3506.15,APC "Alloply, per sq cm",Q4323,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3506.15,APC "Alloply, per sq cm",Q4323,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3506.15,APC "Amniotx, per sq cm",Q4324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3145.53,,,,,,,fee schedule,147.01,3774.97, "Amniotx, per sq cm",Q4324,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3774.97,,,,,,,fee schedule,147.01,3774.97, "Amniotx, per sq cm",Q4324,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3774.97,APC "Amniotx, per sq cm",Q4324,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3774.97,APC "Amniotx, per sq cm",Q4324,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3774.97,APC "Acapatch, per sq cm",Q4325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3184.58,,,,,,,fee schedule,147.01,3830.62, "Acapatch, per sq cm",Q4325,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3184.58,,,,,,,fee schedule,147.01,3830.62, "Acapatch, per sq cm",Q4325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3191.9,,,,,,,fee schedule,147.01,3830.62, "Acapatch, per sq cm",Q4325,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3830.62,,,,,,,fee schedule,147.01,3830.62, "Acapatch, per sq cm",Q4325,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3830.62,APC "Acapatch, per sq cm",Q4325,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3830.62,APC "Acapatch, per sq cm",Q4325,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3830.62,APC "Woundplus, per sq cm",Q4326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1685.72,,,,,,,fee schedule,147.01,2383.68, "Woundplus, per sq cm",Q4326,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1685.72,,,,,,,fee schedule,147.01,2383.68, "Woundplus, per sq cm",Q4326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1986.22,,,,,,,fee schedule,147.01,2383.68, "Woundplus, per sq cm",Q4326,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2383.68,,,,,,,fee schedule,147.01,2383.68, "Woundplus, per sq cm",Q4326,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,2383.68,APC "Woundplus, per sq cm",Q4326,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,2383.68,APC "Woundplus, per sq cm",Q4326,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,2383.68,APC "Most, per sq cm",Q4328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,5717.88,,,,,,,fee schedule,147.01,7717.33, "Most, per sq cm",Q4328,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,5717.88,,,,,,,fee schedule,147.01,7717.33, "Most, per sq cm",Q4328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6430.54,,,,,,,fee schedule,147.01,7717.33, "Most, per sq cm",Q4328,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7717.33,,,,,,,fee schedule,147.01,7717.33, "Most, per sq cm",Q4328,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7717.33,APC "Most, per sq cm",Q4328,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7717.33,APC "Most, per sq cm",Q4328,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7717.33,APC "Axolotl graft, per sq cm",Q4331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2549.02,,,,,,,fee schedule,147.01,3565.72, "Axolotl graft, per sq cm",Q4331,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2549.02,,,,,,,fee schedule,147.01,3565.72, "Axolotl graft, per sq cm",Q4331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2971.17,,,,,,,fee schedule,147.01,3565.72, "Axolotl graft, per sq cm",Q4331,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3565.72,,,,,,,fee schedule,147.01,3565.72, "Axolotl graft, per sq cm",Q4331,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3565.72,APC "Axolotl graft, per sq cm",Q4331,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3565.72,APC "Axolotl graft, per sq cm",Q4331,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3565.72,APC "Axolotl dualgraft, per sq cm",Q4332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2620.5,,,,,,,fee schedule,147.01,3771.22, "Axolotl dualgraft, per sq cm",Q4332,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2620.5,,,,,,,fee schedule,147.01,3771.22, "Axolotl dualgraft, per sq cm",Q4332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3142.41,,,,,,,fee schedule,147.01,3771.22, "Axolotl dualgraft, per sq cm",Q4332,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3771.22,,,,,,,fee schedule,147.01,3771.22, "Axolotl dualgraft, per sq cm",Q4332,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3771.22,APC "Axolotl dualgraft, per sq cm",Q4332,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3771.22,APC "Axolotl dualgraft, per sq cm",Q4332,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3771.22,APC "Ardeograft, per sq cm",Q4333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1429.79,,,,,,,fee schedule,147.01,1715.9, "Ardeograft, per sq cm",Q4333,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1715.9,,,,,,,fee schedule,147.01,1715.9, "Ardeograft, per sq cm",Q4333,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1715.9,APC "Ardeograft, per sq cm",Q4333,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1715.9,APC "Ardeograft, per sq cm",Q4333,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1715.9,APC "Artacent vericlen, per sq cm",Q4339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3199.35,,,,,,,fee schedule,147.01,4610.13, "Artacent vericlen, per sq cm",Q4339,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3199.35,,,,,,,fee schedule,147.01,4610.13, "Artacent vericlen, per sq cm",Q4339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3841.43,,,,,,,fee schedule,147.01,4610.13, "Artacent vericlen, per sq cm",Q4339,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4610.13,,,,,,,fee schedule,147.01,4610.13, "Artacent vericlen, per sq cm",Q4339,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4610.13,APC "Artacent vericlen, per sq cm",Q4339,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4610.13,APC "Artacent vericlen, per sq cm",Q4339,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4610.13,APC "Simpligraft, per sq cm",Q4340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2575.28,,,,,,,fee schedule,147.01,3090.61, "Simpligraft, per sq cm",Q4340,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3090.61,,,,,,,fee schedule,147.01,3090.61, "Simpligraft, per sq cm",Q4340,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,3090.61,APC "Simpligraft, per sq cm",Q4340,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,3090.61,APC "Simpligraft, per sq cm",Q4340,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,3090.61,APC "Simplimax, per sq cm",Q4341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4780.76,,,,,,,fee schedule,147.01,7904.58, "Simplimax, per sq cm",Q4341,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4780.76,,,,,,,fee schedule,147.01,7904.58, "Simplimax, per sq cm",Q4341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6586.56,,,,,,,fee schedule,147.01,7904.58, "Simplimax, per sq cm",Q4341,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7904.58,,,,,,,fee schedule,147.01,7904.58, "Simplimax, per sq cm",Q4341,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7904.58,APC "Simplimax, per sq cm",Q4341,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7904.58,APC "Simplimax, per sq cm",Q4341,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7904.58,APC "Theramend, per sq cm",Q4342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3311.07,,,,,,,fee schedule,147.01,5094.28, "Theramend, per sq cm",Q4342,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3311.07,,,,,,,fee schedule,147.01,5094.28, "Theramend, per sq cm",Q4342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4244.85,,,,,,,fee schedule,147.01,5094.28, "Theramend, per sq cm",Q4342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5094.28,,,,,,,fee schedule,147.01,5094.28, "Theramend, per sq cm",Q4342,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5094.28,APC "Theramend, per sq cm",Q4342,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5094.28,APC "Theramend, per sq cm",Q4342,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5094.28,APC Dermacyte ac matrx per sq cm,Q4343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4595.25,,,,,,,fee schedule,147.01,6621.56, Dermacyte ac matrx per sq cm,Q4343,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4595.25,,,,,,,fee schedule,147.01,6621.56, Dermacyte ac matrx per sq cm,Q4343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5517.47,,,,,,,fee schedule,147.01,6621.56, Dermacyte ac matrx per sq cm,Q4343,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6621.56,,,,,,,fee schedule,147.01,6621.56, Dermacyte ac matrx per sq cm,Q4343,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6621.56,APC Dermacyte ac matrx per sq cm,Q4343,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6621.56,APC Dermacyte ac matrx per sq cm,Q4343,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6621.56,APC "Tri membrane wrap, per sq cm",Q4344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,4186.45,,,,,,,fee schedule,147.01,8017.36, "Tri membrane wrap, per sq cm",Q4344,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,4186.45,,,,,,,fee schedule,147.01,8017.36, "Tri membrane wrap, per sq cm",Q4344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6680.53,,,,,,,fee schedule,147.01,8017.36, "Tri membrane wrap, per sq cm",Q4344,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8017.36,,,,,,,fee schedule,147.01,8017.36, "Tri membrane wrap, per sq cm",Q4344,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8017.36,APC "Tri membrane wrap, per sq cm",Q4344,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8017.36,APC "Tri membrane wrap, per sq cm",Q4344,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8017.36,APC Matrix hd allogrft per sq cm,Q4345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4952.85,,,,,,,fee schedule,147.01,5943.95, Matrix hd allogrft per sq cm,Q4345,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5943.95,,,,,,,fee schedule,147.01,5943.95, Matrix hd allogrft per sq cm,Q4345,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5943.95,APC Matrix hd allogrft per sq cm,Q4345,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5943.95,APC Matrix hd allogrft per sq cm,Q4345,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5943.95,APC Shelter dm matrix per sq cm,Q4346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6847.62,,,,,,,fee schedule,147.01,8217.88, Shelter dm matrix per sq cm,Q4346,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8217.88,,,,,,,fee schedule,147.01,8217.88, Shelter dm matrix per sq cm,Q4346,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8217.88,APC Shelter dm matrix per sq cm,Q4346,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8217.88,APC Shelter dm matrix per sq cm,Q4346,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8217.88,APC Rampart dl matrix per sq cm,Q4347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5792.83,,,,,,,fee schedule,147.01,6952.02, Rampart dl matrix per sq cm,Q4347,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6952.02,,,,,,,fee schedule,147.01,6952.02, Rampart dl matrix per sq cm,Q4347,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6952.02,APC Rampart dl matrix per sq cm,Q4347,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6952.02,APC Rampart dl matrix per sq cm,Q4347,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6952.02,APC Sentry sl matrix per sq cm,Q4348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3803.19,,,,,,,fee schedule,147.01,4564.24, Sentry sl matrix per sq cm,Q4348,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4564.24,,,,,,,fee schedule,147.01,4564.24, Sentry sl matrix per sq cm,Q4348,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4564.24,APC Sentry sl matrix per sq cm,Q4348,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4564.24,APC Sentry sl matrix per sq cm,Q4348,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4564.24,APC Mantle dl matrix per sq cm,Q4349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6672.33,,,,,,,fee schedule,147.01,8007.51, Mantle dl matrix per sq cm,Q4349,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8007.51,,,,,,,fee schedule,147.01,8007.51, Mantle dl matrix per sq cm,Q4349,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8007.51,APC Mantle dl matrix per sq cm,Q4349,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8007.51,APC Mantle dl matrix per sq cm,Q4349,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8007.51,APC Palisade dm matrix per sq cm,Q4350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6743.52,,,,,,,fee schedule,147.01,8092.95, Palisade dm matrix per sq cm,Q4350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8092.95,,,,,,,fee schedule,147.01,8092.95, Palisade dm matrix per sq cm,Q4350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8092.95,APC Palisade dm matrix per sq cm,Q4350,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8092.95,APC Palisade dm matrix per sq cm,Q4350,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8092.95,APC "Enclose tl matrix, per sq cm",Q4351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7148.93,,,,,,,fee schedule,147.01,8579.48, "Enclose tl matrix, per sq cm",Q4351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8579.48,,,,,,,fee schedule,147.01,8579.48, "Enclose tl matrix, per sq cm",Q4351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8579.48,APC "Enclose tl matrix, per sq cm",Q4351,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8579.48,APC "Enclose tl matrix, per sq cm",Q4351,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8579.48,APC "Overlay sl matrix, per sq cm",Q4352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3717.44,,,,,,,fee schedule,147.01,4461.33, "Overlay sl matrix, per sq cm",Q4352,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4461.33,,,,,,,fee schedule,147.01,4461.33, "Overlay sl matrix, per sq cm",Q4352,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4461.33,APC "Overlay sl matrix, per sq cm",Q4352,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4461.33,APC "Overlay sl matrix, per sq cm",Q4352,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4461.33,APC Xceed tl matrix per sq cm,Q4353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7754.18,,,,,,,fee schedule,147.01,9305.85, Xceed tl matrix per sq cm,Q4353,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9305.85,,,,,,,fee schedule,147.01,9305.85, Xceed tl matrix per sq cm,Q4353,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,9305.85,APC Xceed tl matrix per sq cm,Q4353,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,9305.85,APC Xceed tl matrix per sq cm,Q4353,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,9305.85,APC Palingen dual-layer sq cm,Q4354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7919.42,,,,,,,fee schedule,147.01,9504.15, Palingen dual-layer sq cm,Q4354,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9504.15,,,,,,,fee schedule,147.01,9504.15, Palingen dual-layer sq cm,Q4354,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,9504.15,APC Palingen dual-layer sq cm,Q4354,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,9504.15,APC Palingen dual-layer sq cm,Q4354,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,9504.15,APC Abio xpl abio xpl hy p sq cm,Q4355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5299.96,,,,,,,fee schedule,147.01,6360.52, Abio xpl abio xpl hy p sq cm,Q4355,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6360.52,,,,,,,fee schedule,147.01,6360.52, Abio xpl abio xpl hy p sq cm,Q4355,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6360.52,APC Abio xpl abio xpl hy p sq cm,Q4355,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6360.52,APC Abio xpl abio xpl hy p sq cm,Q4355,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6360.52,APC Abio mem abio hyd per sq cm,Q4356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4765.95,,,,,,,fee schedule,147.01,5719.65, Abio mem abio hyd per sq cm,Q4356,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5719.65,,,,,,,fee schedule,147.01,5719.65, Abio mem abio hyd per sq cm,Q4356,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5719.65,APC Abio mem abio hyd per sq cm,Q4356,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5719.65,APC Abio mem abio hyd per sq cm,Q4356,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5719.65,APC "Xwrap plus, per sq cm",Q4357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7425,,,,,,,fee schedule,147.01,10699.11, "Xwrap plus, per sq cm",Q4357,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7425,,,,,,,fee schedule,147.01,10699.11, "Xwrap plus, per sq cm",Q4357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8915.13,,,,,,,fee schedule,147.01,10699.11, "Xwrap plus, per sq cm",Q4357,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10699.11,,,,,,,fee schedule,147.01,10699.11, "Xwrap plus, per sq cm",Q4357,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,10699.11,APC "Xwrap plus, per sq cm",Q4357,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,10699.11,APC "Xwrap plus, per sq cm",Q4357,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,10699.11,APC "Xwrap dual, per sq cm",Q4358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,11014.65,,,,,,,fee schedule,147.01,13218.76, "Xwrap dual, per sq cm",Q4358,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,13218.76,,,,,,,fee schedule,147.01,13218.76, "Xwrap dual, per sq cm",Q4358,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,13218.76,APC "Xwrap dual, per sq cm",Q4358,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,13218.76,APC "Xwrap dual, per sq cm",Q4358,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,13218.76,APC "Choriply, per sq cm",Q4359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5194.55,,,,,,,fee schedule,147.01,6234.01, "Choriply, per sq cm",Q4359,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6234.01,,,,,,,fee schedule,147.01,6234.01, "Choriply, per sq cm",Q4359,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6234.01,APC "Choriply, per sq cm",Q4359,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6234.01,APC "Choriply, per sq cm",Q4359,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6234.01,APC Amchoplast fd per sq cm,Q4360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4440.28,,,,,,,fee schedule,147.01,5328.81, Amchoplast fd per sq cm,Q4360,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5328.81,,,,,,,fee schedule,147.01,5328.81, Amchoplast fd per sq cm,Q4360,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,5328.81,APC Amchoplast fd per sq cm,Q4360,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,5328.81,APC Amchoplast fd per sq cm,Q4360,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,5328.81,APC "Epixpress, per sq cm",Q4361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2475,,,,,,,fee schedule,147.01,4755.16, "Epixpress, per sq cm",Q4361,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2475,,,,,,,fee schedule,147.01,4755.16, "Epixpress, per sq cm",Q4361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3962.28,,,,,,,fee schedule,147.01,4755.16, "Epixpress, per sq cm",Q4361,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4755.16,,,,,,,fee schedule,147.01,4755.16, "Epixpress, per sq cm",Q4361,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4755.16,APC "Epixpress, per sq cm",Q4361,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4755.16,APC "Epixpress, per sq cm",Q4361,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4755.16,APC Am bur xp mem xpl hy p sq cm,Q4364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5886.9,,,,,,,fee schedule,147.01,7064.91, Am bur xp mem xpl hy p sq cm,Q4364,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7064.91,,,,,,,fee schedule,147.01,7064.91, Am bur xp mem xpl hy p sq cm,Q4364,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,7064.91,APC Am bur xp mem xpl hy p sq cm,Q4364,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,7064.91,APC Am bur xp mem xpl hy p sq cm,Q4364,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,7064.91,APC "Amniocore sl, per sq cm",Q4367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,825,,,,,,,fee schedule,147.01,1687.61, "Amniocore sl, per sq cm",Q4367,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,825,,,,,,,fee schedule,147.01,1687.61, "Amniocore sl, per sq cm",Q4367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1406.22,,,,,,,fee schedule,147.01,1687.61, "Amniocore sl, per sq cm",Q4367,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1687.61,,,,,,,fee schedule,147.01,1687.61, "Amniocore sl, per sq cm",Q4367,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,1687.61,APC "Amniocore sl, per sq cm",Q4367,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,1687.61,APC "Amniocore sl, per sq cm",Q4367,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,1687.61,APC Amchothick per sq cm,Q4368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7403.11,,,,,,,fee schedule,147.01,8884.52, Amchothick per sq cm,Q4368,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8884.52,,,,,,,fee schedule,147.01,8884.52, Amchothick per sq cm,Q4368,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8884.52,APC Amchothick per sq cm,Q4368,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8884.52,APC Amchothick per sq cm,Q4368,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8884.52,APC Membrane wrp lt per sq cm,Q4373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6847.72,,,,,,,fee schedule,147.01,8217.99, Membrane wrp lt per sq cm,Q4373,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8217.99,,,,,,,fee schedule,147.01,8217.99, Membrane wrp lt per sq cm,Q4373,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8217.99,APC Membrane wrp lt per sq cm,Q4373,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8217.99,APC Membrane wrp lt per sq cm,Q4373,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8217.99,APC Renew ft matrix per sq cm,Q4378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7339.56,,,,,,,fee schedule,147.01,8808.26, Renew ft matrix per sq cm,Q4378,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,8808.26,,,,,,,fee schedule,147.01,8808.26, Renew ft matrix per sq cm,Q4378,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,8808.26,APC Renew ft matrix per sq cm,Q4378,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,8808.26,APC Renew ft matrix per sq cm,Q4378,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,8808.26,APC Amniodefend ft per sq cm,Q4379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5433.18,,,,,,,fee schedule,147.01,6520.4, Amniodefend ft per sq cm,Q4379,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6520.4,,,,,,,fee schedule,147.01,6520.4, Amniodefend ft per sq cm,Q4379,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6520.4,APC Amniodefend ft per sq cm,Q4379,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6520.4,APC Amniodefend ft per sq cm,Q4379,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6520.4,APC Neothelium ft per sq cm,Q4387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3757.47,,,,,,,fee schedule,147.01,4509.37, Neothelium ft per sq cm,Q4387,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4509.37,,,,,,,fee schedule,147.01,4509.37, Neothelium ft per sq cm,Q4387,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,4509.37,APC Neothelium ft per sq cm,Q4387,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,4509.37,APC Neothelium ft per sq cm,Q4387,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,4509.37,APC Natalin per sq cm,Q4396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5337.86,,,,,,,fee schedule,147.01,6406.01, Natalin per sq cm,Q4396,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6406.01,,,,,,,fee schedule,147.01,6406.01, Natalin per sq cm,Q4396,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,152.89,,,,,,,fee schedule,147.01,6406.01,APC Natalin per sq cm,Q4396,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,154.36,,,,,,,fee schedule,147.01,6406.01,APC Natalin per sq cm,Q4396,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,147.01,,,,,,,fee schedule,147.01,6406.01,APC "Inj ustekinumab-srlf, 1 mg",Q5098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.13,,,,,,,fee schedule,16.13,19.36, "Inj ustekinumab-srlf, 1 mg",Q5098,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,19.36,,,,,,,fee schedule,16.13,19.36, "Inj ustekinumab-stba, 1 mg",Q5099,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,23.62,,,,,,,fee schedule,3.2,28.35, "Inj ustekinumab-stba, 1 mg",Q5099,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,28.35,,,,,,,fee schedule,3.2,28.35, "Inj ustekinumab-stba, 1 mg",Q5099,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.33,,,,,,,fee schedule,3.2,28.35,APC "Inj ustekinumab-stba, 1 mg",Q5099,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.37,,,,,,,fee schedule,3.2,28.35,APC "Inj ustekinumab-stba, 1 mg",Q5099,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.2,,,,,,,fee schedule,3.2,28.35,APC "Inj ustekinumab-kfce, 1 mg",Q5100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,46.69,,,,,,,fee schedule,3.35,56.03, "Inj ustekinumab-kfce, 1 mg",Q5100,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,56.03,,,,,,,fee schedule,3.35,56.03, "Inj ustekinumab-kfce, 1 mg",Q5100,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,3.49,,,,,,,fee schedule,3.35,56.03,APC "Inj ustekinumab-kfce, 1 mg",Q5100,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,3.52,,,,,,,fee schedule,3.35,56.03,APC "Inj ustekinumab-kfce, 1 mg",Q5100,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,3.35,,,,,,,fee schedule,3.35,56.03,APC Inj filgrastim gcsf biosimil,Q5101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.58,,,,,,,fee schedule,0.35,1.03, Inj filgrastim gcsf biosimil,Q5101,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.58,,,,,,,fee schedule,0.35,1.03, Inj filgrastim gcsf biosimil,Q5101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.86,,,,,,,fee schedule,0.35,1.03, Inj filgrastim gcsf biosimil,Q5101,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.03,,,,,,,fee schedule,0.35,1.03, Inj filgrastim gcsf biosimil,Q5101,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.37,,,,,,,fee schedule,0.35,1.03,APC Inj filgrastim gcsf biosimil,Q5101,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.37,,,,,,,fee schedule,0.35,1.03,APC Inj filgrastim gcsf biosimil,Q5101,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.35,,,,,,,fee schedule,0.35,1.03,APC "Injection, inflectra",Q5103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,30.64,,,,,,,fee schedule,26.04,44.84, "Injection, inflectra",Q5103,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,30.64,,,,,,,fee schedule,26.04,44.84, "Injection, inflectra",Q5103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,37.36,,,,,,,fee schedule,26.04,44.84, "Injection, inflectra",Q5103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,44.84,,,,,,,fee schedule,26.04,44.84, "Injection, inflectra",Q5103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.08,,,,,,,fee schedule,26.04,44.84,APC "Injection, inflectra",Q5103,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.34,,,,,,,fee schedule,26.04,44.84,APC "Injection, inflectra",Q5103,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.04,,,,,,,fee schedule,26.04,44.84,APC "Injection, renflexis",Q5104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,38.99,,,,,,,fee schedule,26.8,60.56, "Injection, renflexis",Q5104,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,38.99,,,,,,,fee schedule,26.8,60.56, "Injection, renflexis",Q5104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.46,,,,,,,fee schedule,26.8,60.56, "Injection, renflexis",Q5104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,60.56,,,,,,,fee schedule,26.8,60.56, "Injection, renflexis",Q5104,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.88,,,,,,,fee schedule,26.8,60.56,APC "Injection, renflexis",Q5104,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28.14,,,,,,,fee schedule,26.8,60.56,APC "Injection, renflexis",Q5104,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.8,,,,,,,fee schedule,26.8,60.56,APC Inj Retacrit esrd on dialysi,Q5105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1.17,,,,,,,fee schedule,1.17,1.77, Inj Retacrit esrd on dialysi,Q5105,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1.17,,,,,,,fee schedule,1.17,1.77, Inj Retacrit esrd on dialysi,Q5105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.48,,,,,,,fee schedule,1.17,1.77, Inj Retacrit esrd on dialysi,Q5105,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.77,,,,,,,fee schedule,1.17,1.77, Inj Retacrit non-esrd use,Q5106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,11.78,,,,,,,fee schedule,7.88,17.61, Inj Retacrit non-esrd use,Q5106,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,11.78,,,,,,,fee schedule,7.88,17.61, Inj Retacrit non-esrd use,Q5106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.67,,,,,,,fee schedule,7.88,17.61, Inj Retacrit non-esrd use,Q5106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.61,,,,,,,fee schedule,7.88,17.61, Inj Retacrit non-esrd use,Q5106,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,8.2,,,,,,,fee schedule,7.88,17.61,APC Inj Retacrit non-esrd use,Q5106,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8.28,,,,,,,fee schedule,7.88,17.61,APC Inj Retacrit non-esrd use,Q5106,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,7.88,,,,,,,fee schedule,7.88,17.61,APC Inj mvasi 10 mg,Q5107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.91,,,,,,,fee schedule,23.74,62.49, Inj mvasi 10 mg,Q5107,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.91,,,,,,,fee schedule,23.74,62.49, Inj mvasi 10 mg,Q5107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.07,,,,,,,fee schedule,23.74,62.49, Inj mvasi 10 mg,Q5107,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,62.49,,,,,,,fee schedule,23.74,62.49, Inj mvasi 10 mg,Q5107,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,24.68,,,,,,,fee schedule,23.74,62.49,APC Inj mvasi 10 mg,Q5107,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24.92,,,,,,,fee schedule,23.74,62.49,APC Inj mvasi 10 mg,Q5107,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,23.74,,,,,,,fee schedule,23.74,62.49,APC "Injection, fulphila",Q5108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,161.42,,,,,,,fee schedule,79.5,222.35, "Injection, fulphila",Q5108,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,161.42,,,,,,,fee schedule,79.5,222.35, "Injection, fulphila",Q5108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,185.27,,,,,,,fee schedule,79.5,222.35, "Injection, fulphila",Q5108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,222.35,,,,,,,fee schedule,79.5,222.35, "Injection, fulphila",Q5108,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,82.68,,,,,,,fee schedule,79.5,222.35,APC "Injection, fulphila",Q5108,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,83.47,,,,,,,fee schedule,79.5,222.35,APC "Injection, fulphila",Q5108,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,79.5,,,,,,,fee schedule,79.5,222.35,APC Nivestym,Q5110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.45,,,,,,,fee schedule,0.28,0.67, Nivestym,Q5110,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.45,,,,,,,fee schedule,0.28,0.67, Nivestym,Q5110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.56,,,,,,,fee schedule,0.28,0.67, Nivestym,Q5110,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.67,,,,,,,fee schedule,0.28,0.67, Nivestym,Q5110,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.3,,,,,,,fee schedule,0.28,0.67,APC Nivestym,Q5110,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.3,,,,,,,fee schedule,0.28,0.67,APC Nivestym,Q5110,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.28,,,,,,,fee schedule,0.28,0.67,APC "Injection, udenyca 0.5 mg",Q5111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,211.76,,,,,,,fee schedule,135.89,238.5, "Injection, udenyca 0.5 mg",Q5111,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,211.76,,,,,,,fee schedule,135.89,238.5, "Injection, udenyca 0.5 mg",Q5111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,198.73,,,,,,,fee schedule,135.89,238.5, "Injection, udenyca 0.5 mg",Q5111,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,238.5,,,,,,,fee schedule,135.89,238.5, "Injection, udenyca 0.5 mg",Q5111,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,141.32,,,,,,,fee schedule,135.89,238.5,APC "Injection, udenyca 0.5 mg",Q5111,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,142.68,,,,,,,fee schedule,135.89,238.5,APC "Injection, udenyca 0.5 mg",Q5111,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,135.89,,,,,,,fee schedule,135.89,238.5,APC Inj ontruzant 10 mg,Q5112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,34.22,,,,,,,fee schedule,29.81,42.62, Inj ontruzant 10 mg,Q5112,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,34.22,,,,,,,fee schedule,29.81,42.62, Inj ontruzant 10 mg,Q5112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,35.51,,,,,,,fee schedule,29.81,42.62, Inj ontruzant 10 mg,Q5112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,42.62,,,,,,,fee schedule,29.81,42.62, Inj ontruzant 10 mg,Q5112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,31,,,,,,,fee schedule,29.81,42.62,APC Inj ontruzant 10 mg,Q5112,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.3,,,,,,,fee schedule,29.81,42.62,APC Inj ontruzant 10 mg,Q5112,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.81,,,,,,,fee schedule,29.81,42.62,APC Inj herzuma 10 mg,Q5113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,120.63,,,,,,,fee schedule,56.02,155.6, Inj herzuma 10 mg,Q5113,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,120.63,,,,,,,fee schedule,56.02,155.6, Inj herzuma 10 mg,Q5113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,129.65,,,,,,,fee schedule,56.02,155.6, Inj herzuma 10 mg,Q5113,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,155.6,,,,,,,fee schedule,56.02,155.6, Inj herzuma 10 mg,Q5113,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.26,,,,,,,fee schedule,56.02,155.6,APC Inj herzuma 10 mg,Q5113,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58.82,,,,,,,fee schedule,56.02,155.6,APC Inj herzuma 10 mg,Q5113,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.02,,,,,,,fee schedule,56.02,155.6,APC Inj ogivri 10 mg,Q5114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,69.42,,,,,,,fee schedule,35.78,90.37, Inj ogivri 10 mg,Q5114,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,69.42,,,,,,,fee schedule,35.78,90.37, Inj ogivri 10 mg,Q5114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75.3,,,,,,,fee schedule,35.78,90.37, Inj ogivri 10 mg,Q5114,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.37,,,,,,,fee schedule,35.78,90.37, Inj ogivri 10 mg,Q5114,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.21,,,,,,,fee schedule,35.78,90.37,APC Inj ogivri 10 mg,Q5114,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.57,,,,,,,fee schedule,35.78,90.37,APC Inj ogivri 10 mg,Q5114,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.78,,,,,,,fee schedule,35.78,90.37,APC Inj truxima 10 mg,Q5115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,48.54,,,,,,,fee schedule,31.28,65.9, Inj truxima 10 mg,Q5115,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,48.54,,,,,,,fee schedule,31.28,65.9, Inj truxima 10 mg,Q5115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.91,,,,,,,fee schedule,31.28,65.9, Inj truxima 10 mg,Q5115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.9,,,,,,,fee schedule,31.28,65.9, Inj truxima 10 mg,Q5115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,32.53,,,,,,,fee schedule,31.28,65.9,APC Inj truxima 10 mg,Q5115,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32.84,,,,,,,fee schedule,31.28,65.9,APC Inj truxima 10 mg,Q5115,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.28,,,,,,,fee schedule,31.28,65.9,APC "Inj., trazimera, 10 mg",Q5116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,44.55,,,,,,,fee schedule,10.42,62.78, "Inj., trazimera, 10 mg",Q5116,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,44.55,,,,,,,fee schedule,10.42,62.78, "Inj., trazimera, 10 mg",Q5116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.31,,,,,,,fee schedule,10.42,62.78, "Inj., trazimera, 10 mg",Q5116,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,62.78,,,,,,,fee schedule,10.42,62.78, "Inj., trazimera, 10 mg",Q5116,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.84,,,,,,,fee schedule,10.42,62.78,APC "Inj., trazimera, 10 mg",Q5116,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.95,,,,,,,fee schedule,10.42,62.78,APC "Inj., trazimera, 10 mg",Q5116,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.42,,,,,,,fee schedule,10.42,62.78,APC "Inj., kanjinti, 10 mg",Q5117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.37,,,,,,,fee schedule,56.38,106.65, "Inj., kanjinti, 10 mg",Q5117,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.37,,,,,,,fee schedule,56.38,106.65, "Inj., kanjinti, 10 mg",Q5117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,88.87,,,,,,,fee schedule,56.38,106.65, "Inj., kanjinti, 10 mg",Q5117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,106.65,,,,,,,fee schedule,56.38,106.65, "Inj., kanjinti, 10 mg",Q5117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,58.63,,,,,,,fee schedule,56.38,106.65,APC "Inj., kanjinti, 10 mg",Q5117,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59.2,,,,,,,fee schedule,56.38,106.65,APC "Inj., kanjinti, 10 mg",Q5117,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,56.38,,,,,,,fee schedule,56.38,106.65,APC "Inj., zirabev, 10 mg",Q5118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,37.26,,,,,,,fee schedule,25.85,57.8, "Inj., zirabev, 10 mg",Q5118,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,37.26,,,,,,,fee schedule,25.85,57.8, "Inj., zirabev, 10 mg",Q5118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,48.16,,,,,,,fee schedule,25.85,57.8, "Inj., zirabev, 10 mg",Q5118,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,57.8,,,,,,,fee schedule,25.85,57.8, "Inj., zirabev, 10 mg",Q5118,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,26.89,,,,,,,fee schedule,25.85,57.8,APC "Inj., zirabev, 10 mg",Q5118,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.15,,,,,,,fee schedule,25.85,57.8,APC "Inj., zirabev, 10 mg",Q5118,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,25.85,,,,,,,fee schedule,25.85,57.8,APC "Inj ruxience, 10 mg",Q5119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,41.25,,,,,,,fee schedule,13.69,62.47, "Inj ruxience, 10 mg",Q5119,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,41.25,,,,,,,fee schedule,13.69,62.47, "Inj ruxience, 10 mg",Q5119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,52.05,,,,,,,fee schedule,13.69,62.47, "Inj ruxience, 10 mg",Q5119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,62.47,,,,,,,fee schedule,13.69,62.47, "Inj ruxience, 10 mg",Q5119,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.23,,,,,,,fee schedule,13.69,62.47,APC "Inj ruxience, 10 mg",Q5119,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.37,,,,,,,fee schedule,13.69,62.47,APC "Inj ruxience, 10 mg",Q5119,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,13.69,,,,,,,fee schedule,13.69,62.47,APC Inj pegfilgrastim-bmez 0.5mg,Q5120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,43.56,,,,,,,fee schedule,43.56,125.62, Inj pegfilgrastim-bmez 0.5mg,Q5120,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,43.56,,,,,,,fee schedule,43.56,125.62, Inj pegfilgrastim-bmez 0.5mg,Q5120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.67,,,,,,,fee schedule,43.56,125.62, Inj pegfilgrastim-bmez 0.5mg,Q5120,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,68.01,,,,,,,fee schedule,43.56,125.62, Inj pegfilgrastim-bmez 0.5mg,Q5120,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,124.42,,,,,,,fee schedule,43.56,125.62,APC Inj pegfilgrastim-bmez 0.5mg,Q5120,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,125.62,,,,,,,fee schedule,43.56,125.62,APC Inj pegfilgrastim-bmez 0.5mg,Q5120,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,119.64,,,,,,,fee schedule,43.56,125.62,APC "Inj. avsola, 10 mg",Q5121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,32.51,,,,,,,fee schedule,28.04,45.78, "Inj. avsola, 10 mg",Q5121,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,32.51,,,,,,,fee schedule,28.04,45.78, "Inj. avsola, 10 mg",Q5121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,38.15,,,,,,,fee schedule,28.04,45.78, "Inj. avsola, 10 mg",Q5121,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,45.78,,,,,,,fee schedule,28.04,45.78, "Inj. avsola, 10 mg",Q5121,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.16,,,,,,,fee schedule,28.04,45.78,APC "Inj. avsola, 10 mg",Q5121,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.44,,,,,,,fee schedule,28.04,45.78,APC "Inj. avsola, 10 mg",Q5121,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,28.04,,,,,,,fee schedule,28.04,45.78,APC "Inj, nyvepria",Q5122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,205.54,,,,,,,fee schedule,133.31,294.19, "Inj, nyvepria",Q5122,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,205.54,,,,,,,fee schedule,133.31,294.19, "Inj, nyvepria",Q5122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,245.14,,,,,,,fee schedule,133.31,294.19, "Inj, nyvepria",Q5122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,294.19,,,,,,,fee schedule,133.31,294.19, "Inj, nyvepria",Q5122,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,138.64,,,,,,,fee schedule,133.31,294.19,APC "Inj, nyvepria",Q5122,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,139.98,,,,,,,fee schedule,133.31,294.19,APC "Inj, nyvepria",Q5122,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,133.31,,,,,,,fee schedule,133.31,294.19,APC "Inj. riabni, 10 mg",Q5123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,46.56,,,,,,,fee schedule,20.26,59.46, "Inj. riabni, 10 mg",Q5123,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,46.56,,,,,,,fee schedule,20.26,59.46, "Inj. riabni, 10 mg",Q5123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,49.55,,,,,,,fee schedule,20.26,59.46, "Inj. riabni, 10 mg",Q5123,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,59.46,,,,,,,fee schedule,20.26,59.46, "Inj. riabni, 10 mg",Q5123,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,21.07,,,,,,,fee schedule,20.26,59.46,APC "Inj. riabni, 10 mg",Q5123,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21.27,,,,,,,fee schedule,20.26,59.46,APC "Inj. riabni, 10 mg",Q5123,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,20.26,,,,,,,fee schedule,20.26,59.46,APC "Inj. byooviz, 0.1 mg",Q5124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,96.74,,,,,,,fee schedule,70.9,138.62, "Inj. byooviz, 0.1 mg",Q5124,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,96.74,,,,,,,fee schedule,70.9,138.62, "Inj. byooviz, 0.1 mg",Q5124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,115.5,,,,,,,fee schedule,70.9,138.62, "Inj. byooviz, 0.1 mg",Q5124,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,138.62,,,,,,,fee schedule,70.9,138.62, "Inj. byooviz, 0.1 mg",Q5124,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,73.74,,,,,,,fee schedule,70.9,138.62,APC "Inj. byooviz, 0.1 mg",Q5124,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,74.45,,,,,,,fee schedule,70.9,138.62,APC "Inj. byooviz, 0.1 mg",Q5124,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,70.9,,,,,,,fee schedule,70.9,138.62,APC "Inj, releuko 1 mcg",Q5125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.63,,,,,,,fee schedule,0.32,0.85, "Inj, releuko 1 mcg",Q5125,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.63,,,,,,,fee schedule,0.32,0.85, "Inj, releuko 1 mcg",Q5125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.71,,,,,,,fee schedule,0.32,0.85, "Inj, releuko 1 mcg",Q5125,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.85,,,,,,,fee schedule,0.32,0.85, "Inj, releuko 1 mcg",Q5125,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,0.33,,,,,,,fee schedule,0.32,0.85,APC "Inj, releuko 1 mcg",Q5125,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,0.34,,,,,,,fee schedule,0.32,0.85,APC "Inj, releuko 1 mcg",Q5125,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,0.32,,,,,,,fee schedule,0.32,0.85,APC Inj alymsys 10 mg,Q5126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,66.31,,,,,,,fee schedule,51.59,84.83, Inj alymsys 10 mg,Q5126,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,66.31,,,,,,,fee schedule,51.59,84.83, Inj alymsys 10 mg,Q5126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.69,,,,,,,fee schedule,51.59,84.83, Inj alymsys 10 mg,Q5126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,84.83,,,,,,,fee schedule,51.59,84.83, Inj alymsys 10 mg,Q5126,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.65,,,,,,,fee schedule,51.59,84.83,APC Inj alymsys 10 mg,Q5126,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54.17,,,,,,,fee schedule,51.59,84.83,APC Inj alymsys 10 mg,Q5126,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.59,,,,,,,fee schedule,51.59,84.83,APC "Inj, stimufend, 0.5 mg",Q5127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,356.63,,,,,,,fee schedule,158.26,414.75, "Inj, stimufend, 0.5 mg",Q5127,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,356.63,,,,,,,fee schedule,158.26,414.75, "Inj, stimufend, 0.5 mg",Q5127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,345.6,,,,,,,fee schedule,158.26,414.75, "Inj, stimufend, 0.5 mg",Q5127,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,414.75,,,,,,,fee schedule,158.26,414.75, "Inj, stimufend, 0.5 mg",Q5127,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,164.59,,,,,,,fee schedule,158.26,414.75,APC "Inj, stimufend, 0.5 mg",Q5127,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,166.17,,,,,,,fee schedule,158.26,414.75,APC "Inj, stimufend, 0.5 mg",Q5127,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,158.26,,,,,,,fee schedule,158.26,414.75,APC "Inj, cimerli, 0.1 mg",Q5128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,134.67,,,,,,,fee schedule,83.48,193.26, "Inj, cimerli, 0.1 mg",Q5128,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,134.67,,,,,,,fee schedule,83.48,193.26, "Inj, cimerli, 0.1 mg",Q5128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,161.03,,,,,,,fee schedule,83.48,193.26, "Inj, cimerli, 0.1 mg",Q5128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,193.26,,,,,,,fee schedule,83.48,193.26, "Inj, cimerli, 0.1 mg",Q5128,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,86.82,,,,,,,fee schedule,83.48,193.26,APC "Inj, cimerli, 0.1 mg",Q5128,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,87.65,,,,,,,fee schedule,83.48,193.26,APC "Inj, cimerli, 0.1 mg",Q5128,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,83.48,,,,,,,fee schedule,83.48,193.26,APC "Inj, vegzelma, 10 mg",Q5129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,67.9,,,,,,,fee schedule,34.65,89.63, "Inj, vegzelma, 10 mg",Q5129,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,67.9,,,,,,,fee schedule,34.65,89.63, "Inj, vegzelma, 10 mg",Q5129,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,74.69,,,,,,,fee schedule,34.65,89.63, "Inj, vegzelma, 10 mg",Q5129,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.63,,,,,,,fee schedule,34.65,89.63, "Inj, vegzelma, 10 mg",Q5129,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,36.04,,,,,,,fee schedule,34.65,89.63,APC "Inj, vegzelma, 10 mg",Q5129,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36.39,,,,,,,fee schedule,34.65,89.63,APC "Inj, vegzelma, 10 mg",Q5129,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,34.65,,,,,,,fee schedule,34.65,89.63,APC "Inj, fylnetra, 0.5 mg",Q5130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,232.27,,,,,,,fee schedule,112.13,309.47, "Inj, fylnetra, 0.5 mg",Q5130,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,232.27,,,,,,,fee schedule,112.13,309.47, "Inj, fylnetra, 0.5 mg",Q5130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,257.87,,,,,,,fee schedule,112.13,309.47, "Inj, fylnetra, 0.5 mg",Q5130,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,309.47,,,,,,,fee schedule,112.13,309.47, "Inj, fylnetra, 0.5 mg",Q5130,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,116.62,,,,,,,fee schedule,112.13,309.47,APC "Inj, fylnetra, 0.5 mg",Q5130,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,117.74,,,,,,,fee schedule,112.13,309.47,APC "Inj, fylnetra, 0.5 mg",Q5130,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,112.13,,,,,,,fee schedule,112.13,309.47,APC "Inj, tofidence, 1 mg",Q5133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,9.03,,,,,,,fee schedule,5.26,12.43, "Inj, tofidence, 1 mg",Q5133,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,9.03,,,,,,,fee schedule,5.26,12.43, "Inj, tofidence, 1 mg",Q5133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,10.35,,,,,,,fee schedule,5.26,12.43, "Inj, tofidence, 1 mg",Q5133,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,12.43,,,,,,,fee schedule,5.26,12.43, "Inj, tofidence, 1 mg",Q5133,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,5.47,,,,,,,fee schedule,5.26,12.43,APC "Inj, tofidence, 1 mg",Q5133,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5.52,,,,,,,fee schedule,5.26,12.43,APC "Inj, tofidence, 1 mg",Q5133,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,5.26,,,,,,,fee schedule,5.26,12.43,APC "Inj, tyruko, 1 mg",Q5134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,45.14,,,,,,,fee schedule,24.32,54.17, "Inj, tyruko, 1 mg",Q5134,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,54.17,,,,,,,fee schedule,24.32,54.17, "Inj, tyruko, 1 mg",Q5134,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,25.29,,,,,,,fee schedule,24.32,54.17,APC "Inj, tyruko, 1 mg",Q5134,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25.54,,,,,,,fee schedule,24.32,54.17,APC "Inj, tyruko, 1 mg",Q5134,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,24.32,,,,,,,fee schedule,24.32,54.17,APC "Inj, tyenne, 1 mg",Q5135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,7.29,,,,,,,fee schedule,4.44,9.91, "Inj, tyenne, 1 mg",Q5135,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,7.29,,,,,,,fee schedule,4.44,9.91, "Inj, tyenne, 1 mg",Q5135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.26,,,,,,,fee schedule,4.44,9.91, "Inj, tyenne, 1 mg",Q5135,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.91,,,,,,,fee schedule,4.44,9.91, "Inj, tyenne, 1 mg",Q5135,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.61,,,,,,,fee schedule,4.44,9.91,APC "Inj, tyenne, 1 mg",Q5135,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.66,,,,,,,fee schedule,4.44,9.91,APC "Inj, tyenne, 1 mg",Q5135,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.44,,,,,,,fee schedule,4.44,9.91,APC "Inj. denosumab-bbdz, 1 mg",Q5136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,50.97,,,,,,,fee schedule,27.91,61.17, "Inj. denosumab-bbdz, 1 mg",Q5136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.17,,,,,,,fee schedule,27.91,61.17, "Inj. denosumab-bbdz, 1 mg",Q5136,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,29.03,,,,,,,fee schedule,27.91,61.17,APC "Inj. denosumab-bbdz, 1 mg",Q5136,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29.31,,,,,,,fee schedule,27.91,61.17,APC "Inj. denosumab-bbdz, 1 mg",Q5136,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,27.91,,,,,,,fee schedule,27.91,61.17,APC "Inj, wezlana, sub cu, 1 mg",Q5137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,117.95,,,,,,,fee schedule,117.95,141.56, "Inj, wezlana, sub cu, 1 mg",Q5137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,141.56,,,,,,,fee schedule,117.95,141.56, "Inj, wezlana, iv, 1 mg",Q5138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,21.77,,,,,,,fee schedule,4.54,26.13, "Inj, wezlana, iv, 1 mg",Q5138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,26.13,,,,,,,fee schedule,4.54,26.13, "Inj, wezlana, iv, 1 mg",Q5138,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.73,,,,,,,fee schedule,4.54,26.13,APC "Inj, wezlana, iv, 1 mg",Q5138,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.77,,,,,,,fee schedule,4.54,26.13,APC "Inj, wezlana, iv, 1 mg",Q5138,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.54,,,,,,,fee schedule,4.54,26.13,APC "Inj adalimumab-ryvk, 1 mg",Q5142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.73,,,,,,,fee schedule,24.73,29.67, "Inj adalimumab-ryvk, 1 mg",Q5142,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.67,,,,,,,fee schedule,24.73,29.67, "Inj, idacio, 1 mg",Q5144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,42.84,,,,,,,fee schedule,42.84,51.41, "Inj, idacio, 1 mg",Q5144,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,51.41,,,,,,,fee schedule,42.84,51.41, "Inj, hercessi, 10 mg",Q5146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,118.59,,,,,,,fee schedule,37.86,118.59, "Inj, hercessi, 10 mg",Q5146,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,118.59,,,,,,,fee schedule,37.86,118.59, "Inj, hercessi, 10 mg",Q5146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,74.82,,,,,,,fee schedule,37.86,118.59, "Inj, hercessi, 10 mg",Q5146,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.79,,,,,,,fee schedule,37.86,118.59, "Inj, hercessi, 10 mg",Q5146,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,39.38,,,,,,,fee schedule,37.86,118.59,APC "Inj, hercessi, 10 mg",Q5146,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39.76,,,,,,,fee schedule,37.86,118.59,APC "Inj, hercessi, 10 mg",Q5146,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,37.86,,,,,,,fee schedule,37.86,118.59,APC "Inj, aflibercept-ayyh, 1 mg",Q5147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,1352.82,,,,,,,fee schedule,821.4,1927.54, "Inj, aflibercept-ayyh, 1 mg",Q5147,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,1352.82,,,,,,,fee schedule,821.4,1927.54, "Inj, aflibercept-ayyh, 1 mg",Q5147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1606.14,,,,,,,fee schedule,821.4,1927.54, "Inj, aflibercept-ayyh, 1 mg",Q5147,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1927.54,,,,,,,fee schedule,821.4,1927.54, "Inj, aflibercept-ayyh, 1 mg",Q5147,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,854.25,,,,,,,fee schedule,821.4,1927.54,APC "Inj, aflibercept-ayyh, 1 mg",Q5147,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,862.47,,,,,,,fee schedule,821.4,1927.54,APC "Inj, aflibercept-ayyh, 1 mg",Q5147,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,821.4,,,,,,,fee schedule,821.4,1927.54,APC "Inj, nyposi 1 mcg",Q5148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.91,,,,,,,fee schedule,1.03,2.29, "Inj, nyposi 1 mcg",Q5148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.29,,,,,,,fee schedule,1.03,2.29, "Inj, nyposi 1 mcg",Q5148,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1.07,,,,,,,fee schedule,1.03,2.29,APC "Inj, nyposi 1 mcg",Q5148,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1.08,,,,,,,fee schedule,1.03,2.29,APC "Inj, nyposi 1 mcg",Q5148,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1.03,,,,,,,fee schedule,1.03,2.29,APC "Inj, eculizumab-aagh, 2 mg",Q5151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,58.03,,,,,,,fee schedule,31.93,69.65, "Inj, eculizumab-aagh, 2 mg",Q5151,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,69.65,,,,,,,fee schedule,31.93,69.65, "Inj, eculizumab-aagh, 2 mg",Q5151,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,33.21,,,,,,,fee schedule,31.93,69.65,APC "Inj, eculizumab-aagh, 2 mg",Q5151,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33.52,,,,,,,fee schedule,31.93,69.65,APC "Inj, eculizumab-aagh, 2 mg",Q5151,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,31.93,,,,,,,fee schedule,31.93,69.65,APC "Inj, eculizumab-aeeb, 2 mg?",Q5152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,74.61,,,,,,,fee schedule,41.79,89.54, "Inj, eculizumab-aeeb, 2 mg?",Q5152,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,89.54,,,,,,,fee schedule,41.79,89.54, "Inj, eculizumab-aeeb, 2 mg?",Q5152,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,43.46,,,,,,,fee schedule,41.79,89.54,APC "Inj, eculizumab-aeeb, 2 mg?",Q5152,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43.88,,,,,,,fee schedule,41.79,89.54,APC "Inj, eculizumab-aeeb, 2 mg?",Q5152,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,41.79,,,,,,,fee schedule,41.79,89.54,APC "Inj, tocilizumab-anoh, 1 mg",Q5156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,8.22,,,,,,,fee schedule,8.22,9.87, "Inj, tocilizumab-anoh, 1 mg",Q5156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.87,,,,,,,fee schedule,8.22,9.87, "Inj, denosumab-bmwo, 1 mg",Q5157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,54.33,,,,,,,fee schedule,26.21,65.2, "Inj, denosumab-bmwo, 1 mg",Q5157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,65.2,,,,,,,fee schedule,26.21,65.2, "Inj, denosumab-bmwo, 1 mg",Q5157,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,27.26,,,,,,,fee schedule,26.21,65.2,APC "Inj, denosumab-bmwo, 1 mg",Q5157,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27.52,,,,,,,fee schedule,26.21,65.2,APC "Inj, denosumab-bmwo, 1 mg",Q5157,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,26.21,,,,,,,fee schedule,26.21,65.2,APC "Inj, denosumab-bnht, 1 mg",Q5158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,55.47,,,,,,,fee schedule,29.8,66.57, "Inj, denosumab-bnht, 1 mg",Q5158,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,66.57,,,,,,,fee schedule,29.8,66.57, "Inj, denosumab-bnht, 1 mg",Q5158,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,30.99,,,,,,,fee schedule,29.8,66.57,APC "Inj, denosumab-bnht, 1 mg",Q5158,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31.29,,,,,,,fee schedule,29.8,66.57,APC "Inj, denosumab-bnht, 1 mg",Q5158,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,29.8,,,,,,,fee schedule,29.8,66.57,APC Inj sulf hexa lipid microsph,Q9950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,28.94,,,,,,,fee schedule,28.94,41.7, Inj sulf hexa lipid microsph,Q9950,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,28.94,,,,,,,fee schedule,28.94,41.7, Inj sulf hexa lipid microsph,Q9950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,34.74,,,,,,,fee schedule,28.94,41.7, Inj sulf hexa lipid microsph,Q9950,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,41.7,,,,,,,fee schedule,28.94,41.7, "Inj fe-based mr contrast,1ml",Q9953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,115.97,,,,,,,fee schedule,115.97,139.18, "Inj fe-based mr contrast,1ml",Q9953,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,139.18,,,,,,,fee schedule,115.97,139.18, "Inj perflexane lip micros,ml",Q9955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,24.76,,,,,,,fee schedule,24.76,29.72, "Inj perflexane lip micros,ml",Q9955,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,29.72,,,,,,,fee schedule,24.76,29.72, "Inj octafluoropropane mic,ml",Q9956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.14,,,,,,,fee schedule,64.14,91.18, "Inj octafluoropropane mic,ml",Q9956,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.14,,,,,,,fee schedule,64.14,91.18, "Inj octafluoropropane mic,ml",Q9956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75.97,,,,,,,fee schedule,64.14,91.18, "Inj octafluoropropane mic,ml",Q9956,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.18,,,,,,,fee schedule,64.14,91.18, "Inj perflutren lip micros,ml",Q9957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,64.14,,,,,,,fee schedule,64.14,91.18, "Inj perflutren lip micros,ml",Q9957,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,64.14,,,,,,,fee schedule,64.14,91.18, "Inj perflutren lip micros,ml",Q9957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75.97,,,,,,,fee schedule,64.14,91.18, "Inj perflutren lip micros,ml",Q9957,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,91.18,,,,,,,fee schedule,64.14,91.18, "HOCM <=149 mg/ml iodine, 1ml",Q9958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.12,,,,,,,fee schedule,0.12,0.18, "HOCM <=149 mg/ml iodine, 1ml",Q9958,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.12,,,,,,,fee schedule,0.12,0.18, "HOCM <=149 mg/ml iodine, 1ml",Q9958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.15,,,,,,,fee schedule,0.12,0.18, "HOCM <=149 mg/ml iodine, 1ml",Q9958,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.18,,,,,,,fee schedule,0.12,0.18, "HOCM 200-249mg/ml iodine,1ml",Q9960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.52,,,,,,,fee schedule,0.52,0.63, "HOCM 200-249mg/ml iodine,1ml",Q9960,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.63,,,,,,,fee schedule,0.52,0.63, "HOCM 250-299mg/ml iodine,1ml",Q9961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.45,,,,,,,fee schedule,0.45,0.54, "HOCM 250-299mg/ml iodine,1ml",Q9961,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.45,,,,,,,fee schedule,0.45,0.54, "HOCM 250-299mg/ml iodine,1ml",Q9961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.45,,,,,,,fee schedule,0.45,0.54, "HOCM 250-299mg/ml iodine,1ml",Q9961,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.54,,,,,,,fee schedule,0.45,0.54, "HOCM 300-349mg/ml iodine,1ml",Q9962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.34,,,,,,,fee schedule,0.34,0.4, "HOCM 300-349mg/ml iodine,1ml",Q9962,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.4,,,,,,,fee schedule,0.34,0.4, "HOCM 350-399mg/ml iodine,1ml",Q9963,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.33,,,,,,,fee schedule,0.33,0.49, "HOCM 350-399mg/ml iodine,1ml",Q9963,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.33,,,,,,,fee schedule,0.33,0.49, "HOCM 350-399mg/ml iodine,1ml",Q9963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.41,,,,,,,fee schedule,0.33,0.49, "HOCM 350-399mg/ml iodine,1ml",Q9963,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.49,,,,,,,fee schedule,0.33,0.49, "Hocm>= 400mg/ml iodine, 1ml",Q9964,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.54,,,,,,,fee schedule,0.54,0.65, "Hocm>= 400mg/ml iodine, 1ml",Q9964,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.65,,,,,,,fee schedule,0.54,0.65, "LOCM 100-199mg/ml iodine,1ml",Q9965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,2.81,,,,,,,fee schedule,1.79,2.81, "LOCM 100-199mg/ml iodine,1ml",Q9965,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,2.81,,,,,,,fee schedule,1.79,2.81, "LOCM 100-199mg/ml iodine,1ml",Q9965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.79,,,,,,,fee schedule,1.79,2.81, "LOCM 100-199mg/ml iodine,1ml",Q9965,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.15,,,,,,,fee schedule,1.79,2.81, "LOCM 200-299mg/ml iodine,1ml",Q9966,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.69,,,,,,,fee schedule,0.69,1.01, "LOCM 200-299mg/ml iodine,1ml",Q9966,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.69,,,,,,,fee schedule,0.69,1.01, "LOCM 200-299mg/ml iodine,1ml",Q9966,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.84,,,,,,,fee schedule,0.69,1.01, "LOCM 200-299mg/ml iodine,1ml",Q9966,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.01,,,,,,,fee schedule,0.69,1.01, "LOCM 300-399mg/ml iodine,1ml",Q9967,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,0.23,,,,,,,fee schedule,0.23,0.34, "LOCM 300-399mg/ml iodine,1ml",Q9967,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,0.23,,,,,,,fee schedule,0.23,0.34, "LOCM 300-399mg/ml iodine,1ml",Q9967,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.28,,,,,,,fee schedule,0.23,0.34, "LOCM 300-399mg/ml iodine,1ml",Q9967,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.34,,,,,,,fee schedule,0.23,0.34, Visualization adjunct,Q9968,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.14,,,,,,,fee schedule,5.14,10.8, Visualization adjunct,Q9968,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.17,,,,,,,fee schedule,5.14,10.8, Visualization adjunct,Q9968,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,10.7,,,,,,,fee schedule,5.14,10.8,APC Visualization adjunct,Q9968,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10.8,,,,,,,fee schedule,5.14,10.8,APC Visualization adjunct,Q9968,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,10.29,,,,,,,fee schedule,5.14,10.8,APC flutemetamol f18 diagnostic,Q9982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6100.42,,,,,,,fee schedule,1944.01,7321.15, flutemetamol f18 diagnostic,Q9982,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7321.15,,,,,,,fee schedule,1944.01,7321.15, flutemetamol f18 diagnostic,Q9982,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2021.77,,,,,,,fee schedule,1944.01,7321.15,APC flutemetamol f18 diagnostic,Q9982,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2041.21,,,,,,,fee schedule,1944.01,7321.15,APC flutemetamol f18 diagnostic,Q9982,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1944.01,,,,,,,fee schedule,1944.01,7321.15,APC florbetaben f18 diagnostic,Q9983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6481.69,,,,,,,fee schedule,1584.67,7778.72, florbetaben f18 diagnostic,Q9983,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7778.72,,,,,,,fee schedule,1584.67,7778.72, florbetaben f18 diagnostic,Q9983,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,1648.06,,,,,,,fee schedule,1584.67,7778.72,APC florbetaben f18 diagnostic,Q9983,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1663.9,,,,,,,fee schedule,1584.67,7778.72,APC florbetaben f18 diagnostic,Q9983,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1584.67,,,,,,,fee schedule,1584.67,7778.72,APC Buprenorph xr 100 mg or less,Q9991,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3076.71,,,,,,,fee schedule,1996.56,4522.83, Buprenorph xr 100 mg or less,Q9991,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3076.71,,,,,,,fee schedule,1996.56,4522.83, Buprenorph xr 100 mg or less,Q9991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3768.69,,,,,,,fee schedule,1996.56,4522.83, Buprenorph xr 100 mg or less,Q9991,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4522.83,,,,,,,fee schedule,1996.56,4522.83, Buprenorph xr 100 mg or less,Q9991,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2076.42,,,,,,,fee schedule,1996.56,4522.83,APC Buprenorph xr 100 mg or less,Q9991,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2096.38,,,,,,,fee schedule,1996.56,4522.83,APC Buprenorph xr 100 mg or less,Q9991,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1996.56,,,,,,,fee schedule,1996.56,4522.83,APC Buprenorphine xr over 100 mg,Q9992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,3076.71,,,,,,,fee schedule,1996.56,4522.83, Buprenorphine xr over 100 mg,Q9992,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,3076.71,,,,,,,fee schedule,1996.56,4522.83, Buprenorphine xr over 100 mg,Q9992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3768.69,,,,,,,fee schedule,1996.56,4522.83, Buprenorphine xr over 100 mg,Q9992,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4522.83,,,,,,,fee schedule,1996.56,4522.83, Buprenorphine xr over 100 mg,Q9992,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,2076.42,,,,,,,fee schedule,1996.56,4522.83,APC Buprenorphine xr over 100 mg,Q9992,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,2096.38,,,,,,,fee schedule,1996.56,4522.83,APC Buprenorphine xr over 100 mg,Q9992,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,1996.56,,,,,,,fee schedule,1996.56,4522.83,APC Ustekinumab- ttwe sub cu inj,Q9996,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,87.9,,,,,,,fee schedule,87.9,105.49, Ustekinumab- ttwe sub cu inj,Q9996,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,105.49,,,,,,,fee schedule,87.9,105.49, Ustekinumab-ttwe iv inj 1 mg,Q9997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,16.76,,,,,,,fee schedule,4.53,20.12, Ustekinumab-ttwe iv inj 1 mg,Q9997,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,20.12,,,,,,,fee schedule,4.53,20.12, Ustekinumab-ttwe iv inj 1 mg,Q9997,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,4.71,,,,,,,fee schedule,4.53,20.12,APC Ustekinumab-ttwe iv inj 1 mg,Q9997,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4.76,,,,,,,fee schedule,4.53,20.12,APC Ustekinumab-ttwe iv inj 1 mg,Q9997,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,4.53,,,,,,,fee schedule,4.53,20.12,APC Ustekinumab-aekn inj,Q9998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,75.41,,,,,,,fee schedule,11.75,90.51, Ustekinumab-aekn inj,Q9998,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,90.51,,,,,,,fee schedule,11.75,90.51, Ustekinumab-aekn inj,Q9998,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,12.22,,,,,,,fee schedule,11.75,90.51,APC Ustekinumab-aekn inj,Q9998,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12.34,,,,,,,fee schedule,11.75,90.51,APC Ustekinumab-aekn inj,Q9998,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,11.75,,,,,,,fee schedule,11.75,90.51,APC Inj ustekinumab-aauz 1 mg,Q9999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,61.85,,,,,,,fee schedule,14.05,74.22, Inj ustekinumab-aauz 1 mg,Q9999,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,74.22,,,,,,,fee schedule,14.05,74.22, Inj ustekinumab-aauz 1 mg,Q9999,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,14.61,,,,,,,fee schedule,14.05,74.22,APC Inj ustekinumab-aauz 1 mg,Q9999,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14.75,,,,,,,fee schedule,14.05,74.22,APC Inj ustekinumab-aauz 1 mg,Q9999,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,14.05,,,,,,,fee schedule,14.05,74.22,APC "Butorphanal tartrate, nasal spray, 25 mg",S0012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,115.6,,,,,,,fee schedule,115.6,138.73, "Butorphanal tartrate, nasal spray, 25 mg",S0012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,138.73,,,,,,,fee schedule,115.6,138.73, Description Not Available,S0013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.41,,,,,,,fee schedule,28.41,34.09, Description Not Available,S0013,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.09,,,,,,,fee schedule,28.41,34.09, "Tacrine HCl, 10mg",S0014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.64,,,,,,,fee schedule,4.64,5.56, "Tacrine HCl, 10mg",S0014,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.56,,,,,,,fee schedule,4.64,5.56, "Injection, cefoperazone sodium, 1 g",S0021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,28.6,,,,,,,fee schedule,28.6,34.32, "Injection, cefoperazone sodium, 1 g",S0021,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,34.32,,,,,,,fee schedule,28.6,34.32, "Injection, cimetidine HCl, 300 mg",S0023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,4.56,,,,,,,fee schedule,4.56,5.47, "Injection, cimetidine HCl, 300 mg",S0023,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,5.47,,,,,,,fee schedule,4.56,5.47, "Injection, ofloxacin, 400 mg",S0034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,41.94,,,,,,,fee schedule,41.94,50.33, "Injection, ofloxacin, 400 mg",S0034,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,50.33,,,,,,,fee schedule,41.94,50.33, "Injection, ticarcillin disodium and clavulanate potassium, 3.1 g",S0040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,25.42,,,,,,,fee schedule,25.42,30.5, "Injection, ticarcillin disodium and clavulanate potassium, 3.1 g",S0040,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,30.5,,,,,,,fee schedule,25.42,30.5, "Injection, fosphenytoin sodium, 750 mg",S0078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,70.37,,,,,,,fee schedule,70.37,84.45, "Injection, fosphenytoin sodium, 750 mg",S0078,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,84.45,,,,,,,fee schedule,70.37,84.45, "Injection, pentamidine isethonate, 300 mg",S0080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,186.25,,,,,,,fee schedule,186.25,223.51, "Injection, pentamidine isethonate, 300 mg",S0080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,223.51,,,,,,,fee schedule,186.25,223.51, "Injection, piperacillin sodium, 500 mg",S0081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.33,,,,,,,fee schedule,3.33,3.99, "Injection, piperacillin sodium, 500 mg",S0081,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.99,,,,,,,fee schedule,3.33,3.99, "Imatinib, 100 mg",S0088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.66,,,,,,,fee schedule,5.66,6.8, "Imatinib, 100 mg",S0088,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.8,,,,,,,fee schedule,5.66,6.8, "Sildenafil citrate, 25 mg",S0090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.5,,,,,,,fee schedule,0.5,0.61, "Sildenafil citrate, 25 mg",S0090,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.61,,,,,,,fee schedule,0.5,0.61, "Granisetron HCl, 1mg (for circumstances falling under the Medicare Statute, use Q0166)",S0091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.72,,,,,,,fee schedule,5.72,6.86, "Granisetron HCl, 1mg (for circumstances falling under the Medicare Statute, use Q0166)",S0091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.86,,,,,,,fee schedule,5.72,6.86, "Injection, hydromorphone HCl, 250 mg (loading dose for infusion pump)",S0092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,159.03,,,,,,,fee schedule,159.03,190.86, "Injection, hydromorphone HCl, 250 mg (loading dose for infusion pump)",S0092,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,190.86,,,,,,,fee schedule,159.03,190.86, "Injection, morphine sulfate, 500mg (loding dose for infusion pump)",S0093,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,20.73,,,,,,,fee schedule,20.73,24.87, "Injection, morphine sulfate, 500mg (loding dose for infusion pump)",S0093,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,24.87,,,,,,,fee schedule,20.73,24.87, "Zidovudine, oral, 100 mg",S0104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.9,,,,,,,fee schedule,2.9,3.48, "Zidovudine, oral, 100 mg",S0104,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.48,,,,,,,fee schedule,2.9,3.48, "Buproprion HCl sustained release tablit, 150 mg, per bottle of 60 tablets",S0106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,29.34,,,,,,,fee schedule,29.34,35.22, "Buproprion HCl sustained release tablit, 150 mg, per bottle of 60 tablets",S0106,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,35.22,,,,,,,fee schedule,29.34,35.22, "Mercaptopuine, oral, 50 mg",S0108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,6.21,,,,,,,fee schedule,6.21,7.45, "Mercaptopuine, oral, 50 mg",S0108,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,7.45,,,,,,,fee schedule,6.21,7.45, "Methadone, oral, 5 mg",S0109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.58,,,,,,,fee schedule,0.58,0.7, "Methadone, oral, 5 mg",S0109,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.7,,,,,,,fee schedule,0.58,0.7, "Tretinoin, topical, 5 g",S0117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,7.87,,,,,,,fee schedule,7.87,9.44, "Tretinoin, topical, 5 g",S0117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,9.44,,,,,,,fee schedule,7.87,9.44, Description Not Available,S0119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.88,,,,,,,fee schedule,0.88,1.05, Description Not Available,S0119,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.05,,,,,,,fee schedule,0.88,1.05, "Injection, menotropins, 75 IU",S0122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,481.29,,,,,,,fee schedule,481.29,577.59, "Injection, menotropins, 75 IU",S0122,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,577.59,,,,,,,fee schedule,481.29,577.59, "Injection, follitropin alfa, 75 IU",S0126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,460.41,,,,,,,fee schedule,460.41,552.54, "Injection, follitropin alfa, 75 IU",S0126,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,552.54,,,,,,,fee schedule,460.41,552.54, "Injection, follitropin beta, 75 IU",S0128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,414.64,,,,,,,fee schedule,414.64,497.61, "Injection, follitropin beta, 75 IU",S0128,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,497.61,,,,,,,fee schedule,414.64,497.61, "Injection, ganirelix acetate, 250 mcg",S0132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,358.12,,,,,,,fee schedule,358.12,429.78, "Injection, ganirelix acetate, 250 mcg",S0132,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,429.78,,,,,,,fee schedule,358.12,429.78, "Clozapine, 25 mg",S0136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.23,,,,,,,fee schedule,1.23,1.48, "Clozapine, 25 mg",S0136,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.48,,,,,,,fee schedule,1.23,1.48, "Didanosine (ddI), 25 mg",S0137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.07,,,,,,,fee schedule,1.07,1.28, "Didanosine (ddI), 25 mg",S0137,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.28,,,,,,,fee schedule,1.07,1.28, "Finasteride, 5 mg",S0138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.28,,,,,,,fee schedule,0.28,0.34, "Finasteride, 5 mg",S0138,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.34,,,,,,,fee schedule,0.28,0.34, "Minoxidil, 10 mg",S0139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.88,,,,,,,fee schedule,0.88,1.05, "Minoxidil, 10 mg",S0139,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.05,,,,,,,fee schedule,0.88,1.05, "Saquinavir, 200 mg",S0140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2.32,,,,,,,fee schedule,2.32,2.78, "Saquinavir, 200 mg",S0140,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.78,,,,,,,fee schedule,2.32,2.78, "pegylated interferon alfa-2a, 180 mcg/ ml",S0145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,2122.6,,,,,,,fee schedule,2122.6,2547.35, "pegylated interferon alfa-2a, 180 mcg/ ml",S0145,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2547.35,,,,,,,fee schedule,2122.6,2547.35, Peg interferon alfa-2B/10,S0148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,286.78,,,,,,,fee schedule,286.78,344.17, Peg interferon alfa-2B/10,S0148,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,344.17,,,,,,,fee schedule,286.78,344.17, "Sterile dilutant for epoprostenol, 50 ml",S0155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,27.64,,,,,,,fee schedule,27.64,33.17, "Sterile dilutant for epoprostenol, 50 ml",S0155,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,33.17,,,,,,,fee schedule,27.64,33.17, "Exemestane, 25 mg",S0156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3.18,,,,,,,fee schedule,3.18,3.81, "Exemestane, 25 mg",S0156,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3.81,,,,,,,fee schedule,3.18,3.81, "Becaplermin gel 0.01%, 0.5 gm",S0157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,86.4,,,,,,,fee schedule,86.4,103.69, "Becaplermin gel 0.01%, 0.5 gm",S0157,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,103.69,,,,,,,fee schedule,86.4,103.69, "Dextoamphetamine sulfate, 5 mg",S0160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.33,,,,,,,fee schedule,1.33,1.59, "Dextoamphetamine sulfate, 5 mg",S0160,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.59,,,,,,,fee schedule,1.33,1.59, Calcitrol,S0169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.52,,,,,,,fee schedule,0.52,0.63, Calcitrol,S0169,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.63,,,,,,,fee schedule,0.52,0.63, "Anastrozole, oral, 1 mg",S0170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.92,,,,,,,fee schedule,0.92,1.1, "Anastrozole, oral, 1 mg",S0170,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.1,,,,,,,fee schedule,0.92,1.1, "Chlorambucil, oral, 2 mg",S0172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,503.56,,,,,,,fee schedule,503.56,604.33, "Chlorambucil, oral, 2 mg",S0172,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,604.33,,,,,,,fee schedule,503.56,604.33, "Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)",S0174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,56.35,,,,,,,fee schedule,56.35,67.63, "Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)",S0174,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,67.63,,,,,,,fee schedule,56.35,67.63, "Flutamide, oral, 125 mg",S0175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,84.91,,,,,,,fee schedule,84.91,101.9, "Flutamide, oral, 125 mg",S0175,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,101.9,,,,,,,fee schedule,84.91,101.9, "Hydroxyurea, oral, 500 mg",S0176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.77,,,,,,,fee schedule,0.77,0.92, "Hydroxyurea, oral, 500 mg",S0176,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.92,,,,,,,fee schedule,0.77,0.92, "Levamisole HCl, oral, 50 mg",S0177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,5.64,,,,,,,fee schedule,5.64,6.77, "Levamisole HCl, oral, 50 mg",S0177,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,6.77,,,,,,,fee schedule,5.64,6.77, "Lomustine, oral, 10 mg",S0178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,231.61,,,,,,,fee schedule,231.61,277.95, "Lomustine, oral, 10 mg",S0178,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,277.95,,,,,,,fee schedule,231.61,277.95, "Megestrol acetate, oral, 20 mg",S0179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.52,,,,,,,fee schedule,0.52,0.63, "Megestrol acetate, oral, 20 mg",S0179,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.63,,,,,,,fee schedule,0.52,0.63, "Procarbazine HCl, oral, 50 mg",S0182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,283.13,,,,,,,fee schedule,283.13,339.79, "Procarbazine HCl, oral, 50 mg",S0182,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,339.79,,,,,,,fee schedule,283.13,339.79, "Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164)",S0183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.65,,,,,,,fee schedule,0.65,0.79, "Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164)",S0183,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.79,,,,,,,fee schedule,0.65,0.79, "Tamoxifen citrate, oral, 10 mg",S0187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.37,,,,,,,fee schedule,0.37,0.45, "Tamoxifen citrate, oral, 10 mg",S0187,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.45,,,,,,,fee schedule,0.37,0.45, "testosterone pellet, 75 mg",S0189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,200.43,,,,,,,fee schedule,200.43,240.54, "testosterone pellet, 75 mg",S0189,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,240.54,,,,,,,fee schedule,200.43,240.54, "Mitepristone, oral, 200 mg",S0190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,68.31,,,,,,,fee schedule,68.31,81.98, "Mitepristone, oral, 200 mg",S0190,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,81.98,,,,,,,fee schedule,68.31,81.98, "Misoprostol, oral, 200 mcg",S0191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.85,,,,,,,fee schedule,1.85,2.22, "Misoprostol, oral, 200 mcg",S0191,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2.22,,,,,,,fee schedule,1.85,2.22, "Dialysis/stress vitamin supplement, oral, 100 capsules",S0194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,18.78,,,,,,,fee schedule,18.78,22.54, "Dialysis/stress vitamin supplement, oral, 100 capsules",S0194,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,22.54,,,,,,,fee schedule,18.78,22.54, Screening protoscopy,S0601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Screening protoscopy,S0601,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Screening protoscopy,S0601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Screening protoscopy,S0601,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Laser in situ keratomileusis (LASIK),S0800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Laser in situ keratomileusis (LASIK),S0800,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Laser in situ keratomileusis (LASIK),S0800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Laser in situ keratomileusis (LASIK),S0800,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Photorefractive keratectomy (PRK),S0810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Photorefractive keratectomy (PRK),S0810,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Photorefractive keratectomy (PRK),S0810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Photorefractive keratectomy (PRK),S0810,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Phototherapeutic keratectomy (PTK),S0812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Phototherapeutic keratectomy (PTK),S0812,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Phototherapeutic keratectomy (PTK),S0812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Phototherapeutic keratectomy (PTK),S0812,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,S1091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3288.51,,,,,,,fee schedule,3288.51,3946.56, Description Not Available,S1091,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,3946.56,,,,,,,fee schedule,3288.51,3946.56, "transplant sm. Intest, liver, allograft",S2053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "transplant sm. Intest, liver, allograft",S2053,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "transplant sm. Intest, liver, allograft",S2053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "transplant sm. Intest, liver, allograft",S2053,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Transplant multivisceral organs,S2054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Transplant multivisceral organs,S2054,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Transplant multivisceral organs,S2054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Transplant multivisceral organs,S2054,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "harvesting organs, cadaver donor",S2055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "harvesting organs, cadaver donor",S2055,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "harvesting organs, cadaver donor",S2055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "harvesting organs, cadaver donor",S2055,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Lobar lung transplantation,S2060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Lobar lung transplantation,S2060,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Lobar lung transplantation,S2060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Lobar lung transplantation,S2060,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Donor lobectomy, live donor",S2061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Donor lobectomy, live donor",S2061,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Donor lobectomy, live donor",S2061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Donor lobectomy, live donor",S2061,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Sim Panc/renal transplant,S2065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Sim Panc/renal transplant,S2065,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Sim Panc/renal transplant,S2065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Sim Panc/renal transplant,S2065,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Breast reconstruct, GAP",S2066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Breast reconstruct, GAP",S2066,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Breast reconstruct, GAP",S2066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Breast reconstruct, GAP",S2066,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Breast reconstruct, stacked DEIP or GAP",S2067,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Breast reconstruct, stacked DEIP or GAP",S2067,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Breast reconstruct, stacked DEIP or GAP",S2067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Breast reconstruct, stacked DEIP or GAP",S2067,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Breast reconstruct, DEIP",S2068,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Breast reconstruct, DEIP",S2068,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Breast reconstruct, DEIP",S2068,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Breast reconstruct, DEIP",S2068,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Cystoerethroscopy,S2070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Cystoerethroscopy,S2070,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Cystoerethroscopy,S2070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Cystoerethroscopy,S2070,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Heller esophagomyotomy,S2079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Heller esophagomyotomy,S2079,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Heller esophagomyotomy,S2079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Heller esophagomyotomy,S2079,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, LAUP,S2080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, LAUP,S2080,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, LAUP,S2080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, LAUP,S2080,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "gastric band adjustment, percutaneous",S2083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1544,,,,,,,fee schedule,1544,18617, "gastric band adjustment, percutaneous",S2083,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1866,,,,,,,fee schedule,1544,18617, "gastric band adjustment, percutaneous",S2083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1544,18617, "gastric band adjustment, percutaneous",S2083,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1544,18617, "percut occlusion tumor dest, yttrium-90",S2095,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, "percut occlusion tumor dest, yttrium-90",S2095,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, "percut occlusion tumor dest, yttrium-90",S2095,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, "percut occlusion tumor dest, yttrium-90",S2095,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, "Iselt cell transplant, allogeneic",S2102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Iselt cell transplant, allogeneic",S2102,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Iselt cell transplant, allogeneic",S2102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Iselt cell transplant, allogeneic",S2102,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Adrenal tissue transplant to brain,S2103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Adrenal tissue transplant to brain,S2103,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Adrenal tissue transplant to brain,S2103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Adrenal tissue transplant to brain,S2103,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "arthroscopy, harvest cartilage",S2112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "arthroscopy, harvest cartilage",S2112,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "arthroscopy, harvest cartilage",S2112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "arthroscopy, harvest cartilage",S2112,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Osteotomy, peracteabular, with internal fixation",S2115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Osteotomy, peracteabular, with internal fixation",S2115,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Osteotomy, peracteabular, with internal fixation",S2115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Osteotomy, peracteabular, with internal fixation",S2115,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Arthroereisis, subtalar",S2117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Arthroereisis, subtalar",S2117,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Arthroereisis, subtalar",S2117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Arthroereisis, subtalar",S2117,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2205,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2205,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2206,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2206,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2207,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2207,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2208,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2208,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2209,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Minimally invasive direct co,S2209,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Myringotomy, laser-assisted",S2225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,3408,,,,,,,fee schedule,3408,18617, "Myringotomy, laser-assisted",S2225,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,5044,,,,,,,fee schedule,3408,18617, "Myringotomy, laser-assisted",S2225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,3408,18617, "Myringotomy, laser-assisted",S2225,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,3408,18617, Implant semi-imp hear,S2230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant semi-imp hear,S2230,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant semi-imp hear,S2230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant semi-imp hear,S2230,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Implant auditory brain imp,S2235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Implant auditory brain imp,S2235,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Implant auditory brain imp,S2235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Implant auditory brain imp,S2235,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Arthroscopy, shoulder, surgi",S2300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Arthroscopy, shoulder, surgi",S2300,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Arthroscopy, shoulder, surgi",S2300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Arthroscopy, shoulder, surgi",S2300,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Nasal endoscop po debrid,S2342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,3721,,,,,,,fee schedule,3721,4466, Nasal endoscop po debrid,S2342,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,4466,,,,,,,fee schedule,3721,4466, "Diskectomy, anterior, with d",S2350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Diskectomy, anterior, with d",S2350,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Diskectomy, anterior, with d",S2350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Diskectomy, anterior, with d",S2350,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, "Diskectomy, anterior, with d",S2351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, "Diskectomy, anterior, with d",S2351,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, "Diskectomy, anterior, with d",S2351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, "Diskectomy, anterior, with d",S2351,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fetal surg congen hernia,S2400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fetal surg congen hernia,S2400,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fetal surg congen hernia,S2400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fetal surg congen hernia,S2400,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fetal surg urin trac obstr,S2401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fetal surg urin trac obstr,S2401,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fetal surg urin trac obstr,S2401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fetal surg urin trac obstr,S2401,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fetal surg cong cyst malf,S2402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fetal surg cong cyst malf,S2402,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fetal surg cong cyst malf,S2402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fetal surg cong cyst malf,S2402,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fetal surg pulmon sequest,S2403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fetal surg pulmon sequest,S2403,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fetal surg pulmon sequest,S2403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fetal surg pulmon sequest,S2403,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fetal surg myelomeningo,S2404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fetal surg myelomeningo,S2404,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fetal surg myelomeningo,S2404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fetal surg myelomeningo,S2404,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fetal surg sacrococ teratoma,S2405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fetal surg sacrococ teratoma,S2405,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fetal surg sacrococ teratoma,S2405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fetal surg sacrococ teratoma,S2405,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Fetal surg noc,S2409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Fetal surg noc,S2409,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Fetal surg noc,S2409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Fetal surg noc,S2409,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Robotic surgical system,S2900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Hmo,1406,,,,,,,fee schedule,1406,18617, Robotic surgical system,S2900,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Ppo,1679,,,,,,,fee schedule,1406,18617, Robotic surgical system,S2900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,15514,,,,,,,fee schedule,1406,18617, Robotic surgical system,S2900,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,18617,,,,,,,fee schedule,1406,18617, Description Not Available,S4024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1772.93,,,,,,,fee schedule,1772.93,2127.71, Description Not Available,S4024,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,2127.71,,,,,,,fee schedule,1772.93,2127.71, 5% dextrose and 0.45% saline,S5010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,14.99,,,,,,,fee schedule,14.99,17.99, 5% dextrose and 0.45% saline,S5010,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,17.99,,,,,,,fee schedule,14.99,17.99, 5% dextrose with potassium,S5012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,9.06,,,,,,,fee schedule,9.06,10.88, 5% dextrose with potassium,S5012,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,10.88,,,,,,,fee schedule,9.06,10.88, Insulin rapid 5 u,S5550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.45,,,,,,,fee schedule,0.45,0.54, Insulin rapid 5 u,S5550,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.54,,,,,,,fee schedule,0.45,0.54, Insulin most rapid 5 u,S5551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.69,,,,,,,fee schedule,0.69,0.83, Insulin most rapid 5 u,S5551,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.83,,,,,,,fee schedule,0.69,0.83, Insulin intermed 5 u,S5552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,0.45,,,,,,,fee schedule,0.45,0.54, Insulin intermed 5 u,S5552,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,0.54,,,,,,,fee schedule,0.45,0.54, Insulin long acting 5 u,S5553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,1.12,,,,,,,fee schedule,1.12,1.35, Insulin long acting 5 u,S5553,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,1.35,,,,,,,fee schedule,1.12,1.35, Insulin reuse pen 3 ml,S5561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,81.66,,,,,,,fee schedule,81.66,98, Insulin reuse pen 3 ml,S5561,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,98,,,,,,,fee schedule,81.66,98, Insulin cartridge 300 u,S5566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,51.23,,,,,,,fee schedule,51.23,61.48, Insulin cartridge 300 u,S5566,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,61.48,,,,,,,fee schedule,51.23,61.48, Insulin dispos pen 1.5 ml,S5570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,190.64,,,,,,,fee schedule,190.64,228.79, Insulin dispos pen 1.5 ml,S5570,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,228.79,,,,,,,fee schedule,190.64,228.79, Insulin dispos pen 3 ml,S5571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,60.65,,,,,,,fee schedule,60.65,72.79, Insulin dispos pen 3 ml,S5571,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,72.79,,,,,,,fee schedule,60.65,72.79, 2019 nCoV diagnostic P,U0001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,116.74,,,,,,,fee schedule,35.92,131.47, 2019 nCoV diagnostic P,U0001,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,131.47,,,,,,,fee schedule,35.92,131.47, 2019 nCoV diagnostic P,U0001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,114.58,,,,,,,fee schedule,35.92,131.47, 2019 nCoV diagnostic P,U0001,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,130.95,,,,,,,fee schedule,35.92,131.47, 2019 nCoV diagnostic P,U0001,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,37.36,,,,,,,fee schedule,35.92,131.47,APC 2019 nCoV diagnostic P,U0001,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37.72,,,,,,,fee schedule,35.92,131.47,APC 2019 nCoV diagnostic P,U0001,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,35.92,,,,,,,fee schedule,35.92,131.47,APC COVID-19 lab test non-CDC,U0002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,166.82,,,,,,,fee schedule,51.31,187.87, COVID-19 lab test non-CDC,U0002,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,187.87,,,,,,,fee schedule,51.31,187.87, COVID-19 lab test non-CDC,U0002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Hmo,163.54,,,,,,,fee schedule,51.31,187.87, COVID-19 lab test non-CDC,U0002,HCPCS,,,,,facility,outpatient,,,,,,Cigna,Ppo,186.9,,,,,,,fee schedule,51.31,187.87, COVID-19 lab test non-CDC,U0002,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,53.36,,,,,,,fee schedule,51.31,187.87,APC COVID-19 lab test non-CDC,U0002,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53.88,,,,,,,fee schedule,51.31,187.87,APC COVID-19 lab test non-CDC,U0002,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,51.31,,,,,,,fee schedule,51.31,187.87,APC Cov-19 amp prb hgh thruput,U0003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325,,,,,,,fee schedule,325,366, Cov-19 amp prb hgh thruput,U0003,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,366,,,,,,,fee schedule,325,366, Cov-19 test non-cdc hgh thru,U0004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,325,,,,,,,fee schedule,325,366, Cov-19 test non-cdc hgh thru,U0004,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,366,,,,,,,fee schedule,325,366, Infec agen detec ampli probe,U0005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Hmo,81.25,,,,,,,fee schedule,81.25,91.5, Infec agen detec ampli probe,U0005,HCPCS,,,,,facility,outpatient,,,,,,Bcbs,Carefirst Ppo,91.5,,,,,,,fee schedule,81.25,91.5, Cntct lens hydrophil photoch,V2524,HCPCS,,,,,facility,outpatient,,,,,,Aetna,Medicare Managed Care Plan,193.72,,,,,,,fee schedule,186.27,195.58,APC Cntct lens hydrophil photoch,V2524,HCPCS,,,,,facility,outpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,195.58,,,,,,,fee schedule,186.27,195.58,APC Cntct lens hydrophil photoch,V2524,HCPCS,,,,,facility,outpatient,,,,,,Kaiser,Medicare Managed Care Plan,186.27,,,,,,,fee schedule,186.27,195.58,APC Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,393819.87,,,,,,,fee schedule,239197.91,582616.88, Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,507737.02,,,,,,,fee schedule,239197.91,582616.88, Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,485514.07,,,,,,,fee schedule,239197.91,582616.88, Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,582616.88,,,,,,,fee schedule,239197.91,582616.88, Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,248765.83,,,,,,,fee schedule,239197.91,582616.88,MSDRG Base Rate Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,251157.81,,,,,,,fee schedule,239197.91,582616.88,MSDRG Base Rate Heart Transplant Or Implant Of Heart Assist System With Mcc,1,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,239197.91,,,,,,,fee schedule,239197.91,582616.88,MSDRG Base Rate Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,159245.79,,,,,,,fee schedule,96722.54,235588.12, Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,205309.55,,,,,,,fee schedule,96722.54,235588.12, Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,196323.44,,,,,,,fee schedule,96722.54,235588.12, Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,235588.12,,,,,,,fee schedule,96722.54,235588.12, Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,100591.44,,,,,,,fee schedule,96722.54,235588.12,MSDRG Base Rate Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,101558.67,,,,,,,fee schedule,96722.54,235588.12,MSDRG Base Rate Heart Transplant Or Implant Of Heart Assist System Without Mcc,2,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,96722.54,,,,,,,fee schedule,96722.54,235588.12,MSDRG Base Rate "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,298277.74,,,,,,,fee schedule,181167.63,441271.91, "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,384558.17,,,,,,,fee schedule,181167.63,441271.91, "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,367726.59,,,,,,,fee schedule,181167.63,441271.91, "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,441271.91,,,,,,,fee schedule,181167.63,441271.91, "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,188414.34,,,,,,,fee schedule,181167.63,441271.91,MSDRG Base Rate "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,190226.01,,,,,,,fee schedule,181167.63,441271.91,MSDRG Base Rate "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major",3,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,181167.63,,,,,,,fee schedule,181167.63,441271.91,MSDRG Base Rate "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,194653.72,,,,,,,fee schedule,118228.58,287970.61, "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,250959.67,,,,,,,fee schedule,118228.58,287970.61, "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,239975.51,,,,,,,fee schedule,118228.58,287970.61, "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,287970.61,,,,,,,fee schedule,118228.58,287970.61, "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",118554.16,118554.16,118554.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,122957.72,,,,,,,fee schedule,118228.58,287970.61,MSDRG Base Rate "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,124140.01,,,,,,,fee schedule,118228.58,287970.61,MSDRG Base Rate "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.",4,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,118228.58,,,,,,,fee schedule,118228.58,287970.61,MSDRG Base Rate Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,144893.46,,,,,,,fee schedule,88005.24,214355.3, Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,186805.64,,,,,,,fee schedule,88005.24,214355.3, Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,178629.41,,,,,,,fee schedule,88005.24,214355.3, Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,214355.3,,,,,,,fee schedule,88005.24,214355.3, Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,91525.45,,,,,,,fee schedule,88005.24,214355.3,MSDRG Base Rate Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,92405.5,,,,,,,fee schedule,88005.24,214355.3,MSDRG Base Rate Liver Transplant With Mcc Or Intestinal Transplant,5,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,88005.24,,,,,,,fee schedule,88005.24,214355.3,MSDRG Base Rate Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,65163.76,,,,,,,fee schedule,39579.1,96403.23, Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,84013.17,,,,,,,fee schedule,39579.1,96403.23, Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,80336.03,,,,,,,fee schedule,39579.1,96403.23, Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,96403.23,,,,,,,fee schedule,39579.1,96403.23, Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,41162.26,,,,,,,fee schedule,39579.1,96403.23,MSDRG Base Rate Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41558.06,,,,,,,fee schedule,39579.1,96403.23,MSDRG Base Rate Liver Transplant Without Mcc,6,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,39579.1,,,,,,,fee schedule,39579.1,96403.23,MSDRG Base Rate Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,181989.16,,,,,,,fee schedule,110536.39,269234.66, Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,234631.72,,,,,,,fee schedule,110536.39,269234.66, Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,224362.22,,,,,,,fee schedule,110536.39,269234.66, Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,269234.66,,,,,,,fee schedule,110536.39,269234.66, Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,114957.85,,,,,,,fee schedule,110536.39,269234.66,MSDRG Base Rate Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,116063.21,,,,,,,fee schedule,110536.39,269234.66,MSDRG Base Rate Lung Transplant,7,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,110536.39,,,,,,,fee schedule,110536.39,269234.66,MSDRG Base Rate Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,78761.44,,,,,,,fee schedule,47838.05,116519.63, Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,101544.14,,,,,,,fee schedule,47838.05,116519.63, Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,97099.7,,,,,,,fee schedule,47838.05,116519.63, Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,116519.63,,,,,,,fee schedule,47838.05,116519.63, Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,49751.57,,,,,,,fee schedule,47838.05,116519.63,MSDRG Base Rate Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50229.95,,,,,,,fee schedule,47838.05,116519.63,MSDRG Base Rate Simultaneous Pancreas And Kidney Transplant,8,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,47838.05,,,,,,,fee schedule,47838.05,116519.63,MSDRG Base Rate Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone marrow transplant,9,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,100840.11,,,,,,,fee schedule,61248.16,149182.8, Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,130009.33,,,,,,,fee schedule,61248.16,149182.8, Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,124319,,,,,,,fee schedule,61248.16,149182.8, Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,149182.8,,,,,,,fee schedule,61248.16,149182.8, Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,63698.09,,,,,,,fee schedule,61248.16,149182.8,MSDRG Base Rate Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64310.57,,,,,,,fee schedule,61248.16,149182.8,MSDRG Base Rate Pancreas Transplant,10,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,61248.16,,,,,,,fee schedule,61248.16,149182.8,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,76646.47,,,,,,,fee schedule,46553.45,113390.74, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,98817.38,,,,,,,fee schedule,46553.45,113390.74, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,94492.28,,,,,,,fee schedule,46553.45,113390.74, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,113390.74,,,,,,,fee schedule,46553.45,113390.74, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,48415.59,,,,,,,fee schedule,46553.45,113390.74,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48881.12,,,,,,,fee schedule,46553.45,113390.74,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc",11,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,46553.45,,,,,,,fee schedule,46553.45,113390.74,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,59247.45,,,,,,,fee schedule,35985.65,87650.64, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,76385.49,,,,,,,fee schedule,35985.65,87650.64, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,73042.2,,,,,,,fee schedule,35985.65,87650.64, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,87650.64,,,,,,,fee schedule,35985.65,87650.64, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37425.08,,,,,,,fee schedule,35985.65,87650.64,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37784.93,,,,,,,fee schedule,35985.65,87650.64,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc",12,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35985.65,,,,,,,fee schedule,35985.65,87650.64,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40497.94,,,,,,,fee schedule,24597.59,59912.62, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52212.45,,,,,,,fee schedule,24597.59,59912.62, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,49927.19,,,,,,,fee schedule,24597.59,59912.62, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,59912.62,,,,,,,fee schedule,24597.59,59912.62, "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25581.49,,,,,,,fee schedule,24597.59,59912.62,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25827.47,,,,,,,fee schedule,24597.59,59912.62,MSDRG Base Rate "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc",13,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24597.59,,,,,,,fee schedule,24597.59,59912.62,MSDRG Base Rate Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,168887.55,,,,,,,fee schedule,102578.75,249852.14, Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,217740.31,,,,,,,fee schedule,102578.75,249852.14, Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,208210.12,,,,,,,fee schedule,102578.75,249852.14, Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,249852.14,,,,,,,fee schedule,102578.75,249852.14, Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,106681.9,,,,,,,fee schedule,102578.75,249852.14,MSDRG Base Rate Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,107707.69,,,,,,,fee schedule,102578.75,249852.14,MSDRG Base Rate Allogeneic Bone Marrow Transplant,14,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,102578.75,,,,,,,fee schedule,102578.75,249852.14,MSDRG Base Rate Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,83330.07,,,,,,,fee schedule,50612.94,123278.46, Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,107434.3,,,,,,,fee schedule,50612.94,123278.46, Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,102732.05,,,,,,,fee schedule,50612.94,123278.46, Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,123278.46,,,,,,,fee schedule,50612.94,123278.46, Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,52637.46,,,,,,,fee schedule,50612.94,123278.46,MSDRG Base Rate Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53143.59,,,,,,,fee schedule,50612.94,123278.46,MSDRG Base Rate Autologous Bone Marrow Transplant With Cc/Mcc,16,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,50612.94,,,,,,,fee schedule,50612.94,123278.46,MSDRG Base Rate Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,76340.11,,,,,,,fee schedule,46367.38,112937.52, Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,98422.41,,,,,,,fee schedule,46367.38,112937.52, Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,94114.6,,,,,,,fee schedule,46367.38,112937.52, Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,112937.52,,,,,,,fee schedule,46367.38,112937.52, Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,48222.08,,,,,,,fee schedule,46367.38,112937.52,MSDRG Base Rate Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48685.75,,,,,,,fee schedule,46367.38,112937.52,MSDRG Base Rate Autologous Bone Marrow Transplant Without Cc/Mcc,17,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,46367.38,,,,,,,fee schedule,46367.38,112937.52,MSDRG Base Rate Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,606847.89,,,,,,,fee schedule,368586.65,897770.41, Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,782385.97,,,,,,,fee schedule,368586.65,897770.41, Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,748142.01,,,,,,,fee schedule,368586.65,897770.41, Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,897770.41,,,,,,,fee schedule,368586.65,897770.41, Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,383330.12,,,,,,,fee schedule,368586.65,897770.41,MSDRG Base Rate Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,387015.98,,,,,,,fee schedule,368586.65,897770.41,MSDRG Base Rate Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies,18,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,368586.65,,,,,,,fee schedule,368586.65,897770.41,MSDRG Base Rate Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,100262.53,,,,,,,fee schedule,60897.36,148328.33, Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,129264.68,,,,,,,fee schedule,60897.36,148328.33, Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,123606.95,,,,,,,fee schedule,60897.36,148328.33, Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,148328.33,,,,,,,fee schedule,60897.36,148328.33, Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,63333.25,,,,,,,fee schedule,60897.36,148328.33,MSDRG Base Rate Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,63942.23,,,,,,,fee schedule,60897.36,148328.33,MSDRG Base Rate Simultaneous Pancreas And Kidney Transplant With Hemodialysis,19,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,60897.36,,,,,,,fee schedule,60897.36,148328.33,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,110580.25,,,,,,,fee schedule,67164.12,163592.35, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,142566.92,,,,,,,fee schedule,67164.12,163592.35, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,136326.96,,,,,,,fee schedule,67164.12,163592.35, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,163592.35,,,,,,,fee schedule,67164.12,163592.35, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,69850.68,,,,,,,fee schedule,67164.12,163592.35,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,70522.33,,,,,,,fee schedule,67164.12,163592.35,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc,20,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,67164.12,,,,,,,fee schedule,67164.12,163592.35,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,74393.77,,,,,,,fee schedule,45185.21,110058.1, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,95913.07,,,,,,,fee schedule,45185.21,110058.1, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,91715.09,,,,,,,fee schedule,45185.21,110058.1, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,110058.1,,,,,,,fee schedule,45185.21,110058.1, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,46992.62,,,,,,,fee schedule,45185.21,110058.1,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,47444.47,,,,,,,fee schedule,45185.21,110058.1,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc,21,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,45185.21,,,,,,,fee schedule,45185.21,110058.1,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44652,,,,,,,fee schedule,27120.69,66058.15, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57568.13,,,,,,,fee schedule,27120.69,66058.15, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55048.46,,,,,,,fee schedule,27120.69,66058.15, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,66058.15,,,,,,,fee schedule,27120.69,66058.15, Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28205.52,,,,,,,fee schedule,27120.69,66058.15,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28476.72,,,,,,,fee schedule,27120.69,66058.15,MSDRG Base Rate Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc,22,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27120.69,,,,,,,fee schedule,27120.69,66058.15,MSDRG Base Rate Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,80527.91,,,,,,,fee schedule,48910.96,119132.94, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,103821.58,,,,,,,fee schedule,48910.96,119132.94, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,99277.45,,,,,,,fee schedule,48910.96,119132.94, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,119132.94,,,,,,,fee schedule,48910.96,119132.94, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,50867.4,,,,,,,fee schedule,48910.96,119132.94,MSDRG Base Rate Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51356.51,,,,,,,fee schedule,48910.96,119132.94,MSDRG Base Rate Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla,23,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,48910.96,,,,,,,fee schedule,48910.96,119132.94,MSDRG Base Rate Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,54973.93,,,,,,,fee schedule,33390.01,81328.4, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,70875.8,,,,,,,fee schedule,33390.01,81328.4, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,67773.67,,,,,,,fee schedule,33390.01,81328.4, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,81328.4,,,,,,,fee schedule,33390.01,81328.4, Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,34725.61,,,,,,,fee schedule,33390.01,81328.4,MSDRG Base Rate Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35059.51,,,,,,,fee schedule,33390.01,81328.4,MSDRG Base Rate Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc,24,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,33390.01,,,,,,,fee schedule,33390.01,81328.4,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,63894.78,,,,,,,fee schedule,38808.34,94525.89, Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,82377.11,,,,,,,fee schedule,38808.34,94525.89, Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,78771.58,,,,,,,fee schedule,38808.34,94525.89, Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,94525.89,,,,,,,fee schedule,38808.34,94525.89, Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,40360.67,,,,,,,fee schedule,38808.34,94525.89,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40748.76,,,,,,,fee schedule,38808.34,94525.89,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures With Mcc,25,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,38808.34,,,,,,,fee schedule,38808.34,94525.89,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,43693.59,,,,,,,fee schedule,26538.57,64640.27, Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,56332.49,,,,,,,fee schedule,26538.57,64640.27, Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,53866.89,,,,,,,fee schedule,26538.57,64640.27, Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,64640.27,,,,,,,fee schedule,26538.57,64640.27, Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27600.11,,,,,,,fee schedule,26538.57,64640.27,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27865.5,,,,,,,fee schedule,26538.57,64640.27,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures With Cc,26,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26538.57,,,,,,,fee schedule,26538.57,64640.27,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,35454.31,,,,,,,fee schedule,21534.21,52451.09, Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,45709.9,,,,,,,fee schedule,21534.21,52451.09, Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,43709.24,,,,,,,fee schedule,21534.21,52451.09, Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,52451.09,,,,,,,fee schedule,21534.21,52451.09, Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22395.58,,,,,,,fee schedule,21534.21,52451.09,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22610.92,,,,,,,fee schedule,21534.21,52451.09,MSDRG Base Rate Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc,27,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21534.21,,,,,,,fee schedule,21534.21,52451.09,MSDRG Base Rate Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,84434.64,,,,,,,fee schedule,51283.83,124912.56, Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,108858.38,,,,,,,fee schedule,51283.83,124912.56, Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,104093.8,,,,,,,fee schedule,51283.83,124912.56, Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,124912.56,,,,,,,fee schedule,51283.83,124912.56, Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,53335.18,,,,,,,fee schedule,51283.83,124912.56,MSDRG Base Rate Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53848.02,,,,,,,fee schedule,51283.83,124912.56,MSDRG Base Rate Spinal Procedures With Mcc,28,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,51283.83,,,,,,,fee schedule,51283.83,124912.56,MSDRG Base Rate Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,47943.21,,,,,,,fee schedule,29119.7,70927.16, Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,61811.37,,,,,,,fee schedule,29119.7,70927.16, Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,59105.97,,,,,,,fee schedule,29119.7,70927.16, Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,70927.16,,,,,,,fee schedule,29119.7,70927.16, Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30284.49,,,,,,,fee schedule,29119.7,70927.16,MSDRG Base Rate Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30575.68,,,,,,,fee schedule,29119.7,70927.16,MSDRG Base Rate Spinal Procedures With Cc Or Spinal Neurostimulators,29,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29119.7,,,,,,,fee schedule,29119.7,70927.16,MSDRG Base Rate Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30849.15,,,,,,,fee schedule,18737.12,45638.21, Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39772.63,,,,,,,fee schedule,18737.12,45638.21, Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38031.84,,,,,,,fee schedule,18737.12,45638.21, Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45638.21,,,,,,,fee schedule,18737.12,45638.21, Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19486.6,,,,,,,fee schedule,18737.12,45638.21,MSDRG Base Rate Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19673.98,,,,,,,fee schedule,18737.12,45638.21,MSDRG Base Rate Spinal Procedures Without Cc/Mcc,30,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18737.12,,,,,,,fee schedule,18737.12,45638.21,MSDRG Base Rate Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,62964.47,,,,,,,fee schedule,38243.29,93149.6, Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,81177.7,,,,,,,fee schedule,38243.29,93149.6, Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,77624.66,,,,,,,fee schedule,38243.29,93149.6, Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,93149.6,,,,,,,fee schedule,38243.29,93149.6, Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,39773.02,,,,,,,fee schedule,38243.29,93149.6,MSDRG Base Rate Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40155.45,,,,,,,fee schedule,38243.29,93149.6,MSDRG Base Rate Ventricular Shunt Procedures With Mcc,31,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,38243.29,,,,,,,fee schedule,38243.29,93149.6,MSDRG Base Rate Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29946.94,,,,,,,fee schedule,18189.14,44303.49, Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38609.46,,,,,,,fee schedule,18189.14,44303.49, Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36919.58,,,,,,,fee schedule,18189.14,44303.49, Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44303.49,,,,,,,fee schedule,18189.14,44303.49, Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18916.71,,,,,,,fee schedule,18189.14,44303.49,MSDRG Base Rate Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19098.6,,,,,,,fee schedule,18189.14,44303.49,MSDRG Base Rate Ventricular Shunt Procedures With Cc,32,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18189.14,,,,,,,fee schedule,18189.14,44303.49,MSDRG Base Rate Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23368.73,,,,,,,fee schedule,14193.68,34571.69, Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30128.42,,,,,,,fee schedule,14193.68,34571.69, Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28809.74,,,,,,,fee schedule,14193.68,34571.69, Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34571.69,,,,,,,fee schedule,14193.68,34571.69, Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14761.43,,,,,,,fee schedule,14193.68,34571.69,MSDRG Base Rate Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14903.36,,,,,,,fee schedule,14193.68,34571.69,MSDRG Base Rate Ventricular Shunt Procedures Without Cc/Mcc,33,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14193.68,,,,,,,fee schedule,14193.68,34571.69,MSDRG Base Rate Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,54394.95,,,,,,,fee schedule,33038.35,80471.85, Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,70129.34,,,,,,,fee schedule,33038.35,80471.85, Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,67059.88,,,,,,,fee schedule,33038.35,80471.85, Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,80471.85,,,,,,,fee schedule,33038.35,80471.85, Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,34359.88,,,,,,,fee schedule,33038.35,80471.85,MSDRG Base Rate Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34690.27,,,,,,,fee schedule,33038.35,80471.85,MSDRG Base Rate Carotid Artery Stent Procedures With Mcc,34,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,33038.35,,,,,,,fee schedule,33038.35,80471.85,MSDRG Base Rate Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,33593.7,,,,,,,fee schedule,20404.11,49698.5, Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,43311.08,,,,,,,fee schedule,20404.11,49698.5, Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,41415.41,,,,,,,fee schedule,20404.11,49698.5, Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,49698.5,,,,,,,fee schedule,20404.11,49698.5, Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21220.27,,,,,,,fee schedule,20404.11,49698.5,MSDRG Base Rate Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21424.32,,,,,,,fee schedule,20404.11,49698.5,MSDRG Base Rate Carotid Artery Stent Procedures With Cc,35,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20404.11,,,,,,,fee schedule,20404.11,49698.5,MSDRG Base Rate Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27302.17,,,,,,,fee schedule,16582.76,40390.81, Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35199.65,,,,,,,fee schedule,16582.76,40390.81, Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33659.01,,,,,,,fee schedule,16582.76,40390.81, Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40390.81,,,,,,,fee schedule,16582.76,40390.81, Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17246.07,,,,,,,fee schedule,16582.76,40390.81,MSDRG Base Rate Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17411.9,,,,,,,fee schedule,16582.76,40390.81,MSDRG Base Rate Carotid Artery Stent Procedures Without Cc/Mcc,36,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16582.76,,,,,,,fee schedule,16582.76,40390.81,MSDRG Base Rate Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,46263.88,,,,,,,fee schedule,28099.71,68442.76, Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,59646.27,,,,,,,fee schedule,28099.71,68442.76, Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,57035.63,,,,,,,fee schedule,28099.71,68442.76, Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,68442.76,,,,,,,fee schedule,28099.71,68442.76, Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,29223.7,,,,,,,fee schedule,28099.71,68442.76,MSDRG Base Rate Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29504.7,,,,,,,fee schedule,28099.71,68442.76,MSDRG Base Rate Extracranial Procedures With Mcc,37,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,28099.71,,,,,,,fee schedule,28099.71,68442.76,MSDRG Base Rate Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22802.4,,,,,,,fee schedule,13849.7,33733.85, Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29398.27,,,,,,,fee schedule,13849.7,33733.85, Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28111.55,,,,,,,fee schedule,13849.7,33733.85, Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33733.85,,,,,,,fee schedule,13849.7,33733.85, Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14403.69,,,,,,,fee schedule,13849.7,33733.85,MSDRG Base Rate Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14542.19,,,,,,,fee schedule,13849.7,33733.85,MSDRG Base Rate Extracranial Procedures With Cc,38,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13849.7,,,,,,,fee schedule,13849.7,33733.85,MSDRG Base Rate Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16519.3,,,,,,,fee schedule,10033.48,24438.65, Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21297.71,,,,,,,fee schedule,10033.48,24438.65, Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20365.54,,,,,,,fee schedule,10033.48,24438.65, Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24438.65,,,,,,,fee schedule,10033.48,24438.65, Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10434.82,,,,,,,fee schedule,10033.48,24438.65,MSDRG Base Rate Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10535.15,,,,,,,fee schedule,10033.48,24438.65,MSDRG Base Rate Extracranial Procedures Without Cc/Mcc,39,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10033.48,,,,,,,fee schedule,10033.48,24438.65,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,54261.44,,,,,,,fee schedule,32957.26,80274.35, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,69957.22,,,,,,,fee schedule,32957.26,80274.35, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,66895.29,,,,,,,fee schedule,32957.26,80274.35, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,80274.35,,,,,,,fee schedule,32957.26,80274.35, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,34275.55,,,,,,,fee schedule,32957.26,80274.35,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34605.12,,,,,,,fee schedule,32957.26,80274.35,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc",40,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,32957.26,,,,,,,fee schedule,32957.26,80274.35,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30898.33,,,,,,,fee schedule,18767,45710.97, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39836.05,,,,,,,fee schedule,18767,45710.97, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38092.48,,,,,,,fee schedule,18767,45710.97, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45710.97,,,,,,,fee schedule,18767,45710.97, "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],8606.4,8606.4,8606.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19517.68,,,,,,,fee schedule,18767,45710.97,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19705.35,,,,,,,fee schedule,18767,45710.97,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator",41,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18767,,,,,,,fee schedule,18767,45710.97,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24279.37,,,,,,,fee schedule,14746.78,35918.88, "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31302.47,,,,,,,fee schedule,14746.78,35918.88, "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29932.4,,,,,,,fee schedule,14746.78,35918.88, "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35918.88,,,,,,,fee schedule,14746.78,35918.88, "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15336.65,,,,,,,fee schedule,14746.78,35918.88,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15484.12,,,,,,,fee schedule,14746.78,35918.88,MSDRG Base Rate "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc",42,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14746.78,,,,,,,fee schedule,14746.78,35918.88,MSDRG Base Rate Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hyphema,43,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections,44,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological eye disorders,45,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w CC,46,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age >17 w/o CC,47,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders of the Eye Age 0-17,48,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures,49,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sialoadenectomy,50,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures Except Sialoadenectomy,51,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25454.2,,,,,,,fee schedule,15460.35,37656.93, Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32817.13,,,,,,,fee schedule,15460.35,37656.93, Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31380.77,,,,,,,fee schedule,15460.35,37656.93, Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37656.93,,,,,,,fee schedule,15460.35,37656.93, Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24083.75,24083.75,24083.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16078.76,,,,,,,fee schedule,15460.35,37656.93,MSDRG Base Rate Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16233.37,,,,,,,fee schedule,15460.35,37656.93,MSDRG Base Rate Spinal Disorders And Injuries With Cc/Mcc,52,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15460.35,,,,,,,fee schedule,15460.35,37656.93,MSDRG Base Rate Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13760.7,,,,,,,fee schedule,8357.96,20357.57, Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17741.15,,,,,,,fee schedule,8357.96,20357.57, Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16964.64,,,,,,,fee schedule,8357.96,20357.57, Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20357.57,,,,,,,fee schedule,8357.96,20357.57, Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8692.28,,,,,,,fee schedule,8357.96,20357.57,MSDRG Base Rate Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8775.86,,,,,,,fee schedule,8357.96,20357.57,MSDRG Base Rate Spinal Disorders And Injuries Without Cc/Mcc,53,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8357.96,,,,,,,fee schedule,8357.96,20357.57,MSDRG Base Rate Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21457.53,,,,,,,fee schedule,13032.85,31744.25, Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27664.37,,,,,,,fee schedule,13032.85,31744.25, Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26453.54,,,,,,,fee schedule,13032.85,31744.25, Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31744.25,,,,,,,fee schedule,13032.85,31744.25, Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],23896.13,19875.07,25148.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],19870.07,19870.07,19870.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13554.16,,,,,,,fee schedule,13032.85,31744.25,MSDRG Base Rate Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13684.49,,,,,,,fee schedule,13032.85,31744.25,MSDRG Base Rate Nervous System Neoplasms With Mcc,54,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13032.85,,,,,,,fee schedule,13032.85,31744.25,MSDRG Base Rate Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14328.44,,,,,,,fee schedule,8702.79,21197.48, Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18473.11,,,,,,,fee schedule,8702.79,21197.48, Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17664.57,,,,,,,fee schedule,8702.79,21197.48, Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21197.48,,,,,,,fee schedule,8702.79,21197.48, Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],9137.12,9137.12,9137.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,26118.68,26118.68,26118.68,1 through 10,percent of total billed charges,,, Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9050.9,,,,,,,fee schedule,8702.79,21197.48,MSDRG Base Rate Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9137.93,,,,,,,fee schedule,8702.79,21197.48,MSDRG Base Rate Nervous System Neoplasms Without Mcc,55,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8702.79,,,,,,,fee schedule,8702.79,21197.48,MSDRG Base Rate Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32646.52,,,,,,,fee schedule,19828.81,48297.25, Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,42089.93,,,,,,,fee schedule,19828.81,48297.25, Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40247.71,,,,,,,fee schedule,19828.81,48297.25, Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48297.25,,,,,,,fee schedule,19828.81,48297.25, Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],34548,34548,34548,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20621.96,,,,,,,fee schedule,19828.81,48297.25,MSDRG Base Rate Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20820.25,,,,,,,fee schedule,19828.81,48297.25,MSDRG Base Rate Degenerative Nervous System Disorders With Mcc,56,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19828.81,,,,,,,fee schedule,19828.81,48297.25,MSDRG Base Rate Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18207.07,,,,,,,fee schedule,11058.59,26935.52, Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23473.68,,,,,,,fee schedule,11058.59,26935.52, Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22446.27,,,,,,,fee schedule,11058.59,26935.52, Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26935.52,,,,,,,fee schedule,11058.59,26935.52, Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],12389,12389,35032,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16397.59,16397.59,16397.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],16012.8,16012.8,16012.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22736.77,22736.77,22736.77,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11500.93,,,,,,,fee schedule,11058.59,26935.52,MSDRG Base Rate Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11611.52,,,,,,,fee schedule,11058.59,26935.52,MSDRG Base Rate Degenerative Nervous System Disorders Without Mcc,57,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11058.59,,,,,,,fee schedule,11058.59,26935.52,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24023.6,,,,,,,fee schedule,14591.43,35540.51, Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30972.72,,,,,,,fee schedule,14591.43,35540.51, Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29617.09,,,,,,,fee schedule,14591.43,35540.51, Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35540.51,,,,,,,fee schedule,14591.43,35540.51, Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13213.78,13213.78,13213.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15175.09,,,,,,,fee schedule,14591.43,35540.51,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15321,,,,,,,fee schedule,14591.43,35540.51,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia With Mcc,58,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14591.43,,,,,,,fee schedule,14591.43,35540.51,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17438.37,,,,,,,fee schedule,10591.7,25798.31, Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22482.63,,,,,,,fee schedule,10591.7,25798.31, Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21498.59,,,,,,,fee schedule,10591.7,25798.31, Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25798.31,,,,,,,fee schedule,10591.7,25798.31, Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21852.83,21852.83,21852.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],6380.2,6380.2,6380.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11015.37,,,,,,,fee schedule,10591.7,25798.31,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11121.29,,,,,,,fee schedule,10591.7,25798.31,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia With Cc,59,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10591.7,,,,,,,fee schedule,10591.7,25798.31,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12925.95,,,,,,,fee schedule,7850.95,19122.64, Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16664.94,,,,,,,fee schedule,7850.95,19122.64, Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15935.54,,,,,,,fee schedule,7850.95,19122.64, Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19122.64,,,,,,,fee schedule,7850.95,19122.64, Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11743.94,11743.94,11743.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8164.99,,,,,,,fee schedule,7850.95,19122.64,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8243.5,,,,,,,fee schedule,7850.95,19122.64,MSDRG Base Rate Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc,60,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7850.95,,,,,,,fee schedule,7850.95,19122.64,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38745.53,,,,,,,fee schedule,23533.22,57320.11, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,49953.14,,,,,,,fee schedule,23533.22,57320.11, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,47766.76,,,,,,,fee schedule,23533.22,57320.11, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,57320.11,,,,,,,fee schedule,23533.22,57320.11, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24474.55,,,,,,,fee schedule,23533.22,57320.11,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24709.88,,,,,,,fee schedule,23533.22,57320.11,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc",61,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23533.22,,,,,,,fee schedule,23533.22,57320.11,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24693.93,,,,,,,fee schedule,14998.58,36532.19, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31836.95,,,,,,,fee schedule,14998.58,36532.19, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30443.49,,,,,,,fee schedule,14998.58,36532.19, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36532.19,,,,,,,fee schedule,14998.58,36532.19, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",24127.49,24127.49,24127.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15598.52,,,,,,,fee schedule,14998.58,36532.19,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15748.51,,,,,,,fee schedule,14998.58,36532.19,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc",62,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14998.58,,,,,,,fee schedule,14998.58,36532.19,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19727.6,,,,,,,fee schedule,11982.13,29185, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25434.05,,,,,,,fee schedule,11982.13,29185, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24320.84,,,,,,,fee schedule,11982.13,29185, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29185,,,,,,,fee schedule,11982.13,29185, "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],23559.19,23559.19,23559.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12461.42,,,,,,,fee schedule,11982.13,29185,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12581.24,,,,,,,fee schedule,11982.13,29185,MSDRG Base Rate "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc",63,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11982.13,,,,,,,fee schedule,11982.13,29185,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28260.58,,,,,,,fee schedule,17164.88,41808.69, Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36435.3,,,,,,,fee schedule,17164.88,41808.69, Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34840.58,,,,,,,fee schedule,17164.88,41808.69, Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41808.69,,,,,,,fee schedule,17164.88,41808.69, Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],38339,38339,38339,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],16914.84,8800.81,17214.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",25534.15,25534.15,25534.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",24127.49,24127.49,24127.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13175,13175,13175,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],32821.8,32821.8,32821.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],16556.64,16556.64,16556.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",23709.94,23709.94,23709.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,29322.03,29322.03,29322.03,1 through 10,percent of total billed charges,,, Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17851.48,,,,,,,fee schedule,17164.88,41808.69,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18023.12,,,,,,,fee schedule,17164.88,41808.69,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction With Mcc,64,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17164.88,,,,,,,fee schedule,17164.88,41808.69,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14197.75,,,,,,,fee schedule,8623.41,21004.14, Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18304.62,,,,,,,fee schedule,8623.41,21004.14, Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17503.45,,,,,,,fee schedule,8623.41,21004.14, Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21004.14,,,,,,,fee schedule,8623.41,21004.14, Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],37448,37448,37448,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",25005.25,25005.25,25005.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],5879.09,5879.09,17059.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],8466.71,8466.71,8466.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",41237.36,41237.36,41237.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,22179.2,22179.2,22179.2,1 through 10,percent of total billed charges,,, Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8968.35,,,,,,,fee schedule,8623.41,21004.14,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9054.58,,,,,,,fee schedule,8623.41,21004.14,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours,65,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8623.41,,,,,,,fee schedule,8623.41,21004.14,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9617.87,,,,,,,fee schedule,5841.69,14228.68, Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12399.96,,,,,,,fee schedule,5841.69,14228.68, Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11857.23,,,,,,,fee schedule,5841.69,14228.68, Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14228.68,,,,,,,fee schedule,5841.69,14228.68, Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,25508.96,25508.96,25508.96,1 through 10,percent of total billed charges,,, Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6075.36,,,,,,,fee schedule,5841.69,14228.68,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6133.77,,,,,,,fee schedule,5841.69,14228.68,MSDRG Base Rate Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc,66,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5841.69,,,,,,,fee schedule,5841.69,14228.68,MSDRG Base Rate Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20639.64,,,,,,,fee schedule,12536.08,30534.27, Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26609.91,,,,,,,fee schedule,12536.08,30534.27, Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25445.23,,,,,,,fee schedule,12536.08,30534.27, Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30534.27,,,,,,,fee schedule,12536.08,30534.27, Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13037.52,,,,,,,fee schedule,12536.08,30534.27,MSDRG Base Rate Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13162.88,,,,,,,fee schedule,12536.08,30534.27,MSDRG Base Rate Precerebral Occlusion Without Infarction With Mcc,67,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12536.08,,,,,,,fee schedule,12536.08,30534.27,MSDRG Base Rate Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12147.41,,,,,,,fee schedule,7378.08,17970.88, Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15661.2,,,,,,,fee schedule,7378.08,17970.88, Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14975.73,,,,,,,fee schedule,7378.08,17970.88, Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17970.88,,,,,,,fee schedule,7378.08,17970.88, Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14438.04,14438.04,14438.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7673.2,,,,,,,fee schedule,7378.08,17970.88,MSDRG Base Rate Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7746.98,,,,,,,fee schedule,7378.08,17970.88,MSDRG Base Rate Precerebral Occlusion Without Infarction Without Mcc,68,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7378.08,,,,,,,fee schedule,7378.08,17970.88,MSDRG Base Rate Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11225.54,,,,,,,fee schedule,6818.15,16607.05, Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14472.66,,,,,,,fee schedule,6818.15,16607.05, Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13839.21,,,,,,,fee schedule,6818.15,16607.05, Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16607.05,,,,,,,fee schedule,6818.15,16607.05, Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7090.88,,,,,,,fee schedule,6818.15,16607.05,MSDRG Base Rate Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7159.06,,,,,,,fee schedule,6818.15,16607.05,MSDRG Base Rate Transient Ischemia Without Thrombolytic,69,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6818.15,,,,,,,fee schedule,6818.15,16607.05,MSDRG Base Rate Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23395.43,,,,,,,fee schedule,14209.9,34611.19, Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30162.85,,,,,,,fee schedule,14209.9,34611.19, Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28842.66,,,,,,,fee schedule,14209.9,34611.19, Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34611.19,,,,,,,fee schedule,14209.9,34611.19, Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18243.84,18243.84,18243.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17168.56,17168.56,17168.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],29170.11,29170.11,29170.11,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16883.56,16883.56,16883.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14778.3,,,,,,,fee schedule,14209.9,34611.19,MSDRG Base Rate Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14920.4,,,,,,,fee schedule,14209.9,34611.19,MSDRG Base Rate Other Cerebrovascular Disorders With Mcc,70,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14209.9,,,,,,,fee schedule,14209.9,34611.19,MSDRG Base Rate Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14418.38,,,,,,,fee schedule,8757.42,21330.54, Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18589.07,,,,,,,fee schedule,8757.42,21330.54, Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17775.45,,,,,,,fee schedule,8757.42,21330.54, Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21330.54,,,,,,,fee schedule,8757.42,21330.54, Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8637,8637,8637,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16883.56,16883.56,16883.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,45428.75,45428.75,45428.75,1 through 10,percent of total billed charges,,, Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,22740.14,22740.14,22740.14,1 through 10,percent of total billed charges,,, Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9107.72,,,,,,,fee schedule,8757.42,21330.54,MSDRG Base Rate Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9195.29,,,,,,,fee schedule,8757.42,21330.54,MSDRG Base Rate Other Cerebrovascular Disorders With Cc,71,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8757.42,,,,,,,fee schedule,8757.42,21330.54,MSDRG Base Rate Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10626.88,,,,,,,fee schedule,6454.54,15721.4, Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13700.83,,,,,,,fee schedule,6454.54,15721.4, Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13101.17,,,,,,,fee schedule,6454.54,15721.4, Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15721.4,,,,,,,fee schedule,6454.54,15721.4, Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6712.72,,,,,,,fee schedule,6454.54,15721.4,MSDRG Base Rate Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6777.27,,,,,,,fee schedule,6454.54,15721.4,MSDRG Base Rate Other Cerebrovascular Disorders Without Cc/Mcc,72,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6454.54,,,,,,,fee schedule,6454.54,15721.4,MSDRG Base Rate Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22545.23,,,,,,,fee schedule,13693.5,33353.4, Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29066.71,,,,,,,fee schedule,13693.5,33353.4, Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27794.5,,,,,,,fee schedule,13693.5,33353.4, Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33353.4,,,,,,,fee schedule,13693.5,33353.4, Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",32104.88,32104.88,32104.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14241.24,,,,,,,fee schedule,13693.5,33353.4,MSDRG Base Rate Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14378.18,,,,,,,fee schedule,13693.5,33353.4,MSDRG Base Rate Cranial And Peripheral Nerve Disorders With Mcc,73,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13693.5,,,,,,,fee schedule,13693.5,33353.4,MSDRG Base Rate Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14485.83,,,,,,,fee schedule,8798.39,21430.33, Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18676.03,,,,,,,fee schedule,8798.39,21430.33, Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17858.61,,,,,,,fee schedule,8798.39,21430.33, Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21430.33,,,,,,,fee schedule,8798.39,21430.33, Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2183.2,2183.2,2183.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14087.8,14087.8,18332.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17287.3,17287.3,17487.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],17008.2,17008.2,17008.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13861.48,13861.48,13861.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9150.33,,,,,,,fee schedule,8798.39,21430.33,MSDRG Base Rate Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9238.31,,,,,,,fee schedule,8798.39,21430.33,MSDRG Base Rate Cranial And Peripheral Nerve Disorders Without Mcc,74,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8798.39,,,,,,,fee schedule,8798.39,21430.33,MSDRG Base Rate Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26946.63,,,,,,,fee schedule,16366.82,39864.83, Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34741.27,,,,,,,fee schedule,16366.82,39864.83, Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33220.69,,,,,,,fee schedule,16366.82,39864.83, Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,39864.83,,,,,,,fee schedule,16366.82,39864.83, Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],11516,11516,11516,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17021.49,,,,,,,fee schedule,16366.82,39864.83,MSDRG Base Rate Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17185.16,,,,,,,fee schedule,16366.82,39864.83,MSDRG Base Rate Viral Meningitis With Cc/Mcc,75,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16366.82,,,,,,,fee schedule,16366.82,39864.83,MSDRG Base Rate Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11596.54,,,,,,,fee schedule,7043.49,17155.91, Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14950.97,,,,,,,fee schedule,7043.49,17155.91, Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14296.59,,,,,,,fee schedule,7043.49,17155.91, Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17155.91,,,,,,,fee schedule,7043.49,17155.91, Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7325.23,,,,,,,fee schedule,7043.49,17155.91,MSDRG Base Rate Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7395.66,,,,,,,fee schedule,7043.49,17155.91,MSDRG Base Rate Viral Meningitis Without Cc/Mcc,76,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7043.49,,,,,,,fee schedule,7043.49,17155.91,MSDRG Base Rate Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21728.75,,,,,,,fee schedule,21728.75,28014.05, Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28014.05,,,,,,,fee schedule,21728.75,28014.05, Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Mcc,77,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14022.08,,,,,,,fee schedule,14022.08,18078.14, Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18078.14,,,,,,,fee schedule,14022.08,18078.14, Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy With Cc,78,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9369.14,,,,,,,fee schedule,9369.14,12079.27, Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12079.27,,,,,,,fee schedule,9369.14,12079.27, Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertensive Encephalopathy Without Cc/Mcc,79,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25435.93,,,,,,,fee schedule,15449.25,37629.9, Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32793.58,,,,,,,fee schedule,15449.25,37629.9, Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31358.25,,,,,,,fee schedule,15449.25,37629.9, Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37629.9,,,,,,,fee schedule,15449.25,37629.9, Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],14395,14395,14395,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],29642.52,29642.52,29642.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16067.22,,,,,,,fee schedule,15449.25,37629.9,MSDRG Base Rate Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16221.71,,,,,,,fee schedule,15449.25,37629.9,MSDRG Base Rate Nontraumatic Stupor And Coma With Mcc,80,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15449.25,,,,,,,fee schedule,15449.25,37629.9,MSDRG Base Rate Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12585.87,,,,,,,fee schedule,7644.39,18619.52, Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16226.48,,,,,,,fee schedule,7644.39,18619.52, Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15516.27,,,,,,,fee schedule,7644.39,18619.52, Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18619.52,,,,,,,fee schedule,7644.39,18619.52, Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15178.92,15178.92,15178.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7950.17,,,,,,,fee schedule,7644.39,18619.52,MSDRG Base Rate Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8026.61,,,,,,,fee schedule,7644.39,18619.52,MSDRG Base Rate Nontraumatic Stupor And Coma Without Mcc,81,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7644.39,,,,,,,fee schedule,7644.39,18619.52,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32119.54,,,,,,,fee schedule,19508.73,47517.62, Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41410.5,,,,,,,fee schedule,19508.73,47517.62, Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,39598.02,,,,,,,fee schedule,19508.73,47517.62, Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,47517.62,,,,,,,fee schedule,19508.73,47517.62, Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20289.08,,,,,,,fee schedule,19508.73,47517.62,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20484.17,,,,,,,fee schedule,19508.73,47517.62,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour With Mcc,82,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19508.73,,,,,,,fee schedule,19508.73,47517.62,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19615.18,,,,,,,fee schedule,11913.85,29018.68, Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25289.1,,,,,,,fee schedule,11913.85,29018.68, Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24182.24,,,,,,,fee schedule,11913.85,29018.68, Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29018.68,,,,,,,fee schedule,11913.85,29018.68, Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",24616.03,24616.03,24616.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18432.6,18432.6,18432.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,21498.16,21498.16,21498.16,1 through 10,percent of total billed charges,,, Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12390.4,,,,,,,fee schedule,11913.85,29018.68,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12509.54,,,,,,,fee schedule,11913.85,29018.68,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour With Cc,83,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11913.85,,,,,,,fee schedule,11913.85,29018.68,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13431.86,,,,,,,fee schedule,8158.23,19871.08, Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17317.18,,,,,,,fee schedule,8158.23,19871.08, Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16559.24,,,,,,,fee schedule,8158.23,19871.08, Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19871.08,,,,,,,fee schedule,8158.23,19871.08, Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8484.56,,,,,,,fee schedule,8158.23,19871.08,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8566.14,,,,,,,fee schedule,8158.23,19871.08,MSDRG Base Rate Traumatic Stupor And Coma >1 Hour Without Cc/Mcc,84,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8158.23,,,,,,,fee schedule,8158.23,19871.08,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31927.01,,,,,,,fee schedule,19391.8,47232.8, Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41162.28,,,,,,,fee schedule,19391.8,47232.8, Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,39360.67,,,,,,,fee schedule,19391.8,47232.8, Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,47232.8,,,,,,,fee schedule,19391.8,47232.8, Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20167.47,,,,,,,fee schedule,19391.8,47232.8,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20361.39,,,,,,,fee schedule,19391.8,47232.8,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour With Mcc,85,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19391.8,,,,,,,fee schedule,19391.8,47232.8,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18306.84,,,,,,,fee schedule,11119.19,27083.13, Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23602.32,,,,,,,fee schedule,11119.19,27083.13, Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22569.28,,,,,,,fee schedule,11119.19,27083.13, Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27083.13,,,,,,,fee schedule,11119.19,27083.13, Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11563.96,,,,,,,fee schedule,11119.19,27083.13,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11675.15,,,,,,,fee schedule,11119.19,27083.13,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour With Cc,86,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11119.19,,,,,,,fee schedule,11119.19,27083.13,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12854.28,,,,,,,fee schedule,7807.42,19016.61, Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16572.53,,,,,,,fee schedule,7807.42,19016.61, Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15847.18,,,,,,,fee schedule,7807.42,19016.61, Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19016.61,,,,,,,fee schedule,7807.42,19016.61, Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8119.72,,,,,,,fee schedule,7807.42,19016.61,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8197.79,,,,,,,fee schedule,7807.42,19016.61,MSDRG Base Rate Traumatic Stupor And Coma <1 Hour Without Cc/Mcc,87,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7807.42,,,,,,,fee schedule,7807.42,19016.61,MSDRG Base Rate Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18996.85,,,,,,,fee schedule,11538.28,28103.92, Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24491.91,,,,,,,fee schedule,11538.28,28103.92, Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23419.94,,,,,,,fee schedule,11538.28,28103.92, Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28103.92,,,,,,,fee schedule,11538.28,28103.92, Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11999.81,,,,,,,fee schedule,11538.28,28103.92,MSDRG Base Rate Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12115.19,,,,,,,fee schedule,11538.28,28103.92,MSDRG Base Rate Concussion With Mcc,88,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11538.28,,,,,,,fee schedule,11538.28,28103.92,MSDRG Base Rate Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15438.63,,,,,,,fee schedule,9377.1,22839.89, Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19904.43,,,,,,,fee schedule,9377.1,22839.89, Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19033.25,,,,,,,fee schedule,9377.1,22839.89, Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22839.89,,,,,,,fee schedule,9377.1,22839.89, Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9752.18,,,,,,,fee schedule,9377.1,22839.89,MSDRG Base Rate Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9845.96,,,,,,,fee schedule,9377.1,22839.89,MSDRG Base Rate Concussion With Cc,89,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9377.1,,,,,,,fee schedule,9377.1,22839.89,MSDRG Base Rate Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11568.43,,,,,,,fee schedule,7026.42,17114.33, Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14914.74,,,,,,,fee schedule,7026.42,17114.33, Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14261.94,,,,,,,fee schedule,7026.42,17114.33, Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17114.33,,,,,,,fee schedule,7026.42,17114.33, Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7307.48,,,,,,,fee schedule,7026.42,17114.33,MSDRG Base Rate Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7377.74,,,,,,,fee schedule,7026.42,17114.33,MSDRG Base Rate Concussion Without Cc/Mcc,90,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7026.42,,,,,,,fee schedule,7026.42,17114.33,MSDRG Base Rate Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24679.88,,,,,,,fee schedule,14990.04,36511.4, Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31818.83,,,,,,,fee schedule,14990.04,36511.4, Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30426.17,,,,,,,fee schedule,14990.04,36511.4, Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36511.4,,,,,,,fee schedule,14990.04,36511.4, Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",31467.13,31467.13,31467.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15589.64,,,,,,,fee schedule,14990.04,36511.4,MSDRG Base Rate Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15739.54,,,,,,,fee schedule,14990.04,36511.4,MSDRG Base Rate Other Disorders Of Nervous System With Mcc,91,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14990.04,,,,,,,fee schedule,14990.04,36511.4,MSDRG Base Rate Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14376.22,,,,,,,fee schedule,8731.81,21268.17, Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18534.71,,,,,,,fee schedule,8731.81,21268.17, Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17723.48,,,,,,,fee schedule,8731.81,21268.17, Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21268.17,,,,,,,fee schedule,8731.81,21268.17, Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],6830.62,6830.62,6830.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15895.31,15895.31,15895.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17762.43,17762.43,17762.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12224.53,12224.53,12224.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9081.08,,,,,,,fee schedule,8731.81,21268.17,MSDRG Base Rate Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9168.4,,,,,,,fee schedule,8731.81,21268.17,MSDRG Base Rate Other Disorders Of Nervous System With Cc,92,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8731.81,,,,,,,fee schedule,8731.81,21268.17,MSDRG Base Rate Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11190.4,,,,,,,fee schedule,6796.82,16555.08, Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14427.36,,,,,,,fee schedule,6796.82,16555.08, Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13795.9,,,,,,,fee schedule,6796.82,16555.08, Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16555.08,,,,,,,fee schedule,6796.82,16555.08, Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10443.61,10443.61,13191.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],5973.5,5973.5,5973.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7068.69,,,,,,,fee schedule,6796.82,16555.08,MSDRG Base Rate Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7136.66,,,,,,,fee schedule,6796.82,16555.08,MSDRG Base Rate Other Disorders Of Nervous System Without Cc/Mcc,93,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6796.82,,,,,,,fee schedule,6796.82,16555.08,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,49458.13,,,,,,,fee schedule,30039.83,73168.33, Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,63764.49,,,,,,,fee schedule,30039.83,73168.33, Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,60973.61,,,,,,,fee schedule,30039.83,73168.33, Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,73168.33,,,,,,,fee schedule,30039.83,73168.33, Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",37140.12,37140.12,37140.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31241.42,,,,,,,fee schedule,30039.83,73168.33,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31541.82,,,,,,,fee schedule,30039.83,73168.33,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System With Mcc,94,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30039.83,,,,,,,fee schedule,30039.83,73168.33,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,36245.5,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,46729.95,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44684.64,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,53621.57,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22895.34,,,,,,,fee schedule,22014.75,53621.57,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23115.49,,,,,,,fee schedule,22014.75,53621.57,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System With Cc,95,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22014.75,,,,,,,fee schedule,22014.75,53621.57,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,36245.5,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,46729.95,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44684.64,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,53621.57,,,,,,,fee schedule,22014.75,53621.57, Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22895.34,,,,,,,fee schedule,22014.75,53621.57,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23115.49,,,,,,,fee schedule,22014.75,53621.57,MSDRG Base Rate Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc,96,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22014.75,,,,,,,fee schedule,22014.75,53621.57,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50756.63,,,,,,,fee schedule,30828.51,75089.32, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,65438.59,,,,,,,fee schedule,30828.51,75089.32, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,62574.44,,,,,,,fee schedule,30828.51,75089.32, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,75089.32,,,,,,,fee schedule,30828.51,75089.32, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13135.61,13135.61,13135.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32061.65,,,,,,,fee schedule,30828.51,75089.32,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32369.94,,,,,,,fee schedule,30828.51,75089.32,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc,97,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30828.51,,,,,,,fee schedule,30828.51,75089.32,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32250.23,,,,,,,fee schedule,19588.11,47710.97, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41579,,,,,,,fee schedule,19588.11,47710.97, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,39759.14,,,,,,,fee schedule,19588.11,47710.97, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,47710.97,,,,,,,fee schedule,19588.11,47710.97, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21852.83,21852.83,21852.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21239.08,21239.08,21239.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,58681.26,58681.26,58681.26,1 through 10,percent of total billed charges,,, Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20371.63,,,,,,,fee schedule,19588.11,47710.97,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20567.52,,,,,,,fee schedule,19588.11,47710.97,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc,98,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19588.11,,,,,,,fee schedule,19588.11,47710.97,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19145.81,,,,,,,fee schedule,11628.76,28324.3, Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24683.96,,,,,,,fee schedule,11628.76,28324.3, Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23603.58,,,,,,,fee schedule,11628.76,28324.3, Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28324.3,,,,,,,fee schedule,11628.76,28324.3, Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12093.91,,,,,,,fee schedule,11628.76,28324.3,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12210.2,,,,,,,fee schedule,11628.76,28324.3,MSDRG Base Rate Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc,99,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11628.76,,,,,,,fee schedule,11628.76,28324.3,MSDRG Base Rate Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27217.85,,,,,,,fee schedule,16531.55,40266.07, Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35090.94,,,,,,,fee schedule,16531.55,40266.07, Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33555.06,,,,,,,fee schedule,16531.55,40266.07, Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40266.07,,,,,,,fee schedule,16531.55,40266.07, Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],19328,19328,19328,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],2648.9,2648.9,2648.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",33349.26,33349.26,33349.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],32757.45,32757.45,32757.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9199.05,9199.05,9199.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17192.81,,,,,,,fee schedule,16531.55,40266.07,MSDRG Base Rate Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17358.13,,,,,,,fee schedule,16531.55,40266.07,MSDRG Base Rate Seizures With Mcc,100,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16531.55,,,,,,,fee schedule,16531.55,40266.07,MSDRG Base Rate Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12684.24,,,,,,,fee schedule,7704.14,18765.05, Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16353.31,,,,,,,fee schedule,7704.14,18765.05, Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15637.55,,,,,,,fee schedule,7704.14,18765.05, Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18765.05,,,,,,,fee schedule,7704.14,18765.05, Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],7274.4,7274.4,7274.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15462.44,15462.44,15462.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8012.31,,,,,,,fee schedule,7704.14,18765.05,MSDRG Base Rate Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8089.35,,,,,,,fee schedule,7704.14,18765.05,MSDRG Base Rate Seizures Without Mcc,101,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7704.14,,,,,,,fee schedule,7704.14,18765.05,MSDRG Base Rate Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15752.01,,,,,,,fee schedule,9567.44,23303.51, Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20308.47,,,,,,,fee schedule,9567.44,23303.51, Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19419.59,,,,,,,fee schedule,9567.44,23303.51, Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23303.51,,,,,,,fee schedule,9567.44,23303.51, Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9950.14,,,,,,,fee schedule,9567.44,23303.51,MSDRG Base Rate Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10045.81,,,,,,,fee schedule,9567.44,23303.51,MSDRG Base Rate Headaches With Mcc,102,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9567.44,,,,,,,fee schedule,9567.44,23303.51,MSDRG Base Rate Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11752.52,,,,,,,fee schedule,7138.24,17386.68, Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15152.08,,,,,,,fee schedule,7138.24,17386.68, Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14488.9,,,,,,,fee schedule,7138.24,17386.68, Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17386.68,,,,,,,fee schedule,7138.24,17386.68, Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2879,2879,2879,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11448.78,11448.78,11448.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14259.46,14259.46,38509.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7423.77,,,,,,,fee schedule,7138.24,17386.68,MSDRG Base Rate Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7495.15,,,,,,,fee schedule,7138.24,17386.68,MSDRG Base Rate Headaches Without Mcc,103,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7138.24,,,,,,,fee schedule,7138.24,17386.68,MSDRG Base Rate Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath,104,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath,105,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass w PTCA,106,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,107,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures,108,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,109,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w CC,110,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Cardiovascular Procedures w/o CC,111,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,112,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,33040.01,,,,,,,fee schedule,20067.81,48879.37, Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,42597.23,,,,,,,fee schedule,20067.81,48879.37, Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40732.81,,,,,,,fee schedule,20067.81,48879.37, Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48879.37,,,,,,,fee schedule,20067.81,48879.37, Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20870.52,,,,,,,fee schedule,20067.81,48879.37,MSDRG Base Rate Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21071.2,,,,,,,fee schedule,20067.81,48879.37,MSDRG Base Rate Orbital Procedures With Cc/Mcc,113,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20067.81,,,,,,,fee schedule,20067.81,48879.37,MSDRG Base Rate Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19013.71,,,,,,,fee schedule,11548.53,28128.87, Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24513.65,,,,,,,fee schedule,11548.53,28128.87, Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23440.73,,,,,,,fee schedule,11548.53,28128.87, Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28128.87,,,,,,,fee schedule,11548.53,28128.87, Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12010.47,,,,,,,fee schedule,11548.53,28128.87,MSDRG Base Rate Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12125.96,,,,,,,fee schedule,11548.53,28128.87,MSDRG Base Rate Orbital Procedures Without Cc/Mcc,114,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11548.53,,,,,,,fee schedule,11548.53,28128.87,MSDRG Base Rate Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21569.95,,,,,,,fee schedule,13101.13,31910.57, Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27809.32,,,,,,,fee schedule,13101.13,31910.57, Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26592.14,,,,,,,fee schedule,13101.13,31910.57, Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31910.57,,,,,,,fee schedule,13101.13,31910.57, Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13625.18,,,,,,,fee schedule,13101.13,31910.57,MSDRG Base Rate Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13756.19,,,,,,,fee schedule,13101.13,31910.57,MSDRG Base Rate Extraocular Procedures Except Orbit,115,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13101.13,,,,,,,fee schedule,13101.13,31910.57,MSDRG Base Rate Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25409.23,,,,,,,fee schedule,15433.03,37590.4, Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32759.16,,,,,,,fee schedule,15433.03,37590.4, Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31325.33,,,,,,,fee schedule,15433.03,37590.4, Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37590.4,,,,,,,fee schedule,15433.03,37590.4, Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16050.35,,,,,,,fee schedule,15433.03,37590.4,MSDRG Base Rate Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16204.68,,,,,,,fee schedule,15433.03,37590.4,MSDRG Base Rate Intraocular Procedures With Cc/Mcc,116,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15433.03,,,,,,,fee schedule,15433.03,37590.4,MSDRG Base Rate Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15246.1,,,,,,,fee schedule,9260.16,22555.07, Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19656.22,,,,,,,fee schedule,9260.16,22555.07, Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18795.89,,,,,,,fee schedule,9260.16,22555.07, Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22555.07,,,,,,,fee schedule,9260.16,22555.07, Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9630.57,,,,,,,fee schedule,9260.16,22555.07,MSDRG Base Rate Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9723.17,,,,,,,fee schedule,9260.16,22555.07,MSDRG Base Rate Intraocular Procedures Without Cc/Mcc,117,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9260.16,,,,,,,fee schedule,9260.16,22555.07,MSDRG Base Rate Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement,118,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein ligation & stripping,119,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other circulatory system O.R. procedures,120,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16347.85,,,,,,,fee schedule,9929.34,24185.01, Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21076.67,,,,,,,fee schedule,9929.34,24185.01, Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20154.17,,,,,,,fee schedule,9929.34,24185.01, Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24185.01,,,,,,,fee schedule,9929.34,24185.01, Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10326.51,,,,,,,fee schedule,9929.34,24185.01,MSDRG Base Rate Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10425.81,,,,,,,fee schedule,9929.34,24185.01,MSDRG Base Rate Acute Major Eye Infections With Cc/Mcc,121,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9929.34,,,,,,,fee schedule,9929.34,24185.01,MSDRG Base Rate Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11042.85,,,,,,,fee schedule,6707.19,16336.78, Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14237.12,,,,,,,fee schedule,6707.19,16336.78, Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13613.99,,,,,,,fee schedule,6707.19,16336.78, Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16336.78,,,,,,,fee schedule,6707.19,16336.78, Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6975.48,,,,,,,fee schedule,6707.19,16336.78,MSDRG Base Rate Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7042.55,,,,,,,fee schedule,6707.19,16336.78,MSDRG Base Rate Acute Major Eye Infections Without Cc/Mcc,122,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6707.19,,,,,,,fee schedule,6707.19,16336.78,MSDRG Base Rate Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11222.73,,,,,,,fee schedule,6816.45,16602.89, Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14469.03,,,,,,,fee schedule,6816.45,16602.89, Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13835.75,,,,,,,fee schedule,6816.45,16602.89, Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16602.89,,,,,,,fee schedule,6816.45,16602.89, Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],11516,11516,11516,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10647.83,10647.83,10647.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7089.11,,,,,,,fee schedule,6816.45,16602.89,MSDRG Base Rate Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7157.27,,,,,,,fee schedule,6816.45,16602.89,MSDRG Base Rate Neurological Eye Disorders,123,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6816.45,,,,,,,fee schedule,6816.45,16602.89,MSDRG Base Rate Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18593.52,,,,,,,fee schedule,11293.32,27507.25, Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23971.93,,,,,,,fee schedule,11293.32,27507.25, Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22922.71,,,,,,,fee schedule,11293.32,27507.25, Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27507.25,,,,,,,fee schedule,11293.32,27507.25, Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11745.05,,,,,,,fee schedule,11293.32,27507.25,MSDRG Base Rate Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11857.99,,,,,,,fee schedule,11293.32,27507.25,MSDRG Base Rate Other Disorders Of The Eye With Mcc Or Thrombolytic Agent,124,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11293.32,,,,,,,fee schedule,11293.32,27507.25,MSDRG Base Rate Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10789.89,,,,,,,fee schedule,6553.55,15962.56, Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13911,,,,,,,fee schedule,6553.55,15962.56, Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13302.14,,,,,,,fee schedule,6553.55,15962.56, Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15962.56,,,,,,,fee schedule,6553.55,15962.56, Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13851.94,13851.94,13851.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6815.69,,,,,,,fee schedule,6553.55,15962.56,MSDRG Base Rate Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6881.23,,,,,,,fee schedule,6553.55,15962.56,MSDRG Base Rate Other Disorders Of The Eye Without Mcc,125,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6553.55,,,,,,,fee schedule,6553.55,15962.56,MSDRG Base Rate Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute & Subacute Endocarditis,126,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure & Shock,127,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis,128,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W Cc/Mcc Or Major Device,129,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head & Neck Procedures W/O Cc/Mcc,130,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W Cc/Mcc,131,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cranial/Facial Procedures W/O Cc/Mcc,132,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc",133,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc",134,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30495.01,,,,,,,fee schedule,18522.03,45114.3, Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39316.06,,,,,,,fee schedule,18522.03,45114.3, Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37595.25,,,,,,,fee schedule,18522.03,45114.3, Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45114.3,,,,,,,fee schedule,18522.03,45114.3, Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19262.91,,,,,,,fee schedule,18522.03,45114.3,MSDRG Base Rate Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19448.13,,,,,,,fee schedule,18522.03,45114.3,MSDRG Base Rate Sinus And Mastoid Procedures With Cc/Mcc,135,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18522.03,,,,,,,fee schedule,18522.03,45114.3,MSDRG Base Rate Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14268.01,,,,,,,fee schedule,8666.09,21108.09, Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18395.21,,,,,,,fee schedule,8666.09,21108.09, Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17590.07,,,,,,,fee schedule,8666.09,21108.09, Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21108.09,,,,,,,fee schedule,8666.09,21108.09, Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9012.73,,,,,,,fee schedule,8666.09,21108.09,MSDRG Base Rate Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9099.39,,,,,,,fee schedule,8666.09,21108.09,MSDRG Base Rate Sinus And Mastoid Procedures Without Cc/Mcc,136,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8666.09,,,,,,,fee schedule,8666.09,21108.09,MSDRG Base Rate Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20983.94,,,,,,,fee schedule,12745.2,31043.63, Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27053.8,,,,,,,fee schedule,12745.2,31043.63, Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25869.69,,,,,,,fee schedule,12745.2,31043.63, Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31043.63,,,,,,,fee schedule,12745.2,31043.63, Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13255.01,,,,,,,fee schedule,12745.2,31043.63,MSDRG Base Rate Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13382.46,,,,,,,fee schedule,12745.2,31043.63,MSDRG Base Rate Mouth Procedures With Cc/Mcc,137,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12745.2,,,,,,,fee schedule,12745.2,31043.63,MSDRG Base Rate Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12453.77,,,,,,,fee schedule,7564.16,18424.1, Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16056.17,,,,,,,fee schedule,7564.16,18424.1, Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15353.42,,,,,,,fee schedule,7564.16,18424.1, Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18424.1,,,,,,,fee schedule,7564.16,18424.1, Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7866.73,,,,,,,fee schedule,7564.16,18424.1,MSDRG Base Rate Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7942.37,,,,,,,fee schedule,7564.16,18424.1,MSDRG Base Rate Mouth Procedures Without Cc/Mcc,138,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7564.16,,,,,,,fee schedule,7564.16,18424.1,MSDRG Base Rate Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17365.29,,,,,,,fee schedule,10547.31,25690.2, Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22388.41,,,,,,,fee schedule,10547.31,25690.2, Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21408.5,,,,,,,fee schedule,10547.31,25690.2, Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25690.2,,,,,,,fee schedule,10547.31,25690.2, Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10969.2,,,,,,,fee schedule,10547.31,25690.2,MSDRG Base Rate Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11074.68,,,,,,,fee schedule,10547.31,25690.2,MSDRG Base Rate Salivary Gland Procedures,139,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10547.31,,,,,,,fee schedule,10547.31,25690.2,MSDRG Base Rate Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,59940.26,,,,,,,fee schedule,36406.45,88675.59, Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,77278.71,,,,,,,fee schedule,36406.45,88675.59, Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,73896.32,,,,,,,fee schedule,36406.45,88675.59, Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,88675.59,,,,,,,fee schedule,36406.45,88675.59, Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37862.71,,,,,,,fee schedule,36406.45,88675.59,MSDRG Base Rate Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38226.77,,,,,,,fee schedule,36406.45,88675.59,MSDRG Base Rate Major Head And Neck Procedures With Mcc,140,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,36406.45,,,,,,,fee schedule,36406.45,88675.59,MSDRG Base Rate Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30651,,,,,,,fee schedule,18616.77,45345.07, Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39517.17,,,,,,,fee schedule,18616.77,45345.07, Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37787.56,,,,,,,fee schedule,18616.77,45345.07, Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45345.07,,,,,,,fee schedule,18616.77,45345.07, Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19361.44,,,,,,,fee schedule,18616.77,45345.07,MSDRG Base Rate Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19547.61,,,,,,,fee schedule,18616.77,45345.07,MSDRG Base Rate Major Head And Neck Procedures With Cc,141,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18616.77,,,,,,,fee schedule,18616.77,45345.07,MSDRG Base Rate Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22434.21,,,,,,,fee schedule,13626.07,33189.16, Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28923.58,,,,,,,fee schedule,13626.07,33189.16, Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27657.63,,,,,,,fee schedule,13626.07,33189.16, Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33189.16,,,,,,,fee schedule,13626.07,33189.16, Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14171.11,,,,,,,fee schedule,13626.07,33189.16,MSDRG Base Rate Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14307.37,,,,,,,fee schedule,13626.07,33189.16,MSDRG Base Rate Major Head And Neck Procedures Without Cc/Mcc,142,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13626.07,,,,,,,fee schedule,13626.07,33189.16,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,52650.97,,,,,,,fee schedule,31979.09,77891.81, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,67880.9,,,,,,,fee schedule,31979.09,77891.81, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,64909.85,,,,,,,fee schedule,31979.09,77891.81, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,77891.81,,,,,,,fee schedule,31979.09,77891.81, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,33258.25,,,,,,,fee schedule,31979.09,77891.81,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33578.04,,,,,,,fee schedule,31979.09,77891.81,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc",143,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,31979.09,,,,,,,fee schedule,31979.09,77891.81,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24352.44,,,,,,,fee schedule,14791.16,36026.99, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31396.68,,,,,,,fee schedule,14791.16,36026.99, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30022.49,,,,,,,fee schedule,14791.16,36026.99, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36026.99,,,,,,,fee schedule,14791.16,36026.99, "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15382.81,,,,,,,fee schedule,14791.16,36026.99,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15530.72,,,,,,,fee schedule,14791.16,36026.99,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc",144,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14791.16,,,,,,,fee schedule,14791.16,36026.99,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16895.92,,,,,,,fee schedule,10262.23,24995.82, "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21783.27,,,,,,,fee schedule,10262.23,24995.82, "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20829.85,,,,,,,fee schedule,10262.23,24995.82, "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24995.82,,,,,,,fee schedule,10262.23,24995.82, "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],15740.8,15740.8,15740.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10672.72,,,,,,,fee schedule,10262.23,24995.82,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10775.34,,,,,,,fee schedule,10262.23,24995.82,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc",145,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10262.23,,,,,,,fee schedule,10262.23,24995.82,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29755.82,,,,,,,fee schedule,18073.06,44020.75, "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38363.05,,,,,,,fee schedule,18073.06,44020.75, "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36683.96,,,,,,,fee schedule,18073.06,44020.75, "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44020.75,,,,,,,fee schedule,18073.06,44020.75, "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18795.98,,,,,,,fee schedule,18073.06,44020.75,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18976.71,,,,,,,fee schedule,18073.06,44020.75,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy With Mcc",146,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18073.06,,,,,,,fee schedule,18073.06,44020.75,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17868.39,,,,,,,fee schedule,10852.88,26434.49, "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23037.04,,,,,,,fee schedule,10852.88,26434.49, "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22028.74,,,,,,,fee schedule,10852.88,26434.49, "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26434.49,,,,,,,fee schedule,10852.88,26434.49, "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11287,,,,,,,fee schedule,10852.88,26434.49,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11395.52,,,,,,,fee schedule,10852.88,26434.49,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy With Cc",147,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10852.88,,,,,,,fee schedule,10852.88,26434.49,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11201.65,,,,,,,fee schedule,6803.64,16571.71, "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14441.86,,,,,,,fee schedule,6803.64,16571.71, "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13809.76,,,,,,,fee schedule,6803.64,16571.71, "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16571.71,,,,,,,fee schedule,6803.64,16571.71, "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7075.79,,,,,,,fee schedule,6803.64,16571.71,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7143.82,,,,,,,fee schedule,6803.64,16571.71,MSDRG Base Rate "Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc",148,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6803.64,,,,,,,fee schedule,6803.64,16571.71,MSDRG Base Rate Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10562.23,,,,,,,fee schedule,6415.28,15625.76, Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13617.49,,,,,,,fee schedule,6415.28,15625.76, Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13021.47,,,,,,,fee schedule,6415.28,15625.76, Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15625.76,,,,,,,fee schedule,6415.28,15625.76, Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6671.89,,,,,,,fee schedule,6415.28,15625.76,MSDRG Base Rate Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6736.04,,,,,,,fee schedule,6415.28,15625.76,MSDRG Base Rate Dysequilibrium,149,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6415.28,,,,,,,fee schedule,6415.28,15625.76,MSDRG Base Rate Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18711.57,,,,,,,fee schedule,11365.01,27681.89, Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24124.12,,,,,,,fee schedule,11365.01,27681.89, Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23068.24,,,,,,,fee schedule,11365.01,27681.89, Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27681.89,,,,,,,fee schedule,11365.01,27681.89, Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11819.61,,,,,,,fee schedule,11365.01,27681.89,MSDRG Base Rate Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11933.26,,,,,,,fee schedule,11365.01,27681.89,MSDRG Base Rate Epistaxis With Mcc,150,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11365.01,,,,,,,fee schedule,11365.01,27681.89,MSDRG Base Rate Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10314.9,,,,,,,fee schedule,6265.05,15259.86, Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13298.61,,,,,,,fee schedule,6265.05,15259.86, Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12716.55,,,,,,,fee schedule,6265.05,15259.86, Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15259.86,,,,,,,fee schedule,6265.05,15259.86, Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6515.65,,,,,,,fee schedule,6265.05,15259.86,MSDRG Base Rate Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6578.3,,,,,,,fee schedule,6265.05,15259.86,MSDRG Base Rate Epistaxis Without Mcc,151,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6265.05,,,,,,,fee schedule,6265.05,15259.86,MSDRG Base Rate Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16613.46,,,,,,,fee schedule,10090.66,24577.94, Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21419.1,,,,,,,fee schedule,10090.66,24577.94, Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20481.62,,,,,,,fee schedule,10090.66,24577.94, Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24577.94,,,,,,,fee schedule,10090.66,24577.94, Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19037.4,19037.4,19037.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10494.29,,,,,,,fee schedule,10090.66,24577.94,MSDRG Base Rate Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10595.19,,,,,,,fee schedule,10090.66,24577.94,MSDRG Base Rate Otitis Media And Uri With Mcc,152,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10090.66,,,,,,,fee schedule,10090.66,24577.94,MSDRG Base Rate Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10373.92,,,,,,,fee schedule,6300.9,15347.18, Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13374.71,,,,,,,fee schedule,6300.9,15347.18, Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12789.32,,,,,,,fee schedule,6300.9,15347.18, Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15347.18,,,,,,,fee schedule,6300.9,15347.18, Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8413.87,8413.87,8413.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10447.34,10447.34,10447.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7679.13,7679.13,7679.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6552.94,,,,,,,fee schedule,6300.9,15347.18,MSDRG Base Rate Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6615.94,,,,,,,fee schedule,6300.9,15347.18,MSDRG Base Rate Otitis Media And Uri Without Mcc,153,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6300.9,,,,,,,fee schedule,6300.9,15347.18,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21971.87,,,,,,,fee schedule,13345.25,32505.17, "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28327.49,,,,,,,fee schedule,13345.25,32505.17, "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27087.64,,,,,,,fee schedule,13345.25,32505.17, "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32505.17,,,,,,,fee schedule,13345.25,32505.17, "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13879.06,,,,,,,fee schedule,13345.25,32505.17,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14012.51,,,,,,,fee schedule,13345.25,32505.17,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses With Mcc",154,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13345.25,,,,,,,fee schedule,13345.25,32505.17,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12879.57,,,,,,,fee schedule,7822.78,19054.04, "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16605.15,,,,,,,fee schedule,7822.78,19054.04, "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15878.36,,,,,,,fee schedule,7822.78,19054.04, "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19054.04,,,,,,,fee schedule,7822.78,19054.04, "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15662.07,15662.07,15662.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],12611.42,12611.42,12611.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8135.69,,,,,,,fee schedule,7822.78,19054.04,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8213.92,,,,,,,fee schedule,7822.78,19054.04,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses With Cc",155,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7822.78,,,,,,,fee schedule,7822.78,19054.04,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9712.03,,,,,,,fee schedule,5898.88,14367.97, "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12521.35,,,,,,,fee schedule,5898.88,14367.97, "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11973.31,,,,,,,fee schedule,5898.88,14367.97, "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14367.97,,,,,,,fee schedule,5898.88,14367.97, "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6134.84,,,,,,,fee schedule,5898.88,14367.97,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6193.82,,,,,,,fee schedule,5898.88,14367.97,MSDRG Base Rate "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc",156,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5898.88,,,,,,,fee schedule,5898.88,14367.97,MSDRG Base Rate Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24126.19,,,,,,,fee schedule,14653.74,35692.27, Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31104.98,,,,,,,fee schedule,14653.74,35692.27, Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29743.56,,,,,,,fee schedule,14653.74,35692.27, Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35692.27,,,,,,,fee schedule,14653.74,35692.27, Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15239.89,,,,,,,fee schedule,14653.74,35692.27,MSDRG Base Rate Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15386.43,,,,,,,fee schedule,14653.74,35692.27,MSDRG Base Rate Dental And Oral Diseases With Mcc,157,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14653.74,,,,,,,fee schedule,14653.74,35692.27,MSDRG Base Rate Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12785.42,,,,,,,fee schedule,7765.6,18914.74, Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16483.76,,,,,,,fee schedule,7765.6,18914.74, Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15762.29,,,,,,,fee schedule,7765.6,18914.74, Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18914.74,,,,,,,fee schedule,7765.6,18914.74, Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9888.06,9888.06,9888.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8076.22,,,,,,,fee schedule,7765.6,18914.74,MSDRG Base Rate Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8153.88,,,,,,,fee schedule,7765.6,18914.74,MSDRG Base Rate Dental And Oral Diseases With Cc,158,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7765.6,,,,,,,fee schedule,7765.6,18914.74,MSDRG Base Rate Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9956.55,,,,,,,fee schedule,6047.4,14729.72, Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12836.6,,,,,,,fee schedule,6047.4,14729.72, Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12274.76,,,,,,,fee schedule,6047.4,14729.72, Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14729.72,,,,,,,fee schedule,6047.4,14729.72, Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6289.3,,,,,,,fee schedule,6047.4,14729.72,MSDRG Base Rate Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6349.77,,,,,,,fee schedule,6047.4,14729.72,MSDRG Base Rate Dental And Oral Diseases Without Cc/Mcc,159,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6047.4,,,,,,,fee schedule,6047.4,14729.72,MSDRG Base Rate Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC,160,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w CC,161,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal & Femoral Hernia Procedures Age >17 w/o CC,162,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,62982.74,,,,,,,fee schedule,38254.39,93176.62, Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,81201.25,,,,,,,fee schedule,38254.39,93176.62, Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,77647.19,,,,,,,fee schedule,38254.39,93176.62, Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,93176.62,,,,,,,fee schedule,38254.39,93176.62, Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",31598.61,31598.61,31598.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],30174.17,30174.17,30174.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],16369.65,16369.65,16369.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,39784.57,,,,,,,fee schedule,38254.39,93176.62,MSDRG Base Rate Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40167.11,,,,,,,fee schedule,38254.39,93176.62,MSDRG Base Rate Major Chest Procedures With Mcc,163,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,38254.39,,,,,,,fee schedule,38254.39,93176.62,MSDRG Base Rate Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,35469.77,,,,,,,fee schedule,21543.59,52473.96, Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,45729.83,,,,,,,fee schedule,21543.59,52473.96, Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,43728.3,,,,,,,fee schedule,21543.59,52473.96, Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,52473.96,,,,,,,fee schedule,21543.59,52473.96, Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],26390.74,13195.37,42221.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],33370.39,33370.39,33370.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],49836.6,49836.6,49836.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],41346,41346,41346,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22405.33,,,,,,,fee schedule,21543.59,52473.96,MSDRG Base Rate Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22620.77,,,,,,,fee schedule,21543.59,52473.96,MSDRG Base Rate Major Chest Procedures With Cc,164,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21543.59,,,,,,,fee schedule,21543.59,52473.96,MSDRG Base Rate Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26900.25,,,,,,,fee schedule,16338.65,39796.22, Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34681.48,,,,,,,fee schedule,16338.65,39796.22, Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33163.52,,,,,,,fee schedule,16338.65,39796.22, Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,39796.22,,,,,,,fee schedule,16338.65,39796.22, Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5757.13,5752.24,19653,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24169.5,15635.23,31257.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],30756,30756,30756,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,28552,28552,28552,1 through 10,percent of total billed charges,,, Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,49822.76,49822.76,49822.76,1 through 10,percent of total billed charges,,, Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16992.2,,,,,,,fee schedule,16338.65,39796.22,MSDRG Base Rate Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17155.58,,,,,,,fee schedule,16338.65,39796.22,MSDRG Base Rate Major Chest Procedures Without Cc/Mcc,165,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16338.65,,,,,,,fee schedule,16338.65,39796.22,MSDRG Base Rate Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,52525.9,,,,,,,fee schedule,31903.13,77706.78, Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,67719.65,,,,,,,fee schedule,31903.13,77706.78, Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,64755.65,,,,,,,fee schedule,31903.13,77706.78, Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,77706.78,,,,,,,fee schedule,31903.13,77706.78, Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],12450.55,12450.55,12450.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,33179.26,,,,,,,fee schedule,31903.13,77706.78,MSDRG Base Rate Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33498.29,,,,,,,fee schedule,31903.13,77706.78,MSDRG Base Rate Other Respiratory System O.R. Procedures With Mcc,166,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,31903.13,,,,,,,fee schedule,31903.13,77706.78,MSDRG Base Rate Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25343.18,,,,,,,fee schedule,15392.92,37492.69, Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32674,,,,,,,fee schedule,15392.92,37492.69, Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31243.91,,,,,,,fee schedule,15392.92,37492.69, Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37492.69,,,,,,,fee schedule,15392.92,37492.69, Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2879,2879,2879,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],11717.38,11717.38,11717.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],30303.11,30303.11,30303.11,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16008.64,,,,,,,fee schedule,15392.92,37492.69,MSDRG Base Rate Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16162.57,,,,,,,fee schedule,15392.92,37492.69,MSDRG Base Rate Other Respiratory System O.R. Procedures With Cc,167,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15392.92,,,,,,,fee schedule,15392.92,37492.69,MSDRG Base Rate Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19202.02,,,,,,,fee schedule,11662.9,28407.46, Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24756.44,,,,,,,fee schedule,11662.9,28407.46, Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23672.88,,,,,,,fee schedule,11662.9,28407.46, Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28407.46,,,,,,,fee schedule,11662.9,28407.46, Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22713.03,22713.03,22743.22,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],22339.35,22339.35,22339.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12129.42,,,,,,,fee schedule,11662.9,28407.46,MSDRG Base Rate Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12246.04,,,,,,,fee schedule,11662.9,28407.46,MSDRG Base Rate Other Respiratory System O.R. Procedures Without Cc/Mcc,168,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11662.9,,,,,,,fee schedule,11662.9,28407.46,MSDRG Base Rate Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mouth Procedures w/o CC,169,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures w/o CC,171,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,41827.35,,,,,,,fee schedule,25405.05,61879.36, Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,53926.42,,,,,,,fee schedule,25405.05,61879.36, Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,51566.13,,,,,,,fee schedule,25405.05,61879.36, Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,61879.36,,,,,,,fee schedule,25405.05,61879.36, Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26421.25,,,,,,,fee schedule,25405.05,61879.36,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26675.3,,,,,,,fee schedule,25405.05,61879.36,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism,173,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25405.05,,,,,,,fee schedule,25405.05,61879.36,MSDRG Base Rate G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. G.I. hemorrhage w CC,174,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19303.2,,,,,,,fee schedule,11724.36,28557.14, Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24886.88,,,,,,,fee schedule,11724.36,28557.14, Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23797.62,,,,,,,fee schedule,11724.36,28557.14, Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28557.14,,,,,,,fee schedule,11724.36,28557.14, Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],12195.13,12195.13,12195.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",30065.01,30065.01,30065.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11730.56,6230.64,23635.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],21668.11,21668.11,23250.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],11387.83,11387.83,11387.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",20161.21,20161.21,20161.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12193.33,,,,,,,fee schedule,11724.36,28557.14,MSDRG Base Rate Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12310.58,,,,,,,fee schedule,11724.36,28557.14,MSDRG Base Rate Pulmonary Embolism With Mcc Or Acute Cor Pulmonale,175,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11724.36,,,,,,,fee schedule,11724.36,28557.14,MSDRG Base Rate Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11312.67,,,,,,,fee schedule,6871.07,16735.95, Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14584.99,,,,,,,fee schedule,6871.07,16735.95, Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13946.63,,,,,,,fee schedule,6871.07,16735.95, Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16735.95,,,,,,,fee schedule,6871.07,16735.95, Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5091.89,5091.89,5091.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7048.71,7048.71,7048.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13664.05,13664.05,13664.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],13439.25,13439.25,13439.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14651.04,14651.04,14651.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12236.75,12236.75,12236.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,27902.05,27902.05,27902.05,1 through 10,percent of total billed charges,,, Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7145.91,,,,,,,fee schedule,6871.07,16735.95,MSDRG Base Rate Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7214.62,,,,,,,fee schedule,6871.07,16735.95,MSDRG Base Rate Pulmonary Embolism Without Mcc,176,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6871.07,,,,,,,fee schedule,6871.07,16735.95,MSDRG Base Rate Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21960.62,,,,,,,fee schedule,13338.42,32488.53, Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28313,,,,,,,fee schedule,13338.42,32488.53, Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27073.78,,,,,,,fee schedule,13338.42,32488.53, Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32488.53,,,,,,,fee schedule,13338.42,32488.53, Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8585.67,8585.67,8585.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8928,8928,8928,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10435.17,10435.17,27114.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],3990,3990,3990,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],12750.2,12750.2,12750.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],13470.19,13470.19,13470.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13871.96,,,,,,,fee schedule,13338.42,32488.53,MSDRG Base Rate Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14005.34,,,,,,,fee schedule,13338.42,32488.53,MSDRG Base Rate Respiratory Infections And Inflammations With Mcc,177,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13338.42,,,,,,,fee schedule,13338.42,32488.53,MSDRG Base Rate Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13715.73,,,,,,,fee schedule,8330.64,20291.04, Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17683.17,,,,,,,fee schedule,8330.64,20291.04, Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16909.2,,,,,,,fee schedule,8330.64,20291.04, Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20291.04,,,,,,,fee schedule,8330.64,20291.04, Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],21917.79,21917.79,21917.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16563.79,16563.79,16563.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],3372.63,3372.63,3372.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8663.87,,,,,,,fee schedule,8330.64,20291.04,MSDRG Base Rate Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8747.17,,,,,,,fee schedule,8330.64,20291.04,MSDRG Base Rate Respiratory Infections And Inflammations With Cc,178,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8330.64,,,,,,,fee schedule,8330.64,20291.04,MSDRG Base Rate Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10610.02,,,,,,,fee schedule,6444.3,15696.45, Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13679.09,,,,,,,fee schedule,6444.3,15696.45, Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13080.38,,,,,,,fee schedule,6444.3,15696.45, Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15696.45,,,,,,,fee schedule,6444.3,15696.45, Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15564.87,15564.87,15564.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6702.07,,,,,,,fee schedule,6444.3,15696.45,MSDRG Base Rate Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6766.52,,,,,,,fee schedule,6444.3,15696.45,MSDRG Base Rate Respiratory Infections And Inflammations Without Cc/Mcc,179,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6444.3,,,,,,,fee schedule,6444.3,15696.45,MSDRG Base Rate Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24817.6,,,,,,,fee schedule,15073.69,36715.14, Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31996.39,,,,,,,fee schedule,15073.69,36715.14, Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30595.95,,,,,,,fee schedule,15073.69,36715.14, Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36715.14,,,,,,,fee schedule,15073.69,36715.14, Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],43185,43185,43185,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22378.41,22378.41,22378.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],23172.33,21613.82,29321.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],48618.7,48618.7,48618.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21994.18,21994.18,21994.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15676.64,,,,,,,fee schedule,15073.69,36715.14,MSDRG Base Rate Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15827.37,,,,,,,fee schedule,15073.69,36715.14,MSDRG Base Rate Respiratory Neoplasms With Mcc,180,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15073.69,,,,,,,fee schedule,15073.69,36715.14,MSDRG Base Rate Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15050.76,,,,,,,fee schedule,9141.52,22266.09, Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19404.38,,,,,,,fee schedule,9141.52,22266.09, Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18555.08,,,,,,,fee schedule,9141.52,22266.09, Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22266.09,,,,,,,fee schedule,9141.52,22266.09, Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],20322.95,20322.95,20322.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],21983.94,21983.94,21983.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9507.18,,,,,,,fee schedule,9141.52,22266.09,MSDRG Base Rate Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9598.6,,,,,,,fee schedule,9141.52,22266.09,MSDRG Base Rate Respiratory Neoplasms With Cc,181,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9141.52,,,,,,,fee schedule,9141.52,22266.09,MSDRG Base Rate Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10593.15,,,,,,,fee schedule,6434.06,15671.5, Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13657.35,,,,,,,fee schedule,6434.06,15671.5, Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13059.59,,,,,,,fee schedule,6434.06,15671.5, Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15671.5,,,,,,,fee schedule,6434.06,15671.5, Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6691.42,,,,,,,fee schedule,6434.06,15671.5,MSDRG Base Rate Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6755.76,,,,,,,fee schedule,6434.06,15671.5,MSDRG Base Rate Respiratory Neoplasms Without Cc/Mcc,182,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6434.06,,,,,,,fee schedule,6434.06,15671.5,MSDRG Base Rate Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21499.68,,,,,,,fee schedule,13058.46,31806.62, Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27718.73,,,,,,,fee schedule,13058.46,31806.62, Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26505.52,,,,,,,fee schedule,13058.46,31806.62, Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31806.62,,,,,,,fee schedule,13058.46,31806.62, Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13580.8,,,,,,,fee schedule,13058.46,31806.62,MSDRG Base Rate Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13711.38,,,,,,,fee schedule,13058.46,31806.62,MSDRG Base Rate Major Chest Trauma With Mcc,183,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13058.46,,,,,,,fee schedule,13058.46,31806.62,MSDRG Base Rate Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14953.8,,,,,,,fee schedule,9082.62,22122.64, Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19279.36,,,,,,,fee schedule,9082.62,22122.64, Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18435.53,,,,,,,fee schedule,9082.62,22122.64, Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22122.64,,,,,,,fee schedule,9082.62,22122.64, Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9445.92,,,,,,,fee schedule,9082.62,22122.64,MSDRG Base Rate Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9536.75,,,,,,,fee schedule,9082.62,22122.64,MSDRG Base Rate Major Chest Trauma With Cc,184,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9082.62,,,,,,,fee schedule,9082.62,22122.64,MSDRG Base Rate Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11052.68,,,,,,,fee schedule,6713.17,16351.34, Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14249.81,,,,,,,fee schedule,6713.17,16351.34, Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13626.11,,,,,,,fee schedule,6713.17,16351.34, Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16351.34,,,,,,,fee schedule,6713.17,16351.34, Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6981.7,,,,,,,fee schedule,6713.17,16351.34,MSDRG Base Rate Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7048.83,,,,,,,fee schedule,6713.17,16351.34,MSDRG Base Rate Major Chest Trauma Without Cc/Mcc,185,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6713.17,,,,,,,fee schedule,6713.17,16351.34,MSDRG Base Rate Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21901.6,,,,,,,fee schedule,13302.57,32401.22, Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28236.9,,,,,,,fee schedule,13302.57,32401.22, Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27001.01,,,,,,,fee schedule,13302.57,32401.22, Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32401.22,,,,,,,fee schedule,13302.57,32401.22, Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13834.67,,,,,,,fee schedule,13302.57,32401.22,MSDRG Base Rate Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13967.7,,,,,,,fee schedule,13302.57,32401.22,MSDRG Base Rate Pleural Effusion With Mcc,186,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13302.57,,,,,,,fee schedule,13302.57,32401.22,MSDRG Base Rate Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13899.82,,,,,,,fee schedule,8442.46,20563.39, Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17920.51,,,,,,,fee schedule,8442.46,20563.39, Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17136.16,,,,,,,fee schedule,8442.46,20563.39, Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20563.39,,,,,,,fee schedule,8442.46,20563.39, Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8780.16,,,,,,,fee schedule,8442.46,20563.39,MSDRG Base Rate Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8864.58,,,,,,,fee schedule,8442.46,20563.39,MSDRG Base Rate Pleural Effusion With Cc,187,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8442.46,,,,,,,fee schedule,8442.46,20563.39,MSDRG Base Rate Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10078.81,,,,,,,fee schedule,6121.66,14910.59, Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12994.23,,,,,,,fee schedule,6121.66,14910.59, Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12425.49,,,,,,,fee schedule,6121.66,14910.59, Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14910.59,,,,,,,fee schedule,6121.66,14910.59, Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6366.53,,,,,,,fee schedule,6121.66,14910.59,MSDRG Base Rate Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6427.74,,,,,,,fee schedule,6121.66,14910.59,MSDRG Base Rate Pleural Effusion Without Cc/Mcc,188,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6121.66,,,,,,,fee schedule,6121.66,14910.59,MSDRG Base Rate Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17361.08,,,,,,,fee schedule,10544.75,25683.97, Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22382.98,,,,,,,fee schedule,10544.75,25683.97, Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21403.31,,,,,,,fee schedule,10544.75,25683.97, Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25683.97,,,,,,,fee schedule,10544.75,25683.97, Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],34609.03,34609.03,34609.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10709.13,10709.13,10709.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22020.64,22020.64,22020.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",20773.68,20773.68,20773.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19322.06,13835.7,20260.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],16406.78,16406.78,16406.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],20417.1,20417.1,20417.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],9096.73,9096.73,9096.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14299.93,14299.93,14299.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,45354.92,45354.92,45354.92,1 through 10,percent of total billed charges,,, Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10966.54,,,,,,,fee schedule,10544.75,25683.97,MSDRG Base Rate Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11071.99,,,,,,,fee schedule,10544.75,25683.97,MSDRG Base Rate Pulmonary Edema And Respiratory Failure,189,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10544.75,,,,,,,fee schedule,10544.75,25683.97,MSDRG Base Rate Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15566.51,,,,,,,fee schedule,9454.77,23029.08, Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20069.31,,,,,,,fee schedule,9454.77,23029.08, Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19190.9,,,,,,,fee schedule,9454.77,23029.08, Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23029.08,,,,,,,fee schedule,9454.77,23029.08, Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],26962,26962,26962,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16807.38,16807.38,21479.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9832.96,,,,,,,fee schedule,9454.77,23029.08,MSDRG Base Rate Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9927.51,,,,,,,fee schedule,9454.77,23029.08,MSDRG Base Rate Chronic Obstructive Pulmonary Disease With Mcc,190,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9454.77,,,,,,,fee schedule,9454.77,23029.08,MSDRG Base Rate Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11846.68,,,,,,,fee schedule,7195.42,17525.97, Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15273.47,,,,,,,fee schedule,7195.42,17525.97, Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14604.98,,,,,,,fee schedule,7195.42,17525.97, Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17525.97,,,,,,,fee schedule,7195.42,17525.97, Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14310.9,14310.9,14310.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13414.39,13414.39,13414.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7483.24,,,,,,,fee schedule,7195.42,17525.97,MSDRG Base Rate Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7555.19,,,,,,,fee schedule,7195.42,17525.97,MSDRG Base Rate Chronic Obstructive Pulmonary Disease With Cc,191,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7195.42,,,,,,,fee schedule,7195.42,17525.97,MSDRG Base Rate Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9022.03,,,,,,,fee schedule,5479.79,13347.18, Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11631.76,,,,,,,fee schedule,5479.79,13347.18, Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11122.65,,,,,,,fee schedule,5479.79,13347.18, Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13347.18,,,,,,,fee schedule,5479.79,13347.18, Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14310.9,14310.9,14310.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5698.98,,,,,,,fee schedule,5479.79,13347.18,MSDRG Base Rate Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5753.78,,,,,,,fee schedule,5479.79,13347.18,MSDRG Base Rate Chronic Obstructive Pulmonary Disease Without Cc/Mcc,192,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5479.79,,,,,,,fee schedule,5479.79,13347.18,MSDRG Base Rate Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18471.26,,,,,,,fee schedule,11219.06,27326.38, Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23814.3,,,,,,,fee schedule,11219.06,27326.38, Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22771.98,,,,,,,fee schedule,11219.06,27326.38, Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27326.38,,,,,,,fee schedule,11219.06,27326.38, Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],43360.61,43360.61,43360.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],11430.43,11430.43,11430.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16935.69,16935.69,24359.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21857.41,10976.12,22255.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10570.14,10570.14,10570.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],10397.06,10397.06,10397.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",23937.36,23937.36,23937.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11667.82,,,,,,,fee schedule,11219.06,27326.38,MSDRG Base Rate Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11780.01,,,,,,,fee schedule,11219.06,27326.38,MSDRG Base Rate Simple Pneumonia And Pleurisy With Mcc,193,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11219.06,,,,,,,fee schedule,11219.06,27326.38,MSDRG Base Rate Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11325.31,,,,,,,fee schedule,6878.76,16754.66, Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14601.3,,,,,,,fee schedule,6878.76,16754.66, Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13962.22,,,,,,,fee schedule,6878.76,16754.66, Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16754.66,,,,,,,fee schedule,6878.76,16754.66, Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],6040,6040,6040,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],5626.3,5626.3,5626.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12833.16,12833.16,12833.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13793.23,13793.23,13793.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],13530,13530,13530,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14131.75,14131.75,14131.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,565.22,565.22,565.22,1 through 10,percent of total billed charges,,, Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7153.91,,,,,,,fee schedule,6878.76,16754.66,MSDRG Base Rate Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7222.7,,,,,,,fee schedule,6878.76,16754.66,MSDRG Base Rate Simple Pneumonia And Pleurisy With Cc,194,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6878.76,,,,,,,fee schedule,6878.76,16754.66,MSDRG Base Rate Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8832.31,,,,,,,fee schedule,5364.56,13066.52, Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11387.16,,,,,,,fee schedule,5364.56,13066.52, Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10888.76,,,,,,,fee schedule,5364.56,13066.52, Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13066.52,,,,,,,fee schedule,5364.56,13066.52, Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],10903.48,10903.48,10903.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],2099.02,2099.02,2099.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5579.14,,,,,,,fee schedule,5364.56,13066.52,MSDRG Base Rate Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5632.79,,,,,,,fee schedule,5364.56,13066.52,MSDRG Base Rate Simple Pneumonia And Pleurisy Without Cc/Mcc,195,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5364.56,,,,,,,fee schedule,5364.56,13066.52,MSDRG Base Rate Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26520.82,,,,,,,fee schedule,16108.19,39234.89, Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34192.29,,,,,,,fee schedule,16108.19,39234.89, Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32695.74,,,,,,,fee schedule,16108.19,39234.89, Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,39234.89,,,,,,,fee schedule,16108.19,39234.89, Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],31138.8,31138.8,31138.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16752.52,,,,,,,fee schedule,16108.19,39234.89,MSDRG Base Rate Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16913.6,,,,,,,fee schedule,16108.19,39234.89,MSDRG Base Rate Interstitial Lung Disease With Mcc,196,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16108.19,,,,,,,fee schedule,16108.19,39234.89,MSDRG Base Rate Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13337.7,,,,,,,fee schedule,8101.04,19731.79, Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17195.79,,,,,,,fee schedule,8101.04,19731.79, Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16443.16,,,,,,,fee schedule,8101.04,19731.79, Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19731.79,,,,,,,fee schedule,8101.04,19731.79, Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],2859.7,2859.7,2859.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8425.08,,,,,,,fee schedule,8101.04,19731.79,MSDRG Base Rate Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8506.09,,,,,,,fee schedule,8101.04,19731.79,MSDRG Base Rate Interstitial Lung Disease With Cc,197,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8101.04,,,,,,,fee schedule,8101.04,19731.79,MSDRG Base Rate Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10064.76,,,,,,,fee schedule,6113.12,14889.8, Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12976.11,,,,,,,fee schedule,6113.12,14889.8, Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12408.17,,,,,,,fee schedule,6113.12,14889.8, Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14889.8,,,,,,,fee schedule,6113.12,14889.8, Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],4642.95,4642.95,4642.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6357.64,,,,,,,fee schedule,6113.12,14889.8,MSDRG Base Rate Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6418.78,,,,,,,fee schedule,6113.12,14889.8,MSDRG Base Rate Interstitial Lung Disease Without Cc/Mcc,198,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6113.12,,,,,,,fee schedule,6113.12,14889.8,MSDRG Base Rate Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24790.9,,,,,,,fee schedule,15057.47,36675.64, Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31961.96,,,,,,,fee schedule,15057.47,36675.64, Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30563.03,,,,,,,fee schedule,15057.47,36675.64, Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36675.64,,,,,,,fee schedule,15057.47,36675.64, Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],29506.98,29506.98,29506.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15659.77,,,,,,,fee schedule,15057.47,36675.64,MSDRG Base Rate Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15810.34,,,,,,,fee schedule,15057.47,36675.64,MSDRG Base Rate Pneumothorax With Mcc,199,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15057.47,,,,,,,fee schedule,15057.47,36675.64,MSDRG Base Rate Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15448.46,,,,,,,fee schedule,9383.07,22854.45, Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19917.12,,,,,,,fee schedule,9383.07,22854.45, Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19045.37,,,,,,,fee schedule,9383.07,22854.45, Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22854.45,,,,,,,fee schedule,9383.07,22854.45, Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18229.42,18229.42,18428.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9758.39,,,,,,,fee schedule,9383.07,22854.45,MSDRG Base Rate Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9852.22,,,,,,,fee schedule,9383.07,22854.45,MSDRG Base Rate Pneumothorax With Cc,200,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9383.07,,,,,,,fee schedule,9383.07,22854.45,MSDRG Base Rate Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10049.3,,,,,,,fee schedule,6103.73,14866.93, Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12956.18,,,,,,,fee schedule,6103.73,14866.93, Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12389.11,,,,,,,fee schedule,6103.73,14866.93, Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14866.93,,,,,,,fee schedule,6103.73,14866.93, Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10731.73,10731.73,10731.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6347.88,,,,,,,fee schedule,6103.73,14866.93,MSDRG Base Rate Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6408.92,,,,,,,fee schedule,6103.73,14866.93,MSDRG Base Rate Pneumothorax Without Cc/Mcc,201,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6103.73,,,,,,,fee schedule,6103.73,14866.93,MSDRG Base Rate Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13648.27,,,,,,,fee schedule,8289.67,20191.25, Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17596.2,,,,,,,fee schedule,8289.67,20191.25, Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16826.04,,,,,,,fee schedule,8289.67,20191.25, Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20191.25,,,,,,,fee schedule,8289.67,20191.25, Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],13758.22,13758.22,13758.22,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12710.29,12710.29,12710.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12327.76,12327.76,12327.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8621.26,,,,,,,fee schedule,8289.67,20191.25,MSDRG Base Rate Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8704.15,,,,,,,fee schedule,8289.67,20191.25,MSDRG Base Rate Bronchitis And Asthma With Cc/Mcc,202,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8289.67,,,,,,,fee schedule,8289.67,20191.25,MSDRG Base Rate Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9415.51,,,,,,,fee schedule,5718.78,13929.3, Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12139.06,,,,,,,fee schedule,5718.78,13929.3, Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11607.75,,,,,,,fee schedule,5718.78,13929.3, Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13929.3,,,,,,,fee schedule,5718.78,13929.3, Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],11193,11193,11193,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],5798.39,5798.39,5798.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5947.53,,,,,,,fee schedule,5718.78,13929.3,MSDRG Base Rate Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6004.72,,,,,,,fee schedule,5718.78,13929.3,MSDRG Base Rate Bronchitis And Asthma Without Cc/Mcc,203,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5718.78,,,,,,,fee schedule,5718.78,13929.3,MSDRG Base Rate Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11346.39,,,,,,,fee schedule,6891.56,16785.85, Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14628.47,,,,,,,fee schedule,6891.56,16785.85, Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13988.21,,,,,,,fee schedule,6891.56,16785.85, Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16785.85,,,,,,,fee schedule,6891.56,16785.85, Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7167.22,,,,,,,fee schedule,6891.56,16785.85,MSDRG Base Rate Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7236.14,,,,,,,fee schedule,6891.56,16785.85,MSDRG Base Rate Respiratory Signs And Symptoms,204,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6891.56,,,,,,,fee schedule,6891.56,16785.85,MSDRG Base Rate Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25731.04,,,,,,,fee schedule,15628.49,38066.49, Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33174.06,,,,,,,fee schedule,15628.49,38066.49, Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31722.08,,,,,,,fee schedule,15628.49,38066.49, Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38066.49,,,,,,,fee schedule,15628.49,38066.49, Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],5793.62,5793.62,5793.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],31148.7,31148.7,31148.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16253.63,,,,,,,fee schedule,15628.49,38066.49,MSDRG Base Rate Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16409.91,,,,,,,fee schedule,15628.49,38066.49,MSDRG Base Rate Other Respiratory System Diagnoses With Mcc,205,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15628.49,,,,,,,fee schedule,15628.49,38066.49,MSDRG Base Rate Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13225.28,,,,,,,fee schedule,8032.76,19565.47, Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17050.85,,,,,,,fee schedule,8032.76,19565.47, Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16304.56,,,,,,,fee schedule,8032.76,19565.47, Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19565.47,,,,,,,fee schedule,8032.76,19565.47, Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14943.2,14943.2,14943.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],17934.84,17934.84,17934.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8354.07,,,,,,,fee schedule,8032.76,19565.47,MSDRG Base Rate Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8434.4,,,,,,,fee schedule,8032.76,19565.47,MSDRG Base Rate Other Respiratory System Diagnoses Without Mcc,206,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8032.76,,,,,,,fee schedule,8032.76,19565.47,MSDRG Base Rate Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,90426.84,,,,,,,fee schedule,54923.36,133777.41, Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,116583.89,,,,,,,fee schedule,54923.36,133777.41, Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,111481.18,,,,,,,fee schedule,54923.36,133777.41, Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,133777.41,,,,,,,fee schedule,54923.36,133777.41, Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,57120.29,,,,,,,fee schedule,54923.36,133777.41,MSDRG Base Rate Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,57669.53,,,,,,,fee schedule,54923.36,133777.41,MSDRG Base Rate Respiratory System Diagnosis With Ventilator Support >96 Hours,207,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,54923.36,,,,,,,fee schedule,54923.36,133777.41,MSDRG Base Rate Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38627.48,,,,,,,fee schedule,23461.52,57145.47, Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,49800.95,,,,,,,fee schedule,23461.52,57145.47, Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,47621.23,,,,,,,fee schedule,23461.52,57145.47, Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,57145.47,,,,,,,fee schedule,23461.52,57145.47, Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],24487,24487,24487,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],9507.82,9507.82,9507.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],12928.66,12928.66,12928.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",32267.79,32267.79,32267.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24399.98,,,,,,,fee schedule,23461.52,57145.47,MSDRG Base Rate Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24634.6,,,,,,,fee schedule,23461.52,57145.47,MSDRG Base Rate Respiratory System Diagnosis With Ventilator Support <=96 Hours,208,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23461.52,,,,,,,fee schedule,23461.52,57145.47,MSDRG Base Rate Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,159063.1,,,,,,,fee schedule,96611.58,235317.85, Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,205074.02,,,,,,,fee schedule,96611.58,235317.85, Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,196098.21,,,,,,,fee schedule,96611.58,235317.85, Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,235317.85,,,,,,,fee schedule,96611.58,235317.85, Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,100476.04,,,,,,,fee schedule,96611.58,235317.85,MSDRG Base Rate Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,101442.16,,,,,,,fee schedule,96611.58,235317.85,MSDRG Base Rate Complex Aortic Arch Procedures,209,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,96611.58,,,,,,,fee schedule,96611.58,235317.85,MSDRG Base Rate Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w CC,210,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip & Femur Procedures Except Major Joint Age >17 w/o CC,211,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,152813.73,,,,,,,fee schedule,92815.85,226072.54, Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,197016.94,,,,,,,fee schedule,92815.85,226072.54, Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,188393.78,,,,,,,fee schedule,92815.85,226072.54, Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,226072.54,,,,,,,fee schedule,92815.85,226072.54, Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,96528.48,,,,,,,fee schedule,92815.85,226072.54,MSDRG Base Rate Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,97456.64,,,,,,,fee schedule,92815.85,226072.54,MSDRG Base Rate Concomitant Aortic And Mitral Valve Procedures,212,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,92815.85,,,,,,,fee schedule,92815.85,226072.54,MSDRG Base Rate Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,80199.07,,,,,,,fee schedule,48711.23,118646.45, Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,103397.61,,,,,,,fee schedule,48711.23,118646.45, Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,98872.04,,,,,,,fee schedule,48711.23,118646.45, Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,118646.45,,,,,,,fee schedule,48711.23,118646.45, Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,50659.68,,,,,,,fee schedule,48711.23,118646.45,MSDRG Base Rate Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51146.79,,,,,,,fee schedule,48711.23,118646.45,MSDRG Base Rate Endovascular Abdominal Aorta With Iliac Branch Procedures,213,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,48711.23,,,,,,,fee schedule,48711.23,118646.45,MSDRG Base Rate No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,214,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,139925.72,,,,,,,fee schedule,84987.94,207006.03, Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,180400.93,,,,,,,fee schedule,84987.94,207006.03, Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,172505.03,,,,,,,fee schedule,84987.94,207006.03, Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,207006.03,,,,,,,fee schedule,84987.94,207006.03, Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,88387.46,,,,,,,fee schedule,84987.94,207006.03,MSDRG Base Rate Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,89237.34,,,,,,,fee schedule,84987.94,207006.03,MSDRG Base Rate Other Heart Assist System Implant,215,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,84987.94,,,,,,,fee schedule,84987.94,207006.03,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,137477.69,,,,,,,fee schedule,83501.06,203384.41, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,177244.77,,,,,,,fee schedule,83501.06,203384.41, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,169487.01,,,,,,,fee schedule,83501.06,203384.41, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,203384.41,,,,,,,fee schedule,83501.06,203384.41, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,86841.1,,,,,,,fee schedule,83501.06,203384.41,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,87676.11,,,,,,,fee schedule,83501.06,203384.41,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc,216,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,83501.06,,,,,,,fee schedule,83501.06,203384.41,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,92402.69,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,119131.29,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,113917.07,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,136700.49,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,58368.39,,,,,,,fee schedule,56123.45,136700.49,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58929.62,,,,,,,fee schedule,56123.45,136700.49,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc,217,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,56123.45,,,,,,,fee schedule,56123.45,136700.49,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,92402.69,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,119131.29,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,113917.07,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,136700.49,,,,,,,fee schedule,56123.45,136700.49, Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,58368.39,,,,,,,fee schedule,56123.45,136700.49,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58929.62,,,,,,,fee schedule,56123.45,136700.49,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc,218,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,56123.45,,,,,,,fee schedule,56123.45,136700.49,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,107903.15,,,,,,,fee schedule,65538.11,159631.86, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,139115.44,,,,,,,fee schedule,65538.11,159631.86, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,133026.55,,,,,,,fee schedule,65538.11,159631.86, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,159631.86,,,,,,,fee schedule,65538.11,159631.86, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,68159.63,,,,,,,fee schedule,65538.11,159631.86,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68815.02,,,,,,,fee schedule,65538.11,159631.86,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc,219,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,65538.11,,,,,,,fee schedule,65538.11,159631.86,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,74941.84,,,,,,,fee schedule,45518.1,110868.91, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,96619.67,,,,,,,fee schedule,45518.1,110868.91, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,92390.76,,,,,,,fee schedule,45518.1,110868.91, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,110868.91,,,,,,,fee schedule,45518.1,110868.91, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,47338.82,,,,,,,fee schedule,45518.1,110868.91,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,47794,,,,,,,fee schedule,45518.1,110868.91,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc,220,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,45518.1,,,,,,,fee schedule,45518.1,110868.91,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,70829.93,,,,,,,fee schedule,43020.61,104785.76, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,91318.34,,,,,,,fee schedule,43020.61,104785.76, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,87321.47,,,,,,,fee schedule,43020.61,104785.76, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,104785.76,,,,,,,fee schedule,43020.61,104785.76, Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,44741.43,,,,,,,fee schedule,43020.61,104785.76,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,45171.64,,,,,,,fee schedule,43020.61,104785.76,MSDRG Base Rate Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M,221,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,43020.61,,,,,,,fee schedule,43020.61,104785.76,MSDRG Base Rate "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc",222,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc",223,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc",224,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc",225,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc,226,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc,227,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,69525.81,,,,,,,fee schedule,42228.52,102856.45, Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,89636.99,,,,,,,fee schedule,42228.52,102856.45, Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,85713.71,,,,,,,fee schedule,42228.52,102856.45, Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,102856.45,,,,,,,fee schedule,42228.52,102856.45, Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,43917.66,,,,,,,fee schedule,42228.52,102856.45,MSDRG Base Rate Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44339.95,,,,,,,fee schedule,42228.52,102856.45,MSDRG Base Rate Other Cardiothoracic Procedures With Mcc,228,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,42228.52,,,,,,,fee schedule,42228.52,102856.45,MSDRG Base Rate Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44259.92,,,,,,,fee schedule,26882.55,65478.11, Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57062.64,,,,,,,fee schedule,26882.55,65478.11, Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,54565.09,,,,,,,fee schedule,26882.55,65478.11, Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,65478.11,,,,,,,fee schedule,26882.55,65478.11, Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27957.85,,,,,,,fee schedule,26882.55,65478.11,MSDRG Base Rate Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28226.68,,,,,,,fee schedule,26882.55,65478.11,MSDRG Base Rate Other Cardiothoracic Procedures Without Mcc,229,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26882.55,,,,,,,fee schedule,26882.55,65478.11,MSDRG Base Rate Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other cardiothoracic procedures w/o CC/MCC,230,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,118465.38,,,,,,,fee schedule,71953.38,175257.62, Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,152732.93,,,,,,,fee schedule,71953.38,175257.62, Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,146048.02,,,,,,,fee schedule,71953.38,175257.62, Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,175257.62,,,,,,,fee schedule,71953.38,175257.62, Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,74831.52,,,,,,,fee schedule,71953.38,175257.62,MSDRG Base Rate Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75551.05,,,,,,,fee schedule,71953.38,175257.62,MSDRG Base Rate Coronary Bypass With Ptca With Mcc,231,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,71953.38,,,,,,,fee schedule,71953.38,175257.62,MSDRG Base Rate Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,85197.72,,,,,,,fee schedule,51747.3,126041.45, Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,109842.19,,,,,,,fee schedule,51747.3,126041.45, Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,105034.55,,,,,,,fee schedule,51747.3,126041.45, Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,126041.45,,,,,,,fee schedule,51747.3,126041.45, Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,53817.19,,,,,,,fee schedule,51747.3,126041.45,MSDRG Base Rate Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54334.67,,,,,,,fee schedule,51747.3,126041.45,MSDRG Base Rate Coronary Bypass With Ptca Without Mcc,232,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,51747.3,,,,,,,fee schedule,51747.3,126041.45,MSDRG Base Rate Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,107438,,,,,,,fee schedule,65255.58,158943.71, Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,138515.73,,,,,,,fee schedule,65255.58,158943.71, Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,132453.09,,,,,,,fee schedule,65255.58,158943.71, Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,158943.71,,,,,,,fee schedule,65255.58,158943.71, Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,67865.8,,,,,,,fee schedule,65255.58,158943.71,MSDRG Base Rate Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68518.36,,,,,,,fee schedule,65255.58,158943.71,MSDRG Base Rate Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc,233,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,65255.58,,,,,,,fee schedule,65255.58,158943.71,MSDRG Base Rate Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,76767.32,,,,,,,fee schedule,46626.86,113569.53, Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,98973.2,,,,,,,fee schedule,46626.86,113569.53, Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,94641.28,,,,,,,fee schedule,46626.86,113569.53, Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,113569.53,,,,,,,fee schedule,46626.86,113569.53, Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,48491.93,,,,,,,fee schedule,46626.86,113569.53,MSDRG Base Rate Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,48958.2,,,,,,,fee schedule,46626.86,113569.53,MSDRG Base Rate Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc,234,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,46626.86,,,,,,,fee schedule,46626.86,113569.53,MSDRG Base Rate Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,82471.44,,,,,,,fee schedule,50091.42,122008.19, Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,106327.29,,,,,,,fee schedule,50091.42,122008.19, Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,101673.5,,,,,,,fee schedule,50091.42,122008.19, Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,122008.19,,,,,,,fee schedule,50091.42,122008.19, Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,52095.08,,,,,,,fee schedule,50091.42,122008.19,MSDRG Base Rate Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52595.99,,,,,,,fee schedule,50091.42,122008.19,MSDRG Base Rate Coronary Bypass Without Cardiac Catheterization With Mcc,235,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,50091.42,,,,,,,fee schedule,50091.42,122008.19,MSDRG Base Rate Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,58865.21,,,,,,,fee schedule,35753.49,87085.15, Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,75892.68,,,,,,,fee schedule,35753.49,87085.15, Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,72570.96,,,,,,,fee schedule,35753.49,87085.15, Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,87085.15,,,,,,,fee schedule,35753.49,87085.15, Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37183.63,,,,,,,fee schedule,35753.49,87085.15,MSDRG Base Rate Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37541.16,,,,,,,fee schedule,35753.49,87085.15,MSDRG Base Rate Coronary Bypass Without Cardiac Catheterization Without Mcc,236,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35753.49,,,,,,,fee schedule,35753.49,87085.15,MSDRG Base Rate Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w MCC,237,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major cardiovasc procedures w/o MCC,238,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,69164.65,,,,,,,fee schedule,42009.15,102322.14, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,89171.36,,,,,,,fee schedule,42009.15,102322.14, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,85268.45,,,,,,,fee schedule,42009.15,102322.14, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,102322.14,,,,,,,fee schedule,42009.15,102322.14, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,43689.52,,,,,,,fee schedule,42009.15,102322.14,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44109.61,,,,,,,fee schedule,42009.15,102322.14,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc,239,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,42009.15,,,,,,,fee schedule,42009.15,102322.14,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40058.08,,,,,,,fee schedule,24330.43,59261.9, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,51645.36,,,,,,,fee schedule,24330.43,59261.9, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,49384.91,,,,,,,fee schedule,24330.43,59261.9, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,59261.9,,,,,,,fee schedule,24330.43,59261.9, Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25303.65,,,,,,,fee schedule,24330.43,59261.9,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25546.95,,,,,,,fee schedule,24330.43,59261.9,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc,240,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24330.43,,,,,,,fee schedule,24330.43,59261.9,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19454.97,,,,,,,fee schedule,11816.54,28781.68, Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25082.56,,,,,,,fee schedule,11816.54,28781.68, Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23984.73,,,,,,,fee schedule,11816.54,28781.68, Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28781.68,,,,,,,fee schedule,11816.54,28781.68, Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12289.2,,,,,,,fee schedule,11816.54,28781.68,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12407.37,,,,,,,fee schedule,11816.54,28781.68,MSDRG Base Rate Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc,241,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11816.54,,,,,,,fee schedule,11816.54,28781.68,MSDRG Base Rate Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44868.42,,,,,,,fee schedule,27252.13,66378.31, Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57847.15,,,,,,,fee schedule,27252.13,66378.31, Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55315.26,,,,,,,fee schedule,27252.13,66378.31, Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,66378.31,,,,,,,fee schedule,27252.13,66378.31, Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28342.22,,,,,,,fee schedule,27252.13,66378.31,MSDRG Base Rate Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28614.74,,,,,,,fee schedule,27252.13,66378.31,MSDRG Base Rate Permanent Cardiac Pacemaker Implant With Mcc,242,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27252.13,,,,,,,fee schedule,27252.13,66378.31,MSDRG Base Rate Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29945.54,,,,,,,fee schedule,18188.29,44301.41, Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38607.65,,,,,,,fee schedule,18188.29,44301.41, Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36917.84,,,,,,,fee schedule,18188.29,44301.41, Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44301.41,,,,,,,fee schedule,18188.29,44301.41, Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18915.82,,,,,,,fee schedule,18188.29,44301.41,MSDRG Base Rate Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19097.7,,,,,,,fee schedule,18188.29,44301.41,MSDRG Base Rate Permanent Cardiac Pacemaker Implant With Cc,243,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18188.29,,,,,,,fee schedule,18188.29,44301.41,MSDRG Base Rate Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25400.8,,,,,,,fee schedule,15427.91,37577.93, Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32748.29,,,,,,,fee schedule,15427.91,37577.93, Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31314.94,,,,,,,fee schedule,15427.91,37577.93, Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37577.93,,,,,,,fee schedule,15427.91,37577.93, Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16045.03,,,,,,,fee schedule,15427.91,37577.93,MSDRG Base Rate Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16199.31,,,,,,,fee schedule,15427.91,37577.93,MSDRG Base Rate Permanent Cardiac Pacemaker Implant Without Cc/Mcc,244,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15427.91,,,,,,,fee schedule,15427.91,37577.93,MSDRG Base Rate Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,64115.41,,,,,,,fee schedule,38942.35,94852.3, Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,82661.56,,,,,,,fee schedule,38942.35,94852.3, Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,79043.58,,,,,,,fee schedule,38942.35,94852.3, Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,94852.3,,,,,,,fee schedule,38942.35,94852.3, Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,40500.04,,,,,,,fee schedule,38942.35,94852.3,MSDRG Base Rate Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40889.47,,,,,,,fee schedule,38942.35,94852.3,MSDRG Base Rate Aicd Generator Procedures,245,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,38942.35,,,,,,,fee schedule,38942.35,94852.3,MSDRG Base Rate Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,246,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc,247,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents,248,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc,249,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30670.67,,,,,,,fee schedule,18628.72,45374.18, Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39542.54,,,,,,,fee schedule,18628.72,45374.18, Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37811.81,,,,,,,fee schedule,18628.72,45374.18, Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45374.18,,,,,,,fee schedule,18628.72,45374.18, Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19373.87,,,,,,,fee schedule,18628.72,45374.18,MSDRG Base Rate Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19560.16,,,,,,,fee schedule,18628.72,45374.18,MSDRG Base Rate Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc,250,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18628.72,,,,,,,fee schedule,18628.72,45374.18,MSDRG Base Rate Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21002.21,,,,,,,fee schedule,12756.3,31070.66, Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27077.35,,,,,,,fee schedule,12756.3,31070.66, Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25892.21,,,,,,,fee schedule,12756.3,31070.66, Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31070.66,,,,,,,fee schedule,12756.3,31070.66, Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13266.55,,,,,,,fee schedule,12756.3,31070.66,MSDRG Base Rate Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13394.12,,,,,,,fee schedule,12756.3,31070.66,MSDRG Base Rate Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc,251,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12756.3,,,,,,,fee schedule,12756.3,31070.66,MSDRG Base Rate Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,49021.08,,,,,,,fee schedule,29774.37,72521.76, Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,63201.02,,,,,,,fee schedule,29774.37,72521.76, Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,60434.8,,,,,,,fee schedule,29774.37,72521.76, Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,72521.76,,,,,,,fee schedule,29774.37,72521.76, Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",43758,43758,43758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30965.34,,,,,,,fee schedule,29774.37,72521.76,MSDRG Base Rate Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31263.09,,,,,,,fee schedule,29774.37,72521.76,MSDRG Base Rate Other Vascular Procedures With Mcc,252,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29774.37,,,,,,,fee schedule,29774.37,72521.76,MSDRG Base Rate Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,36475.97,,,,,,,fee schedule,22154.74,53962.52, Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,47027.08,,,,,,,fee schedule,22154.74,53962.52, Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44968.77,,,,,,,fee schedule,22154.74,53962.52, Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,53962.52,,,,,,,fee schedule,22154.74,53962.52, Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,23040.93,,,,,,,fee schedule,22154.74,53962.52,MSDRG Base Rate Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23262.48,,,,,,,fee schedule,22154.74,53962.52,MSDRG Base Rate Other Vascular Procedures With Cc,253,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22154.74,,,,,,,fee schedule,22154.74,53962.52,MSDRG Base Rate Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25038.23,,,,,,,fee schedule,15207.69,37041.54, Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32280.84,,,,,,,fee schedule,15207.69,37041.54, Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30867.95,,,,,,,fee schedule,15207.69,37041.54, Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37041.54,,,,,,,fee schedule,15207.69,37041.54, Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15816,,,,,,,fee schedule,15207.69,37041.54,MSDRG Base Rate Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15968.07,,,,,,,fee schedule,15207.69,37041.54,MSDRG Base Rate Other Vascular Procedures Without Cc/Mcc,254,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15207.69,,,,,,,fee schedule,15207.69,37041.54,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,37906.56,,,,,,,fee schedule,23023.65,56078.95, Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,48871.49,,,,,,,fee schedule,23023.65,56078.95, Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,46732.46,,,,,,,fee schedule,23023.65,56078.95, Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,56078.95,,,,,,,fee schedule,23023.65,56078.95, Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,23944.6,,,,,,,fee schedule,23023.65,56078.95,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24174.83,,,,,,,fee schedule,23023.65,56078.95,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc,255,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23023.65,,,,,,,fee schedule,23023.65,56078.95,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23860.59,,,,,,,fee schedule,14492.42,35299.34, Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30762.55,,,,,,,fee schedule,14492.42,35299.34, Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29416.12,,,,,,,fee schedule,14492.42,35299.34, Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35299.34,,,,,,,fee schedule,14492.42,35299.34, Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],12380.69,12380.69,12380.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15072.12,,,,,,,fee schedule,14492.42,35299.34,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15217.04,,,,,,,fee schedule,14492.42,35299.34,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders With Cc,256,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14492.42,,,,,,,fee schedule,14492.42,35299.34,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15348.69,,,,,,,fee schedule,9322.47,22706.84, Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19788.48,,,,,,,fee schedule,9322.47,22706.84, Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18922.37,,,,,,,fee schedule,9322.47,22706.84, Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22706.84,,,,,,,fee schedule,9322.47,22706.84, Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9695.37,,,,,,,fee schedule,9322.47,22706.84,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9788.59,,,,,,,fee schedule,9322.47,22706.84,MSDRG Base Rate Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc,257,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9322.47,,,,,,,fee schedule,9322.47,22706.84,MSDRG Base Rate Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44155.93,,,,,,,fee schedule,26819.38,65324.26, Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,56928.57,,,,,,,fee schedule,26819.38,65324.26, Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,54436.88,,,,,,,fee schedule,26819.38,65324.26, Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,65324.26,,,,,,,fee schedule,26819.38,65324.26, Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27892.16,,,,,,,fee schedule,26819.38,65324.26,MSDRG Base Rate Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28160.35,,,,,,,fee schedule,26819.38,65324.26,MSDRG Base Rate Cardiac Pacemaker Device Replacement With Mcc,258,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26819.38,,,,,,,fee schedule,26819.38,65324.26,MSDRG Base Rate Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28416.57,,,,,,,fee schedule,17259.63,42039.46, Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36636.41,,,,,,,fee schedule,17259.63,42039.46, Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,35032.88,,,,,,,fee schedule,17259.63,42039.46, Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,42039.46,,,,,,,fee schedule,17259.63,42039.46, Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17950.02,,,,,,,fee schedule,17259.63,42039.46,MSDRG Base Rate Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18122.61,,,,,,,fee schedule,17259.63,42039.46,MSDRG Base Rate Cardiac Pacemaker Device Replacement Without Mcc,259,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17259.63,,,,,,,fee schedule,17259.63,42039.46,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45711.6,,,,,,,fee schedule,27764.26,67625.71, Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58934.23,,,,,,,fee schedule,27764.26,67625.71, Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,56354.76,,,,,,,fee schedule,27764.26,67625.71, Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,67625.71,,,,,,,fee schedule,27764.26,67625.71, Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28874.83,,,,,,,fee schedule,27764.26,67625.71,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29152.47,,,,,,,fee schedule,27764.26,67625.71,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement With Mcc,260,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27764.26,,,,,,,fee schedule,27764.26,67625.71,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26567.2,,,,,,,fee schedule,16136.36,39303.5, Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34252.08,,,,,,,fee schedule,16136.36,39303.5, Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32752.91,,,,,,,fee schedule,16136.36,39303.5, Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,39303.5,,,,,,,fee schedule,16136.36,39303.5, Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16781.81,,,,,,,fee schedule,16136.36,39303.5,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16943.18,,,,,,,fee schedule,16136.36,39303.5,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement With Cc,261,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16136.36,,,,,,,fee schedule,16136.36,39303.5,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22904.98,,,,,,,fee schedule,13912.01,33885.62, Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29530.53,,,,,,,fee schedule,13912.01,33885.62, Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28238.02,,,,,,,fee schedule,13912.01,33885.62, Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33885.62,,,,,,,fee schedule,13912.01,33885.62, Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14468.49,,,,,,,fee schedule,13912.01,33885.62,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14607.61,,,,,,,fee schedule,13912.01,33885.62,MSDRG Base Rate Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc,262,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13912.01,,,,,,,fee schedule,13912.01,33885.62,MSDRG Base Rate Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,42965.64,,,,,,,fee schedule,26096.43,63563.35, Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,55393.97,,,,,,,fee schedule,26096.43,63563.35, Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,52969.46,,,,,,,fee schedule,26096.43,63563.35, Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,63563.35,,,,,,,fee schedule,26096.43,63563.35, Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27140.29,,,,,,,fee schedule,26096.43,63563.35,MSDRG Base Rate Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27401.25,,,,,,,fee schedule,26096.43,63563.35,MSDRG Base Rate Vein Ligation And Stripping,263,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26096.43,,,,,,,fee schedule,26096.43,63563.35,MSDRG Base Rate Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,46945.45,,,,,,,fee schedule,28513.68,69451.07, Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,60524.99,,,,,,,fee schedule,28513.68,69451.07, Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,57875.9,,,,,,,fee schedule,28513.68,69451.07, Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,69451.07,,,,,,,fee schedule,28513.68,69451.07, Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,29654.23,,,,,,,fee schedule,28513.68,69451.07,MSDRG Base Rate Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29939.36,,,,,,,fee schedule,28513.68,69451.07,MSDRG Base Rate Other Circulatory System O.R. Procedures,264,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,28513.68,,,,,,,fee schedule,28513.68,69451.07,MSDRG Base Rate Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50846.56,,,,,,,fee schedule,30883.13,75222.38, Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,65554.55,,,,,,,fee schedule,30883.13,75222.38, Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,62685.32,,,,,,,fee schedule,30883.13,75222.38, Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,75222.38,,,,,,,fee schedule,30883.13,75222.38, Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32118.46,,,,,,,fee schedule,30883.13,75222.38,MSDRG Base Rate Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32427.29,,,,,,,fee schedule,30883.13,75222.38,MSDRG Base Rate Aicd Lead Procedures,265,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30883.13,,,,,,,fee schedule,30883.13,75222.38,MSDRG Base Rate Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,86122.41,,,,,,,fee schedule,52308.94,127409.44, Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,111034.35,,,,,,,fee schedule,52308.94,127409.44, Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,106174.53,,,,,,,fee schedule,52308.94,127409.44, Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,127409.44,,,,,,,fee schedule,52308.94,127409.44, Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,54401.3,,,,,,,fee schedule,52308.94,127409.44,MSDRG Base Rate Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54924.39,,,,,,,fee schedule,52308.94,127409.44,MSDRG Base Rate Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc,266,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,52308.94,,,,,,,fee schedule,52308.94,127409.44,MSDRG Base Rate Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,66903.52,,,,,,,fee schedule,40635.79,98977.03, Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,86256.17,,,,,,,fee schedule,40635.79,98977.03, Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,82480.86,,,,,,,fee schedule,40635.79,98977.03, Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,98977.03,,,,,,,fee schedule,40635.79,98977.03, Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,42261.22,,,,,,,fee schedule,40635.79,98977.03,MSDRG Base Rate Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42667.58,,,,,,,fee schedule,40635.79,98977.03,MSDRG Base Rate Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc,267,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,40635.79,,,,,,,fee schedule,40635.79,98977.03,MSDRG Base Rate Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,96655.13,,,,,,,fee schedule,58706.29,142991.54, Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,124613.79,,,,,,,fee schedule,58706.29,142991.54, Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,119159.62,,,,,,,fee schedule,58706.29,142991.54, Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,142991.54,,,,,,,fee schedule,58706.29,142991.54, Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,61054.54,,,,,,,fee schedule,58706.29,142991.54,MSDRG Base Rate Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61641.6,,,,,,,fee schedule,58706.29,142991.54,MSDRG Base Rate Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc,268,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,58706.29,,,,,,,fee schedule,58706.29,142991.54,MSDRG Base Rate Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,59348.63,,,,,,,fee schedule,36047.11,87800.33, Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,76515.94,,,,,,,fee schedule,36047.11,87800.33, Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,73166.94,,,,,,,fee schedule,36047.11,87800.33, Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,87800.33,,,,,,,fee schedule,36047.11,87800.33, Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37488.99,,,,,,,fee schedule,36047.11,87800.33,MSDRG Base Rate Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37849.47,,,,,,,fee schedule,36047.11,87800.33,MSDRG Base Rate Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc,269,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,36047.11,,,,,,,fee schedule,36047.11,87800.33,MSDRG Base Rate Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,74147.84,,,,,,,fee schedule,45035.84,109694.28, Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,95596,,,,,,,fee schedule,45035.84,109694.28, Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,91411.9,,,,,,,fee schedule,45035.84,109694.28, Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,109694.28,,,,,,,fee schedule,45035.84,109694.28, Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,46837.27,,,,,,,fee schedule,45035.84,109694.28,MSDRG Base Rate Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,47287.63,,,,,,,fee schedule,45035.84,109694.28,MSDRG Base Rate Other Major Cardiovascular Procedures With Mcc,270,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,45035.84,,,,,,,fee schedule,45035.84,109694.28,MSDRG Base Rate Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,49976.68,,,,,,,fee schedule,30354.79,73935.48, Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,64433.04,,,,,,,fee schedule,30354.79,73935.48, Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,61612.9,,,,,,,fee schedule,30354.79,73935.48, Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,73935.48,,,,,,,fee schedule,30354.79,73935.48, Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31568.98,,,,,,,fee schedule,30354.79,73935.48,MSDRG Base Rate Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31872.53,,,,,,,fee schedule,30354.79,73935.48,MSDRG Base Rate Other Major Cardiovascular Procedures With Cc,271,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30354.79,,,,,,,fee schedule,30354.79,73935.48,MSDRG Base Rate Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,35877.31,,,,,,,fee schedule,21791.12,53076.87, Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,46255.25,,,,,,,fee schedule,21791.12,53076.87, Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44230.73,,,,,,,fee schedule,21791.12,53076.87, Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,53076.87,,,,,,,fee schedule,21791.12,53076.87, Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22662.76,,,,,,,fee schedule,21791.12,53076.87,MSDRG Base Rate Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22880.68,,,,,,,fee schedule,21791.12,53076.87,MSDRG Base Rate Other Major Cardiovascular Procedures Without Cc/Mcc,272,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21791.12,,,,,,,fee schedule,21791.12,53076.87,MSDRG Base Rate Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,57975.65,,,,,,,fee schedule,35213.19,85769.15, Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,74745.81,,,,,,,fee schedule,35213.19,85769.15, Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,71474.29,,,,,,,fee schedule,35213.19,85769.15, Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,85769.15,,,,,,,fee schedule,35213.19,85769.15, Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,36621.72,,,,,,,fee schedule,35213.19,85769.15,MSDRG Base Rate Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36973.85,,,,,,,fee schedule,35213.19,85769.15,MSDRG Base Rate Percutaneous And Other Intracardiac Procedures With Mcc,273,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35213.19,,,,,,,fee schedule,35213.19,85769.15,MSDRG Base Rate Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,46258.26,,,,,,,fee schedule,28096.3,68434.44, Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,59639.02,,,,,,,fee schedule,28096.3,68434.44, Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,57028.7,,,,,,,fee schedule,28096.3,68434.44, Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,68434.44,,,,,,,fee schedule,28096.3,68434.44, Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,29220.15,,,,,,,fee schedule,28096.3,68434.44,MSDRG Base Rate Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29501.12,,,,,,,fee schedule,28096.3,68434.44,MSDRG Base Rate Percutaneous And Other Intracardiac Procedures Without Mcc,274,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,28096.3,,,,,,,fee schedule,28096.3,68434.44,MSDRG Base Rate Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,100203.51,,,,,,,fee schedule,60861.51,148241.02, Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,129188.59,,,,,,,fee schedule,60861.51,148241.02, Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,123534.18,,,,,,,fee schedule,60861.51,148241.02, Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,148241.02,,,,,,,fee schedule,60861.51,148241.02, Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,63295.97,,,,,,,fee schedule,60861.51,148241.02,MSDRG Base Rate Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,63904.59,,,,,,,fee schedule,60861.51,148241.02,MSDRG Base Rate Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc,275,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,60861.51,,,,,,,fee schedule,60861.51,148241.02,MSDRG Base Rate Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,84410.75,,,,,,,fee schedule,51269.32,124877.21, Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,108827.58,,,,,,,fee schedule,51269.32,124877.21, Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,104064.35,,,,,,,fee schedule,51269.32,124877.21, Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,124877.21,,,,,,,fee schedule,51269.32,124877.21, Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,53320.09,,,,,,,fee schedule,51269.32,124877.21,MSDRG Base Rate Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53832.79,,,,,,,fee schedule,51269.32,124877.21,MSDRG Base Rate Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator,276,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,51269.32,,,,,,,fee schedule,51269.32,124877.21,MSDRG Base Rate Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,64903.78,,,,,,,fee schedule,39421.19,96018.62, Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,83677.98,,,,,,,fee schedule,39421.19,96018.62, Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,80015.51,,,,,,,fee schedule,39421.19,96018.62, Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,96018.62,,,,,,,fee schedule,39421.19,96018.62, Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,40998.04,,,,,,,fee schedule,39421.19,96018.62,MSDRG Base Rate Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41392.25,,,,,,,fee schedule,39421.19,96018.62,MSDRG Base Rate Cardiac Defibrillator Implant Without Mcc,277,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,39421.19,,,,,,,fee schedule,39421.19,96018.62,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,78221.81,,,,,,,fee schedule,47510.28,115721.3, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,100848.41,,,,,,,fee schedule,47510.28,115721.3, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,96434.42,,,,,,,fee schedule,47510.28,115721.3, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,115721.3,,,,,,,fee schedule,47510.28,115721.3, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,49410.69,,,,,,,fee schedule,47510.28,115721.3,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49885.79,,,,,,,fee schedule,47510.28,115721.3,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc,278,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,47510.28,,,,,,,fee schedule,47510.28,115721.3,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50680.74,,,,,,,fee schedule,30782.42,74977.06, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,65340.76,,,,,,,fee schedule,30782.42,74977.06, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,62480.88,,,,,,,fee schedule,30782.42,74977.06, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,74977.06,,,,,,,fee schedule,30782.42,74977.06, Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32013.72,,,,,,,fee schedule,30782.42,74977.06,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32321.54,,,,,,,fee schedule,30782.42,74977.06,MSDRG Base Rate Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc,279,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30782.42,,,,,,,fee schedule,30782.42,74977.06,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22542.42,,,,,,,fee schedule,13691.79,33349.24, "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29063.08,,,,,,,fee schedule,13691.79,33349.24, "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27791.03,,,,,,,fee schedule,13691.79,33349.24, "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33349.24,,,,,,,fee schedule,13691.79,33349.24, "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],13949.75,13949.75,13949.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19293.31,19293.31,19293.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21611.68,21611.68,27536.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10500.53,10500.53,10500.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],16272.19,16272.19,16272.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14239.46,,,,,,,fee schedule,13691.79,33349.24,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14376.38,,,,,,,fee schedule,13691.79,33349.24,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive With Mcc",280,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13691.79,,,,,,,fee schedule,13691.79,33349.24,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12916.11,,,,,,,fee schedule,7844.98,19108.09, "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16652.25,,,,,,,fee schedule,7844.98,19108.09, "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15923.41,,,,,,,fee schedule,7844.98,19108.09, "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19108.09,,,,,,,fee schedule,7844.98,19108.09, "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],11105.53,11105.53,11105.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12829.44,12829.44,12829.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16603.5,16603.5,16603.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],15208.65,15208.65,15208.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],7102.06,7102.06,7102.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8158.78,,,,,,,fee schedule,7844.98,19108.09,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8237.23,,,,,,,fee schedule,7844.98,19108.09,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive With Cc",281,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7844.98,,,,,,,fee schedule,7844.98,19108.09,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10161.72,,,,,,,fee schedule,6172.02,15033.25, "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13101.13,,,,,,,fee schedule,6172.02,15033.25, "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12527.71,,,,,,,fee schedule,6172.02,15033.25, "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15033.25,,,,,,,fee schedule,6172.02,15033.25, "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],4806.69,4806.69,5629.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6418.9,,,,,,,fee schedule,6172.02,15033.25,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6480.62,,,,,,,fee schedule,6172.02,15033.25,MSDRG Base Rate "Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc",282,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6172.02,,,,,,,fee schedule,6172.02,15033.25,MSDRG Base Rate "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27836.18,,,,,,,fee schedule,16907.11,41180.83, "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35888.13,,,,,,,fee schedule,16907.11,41180.83, "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34317.36,,,,,,,fee schedule,16907.11,41180.83, "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41180.83,,,,,,,fee schedule,16907.11,41180.83, "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17583.39,,,,,,,fee schedule,16907.11,41180.83,MSDRG Base Rate "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17752.47,,,,,,,fee schedule,16907.11,41180.83,MSDRG Base Rate "Acute Myocardial Infarction, Expired With Mcc",283,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16907.11,,,,,,,fee schedule,16907.11,41180.83,MSDRG Base Rate "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9727.49,,,,,,,fee schedule,5908.27,14390.84, "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12541.28,,,,,,,fee schedule,5908.27,14390.84, "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11992.37,,,,,,,fee schedule,5908.27,14390.84, "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14390.84,,,,,,,fee schedule,5908.27,14390.84, "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6144.6,,,,,,,fee schedule,5908.27,14390.84,MSDRG Base Rate "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6203.68,,,,,,,fee schedule,5908.27,14390.84,MSDRG Base Rate "Acute Myocardial Infarction, Expired With Cc",284,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5908.27,,,,,,,fee schedule,5908.27,14390.84,MSDRG Base Rate "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8416.34,,,,,,,fee schedule,5111.91,12451.13, "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,10850.87,,,,,,,fee schedule,5111.91,12451.13, "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10375.94,,,,,,,fee schedule,5111.91,12451.13, "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,12451.13,,,,,,,fee schedule,5111.91,12451.13, "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5316.39,,,,,,,fee schedule,5111.91,12451.13,MSDRG Base Rate "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5367.51,,,,,,,fee schedule,5111.91,12451.13,MSDRG Base Rate "Acute Myocardial Infarction, Expired Without Cc/Mcc",285,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5111.91,,,,,,,fee schedule,5111.91,12451.13,MSDRG Base Rate "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31096.48,,,,,,,fee schedule,18887.35,46004.11, "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,40091.51,,,,,,,fee schedule,18887.35,46004.11, "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38336.76,,,,,,,fee schedule,18887.35,46004.11, "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,46004.11,,,,,,,fee schedule,18887.35,46004.11, "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19642.84,,,,,,,fee schedule,18887.35,46004.11,MSDRG Base Rate "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19831.72,,,,,,,fee schedule,18887.35,46004.11,MSDRG Base Rate "Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc",286,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18887.35,,,,,,,fee schedule,18887.35,46004.11,MSDRG Base Rate "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15038.12,,,,,,,fee schedule,9133.84,22247.38, "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19388.07,,,,,,,fee schedule,9133.84,22247.38, "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18539.48,,,,,,,fee schedule,9133.84,22247.38, "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22247.38,,,,,,,fee schedule,9133.84,22247.38, "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9499.19,,,,,,,fee schedule,9133.84,22247.38,MSDRG Base Rate "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9590.53,,,,,,,fee schedule,9133.84,22247.38,MSDRG Base Rate "Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc",287,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9133.84,,,,,,,fee schedule,9133.84,22247.38,MSDRG Base Rate Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38030.23,,,,,,,fee schedule,23098.76,56261.9, Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,49030.93,,,,,,,fee schedule,23098.76,56261.9, Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,46884.92,,,,,,,fee schedule,23098.76,56261.9, Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,56261.9,,,,,,,fee schedule,23098.76,56261.9, Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24022.71,,,,,,,fee schedule,23098.76,56261.9,MSDRG Base Rate Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24253.7,,,,,,,fee schedule,23098.76,56261.9,MSDRG Base Rate Acute And Subacute Endocarditis With Mcc,288,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23098.76,,,,,,,fee schedule,23098.76,56261.9,MSDRG Base Rate Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23987.07,,,,,,,fee schedule,14569.24,35486.45, Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30925.61,,,,,,,fee schedule,14569.24,35486.45, Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29572.04,,,,,,,fee schedule,14569.24,35486.45, Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35486.45,,,,,,,fee schedule,14569.24,35486.45, Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15152.01,,,,,,,fee schedule,14569.24,35486.45,MSDRG Base Rate Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15297.7,,,,,,,fee schedule,14569.24,35486.45,MSDRG Base Rate Acute And Subacute Endocarditis With Cc,289,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14569.24,,,,,,,fee schedule,14569.24,35486.45,MSDRG Base Rate Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13065.07,,,,,,,fee schedule,7935.45,19328.46, Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16844.3,,,,,,,fee schedule,7935.45,19328.46, Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16107.05,,,,,,,fee schedule,7935.45,19328.46, Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19328.46,,,,,,,fee schedule,7935.45,19328.46, Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8252.87,,,,,,,fee schedule,7935.45,19328.46,MSDRG Base Rate Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8332.22,,,,,,,fee schedule,7935.45,19328.46,MSDRG Base Rate Acute And Subacute Endocarditis Without Cc/Mcc,290,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7935.45,,,,,,,fee schedule,7935.45,19328.46,MSDRG Base Rate Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18041.24,,,,,,,fee schedule,10957.87,26690.2, Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23259.89,,,,,,,fee schedule,10957.87,26690.2, Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22241.84,,,,,,,fee schedule,10957.87,26690.2, Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26690.2,,,,,,,fee schedule,10957.87,26690.2, Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],11291.78,9991.01,11452.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19293.31,19293.31,19293.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18170.32,13746.92,18170.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18414.48,11798.53,21865.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],20782.87,20782.87,20782.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],10004.88,10004.88,10004.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17866.24,17866.24,17866.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,30997.57,30997.57,44629.69,1 through 10,percent of total billed charges,,, Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,54911.75,54911.75,54911.75,1 through 10,percent of total billed charges,,, Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11396.18,,,,,,,fee schedule,10957.87,26690.2,MSDRG Base Rate Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11505.76,,,,,,,fee schedule,10957.87,26690.2,MSDRG Base Rate Heart Failure And Shock With Mcc,291,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10957.87,,,,,,,fee schedule,10957.87,26690.2,MSDRG Base Rate Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11931,,,,,,,fee schedule,7246.64,17650.71, Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15382.18,,,,,,,fee schedule,7246.64,17650.71, Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14708.93,,,,,,,fee schedule,7246.64,17650.71, Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17650.71,,,,,,,fee schedule,7246.64,17650.71, Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18170.32,18170.32,18170.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7536.51,,,,,,,fee schedule,7246.64,17650.71,MSDRG Base Rate Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7608.97,,,,,,,fee schedule,7246.64,17650.71,MSDRG Base Rate Heart Failure And Shock With Cc,292,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7246.64,,,,,,,fee schedule,7246.64,17650.71,MSDRG Base Rate Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,7954,,,,,,,fee schedule,4831.09,11767.14, Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,10254.79,,,,,,,fee schedule,4831.09,11767.14, Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,9805.95,,,,,,,fee schedule,4831.09,11767.14, Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,11767.14,,,,,,,fee schedule,4831.09,11767.14, Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5024.33,,,,,,,fee schedule,4831.09,11767.14,MSDRG Base Rate Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5072.64,,,,,,,fee schedule,4831.09,11767.14,MSDRG Base Rate Heart Failure And Shock Without Cc/Mcc,293,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,4831.09,,,,,,,fee schedule,4831.09,11767.14,MSDRG Base Rate Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17255.68,,,,,,,fee schedule,17255.68,22247.09, Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22247.09,,,,,,,fee schedule,17255.68,22247.09, Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,14498.51,14498.51,14498.51,1 through 10,percent of total billed charges,,, Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis With Cc/Mcc,294,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11099.06,,,,,,,fee schedule,11099.06,14309.6, Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14309.6,,,,,,,fee schedule,11099.06,14309.6, Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Deep Vein Thrombophlebitis Without Cc/Mcc,295,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21949.38,,,,,,,fee schedule,13331.59,32471.9, "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28298.5,,,,,,,fee schedule,13331.59,32471.9, "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27059.92,,,,,,,fee schedule,13331.59,32471.9, "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32471.9,,,,,,,fee schedule,13331.59,32471.9, "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",29978.16,29978.16,29978.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13864.85,,,,,,,fee schedule,13331.59,32471.9,MSDRG Base Rate "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13998.17,,,,,,,fee schedule,13331.59,32471.9,MSDRG Base Rate "Cardiac Arrest, Unexplained With Mcc",296,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13331.59,,,,,,,fee schedule,13331.59,32471.9,MSDRG Base Rate "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8909.6,,,,,,,fee schedule,5411.51,13180.86, "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11486.81,,,,,,,fee schedule,5411.51,13180.86, "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10984.05,,,,,,,fee schedule,5411.51,13180.86, "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13180.86,,,,,,,fee schedule,5411.51,13180.86, "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5627.97,,,,,,,fee schedule,5411.51,13180.86,MSDRG Base Rate "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5682.09,,,,,,,fee schedule,5411.51,13180.86,MSDRG Base Rate "Cardiac Arrest, Unexplained With Cc",297,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5411.51,,,,,,,fee schedule,5411.51,13180.86,MSDRG Base Rate "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,6395.52,,,,,,,fee schedule,3884.5,9461.53, "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,8245.5,,,,,,,fee schedule,3884.5,9461.53, "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,7884.61,,,,,,,fee schedule,3884.5,9461.53, "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,9461.53,,,,,,,fee schedule,3884.5,9461.53, "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,4039.88,,,,,,,fee schedule,3884.5,9461.53,MSDRG Base Rate "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4078.73,,,,,,,fee schedule,3884.5,9461.53,MSDRG Base Rate "Cardiac Arrest, Unexplained Without Cc/Mcc",298,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,3884.5,,,,,,,fee schedule,3884.5,9461.53,MSDRG Base Rate Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22944.33,,,,,,,fee schedule,13935.91,33943.83, Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29581.26,,,,,,,fee schedule,13935.91,33943.83, Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28286.53,,,,,,,fee schedule,13935.91,33943.83, Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33943.83,,,,,,,fee schedule,13935.91,33943.83, Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20897.26,10124.32,26536.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],26690.4,26690.4,26690.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",28873.96,28873.96,28873.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14493.35,,,,,,,fee schedule,13935.91,33943.83,MSDRG Base Rate Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14632.71,,,,,,,fee schedule,13935.91,33943.83,MSDRG Base Rate Peripheral Vascular Disorders With Mcc,299,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13935.91,,,,,,,fee schedule,13935.91,33943.83,MSDRG Base Rate Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15001.58,,,,,,,fee schedule,9111.64,22193.33, Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19340.97,,,,,,,fee schedule,9111.64,22193.33, Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18494.44,,,,,,,fee schedule,9111.64,22193.33, Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22193.33,,,,,,,fee schedule,9111.64,22193.33, Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],20153,20153,20153,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8526.32,8526.32,8526.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17897.99,17897.99,17897.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],23673.9,23673.9,23673.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12788.72,12788.72,12788.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9476.11,,,,,,,fee schedule,9111.64,22193.33,MSDRG Base Rate Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9567.22,,,,,,,fee schedule,9111.64,22193.33,MSDRG Base Rate Peripheral Vascular Disorders With Cc,300,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9111.64,,,,,,,fee schedule,9111.64,22193.33,MSDRG Base Rate Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10113.94,,,,,,,fee schedule,6143,14962.56, Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13039.52,,,,,,,fee schedule,6143,14962.56, Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12468.8,,,,,,,fee schedule,6143,14962.56, Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14962.56,,,,,,,fee schedule,6143,14962.56, Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10129.18,10129.18,10129.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6388.72,,,,,,,fee schedule,6143,14962.56,MSDRG Base Rate Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6450.15,,,,,,,fee schedule,6143,14962.56,MSDRG Base Rate Peripheral Vascular Disorders Without Cc/Mcc,301,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6143,,,,,,,fee schedule,6143,14962.56,MSDRG Base Rate Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16815.82,,,,,,,fee schedule,10213.58,24877.31, Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21680,,,,,,,fee schedule,10213.58,24877.31, Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20731.1,,,,,,,fee schedule,10213.58,24877.31, Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24877.31,,,,,,,fee schedule,10213.58,24877.31, Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10622.12,,,,,,,fee schedule,10213.58,24877.31,MSDRG Base Rate Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10724.26,,,,,,,fee schedule,10213.58,24877.31,MSDRG Base Rate Atherosclerosis With Mcc,302,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10213.58,,,,,,,fee schedule,10213.58,24877.31,MSDRG Base Rate Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9460.48,,,,,,,fee schedule,5746.1,13995.83, Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12197.04,,,,,,,fee schedule,5746.1,13995.83, Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11663.19,,,,,,,fee schedule,5746.1,13995.83, Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13995.83,,,,,,,fee schedule,5746.1,13995.83, Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11275.18,11275.18,11275.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5975.94,,,,,,,fee schedule,5746.1,13995.83,MSDRG Base Rate Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6033.41,,,,,,,fee schedule,5746.1,13995.83,MSDRG Base Rate Atherosclerosis Without Mcc,303,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5746.1,,,,,,,fee schedule,5746.1,13995.83,MSDRG Base Rate Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16723.07,,,,,,,fee schedule,10157.24,24740.1, Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21560.42,,,,,,,fee schedule,10157.24,24740.1, Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20616.75,,,,,,,fee schedule,10157.24,24740.1, Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24740.1,,,,,,,fee schedule,10157.24,24740.1, Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10167.35,10167.35,10167.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17641.68,17641.68,17641.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",23216.34,23216.34,23216.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],19134.2,19134.2,19134.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,20032.07,20032.07,20032.07,1 through 10,percent of total billed charges,,, Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10563.53,,,,,,,fee schedule,10157.24,24740.1,MSDRG Base Rate Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10665.1,,,,,,,fee schedule,10157.24,24740.1,MSDRG Base Rate Hypertension With Mcc,304,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10157.24,,,,,,,fee schedule,10157.24,24740.1,MSDRG Base Rate Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10611.42,,,,,,,fee schedule,6445.15,15698.53, Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13680.9,,,,,,,fee schedule,6445.15,15698.53, Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13082.11,,,,,,,fee schedule,6445.15,15698.53, Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15698.53,,,,,,,fee schedule,6445.15,15698.53, Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],5845.86,5845.86,5845.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13511.23,13511.23,13511.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6702.96,,,,,,,fee schedule,6445.15,15698.53,MSDRG Base Rate Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6767.41,,,,,,,fee schedule,6445.15,15698.53,MSDRG Base Rate Hypertension Without Mcc,305,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6445.15,,,,,,,fee schedule,6445.15,15698.53,MSDRG Base Rate Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22144.72,,,,,,,fee schedule,13450.24,32760.88, Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28550.34,,,,,,,fee schedule,13450.24,32760.88, Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27300.74,,,,,,,fee schedule,13450.24,32760.88, Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32760.88,,,,,,,fee schedule,13450.24,32760.88, Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13988.25,,,,,,,fee schedule,13450.24,32760.88,MSDRG Base Rate Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14122.75,,,,,,,fee schedule,13450.24,32760.88,MSDRG Base Rate Cardiac Congenital And Valvular Disorders With Mcc,306,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13450.24,,,,,,,fee schedule,13450.24,32760.88,MSDRG Base Rate Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12833.2,,,,,,,fee schedule,7794.62,18985.43, Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16545.36,,,,,,,fee schedule,7794.62,18985.43, Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15821.19,,,,,,,fee schedule,7794.62,18985.43, Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18985.43,,,,,,,fee schedule,7794.62,18985.43, Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8106.4,,,,,,,fee schedule,7794.62,18985.43,MSDRG Base Rate Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8184.35,,,,,,,fee schedule,7794.62,18985.43,MSDRG Base Rate Cardiac Congenital And Valvular Disorders Without Mcc,307,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7794.62,,,,,,,fee schedule,7794.62,18985.43,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16919.81,,,,,,,fee schedule,10276.74,25031.16, Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21814.07,,,,,,,fee schedule,10276.74,25031.16, Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20859.3,,,,,,,fee schedule,10276.74,25031.16, Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25031.16,,,,,,,fee schedule,10276.74,25031.16, Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],9333.39,9333.39,9333.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13948.35,8303.44,20228.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10687.81,,,,,,,fee schedule,10276.74,25031.16,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10790.58,,,,,,,fee schedule,10276.74,25031.16,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders With Mcc,308,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10276.74,,,,,,,fee schedule,10276.74,25031.16,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10338.79,,,,,,,fee schedule,6279.57,15295.2, Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13329.41,,,,,,,fee schedule,6279.57,15295.2, Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12746,,,,,,,fee schedule,6279.57,15295.2, Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15295.2,,,,,,,fee schedule,6279.57,15295.2, Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12879.19,12879.19,12879.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],12386.84,12386.84,12386.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6530.75,,,,,,,fee schedule,6279.57,15295.2,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6593.55,,,,,,,fee schedule,6279.57,15295.2,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders With Cc,309,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6279.57,,,,,,,fee schedule,6279.57,15295.2,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,7955.4,,,,,,,fee schedule,4831.94,11769.22, Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,10256.6,,,,,,,fee schedule,4831.94,11769.22, Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,9807.68,,,,,,,fee schedule,4831.94,11769.22, Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,11769.22,,,,,,,fee schedule,4831.94,11769.22, Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2618.83,2618.83,2618.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],8824.19,8824.19,8824.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],7417.85,7417.85,7417.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9231.75,9231.75,9231.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5025.22,,,,,,,fee schedule,4831.94,11769.22,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5073.54,,,,,,,fee schedule,4831.94,11769.22,MSDRG Base Rate Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc,310,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,4831.94,,,,,,,fee schedule,4831.94,11769.22,MSDRG Base Rate Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9863.8,,,,,,,fee schedule,5991.07,14592.5, Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12717.02,,,,,,,fee schedule,5991.07,14592.5, Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12160.42,,,,,,,fee schedule,5991.07,14592.5, Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14592.5,,,,,,,fee schedule,5991.07,14592.5, Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6230.71,,,,,,,fee schedule,5991.07,14592.5,MSDRG Base Rate Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6290.62,,,,,,,fee schedule,5991.07,14592.5,MSDRG Base Rate Angina Pectoris,311,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5991.07,,,,,,,fee schedule,5991.07,14592.5,MSDRG Base Rate Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12248.59,,,,,,,fee schedule,7439.54,18120.56, Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15791.65,,,,,,,fee schedule,7439.54,18120.56, Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15100.47,,,,,,,fee schedule,7439.54,18120.56, Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18120.56,,,,,,,fee schedule,7439.54,18120.56, Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14616.93,14616.93,14616.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7737.12,,,,,,,fee schedule,7439.54,18120.56,MSDRG Base Rate Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7811.52,,,,,,,fee schedule,7439.54,18120.56,MSDRG Base Rate Syncope And Collapse,312,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7439.54,,,,,,,fee schedule,7439.54,18120.56,MSDRG Base Rate Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10118.16,,,,,,,fee schedule,6145.56,14968.8, Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13044.96,,,,,,,fee schedule,6145.56,14968.8, Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12474,,,,,,,fee schedule,6145.56,14968.8, Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14968.8,,,,,,,fee schedule,6145.56,14968.8, Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6391.38,,,,,,,fee schedule,6145.56,14968.8,MSDRG Base Rate Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6452.84,,,,,,,fee schedule,6145.56,14968.8,MSDRG Base Rate Chest Pain,313,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6145.56,,,,,,,fee schedule,6145.56,14968.8,MSDRG Base Rate Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29303.32,,,,,,,fee schedule,17798.22,43351.31, Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37779.65,,,,,,,fee schedule,17798.22,43351.31, Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36126.09,,,,,,,fee schedule,17798.22,43351.31, Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43351.31,,,,,,,fee schedule,17798.22,43351.31, Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],36127.12,36127.12,36127.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],28551.1,28551.1,28551.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,19530,19530,19530,1 through 10,percent of total billed charges,,, Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18510.15,,,,,,,fee schedule,17798.22,43351.31,MSDRG Base Rate Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18688.13,,,,,,,fee schedule,17798.22,43351.31,MSDRG Base Rate Other Circulatory System Diagnoses With Mcc,314,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17798.22,,,,,,,fee schedule,17798.22,43351.31,MSDRG Base Rate Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13537.25,,,,,,,fee schedule,8222.24,20027.01, Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17453.07,,,,,,,fee schedule,8222.24,20027.01, Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16689.17,,,,,,,fee schedule,8222.24,20027.01, Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20027.01,,,,,,,fee schedule,8222.24,20027.01, Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10801.62,10801.62,10801.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8551.13,,,,,,,fee schedule,8222.24,20027.01,MSDRG Base Rate Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8633.35,,,,,,,fee schedule,8222.24,20027.01,MSDRG Base Rate Other Circulatory System Diagnoses With Cc,315,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8222.24,,,,,,,fee schedule,8222.24,20027.01,MSDRG Base Rate Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9585.55,,,,,,,fee schedule,5822.06,14180.86, Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12358.29,,,,,,,fee schedule,5822.06,14180.86, Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11817.38,,,,,,,fee schedule,5822.06,14180.86, Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14180.86,,,,,,,fee schedule,5822.06,14180.86, Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6054.94,,,,,,,fee schedule,5822.06,14180.86,MSDRG Base Rate Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6113.16,,,,,,,fee schedule,5822.06,14180.86,MSDRG Base Rate Other Circulatory System Diagnoses Without Cc/Mcc,316,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5822.06,,,,,,,fee schedule,5822.06,14180.86,MSDRG Base Rate Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,93965.38,,,,,,,fee schedule,57072.6,139012.34, Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,121146.01,,,,,,,fee schedule,57072.6,139012.34, Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,115843.61,,,,,,,fee schedule,57072.6,139012.34, Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,139012.34,,,,,,,fee schedule,57072.6,139012.34, Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,59355.5,,,,,,,fee schedule,57072.6,139012.34,MSDRG Base Rate Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59926.23,,,,,,,fee schedule,57072.6,139012.34,MSDRG Base Rate Concomitant Left Atrial Appendage Closure And Cardiac Ablation,317,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,57072.6,,,,,,,fee schedule,57072.6,139012.34,MSDRG Base Rate Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34039.18,,,,,,,fee schedule,20674.68,50357.54, Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,43885.42,,,,,,,fee schedule,20674.68,50357.54, Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,41964.62,,,,,,,fee schedule,20674.68,50357.54, Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,50357.54,,,,,,,fee schedule,20674.68,50357.54, Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21501.67,,,,,,,fee schedule,20674.68,50357.54,MSDRG Base Rate Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21708.41,,,,,,,fee schedule,20674.68,50357.54,MSDRG Base Rate Percutaneous Coronary Atherectomy Without Intraluminal Device,318,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20674.68,,,,,,,fee schedule,20674.68,50357.54,MSDRG Base Rate Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,62717.13,,,,,,,fee schedule,38093.07,92783.69, Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,80858.82,,,,,,,fee schedule,38093.07,92783.69, Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,77319.74,,,,,,,fee schedule,38093.07,92783.69, Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,92783.69,,,,,,,fee schedule,38093.07,92783.69, Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,39616.79,,,,,,,fee schedule,38093.07,92783.69,MSDRG Base Rate Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39997.72,,,,,,,fee schedule,38093.07,92783.69,MSDRG Base Rate Other Endovascular Cardiac Valve Procedures With Mcc,319,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,38093.07,,,,,,,fee schedule,38093.07,92783.69,MSDRG Base Rate Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,33801.68,,,,,,,fee schedule,20530.43,50006.19, Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,43579.23,,,,,,,fee schedule,20530.43,50006.19, Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,41671.82,,,,,,,fee schedule,20530.43,50006.19, Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,50006.19,,,,,,,fee schedule,20530.43,50006.19, Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21351.65,,,,,,,fee schedule,20530.43,50006.19,MSDRG Base Rate Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21556.95,,,,,,,fee schedule,20530.43,50006.19,MSDRG Base Rate Other Endovascular Cardiac Valve Procedures Without Mcc,320,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20530.43,,,,,,,fee schedule,20530.43,50006.19,MSDRG Base Rate Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38235.4,,,,,,,fee schedule,23223.38,56565.43, Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,49295.45,,,,,,,fee schedule,23223.38,56565.43, Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,47137.86,,,,,,,fee schedule,23223.38,56565.43, Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,56565.43,,,,,,,fee schedule,23223.38,56565.43, Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24152.32,,,,,,,fee schedule,23223.38,56565.43,MSDRG Base Rate Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24384.55,,,,,,,fee schedule,23223.38,56565.43,MSDRG Base Rate Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal,321,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23223.38,,,,,,,fee schedule,23223.38,56565.43,MSDRG Base Rate Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24775.44,,,,,,,fee schedule,15048.08,36652.77, Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31942.03,,,,,,,fee schedule,15048.08,36652.77, Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30543.98,,,,,,,fee schedule,15048.08,36652.77, Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36652.77,,,,,,,fee schedule,15048.08,36652.77, Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15650,,,,,,,fee schedule,15048.08,36652.77,MSDRG Base Rate Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15800.48,,,,,,,fee schedule,15048.08,36652.77,MSDRG Base Rate Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc,322,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15048.08,,,,,,,fee schedule,15048.08,36652.77,MSDRG Base Rate Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,60812.95,,,,,,,fee schedule,36936.51,89966.65, Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,78403.83,,,,,,,fee schedule,36936.51,89966.65, Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,74972.21,,,,,,,fee schedule,36936.51,89966.65, Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,89966.65,,,,,,,fee schedule,36936.51,89966.65, Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,38413.97,,,,,,,fee schedule,36936.51,89966.65,MSDRG Base Rate Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38783.34,,,,,,,fee schedule,36936.51,89966.65,MSDRG Base Rate Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc,323,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,36936.51,,,,,,,fee schedule,36936.51,89966.65,MSDRG Base Rate Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44281,,,,,,,fee schedule,26895.35,65509.29, Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57089.82,,,,,,,fee schedule,26895.35,65509.29, Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,54591.08,,,,,,,fee schedule,26895.35,65509.29, Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,65509.29,,,,,,,fee schedule,26895.35,65509.29, Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27971.16,,,,,,,fee schedule,26895.35,65509.29,MSDRG Base Rate Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28240.12,,,,,,,fee schedule,26895.35,65509.29,MSDRG Base Rate Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc,324,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26895.35,,,,,,,fee schedule,26895.35,65509.29,MSDRG Base Rate Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45115.75,,,,,,,fee schedule,27402.36,66744.22, Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58166.03,,,,,,,fee schedule,27402.36,66744.22, Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55620.18,,,,,,,fee schedule,27402.36,66744.22, Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,66744.22,,,,,,,fee schedule,27402.36,66744.22, Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28498.45,,,,,,,fee schedule,27402.36,66744.22,MSDRG Base Rate Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28772.48,,,,,,,fee schedule,27402.36,66744.22,MSDRG Base Rate Coronary Intravascular Lithotripsy Without Intraluminal Device,325,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27402.36,,,,,,,fee schedule,27402.36,66744.22,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,70087.93,,,,,,,fee schedule,42569.94,103688.05, "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,90361.71,,,,,,,fee schedule,42569.94,103688.05, "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,86406.71,,,,,,,fee schedule,42569.94,103688.05, "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,103688.05,,,,,,,fee schedule,42569.94,103688.05, "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],85201.8,85201.8,85205.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],83803.5,83803.5,83803.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,44272.74,,,,,,,fee schedule,42569.94,103688.05,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44698.44,,,,,,,fee schedule,42569.94,103688.05,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures With Mcc",326,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,42569.94,,,,,,,fee schedule,42569.94,103688.05,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34348.34,,,,,,,fee schedule,20862.46,50814.92, "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,44284.02,,,,,,,fee schedule,20862.46,50814.92, "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,42345.77,,,,,,,fee schedule,20862.46,50814.92, "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,50814.92,,,,,,,fee schedule,20862.46,50814.92, "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",57501.25,57501.25,57501.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],40733.81,40733.81,40733.81,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],20882.44,20882.44,20882.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21696.96,,,,,,,fee schedule,20862.46,50814.92,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21905.58,,,,,,,fee schedule,20862.46,50814.92,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures With Cc",327,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20862.46,,,,,,,fee schedule,20862.46,50814.92,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22517.12,,,,,,,fee schedule,13676.43,33311.82, "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29030.47,,,,,,,fee schedule,13676.43,33311.82, "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27759.85,,,,,,,fee schedule,13676.43,33311.82, "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33311.82,,,,,,,fee schedule,13676.43,33311.82, "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],26732.56,26732.56,26732.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],26292.75,26292.75,26292.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,23294.09,23294.09,23294.09,1 through 10,percent of total billed charges,,, "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,42021.13,42021.13,42021.13,1 through 10,percent of total billed charges,,, "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,39108.27,39108.27,39108.27,1 through 10,percent of total billed charges,,, "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14223.49,,,,,,,fee schedule,13676.43,33311.82,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14360.25,,,,,,,fee schedule,13676.43,33311.82,MSDRG Base Rate "Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc",328,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13676.43,,,,,,,fee schedule,13676.43,33311.82,MSDRG Base Rate Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,64594.61,,,,,,,fee schedule,39233.41,95561.24, Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,83279.39,,,,,,,fee schedule,39233.41,95561.24, Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,79634.36,,,,,,,fee schedule,39233.41,95561.24, Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,95561.24,,,,,,,fee schedule,39233.41,95561.24, Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],56875.75,56875.75,56875.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],37184.93,37184.93,37184.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",51342.46,51342.46,51342.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],35013.8,27669.75,75773.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],72350.49,59063.93,91790.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],77746.67,77746.67,77746.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],36553.74,36553.74,36553.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],39777.52,39777.52,39777.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",46395.17,46395.17,46960.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,40802.75,,,,,,,fee schedule,39233.41,95561.24,MSDRG Base Rate Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41195.08,,,,,,,fee schedule,39233.41,95561.24,MSDRG Base Rate Major Small And Large Bowel Procedures With Mcc,329,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,39233.41,,,,,,,fee schedule,39233.41,95561.24,MSDRG Base Rate Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,33687.85,,,,,,,fee schedule,20461.29,49837.79, Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,43432.47,,,,,,,fee schedule,20461.29,49837.79, Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,41531.49,,,,,,,fee schedule,20461.29,49837.79, Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,49837.79,,,,,,,fee schedule,20461.29,49837.79, Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8619.73,8568.62,14395,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],20489.93,20489.93,20489.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",34843.04,34843.04,34843.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",33720.05,33720.05,33720.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27665.18,18093.46,39653.43,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],31337.93,31337.93,39642.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],39001.05,39001.05,63589.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",32426.45,32426.45,32426.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21279.74,,,,,,,fee schedule,20461.29,49837.79,MSDRG Base Rate Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21484.35,,,,,,,fee schedule,20461.29,49837.79,MSDRG Base Rate Major Small And Large Bowel Procedures With Cc,330,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20461.29,,,,,,,fee schedule,20461.29,49837.79,MSDRG Base Rate Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23649.79,,,,,,,fee schedule,14364.39,34987.49, Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30490.78,,,,,,,fee schedule,14364.39,34987.49, Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29156.24,,,,,,,fee schedule,14364.39,34987.49, Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34987.49,,,,,,,fee schedule,14364.39,34987.49, Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8637,7821.78,11516,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",26107.35,26107.35,26107.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],21842.65,21842.65,21842.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20903.53,16200.26,27697.18,31,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],27241.5,22782.56,27767.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],24568.06,24568.06,24568.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,61477.38,61477.38,61477.38,1 through 10,percent of total billed charges,,, Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14938.97,,,,,,,fee schedule,14364.39,34987.49,MSDRG Base Rate Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15082.61,,,,,,,fee schedule,14364.39,34987.49,MSDRG Base Rate Major Small And Large Bowel Procedures Without Cc/Mcc,331,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14364.39,,,,,,,fee schedule,14364.39,34987.49,MSDRG Base Rate Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50881.7,,,,,,,fee schedule,30904.47,75274.35, Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,65599.84,,,,,,,fee schedule,30904.47,75274.35, Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,62728.63,,,,,,,fee schedule,30904.47,75274.35, Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,75274.35,,,,,,,fee schedule,30904.47,75274.35, Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32140.65,,,,,,,fee schedule,30904.47,75274.35,MSDRG Base Rate Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32449.69,,,,,,,fee schedule,30904.47,75274.35,MSDRG Base Rate Rectal Resection With Mcc,332,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30904.47,,,,,,,fee schedule,30904.47,75274.35,MSDRG Base Rate Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32914.94,,,,,,,fee schedule,19991.84,48694.34, Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,42435.98,,,,,,,fee schedule,19991.84,48694.34, Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40578.62,,,,,,,fee schedule,19991.84,48694.34, Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48694.34,,,,,,,fee schedule,19991.84,48694.34, Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20791.51,,,,,,,fee schedule,19991.84,48694.34,MSDRG Base Rate Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20991.43,,,,,,,fee schedule,19991.84,48694.34,MSDRG Base Rate Rectal Resection With Cc,333,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19991.84,,,,,,,fee schedule,19991.84,48694.34,MSDRG Base Rate Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23017.41,,,,,,,fee schedule,13980.29,34051.94, Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29675.47,,,,,,,fee schedule,13980.29,34051.94, Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28376.62,,,,,,,fee schedule,13980.29,34051.94, Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34051.94,,,,,,,fee schedule,13980.29,34051.94, Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5076.96,5076.96,5076.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27822.17,27822.17,27822.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],19899.49,19899.49,19899.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14539.5,,,,,,,fee schedule,13980.29,34051.94,MSDRG Base Rate Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14679.3,,,,,,,fee schedule,13980.29,34051.94,MSDRG Base Rate Rectal Resection Without Cc/Mcc,334,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13980.29,,,,,,,fee schedule,13980.29,34051.94,MSDRG Base Rate Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50181.86,,,,,,,fee schedule,30479.41,74239.01, Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,64697.57,,,,,,,fee schedule,30479.41,74239.01, Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,61865.84,,,,,,,fee schedule,30479.41,74239.01, Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,74239.01,,,,,,,fee schedule,30479.41,74239.01, Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],60782.16,60782.16,60782.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],25329.15,25329.15,25329.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31698.59,,,,,,,fee schedule,30479.41,74239.01,MSDRG Base Rate Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32003.38,,,,,,,fee schedule,30479.41,74239.01,MSDRG Base Rate Peritoneal Adhesiolysis With Mcc,335,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30479.41,,,,,,,fee schedule,30479.41,74239.01,MSDRG Base Rate Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29633.56,,,,,,,fee schedule,17998.8,43839.87, Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38205.43,,,,,,,fee schedule,17998.8,43839.87, Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36533.23,,,,,,,fee schedule,17998.8,43839.87, Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43839.87,,,,,,,fee schedule,17998.8,43839.87, Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],35435.94,35435.94,35435.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18718.75,,,,,,,fee schedule,17998.8,43839.87,MSDRG Base Rate Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18898.74,,,,,,,fee schedule,17998.8,43839.87,MSDRG Base Rate Peritoneal Adhesiolysis With Cc,336,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17998.8,,,,,,,fee schedule,17998.8,43839.87,MSDRG Base Rate Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21571.36,,,,,,,fee schedule,13101.99,31912.65, Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27811.13,,,,,,,fee schedule,13101.99,31912.65, Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26593.88,,,,,,,fee schedule,13101.99,31912.65, Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31912.65,,,,,,,fee schedule,13101.99,31912.65, Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],25402.84,10912.61,25752.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13626.07,,,,,,,fee schedule,13101.99,31912.65,MSDRG Base Rate Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13757.09,,,,,,,fee schedule,13101.99,31912.65,MSDRG Base Rate Peritoneal Adhesiolysis Without Cc/Mcc,337,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13101.99,,,,,,,fee schedule,13101.99,31912.65,MSDRG Base Rate Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Mcc,338,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis With Cc,339,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc,340,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Mcc,341,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis With Cc,342,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc,343,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,36296.09,,,,,,,fee schedule,22045.48,53696.41, Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,46795.17,,,,,,,fee schedule,22045.48,53696.41, Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44747.01,,,,,,,fee schedule,22045.48,53696.41, Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,53696.41,,,,,,,fee schedule,22045.48,53696.41, Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22927.3,,,,,,,fee schedule,22045.48,53696.41,MSDRG Base Rate Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23147.75,,,,,,,fee schedule,22045.48,53696.41,MSDRG Base Rate Minor Small And Large Bowel Procedures With Mcc,344,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22045.48,,,,,,,fee schedule,22045.48,53696.41,MSDRG Base Rate Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21145.55,,,,,,,fee schedule,12843.36,31282.71, Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27262.15,,,,,,,fee schedule,12843.36,31282.71, Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26068.93,,,,,,,fee schedule,12843.36,31282.71, Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31282.71,,,,,,,fee schedule,12843.36,31282.71, Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13357.09,,,,,,,fee schedule,12843.36,31282.71,MSDRG Base Rate Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13485.53,,,,,,,fee schedule,12843.36,31282.71,MSDRG Base Rate Minor Small And Large Bowel Procedures With Cc,345,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12843.36,,,,,,,fee schedule,12843.36,31282.71,MSDRG Base Rate Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16669.67,,,,,,,fee schedule,10124.81,24661.1, Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21491.57,,,,,,,fee schedule,10124.81,24661.1, Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20550.92,,,,,,,fee schedule,10124.81,24661.1, Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24661.1,,,,,,,fee schedule,10124.81,24661.1, Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10529.8,,,,,,,fee schedule,10124.81,24661.1,MSDRG Base Rate Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10631.05,,,,,,,fee schedule,10124.81,24661.1,MSDRG Base Rate Minor Small And Large Bowel Procedures Without Cc/Mcc,346,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10124.81,,,,,,,fee schedule,10124.81,24661.1,MSDRG Base Rate Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32260.07,,,,,,,fee schedule,19594.09,47725.52, Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41591.68,,,,,,,fee schedule,19594.09,47725.52, Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,39771.27,,,,,,,fee schedule,19594.09,47725.52, Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,47725.52,,,,,,,fee schedule,19594.09,47725.52, Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],19801.82,19801.82,19801.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20377.85,,,,,,,fee schedule,19594.09,47725.52,MSDRG Base Rate Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20573.79,,,,,,,fee schedule,19594.09,47725.52,MSDRG Base Rate Anal And Stomal Procedures With Mcc,347,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19594.09,,,,,,,fee schedule,19594.09,47725.52,MSDRG Base Rate Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18392.57,,,,,,,fee schedule,11171.26,27209.95, Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23712.84,,,,,,,fee schedule,11171.26,27209.95, Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22674.96,,,,,,,fee schedule,11171.26,27209.95, Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27209.95,,,,,,,fee schedule,11171.26,27209.95, Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15761.52,15761.52,15761.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",20527.32,20527.32,20527.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11618.11,,,,,,,fee schedule,11171.26,27209.95,MSDRG Base Rate Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11729.82,,,,,,,fee schedule,11171.26,27209.95,MSDRG Base Rate Anal And Stomal Procedures With Cc,348,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11171.26,,,,,,,fee schedule,11171.26,27209.95,MSDRG Base Rate Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12234.54,,,,,,,fee schedule,7431,18099.77, Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15773.53,,,,,,,fee schedule,7431,18099.77, Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15083.15,,,,,,,fee schedule,7431,18099.77, Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18099.77,,,,,,,fee schedule,7431,18099.77, Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7728.24,,,,,,,fee schedule,7431,18099.77,MSDRG Base Rate Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7802.55,,,,,,,fee schedule,7431,18099.77,MSDRG Base Rate Anal And Stomal Procedures Without Cc/Mcc,349,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7431,,,,,,,fee schedule,7431,18099.77,MSDRG Base Rate Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,35018.67,,,,,,,fee schedule,21269.6,51806.6, Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,45148.24,,,,,,,fee schedule,21269.6,51806.6, Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,43172.17,,,,,,,fee schedule,21269.6,51806.6, Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,51806.6,,,,,,,fee schedule,21269.6,51806.6, Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22120.38,,,,,,,fee schedule,21269.6,51806.6,MSDRG Base Rate Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22333.08,,,,,,,fee schedule,21269.6,51806.6,MSDRG Base Rate Inguinal And Femoral Hernia Procedures With Mcc,350,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21269.6,,,,,,,fee schedule,21269.6,51806.6,MSDRG Base Rate Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21423.8,,,,,,,fee schedule,13012.36,31694.36, Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27620.89,,,,,,,fee schedule,13012.36,31694.36, Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26411.96,,,,,,,fee schedule,13012.36,31694.36, Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31694.36,,,,,,,fee schedule,13012.36,31694.36, Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13532.85,,,,,,,fee schedule,13012.36,31694.36,MSDRG Base Rate Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13662.98,,,,,,,fee schedule,13012.36,31694.36,MSDRG Base Rate Inguinal And Femoral Hernia Procedures With Cc,351,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13012.36,,,,,,,fee schedule,13012.36,31694.36,MSDRG Base Rate Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16411.09,,,,,,,fee schedule,9967.75,24278.56, Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21158.2,,,,,,,fee schedule,9967.75,24278.56, Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20232.14,,,,,,,fee schedule,9967.75,24278.56, Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24278.56,,,,,,,fee schedule,9967.75,24278.56, Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10366.46,,,,,,,fee schedule,9967.75,24278.56,MSDRG Base Rate Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10466.14,,,,,,,fee schedule,9967.75,24278.56,MSDRG Base Rate Inguinal And Femoral Hernia Procedures Without Cc/Mcc,352,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9967.75,,,,,,,fee schedule,9967.75,24278.56,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40781.81,,,,,,,fee schedule,24770.01,60332.58, Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52578.44,,,,,,,fee schedule,24770.01,60332.58, Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,50277.15,,,,,,,fee schedule,24770.01,60332.58, Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,60332.58,,,,,,,fee schedule,24770.01,60332.58, Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25760.81,,,,,,,fee schedule,24770.01,60332.58,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26008.51,,,,,,,fee schedule,24770.01,60332.58,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral With Mcc,353,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24770.01,,,,,,,fee schedule,24770.01,60332.58,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23642.77,,,,,,,fee schedule,14360.12,34977.1, Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30481.72,,,,,,,fee schedule,14360.12,34977.1, Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29147.58,,,,,,,fee schedule,14360.12,34977.1, Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34977.1,,,,,,,fee schedule,14360.12,34977.1, Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],28537.65,28537.65,28537.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14934.52,,,,,,,fee schedule,14360.12,34977.1,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15078.13,,,,,,,fee schedule,14360.12,34977.1,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral With Cc,354,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14360.12,,,,,,,fee schedule,14360.12,34977.1,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18901.29,,,,,,,fee schedule,11480.24,27962.55, Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24368.71,,,,,,,fee schedule,11480.24,27962.55, Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23302.13,,,,,,,fee schedule,11480.24,27962.55, Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27962.55,,,,,,,fee schedule,11480.24,27962.55, Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10999.41,10999.41,10999.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21918.09,21918.09,21918.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11939.45,,,,,,,fee schedule,11480.24,27962.55,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12054.25,,,,,,,fee schedule,11480.24,27962.55,MSDRG Base Rate Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc,355,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11480.24,,,,,,,fee schedule,11480.24,27962.55,MSDRG Base Rate Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,61732.02,,,,,,,fee schedule,37494.73,91326.31, Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,79588.75,,,,,,,fee schedule,37494.73,91326.31, Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,76105.26,,,,,,,fee schedule,37494.73,91326.31, Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,91326.31,,,,,,,fee schedule,37494.73,91326.31, Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],56304.65,56304.65,56304.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",41294.96,41294.96,41294.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,33292.19,33292.19,33292.19,1 through 10,percent of total billed charges,,, Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,38994.52,,,,,,,fee schedule,37494.73,91326.31,MSDRG Base Rate Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,39369.47,,,,,,,fee schedule,37494.73,91326.31,MSDRG Base Rate Other Digestive System O.R. Procedures With Mcc,356,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,37494.73,,,,,,,fee schedule,37494.73,91326.31,MSDRG Base Rate Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32680.25,,,,,,,fee schedule,19849.3,48347.15, Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,42133.41,,,,,,,fee schedule,19849.3,48347.15, Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40289.29,,,,,,,fee schedule,19849.3,48347.15, Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48347.15,,,,,,,fee schedule,19849.3,48347.15, Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],8654.21,8654.21,8654.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,54022.91,54022.91,54022.91,1 through 10,percent of total billed charges,,, Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20643.27,,,,,,,fee schedule,19849.3,48347.15,MSDRG Base Rate Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20841.76,,,,,,,fee schedule,19849.3,48347.15,MSDRG Base Rate Other Digestive System O.R. Procedures With Cc,357,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19849.3,,,,,,,fee schedule,19849.3,48347.15,MSDRG Base Rate Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19644.69,,,,,,,fee schedule,11931.77,29062.34, Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25327.15,,,,,,,fee schedule,11931.77,29062.34, Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24218.62,,,,,,,fee schedule,11931.77,29062.34, Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29062.34,,,,,,,fee schedule,11931.77,29062.34, Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21084.69,21084.69,21084.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,37222.16,37222.16,37222.16,1 through 10,percent of total billed charges,,, Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12409.04,,,,,,,fee schedule,11931.77,29062.34,MSDRG Base Rate Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12528.36,,,,,,,fee schedule,11931.77,29062.34,MSDRG Base Rate Other Digestive System O.R. Procedures Without Cc/Mcc,358,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11931.77,,,,,,,fee schedule,11931.77,29062.34,MSDRG Base Rate Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,48322.65,,,,,,,fee schedule,29350.16,71488.49, Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,62300.55,,,,,,,fee schedule,29350.16,71488.49, Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,59573.75,,,,,,,fee schedule,29350.16,71488.49, Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,71488.49,,,,,,,fee schedule,29350.16,71488.49, Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30524.17,,,,,,,fee schedule,29350.16,71488.49,MSDRG Base Rate Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30817.67,,,,,,,fee schedule,29350.16,71488.49,MSDRG Base Rate Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc,359,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29350.16,,,,,,,fee schedule,29350.16,71488.49,MSDRG Base Rate Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,33928.16,,,,,,,fee schedule,20607.25,50193.3, Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,43742.29,,,,,,,fee schedule,20607.25,50193.3, Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,41827.75,,,,,,,fee schedule,20607.25,50193.3, Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,50193.3,,,,,,,fee schedule,20607.25,50193.3, Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21431.54,,,,,,,fee schedule,20607.25,50193.3,MSDRG Base Rate Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21637.61,,,,,,,fee schedule,20607.25,50193.3,MSDRG Base Rate Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc,360,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20607.25,,,,,,,fee schedule,20607.25,50193.3,MSDRG Base Rate Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopy & Incisional Tubal Interruption,361,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endoscopic Tubal Interruption,362,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization & Radio-Implant, for Malignancy",363,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization Except for Malignancy",364,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures,365,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, female reproductive system w CC",366,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System w/o CC",367,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22370.97,,,,,,,fee schedule,13587.66,33095.6, Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28842.04,,,,,,,fee schedule,13587.66,33095.6, Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27579.67,,,,,,,fee schedule,13587.66,33095.6, Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33095.6,,,,,,,fee schedule,13587.66,33095.6, Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19579.92,19579.92,19579.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],27335.84,27335.84,27335.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14131.17,,,,,,,fee schedule,13587.66,33095.6,MSDRG Base Rate Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14267.04,,,,,,,fee schedule,13587.66,33095.6,MSDRG Base Rate Major Esophageal Disorders With Mcc,368,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13587.66,,,,,,,fee schedule,13587.66,33095.6,MSDRG Base Rate Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14055.81,,,,,,,fee schedule,8537.2,20794.16, Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18121.62,,,,,,,fee schedule,8537.2,20794.16, Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17328.47,,,,,,,fee schedule,8537.2,20794.16, Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20794.16,,,,,,,fee schedule,8537.2,20794.16, Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8878.69,,,,,,,fee schedule,8537.2,20794.16,MSDRG Base Rate Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8964.06,,,,,,,fee schedule,8537.2,20794.16,MSDRG Base Rate Major Esophageal Disorders With Cc,369,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8537.2,,,,,,,fee schedule,8537.2,20794.16,MSDRG Base Rate Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9848.34,,,,,,,fee schedule,5981.68,14569.63, Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12697.09,,,,,,,fee schedule,5981.68,14569.63, Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12141.36,,,,,,,fee schedule,5981.68,14569.63, Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14569.63,,,,,,,fee schedule,5981.68,14569.63, Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6220.95,,,,,,,fee schedule,5981.68,14569.63,MSDRG Base Rate Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6280.76,,,,,,,fee schedule,5981.68,14569.63,MSDRG Base Rate Major Esophageal Disorders Without Cc/Mcc,370,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5981.68,,,,,,,fee schedule,5981.68,14569.63,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24917.37,,,,,,,fee schedule,15134.29,36862.75, Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32125.03,,,,,,,fee schedule,15134.29,36862.75, Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30718.96,,,,,,,fee schedule,15134.29,36862.75, Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36862.75,,,,,,,fee schedule,15134.29,36862.75, Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7606.67,7606.67,7606.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13198.12,13198.12,13198.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,18283.7,18283.7,18283.7,1 through 10,percent of total billed charges,,, Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15739.66,,,,,,,fee schedule,15134.29,36862.75,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15891,,,,,,,fee schedule,15134.29,36862.75,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections With Mcc,371,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15134.29,,,,,,,fee schedule,15134.29,36862.75,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14348.11,,,,,,,fee schedule,8714.74,21226.59, Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18498.48,,,,,,,fee schedule,8714.74,21226.59, Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17688.83,,,,,,,fee schedule,8714.74,21226.59, Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21226.59,,,,,,,fee schedule,8714.74,21226.59, Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],20153,20153,20153,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14064.15,14064.15,14064.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],8664.42,8664.42,17456.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],16972.86,16972.86,16972.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10909.18,10909.18,10909.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,33423.39,33423.39,33423.39,1 through 10,percent of total billed charges,,, Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9063.33,,,,,,,fee schedule,8714.74,21226.59,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9150.48,,,,,,,fee schedule,8714.74,21226.59,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections With Cc,372,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8714.74,,,,,,,fee schedule,8714.74,21226.59,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10222.15,,,,,,,fee schedule,6208.72,15122.65, Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13179.03,,,,,,,fee schedule,6208.72,15122.65, Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12602.21,,,,,,,fee schedule,6208.72,15122.65, Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15122.65,,,,,,,fee schedule,6208.72,15122.65, Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11180.52,11180.52,11180.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],11427.4,11427.4,11427.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6457.07,,,,,,,fee schedule,6208.72,15122.65,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6519.16,,,,,,,fee schedule,6208.72,15122.65,MSDRG Base Rate Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc,373,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6208.72,,,,,,,fee schedule,6208.72,15122.65,MSDRG Base Rate Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30055.15,,,,,,,fee schedule,18254.87,44463.57, Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38748.97,,,,,,,fee schedule,18254.87,44463.57, Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37052.98,,,,,,,fee schedule,18254.87,44463.57, Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44463.57,,,,,,,fee schedule,18254.87,44463.57, Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],14395,14395,14395,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27428.54,20062.32,35420.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],34838.1,34838.1,34838.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18985.06,,,,,,,fee schedule,18254.87,44463.57,MSDRG Base Rate Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19167.61,,,,,,,fee schedule,18254.87,44463.57,MSDRG Base Rate Digestive Malignancy With Mcc,374,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18254.87,,,,,,,fee schedule,18254.87,44463.57,MSDRG Base Rate Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16998.51,,,,,,,fee schedule,10324.54,25147.58, Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21915.53,,,,,,,fee schedule,10324.54,25147.58, Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20956.32,,,,,,,fee schedule,10324.54,25147.58, Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25147.58,,,,,,,fee schedule,10324.54,25147.58, Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22620.25,22620.25,22620.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20102.68,20102.68,20102.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],20273.55,20273.55,20273.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,15798.51,15798.51,15798.51,1 through 10,percent of total billed charges,,, Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10737.52,,,,,,,fee schedule,10324.54,25147.58,MSDRG Base Rate Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10840.77,,,,,,,fee schedule,10324.54,25147.58,MSDRG Base Rate Digestive Malignancy With Cc,375,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10324.54,,,,,,,fee schedule,10324.54,25147.58,MSDRG Base Rate Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12989.19,,,,,,,fee schedule,7889.36,19216.2, Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16746.47,,,,,,,fee schedule,7889.36,19216.2, Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16013.5,,,,,,,fee schedule,7889.36,19216.2, Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19216.2,,,,,,,fee schedule,7889.36,19216.2, Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8204.93,,,,,,,fee schedule,7889.36,19216.2,MSDRG Base Rate Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8283.83,,,,,,,fee schedule,7889.36,19216.2,MSDRG Base Rate Digestive Malignancy Without Cc/Mcc,376,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7889.36,,,,,,,fee schedule,7889.36,19216.2,MSDRG Base Rate Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25688.88,,,,,,,fee schedule,15602.89,38004.12, Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33119.7,,,,,,,fee schedule,15602.89,38004.12, Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31670.1,,,,,,,fee schedule,15602.89,38004.12, Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38004.12,,,,,,,fee schedule,15602.89,38004.12, Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],15734.74,15734.74,15734.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22084.77,22084.77,22084.77,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",20834.9,20834.9,20834.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],30152.12,17855.09,30502.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],30000.3,30000.3,30000.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16227.01,,,,,,,fee schedule,15602.89,38004.12,MSDRG Base Rate Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16383.03,,,,,,,fee schedule,15602.89,38004.12,MSDRG Base Rate Gastrointestinal Hemorrhage With Mcc,377,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15602.89,,,,,,,fee schedule,15602.89,38004.12,MSDRG Base Rate Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13781.78,,,,,,,fee schedule,8370.76,20388.75, Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17768.32,,,,,,,fee schedule,8370.76,20388.75, Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16990.63,,,,,,,fee schedule,8370.76,20388.75, Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20388.75,,,,,,,fee schedule,8370.76,20388.75, Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2303.2,2303.2,2303.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15956.89,15956.89,15956.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14985.56,14985.56,19828.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16404.36,12893.22,16539.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14253.5,14253.5,14253.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],28736.69,28736.69,28736.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],7635.94,7635.94,7635.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8705.59,,,,,,,fee schedule,8370.76,20388.75,MSDRG Base Rate Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8789.3,,,,,,,fee schedule,8370.76,20388.75,MSDRG Base Rate Gastrointestinal Hemorrhage With Cc,378,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8370.76,,,,,,,fee schedule,8370.76,20388.75,MSDRG Base Rate Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8859.01,,,,,,,fee schedule,5380.78,13106.02, Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11421.59,,,,,,,fee schedule,5380.78,13106.02, Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10921.68,,,,,,,fee schedule,5380.78,13106.02, Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13106.02,,,,,,,fee schedule,5380.78,13106.02, Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5596.01,,,,,,,fee schedule,5380.78,13106.02,MSDRG Base Rate Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5649.82,,,,,,,fee schedule,5380.78,13106.02,MSDRG Base Rate Gastrointestinal Hemorrhage Without Cc/Mcc,379,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5380.78,,,,,,,fee schedule,5380.78,13106.02,MSDRG Base Rate Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27574.8,,,,,,,fee schedule,16748.35,40794.14, Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35551.14,,,,,,,fee schedule,16748.35,40794.14, Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33995.12,,,,,,,fee schedule,16748.35,40794.14, Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40794.14,,,,,,,fee schedule,16748.35,40794.14, Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],38009,38009,38009,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18741.12,18741.12,18741.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],7276.96,7276.96,7276.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],32282.06,32282.06,32282.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17418.28,,,,,,,fee schedule,16748.35,40794.14,MSDRG Base Rate Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17585.77,,,,,,,fee schedule,16748.35,40794.14,MSDRG Base Rate Complicated Peptic Ulcer With Mcc,380,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16748.35,,,,,,,fee schedule,16748.35,40794.14,MSDRG Base Rate Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15226.43,,,,,,,fee schedule,9248.21,22525.97, Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19630.85,,,,,,,fee schedule,9248.21,22525.97, Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18771.64,,,,,,,fee schedule,9248.21,22525.97, Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22525.97,,,,,,,fee schedule,9248.21,22525.97, Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18741.12,18741.12,18741.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9618.14,,,,,,,fee schedule,9248.21,22525.97,MSDRG Base Rate Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9710.62,,,,,,,fee schedule,9248.21,22525.97,MSDRG Base Rate Complicated Peptic Ulcer With Cc,381,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9248.21,,,,,,,fee schedule,9248.21,22525.97,MSDRG Base Rate Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11250.83,,,,,,,fee schedule,6833.52,16644.47, Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14505.27,,,,,,,fee schedule,6833.52,16644.47, Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13870.4,,,,,,,fee schedule,6833.52,16644.47, Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16644.47,,,,,,,fee schedule,6833.52,16644.47, Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,31986.77,31986.77,31986.77,1 through 10,percent of total billed charges,,, Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7106.86,,,,,,,fee schedule,6833.52,16644.47,MSDRG Base Rate Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7175.2,,,,,,,fee schedule,6833.52,16644.47,MSDRG Base Rate Complicated Peptic Ulcer Without Cc/Mcc,382,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6833.52,,,,,,,fee schedule,6833.52,16644.47,MSDRG Base Rate Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19402.98,,,,,,,fee schedule,11784.96,28704.75, Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25015.52,,,,,,,fee schedule,11784.96,28704.75, Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23920.63,,,,,,,fee schedule,11784.96,28704.75, Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28704.75,,,,,,,fee schedule,11784.96,28704.75, Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12256.36,,,,,,,fee schedule,11784.96,28704.75,MSDRG Base Rate Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12374.21,,,,,,,fee schedule,11784.96,28704.75,MSDRG Base Rate Uncomplicated Peptic Ulcer With Mcc,383,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11784.96,,,,,,,fee schedule,11784.96,28704.75,MSDRG Base Rate Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12012.5,,,,,,,fee schedule,7296.14,17771.29, Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15487.27,,,,,,,fee schedule,7296.14,17771.29, Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14809.41,,,,,,,fee schedule,7296.14,17771.29, Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17771.29,,,,,,,fee schedule,7296.14,17771.29, Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7587.99,,,,,,,fee schedule,7296.14,17771.29,MSDRG Base Rate Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7660.95,,,,,,,fee schedule,7296.14,17771.29,MSDRG Base Rate Uncomplicated Peptic Ulcer Without Mcc,384,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7296.14,,,,,,,fee schedule,7296.14,17771.29,MSDRG Base Rate Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22236.06,,,,,,,fee schedule,13505.72,32896.02, Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28668.11,,,,,,,fee schedule,13505.72,32896.02, Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27413.35,,,,,,,fee schedule,13505.72,32896.02, Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32896.02,,,,,,,fee schedule,13505.72,32896.02, Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],11516,11516,11516,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21540.27,21540.27,27257.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],34821.2,34821.2,34821.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19248.13,19248.13,19248.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14045.95,,,,,,,fee schedule,13505.72,32896.02,MSDRG Base Rate Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14181.01,,,,,,,fee schedule,13505.72,32896.02,MSDRG Base Rate Inflammatory Bowel Disease With Mcc,385,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13505.72,,,,,,,fee schedule,13505.72,32896.02,MSDRG Base Rate Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13719.94,,,,,,,fee schedule,8333.21,20297.28, Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17688.6,,,,,,,fee schedule,8333.21,20297.28, Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16914.4,,,,,,,fee schedule,8333.21,20297.28, Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20297.28,,,,,,,fee schedule,8333.21,20297.28, Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],38618.53,38618.53,38618.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15255.24,15255.24,15255.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16298.5,16298.5,16300.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],16108.95,16108.95,16108.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],11910,11910,11910,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,12035.44,12035.44,12035.44,1 through 10,percent of total billed charges,,, Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8666.54,,,,,,,fee schedule,8333.21,20297.28,MSDRG Base Rate Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8749.87,,,,,,,fee schedule,8333.21,20297.28,MSDRG Base Rate Inflammatory Bowel Disease With Cc,386,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8333.21,,,,,,,fee schedule,8333.21,20297.28,MSDRG Base Rate Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9574.31,,,,,,,fee schedule,5815.23,14164.23, Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12343.79,,,,,,,fee schedule,5815.23,14164.23, Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11803.52,,,,,,,fee schedule,5815.23,14164.23, Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14164.23,,,,,,,fee schedule,5815.23,14164.23, Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],4606.4,4606.4,4606.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14315.8,14315.8,14315.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11476.46,11476.46,11476.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],15273.44,15273.44,15273.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6047.84,,,,,,,fee schedule,5815.23,14164.23,MSDRG Base Rate Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6105.99,,,,,,,fee schedule,5815.23,14164.23,MSDRG Base Rate Inflammatory Bowel Disease Without Cc/Mcc,387,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5815.23,,,,,,,fee schedule,5815.23,14164.23,MSDRG Base Rate Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20753.47,,,,,,,fee schedule,12605.22,30702.67, Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26756.66,,,,,,,fee schedule,12605.22,30702.67, Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25585.56,,,,,,,fee schedule,12605.22,30702.67, Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30702.67,,,,,,,fee schedule,12605.22,30702.67, Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],16973.69,16973.69,16973.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],31669,31669,31669,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10714.67,10714.67,10714.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24210.72,6282.56,24660.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],7437.55,7437.55,7437.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],20430.1,20430.1,20430.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13109.43,,,,,,,fee schedule,12605.22,30702.67,MSDRG Base Rate Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13235.48,,,,,,,fee schedule,12605.22,30702.67,MSDRG Base Rate Gastrointestinal Obstruction With Mcc,388,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12605.22,,,,,,,fee schedule,12605.22,30702.67,MSDRG Base Rate Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11099.06,,,,,,,fee schedule,6741.34,16419.94, Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14309.6,,,,,,,fee schedule,6741.34,16419.94, Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13683.29,,,,,,,fee schedule,6741.34,16419.94, Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16419.94,,,,,,,fee schedule,6741.34,16419.94, Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],6055.08,6055.08,6055.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10627.61,6112.56,13449.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],10573.07,10573.07,10573.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],13226.4,13226.4,13226.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],4460.82,4460.82,4460.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],10454.96,10454.96,10454.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,10282.15,10282.15,10282.15,1 through 10,percent of total billed charges,,, Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7010.99,,,,,,,fee schedule,6741.34,16419.94,MSDRG Base Rate Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7078.41,,,,,,,fee schedule,6741.34,16419.94,MSDRG Base Rate Gastrointestinal Obstruction With Cc,389,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6741.34,,,,,,,fee schedule,6741.34,16419.94,MSDRG Base Rate Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,7644.83,,,,,,,fee schedule,4643.31,11309.76, Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,9856.19,,,,,,,fee schedule,4643.31,11309.76, Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,9424.8,,,,,,,fee schedule,4643.31,11309.76, Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,11309.76,,,,,,,fee schedule,4643.31,11309.76, Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],6477.75,6477.75,6477.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10260.58,10260.58,10260.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],9178.15,7343.92,9179.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9028.8,9028.8,9028.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,10502.49,10502.49,10502.49,1 through 10,percent of total billed charges,,, Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,12768.02,12768.02,12768.02,1 through 10,percent of total billed charges,,, Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,4829.04,,,,,,,fee schedule,4643.31,11309.76,MSDRG Base Rate Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4875.48,,,,,,,fee schedule,4643.31,11309.76,MSDRG Base Rate Gastrointestinal Obstruction Without Cc/Mcc,390,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,4643.31,,,,,,,fee schedule,4643.31,11309.76,MSDRG Base Rate "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17823.42,,,,,,,fee schedule,10825.57,26367.96, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22979.06,,,,,,,fee schedule,10825.57,26367.96, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21973.3,,,,,,,fee schedule,10825.57,26367.96, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26367.96,,,,,,,fee schedule,10825.57,26367.96, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8637,5758,8637,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],1763.01,1763.01,1763.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13549.7,13549.7,19725.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13336.14,13336.14,13336.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],15972.84,15972.84,15972.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],9420.59,9420.59,9420.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],10688.56,10688.56,10688.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",31622.73,31622.73,31622.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,51318.02,51318.02,51318.02,1 through 10,percent of total billed charges,,, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11258.59,,,,,,,fee schedule,10825.57,26367.96,MSDRG Base Rate "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11366.85,,,,,,,fee schedule,10825.57,26367.96,MSDRG Base Rate "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc",391,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10825.57,,,,,,,fee schedule,10825.57,26367.96,MSDRG Base Rate "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10955.72,,,,,,,fee schedule,6654.27,16207.88, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14124.79,,,,,,,fee schedule,6654.27,16207.88, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13506.57,,,,,,,fee schedule,6654.27,16207.88, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16207.88,,,,,,,fee schedule,6654.27,16207.88, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2879,2879,17264,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11613.48,11073.47,13549.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],5699.88,5699.88,5699.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11824.44,10174.7,13090.31,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],12850.75,12850.75,12850.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13566.85,13566.85,13566.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8342.34,8342.34,8342.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,8317.95,8317.95,8317.95,1 through 10,percent of total billed charges,,, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,23972.01,23972.01,23972.01,1 through 10,percent of total billed charges,,, "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6920.44,,,,,,,fee schedule,6654.27,16207.88,MSDRG Base Rate "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6986.98,,,,,,,fee schedule,6654.27,16207.88,MSDRG Base Rate "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc",392,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6654.27,,,,,,,fee schedule,6654.27,16207.88,MSDRG Base Rate Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22474.96,,,,,,,fee schedule,13650.82,33249.45, Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28976.12,,,,,,,fee schedule,13650.82,33249.45, Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27707.87,,,,,,,fee schedule,13650.82,33249.45, Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33249.45,,,,,,,fee schedule,13650.82,33249.45, Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],14331.93,14331.93,14331.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],21472.66,21472.66,21472.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27779.38,21955.25,27781.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14196.85,,,,,,,fee schedule,13650.82,33249.45,MSDRG Base Rate Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14333.36,,,,,,,fee schedule,13650.82,33249.45,MSDRG Base Rate Other Digestive System Diagnoses With Mcc,393,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13650.82,,,,,,,fee schedule,13650.82,33249.45,MSDRG Base Rate Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13149.39,,,,,,,fee schedule,7986.66,19453.2, Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16953.01,,,,,,,fee schedule,7986.66,19453.2, Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16211,,,,,,,fee schedule,7986.66,19453.2, Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19453.2,,,,,,,fee schedule,7986.66,19453.2, Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8146.51,8146.51,8146.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12664.74,12664.74,12664.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18859.38,18859.38,18859.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15786.25,15713.93,15791.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],15531.45,15531.45,15531.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8306.13,,,,,,,fee schedule,7986.66,19453.2,MSDRG Base Rate Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8385.99,,,,,,,fee schedule,7986.66,19453.2,MSDRG Base Rate Other Digestive System Diagnoses With Cc,394,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7986.66,,,,,,,fee schedule,7986.66,19453.2,MSDRG Base Rate Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9120.4,,,,,,,fee schedule,5539.54,13492.71, Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11758.58,,,,,,,fee schedule,5539.54,13492.71, Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11243.93,,,,,,,fee schedule,5539.54,13492.71, Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13492.71,,,,,,,fee schedule,5539.54,13492.71, Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10665.92,10665.92,10665.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],10500.6,10500.6,10500.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5761.12,,,,,,,fee schedule,5539.54,13492.71,MSDRG Base Rate Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5816.52,,,,,,,fee schedule,5539.54,13492.71,MSDRG Base Rate Other Digestive System Diagnoses Without Cc/Mcc,395,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5539.54,,,,,,,fee schedule,5539.54,13492.71,MSDRG Base Rate Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Age 0-17,396,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,33655.53,,,,,,,fee schedule,20441.66,49789.97, Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,43390.8,,,,,,,fee schedule,20441.66,49789.97, Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,41491.64,,,,,,,fee schedule,20441.66,49789.97, Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,49789.97,,,,,,,fee schedule,20441.66,49789.97, Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],41564.07,41564.07,41564.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21259.33,,,,,,,fee schedule,20441.66,49789.97,MSDRG Base Rate Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21463.74,,,,,,,fee schedule,20441.66,49789.97,MSDRG Base Rate Appendix Procedures With Mcc,397,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20441.66,,,,,,,fee schedule,20441.66,49789.97,MSDRG Base Rate Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21270.62,,,,,,,fee schedule,12919.33,31467.74, Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27423.4,,,,,,,fee schedule,12919.33,31467.74, Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26223.12,,,,,,,fee schedule,12919.33,31467.74, Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31467.74,,,,,,,fee schedule,12919.33,31467.74, Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2876.12,2876.12,2876.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],25035.44,23485.44,25387.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,18524.82,18524.82,18524.82,1 through 10,percent of total billed charges,,, Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13436.1,,,,,,,fee schedule,12919.33,31467.74,MSDRG Base Rate Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13565.3,,,,,,,fee schedule,12919.33,31467.74,MSDRG Base Rate Appendix Procedures With Cc,398,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12919.33,,,,,,,fee schedule,12919.33,31467.74,MSDRG Base Rate Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16086.47,,,,,,,fee schedule,9770.58,23798.31, Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20739.67,,,,,,,fee schedule,9770.58,23798.31, Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19831.93,,,,,,,fee schedule,9770.58,23798.31, Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23798.31,,,,,,,fee schedule,9770.58,23798.31, Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2876.12,2876.12,2876.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14899.34,14167.93,18852.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],14899.34,14899.34,14899.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14845,14845,18454.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],22051.24,22051.24,22051.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10161.4,,,,,,,fee schedule,9770.58,23798.31,MSDRG Base Rate Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10259.11,,,,,,,fee schedule,9770.58,23798.31,MSDRG Base Rate Appendix Procedures Without Cc/Mcc,399,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9770.58,,,,,,,fee schedule,9770.58,23798.31,MSDRG Base Rate No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,400,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w other O.R. proc w CC,401,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,56500.09,,,,,,,fee schedule,34316.97,83586.2, Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,72843.42,,,,,,,fee schedule,34316.97,83586.2, Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,69655.16,,,,,,,fee schedule,34316.97,83586.2, Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,83586.2,,,,,,,fee schedule,34316.97,83586.2, Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],65617.07,49966.64,65912.76,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",57864.2,57864.2,57864.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,59556.89,59556.89,59556.89,1 through 10,percent of total billed charges,,, Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,35689.65,,,,,,,fee schedule,34316.97,83586.2,MSDRG Base Rate Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36032.82,,,,,,,fee schedule,34316.97,83586.2,MSDRG Base Rate Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical,402,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,34316.97,,,,,,,fee schedule,34316.97,83586.2,MSDRG Base Rate Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & non-acute leukemia w CC,403,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma & Non-Acute Leukemia w/o CC,404,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,76876.94,,,,,,,fee schedule,46693.44,113731.7, "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,99114.52,,,,,,,fee schedule,46693.44,113731.7, "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,94776.41,,,,,,,fee schedule,46693.44,113731.7, "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,113731.7,,,,,,,fee schedule,46693.44,113731.7, "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,48561.18,,,,,,,fee schedule,46693.44,113731.7,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49028.11,,,,,,,fee schedule,46693.44,113731.7,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures With Mcc",405,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,46693.44,,,,,,,fee schedule,46693.44,113731.7,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40756.51,,,,,,,fee schedule,24754.65,60295.16, "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52545.82,,,,,,,fee schedule,24754.65,60295.16, "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,50245.97,,,,,,,fee schedule,24754.65,60295.16, "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,60295.16,,,,,,,fee schedule,24754.65,60295.16, "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],14395,14395,14395,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25744.84,,,,,,,fee schedule,24754.65,60295.16,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25992.38,,,,,,,fee schedule,24754.65,60295.16,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures With Cc",406,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24754.65,,,,,,,fee schedule,24754.65,60295.16,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31192.04,,,,,,,fee schedule,18945.39,46145.48, "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,40214.71,,,,,,,fee schedule,18945.39,46145.48, "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38454.57,,,,,,,fee schedule,18945.39,46145.48, "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,46145.48,,,,,,,fee schedule,18945.39,46145.48, "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],26837.68,26837.68,26837.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19703.21,,,,,,,fee schedule,18945.39,46145.48,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19892.66,,,,,,,fee schedule,18945.39,46145.48,MSDRG Base Rate "Pancreas, Liver And Shunt Procedures Without Cc/Mcc",407,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18945.39,,,,,,,fee schedule,18945.39,46145.48,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50107.38,,,,,,,fee schedule,30434.17,74128.82, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,64601.54,,,,,,,fee schedule,30434.17,74128.82, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,61774.02,,,,,,,fee schedule,30434.17,74128.82, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,74128.82,,,,,,,fee schedule,30434.17,74128.82, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],58737.81,58737.81,58737.81,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,82268.67,82268.67,82268.67,1 through 10,percent of total billed charges,,, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31651.54,,,,,,,fee schedule,30434.17,74128.82,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31955.88,,,,,,,fee schedule,30434.17,74128.82,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc,408,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30434.17,,,,,,,fee schedule,30434.17,74128.82,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30597.6,,,,,,,fee schedule,18584.34,45266.07, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39448.32,,,,,,,fee schedule,18584.34,45266.07, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37721.72,,,,,,,fee schedule,18584.34,45266.07, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45266.07,,,,,,,fee schedule,18584.34,45266.07, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19327.71,,,,,,,fee schedule,18584.34,45266.07,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19513.56,,,,,,,fee schedule,18584.34,45266.07,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc,409,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18584.34,,,,,,,fee schedule,18584.34,45266.07,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22311.95,,,,,,,fee schedule,13551.81,33008.28, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28765.95,,,,,,,fee schedule,13551.81,33008.28, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27506.9,,,,,,,fee schedule,13551.81,33008.28, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33008.28,,,,,,,fee schedule,13551.81,33008.28, Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11384.3,11384.3,11384.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14093.88,,,,,,,fee schedule,13551.81,33008.28,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14229.4,,,,,,,fee schedule,13551.81,33008.28,MSDRG Base Rate Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc,410,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13551.81,,,,,,,fee schedule,13551.81,33008.28,MSDRG Base Rate Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,46421.27,,,,,,,fee schedule,28195.31,68675.61, Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,59849.19,,,,,,,fee schedule,28195.31,68675.61, Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,57229.67,,,,,,,fee schedule,28195.31,68675.61, Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,68675.61,,,,,,,fee schedule,28195.31,68675.61, Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,29323.12,,,,,,,fee schedule,28195.31,68675.61,MSDRG Base Rate Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29605.08,,,,,,,fee schedule,28195.31,68675.61,MSDRG Base Rate Cholecystectomy With C.D.E. With Mcc,411,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,28195.31,,,,,,,fee schedule,28195.31,68675.61,MSDRG Base Rate Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29546.43,,,,,,,fee schedule,17945.88,43710.98, Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38093.1,,,,,,,fee schedule,17945.88,43710.98, Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36425.81,,,,,,,fee schedule,17945.88,43710.98, Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43710.98,,,,,,,fee schedule,17945.88,43710.98, Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18663.72,,,,,,,fee schedule,17945.88,43710.98,MSDRG Base Rate Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18843.17,,,,,,,fee schedule,17945.88,43710.98,MSDRG Base Rate Cholecystectomy With C.D.E. With Cc,412,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17945.88,,,,,,,fee schedule,17945.88,43710.98,MSDRG Base Rate Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23335.01,,,,,,,fee schedule,14173.19,34521.8, Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30084.94,,,,,,,fee schedule,14173.19,34521.8, Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28768.16,,,,,,,fee schedule,14173.19,34521.8, Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34521.8,,,,,,,fee schedule,14173.19,34521.8, Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14740.12,,,,,,,fee schedule,14173.19,34521.8,MSDRG Base Rate Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14881.85,,,,,,,fee schedule,14173.19,34521.8,MSDRG Base Rate Cholecystectomy With C.D.E. Without Cc/Mcc,413,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14173.19,,,,,,,fee schedule,14173.19,34521.8,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50065.22,,,,,,,fee schedule,30408.56,74066.45, Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,64547.19,,,,,,,fee schedule,30408.56,74066.45, Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,61722.05,,,,,,,fee schedule,30408.56,74066.45, Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,74066.45,,,,,,,fee schedule,30408.56,74066.45, Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31624.9,,,,,,,fee schedule,30408.56,74066.45,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31928.99,,,,,,,fee schedule,30408.56,74066.45,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc,414,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30408.56,,,,,,,fee schedule,30408.56,74066.45,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29043.34,,,,,,,fee schedule,17640.31,42966.69, Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37444.47,,,,,,,fee schedule,17640.31,42966.69, Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,35805.58,,,,,,,fee schedule,17640.31,42966.69, Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,42966.69,,,,,,,fee schedule,17640.31,42966.69, Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18345.92,,,,,,,fee schedule,17640.31,42966.69,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18522.33,,,,,,,fee schedule,17640.31,42966.69,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. With Cc,415,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17640.31,,,,,,,fee schedule,17640.31,42966.69,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19158.45,,,,,,,fee schedule,11636.44,28343.01, Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24700.27,,,,,,,fee schedule,11636.44,28343.01, Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23619.17,,,,,,,fee schedule,11636.44,28343.01, Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28343.01,,,,,,,fee schedule,11636.44,28343.01, Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12101.9,,,,,,,fee schedule,11636.44,28343.01,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12218.26,,,,,,,fee schedule,11636.44,28343.01,MSDRG Base Rate Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc,416,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11636.44,,,,,,,fee schedule,11636.44,28343.01,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,33536.08,,,,,,,fee schedule,20369.11,49613.26, Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,43236.8,,,,,,,fee schedule,20369.11,49613.26, Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,41344.38,,,,,,,fee schedule,20369.11,49613.26, Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,49613.26,,,,,,,fee schedule,20369.11,49613.26, Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24910.6,24910.6,24910.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],31007.64,31007.64,31007.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],3080,3080,3080,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21183.87,,,,,,,fee schedule,20369.11,49613.26,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21387.57,,,,,,,fee schedule,20369.11,49613.26,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. With Mcc,417,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20369.11,,,,,,,fee schedule,20369.11,49613.26,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23772.05,,,,,,,fee schedule,14438.65,35168.36, Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30648.41,,,,,,,fee schedule,14438.65,35168.36, Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29306.97,,,,,,,fee schedule,14438.65,35168.36, Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35168.36,,,,,,,fee schedule,14438.65,35168.36, Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],10364.4,10364.4,10364.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",25306.82,25306.82,25306.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27811.38,27811.38,27811.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,25681.85,25681.85,25681.85,1 through 10,percent of total billed charges,,, Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,74391.4,74391.4,74391.4,1 through 10,percent of total billed charges,,, Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15016.2,,,,,,,fee schedule,14438.65,35168.36,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15160.58,,,,,,,fee schedule,14438.65,35168.36,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. With Cc,418,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14438.65,,,,,,,fee schedule,14438.65,35168.36,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19193.59,,,,,,,fee schedule,11657.78,28394.98, Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24745.56,,,,,,,fee schedule,11657.78,28394.98, Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23662.49,,,,,,,fee schedule,11657.78,28394.98, Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28394.98,,,,,,,fee schedule,11657.78,28394.98, Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],29255.94,29255.94,29255.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",26769.63,24336.03,26769.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",20431.24,20431.24,20431.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22104.06,22104.06,22104.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12124.09,,,,,,,fee schedule,11657.78,28394.98,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12240.67,,,,,,,fee schedule,11657.78,28394.98,MSDRG Base Rate Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc,419,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11657.78,,,,,,,fee schedule,11657.78,28394.98,MSDRG Base Rate Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,47879.98,,,,,,,fee schedule,29081.29,70833.61, Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,61729.84,,,,,,,fee schedule,29081.29,70833.61, Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,59028.01,,,,,,,fee schedule,29081.29,70833.61, Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,70833.61,,,,,,,fee schedule,29081.29,70833.61, Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30244.54,,,,,,,fee schedule,29081.29,70833.61,MSDRG Base Rate Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30535.35,,,,,,,fee schedule,29081.29,70833.61,MSDRG Base Rate Hepatobiliary Diagnostic Procedures With Mcc,420,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29081.29,,,,,,,fee schedule,29081.29,70833.61,MSDRG Base Rate Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24417.09,,,,,,,fee schedule,14830.43,36122.63, Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31480.03,,,,,,,fee schedule,14830.43,36122.63, Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30102.19,,,,,,,fee schedule,14830.43,36122.63, Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36122.63,,,,,,,fee schedule,14830.43,36122.63, Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15423.65,,,,,,,fee schedule,14830.43,36122.63,MSDRG Base Rate Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15571.95,,,,,,,fee schedule,14830.43,36122.63,MSDRG Base Rate Hepatobiliary Diagnostic Procedures With Cc,421,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14830.43,,,,,,,fee schedule,14830.43,36122.63,MSDRG Base Rate Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19667.17,,,,,,,fee schedule,11945.43,29095.61, Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25356.14,,,,,,,fee schedule,11945.43,29095.61, Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24246.34,,,,,,,fee schedule,11945.43,29095.61, Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29095.61,,,,,,,fee schedule,11945.43,29095.61, Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12423.25,,,,,,,fee schedule,11945.43,29095.61,MSDRG Base Rate Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12542.7,,,,,,,fee schedule,11945.43,29095.61,MSDRG Base Rate Hepatobiliary Diagnostic Procedures Without Cc/Mcc,422,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11945.43,,,,,,,fee schedule,11945.43,29095.61,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,58362.11,,,,,,,fee schedule,35447.92,86340.87, Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,75244.05,,,,,,,fee schedule,35447.92,86340.87, Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,71950.73,,,,,,,fee schedule,35447.92,86340.87, Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,86340.87,,,,,,,fee schedule,35447.92,86340.87, Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,36865.84,,,,,,,fee schedule,35447.92,86340.87,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37220.32,,,,,,,fee schedule,35447.92,86340.87,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc,423,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35447.92,,,,,,,fee schedule,35447.92,86340.87,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30746.56,,,,,,,fee schedule,18674.81,45486.44, Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39640.37,,,,,,,fee schedule,18674.81,45486.44, Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37905.37,,,,,,,fee schedule,18674.81,45486.44, Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45486.44,,,,,,,fee schedule,18674.81,45486.44, Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],30271.99,30271.99,30271.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19421.8,,,,,,,fee schedule,18674.81,45486.44,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19608.55,,,,,,,fee schedule,18674.81,45486.44,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures With Cc,424,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18674.81,,,,,,,fee schedule,18674.81,45486.44,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21083.72,,,,,,,fee schedule,12805.81,31191.24, Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27182.44,,,,,,,fee schedule,12805.81,31191.24, Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25992.7,,,,,,,fee schedule,12805.81,31191.24, Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31191.24,,,,,,,fee schedule,12805.81,31191.24, Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13318.04,,,,,,,fee schedule,12805.81,31191.24,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13446.1,,,,,,,fee schedule,12805.81,31191.24,MSDRG Base Rate Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc,425,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12805.81,,,,,,,fee schedule,12805.81,31191.24,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,154880.92,,,,,,,fee schedule,94071.42,229130.75, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,199682.1,,,,,,,fee schedule,94071.42,229130.75, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,190942.29,,,,,,,fee schedule,94071.42,229130.75, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,229130.75,,,,,,,fee schedule,94071.42,229130.75, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,97834.28,,,,,,,fee schedule,94071.42,229130.75,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,98774.99,,,,,,,fee schedule,94071.42,229130.75,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made,426,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,94071.42,,,,,,,fee schedule,94071.42,229130.75,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,101442.99,,,,,,,fee schedule,61614.34,150074.69, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,130786.59,,,,,,,fee schedule,61614.34,150074.69, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,125062.25,,,,,,,fee schedule,61614.34,150074.69, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,150074.69,,,,,,,fee schedule,61614.34,150074.69, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],106154.91,106154.91,106154.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],94167.6,94167.6,119151.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],110131.71,110131.71,110131.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,120366.81,120366.81,120366.81,1 through 10,percent of total billed charges,,, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,80634.96,80634.96,80634.96,1 through 10,percent of total billed charges,,, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,64078.91,,,,,,,fee schedule,61614.34,150074.69,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64695.06,,,,,,,fee schedule,61614.34,150074.69,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc,427,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,61614.34,,,,,,,fee schedule,61614.34,150074.69,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,79005.97,,,,,,,fee schedule,47986.56,116881.38, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,101859.4,,,,,,,fee schedule,47986.56,116881.38, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,97401.15,,,,,,,fee schedule,47986.56,116881.38, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,116881.38,,,,,,,fee schedule,47986.56,116881.38, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],91305.24,72573.36,92336.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],108749.72,108749.72,108749.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,98493.36,98493.36,98493.36,1 through 10,percent of total billed charges,,, Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,49906.02,,,,,,,fee schedule,47986.56,116881.38,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,50385.89,,,,,,,fee schedule,47986.56,116881.38,MSDRG Base Rate Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc,428,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,47986.56,,,,,,,fee schedule,47986.56,116881.38,MSDRG Base Rate Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,126611.91,,,,,,,fee schedule,76901.41,187309.58, Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,163235.93,,,,,,,fee schedule,76901.41,187309.58, Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,156091.32,,,,,,,fee schedule,76901.41,187309.58, Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,187309.58,,,,,,,fee schedule,76901.41,187309.58, Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,79977.47,,,,,,,fee schedule,76901.41,187309.58,MSDRG Base Rate Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,80746.48,,,,,,,fee schedule,76901.41,187309.58,MSDRG Base Rate Combined Anterior And Posterior Cervical Spinal Fusion With Mcc,429,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,76901.41,,,,,,,fee schedule,76901.41,187309.58,MSDRG Base Rate Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,81045.06,,,,,,,fee schedule,49225.06,119898.01, Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,104488.32,,,,,,,fee schedule,49225.06,119898.01, Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,99915.01,,,,,,,fee schedule,49225.06,119898.01, Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,119898.01,,,,,,,fee schedule,49225.06,119898.01, Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,51194.06,,,,,,,fee schedule,49225.06,119898.01,MSDRG Base Rate Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51686.31,,,,,,,fee schedule,49225.06,119898.01,MSDRG Base Rate Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc,430,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,49225.06,,,,,,,fee schedule,49225.06,119898.01,MSDRG Base Rate Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Childhood Mental Disorders,431,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27659.11,,,,,,,fee schedule,16799.56,40918.88, Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35659.85,,,,,,,fee schedule,16799.56,40918.88, Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34099.07,,,,,,,fee schedule,16799.56,40918.88, Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40918.88,,,,,,,fee schedule,16799.56,40918.88, Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17873.42,17176.83,32865.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],14106.43,14106.43,14106.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17471.54,,,,,,,fee schedule,16799.56,40918.88,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17639.54,,,,,,,fee schedule,16799.56,40918.88,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis With Mcc,432,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16799.56,,,,,,,fee schedule,16799.56,40918.88,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14842.78,,,,,,,fee schedule,9015.19,21958.4, Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19136.23,,,,,,,fee schedule,9015.19,21958.4, Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18298.67,,,,,,,fee schedule,9015.19,21958.4, Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21958.4,,,,,,,fee schedule,9015.19,21958.4, Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5752.24,5752.24,5752.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19344.09,19344.09,19344.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17696.96,17696.96,17696.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],17427.3,17427.3,17651.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19017.65,19017.65,19017.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9375.8,,,,,,,fee schedule,9015.19,21958.4,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9465.95,,,,,,,fee schedule,9015.19,21958.4,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis With Cc,433,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9015.19,,,,,,,fee schedule,9015.19,21958.4,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10012.76,,,,,,,fee schedule,6081.54,14812.88, Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12909.08,,,,,,,fee schedule,6081.54,14812.88, Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12344.06,,,,,,,fee schedule,6081.54,14812.88, Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14812.88,,,,,,,fee schedule,6081.54,14812.88, Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6324.8,,,,,,,fee schedule,6081.54,14812.88,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6385.62,,,,,,,fee schedule,6081.54,14812.88,MSDRG Base Rate Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc,434,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6081.54,,,,,,,fee schedule,6081.54,14812.88,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25811.15,,,,,,,fee schedule,15677.15,38184.99, Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33277.33,,,,,,,fee schedule,15677.15,38184.99, Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31820.83,,,,,,,fee schedule,15677.15,38184.99, Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38184.99,,,,,,,fee schedule,15677.15,38184.99, Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],40323.06,40323.06,40323.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",29074.56,29074.56,29074.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15697.17,7848.59,29174.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],50135.9,50135.9,50135.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],15206.93,15206.93,15206.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16304.24,,,,,,,fee schedule,15677.15,38184.99,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16461.01,,,,,,,fee schedule,15677.15,38184.99,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas With Mcc,435,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15677.15,,,,,,,fee schedule,15677.15,38184.99,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15895.35,,,,,,,fee schedule,9654.5,23515.57, Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20493.27,,,,,,,fee schedule,9654.5,23515.57, Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19596.31,,,,,,,fee schedule,9654.5,23515.57, Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23515.57,,,,,,,fee schedule,9654.5,23515.57, Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18918.3,18918.3,18918.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],14501.05,14501.05,14501.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9189.18,9189.18,9189.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10040.68,,,,,,,fee schedule,9654.5,23515.57,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10137.22,,,,,,,fee schedule,9654.5,23515.57,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas With Cc,436,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9654.5,,,,,,,fee schedule,9654.5,23515.57,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11991.42,,,,,,,fee schedule,7283.34,17740.11, Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15460.09,,,,,,,fee schedule,7283.34,17740.11, Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14783.42,,,,,,,fee schedule,7283.34,17740.11, Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17740.11,,,,,,,fee schedule,7283.34,17740.11, Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7574.67,,,,,,,fee schedule,7283.34,17740.11,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7647.51,,,,,,,fee schedule,7283.34,17740.11,MSDRG Base Rate Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc,437,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7283.34,,,,,,,fee schedule,7283.34,17740.11,MSDRG Base Rate Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22909.2,,,,,,,fee schedule,13914.57,33891.86, Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29535.96,,,,,,,fee schedule,13914.57,33891.86, Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28243.22,,,,,,,fee schedule,13914.57,33891.86, Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33891.86,,,,,,,fee schedule,13914.57,33891.86, Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],14794.98,14794.98,31485.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27895.23,27895.23,27895.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13627.24,13627.24,13627.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14471.15,,,,,,,fee schedule,13914.57,33891.86,MSDRG Base Rate Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14610.3,,,,,,,fee schedule,13914.57,33891.86,MSDRG Base Rate Disorders Of Pancreas Except Malignancy With Mcc,438,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13914.57,,,,,,,fee schedule,13914.57,33891.86,MSDRG Base Rate Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11821.38,,,,,,,fee schedule,7180.06,17488.55, Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15240.86,,,,,,,fee schedule,7180.06,17488.55, Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14573.79,,,,,,,fee schedule,7180.06,17488.55, Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17488.55,,,,,,,fee schedule,7180.06,17488.55, Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8006.67,8006.67,8006.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11147.39,11147.39,11147.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11397.74,5786.58,14080.72,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9972.4,9972.4,13849.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13627.24,13627.24,13627.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,14480.4,14480.4,14480.4,1 through 10,percent of total billed charges,,, Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7467.26,,,,,,,fee schedule,7180.06,17488.55,MSDRG Base Rate Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7539.06,,,,,,,fee schedule,7180.06,17488.55,MSDRG Base Rate Disorders Of Pancreas Except Malignancy With Cc,439,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7180.06,,,,,,,fee schedule,7180.06,17488.55,MSDRG Base Rate Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8732.53,,,,,,,fee schedule,5303.96,12918.91, Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11258.53,,,,,,,fee schedule,5303.96,12918.91, Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10765.76,,,,,,,fee schedule,5303.96,12918.91, Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,12918.91,,,,,,,fee schedule,5303.96,12918.91, Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13423.84,13423.84,13423.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],5425.79,5425.79,5425.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],10253.1,10253.1,10253.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5516.12,,,,,,,fee schedule,5303.96,12918.91,MSDRG Base Rate Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5569.16,,,,,,,fee schedule,5303.96,12918.91,MSDRG Base Rate Disorders Of Pancreas Except Malignancy Without Cc/Mcc,440,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5303.96,,,,,,,fee schedule,5303.96,12918.91,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25220.92,,,,,,,fee schedule,15318.66,37311.81, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32516.37,,,,,,,fee schedule,15318.66,37311.81, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31093.18,,,,,,,fee schedule,15318.66,37311.81, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37311.81,,,,,,,fee schedule,15318.66,37311.81, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",35432.78,35432.78,35432.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24561.6,13514.21,31713.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],65242.6,65242.6,65242.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],50253.49,50253.49,50253.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15931.41,,,,,,,fee schedule,15318.66,37311.81,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16084.59,,,,,,,fee schedule,15318.66,37311.81,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc",441,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15318.66,,,,,,,fee schedule,15318.66,37311.81,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13565.36,,,,,,,fee schedule,8239.32,20068.59, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17489.31,,,,,,,fee schedule,8239.32,20068.59, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16723.82,,,,,,,fee schedule,8239.32,20068.59, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20068.59,,,,,,,fee schedule,8239.32,20068.59, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],6081.17,6081.17,6081.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16208.97,16208.97,16208.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],9516.07,9516.07,9516.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8568.89,,,,,,,fee schedule,8239.32,20068.59,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8651.29,,,,,,,fee schedule,8239.32,20068.59,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc",442,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8239.32,,,,,,,fee schedule,8239.32,20068.59,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9832.88,,,,,,,fee schedule,5972.29,14546.76, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12677.16,,,,,,,fee schedule,5972.29,14546.76, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12122.3,,,,,,,fee schedule,5972.29,14546.76, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14546.76,,,,,,,fee schedule,5972.29,14546.76, "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11419.32,11419.32,11419.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6211.18,,,,,,,fee schedule,5972.29,14546.76,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6270.9,,,,,,,fee schedule,5972.29,14546.76,MSDRG Base Rate "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc",443,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5972.29,,,,,,,fee schedule,5972.29,14546.76,MSDRG Base Rate Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23481.16,,,,,,,fee schedule,14261.96,34738.01, Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30273.37,,,,,,,fee schedule,14261.96,34738.01, Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28948.34,,,,,,,fee schedule,14261.96,34738.01, Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34738.01,,,,,,,fee schedule,14261.96,34738.01, Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",36561.33,36561.33,36561.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],27554.08,27554.08,27554.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,38593.19,38593.19,38593.19,1 through 10,percent of total billed charges,,, Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14832.44,,,,,,,fee schedule,14261.96,34738.01,MSDRG Base Rate Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14975.06,,,,,,,fee schedule,14261.96,34738.01,MSDRG Base Rate Disorders Of The Biliary Tract With Mcc,444,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14261.96,,,,,,,fee schedule,14261.96,34738.01,MSDRG Base Rate Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15379.6,,,,,,,fee schedule,9341.25,22752.58, Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19828.34,,,,,,,fee schedule,9341.25,22752.58, Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18960.48,,,,,,,fee schedule,9341.25,22752.58, Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22752.58,,,,,,,fee schedule,9341.25,22752.58, Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8621.14,8621.14,17318.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18193.57,12939.29,18193.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9714.9,,,,,,,fee schedule,9341.25,22752.58,MSDRG Base Rate Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9808.31,,,,,,,fee schedule,9341.25,22752.58,MSDRG Base Rate Disorders Of The Biliary Tract With Cc,445,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9341.25,,,,,,,fee schedule,9341.25,22752.58,MSDRG Base Rate Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11626.05,,,,,,,fee schedule,7061.42,17199.57, Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14989.02,,,,,,,fee schedule,7061.42,17199.57, Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14332.97,,,,,,,fee schedule,7061.42,17199.57, Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17199.57,,,,,,,fee schedule,7061.42,17199.57, Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10270.6,10270.6,10270.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7343.88,,,,,,,fee schedule,7061.42,17199.57,MSDRG Base Rate Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7414.49,,,,,,,fee schedule,7061.42,17199.57,MSDRG Base Rate Disorders Of The Biliary Tract Without Cc/Mcc,446,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7061.42,,,,,,,fee schedule,7061.42,17199.57,MSDRG Base Rate Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,93896.52,,,,,,,fee schedule,57030.78,138910.46, Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,121057.23,,,,,,,fee schedule,57030.78,138910.46, Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,115758.72,,,,,,,fee schedule,57030.78,138910.46, Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,138910.46,,,,,,,fee schedule,57030.78,138910.46, Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,59312.01,,,,,,,fee schedule,57030.78,138910.46,MSDRG Base Rate Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,59882.32,,,,,,,fee schedule,57030.78,138910.46,MSDRG Base Rate Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody,447,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,57030.78,,,,,,,fee schedule,57030.78,138910.46,MSDRG Base Rate Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,59595.96,,,,,,,fee schedule,36197.34,88166.23, Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,76834.81,,,,,,,fee schedule,36197.34,88166.23, Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,73471.86,,,,,,,fee schedule,36197.34,88166.23, Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,88166.23,,,,,,,fee schedule,36197.34,88166.23, Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],54130.57,54130.57,54130.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],68504.8,68504.8,68504.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],111411.93,111411.93,111411.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37645.23,,,,,,,fee schedule,36197.34,88166.23,MSDRG Base Rate Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38007.21,,,,,,,fee schedule,36197.34,88166.23,MSDRG Base Rate Multiple Level Spinal Fusion Except Cervical Without Mcc,448,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,36197.34,,,,,,,fee schedule,36197.34,88166.23,MSDRG Base Rate Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning & toxic Effects of Drugs Age >17 w CC,449,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,74896.87,,,,,,,fee schedule,45490.78,110802.38, Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,96561.69,,,,,,,fee schedule,45490.78,110802.38, Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,92335.32,,,,,,,fee schedule,45490.78,110802.38, Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,110802.38,,,,,,,fee schedule,45490.78,110802.38, Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,47310.41,,,,,,,fee schedule,45490.78,110802.38,MSDRG Base Rate Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,47765.32,,,,,,,fee schedule,45490.78,110802.38,MSDRG Base Rate Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F,450,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,45490.78,,,,,,,fee schedule,45490.78,110802.38,MSDRG Base Rate Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45396.81,,,,,,,fee schedule,27573.07,67160.02, Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58528.39,,,,,,,fee schedule,27573.07,67160.02, Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55966.68,,,,,,,fee schedule,27573.07,67160.02, Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,67160.02,,,,,,,fee schedule,27573.07,67160.02, Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],90589.26,90589.26,90589.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],26707.91,26707.91,26707.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],51770.74,51766.74,51770.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],77360.66,77360.66,77360.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28675.99,,,,,,,fee schedule,27573.07,67160.02,MSDRG Base Rate Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28951.72,,,,,,,fee schedule,27573.07,67160.02,MSDRG Base Rate Single Level Spinal Fusion Except Cervical Without Mcc,451,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27573.07,,,,,,,fee schedule,27573.07,67160.02,MSDRG Base Rate Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications of treatment w CC,452,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Mcc,453,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion With Cc,454,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc,455,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,118092.98,,,,,,,fee schedule,71727.19,174706.69, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,152252.8,,,,,,,fee schedule,71727.19,174706.69, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,145588.91,,,,,,,fee schedule,71727.19,174706.69, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,174706.69,,,,,,,fee schedule,71727.19,174706.69, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],112276.7,112276.7,140086.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,74596.28,,,,,,,fee schedule,71727.19,174706.69,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,75313.55,,,,,,,fee schedule,71727.19,174706.69,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",456,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,71727.19,,,,,,,fee schedule,71727.19,174706.69,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,83799.44,,,,,,,fee schedule,50898.02,123972.85, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,108039.45,,,,,,,fee schedule,50898.02,123972.85, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,103310.71,,,,,,,fee schedule,50898.02,123972.85, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,123972.85,,,,,,,fee schedule,50898.02,123972.85, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],94728.17,94728.17,94728.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,52933.94,,,,,,,fee schedule,50898.02,123972.85,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53442.92,,,,,,,fee schedule,50898.02,123972.85,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",457,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,50898.02,,,,,,,fee schedule,50898.02,123972.85,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,58637.55,,,,,,,fee schedule,35615.21,86748.35, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,75599.17,,,,,,,fee schedule,35615.21,86748.35, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,72290.3,,,,,,,fee schedule,35615.21,86748.35, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,86748.35,,,,,,,fee schedule,35615.21,86748.35, "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37039.82,,,,,,,fee schedule,35615.21,86748.35,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37395.97,,,,,,,fee schedule,35615.21,86748.35,MSDRG Base Rate "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With",458,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35615.21,,,,,,,fee schedule,35615.21,86748.35,MSDRG Base Rate Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical With Mcc,459,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Fusion Except Cervical Without Mcc,460,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,77614.72,,,,,,,fee schedule,47141.55,114823.17, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,100065.71,,,,,,,fee schedule,47141.55,114823.17, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,95685.98,,,,,,,fee schedule,47141.55,114823.17, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,114823.17,,,,,,,fee schedule,47141.55,114823.17, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,49027.21,,,,,,,fee schedule,47141.55,114823.17,MSDRG Base Rate Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49498.63,,,,,,,fee schedule,47141.55,114823.17,MSDRG Base Rate Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc,461,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,47141.55,,,,,,,fee schedule,47141.55,114823.17,MSDRG Base Rate Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,37380.98,,,,,,,fee schedule,22704.42,55301.4, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,48193.88,,,,,,,fee schedule,22704.42,55301.4, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,46084.5,,,,,,,fee schedule,22704.42,55301.4, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,55301.4,,,,,,,fee schedule,22704.42,55301.4, Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],37736.25,37736.25,37736.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,23612.6,,,,,,,fee schedule,22704.42,55301.4,MSDRG Base Rate Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23839.64,,,,,,,fee schedule,22704.42,55301.4,MSDRG Base Rate Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc,462,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22704.42,,,,,,,fee schedule,22704.42,55301.4,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,80095.07,,,,,,,fee schedule,48648.06,118492.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,103263.54,,,,,,,fee schedule,48648.06,118492.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,98743.84,,,,,,,fee schedule,48648.06,118492.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,118492.61,,,,,,,fee schedule,48648.06,118492.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",45723.93,45723.93,45723.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,79619.82,79619.82,79619.82,1 through 10,percent of total billed charges,,, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,50593.98,,,,,,,fee schedule,48648.06,118492.61,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,51080.46,,,,,,,fee schedule,48648.06,118492.61,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,463,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,48648.06,,,,,,,fee schedule,48648.06,118492.61,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,43770.88,,,,,,,fee schedule,26585.51,64754.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,56432.13,,,,,,,fee schedule,26585.51,64754.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,53962.18,,,,,,,fee schedule,26585.51,64754.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,64754.61,,,,,,,fee schedule,26585.51,64754.61, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],25517.25,25517.25,25517.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],49465.71,49465.71,49465.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],39092.54,39092.54,39092.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27648.93,,,,,,,fee schedule,26585.51,64754.61,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27914.79,,,,,,,fee schedule,26585.51,64754.61,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,464,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26585.51,,,,,,,fee schedule,26585.51,64754.61,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25628.46,,,,,,,fee schedule,15566.19,37914.72, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33041.8,,,,,,,fee schedule,15566.19,37914.72, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31595.6,,,,,,,fee schedule,15566.19,37914.72, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37914.72,,,,,,,fee schedule,15566.19,37914.72, Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16188.84,,,,,,,fee schedule,15566.19,37914.72,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16344.5,,,,,,,fee schedule,15566.19,37914.72,MSDRG Base Rate Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit,465,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15566.19,,,,,,,fee schedule,15566.19,37914.72,MSDRG Base Rate Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,73151.49,,,,,,,fee schedule,44430.68,108220.27, Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,94311.44,,,,,,,fee schedule,44430.68,108220.27, Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,90183.56,,,,,,,fee schedule,44430.68,108220.27, Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,108220.27,,,,,,,fee schedule,44430.68,108220.27, Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],44091.42,44091.42,44091.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],85117.01,85117.01,85458.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,46207.91,,,,,,,fee schedule,44430.68,108220.27,MSDRG Base Rate Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46652.21,,,,,,,fee schedule,44430.68,108220.27,MSDRG Base Rate Revision Of Hip Or Knee Replacement With Mcc,466,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,44430.68,,,,,,,fee schedule,44430.68,108220.27,MSDRG Base Rate Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,49559.31,,,,,,,fee schedule,30101.28,73318.01, Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,63894.94,,,,,,,fee schedule,30101.28,73318.01, Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,61098.35,,,,,,,fee schedule,30101.28,73318.01, Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,73318.01,,,,,,,fee schedule,30101.28,73318.01, Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],22702.1,22702.1,22702.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],21723.51,21723.51,21723.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],37957.44,37957.44,45411.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],76863.59,76863.59,76863.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],29946.05,29946.05,29946.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31305.33,,,,,,,fee schedule,30101.28,73318.01,MSDRG Base Rate Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31606.34,,,,,,,fee schedule,30101.28,73318.01,MSDRG Base Rate Revision Of Hip Or Knee Replacement With Cc,467,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30101.28,,,,,,,fee schedule,30101.28,73318.01,MSDRG Base Rate Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38617.64,,,,,,,fee schedule,23455.55,57130.92, Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,49788.26,,,,,,,fee schedule,23455.55,57130.92, Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,47609.1,,,,,,,fee schedule,23455.55,57130.92, Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,57130.92,,,,,,,fee schedule,23455.55,57130.92, Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],43556.8,34765.21,44006.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],68112.66,68112.66,73677.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,97302.94,97302.94,97302.94,1 through 10,percent of total billed charges,,, Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24393.77,,,,,,,fee schedule,23455.55,57130.92,MSDRG Base Rate Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24628.33,,,,,,,fee schedule,23455.55,57130.92,MSDRG Base Rate Revision Of Hip Or Knee Replacement Without Cc/Mcc,468,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23455.55,,,,,,,fee schedule,23455.55,57130.92,MSDRG Base Rate Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,42625.56,,,,,,,fee schedule,25889.87,63060.23, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,54955.52,,,,,,,fee schedule,25889.87,63060.23, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,52550.19,,,,,,,fee schedule,25889.87,63060.23, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,63060.23,,,,,,,fee schedule,25889.87,63060.23, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],55860.72,55860.72,55860.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26925.46,,,,,,,fee schedule,25889.87,63060.23,MSDRG Base Rate Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27184.36,,,,,,,fee schedule,25889.87,63060.23,MSDRG Base Rate Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl,469,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25889.87,,,,,,,fee schedule,25889.87,63060.23,MSDRG Base Rate Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27106.83,,,,,,,fee schedule,16464.12,40101.83, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34947.81,,,,,,,fee schedule,16464.12,40101.83, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33418.19,,,,,,,fee schedule,16464.12,40101.83, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40101.83,,,,,,,fee schedule,16464.12,40101.83, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],16329.75,16329.75,16329.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],31631.15,31631.15,31631.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,41826.37,41826.37,41826.37,1 through 10,percent of total billed charges,,, Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17122.68,,,,,,,fee schedule,16464.12,40101.83,MSDRG Base Rate Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17287.33,,,,,,,fee schedule,16464.12,40101.83,MSDRG Base Rate Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc,470,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16464.12,,,,,,,fee schedule,16464.12,40101.83,MSDRG Base Rate Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,67857.72,,,,,,,fee schedule,41215.35,100388.67, Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,87486.39,,,,,,,fee schedule,41215.35,100388.67, Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,83657.23,,,,,,,fee schedule,41215.35,100388.67, Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,100388.67,,,,,,,fee schedule,41215.35,100388.67, Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,42863.96,,,,,,,fee schedule,41215.35,100388.67,MSDRG Base Rate Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43276.12,,,,,,,fee schedule,41215.35,100388.67,MSDRG Base Rate Cervical Spinal Fusion With Mcc,471,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,41215.35,,,,,,,fee schedule,41215.35,100388.67,MSDRG Base Rate Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,41401.54,,,,,,,fee schedule,25146.43,61249.42, Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,53377.44,,,,,,,fee schedule,25146.43,61249.42, Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,51041.18,,,,,,,fee schedule,25146.43,61249.42, Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,61249.42,,,,,,,fee schedule,25146.43,61249.42, Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],39182.69,39182.69,39182.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],38411.08,38411.08,38411.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26152.29,,,,,,,fee schedule,25146.43,61249.42,MSDRG Base Rate Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26403.75,,,,,,,fee schedule,25146.43,61249.42,MSDRG Base Rate Cervical Spinal Fusion With Cc,472,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25146.43,,,,,,,fee schedule,25146.43,61249.42,MSDRG Base Rate Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34307.59,,,,,,,fee schedule,20837.71,50754.63, Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,44231.47,,,,,,,fee schedule,20837.71,50754.63, Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,42295.52,,,,,,,fee schedule,20837.71,50754.63, Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,50754.63,,,,,,,fee schedule,20837.71,50754.63, Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21671.22,,,,,,,fee schedule,20837.71,50754.63,MSDRG Base Rate Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21879.6,,,,,,,fee schedule,20837.71,50754.63,MSDRG Base Rate Cervical Spinal Fusion Without Cc/Mcc,473,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20837.71,,,,,,,fee schedule,20837.71,50754.63,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,60328.12,,,,,,,fee schedule,36642.03,89249.39, Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,77778.76,,,,,,,fee schedule,36642.03,89249.39, Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,74374.49,,,,,,,fee schedule,36642.03,89249.39, Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,89249.39,,,,,,,fee schedule,36642.03,89249.39, Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],124670.31,124670.31,124670.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,38107.71,,,,,,,fee schedule,36642.03,89249.39,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,38474.13,,,,,,,fee schedule,36642.03,89249.39,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc,474,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,36642.03,,,,,,,fee schedule,36642.03,89249.39,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31980.41,,,,,,,fee schedule,19424.23,47311.8, Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41231.13,,,,,,,fee schedule,19424.23,47311.8, Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,39426.5,,,,,,,fee schedule,19424.23,47311.8, Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,47311.8,,,,,,,fee schedule,19424.23,47311.8, Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",40299.51,40299.51,40299.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20201.2,,,,,,,fee schedule,19424.23,47311.8,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20395.44,,,,,,,fee schedule,19424.23,47311.8,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc,475,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19424.23,,,,,,,fee schedule,19424.23,47311.8,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16585.35,,,,,,,fee schedule,10073.59,24536.36, Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21382.86,,,,,,,fee schedule,10073.59,24536.36, Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20446.97,,,,,,,fee schedule,10073.59,24536.36, Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24536.36,,,,,,,fee schedule,10073.59,24536.36, Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10476.53,,,,,,,fee schedule,10073.59,24536.36,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10577.27,,,,,,,fee schedule,10073.59,24536.36,MSDRG Base Rate Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc,476,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10073.59,,,,,,,fee schedule,10073.59,24536.36,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,48547.49,,,,,,,fee schedule,29486.73,71821.13, Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,62590.44,,,,,,,fee schedule,29486.73,71821.13, Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,59850.95,,,,,,,fee schedule,29486.73,71821.13, Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,71821.13,,,,,,,fee schedule,29486.73,71821.13, Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30666.2,,,,,,,fee schedule,29486.73,71821.13,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30961.07,,,,,,,fee schedule,29486.73,71821.13,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue With Mcc,477,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29486.73,,,,,,,fee schedule,29486.73,71821.13,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34559.14,,,,,,,fee schedule,20990.49,51126.77, Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,44555.79,,,,,,,fee schedule,20990.49,51126.77, Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,42605.64,,,,,,,fee schedule,20990.49,51126.77, Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,51126.77,,,,,,,fee schedule,20990.49,51126.77, Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],20238.29,20238.29,20238.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21830.11,,,,,,,fee schedule,20990.49,51126.77,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22040.01,,,,,,,fee schedule,20990.49,51126.77,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue With Cc,478,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20990.49,,,,,,,fee schedule,20990.49,51126.77,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26123.12,,,,,,,fee schedule,15866.64,38646.53, Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33679.55,,,,,,,fee schedule,15866.64,38646.53, Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32205.44,,,,,,,fee schedule,15866.64,38646.53, Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38646.53,,,,,,,fee schedule,15866.64,38646.53, Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16501.31,,,,,,,fee schedule,15866.64,38646.53,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16659.97,,,,,,,fee schedule,15866.64,38646.53,MSDRG Base Rate Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc,479,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15866.64,,,,,,,fee schedule,15866.64,38646.53,MSDRG Base Rate Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40926.55,,,,,,,fee schedule,24857.93,60546.72, Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52765.05,,,,,,,fee schedule,24857.93,60546.72, Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,50455.6,,,,,,,fee schedule,24857.93,60546.72, Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,60546.72,,,,,,,fee schedule,24857.93,60546.72, Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25852.25,,,,,,,fee schedule,24857.93,60546.72,MSDRG Base Rate Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26100.83,,,,,,,fee schedule,24857.93,60546.72,MSDRG Base Rate Hip And Femur Procedures Except Major Joint With Mcc,480,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24857.93,,,,,,,fee schedule,24857.93,60546.72,MSDRG Base Rate Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29434.01,,,,,,,fee schedule,17877.6,43544.66, Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37948.15,,,,,,,fee schedule,17877.6,43544.66, Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36287.21,,,,,,,fee schedule,17877.6,43544.66, Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43544.66,,,,,,,fee schedule,17877.6,43544.66, Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],17957.3,17957.3,17957.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",30376.32,30376.32,30376.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],8838.38,8838.38,8838.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],15795.61,15795.61,15795.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",37685.83,37685.83,37685.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18592.7,,,,,,,fee schedule,17877.6,43544.66,MSDRG Base Rate Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18771.48,,,,,,,fee schedule,17877.6,43544.66,MSDRG Base Rate Hip And Femur Procedures Except Major Joint With Cc,481,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17877.6,,,,,,,fee schedule,17877.6,43544.66,MSDRG Base Rate Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22920.44,,,,,,,fee schedule,13921.4,33908.49, Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29550.46,,,,,,,fee schedule,13921.4,33908.49, Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28257.08,,,,,,,fee schedule,13921.4,33908.49, Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33908.49,,,,,,,fee schedule,13921.4,33908.49, Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],26595.36,26595.36,26595.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14478.26,,,,,,,fee schedule,13921.4,33908.49,MSDRG Base Rate Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14617.47,,,,,,,fee schedule,13921.4,33908.49,MSDRG Base Rate Hip And Femur Procedures Except Major Joint Without Cc/Mcc,482,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13921.4,,,,,,,fee schedule,13921.4,33908.49,MSDRG Base Rate Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38953.51,,,,,,,fee schedule,23659.54,57627.8, Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,50221.28,,,,,,,fee schedule,23659.54,57627.8, Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,48023.17,,,,,,,fee schedule,23659.54,57627.8, Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,57627.8,,,,,,,fee schedule,23659.54,57627.8, Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24605.92,,,,,,,fee schedule,23659.54,57627.8,MSDRG Base Rate Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24842.52,,,,,,,fee schedule,23659.54,57627.8,MSDRG Base Rate Major Joint Or Limb Reattachment Procedures Of Upper Extremities,483,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23659.54,,,,,,,fee schedule,23659.54,57627.8,MSDRG Base Rate Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major joint & limb reattachment proc of upper extremity w/o CC/MCC,484,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45350.44,,,,,,,fee schedule,27544.9,67091.41, Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58468.6,,,,,,,fee schedule,27544.9,67091.41, Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55909.51,,,,,,,fee schedule,27544.9,67091.41, Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,67091.41,,,,,,,fee schedule,27544.9,67091.41, Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28646.7,,,,,,,fee schedule,27544.9,67091.41,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28922.15,,,,,,,fee schedule,27544.9,67091.41,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection With Mcc,485,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27544.9,,,,,,,fee schedule,27544.9,67091.41,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29386.23,,,,,,,fee schedule,17848.58,43473.97, Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37886.55,,,,,,,fee schedule,17848.58,43473.97, Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36228.31,,,,,,,fee schedule,17848.58,43473.97, Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43473.97,,,,,,,fee schedule,17848.58,43473.97, Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18562.52,,,,,,,fee schedule,17848.58,43473.97,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18741.01,,,,,,,fee schedule,17848.58,43473.97,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection With Cc,486,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17848.58,,,,,,,fee schedule,17848.58,43473.97,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22009.81,,,,,,,fee schedule,13368.3,32561.3, Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28376.41,,,,,,,fee schedule,13368.3,32561.3, Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27134.42,,,,,,,fee schedule,13368.3,32561.3, Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32561.3,,,,,,,fee schedule,13368.3,32561.3, Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],11416,11416,11416,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13903.03,,,,,,,fee schedule,13368.3,32561.3,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14036.72,,,,,,,fee schedule,13368.3,32561.3,MSDRG Base Rate Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc,487,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13368.3,,,,,,,fee schedule,13368.3,32561.3,MSDRG Base Rate Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24858.35,,,,,,,fee schedule,15098.44,36775.43, Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32048.93,,,,,,,fee schedule,15098.44,36775.43, Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30646.19,,,,,,,fee schedule,15098.44,36775.43, Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36775.43,,,,,,,fee schedule,15098.44,36775.43, Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],98914.65,98914.65,98914.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15702.38,,,,,,,fee schedule,15098.44,36775.43,MSDRG Base Rate Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15853.36,,,,,,,fee schedule,15098.44,36775.43,MSDRG Base Rate Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc,488,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15098.44,,,,,,,fee schedule,15098.44,36775.43,MSDRG Base Rate Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15694.39,,,,,,,fee schedule,9532.44,23218.27, Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20234.18,,,,,,,fee schedule,9532.44,23218.27, Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19348.56,,,,,,,fee schedule,9532.44,23218.27, Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23218.27,,,,,,,fee schedule,9532.44,23218.27, Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10725.25,10725.25,10725.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9913.74,,,,,,,fee schedule,9532.44,23218.27,MSDRG Base Rate Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10009.06,,,,,,,fee schedule,9532.44,23218.27,MSDRG Base Rate Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc,489,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9532.44,,,,,,,fee schedule,9532.44,23218.27,MSDRG Base Rate Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim,490,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back & neck proc exc spinal fusion w/o CC/MCC,491,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,51596.99,,,,,,,fee schedule,31338.93,76332.56, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,66522.05,,,,,,,fee schedule,31338.93,76332.56, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,63610.47,,,,,,,fee schedule,31338.93,76332.56, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,76332.56,,,,,,,fee schedule,31338.93,76332.56, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32592.49,,,,,,,fee schedule,31338.93,76332.56,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32905.88,,,,,,,fee schedule,31338.93,76332.56,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc",492,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,31338.93,,,,,,,fee schedule,31338.93,76332.56,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,35639.81,,,,,,,fee schedule,21646.87,52725.52, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,45949.06,,,,,,,fee schedule,21646.87,52725.52, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,43937.93,,,,,,,fee schedule,21646.87,52725.52, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,52725.52,,,,,,,fee schedule,21646.87,52725.52, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],40261.68,40261.68,40261.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22512.74,,,,,,,fee schedule,21646.87,52725.52,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22729.21,,,,,,,fee schedule,21646.87,52725.52,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc",493,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21646.87,,,,,,,fee schedule,21646.87,52725.52,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28197.34,,,,,,,fee schedule,17126.47,41715.14, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36353.77,,,,,,,fee schedule,17126.47,41715.14, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34762.61,,,,,,,fee schedule,17126.47,41715.14, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41715.14,,,,,,,fee schedule,17126.47,41715.14, "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],31031.15,31031.15,31354.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17811.53,,,,,,,fee schedule,17126.47,41715.14,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17982.79,,,,,,,fee schedule,17126.47,41715.14,MSDRG Base Rate "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc",494,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17126.47,,,,,,,fee schedule,17126.47,41715.14,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50951.96,,,,,,,fee schedule,30947.15,75378.3, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,65690.43,,,,,,,fee schedule,30947.15,75378.3, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,62815.25,,,,,,,fee schedule,30947.15,75378.3, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,75378.3,,,,,,,fee schedule,30947.15,75378.3, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32185.04,,,,,,,fee schedule,30947.15,75378.3,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32494.51,,,,,,,fee schedule,30947.15,75378.3,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc,495,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30947.15,,,,,,,fee schedule,30947.15,75378.3,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25350.21,,,,,,,fee schedule,15397.18,37503.08, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32683.06,,,,,,,fee schedule,15397.18,37503.08, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31252.57,,,,,,,fee schedule,15397.18,37503.08, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37503.08,,,,,,,fee schedule,15397.18,37503.08, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16013.07,,,,,,,fee schedule,15397.18,37503.08,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16167.04,,,,,,,fee schedule,15397.18,37503.08,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc,496,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15397.18,,,,,,,fee schedule,15397.18,37503.08,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16980.24,,,,,,,fee schedule,10313.44,25120.56, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21891.98,,,,,,,fee schedule,10313.44,25120.56, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20933.8,,,,,,,fee schedule,10313.44,25120.56, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25120.56,,,,,,,fee schedule,10313.44,25120.56, Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],39411.47,39411.47,39411.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],22145.06,22145.06,22145.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10725.98,,,,,,,fee schedule,10313.44,25120.56,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10829.11,,,,,,,fee schedule,10313.44,25120.56,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc,497,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10313.44,,,,,,,fee schedule,10313.44,25120.56,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,42395.09,,,,,,,fee schedule,25749.89,62719.27, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,54658.38,,,,,,,fee schedule,25749.89,62719.27, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,52266.06,,,,,,,fee schedule,25749.89,62719.27, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,62719.27,,,,,,,fee schedule,25749.89,62719.27, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26779.89,,,,,,,fee schedule,25749.89,62719.27,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27037.38,,,,,,,fee schedule,25749.89,62719.27,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc,498,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25749.89,,,,,,,fee schedule,25749.89,62719.27,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28313.98,,,,,,,fee schedule,17197.32,41887.69, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36504.15,,,,,,,fee schedule,17197.32,41887.69, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34906.41,,,,,,,fee schedule,17197.32,41887.69, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41887.69,,,,,,,fee schedule,17197.32,41887.69, Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17885.21,,,,,,,fee schedule,17197.32,41887.69,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18057.19,,,,,,,fee schedule,17197.32,41887.69,MSDRG Base Rate Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc,499,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17197.32,,,,,,,fee schedule,17197.32,41887.69,MSDRG Base Rate Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44474.93,,,,,,,fee schedule,27013.14,65796.19, Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57339.85,,,,,,,fee schedule,27013.14,65796.19, Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,54830.16,,,,,,,fee schedule,27013.14,65796.19, Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,65796.19,,,,,,,fee schedule,27013.14,65796.19, Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],42993.04,42993.04,42993.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28093.67,,,,,,,fee schedule,27013.14,65796.19,MSDRG Base Rate Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28363.8,,,,,,,fee schedule,27013.14,65796.19,MSDRG Base Rate Soft Tissue Procedures With Mcc,500,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27013.14,,,,,,,fee schedule,27013.14,65796.19,MSDRG Base Rate Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24566.05,,,,,,,fee schedule,14920.9,36343, Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31672.08,,,,,,,fee schedule,14920.9,36343, Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30285.83,,,,,,,fee schedule,14920.9,36343, Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36343,,,,,,,fee schedule,14920.9,36343, Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],29940.13,29940.13,29940.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15517.74,,,,,,,fee schedule,14920.9,36343,MSDRG Base Rate Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15666.94,,,,,,,fee schedule,14920.9,36343,MSDRG Base Rate Soft Tissue Procedures With Cc,501,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14920.9,,,,,,,fee schedule,14920.9,36343,MSDRG Base Rate Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18913.93,,,,,,,fee schedule,11487.93,27981.26, Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24385.02,,,,,,,fee schedule,11487.93,27981.26, Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23317.72,,,,,,,fee schedule,11487.93,27981.26, Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27981.26,,,,,,,fee schedule,11487.93,27981.26, Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11947.45,,,,,,,fee schedule,11487.93,27981.26,MSDRG Base Rate Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12062.33,,,,,,,fee schedule,11487.93,27981.26,MSDRG Base Rate Soft Tissue Procedures Without Cc/Mcc,502,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11487.93,,,,,,,fee schedule,11487.93,27981.26,MSDRG Base Rate Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,39223.33,,,,,,,fee schedule,23823.43,58026.97, Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,50569.15,,,,,,,fee schedule,23823.43,58026.97, Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,48355.81,,,,,,,fee schedule,23823.43,58026.97, Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,58026.97,,,,,,,fee schedule,23823.43,58026.97, Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24776.37,,,,,,,fee schedule,23823.43,58026.97,MSDRG Base Rate Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25014.6,,,,,,,fee schedule,23823.43,58026.97,MSDRG Base Rate Foot Procedures With Mcc,503,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23823.43,,,,,,,fee schedule,23823.43,58026.97,MSDRG Base Rate Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26267.87,,,,,,,fee schedule,15954.55,38860.67, Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33866.17,,,,,,,fee schedule,15954.55,38860.67, Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32383.89,,,,,,,fee schedule,15954.55,38860.67, Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38860.67,,,,,,,fee schedule,15954.55,38860.67, Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5014.25,5014.25,5014.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,33372.59,33372.59,33372.59,1 through 10,percent of total billed charges,,, Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16592.73,,,,,,,fee schedule,15954.55,38860.67,MSDRG Base Rate Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16752.28,,,,,,,fee schedule,15954.55,38860.67,MSDRG Base Rate Foot Procedures With Cc,504,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15954.55,,,,,,,fee schedule,15954.55,38860.67,MSDRG Base Rate Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25194.22,,,,,,,fee schedule,15302.44,37272.31, Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32481.95,,,,,,,fee schedule,15302.44,37272.31, Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31060.26,,,,,,,fee schedule,15302.44,37272.31, Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37272.31,,,,,,,fee schedule,15302.44,37272.31, Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15914.54,,,,,,,fee schedule,15302.44,37272.31,MSDRG Base Rate Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16067.56,,,,,,,fee schedule,15302.44,37272.31,MSDRG Base Rate Foot Procedures Without Cc/Mcc,505,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15302.44,,,,,,,fee schedule,15302.44,37272.31,MSDRG Base Rate Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18960.31,,,,,,,fee schedule,11516.09,28049.87, Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24444.81,,,,,,,fee schedule,11516.09,28049.87, Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23374.89,,,,,,,fee schedule,11516.09,28049.87, Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28049.87,,,,,,,fee schedule,11516.09,28049.87, Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11976.73,,,,,,,fee schedule,11516.09,28049.87,MSDRG Base Rate Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12091.89,,,,,,,fee schedule,11516.09,28049.87,MSDRG Base Rate Major Thumb Or Joint Procedures,506,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11516.09,,,,,,,fee schedule,11516.09,28049.87,MSDRG Base Rate Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25385.34,,,,,,,fee schedule,15418.52,37555.06, Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32728.36,,,,,,,fee schedule,15418.52,37555.06, Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31295.88,,,,,,,fee schedule,15418.52,37555.06, Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37555.06,,,,,,,fee schedule,15418.52,37555.06, Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",27864.49,27864.49,27864.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16035.26,,,,,,,fee schedule,15418.52,37555.06,MSDRG Base Rate Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16189.45,,,,,,,fee schedule,15418.52,37555.06,MSDRG Base Rate Major Shoulder Or Elbow Joint Procedures With Cc/Mcc,507,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15418.52,,,,,,,fee schedule,15418.52,37555.06,MSDRG Base Rate Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21281.86,,,,,,,fee schedule,12926.16,31484.38, Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27437.9,,,,,,,fee schedule,12926.16,31484.38, Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26236.98,,,,,,,fee schedule,12926.16,31484.38, Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31484.38,,,,,,,fee schedule,12926.16,31484.38, Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13443.21,,,,,,,fee schedule,12926.16,31484.38,MSDRG Base Rate Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13572.47,,,,,,,fee schedule,12926.16,31484.38,MSDRG Base Rate Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc,508,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12926.16,,,,,,,fee schedule,12926.16,31484.38,MSDRG Base Rate Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24684.09,,,,,,,fee schedule,24684.09,31824.27, Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31824.27,,,,,,,fee schedule,24684.09,31824.27, Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Arthroscopy,509,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,42447.09,,,,,,,fee schedule,25781.47,62796.2, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,54725.42,,,,,,,fee schedule,25781.47,62796.2, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,52330.16,,,,,,,fee schedule,25781.47,62796.2, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,62796.2,,,,,,,fee schedule,25781.47,62796.2, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26812.73,,,,,,,fee schedule,25781.47,62796.2,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27070.54,,,,,,,fee schedule,25781.47,62796.2,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc",510,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25781.47,,,,,,,fee schedule,25781.47,62796.2,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29221.81,,,,,,,fee schedule,17748.71,43230.73, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37674.57,,,,,,,fee schedule,17748.71,43230.73, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36025.61,,,,,,,fee schedule,17748.71,43230.73, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43230.73,,,,,,,fee schedule,17748.71,43230.73, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],6734.28,6734.28,6734.28,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18458.66,,,,,,,fee schedule,17748.71,43230.73,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18636.15,,,,,,,fee schedule,17748.71,43230.73,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc",511,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17748.71,,,,,,,fee schedule,17748.71,43230.73,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23263.34,,,,,,,fee schedule,14129.66,34415.77, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29992.54,,,,,,,fee schedule,14129.66,34415.77, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28679.81,,,,,,,fee schedule,14129.66,34415.77, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34415.77,,,,,,,fee schedule,14129.66,34415.77, "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14694.85,,,,,,,fee schedule,14129.66,34415.77,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14836.14,,,,,,,fee schedule,14129.66,34415.77,MSDRG Base Rate "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc",512,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14129.66,,,,,,,fee schedule,14129.66,34415.77,MSDRG Base Rate "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22123.64,,,,,,,fee schedule,13437.43,32729.7, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28523.17,,,,,,,fee schedule,13437.43,32729.7, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27274.75,,,,,,,fee schedule,13437.43,32729.7, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32729.7,,,,,,,fee schedule,13437.43,32729.7, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5755.5,5755.5,5755.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",25949.23,25949.23,25949.23,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13974.93,,,,,,,fee schedule,13437.43,32729.7,MSDRG Base Rate "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14109.3,,,,,,,fee schedule,13437.43,32729.7,MSDRG Base Rate "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc",513,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13437.43,,,,,,,fee schedule,13437.43,32729.7,MSDRG Base Rate "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14366.38,,,,,,,fee schedule,8725.84,21253.62, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18522.03,,,,,,,fee schedule,8725.84,21253.62, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17711.35,,,,,,,fee schedule,8725.84,21253.62, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21253.62,,,,,,,fee schedule,8725.84,21253.62, "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9074.87,,,,,,,fee schedule,8725.84,21253.62,MSDRG Base Rate "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9162.13,,,,,,,fee schedule,8725.84,21253.62,MSDRG Base Rate "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc",514,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8725.84,,,,,,,fee schedule,8725.84,21253.62,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44785.51,,,,,,,fee schedule,27201.77,66255.65, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57740.25,,,,,,,fee schedule,27201.77,66255.65, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55213.04,,,,,,,fee schedule,27201.77,66255.65, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,66255.65,,,,,,,fee schedule,27201.77,66255.65, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28289.84,,,,,,,fee schedule,27201.77,66255.65,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28561.86,,,,,,,fee schedule,27201.77,66255.65,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc,515,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27201.77,,,,,,,fee schedule,27201.77,66255.65,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29203.54,,,,,,,fee schedule,17737.62,43203.7, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37651.02,,,,,,,fee schedule,17737.62,43203.7, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36003.08,,,,,,,fee schedule,17737.62,43203.7, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43203.7,,,,,,,fee schedule,17737.62,43203.7, Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18447.12,,,,,,,fee schedule,17737.62,43203.7,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18624.5,,,,,,,fee schedule,17737.62,43203.7,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc,516,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17737.62,,,,,,,fee schedule,17737.62,43203.7,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21595.25,,,,,,,fee schedule,13116.5,31947.99, Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27841.93,,,,,,,fee schedule,13116.5,31947.99, Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26623.33,,,,,,,fee schedule,13116.5,31947.99, Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31947.99,,,,,,,fee schedule,13116.5,31947.99, Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],25064.89,25064.89,25064.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],12450.02,12450.02,12450.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13641.16,,,,,,,fee schedule,13116.5,31947.99,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13772.32,,,,,,,fee schedule,13116.5,31947.99,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc,517,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13116.5,,,,,,,fee schedule,13116.5,31947.99,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,52520.28,,,,,,,fee schedule,31899.71,77698.47, Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,67712.4,,,,,,,fee schedule,31899.71,77698.47, Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,64748.72,,,,,,,fee schedule,31899.71,77698.47, Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,77698.47,,,,,,,fee schedule,31899.71,77698.47, Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,33175.7,,,,,,,fee schedule,31899.71,77698.47,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33494.7,,,,,,,fee schedule,31899.71,77698.47,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator,518,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,31899.71,,,,,,,fee schedule,31899.71,77698.47,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28108.81,,,,,,,fee schedule,17072.7,41584.16, Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36239.62,,,,,,,fee schedule,17072.7,41584.16, Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34653.47,,,,,,,fee schedule,17072.7,41584.16, Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41584.16,,,,,,,fee schedule,17072.7,41584.16, Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17755.61,,,,,,,fee schedule,17072.7,41584.16,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17926.34,,,,,,,fee schedule,17072.7,41584.16,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion With Cc,519,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17072.7,,,,,,,fee schedule,17072.7,41584.16,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20993.78,,,,,,,fee schedule,12751.18,31058.18, Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27066.48,,,,,,,fee schedule,12751.18,31058.18, Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25881.82,,,,,,,fee schedule,12751.18,31058.18, Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31058.18,,,,,,,fee schedule,12751.18,31058.18, Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],23691.69,23691.69,23691.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13261.23,,,,,,,fee schedule,12751.18,31058.18,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13388.74,,,,,,,fee schedule,12751.18,31058.18,MSDRG Base Rate Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc,520,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12751.18,,,,,,,fee schedule,12751.18,31058.18,MSDRG Base Rate Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40334.92,,,,,,,fee schedule,24498.58,59671.46, Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52002.28,,,,,,,fee schedule,24498.58,59671.46, Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,49726.22,,,,,,,fee schedule,24498.58,59671.46, Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,59671.46,,,,,,,fee schedule,24498.58,59671.46, Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],25254.34,25254.34,25254.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],23781.92,23781.92,23781.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25478.52,,,,,,,fee schedule,24498.58,59671.46,MSDRG Base Rate Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25723.51,,,,,,,fee schedule,24498.58,59671.46,MSDRG Base Rate Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc,521,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24498.58,,,,,,,fee schedule,24498.58,59671.46,MSDRG Base Rate Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29760.04,,,,,,,fee schedule,18075.62,44026.98, Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38368.49,,,,,,,fee schedule,18075.62,44026.98, Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36689.15,,,,,,,fee schedule,18075.62,44026.98, Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44026.98,,,,,,,fee schedule,18075.62,44026.98, Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],15966.43,15966.43,15966.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],35434.27,35434.27,35434.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,37436.17,37436.17,37436.17,1 through 10,percent of total billed charges,,, Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18798.64,,,,,,,fee schedule,18075.62,44026.98,MSDRG Base Rate Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18979.4,,,,,,,fee schedule,18075.62,44026.98,MSDRG Base Rate Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc,522,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18075.62,,,,,,,fee schedule,18075.62,44026.98,MSDRG Base Rate Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC,523,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transient ischemia,524,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other heart assist system implant,525,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,526,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. No Longer Valid,527,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Intracranial Vascular Proc w Pdx Hemorrhage,528,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular shunt procedures w CC,529,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ventricular Shunt Procedures w/o CC,530,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w CC,531,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Spinal Procedures w/o CC,532,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22030.89,,,,,,,fee schedule,13381.1,32592.48, Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28403.59,,,,,,,fee schedule,13381.1,32592.48, Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27160.4,,,,,,,fee schedule,13381.1,32592.48, Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32592.48,,,,,,,fee schedule,13381.1,32592.48, Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13916.34,,,,,,,fee schedule,13381.1,32592.48,MSDRG Base Rate Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14050.16,,,,,,,fee schedule,13381.1,32592.48,MSDRG Base Rate Fractures Of Femur With Mcc,533,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13381.1,,,,,,,fee schedule,13381.1,32592.48,MSDRG Base Rate Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11328.12,,,,,,,fee schedule,6880.46,16758.82, Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14604.92,,,,,,,fee schedule,6880.46,16758.82, Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13965.68,,,,,,,fee schedule,6880.46,16758.82, Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16758.82,,,,,,,fee schedule,6880.46,16758.82, Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],7055.18,7055.18,7055.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7155.68,,,,,,,fee schedule,6880.46,16758.82,MSDRG Base Rate Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7224.48,,,,,,,fee schedule,6880.46,16758.82,MSDRG Base Rate Fractures Of Femur Without Mcc,534,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6880.46,,,,,,,fee schedule,6880.46,16758.82,MSDRG Base Rate Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18015.95,,,,,,,fee schedule,10942.51,26652.78, Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23227.28,,,,,,,fee schedule,10942.51,26652.78, Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22210.65,,,,,,,fee schedule,10942.51,26652.78, Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26652.78,,,,,,,fee schedule,10942.51,26652.78, Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11380.21,,,,,,,fee schedule,10942.51,26652.78,MSDRG Base Rate Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11489.64,,,,,,,fee schedule,10942.51,26652.78,MSDRG Base Rate Fractures Of Hip And Pelvis With Mcc,535,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10942.51,,,,,,,fee schedule,10942.51,26652.78,MSDRG Base Rate Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11349.2,,,,,,,fee schedule,6893.27,16790, Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14632.1,,,,,,,fee schedule,6893.27,16790, Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13991.67,,,,,,,fee schedule,6893.27,16790, Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16790,,,,,,,fee schedule,6893.27,16790, Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13174.39,13174.39,13174.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7169,,,,,,,fee schedule,6893.27,16790,MSDRG Base Rate Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7237.93,,,,,,,fee schedule,6893.27,16790,MSDRG Base Rate Fractures Of Hip And Pelvis Without Mcc,536,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6893.27,,,,,,,fee schedule,6893.27,16790,MSDRG Base Rate "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13410.78,,,,,,,fee schedule,8145.42,19839.9, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17290.01,,,,,,,fee schedule,8145.42,19839.9, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16533.25,,,,,,,fee schedule,8145.42,19839.9, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19839.9,,,,,,,fee schedule,8145.42,19839.9, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8471.24,,,,,,,fee schedule,8145.42,19839.9,MSDRG Base Rate "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8552.69,,,,,,,fee schedule,8145.42,19839.9,MSDRG Base Rate "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc",537,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8145.42,,,,,,,fee schedule,8145.42,19839.9,MSDRG Base Rate "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10122.38,,,,,,,fee schedule,6148.12,14975.04, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13050.4,,,,,,,fee schedule,6148.12,14975.04, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12479.2,,,,,,,fee schedule,6148.12,14975.04, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14975.04,,,,,,,fee schedule,6148.12,14975.04, "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11261.58,11261.58,11261.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6394.04,,,,,,,fee schedule,6148.12,14975.04,MSDRG Base Rate "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6455.53,,,,,,,fee schedule,6148.12,14975.04,MSDRG Base Rate "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc",538,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6148.12,,,,,,,fee schedule,6148.12,14975.04,MSDRG Base Rate Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27680.19,,,,,,,fee schedule,16812.37,40950.06, Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35687.02,,,,,,,fee schedule,16812.37,40950.06, Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34125.05,,,,,,,fee schedule,16812.37,40950.06, Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40950.06,,,,,,,fee schedule,16812.37,40950.06, Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],26812.98,26812.98,26812.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17484.86,,,,,,,fee schedule,16812.37,40950.06,MSDRG Base Rate Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17652.99,,,,,,,fee schedule,16812.37,40950.06,MSDRG Base Rate Osteomyelitis With Mcc,539,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16812.37,,,,,,,fee schedule,16812.37,40950.06,MSDRG Base Rate Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18216.9,,,,,,,fee schedule,11064.56,26950.08, Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23486.36,,,,,,,fee schedule,11064.56,26950.08, Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22458.4,,,,,,,fee schedule,11064.56,26950.08, Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26950.08,,,,,,,fee schedule,11064.56,26950.08, Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17574.99,17574.99,17574.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21778.6,21778.6,21778.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],117496.65,117496.65,117496.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11507.14,,,,,,,fee schedule,11064.56,26950.08,MSDRG Base Rate Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11617.79,,,,,,,fee schedule,11064.56,26950.08,MSDRG Base Rate Osteomyelitis With Cc,540,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11064.56,,,,,,,fee schedule,11064.56,26950.08,MSDRG Base Rate Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11065.33,,,,,,,fee schedule,6720.85,16370.05, Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14266.11,,,,,,,fee schedule,6720.85,16370.05, Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13641.71,,,,,,,fee schedule,6720.85,16370.05, Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16370.05,,,,,,,fee schedule,6720.85,16370.05, Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11288.95,11288.95,11288.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6989.68,,,,,,,fee schedule,6720.85,16370.05,MSDRG Base Rate Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7056.89,,,,,,,fee schedule,6720.85,16370.05,MSDRG Base Rate Osteomyelitis Without Cc/Mcc,541,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6720.85,,,,,,,fee schedule,6720.85,16370.05,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24824.62,,,,,,,fee schedule,15077.96,36725.54, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32005.45,,,,,,,fee schedule,15077.96,36725.54, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30604.61,,,,,,,fee schedule,15077.96,36725.54, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36725.54,,,,,,,fee schedule,15077.96,36725.54, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],27204.35,27204.35,27204.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],16141.6,16141.6,16141.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",38351.97,38351.97,38351.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],6914.97,6914.97,6914.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15681.08,,,,,,,fee schedule,15077.96,36725.54,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15831.86,,,,,,,fee schedule,15077.96,36725.54,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc,542,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15077.96,,,,,,,fee schedule,15077.96,36725.54,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14446.48,,,,,,,fee schedule,8774.49,21372.12, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18625.3,,,,,,,fee schedule,8774.49,21372.12, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17810.1,,,,,,,fee schedule,8774.49,21372.12, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21372.12,,,,,,,fee schedule,8774.49,21372.12, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18275,18275,35595.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9125.47,,,,,,,fee schedule,8774.49,21372.12,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9213.21,,,,,,,fee schedule,8774.49,21372.12,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc,543,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8774.49,,,,,,,fee schedule,8774.49,21372.12,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10604.39,,,,,,,fee schedule,6440.89,15688.13, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13671.84,,,,,,,fee schedule,6440.89,15688.13, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13073.45,,,,,,,fee schedule,6440.89,15688.13, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15688.13,,,,,,,fee schedule,6440.89,15688.13, Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],6050.25,6050.25,6050.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17190.82,17190.82,17190.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6698.53,,,,,,,fee schedule,6440.89,15688.13,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6762.93,,,,,,,fee schedule,6440.89,15688.13,MSDRG Base Rate Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc,544,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6440.89,,,,,,,fee schedule,6440.89,15688.13,MSDRG Base Rate Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34875.33,,,,,,,fee schedule,21182.54,51594.54, Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,44963.44,,,,,,,fee schedule,21182.54,51594.54, Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,42995.45,,,,,,,fee schedule,21182.54,51594.54, Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,51594.54,,,,,,,fee schedule,21182.54,51594.54, Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],42391.27,42391.27,42391.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22029.84,,,,,,,fee schedule,21182.54,51594.54,MSDRG Base Rate Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22241.67,,,,,,,fee schedule,21182.54,51594.54,MSDRG Base Rate Connective Tissue Disorders With Mcc,545,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21182.54,,,,,,,fee schedule,21182.54,51594.54,MSDRG Base Rate Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16208.73,,,,,,,fee schedule,9844.84,23979.19, Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20897.3,,,,,,,fee schedule,9844.84,23979.19, Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19982.66,,,,,,,fee schedule,9844.84,23979.19, Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23979.19,,,,,,,fee schedule,9844.84,23979.19, Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14083.63,14083.63,14083.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10238.63,,,,,,,fee schedule,9844.84,23979.19,MSDRG Base Rate Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10337.08,,,,,,,fee schedule,9844.84,23979.19,MSDRG Base Rate Connective Tissue Disorders With Cc,546,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9844.84,,,,,,,fee schedule,9844.84,23979.19,MSDRG Base Rate Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11751.12,,,,,,,fee schedule,7137.38,17384.6, Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15150.27,,,,,,,fee schedule,7137.38,17384.6, Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14487.17,,,,,,,fee schedule,7137.38,17384.6, Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17384.6,,,,,,,fee schedule,7137.38,17384.6, Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12473.5,12473.5,12473.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7422.88,,,,,,,fee schedule,7137.38,17384.6,MSDRG Base Rate Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7494.25,,,,,,,fee schedule,7137.38,17384.6,MSDRG Base Rate Connective Tissue Disorders Without Cc/Mcc,547,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7137.38,,,,,,,fee schedule,7137.38,17384.6,MSDRG Base Rate Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27134.94,,,,,,,fee schedule,16481.19,40143.41, Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34984.05,,,,,,,fee schedule,16481.19,40143.41, Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33452.84,,,,,,,fee schedule,16481.19,40143.41, Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40143.41,,,,,,,fee schedule,16481.19,40143.41, Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17140.44,,,,,,,fee schedule,16481.19,40143.41,MSDRG Base Rate Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17305.25,,,,,,,fee schedule,16481.19,40143.41,MSDRG Base Rate Septic Arthritis With Mcc,548,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16481.19,,,,,,,fee schedule,16481.19,40143.41,MSDRG Base Rate Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16964.78,,,,,,,fee schedule,10304.05,25097.69, Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21872.05,,,,,,,fee schedule,10304.05,25097.69, Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20914.74,,,,,,,fee schedule,10304.05,25097.69, Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25097.69,,,,,,,fee schedule,10304.05,25097.69, Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10716.21,,,,,,,fee schedule,10304.05,25097.69,MSDRG Base Rate Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10819.25,,,,,,,fee schedule,10304.05,25097.69,MSDRG Base Rate Septic Arthritis With Cc,549,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10304.05,,,,,,,fee schedule,10304.05,25097.69,MSDRG Base Rate Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12283.73,,,,,,,fee schedule,7460.88,18172.54, Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15836.94,,,,,,,fee schedule,7460.88,18172.54, Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15143.78,,,,,,,fee schedule,7460.88,18172.54, Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18172.54,,,,,,,fee schedule,7460.88,18172.54, Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7759.32,,,,,,,fee schedule,7460.88,18172.54,MSDRG Base Rate Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7833.92,,,,,,,fee schedule,7460.88,18172.54,MSDRG Base Rate Septic Arthritis Without Cc/Mcc,550,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7460.88,,,,,,,fee schedule,7460.88,18172.54,MSDRG Base Rate Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23554.23,,,,,,,fee schedule,14306.35,34846.12, Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30367.58,,,,,,,fee schedule,14306.35,34846.12, Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29038.43,,,,,,,fee schedule,14306.35,34846.12, Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34846.12,,,,,,,fee schedule,14306.35,34846.12, Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],5388.86,5388.86,5388.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14878.6,,,,,,,fee schedule,14306.35,34846.12,MSDRG Base Rate Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15021.67,,,,,,,fee schedule,14306.35,34846.12,MSDRG Base Rate Medical Back Problems With Mcc,551,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14306.35,,,,,,,fee schedule,14306.35,34846.12,MSDRG Base Rate Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13509.15,,,,,,,fee schedule,8205.17,19985.43, Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17416.83,,,,,,,fee schedule,8205.17,19985.43, Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16654.52,,,,,,,fee schedule,8205.17,19985.43, Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19985.43,,,,,,,fee schedule,8205.17,19985.43, Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8357.83,8357.83,8357.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15895.31,15895.31,15895.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14926.77,14926.77,19420.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13112.79,13112.79,13112.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],15902.7,15902.7,15902.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],8051.27,8051.27,8051.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14684.48,14684.48,20792.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,20912.67,20912.67,20912.67,1 through 10,percent of total billed charges,,, Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8533.38,,,,,,,fee schedule,8205.17,19985.43,MSDRG Base Rate Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8615.43,,,,,,,fee schedule,8205.17,19985.43,MSDRG Base Rate Medical Back Problems Without Mcc,552,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8205.17,,,,,,,fee schedule,8205.17,19985.43,MSDRG Base Rate Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18216.9,,,,,,,fee schedule,11064.56,26950.08, Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23486.36,,,,,,,fee schedule,11064.56,26950.08, Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22458.4,,,,,,,fee schedule,11064.56,26950.08, Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26950.08,,,,,,,fee schedule,11064.56,26950.08, Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11507.14,,,,,,,fee schedule,11064.56,26950.08,MSDRG Base Rate Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11617.79,,,,,,,fee schedule,11064.56,26950.08,MSDRG Base Rate Bone Diseases And Arthropathies With Mcc,553,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11064.56,,,,,,,fee schedule,11064.56,26950.08,MSDRG Base Rate Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11665.4,,,,,,,fee schedule,7085.32,17257.78, Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15039.75,,,,,,,fee schedule,7085.32,17257.78, Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14381.48,,,,,,,fee schedule,7085.32,17257.78, Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17257.78,,,,,,,fee schedule,7085.32,17257.78, Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],5596.27,5596.27,5596.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7368.73,,,,,,,fee schedule,7085.32,17257.78,MSDRG Base Rate Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7439.59,,,,,,,fee schedule,7085.32,17257.78,MSDRG Base Rate Bone Diseases And Arthropathies Without Mcc,554,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7085.32,,,,,,,fee schedule,7085.32,17257.78,MSDRG Base Rate Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18575.26,,,,,,,fee schedule,11282.22,27480.22, Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23948.37,,,,,,,fee schedule,11282.22,27480.22, Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22900.19,,,,,,,fee schedule,11282.22,27480.22, Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27480.22,,,,,,,fee schedule,11282.22,27480.22, Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],7869.94,7869.94,7869.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11733.51,,,,,,,fee schedule,11282.22,27480.22,MSDRG Base Rate Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11846.33,,,,,,,fee schedule,11282.22,27480.22,MSDRG Base Rate Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc,555,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11282.22,,,,,,,fee schedule,11282.22,27480.22,MSDRG Base Rate Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11672.42,,,,,,,fee schedule,7089.58,17268.17, Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15048.81,,,,,,,fee schedule,7089.58,17268.17, Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14390.15,,,,,,,fee schedule,7089.58,17268.17, Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17268.17,,,,,,,fee schedule,7089.58,17268.17, Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8637,8637,8637,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7373.16,,,,,,,fee schedule,7089.58,17268.17,MSDRG Base Rate Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7444.06,,,,,,,fee schedule,7089.58,17268.17,MSDRG Base Rate Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc,556,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7089.58,,,,,,,fee schedule,7089.58,17268.17,MSDRG Base Rate "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20895.41,,,,,,,fee schedule,12691.43,30912.65, "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26939.65,,,,,,,fee schedule,12691.43,30912.65, "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25760.54,,,,,,,fee schedule,12691.43,30912.65, "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30912.65,,,,,,,fee schedule,12691.43,30912.65, "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13199.09,,,,,,,fee schedule,12691.43,30912.65,MSDRG Base Rate "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13326,,,,,,,fee schedule,12691.43,30912.65,MSDRG Base Rate "Tendonitis, Myositis And Bursitis With Mcc",557,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12691.43,,,,,,,fee schedule,12691.43,30912.65,MSDRG Base Rate "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12552.14,,,,,,,fee schedule,7623.91,18569.63, "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16183,,,,,,,fee schedule,7623.91,18569.63, "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15474.69,,,,,,,fee schedule,7623.91,18569.63, "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18569.63,,,,,,,fee schedule,7623.91,18569.63, "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5182.2,5182.2,5182.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13289.68,13289.68,13289.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14487.61,14487.61,14487.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7928.87,,,,,,,fee schedule,7623.91,18569.63,MSDRG Base Rate "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8005.11,,,,,,,fee schedule,7623.91,18569.63,MSDRG Base Rate "Tendonitis, Myositis And Bursitis Without Mcc",558,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7623.91,,,,,,,fee schedule,7623.91,18569.63,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26207.44,,,,,,,fee schedule,15917.85,38771.27, "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33788.26,,,,,,,fee schedule,15917.85,38771.27, "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32309.39,,,,,,,fee schedule,15917.85,38771.27, "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38771.27,,,,,,,fee schedule,15917.85,38771.27, "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10332.09,10332.09,10332.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24608.17,24608.17,24608.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16554.56,,,,,,,fee schedule,15917.85,38771.27,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16713.74,,,,,,,fee schedule,15917.85,38771.27,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue With Mcc",559,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15917.85,,,,,,,fee schedule,15917.85,38771.27,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15825.08,,,,,,,fee schedule,9611.82,23411.62, "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20402.68,,,,,,,fee schedule,9611.82,23411.62, "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19509.68,,,,,,,fee schedule,9611.82,23411.62, "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23411.62,,,,,,,fee schedule,9611.82,23411.62, "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],19328,19328,19328,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19102.83,19102.83,19102.83,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9996.29,,,,,,,fee schedule,9611.82,23411.62,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10092.41,,,,,,,fee schedule,9611.82,23411.62,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue With Cc",560,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9611.82,,,,,,,fee schedule,9611.82,23411.62,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11297.21,,,,,,,fee schedule,6861.69,16713.08, "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14565.06,,,,,,,fee schedule,6861.69,16713.08, "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13927.57,,,,,,,fee schedule,6861.69,16713.08, "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16713.08,,,,,,,fee schedule,6861.69,16713.08, "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10927.29,10178.42,23005.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],9350,9350,9350,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7136.16,,,,,,,fee schedule,6861.69,16713.08,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7204.77,,,,,,,fee schedule,6861.69,16713.08,MSDRG Base Rate "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc",561,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6861.69,,,,,,,fee schedule,6861.69,16713.08,MSDRG Base Rate "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20022.71,,,,,,,fee schedule,12161.38,29621.59, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25814.53,,,,,,,fee schedule,12161.38,29621.59, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24684.66,,,,,,,fee schedule,12161.38,29621.59, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29621.59,,,,,,,fee schedule,12161.38,29621.59, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12647.84,,,,,,,fee schedule,12161.38,29621.59,MSDRG Base Rate "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12769.45,,,,,,,fee schedule,12161.38,29621.59,MSDRG Base Rate "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc",562,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12161.38,,,,,,,fee schedule,12161.38,29621.59,MSDRG Base Rate "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12584.46,,,,,,,fee schedule,7643.54,18617.45, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16224.67,,,,,,,fee schedule,7643.54,18617.45, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15514.54,,,,,,,fee schedule,7643.54,18617.45, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18617.45,,,,,,,fee schedule,7643.54,18617.45, "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7949.28,,,,,,,fee schedule,7643.54,18617.45,MSDRG Base Rate "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8025.72,,,,,,,fee schedule,7643.54,18617.45,MSDRG Base Rate "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc",563,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7643.54,,,,,,,fee schedule,7643.54,18617.45,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21692.21,,,,,,,fee schedule,13175.39,32091.44, Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27966.94,,,,,,,fee schedule,13175.39,32091.44, Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26742.87,,,,,,,fee schedule,13175.39,32091.44, Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32091.44,,,,,,,fee schedule,13175.39,32091.44, Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13702.41,,,,,,,fee schedule,13175.39,32091.44,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13834.16,,,,,,,fee schedule,13175.39,32091.44,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc,564,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13175.39,,,,,,,fee schedule,13175.39,32091.44,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13693.24,,,,,,,fee schedule,8316.99,20257.78, Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17654.18,,,,,,,fee schedule,8316.99,20257.78, Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16881.48,,,,,,,fee schedule,8316.99,20257.78, Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20257.78,,,,,,,fee schedule,8316.99,20257.78, Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8649.67,,,,,,,fee schedule,8316.99,20257.78,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8732.84,,,,,,,fee schedule,8316.99,20257.78,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses With Cc,565,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8316.99,,,,,,,fee schedule,8316.99,20257.78,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10529.91,,,,,,,fee schedule,6395.65,15577.95, Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13575.82,,,,,,,fee schedule,6395.65,15577.95, Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12981.62,,,,,,,fee schedule,6395.65,15577.95, Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15577.95,,,,,,,fee schedule,6395.65,15577.95, Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6651.48,,,,,,,fee schedule,6395.65,15577.95,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6715.43,,,,,,,fee schedule,6395.65,15577.95,MSDRG Base Rate Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc,566,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6395.65,,,,,,,fee schedule,6395.65,15577.95,MSDRG Base Rate "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx",567,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx",568,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Small & Large Bowel Procedures w CC w Major Gi Dx,569,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,41331.28,,,,,,,fee schedule,25103.75,61145.47, Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,53286.85,,,,,,,fee schedule,25103.75,61145.47, Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,50954.56,,,,,,,fee schedule,25103.75,61145.47, Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,61145.47,,,,,,,fee schedule,25103.75,61145.47, Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26107.9,,,,,,,fee schedule,25103.75,61145.47,MSDRG Base Rate Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26358.94,,,,,,,fee schedule,25103.75,61145.47,MSDRG Base Rate Skin Debridement With Mcc,570,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25103.75,,,,,,,fee schedule,25103.75,61145.47,MSDRG Base Rate Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23742.54,,,,,,,fee schedule,14420.72,35124.71, Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30610.36,,,,,,,fee schedule,14420.72,35124.71, Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29270.59,,,,,,,fee schedule,14420.72,35124.71, Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35124.71,,,,,,,fee schedule,14420.72,35124.71, Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5103.24,5103.24,5103.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14997.55,,,,,,,fee schedule,14420.72,35124.71,MSDRG Base Rate Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15141.76,,,,,,,fee schedule,14420.72,35124.71,MSDRG Base Rate Skin Debridement With Cc,571,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14420.72,,,,,,,fee schedule,14420.72,35124.71,MSDRG Base Rate Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16108.95,,,,,,,fee schedule,9784.24,23831.58, Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20768.66,,,,,,,fee schedule,9784.24,23831.58, Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19859.65,,,,,,,fee schedule,9784.24,23831.58, Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23831.58,,,,,,,fee schedule,9784.24,23831.58, Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],6456.08,6456.08,6456.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10175.61,,,,,,,fee schedule,9784.24,23831.58,MSDRG Base Rate Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10273.45,,,,,,,fee schedule,9784.24,23831.58,MSDRG Base Rate Skin Debridement Without Cc/Mcc,572,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9784.24,,,,,,,fee schedule,9784.24,23831.58,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,92066.82,,,,,,,fee schedule,55919.45,136203.61, Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,118698.27,,,,,,,fee schedule,55919.45,136203.61, Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,113503.01,,,,,,,fee schedule,55919.45,136203.61, Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,136203.61,,,,,,,fee schedule,55919.45,136203.61, Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],81645.42,81645.42,81645.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],52093.86,52093.86,52093.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,58156.23,,,,,,,fee schedule,55919.45,136203.61,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,58715.42,,,,,,,fee schedule,55919.45,136203.61,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis With Mcc,573,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,55919.45,,,,,,,fee schedule,55919.45,136203.61,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,48783.58,,,,,,,fee schedule,29630.12,72170.41, Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,62894.83,,,,,,,fee schedule,29630.12,72170.41, Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,60142.01,,,,,,,fee schedule,29630.12,72170.41, Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,72170.41,,,,,,,fee schedule,29630.12,72170.41, Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30815.32,,,,,,,fee schedule,29630.12,72170.41,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31111.63,,,,,,,fee schedule,29630.12,72170.41,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis With Cc,574,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29630.12,,,,,,,fee schedule,29630.12,72170.41,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25253.24,,,,,,,fee schedule,15338.29,37359.63, Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32558.05,,,,,,,fee schedule,15338.29,37359.63, Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31133.03,,,,,,,fee schedule,15338.29,37359.63, Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37359.63,,,,,,,fee schedule,15338.29,37359.63, Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15951.82,,,,,,,fee schedule,15338.29,37359.63,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16105.2,,,,,,,fee schedule,15338.29,37359.63,MSDRG Base Rate Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc,575,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15338.29,,,,,,,fee schedule,15338.29,37359.63,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,68876.56,,,,,,,fee schedule,41834.18,101895.95, Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,88799.94,,,,,,,fee schedule,41834.18,101895.95, Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,84913.29,,,,,,,fee schedule,41834.18,101895.95, Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,101895.95,,,,,,,fee schedule,41834.18,101895.95, Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],71530.89,71530.89,71530.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,43507.55,,,,,,,fee schedule,41834.18,101895.95,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43925.89,,,,,,,fee schedule,41834.18,101895.95,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc,576,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,41834.18,,,,,,,fee schedule,41834.18,101895.95,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,37250.29,,,,,,,fee schedule,22625.04,55108.05, Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,48025.38,,,,,,,fee schedule,22625.04,55108.05, Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,45923.38,,,,,,,fee schedule,22625.04,55108.05, Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,55108.05,,,,,,,fee schedule,22625.04,55108.05, Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",30707.78,30707.78,30707.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,65306.78,65306.78,65306.78,1 through 10,percent of total billed charges,,, Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,23530.04,,,,,,,fee schedule,22625.04,55108.05,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23756.29,,,,,,,fee schedule,22625.04,55108.05,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis With Cc,577,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22625.04,,,,,,,fee schedule,22625.04,55108.05,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22574.74,,,,,,,fee schedule,13711.42,33397.06, Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29104.76,,,,,,,fee schedule,13711.42,33397.06, Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27830.88,,,,,,,fee schedule,13711.42,33397.06, Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33397.06,,,,,,,fee schedule,13711.42,33397.06, Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8637,8637,8637,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22411.32,22411.32,22411.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14259.88,,,,,,,fee schedule,13711.42,33397.06,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14396.99,,,,,,,fee schedule,13711.42,33397.06,MSDRG Base Rate Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc,578,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13711.42,,,,,,,fee schedule,13711.42,33397.06,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45510.64,,,,,,,fee schedule,27642.21,67328.42, "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58675.14,,,,,,,fee schedule,27642.21,67328.42, "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,56107.01,,,,,,,fee schedule,27642.21,67328.42, "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,67328.42,,,,,,,fee schedule,27642.21,67328.42, "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28747.9,,,,,,,fee schedule,27642.21,67328.42,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,29024.32,,,,,,,fee schedule,27642.21,67328.42,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc",579,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27642.21,,,,,,,fee schedule,27642.21,67328.42,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24283.58,,,,,,,fee schedule,14749.34,35925.12, "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31307.9,,,,,,,fee schedule,14749.34,35925.12, "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29937.6,,,,,,,fee schedule,14749.34,35925.12, "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35925.12,,,,,,,fee schedule,14749.34,35925.12, "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],28654.5,28654.5,28654.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15339.31,,,,,,,fee schedule,14749.34,35925.12,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15486.81,,,,,,,fee schedule,14749.34,35925.12,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc",580,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14749.34,,,,,,,fee schedule,14749.34,35925.12,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20279.88,,,,,,,fee schedule,12317.58,30002.05, "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26146.09,,,,,,,fee schedule,12317.58,30002.05, "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25001.71,,,,,,,fee schedule,12317.58,30002.05, "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30002.05,,,,,,,fee schedule,12317.58,30002.05, "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24131.84,24131.84,24144.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],36732.18,36732.18,36732.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12810.28,,,,,,,fee schedule,12317.58,30002.05,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12933.46,,,,,,,fee schedule,12317.58,30002.05,MSDRG Base Rate "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc",581,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12317.58,,,,,,,fee schedule,12317.58,30002.05,MSDRG Base Rate Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27074.51,,,,,,,fee schedule,16444.49,40054.01, Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34906.14,,,,,,,fee schedule,16444.49,40054.01, Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33378.35,,,,,,,fee schedule,16444.49,40054.01, Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40054.01,,,,,,,fee schedule,16444.49,40054.01, Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],29378.13,29378.13,29378.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17102.27,,,,,,,fee schedule,16444.49,40054.01,MSDRG Base Rate Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17266.71,,,,,,,fee schedule,16444.49,40054.01,MSDRG Base Rate Mastectomy For Malignancy With Cc/Mcc,582,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16444.49,,,,,,,fee schedule,16444.49,40054.01,MSDRG Base Rate Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24232.99,,,,,,,fee schedule,14718.61,35850.28, Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31242.68,,,,,,,fee schedule,14718.61,35850.28, Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29875.23,,,,,,,fee schedule,14718.61,35850.28, Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35850.28,,,,,,,fee schedule,14718.61,35850.28, Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],35305.28,35305.28,35305.28,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15307.35,,,,,,,fee schedule,14718.61,35850.28,MSDRG Base Rate Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15454.54,,,,,,,fee schedule,14718.61,35850.28,MSDRG Base Rate Mastectomy For Malignancy Without Cc/Mcc,583,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14718.61,,,,,,,fee schedule,14718.61,35850.28,MSDRG Base Rate "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30083.26,,,,,,,fee schedule,18271.94,44505.15, "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38785.2,,,,,,,fee schedule,18271.94,44505.15, "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37087.63,,,,,,,fee schedule,18271.94,44505.15, "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44505.15,,,,,,,fee schedule,18271.94,44505.15, "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],33843.68,33843.68,33843.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19002.82,,,,,,,fee schedule,18271.94,44505.15,MSDRG Base Rate "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19185.54,,,,,,,fee schedule,18271.94,44505.15,MSDRG Base Rate "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc",584,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18271.94,,,,,,,fee schedule,18271.94,44505.15,MSDRG Base Rate "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27109.64,,,,,,,fee schedule,16465.83,40105.99, "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34951.43,,,,,,,fee schedule,16465.83,40105.99, "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33421.66,,,,,,,fee schedule,16465.83,40105.99, "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40105.99,,,,,,,fee schedule,16465.83,40105.99, "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",35000.6,35000.6,35000.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],33286.86,32952.04,33302.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17124.46,,,,,,,fee schedule,16465.83,40105.99,MSDRG Base Rate "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17289.12,,,,,,,fee schedule,16465.83,40105.99,MSDRG Base Rate "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc",585,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16465.83,,,,,,,fee schedule,16465.83,40105.99,MSDRG Base Rate Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27196.77,,,,,,,fee schedule,16518.75,40234.89, Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35063.77,,,,,,,fee schedule,16518.75,40234.89, Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33529.07,,,,,,,fee schedule,16518.75,40234.89, Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40234.89,,,,,,,fee schedule,16518.75,40234.89, Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17179.5,,,,,,,fee schedule,16518.75,40234.89,MSDRG Base Rate Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17344.69,,,,,,,fee schedule,16518.75,40234.89,MSDRG Base Rate Skin Ulcers With Mcc,592,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16518.75,,,,,,,fee schedule,16518.75,40234.89,MSDRG Base Rate Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16671.07,,,,,,,fee schedule,10125.66,24663.18, Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21493.38,,,,,,,fee schedule,10125.66,24663.18, Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20552.65,,,,,,,fee schedule,10125.66,24663.18, Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24663.18,,,,,,,fee schedule,10125.66,24663.18, Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10530.69,,,,,,,fee schedule,10125.66,24663.18,MSDRG Base Rate Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10631.94,,,,,,,fee schedule,10125.66,24663.18,MSDRG Base Rate Skin Ulcers With Cc,593,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10125.66,,,,,,,fee schedule,10125.66,24663.18,MSDRG Base Rate Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12181.14,,,,,,,fee schedule,7398.57,18020.77, Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15704.68,,,,,,,fee schedule,7398.57,18020.77, Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15017.31,,,,,,,fee schedule,7398.57,18020.77, Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18020.77,,,,,,,fee schedule,7398.57,18020.77, Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7694.51,,,,,,,fee schedule,7398.57,18020.77,MSDRG Base Rate Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7768.5,,,,,,,fee schedule,7398.57,18020.77,MSDRG Base Rate Skin Ulcers Without Cc/Mcc,594,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7398.57,,,,,,,fee schedule,7398.57,18020.77,MSDRG Base Rate Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29802.2,,,,,,,fee schedule,18101.23,44089.35, Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38422.84,,,,,,,fee schedule,18101.23,44089.35, Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36741.13,,,,,,,fee schedule,18101.23,44089.35, Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44089.35,,,,,,,fee schedule,18101.23,44089.35, Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18825.28,,,,,,,fee schedule,18101.23,44089.35,MSDRG Base Rate Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19006.29,,,,,,,fee schedule,18101.23,44089.35,MSDRG Base Rate Major Skin Disorders With Mcc,595,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18101.23,,,,,,,fee schedule,18101.23,44089.35,MSDRG Base Rate Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15212.37,,,,,,,fee schedule,9239.68,22505.18, Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19612.74,,,,,,,fee schedule,9239.68,22505.18, Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18754.31,,,,,,,fee schedule,9239.68,22505.18, Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22505.18,,,,,,,fee schedule,9239.68,22505.18, Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9609.27,,,,,,,fee schedule,9239.68,22505.18,MSDRG Base Rate Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9701.66,,,,,,,fee schedule,9239.68,22505.18,MSDRG Base Rate Major Skin Disorders Without Mcc,596,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9239.68,,,,,,,fee schedule,9239.68,22505.18,MSDRG Base Rate Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23427.76,,,,,,,fee schedule,14229.53,34659.01, Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30204.52,,,,,,,fee schedule,14229.53,34659.01, Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28882.51,,,,,,,fee schedule,14229.53,34659.01, Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34659.01,,,,,,,fee schedule,14229.53,34659.01, Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18896.42,18896.42,18896.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18578.51,18578.51,18578.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14798.71,,,,,,,fee schedule,14229.53,34659.01,MSDRG Base Rate Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14941.01,,,,,,,fee schedule,14229.53,34659.01,MSDRG Base Rate Malignant Breast Disorders With Mcc,597,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14229.53,,,,,,,fee schedule,14229.53,34659.01,MSDRG Base Rate Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15898.16,,,,,,,fee schedule,9656.21,23519.73, Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20496.89,,,,,,,fee schedule,9656.21,23519.73, Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19599.77,,,,,,,fee schedule,9656.21,23519.73, Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23519.73,,,,,,,fee schedule,9656.21,23519.73, Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18099.63,18099.63,18099.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],2626.5,2626.5,2626.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10042.46,,,,,,,fee schedule,9656.21,23519.73,MSDRG Base Rate Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10139.02,,,,,,,fee schedule,9656.21,23519.73,MSDRG Base Rate Malignant Breast Disorders With Cc,598,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9656.21,,,,,,,fee schedule,9656.21,23519.73,MSDRG Base Rate Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10812.38,,,,,,,fee schedule,6567.21,15995.83, Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13939.99,,,,,,,fee schedule,6567.21,15995.83, Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13329.86,,,,,,,fee schedule,6567.21,15995.83, Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15995.83,,,,,,,fee schedule,6567.21,15995.83, Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6829.9,,,,,,,fee schedule,6567.21,15995.83,MSDRG Base Rate Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6895.57,,,,,,,fee schedule,6567.21,15995.83,MSDRG Base Rate Malignant Breast Disorders Without Cc/Mcc,599,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6567.21,,,,,,,fee schedule,6567.21,15995.83,MSDRG Base Rate Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14637.6,,,,,,,fee schedule,8890.57,21654.86, Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18871.71,,,,,,,fee schedule,8890.57,21654.86, Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18045.72,,,,,,,fee schedule,8890.57,21654.86, Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21654.86,,,,,,,fee schedule,8890.57,21654.86, Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16047.92,16047.92,16047.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9246.19,,,,,,,fee schedule,8890.57,21654.86,MSDRG Base Rate Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9335.1,,,,,,,fee schedule,8890.57,21654.86,MSDRG Base Rate Non-Malignant Breast Disorders With Cc/Mcc,600,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8890.57,,,,,,,fee schedule,8890.57,21654.86,MSDRG Base Rate Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8502.07,,,,,,,fee schedule,5163.98,12577.95, Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,10961.39,,,,,,,fee schedule,5163.98,12577.95, Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10481.63,,,,,,,fee schedule,5163.98,12577.95, Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,12577.95,,,,,,,fee schedule,5163.98,12577.95, Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5370.54,,,,,,,fee schedule,5163.98,12577.95,MSDRG Base Rate Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5422.18,,,,,,,fee schedule,5163.98,12577.95,MSDRG Base Rate Non-Malignant Breast Disorders Without Cc/Mcc,601,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5163.98,,,,,,,fee schedule,5163.98,12577.95,MSDRG Base Rate Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19973.53,,,,,,,fee schedule,12131.5,29548.83, Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25751.11,,,,,,,fee schedule,12131.5,29548.83, Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24624.02,,,,,,,fee schedule,12131.5,29548.83, Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29548.83,,,,,,,fee schedule,12131.5,29548.83, Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14991.6,14991.6,14991.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17144.21,17144.21,17144.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15900.14,15900.14,15900.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16859.68,16859.68,16859.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12616.76,,,,,,,fee schedule,12131.5,29548.83,MSDRG Base Rate Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12738.08,,,,,,,fee schedule,12131.5,29548.83,MSDRG Base Rate Cellulitis With Mcc,602,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12131.5,,,,,,,fee schedule,12131.5,29548.83,MSDRG Base Rate Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12238.76,,,,,,,fee schedule,7433.56,18106.01, Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15778.97,,,,,,,fee schedule,7433.56,18106.01, Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15088.34,,,,,,,fee schedule,7433.56,18106.01, Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18106.01,,,,,,,fee schedule,7433.56,18106.01, Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2879,2879,8637,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7578.63,7578.63,7578.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10243.51,10243.51,13087.81,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12246.89,12246.89,12246.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],11612.46,11612.46,11612.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14427.98,11729.35,14774.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14533.2,14533.2,14533.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9392.34,9392.34,9392.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,27525.92,27525.92,27525.92,1 through 10,percent of total billed charges,,, Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,12706.77,12706.77,12706.77,1 through 10,percent of total billed charges,,, Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7730.9,,,,,,,fee schedule,7433.56,18106.01,MSDRG Base Rate Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7805.24,,,,,,,fee schedule,7433.56,18106.01,MSDRG Base Rate Cellulitis Without Mcc,603,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7433.56,,,,,,,fee schedule,7433.56,18106.01,MSDRG Base Rate "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20687.42,,,,,,,fee schedule,12565.1,30604.96, "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26671.51,,,,,,,fee schedule,12565.1,30604.96, "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25504.13,,,,,,,fee schedule,12565.1,30604.96, "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30604.96,,,,,,,fee schedule,12565.1,30604.96, "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13067.7,,,,,,,fee schedule,12565.1,30604.96,MSDRG Base Rate "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13193.36,,,,,,,fee schedule,12565.1,30604.96,MSDRG Base Rate "Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc",604,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12565.1,,,,,,,fee schedule,12565.1,30604.96,MSDRG Base Rate "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12872.55,,,,,,,fee schedule,7818.52,19043.64, "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16596.09,,,,,,,fee schedule,7818.52,19043.64, "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15869.7,,,,,,,fee schedule,7818.52,19043.64, "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19043.64,,,,,,,fee schedule,7818.52,19043.64, "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15243.53,15243.53,15243.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8131.26,,,,,,,fee schedule,7818.52,19043.64,MSDRG Base Rate "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8209.45,,,,,,,fee schedule,7818.52,19043.64,MSDRG Base Rate "Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc",605,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7818.52,,,,,,,fee schedule,7818.52,19043.64,MSDRG Base Rate Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21265,,,,,,,fee schedule,12915.91,31459.43, Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27416.16,,,,,,,fee schedule,12915.91,31459.43, Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26216.19,,,,,,,fee schedule,12915.91,31459.43, Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31459.43,,,,,,,fee schedule,12915.91,31459.43, Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13432.55,,,,,,,fee schedule,12915.91,31459.43,MSDRG Base Rate Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13561.71,,,,,,,fee schedule,12915.91,31459.43,MSDRG Base Rate Minor Skin Disorders With Mcc,606,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12915.91,,,,,,,fee schedule,12915.91,31459.43,MSDRG Base Rate Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12737.64,,,,,,,fee schedule,7736.57,18844.06, Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16422.16,,,,,,,fee schedule,7736.57,18844.06, Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15703.38,,,,,,,fee schedule,7736.57,18844.06, Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18844.06,,,,,,,fee schedule,7736.57,18844.06, Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12535.02,12535.02,12535.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8046.03,,,,,,,fee schedule,7736.57,18844.06,MSDRG Base Rate Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8123.4,,,,,,,fee schedule,7736.57,18844.06,MSDRG Base Rate Minor Skin Disorders Without Mcc,607,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7736.57,,,,,,,fee schedule,7736.57,18844.06,MSDRG Base Rate Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30801.37,,,,,,,fee schedule,18708.1,45567.52, Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39711.03,,,,,,,fee schedule,18708.1,45567.52, Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37972.94,,,,,,,fee schedule,18708.1,45567.52, Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45567.52,,,,,,,fee schedule,18708.1,45567.52, Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19456.42,,,,,,,fee schedule,18708.1,45567.52,MSDRG Base Rate Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19643.5,,,,,,,fee schedule,18708.1,45567.52,MSDRG Base Rate Adrenal And Pituitary Procedures With Cc/Mcc,614,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18708.1,,,,,,,fee schedule,18708.1,45567.52,MSDRG Base Rate Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19664.36,,,,,,,fee schedule,11943.72,29091.45, Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25352.52,,,,,,,fee schedule,11943.72,29091.45, Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24242.87,,,,,,,fee schedule,11943.72,29091.45, Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29091.45,,,,,,,fee schedule,11943.72,29091.45, Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],23644.5,23644.5,23644.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12421.47,,,,,,,fee schedule,11943.72,29091.45,MSDRG Base Rate Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12540.91,,,,,,,fee schedule,11943.72,29091.45,MSDRG Base Rate Adrenal And Pituitary Procedures Without Cc/Mcc,615,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11943.72,,,,,,,fee schedule,11943.72,29091.45,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,49008.43,,,,,,,fee schedule,29766.69,72503.05, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,63184.71,,,,,,,fee schedule,29766.69,72503.05, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,60419.21,,,,,,,fee schedule,29766.69,72503.05, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,72503.05,,,,,,,fee schedule,29766.69,72503.05, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],20284.35,20284.35,20284.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",38221.71,38221.71,38221.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30957.36,,,,,,,fee schedule,29766.69,72503.05,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31255.02,,,,,,,fee schedule,29766.69,72503.05,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc",616,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29766.69,,,,,,,fee schedule,29766.69,72503.05,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26283.33,,,,,,,fee schedule,15963.94,38883.54, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33886.1,,,,,,,fee schedule,15963.94,38883.54, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32402.95,,,,,,,fee schedule,15963.94,38883.54, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38883.54,,,,,,,fee schedule,15963.94,38883.54, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22289.19,22289.19,22289.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],31154.52,31154.52,31154.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16602.5,,,,,,,fee schedule,15963.94,38883.54,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16762.14,,,,,,,fee schedule,15963.94,38883.54,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc",617,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15963.94,,,,,,,fee schedule,15963.94,38883.54,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19931.37,,,,,,,fee schedule,12105.9,29486.46, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25696.76,,,,,,,fee schedule,12105.9,29486.46, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24572.05,,,,,,,fee schedule,12105.9,29486.46, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29486.46,,,,,,,fee schedule,12105.9,29486.46, "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12590.14,,,,,,,fee schedule,12105.9,29486.46,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12711.2,,,,,,,fee schedule,12105.9,29486.46,MSDRG Base Rate "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",618,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12105.9,,,,,,,fee schedule,12105.9,29486.46,MSDRG Base Rate O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40576.63,,,,,,,fee schedule,24645.39,60029.05, O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52313.91,,,,,,,fee schedule,24645.39,60029.05, O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,50024.21,,,,,,,fee schedule,24645.39,60029.05, O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,60029.05,,,,,,,fee schedule,24645.39,60029.05, O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],30661.11,30661.11,30661.11,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25631.21,,,,,,,fee schedule,24645.39,60029.05,MSDRG Base Rate O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25877.66,,,,,,,fee schedule,24645.39,60029.05,MSDRG Base Rate O.R. Procedures For Obesity With Mcc,619,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24645.39,,,,,,,fee schedule,24645.39,60029.05,MSDRG Base Rate O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22489.02,,,,,,,fee schedule,13659.36,33270.24, O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28994.24,,,,,,,fee schedule,13659.36,33270.24, O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27725.2,,,,,,,fee schedule,13659.36,33270.24, O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33270.24,,,,,,,fee schedule,13659.36,33270.24, O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",25969.79,25969.79,25969.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],26791.27,26791.27,26791.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,26330.45,26330.45,26330.45,1 through 10,percent of total billed charges,,, O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14205.73,,,,,,,fee schedule,13659.36,33270.24,MSDRG Base Rate O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14342.33,,,,,,,fee schedule,13659.36,33270.24,MSDRG Base Rate O.R. Procedures For Obesity With Cc,620,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13659.36,,,,,,,fee schedule,13659.36,33270.24,MSDRG Base Rate O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21197.55,,,,,,,fee schedule,12874.94,31359.64, O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27329.19,,,,,,,fee schedule,12874.94,31359.64, O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26133.03,,,,,,,fee schedule,12874.94,31359.64, O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31359.64,,,,,,,fee schedule,12874.94,31359.64, O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",24543.33,24543.33,24543.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19229.22,18818.92,24027.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,31000.79,30355.04,38357.28,1 through 10,percent of total billed charges,,, O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13389.94,,,,,,,fee schedule,12874.94,31359.64,MSDRG Base Rate O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13518.69,,,,,,,fee schedule,12874.94,31359.64,MSDRG Base Rate O.R. Procedures For Obesity Without Cc/Mcc,621,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12874.94,,,,,,,fee schedule,12874.94,31359.64,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50017.44,,,,,,,fee schedule,30379.54,73995.77, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,64485.59,,,,,,,fee schedule,30379.54,73995.77, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,61663.14,,,,,,,fee schedule,30379.54,73995.77, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,73995.77,,,,,,,fee schedule,30379.54,73995.77, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",45723.93,45723.93,45723.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,161665.95,161665.95,161665.95,1 through 10,percent of total billed charges,,, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31594.72,,,,,,,fee schedule,30379.54,73995.77,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,31898.52,,,,,,,fee schedule,30379.54,73995.77,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc",622,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30379.54,,,,,,,fee schedule,30379.54,73995.77,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25209.68,,,,,,,fee schedule,15311.83,37295.18, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32501.88,,,,,,,fee schedule,15311.83,37295.18, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31079.32,,,,,,,fee schedule,15311.83,37295.18, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37295.18,,,,,,,fee schedule,15311.83,37295.18, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15924.3,,,,,,,fee schedule,15311.83,37295.18,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16077.42,,,,,,,fee schedule,15311.83,37295.18,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc",623,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15311.83,,,,,,,fee schedule,15311.83,37295.18,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17592.95,,,,,,,fee schedule,10685.59,26027, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22681.92,,,,,,,fee schedule,10685.59,26027, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21689.17,,,,,,,fee schedule,10685.59,26027, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26027,,,,,,,fee schedule,10685.59,26027, "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11113.01,,,,,,,fee schedule,10685.59,26027,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11219.87,,,,,,,fee schedule,10685.59,26027,MSDRG Base Rate "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc",624,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10685.59,,,,,,,fee schedule,10685.59,26027,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,42441.47,,,,,,,fee schedule,25778.05,62787.88, "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,54718.17,,,,,,,fee schedule,25778.05,62787.88, "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,52323.23,,,,,,,fee schedule,25778.05,62787.88, "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,62787.88,,,,,,,fee schedule,25778.05,62787.88, "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26809.17,,,,,,,fee schedule,25778.05,62787.88,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27066.95,,,,,,,fee schedule,25778.05,62787.88,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures With Mcc",625,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25778.05,,,,,,,fee schedule,25778.05,62787.88,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21071.07,,,,,,,fee schedule,12798.12,31172.53, "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27166.13,,,,,,,fee schedule,12798.12,31172.53, "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25977.11,,,,,,,fee schedule,12798.12,31172.53, "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31172.53,,,,,,,fee schedule,12798.12,31172.53, "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13310.04,,,,,,,fee schedule,12798.12,31172.53,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13438.03,,,,,,,fee schedule,12798.12,31172.53,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures With Cc",626,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12798.12,,,,,,,fee schedule,12798.12,31172.53,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18666.6,,,,,,,fee schedule,11337.7,27615.36, "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24066.14,,,,,,,fee schedule,11337.7,27615.36, "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23012.8,,,,,,,fee schedule,11337.7,27615.36, "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27615.36,,,,,,,fee schedule,11337.7,27615.36, "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11791.21,,,,,,,fee schedule,11337.7,27615.36,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11904.58,,,,,,,fee schedule,11337.7,27615.36,MSDRG Base Rate "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc",627,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11337.7,,,,,,,fee schedule,11337.7,27615.36,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,52372.72,,,,,,,fee schedule,31810.09,77480.17, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,67522.16,,,,,,,fee schedule,31810.09,77480.17, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,64566.81,,,,,,,fee schedule,31810.09,77480.17, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,77480.17,,,,,,,fee schedule,31810.09,77480.17, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,33082.49,,,,,,,fee schedule,31810.09,77480.17,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33400.59,,,,,,,fee schedule,31810.09,77480.17,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc",628,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,31810.09,,,,,,,fee schedule,31810.09,77480.17,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30618.68,,,,,,,fee schedule,18597.14,45297.25, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,39475.5,,,,,,,fee schedule,18597.14,45297.25, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37747.71,,,,,,,fee schedule,18597.14,45297.25, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45297.25,,,,,,,fee schedule,18597.14,45297.25, "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19341.03,,,,,,,fee schedule,18597.14,45297.25,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19527,,,,,,,fee schedule,18597.14,45297.25,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc",629,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18597.14,,,,,,,fee schedule,18597.14,45297.25,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20510.35,,,,,,,fee schedule,12457.56,30343.01, "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26443.22,,,,,,,fee schedule,12457.56,30343.01, "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25285.84,,,,,,,fee schedule,12457.56,30343.01, "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30343.01,,,,,,,fee schedule,12457.56,30343.01, "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12955.86,,,,,,,fee schedule,12457.56,30343.01,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13080.44,,,,,,,fee schedule,12457.56,30343.01,MSDRG Base Rate "Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc",630,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12457.56,,,,,,,fee schedule,12457.56,30343.01,MSDRG Base Rate Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20189.95,,,,,,,fee schedule,12262.95,29868.99, Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26030.13,,,,,,,fee schedule,12262.95,29868.99, Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24890.83,,,,,,,fee schedule,12262.95,29868.99, Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29868.99,,,,,,,fee schedule,12262.95,29868.99, Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],15830,15830,15830,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",24074.94,24074.94,24074.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",29570.74,29570.74,29570.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24430.89,22980.89,72764.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],24028.95,24028.95,24028.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],12033.95,12033.95,12033.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],12365.43,12365.43,12365.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",31112.63,31112.63,31112.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,31903.62,31903.62,45256.62,1 through 10,percent of total billed charges,,, Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,33710.59,33710.59,33710.59,1 through 10,percent of total billed charges,,, Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12753.47,,,,,,,fee schedule,12262.95,29868.99,MSDRG Base Rate Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12876.1,,,,,,,fee schedule,12262.95,29868.99,MSDRG Base Rate Diabetes With Mcc,637,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12262.95,,,,,,,fee schedule,12262.95,29868.99,MSDRG Base Rate Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12594.3,,,,,,,fee schedule,7649.51,18632, Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16237.35,,,,,,,fee schedule,7649.51,18632, Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15526.67,,,,,,,fee schedule,7649.51,18632, Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18632,,,,,,,fee schedule,7649.51,18632, Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17228.99,12484.36,17574.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11670.88,11670.88,13827.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14386.95,14386.95,14386.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],4616.77,4616.77,4616.77,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15933.3,15933.3,15933.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7955.49,,,,,,,fee schedule,7649.51,18632,MSDRG Base Rate Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8031.99,,,,,,,fee schedule,7649.51,18632,MSDRG Base Rate Diabetes With Cc,638,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7649.51,,,,,,,fee schedule,7649.51,18632,MSDRG Base Rate Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8729.72,,,,,,,fee schedule,5302.25,12914.75, Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11254.9,,,,,,,fee schedule,5302.25,12914.75, Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10762.29,,,,,,,fee schedule,5302.25,12914.75, Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,12914.75,,,,,,,fee schedule,5302.25,12914.75, Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12484.36,12484.36,12484.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13563.82,13563.82,13563.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],8007.46,8007.46,8007.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],10038.9,10038.9,10038.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],12650.46,12650.46,12650.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11490.6,11490.6,11490.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,11411.49,11411.49,11411.49,1 through 10,percent of total billed charges,,, Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5514.34,,,,,,,fee schedule,5302.25,12914.75,MSDRG Base Rate Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5567.36,,,,,,,fee schedule,5302.25,12914.75,MSDRG Base Rate Diabetes Without Cc/Mcc,639,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5302.25,,,,,,,fee schedule,5302.25,12914.75,MSDRG Base Rate "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18769.19,,,,,,,fee schedule,11400.01,27767.12, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24198.4,,,,,,,fee schedule,11400.01,27767.12, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23139.27,,,,,,,fee schedule,11400.01,27767.12, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27767.12,,,,,,,fee schedule,11400.01,27767.12, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],11492.54,11492.54,11493.22,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",27808.17,27808.17,27808.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",26298.15,14392.15,26298.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21828.53,17374.17,22278.53,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],11276.71,11276.71,11276.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],15984.51,15984.51,15984.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],11495.24,11495.24,11495.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",28635.97,17343,28635.97,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11856.01,,,,,,,fee schedule,11400.01,27767.12,MSDRG Base Rate "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11970.01,,,,,,,fee schedule,11400.01,27767.12,MSDRG Base Rate "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc",640,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11400.01,,,,,,,fee schedule,11400.01,27767.12,MSDRG Base Rate "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10936.04,,,,,,,fee schedule,6642.32,16178.78, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14099.43,,,,,,,fee schedule,6642.32,16178.78, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13482.32,,,,,,,fee schedule,6642.32,16178.78, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16178.78,,,,,,,fee schedule,6642.32,16178.78, "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],6789.76,6789.76,6789.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15335.22,12002.27,15551.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11210.69,11210.69,11210.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13108.77,13108.77,13110.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],6507.17,6507.17,6507.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17214.19,17214.19,17214.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6908.01,,,,,,,fee schedule,6642.32,16178.78,MSDRG Base Rate "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6974.44,,,,,,,fee schedule,6642.32,16178.78,MSDRG Base Rate "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc",641,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6642.32,,,,,,,fee schedule,6642.32,16178.78,MSDRG Base Rate Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19984.77,,,,,,,fee schedule,12138.33,29565.46, Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25765.61,,,,,,,fee schedule,12138.33,29565.46, Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24637.88,,,,,,,fee schedule,12138.33,29565.46, Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29565.46,,,,,,,fee schedule,12138.33,29565.46, Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14893.2,14893.2,14893.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12623.86,,,,,,,fee schedule,12138.33,29565.46,MSDRG Base Rate Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12745.25,,,,,,,fee schedule,12138.33,29565.46,MSDRG Base Rate Inborn And Other Disorders Of Metabolism,642,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12138.33,,,,,,,fee schedule,12138.33,29565.46,MSDRG Base Rate Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23132.64,,,,,,,fee schedule,14050.28,34222.42, Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29824.04,,,,,,,fee schedule,14050.28,34222.42, Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28518.68,,,,,,,fee schedule,14050.28,34222.42, Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34222.42,,,,,,,fee schedule,14050.28,34222.42, Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9093,9093,9093,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],6739.27,6739.27,6739.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13714.57,13714.57,13714.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14612.29,,,,,,,fee schedule,14050.28,34222.42,MSDRG Base Rate Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14752.79,,,,,,,fee schedule,14050.28,34222.42,MSDRG Base Rate Endocrine Disorders With Mcc,643,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14050.28,,,,,,,fee schedule,14050.28,34222.42,MSDRG Base Rate Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14404.33,,,,,,,fee schedule,8748.88,21309.75, Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18570.95,,,,,,,fee schedule,8748.88,21309.75, Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17758.13,,,,,,,fee schedule,8748.88,21309.75, Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21309.75,,,,,,,fee schedule,8748.88,21309.75, Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13714.57,13714.57,13714.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17334.5,17334.5,17334.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9098.84,,,,,,,fee schedule,8748.88,21309.75,MSDRG Base Rate Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9186.32,,,,,,,fee schedule,8748.88,21309.75,MSDRG Base Rate Endocrine Disorders With Cc,644,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8748.88,,,,,,,fee schedule,8748.88,21309.75,MSDRG Base Rate Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10796.92,,,,,,,fee schedule,6557.82,15972.96, Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13920.06,,,,,,,fee schedule,6557.82,15972.96, Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13310.8,,,,,,,fee schedule,6557.82,15972.96, Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15972.96,,,,,,,fee schedule,6557.82,15972.96, Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10055.54,10055.54,10055.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6820.13,,,,,,,fee schedule,6557.82,15972.96,MSDRG Base Rate Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6885.71,,,,,,,fee schedule,6557.82,15972.96,MSDRG Base Rate Endocrine Disorders Without Cc/Mcc,645,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6557.82,,,,,,,fee schedule,6557.82,15972.96,MSDRG Base Rate Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,66068.77,,,,,,,fee schedule,40128.78,97742.11, Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,85179.97,,,,,,,fee schedule,40128.78,97742.11, Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,81451.76,,,,,,,fee schedule,40128.78,97742.11, Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,97742.11,,,,,,,fee schedule,40128.78,97742.11, Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,41733.93,,,,,,,fee schedule,40128.78,97742.11,MSDRG Base Rate Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42135.22,,,,,,,fee schedule,40128.78,97742.11,MSDRG Base Rate Kidney Transplant With Hemodialysis With Mcc,650,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,40128.78,,,,,,,fee schedule,40128.78,97742.11,MSDRG Base Rate Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,52077.61,,,,,,,fee schedule,31630.84,77043.58, Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,67141.68,,,,,,,fee schedule,31630.84,77043.58, Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,64202.99,,,,,,,fee schedule,31630.84,77043.58, Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,77043.58,,,,,,,fee schedule,31630.84,77043.58, Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32896.07,,,,,,,fee schedule,31630.84,77043.58,MSDRG Base Rate Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33212.38,,,,,,,fee schedule,31630.84,77043.58,MSDRG Base Rate Kidney Transplant With Hemodialysis Without Mcc,651,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,31630.84,,,,,,,fee schedule,31630.84,77043.58,MSDRG Base Rate Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45384.16,,,,,,,fee schedule,27565.39,67141.31, Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58512.08,,,,,,,fee schedule,27565.39,67141.31, Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55951.09,,,,,,,fee schedule,27565.39,67141.31, Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,67141.31,,,,,,,fee schedule,27565.39,67141.31, Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28668.01,,,,,,,fee schedule,27565.39,67141.31,MSDRG Base Rate Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28943.66,,,,,,,fee schedule,27565.39,67141.31,MSDRG Base Rate Kidney Transplant,652,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27565.39,,,,,,,fee schedule,27565.39,67141.31,MSDRG Base Rate Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,73025.01,,,,,,,fee schedule,44353.86,108033.16, Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,94148.38,,,,,,,fee schedule,44353.86,108033.16, Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,90027.63,,,,,,,fee schedule,44353.86,108033.16, Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,108033.16,,,,,,,fee schedule,44353.86,108033.16, Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],73708.05,73708.05,73708.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,46128.01,,,,,,,fee schedule,44353.86,108033.16,MSDRG Base Rate Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,46571.55,,,,,,,fee schedule,44353.86,108033.16,MSDRG Base Rate Major Bladder Procedures With Mcc,653,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,44353.86,,,,,,,fee schedule,44353.86,108033.16,MSDRG Base Rate Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,39338.56,,,,,,,fee schedule,23893.42,58197.45, Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,50717.72,,,,,,,fee schedule,23893.42,58197.45, Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,48497.87,,,,,,,fee schedule,23893.42,58197.45, Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,58197.45,,,,,,,fee schedule,23893.42,58197.45, Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],47108.82,37415.4,47343.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],46314.65,46314.65,46314.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,46290.12,46290.12,46290.12,1 through 10,percent of total billed charges,,, Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,31570.54,31570.54,31570.54,1 through 10,percent of total billed charges,,, Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24849.16,,,,,,,fee schedule,23893.42,58197.45,MSDRG Base Rate Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25088.09,,,,,,,fee schedule,23893.42,58197.45,MSDRG Base Rate Major Bladder Procedures With Cc,654,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23893.42,,,,,,,fee schedule,23893.42,58197.45,MSDRG Base Rate Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29744.58,,,,,,,fee schedule,18066.23,44004.11, Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38348.56,,,,,,,fee schedule,18066.23,44004.11, Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36670.1,,,,,,,fee schedule,18066.23,44004.11, Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44004.11,,,,,,,fee schedule,18066.23,44004.11, Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],11516,11516,11516,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],17978.09,17978.09,17978.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],34275.45,34275.45,34275.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18788.88,,,,,,,fee schedule,18066.23,44004.11,MSDRG Base Rate Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18969.54,,,,,,,fee schedule,18066.23,44004.11,MSDRG Base Rate Major Bladder Procedures Without Cc/Mcc,655,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18066.23,,,,,,,fee schedule,18066.23,44004.11,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44741.94,,,,,,,fee schedule,27175.31,66191.2, Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57684.09,,,,,,,fee schedule,27175.31,66191.2, Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55159.34,,,,,,,fee schedule,27175.31,66191.2, Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,66191.2,,,,,,,fee schedule,27175.31,66191.2, Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],43194.56,43194.56,43194.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28262.32,,,,,,,fee schedule,27175.31,66191.2,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28534.08,,,,,,,fee schedule,27175.31,66191.2,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm With Mcc,656,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27175.31,,,,,,,fee schedule,27175.31,66191.2,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25716.99,,,,,,,fee schedule,15619.96,38045.7, Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33155.94,,,,,,,fee schedule,15619.96,38045.7, Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31704.75,,,,,,,fee schedule,15619.96,38045.7, Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38045.7,,,,,,,fee schedule,15619.96,38045.7, Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2303.2,2303.2,2303.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24236.95,23888.16,24418.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],24497.68,24497.68,24497.68,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16244.76,,,,,,,fee schedule,15619.96,38045.7,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16400.96,,,,,,,fee schedule,15619.96,38045.7,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm With Cc,657,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15619.96,,,,,,,fee schedule,15619.96,38045.7,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21807.45,,,,,,,fee schedule,13245.38,32261.92, Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28115.51,,,,,,,fee schedule,13245.38,32261.92, Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26884.94,,,,,,,fee schedule,13245.38,32261.92, Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32261.92,,,,,,,fee schedule,13245.38,32261.92, Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],13020.18,13020.18,13020.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],25229.43,25229.43,25229.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13775.2,,,,,,,fee schedule,13245.38,32261.92,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13907.65,,,,,,,fee schedule,13245.38,32261.92,MSDRG Base Rate Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc,658,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13245.38,,,,,,,fee schedule,13245.38,32261.92,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,35707.27,,,,,,,fee schedule,21687.84,52825.31, Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,46036.03,,,,,,,fee schedule,21687.84,52825.31, Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44021.09,,,,,,,fee schedule,21687.84,52825.31, Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,52825.31,,,,,,,fee schedule,21687.84,52825.31, Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],15268,15268,15268,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],43352.54,43352.54,43426.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22555.35,,,,,,,fee schedule,21687.84,52825.31,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22772.23,,,,,,,fee schedule,21687.84,52825.31,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm With Mcc,659,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21687.84,,,,,,,fee schedule,21687.84,52825.31,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18573.85,,,,,,,fee schedule,11281.37,27478.14, Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23946.56,,,,,,,fee schedule,11281.37,27478.14, Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22898.45,,,,,,,fee schedule,11281.37,27478.14, Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27478.14,,,,,,,fee schedule,11281.37,27478.14, Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],508.88,508.88,508.88,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",25194.99,25194.99,25194.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22108.16,21728.82,22578.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11732.62,,,,,,,fee schedule,11281.37,27478.14,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11845.44,,,,,,,fee schedule,11281.37,27478.14,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm With Cc,660,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11281.37,,,,,,,fee schedule,11281.37,27478.14,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14550.48,,,,,,,fee schedule,8837.65,21525.97, Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18759.38,,,,,,,fee schedule,8837.65,21525.97, Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17938.31,,,,,,,fee schedule,8837.65,21525.97, Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21525.97,,,,,,,fee schedule,8837.65,21525.97, Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17218.74,16622.24,17222.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],16938.9,16938.9,16938.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9191.16,,,,,,,fee schedule,8837.65,21525.97,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9279.53,,,,,,,fee schedule,8837.65,21525.97,MSDRG Base Rate Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc,661,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8837.65,,,,,,,fee schedule,8837.65,21525.97,MSDRG Base Rate Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,43023.26,,,,,,,fee schedule,26131.42,63648.59, Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,55468.26,,,,,,,fee schedule,26131.42,63648.59, Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,53040.49,,,,,,,fee schedule,26131.42,63648.59, Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,63648.59,,,,,,,fee schedule,26131.42,63648.59, Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27176.68,,,,,,,fee schedule,26131.42,63648.59,MSDRG Base Rate Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27437.99,,,,,,,fee schedule,26131.42,63648.59,MSDRG Base Rate Minor Bladder Procedures With Mcc,662,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26131.42,,,,,,,fee schedule,26131.42,63648.59,MSDRG Base Rate Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21363.37,,,,,,,fee schedule,12975.66,31604.96, Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27542.98,,,,,,,fee schedule,12975.66,31604.96, Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26337.47,,,,,,,fee schedule,12975.66,31604.96, Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31604.96,,,,,,,fee schedule,12975.66,31604.96, Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],14388.56,14388.56,14388.56,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13494.69,,,,,,,fee schedule,12975.66,31604.96,MSDRG Base Rate Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13624.44,,,,,,,fee schedule,12975.66,31604.96,MSDRG Base Rate Minor Bladder Procedures With Cc,663,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12975.66,,,,,,,fee schedule,12975.66,31604.96,MSDRG Base Rate Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14712.09,,,,,,,fee schedule,8935.81,21765.05, Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18967.73,,,,,,,fee schedule,8935.81,21765.05, Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18137.54,,,,,,,fee schedule,8935.81,21765.05, Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21765.05,,,,,,,fee schedule,8935.81,21765.05, Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9293.24,,,,,,,fee schedule,8935.81,21765.05,MSDRG Base Rate Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9382.6,,,,,,,fee schedule,8935.81,21765.05,MSDRG Base Rate Minor Bladder Procedures Without Cc/Mcc,664,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8935.81,,,,,,,fee schedule,8935.81,21765.05,MSDRG Base Rate Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,43862.22,,,,,,,fee schedule,26640.99,64889.75, Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,56549.9,,,,,,,fee schedule,26640.99,64889.75, Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,54074.79,,,,,,,fee schedule,26640.99,64889.75, Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,64889.75,,,,,,,fee schedule,26640.99,64889.75, Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,27706.63,,,,,,,fee schedule,26640.99,64889.75,MSDRG Base Rate Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,27973.04,,,,,,,fee schedule,26640.99,64889.75,MSDRG Base Rate Prostatectomy With Mcc,665,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26640.99,,,,,,,fee schedule,26640.99,64889.75,MSDRG Base Rate Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24582.91,,,,,,,fee schedule,14931.14,36367.95, Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31693.82,,,,,,,fee schedule,14931.14,36367.95, Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30306.62,,,,,,,fee schedule,14931.14,36367.95, Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36367.95,,,,,,,fee schedule,14931.14,36367.95, Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15528.39,,,,,,,fee schedule,14931.14,36367.95,MSDRG Base Rate Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15677.7,,,,,,,fee schedule,14931.14,36367.95,MSDRG Base Rate Prostatectomy With Cc,666,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14931.14,,,,,,,fee schedule,14931.14,36367.95,MSDRG Base Rate Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15545.43,,,,,,,fee schedule,9441.97,22997.9, Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20042.13,,,,,,,fee schedule,9441.97,22997.9, Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19164.92,,,,,,,fee schedule,9441.97,22997.9, Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22997.9,,,,,,,fee schedule,9441.97,22997.9, Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9819.65,,,,,,,fee schedule,9441.97,22997.9,MSDRG Base Rate Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9914.07,,,,,,,fee schedule,9441.97,22997.9,MSDRG Base Rate Prostatectomy Without Cc/Mcc,667,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9441.97,,,,,,,fee schedule,9441.97,22997.9,MSDRG Base Rate Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,41034.76,,,,,,,fee schedule,24923.65,60706.8, Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52904.56,,,,,,,fee schedule,24923.65,60706.8, Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,50589,,,,,,,fee schedule,24923.65,60706.8, Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,60706.8,,,,,,,fee schedule,24923.65,60706.8, Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25920.6,,,,,,,fee schedule,24923.65,60706.8,MSDRG Base Rate Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26169.83,,,,,,,fee schedule,24923.65,60706.8,MSDRG Base Rate Transurethral Procedures With Mcc,668,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24923.65,,,,,,,fee schedule,24923.65,60706.8,MSDRG Base Rate Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21810.26,,,,,,,fee schedule,13247.09,32266.08, Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28119.14,,,,,,,fee schedule,13247.09,32266.08, Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26888.4,,,,,,,fee schedule,13247.09,32266.08, Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32266.08,,,,,,,fee schedule,13247.09,32266.08, Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2873.24,2873.24,2873.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],13392.9,13392.9,13392.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13776.97,,,,,,,fee schedule,13247.09,32266.08,MSDRG Base Rate Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13909.44,,,,,,,fee schedule,13247.09,32266.08,MSDRG Base Rate Transurethral Procedures With Cc,669,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13247.09,,,,,,,fee schedule,13247.09,32266.08,MSDRG Base Rate Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13734,,,,,,,fee schedule,8341.74,20318.07, Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17706.72,,,,,,,fee schedule,8341.74,20318.07, Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16931.72,,,,,,,fee schedule,8341.74,20318.07, Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20318.07,,,,,,,fee schedule,8341.74,20318.07, Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8675.41,,,,,,,fee schedule,8341.74,20318.07,MSDRG Base Rate Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8758.83,,,,,,,fee schedule,8341.74,20318.07,MSDRG Base Rate Transurethral Procedures Without Cc/Mcc,670,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8341.74,,,,,,,fee schedule,8341.74,20318.07,MSDRG Base Rate Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25225.14,,,,,,,fee schedule,15321.22,37318.05, Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32521.81,,,,,,,fee schedule,15321.22,37318.05, Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31098.38,,,,,,,fee schedule,15321.22,37318.05, Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37318.05,,,,,,,fee schedule,15321.22,37318.05, Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15934.07,,,,,,,fee schedule,15321.22,37318.05,MSDRG Base Rate Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16087.28,,,,,,,fee schedule,15321.22,37318.05,MSDRG Base Rate Urethral Procedures With Cc/Mcc,671,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15321.22,,,,,,,fee schedule,15321.22,37318.05,MSDRG Base Rate Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15170.21,,,,,,,fee schedule,9214.07,22442.81, Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19558.38,,,,,,,fee schedule,9214.07,22442.81, Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18702.34,,,,,,,fee schedule,9214.07,22442.81, Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22442.81,,,,,,,fee schedule,9214.07,22442.81, Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9582.63,,,,,,,fee schedule,9214.07,22442.81,MSDRG Base Rate Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9674.77,,,,,,,fee schedule,9214.07,22442.81,MSDRG Base Rate Urethral Procedures Without Cc/Mcc,672,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9214.07,,,,,,,fee schedule,9214.07,22442.81,MSDRG Base Rate Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,59045.08,,,,,,,fee schedule,35862.74,87351.26, Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,76124.59,,,,,,,fee schedule,35862.74,87351.26, Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,72792.72,,,,,,,fee schedule,35862.74,87351.26, Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,87351.26,,,,,,,fee schedule,35862.74,87351.26, Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18091.34,18091.34,18091.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",32027.32,32027.32,32027.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],69521.44,69521.44,69521.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",32208.25,32208.25,41003.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37297.25,,,,,,,fee schedule,35862.74,87351.26,MSDRG Base Rate Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37655.88,,,,,,,fee schedule,35862.74,87351.26,MSDRG Base Rate Other Kidney And Urinary Tract Procedures With Mcc,673,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35862.74,,,,,,,fee schedule,35862.74,87351.26,MSDRG Base Rate Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32864.35,,,,,,,fee schedule,19961.11,48619.49, Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,42370.75,,,,,,,fee schedule,19961.11,48619.49, Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40516.25,,,,,,,fee schedule,19961.11,48619.49, Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48619.49,,,,,,,fee schedule,19961.11,48619.49, Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],3676.4,3676.4,3676.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19267.07,19267.07,19267.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27381.08,27381.08,27381.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],28354.77,28354.77,28354.77,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20759.55,,,,,,,fee schedule,19961.11,48619.49,MSDRG Base Rate Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20959.17,,,,,,,fee schedule,19961.11,48619.49,MSDRG Base Rate Other Kidney And Urinary Tract Procedures With Cc,674,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19961.11,,,,,,,fee schedule,19961.11,48619.49,MSDRG Base Rate Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23066.59,,,,,,,fee schedule,14010.16,34124.71, Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29738.89,,,,,,,fee schedule,14010.16,34124.71, Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28437.26,,,,,,,fee schedule,14010.16,34124.71, Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34124.71,,,,,,,fee schedule,14010.16,34124.71, Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14570.57,,,,,,,fee schedule,14010.16,34124.71,MSDRG Base Rate Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14710.67,,,,,,,fee schedule,14010.16,34124.71,MSDRG Base Rate Other Kidney And Urinary Tract Procedures Without Cc/Mcc,675,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14010.16,,,,,,,fee schedule,14010.16,34124.71,MSDRG Base Rate Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20812.49,,,,,,,fee schedule,12641.07,30789.99, Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26832.76,,,,,,,fee schedule,12641.07,30789.99, Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25658.33,,,,,,,fee schedule,12641.07,30789.99, Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30789.99,,,,,,,fee schedule,12641.07,30789.99, Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],12719.31,12719.31,12719.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19267.07,19267.07,19267.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18145.28,18145.28,32027.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19913.52,18558.41,25197.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],28757.81,28757.81,28757.81,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],13139.95,13139.95,13139.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],12512.58,12512.58,12512.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,27041.03,27041.03,27041.03,1 through 10,percent of total billed charges,,, Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13146.71,,,,,,,fee schedule,12641.07,30789.99,MSDRG Base Rate Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13273.12,,,,,,,fee schedule,12641.07,30789.99,MSDRG Base Rate Renal Failure With Mcc,682,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12641.07,,,,,,,fee schedule,12641.07,30789.99,MSDRG Base Rate Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12307.62,,,,,,,fee schedule,7475.39,18207.88, Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15867.74,,,,,,,fee schedule,7475.39,18207.88, Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15173.24,,,,,,,fee schedule,7475.39,18207.88, Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18207.88,,,,,,,fee schedule,7475.39,18207.88, Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7502.55,7502.55,7715.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19267.07,19267.07,19267.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18145.28,12417.67,18145.28,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11785.04,4168.79,14912.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17841.67,17841.67,17841.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,9694.68,9694.68,9694.68,1 through 10,percent of total billed charges,,, Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,96985.25,96985.25,96985.25,1 through 10,percent of total billed charges,,, Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7774.41,,,,,,,fee schedule,7475.39,18207.88,MSDRG Base Rate Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7849.16,,,,,,,fee schedule,7475.39,18207.88,MSDRG Base Rate Renal Failure With Cc,683,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7475.39,,,,,,,fee schedule,7475.39,18207.88,MSDRG Base Rate Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8436.02,,,,,,,fee schedule,5123.86,12480.24, Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,10876.24,,,,,,,fee schedule,5123.86,12480.24, Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10400.2,,,,,,,fee schedule,5123.86,12480.24, Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,12480.24,,,,,,,fee schedule,5123.86,12480.24, Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10080.75,10080.75,10080.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5328.81,,,,,,,fee schedule,5123.86,12480.24,MSDRG Base Rate Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5380.05,,,,,,,fee schedule,5123.86,12480.24,MSDRG Base Rate Renal Failure Without Cc/Mcc,684,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5123.86,,,,,,,fee schedule,5123.86,12480.24,MSDRG Base Rate Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Admit For Renal Dialysis,685,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25347.4,,,,,,,fee schedule,15395.48,37498.92, Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32679.44,,,,,,,fee schedule,15395.48,37498.92, Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31249.1,,,,,,,fee schedule,15395.48,37498.92, Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37498.92,,,,,,,fee schedule,15395.48,37498.92, Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],31634.5,31634.5,31634.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16011.3,,,,,,,fee schedule,15395.48,37498.92,MSDRG Base Rate Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16165.25,,,,,,,fee schedule,15395.48,37498.92,MSDRG Base Rate Kidney And Urinary Tract Neoplasms With Mcc,686,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15395.48,,,,,,,fee schedule,15395.48,37498.92,MSDRG Base Rate Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14724.73,,,,,,,fee schedule,8943.49,21783.76, Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18984.04,,,,,,,fee schedule,8943.49,21783.76, Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18153.14,,,,,,,fee schedule,8943.49,21783.76, Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21783.76,,,,,,,fee schedule,8943.49,21783.76, Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7527.49,7527.49,7527.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17210.1,17210.1,17210.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9301.23,,,,,,,fee schedule,8943.49,21783.76,MSDRG Base Rate Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9390.66,,,,,,,fee schedule,8943.49,21783.76,MSDRG Base Rate Kidney And Urinary Tract Neoplasms With Cc,687,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8943.49,,,,,,,fee schedule,8943.49,21783.76,MSDRG Base Rate Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11106.09,,,,,,,fee schedule,6745.6,16430.34, Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14318.66,,,,,,,fee schedule,6745.6,16430.34, Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13691.95,,,,,,,fee schedule,6745.6,16430.34, Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16430.34,,,,,,,fee schedule,6745.6,16430.34, Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],2845.99,2845.99,2845.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7015.42,,,,,,,fee schedule,6745.6,16430.34,MSDRG Base Rate Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7082.88,,,,,,,fee schedule,6745.6,16430.34,MSDRG Base Rate Kidney And Urinary Tract Neoplasms Without Cc/Mcc,688,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6745.6,,,,,,,fee schedule,6745.6,16430.34,MSDRG Base Rate Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16305.7,,,,,,,fee schedule,9903.74,24122.64, Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21022.32,,,,,,,fee schedule,9903.74,24122.64, Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20102.2,,,,,,,fee schedule,9903.74,24122.64, Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24122.64,,,,,,,fee schedule,9903.74,24122.64, Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",23155.82,23155.82,23155.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19632.95,19632.95,19632.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],19309.95,19309.95,19309.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22756.78,22756.78,22756.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10299.89,,,,,,,fee schedule,9903.74,24122.64,MSDRG Base Rate Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10398.93,,,,,,,fee schedule,9903.74,24122.64,MSDRG Base Rate Kidney And Urinary Tract Infections With Mcc,689,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9903.74,,,,,,,fee schedule,9903.74,24122.64,MSDRG Base Rate Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11375.9,,,,,,,fee schedule,6909.48,16829.51, Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14666.52,,,,,,,fee schedule,6909.48,16829.51, Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14024.59,,,,,,,fee schedule,6909.48,16829.51, Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16829.51,,,,,,,fee schedule,6909.48,16829.51, Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15672.18,15672.18,15672.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13464.42,13114.42,26928.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],13238.9,13238.9,13238.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12043.52,12043.52,12043.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,23448.54,23448.54,23448.54,1 through 10,percent of total billed charges,,, Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7185.86,,,,,,,fee schedule,6909.48,16829.51,MSDRG Base Rate Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7254.95,,,,,,,fee schedule,6909.48,16829.51,MSDRG Base Rate Kidney And Urinary Tract Infections Without Mcc,690,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6909.48,,,,,,,fee schedule,6909.48,16829.51,MSDRG Base Rate Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W Cc/Mcc,691,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones W Esw Lithotripsy W/O Cc/Mcc,692,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18894.26,,,,,,,fee schedule,11475.98,27952.16, Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24359.65,,,,,,,fee schedule,11475.98,27952.16, Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23293.46,,,,,,,fee schedule,11475.98,27952.16, Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27952.16,,,,,,,fee schedule,11475.98,27952.16, Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11935.02,,,,,,,fee schedule,11475.98,27952.16,MSDRG Base Rate Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12049.78,,,,,,,fee schedule,11475.98,27952.16,MSDRG Base Rate Urinary Stones With Mcc,693,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11475.98,,,,,,,fee schedule,11475.98,27952.16,MSDRG Base Rate Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10985.23,,,,,,,fee schedule,6672.2,16251.54, Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14162.84,,,,,,,fee schedule,6672.2,16251.54, Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13542.95,,,,,,,fee schedule,6672.2,16251.54, Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16251.54,,,,,,,fee schedule,6672.2,16251.54, Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19296.95,19296.95,19296.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6939.09,,,,,,,fee schedule,6672.2,16251.54,MSDRG Base Rate Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7005.81,,,,,,,fee schedule,6672.2,16251.54,MSDRG Base Rate Urinary Stones Without Mcc,694,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6672.2,,,,,,,fee schedule,6672.2,16251.54,MSDRG Base Rate Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16073.82,,,,,,,fee schedule,9762.9,23779.6, Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20723.37,,,,,,,fee schedule,9762.9,23779.6, Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19816.34,,,,,,,fee schedule,9762.9,23779.6, Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23779.6,,,,,,,fee schedule,9762.9,23779.6, Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10153.42,,,,,,,fee schedule,9762.9,23779.6,MSDRG Base Rate Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10251.04,,,,,,,fee schedule,9762.9,23779.6,MSDRG Base Rate Kidney And Urinary Tract Signs And Symptoms With Mcc,695,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9762.9,,,,,,,fee schedule,9762.9,23779.6,MSDRG Base Rate Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9682.52,,,,,,,fee schedule,5880.96,14324.31, Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12483.3,,,,,,,fee schedule,5880.96,14324.31, Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11936.93,,,,,,,fee schedule,5880.96,14324.31, Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14324.31,,,,,,,fee schedule,5880.96,14324.31, Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6116.2,,,,,,,fee schedule,5880.96,14324.31,MSDRG Base Rate Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6175.01,,,,,,,fee schedule,5880.96,14324.31,MSDRG Base Rate Kidney And Urinary Tract Signs And Symptoms Without Mcc,696,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5880.96,,,,,,,fee schedule,5880.96,14324.31,MSDRG Base Rate Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15146.32,,,,,,,fee schedule,9199.56,22407.46, Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19527.58,,,,,,,fee schedule,9199.56,22407.46, Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18672.89,,,,,,,fee schedule,9199.56,22407.46, Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22407.46,,,,,,,fee schedule,9199.56,22407.46, Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9567.54,,,,,,,fee schedule,9199.56,22407.46,MSDRG Base Rate Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9659.54,,,,,,,fee schedule,9199.56,22407.46,MSDRG Base Rate Urethral Stricture,697,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9199.56,,,,,,,fee schedule,9199.56,22407.46,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23249.28,,,,,,,fee schedule,14121.13,34394.98, Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29974.42,,,,,,,fee schedule,14121.13,34394.98, Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28662.48,,,,,,,fee schedule,14121.13,34394.98, Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34394.98,,,,,,,fee schedule,14121.13,34394.98, Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],17274,17274,17274,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],11944.53,11944.53,11944.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16886.47,16886.47,16886.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22285.37,22135.37,27848.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],22285.37,22285.37,22285.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],33743.85,33743.85,33743.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],26996.03,26996.03,26996.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16606.84,16606.84,16606.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10954.44,10954.44,10954.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,37955.76,37955.76,37955.76,1 through 10,percent of total billed charges,,, Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14685.98,,,,,,,fee schedule,14121.13,34394.98,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14827.19,,,,,,,fee schedule,14121.13,34394.98,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses With Mcc,698,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14121.13,,,,,,,fee schedule,14121.13,34394.98,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14263.8,,,,,,,fee schedule,8663.53,21101.85, Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18389.77,,,,,,,fee schedule,8663.53,21101.85, Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17584.88,,,,,,,fee schedule,8663.53,21101.85, Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21101.85,,,,,,,fee schedule,8663.53,21101.85, Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12912.12,12912.12,12912.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16758.16,13371.83,16758.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],15460.58,15460.58,15460.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16606.84,16606.84,16606.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,10636.89,10636.89,10636.89,1 through 10,percent of total billed charges,,, Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9010.07,,,,,,,fee schedule,8663.53,21101.85,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9096.71,,,,,,,fee schedule,8663.53,21101.85,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses With Cc,699,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8663.53,,,,,,,fee schedule,8663.53,21101.85,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9695.16,,,,,,,fee schedule,5888.64,14343.02, Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12499.61,,,,,,,fee schedule,5888.64,14343.02, Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11952.52,,,,,,,fee schedule,5888.64,14343.02, Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14343.02,,,,,,,fee schedule,5888.64,14343.02, Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6124.19,,,,,,,fee schedule,5888.64,14343.02,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6183.07,,,,,,,fee schedule,5888.64,14343.02,MSDRG Base Rate Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc,700,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5888.64,,,,,,,fee schedule,5888.64,14343.02,MSDRG Base Rate Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28110.22,,,,,,,fee schedule,17073.55,41586.24, Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36241.44,,,,,,,fee schedule,17073.55,41586.24, Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34655.2,,,,,,,fee schedule,17073.55,41586.24, Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41586.24,,,,,,,fee schedule,17073.55,41586.24, Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17756.49,,,,,,,fee schedule,17073.55,41586.24,MSDRG Base Rate Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17927.23,,,,,,,fee schedule,17073.55,41586.24,MSDRG Base Rate Major Male Pelvic Procedures With Cc/Mcc,707,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17073.55,,,,,,,fee schedule,17073.55,41586.24,MSDRG Base Rate Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21560.11,,,,,,,fee schedule,13095.16,31896.02, Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27796.64,,,,,,,fee schedule,13095.16,31896.02, Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26580.02,,,,,,,fee schedule,13095.16,31896.02, Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31896.02,,,,,,,fee schedule,13095.16,31896.02, Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,23923.97,23923.97,23923.97,1 through 10,percent of total billed charges,,, Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13618.97,,,,,,,fee schedule,13095.16,31896.02,MSDRG Base Rate Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13749.92,,,,,,,fee schedule,13095.16,31896.02,MSDRG Base Rate Major Male Pelvic Procedures Without Cc/Mcc,708,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13095.16,,,,,,,fee schedule,13095.16,31896.02,MSDRG Base Rate Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32702.74,,,,,,,fee schedule,19862.95,48380.41, Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,42162.4,,,,,,,fee schedule,19862.95,48380.41, Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40317.01,,,,,,,fee schedule,19862.95,48380.41, Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48380.41,,,,,,,fee schedule,19862.95,48380.41, Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20657.47,,,,,,,fee schedule,19862.95,48380.41,MSDRG Base Rate Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20856.1,,,,,,,fee schedule,19862.95,48380.41,MSDRG Base Rate Penis Procedures With Cc/Mcc,709,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19862.95,,,,,,,fee schedule,19862.95,48380.41,MSDRG Base Rate Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19691.06,,,,,,,fee schedule,11959.94,29130.95, Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25386.94,,,,,,,fee schedule,11959.94,29130.95, Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24275.79,,,,,,,fee schedule,11959.94,29130.95, Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29130.95,,,,,,,fee schedule,11959.94,29130.95, Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12438.34,,,,,,,fee schedule,11959.94,29130.95,MSDRG Base Rate Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12557.94,,,,,,,fee schedule,11959.94,29130.95,MSDRG Base Rate Penis Procedures Without Cc/Mcc,710,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11959.94,,,,,,,fee schedule,11959.94,29130.95,MSDRG Base Rate Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29283.64,,,,,,,fee schedule,17786.27,43322.2, Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37754.29,,,,,,,fee schedule,17786.27,43322.2, Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36101.84,,,,,,,fee schedule,17786.27,43322.2, Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43322.2,,,,,,,fee schedule,17786.27,43322.2, Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],25330.73,25330.73,25330.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18497.72,,,,,,,fee schedule,17786.27,43322.2,MSDRG Base Rate Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18675.58,,,,,,,fee schedule,17786.27,43322.2,MSDRG Base Rate Testes Procedures With Cc/Mcc,711,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17786.27,,,,,,,fee schedule,17786.27,43322.2,MSDRG Base Rate Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15454.08,,,,,,,fee schedule,9386.49,22862.76, Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19924.36,,,,,,,fee schedule,9386.49,22862.76, Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19052.3,,,,,,,fee schedule,9386.49,22862.76, Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22862.76,,,,,,,fee schedule,9386.49,22862.76, Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9761.95,,,,,,,fee schedule,9386.49,22862.76,MSDRG Base Rate Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9855.81,,,,,,,fee schedule,9386.49,22862.76,MSDRG Base Rate Testes Procedures Without Cc/Mcc,712,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9386.49,,,,,,,fee schedule,9386.49,22862.76,MSDRG Base Rate Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21127.28,,,,,,,fee schedule,12832.27,31255.69, Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27238.6,,,,,,,fee schedule,12832.27,31255.69, Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26046.41,,,,,,,fee schedule,12832.27,31255.69, Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31255.69,,,,,,,fee schedule,12832.27,31255.69, Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13345.56,,,,,,,fee schedule,12832.27,31255.69,MSDRG Base Rate Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13473.88,,,,,,,fee schedule,12832.27,31255.69,MSDRG Base Rate Transurethral Prostatectomy With Cc/Mcc,713,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12832.27,,,,,,,fee schedule,12832.27,31255.69,MSDRG Base Rate Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14859.64,,,,,,,fee schedule,9025.43,21983.35, Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19157.97,,,,,,,fee schedule,9025.43,21983.35, Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18319.46,,,,,,,fee schedule,9025.43,21983.35, Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21983.35,,,,,,,fee schedule,9025.43,21983.35, Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,30905.01,30905.01,30905.01,1 through 10,percent of total billed charges,,, Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9386.45,,,,,,,fee schedule,9025.43,21983.35,MSDRG Base Rate Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9476.7,,,,,,,fee schedule,9025.43,21983.35,MSDRG Base Rate Transurethral Prostatectomy Without Cc/Mcc,714,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9025.43,,,,,,,fee schedule,9025.43,21983.35,MSDRG Base Rate Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31440.78,,,,,,,fee schedule,19096.47,46513.47, Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,40535.4,,,,,,,fee schedule,19096.47,46513.47, Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38761.22,,,,,,,fee schedule,19096.47,46513.47, Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,46513.47,,,,,,,fee schedule,19096.47,46513.47, Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19860.33,,,,,,,fee schedule,19096.47,46513.47,MSDRG Base Rate Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20051.29,,,,,,,fee schedule,19096.47,46513.47,MSDRG Base Rate Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc,715,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19096.47,,,,,,,fee schedule,19096.47,46513.47,MSDRG Base Rate Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20671.96,,,,,,,fee schedule,12555.72,30582.09, Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26651.58,,,,,,,fee schedule,12555.72,30582.09, Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25485.08,,,,,,,fee schedule,12555.72,30582.09, Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30582.09,,,,,,,fee schedule,12555.72,30582.09, Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13057.95,,,,,,,fee schedule,12555.72,30582.09,MSDRG Base Rate Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13183.51,,,,,,,fee schedule,12555.72,30582.09,MSDRG Base Rate Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc,716,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12555.72,,,,,,,fee schedule,12555.72,30582.09,MSDRG Base Rate Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26567.2,,,,,,,fee schedule,16136.36,39303.5, Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34252.08,,,,,,,fee schedule,16136.36,39303.5, Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32752.91,,,,,,,fee schedule,16136.36,39303.5, Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,39303.5,,,,,,,fee schedule,16136.36,39303.5, Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16781.81,,,,,,,fee schedule,16136.36,39303.5,MSDRG Base Rate Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16943.18,,,,,,,fee schedule,16136.36,39303.5,MSDRG Base Rate Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc,717,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16136.36,,,,,,,fee schedule,16136.36,39303.5,MSDRG Base Rate Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18874.58,,,,,,,fee schedule,11464.03,27923.05, Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24334.29,,,,,,,fee schedule,11464.03,27923.05, Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23269.21,,,,,,,fee schedule,11464.03,27923.05, Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27923.05,,,,,,,fee schedule,11464.03,27923.05, Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11922.59,,,,,,,fee schedule,11464.03,27923.05,MSDRG Base Rate Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12037.23,,,,,,,fee schedule,11464.03,27923.05,MSDRG Base Rate Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc,718,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11464.03,,,,,,,fee schedule,11464.03,27923.05,MSDRG Base Rate "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25431.71,,,,,,,fee schedule,15446.69,37623.66, "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32788.14,,,,,,,fee schedule,15446.69,37623.66, "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31353.05,,,,,,,fee schedule,15446.69,37623.66, "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37623.66,,,,,,,fee schedule,15446.69,37623.66, "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16064.56,,,,,,,fee schedule,15446.69,37623.66,MSDRG Base Rate "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16219.02,,,,,,,fee schedule,15446.69,37623.66,MSDRG Base Rate "Malignancy, Male Reproductive System With Mcc",722,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15446.69,,,,,,,fee schedule,15446.69,37623.66,MSDRG Base Rate "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16058.36,,,,,,,fee schedule,9753.51,23756.73, "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20703.44,,,,,,,fee schedule,9753.51,23756.73, "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19797.28,,,,,,,fee schedule,9753.51,23756.73, "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23756.73,,,,,,,fee schedule,9753.51,23756.73, "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19954.53,19954.53,19954.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10143.65,,,,,,,fee schedule,9753.51,23756.73,MSDRG Base Rate "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10241.19,,,,,,,fee schedule,9753.51,23756.73,MSDRG Base Rate "Malignancy, Male Reproductive System With Cc",723,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9753.51,,,,,,,fee schedule,9753.51,23756.73,MSDRG Base Rate "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9214.55,,,,,,,fee schedule,5596.73,13632, "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11879.97,,,,,,,fee schedule,5596.73,13632, "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11360,,,,,,,fee schedule,5596.73,13632, "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13632,,,,,,,fee schedule,5596.73,13632, "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5820.6,,,,,,,fee schedule,5596.73,13632,MSDRG Base Rate "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5876.57,,,,,,,fee schedule,5596.73,13632,MSDRG Base Rate "Malignancy, Male Reproductive System Without Cc/Mcc",724,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5596.73,,,,,,,fee schedule,5596.73,13632,MSDRG Base Rate Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16444.82,,,,,,,fee schedule,9988.24,24328.46, Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21201.68,,,,,,,fee schedule,9988.24,24328.46, Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20273.72,,,,,,,fee schedule,9988.24,24328.46, Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24328.46,,,,,,,fee schedule,9988.24,24328.46, Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10387.77,,,,,,,fee schedule,9988.24,24328.46,MSDRG Base Rate Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10487.65,,,,,,,fee schedule,9988.24,24328.46,MSDRG Base Rate Benign Prostatic Hypertrophy With Mcc,725,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9988.24,,,,,,,fee schedule,9988.24,24328.46,MSDRG Base Rate Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10146.27,,,,,,,fee schedule,6162.63,15010.38, Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13081.2,,,,,,,fee schedule,6162.63,15010.38, Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12508.65,,,,,,,fee schedule,6162.63,15010.38, Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15010.38,,,,,,,fee schedule,6162.63,15010.38, Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6409.14,,,,,,,fee schedule,6162.63,15010.38,MSDRG Base Rate Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6470.76,,,,,,,fee schedule,6162.63,15010.38,MSDRG Base Rate Benign Prostatic Hypertrophy Without Mcc,726,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6162.63,,,,,,,fee schedule,6162.63,15010.38,MSDRG Base Rate Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20839.19,,,,,,,fee schedule,12657.29,30829.49, Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26867.18,,,,,,,fee schedule,12657.29,30829.49, Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25691.24,,,,,,,fee schedule,12657.29,30829.49, Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30829.49,,,,,,,fee schedule,12657.29,30829.49, Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13163.58,,,,,,,fee schedule,12657.29,30829.49,MSDRG Base Rate Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13290.15,,,,,,,fee schedule,12657.29,30829.49,MSDRG Base Rate Inflammation Of The Male Reproductive System With Mcc,727,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12657.29,,,,,,,fee schedule,12657.29,30829.49,MSDRG Base Rate Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11399.79,,,,,,,fee schedule,6924,16864.85, Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14697.32,,,,,,,fee schedule,6924,16864.85, Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14054.04,,,,,,,fee schedule,6924,16864.85, Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16864.85,,,,,,,fee schedule,6924,16864.85, Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2879,2879,2879,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],4468.75,4468.75,4468.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13207.67,13207.67,13207.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7200.96,,,,,,,fee schedule,6924,16864.85,MSDRG Base Rate Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7270.2,,,,,,,fee schedule,6924,16864.85,MSDRG Base Rate Inflammation Of The Male Reproductive System Without Mcc,728,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6924,,,,,,,fee schedule,6924,16864.85,MSDRG Base Rate Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14877.91,,,,,,,fee schedule,9036.53,22010.37, Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19181.53,,,,,,,fee schedule,9036.53,22010.37, Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18341.98,,,,,,,fee schedule,9036.53,22010.37, Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22010.37,,,,,,,fee schedule,9036.53,22010.37, Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9397.99,,,,,,,fee schedule,9036.53,22010.37,MSDRG Base Rate Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9488.36,,,,,,,fee schedule,9036.53,22010.37,MSDRG Base Rate Other Male Reproductive System Diagnoses With Cc/Mcc,729,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9036.53,,,,,,,fee schedule,9036.53,22010.37,MSDRG Base Rate Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9443.62,,,,,,,fee schedule,5735.85,13970.88, Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12175.3,,,,,,,fee schedule,5735.85,13970.88, Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11642.4,,,,,,,fee schedule,5735.85,13970.88, Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13970.88,,,,,,,fee schedule,5735.85,13970.88, Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5965.28,,,,,,,fee schedule,5735.85,13970.88,MSDRG Base Rate Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6022.64,,,,,,,fee schedule,5735.85,13970.88,MSDRG Base Rate Other Male Reproductive System Diagnoses Without Cc/Mcc,730,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5735.85,,,,,,,fee schedule,5735.85,13970.88,MSDRG Base Rate "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29932.89,,,,,,,fee schedule,18180.61,44282.7, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38591.34,,,,,,,fee schedule,18180.61,44282.7, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36902.25,,,,,,,fee schedule,18180.61,44282.7, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44282.7,,,,,,,fee schedule,18180.61,44282.7, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18907.83,,,,,,,fee schedule,18180.61,44282.7,MSDRG Base Rate "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19089.64,,,,,,,fee schedule,18180.61,44282.7,MSDRG Base Rate "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc",734,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18180.61,,,,,,,fee schedule,18180.61,44282.7,MSDRG Base Rate "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18908.31,,,,,,,fee schedule,11484.51,27972.95, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24377.77,,,,,,,fee schedule,11484.51,27972.95, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23310.79,,,,,,,fee schedule,11484.51,27972.95, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27972.95,,,,,,,fee schedule,11484.51,27972.95, "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11943.89,,,,,,,fee schedule,11484.51,27972.95,MSDRG Base Rate "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12058.74,,,,,,,fee schedule,11484.51,27972.95,MSDRG Base Rate "Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc",735,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11484.51,,,,,,,fee schedule,11484.51,27972.95,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50232.45,,,,,,,fee schedule,30510.13,74313.86, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,64762.79,,,,,,,fee schedule,30510.13,74313.86, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,61928.21,,,,,,,fee schedule,30510.13,74313.86, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,74313.86,,,,,,,fee schedule,30510.13,74313.86, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],39131,39131,39131,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31730.54,,,,,,,fee schedule,30510.13,74313.86,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32035.64,,,,,,,fee schedule,30510.13,74313.86,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc,736,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30510.13,,,,,,,fee schedule,30510.13,74313.86,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28957.61,,,,,,,fee schedule,17588.24,42839.87, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37333.95,,,,,,,fee schedule,17588.24,42839.87, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,35699.9,,,,,,,fee schedule,17588.24,42839.87, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,42839.87,,,,,,,fee schedule,17588.24,42839.87, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",30131.45,30131.45,30131.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],33512.98,33512.98,33520.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",29599.54,29599.54,29599.54,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,47362.61,47362.61,47362.61,1 through 10,percent of total billed charges,,, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,35378.2,35378.2,35378.2,1 through 10,percent of total billed charges,,, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18291.77,,,,,,,fee schedule,17588.24,42839.87,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18467.65,,,,,,,fee schedule,17588.24,42839.87,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc,737,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17588.24,,,,,,,fee schedule,17588.24,42839.87,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20636.83,,,,,,,fee schedule,12534.38,30530.12, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26606.28,,,,,,,fee schedule,12534.38,30530.12, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25441.76,,,,,,,fee schedule,12534.38,30530.12, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30530.12,,,,,,,fee schedule,12534.38,30530.12, Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13035.76,,,,,,,fee schedule,12534.38,30530.12,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13161.1,,,,,,,fee schedule,12534.38,30530.12,MSDRG Base Rate Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc,738,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12534.38,,,,,,,fee schedule,12534.38,30530.12,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50349.09,,,,,,,fee schedule,30580.98,74486.41, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,64913.17,,,,,,,fee schedule,30580.98,74486.41, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,62072.01,,,,,,,fee schedule,30580.98,74486.41, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,74486.41,,,,,,,fee schedule,30580.98,74486.41, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,31804.22,,,,,,,fee schedule,30580.98,74486.41,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32110.03,,,,,,,fee schedule,30580.98,74486.41,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc,739,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30580.98,,,,,,,fee schedule,30580.98,74486.41,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25430.31,,,,,,,fee schedule,15445.84,37621.58, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32786.33,,,,,,,fee schedule,15445.84,37621.58, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31351.32,,,,,,,fee schedule,15445.84,37621.58, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37621.58,,,,,,,fee schedule,15445.84,37621.58, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8684.89,8684.89,8684.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],23607.02,23607.02,23607.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16063.67,,,,,,,fee schedule,15445.84,37621.58,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16218.13,,,,,,,fee schedule,15445.84,37621.58,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc,740,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15445.84,,,,,,,fee schedule,15445.84,37621.58,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20040.98,,,,,,,fee schedule,12172.47,29648.62, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25838.08,,,,,,,fee schedule,12172.47,29648.62, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24707.18,,,,,,,fee schedule,12172.47,29648.62, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29648.62,,,,,,,fee schedule,12172.47,29648.62, Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12659.37,,,,,,,fee schedule,12172.47,29648.62,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12781.09,,,,,,,fee schedule,12172.47,29648.62,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc,741,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12172.47,,,,,,,fee schedule,12172.47,29648.62,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25784.44,,,,,,,fee schedule,15660.93,38145.49, Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33242.91,,,,,,,fee schedule,15660.93,38145.49, Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31787.91,,,,,,,fee schedule,15660.93,38145.49, Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38145.49,,,,,,,fee schedule,15660.93,38145.49, Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],17274,17274,25081.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],29893.15,24218.39,30643.04,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],27170.48,27170.48,27170.48,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,32239.31,32239.31,32239.31,1 through 10,percent of total billed charges,,, Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,61068.24,61068.24,61068.24,1 through 10,percent of total billed charges,,, Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16287.37,,,,,,,fee schedule,15660.93,38145.49,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16443.98,,,,,,,fee schedule,15660.93,38145.49,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc,742,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15660.93,,,,,,,fee schedule,15660.93,38145.49,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17435.56,,,,,,,fee schedule,10589.99,25794.15, Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22479,,,,,,,fee schedule,10589.99,25794.15, Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21495.13,,,,,,,fee schedule,10589.99,25794.15, Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25794.15,,,,,,,fee schedule,10589.99,25794.15, Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],23964.33,23964.33,23964.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19477.37,15592.36,20109.39,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],13063.01,13063.01,13063.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14384.4,14384.4,14384.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,23271.75,23271.75,23271.75,1 through 10,percent of total billed charges,,, Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11013.59,,,,,,,fee schedule,10589.99,25794.15,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11119.49,,,,,,,fee schedule,10589.99,25794.15,MSDRG Base Rate Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc,743,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10589.99,,,,,,,fee schedule,10589.99,25794.15,MSDRG Base Rate "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28796,,,,,,,fee schedule,17490.09,42600.79, "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37125.59,,,,,,,fee schedule,17490.09,42600.79, "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,35500.66,,,,,,,fee schedule,17490.09,42600.79, "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,42600.79,,,,,,,fee schedule,17490.09,42600.79, "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18189.69,,,,,,,fee schedule,17490.09,42600.79,MSDRG Base Rate "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18364.59,,,,,,,fee schedule,17490.09,42600.79,MSDRG Base Rate "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc",744,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17490.09,,,,,,,fee schedule,17490.09,42600.79,MSDRG Base Rate "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15985.29,,,,,,,fee schedule,9709.13,23648.63, "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20609.23,,,,,,,fee schedule,9709.13,23648.63, "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19707.19,,,,,,,fee schedule,9709.13,23648.63, "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23648.63,,,,,,,fee schedule,9709.13,23648.63, "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10097.5,,,,,,,fee schedule,9709.13,23648.63,MSDRG Base Rate "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10194.59,,,,,,,fee schedule,9709.13,23648.63,MSDRG Base Rate "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc",745,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9709.13,,,,,,,fee schedule,9709.13,23648.63,MSDRG Base Rate "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24411.47,,,,,,,fee schedule,14827.01,36114.31, "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31472.78,,,,,,,fee schedule,14827.01,36114.31, "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30095.26,,,,,,,fee schedule,14827.01,36114.31, "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36114.31,,,,,,,fee schedule,14827.01,36114.31, "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],28118.25,28118.25,28118.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15420.09,,,,,,,fee schedule,14827.01,36114.31,MSDRG Base Rate "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15568.36,,,,,,,fee schedule,14827.01,36114.31,MSDRG Base Rate "Vagina, Cervix And Vulva Procedures With Cc/Mcc",746,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14827.01,,,,,,,fee schedule,14827.01,36114.31,MSDRG Base Rate "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12081.36,,,,,,,fee schedule,7337.97,17873.16, "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15576.04,,,,,,,fee schedule,7337.97,17873.16, "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14894.3,,,,,,,fee schedule,7337.97,17873.16, "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17873.16,,,,,,,fee schedule,7337.97,17873.16, "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16017.79,16017.79,16017.79,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7631.49,,,,,,,fee schedule,7337.97,17873.16,MSDRG Base Rate "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7704.87,,,,,,,fee schedule,7337.97,17873.16,MSDRG Base Rate "Vagina, Cervix And Vulva Procedures Without Cc/Mcc",747,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7337.97,,,,,,,fee schedule,7337.97,17873.16,MSDRG Base Rate Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19495.73,,,,,,,fee schedule,11841.29,28841.97, Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25135.1,,,,,,,fee schedule,11841.29,28841.97, Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24034.97,,,,,,,fee schedule,11841.29,28841.97, Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28841.97,,,,,,,fee schedule,11841.29,28841.97, Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12314.94,,,,,,,fee schedule,11841.29,28841.97,MSDRG Base Rate Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12433.35,,,,,,,fee schedule,11841.29,28841.97,MSDRG Base Rate Female Reproductive System Reconstructive Procedures,748,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11841.29,,,,,,,fee schedule,11841.29,28841.97,MSDRG Base Rate Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,36082.48,,,,,,,fee schedule,21915.74,53380.4, Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,46519.78,,,,,,,fee schedule,21915.74,53380.4, Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44483.67,,,,,,,fee schedule,21915.74,53380.4, Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,53380.4,,,,,,,fee schedule,21915.74,53380.4, Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],60738.9,60738.9,60738.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,22792.37,,,,,,,fee schedule,21915.74,53380.4,MSDRG Base Rate Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23011.53,,,,,,,fee schedule,21915.74,53380.4,MSDRG Base Rate Other Female Reproductive System O.R. Procedures With Cc/Mcc,749,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,21915.74,,,,,,,fee schedule,21915.74,53380.4,MSDRG Base Rate Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20739.42,,,,,,,fee schedule,12596.69,30681.88, Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26738.54,,,,,,,fee schedule,12596.69,30681.88, Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25568.24,,,,,,,fee schedule,12596.69,30681.88, Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30681.88,,,,,,,fee schedule,12596.69,30681.88, Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21628.06,21628.06,21628.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13100.56,,,,,,,fee schedule,12596.69,30681.88,MSDRG Base Rate Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13226.52,,,,,,,fee schedule,12596.69,30681.88,MSDRG Base Rate Other Female Reproductive System O.R. Procedures Without Cc/Mcc,750,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12596.69,,,,,,,fee schedule,12596.69,30681.88,MSDRG Base Rate "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25881.41,,,,,,,fee schedule,15719.82,38288.94, "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33367.92,,,,,,,fee schedule,15719.82,38288.94, "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31907.45,,,,,,,fee schedule,15719.82,38288.94, "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38288.94,,,,,,,fee schedule,15719.82,38288.94, "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",30777.39,30777.39,30777.39,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],6375,6375,6375,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],23987.7,23987.7,23987.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],29853.45,29853.45,29853.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",30181.47,30181.47,30181.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16348.61,,,,,,,fee schedule,15719.82,38288.94,MSDRG Base Rate "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16505.81,,,,,,,fee schedule,15719.82,38288.94,MSDRG Base Rate "Malignancy, Female Reproductive System With Mcc",754,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15719.82,,,,,,,fee schedule,15719.82,38288.94,MSDRG Base Rate "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15286.85,,,,,,,fee schedule,9284.91,22615.36, "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19708.76,,,,,,,fee schedule,9284.91,22615.36, "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18846.14,,,,,,,fee schedule,9284.91,22615.36, "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22615.36,,,,,,,fee schedule,9284.91,22615.36, "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7362.91,7362.91,7362.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],18313.98,18313.98,18313.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9656.31,,,,,,,fee schedule,9284.91,22615.36,MSDRG Base Rate "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9749.16,,,,,,,fee schedule,9284.91,22615.36,MSDRG Base Rate "Malignancy, Female Reproductive System With Cc",755,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9284.91,,,,,,,fee schedule,9284.91,22615.36,MSDRG Base Rate "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13497.91,,,,,,,fee schedule,8198.34,19968.8, "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17402.34,,,,,,,fee schedule,8198.34,19968.8, "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16640.66,,,,,,,fee schedule,8198.34,19968.8, "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19968.8,,,,,,,fee schedule,8198.34,19968.8, "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8526.27,,,,,,,fee schedule,8198.34,19968.8,MSDRG Base Rate "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8608.26,,,,,,,fee schedule,8198.34,19968.8,MSDRG Base Rate "Malignancy, Female Reproductive System Without Cc/Mcc",756,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8198.34,,,,,,,fee schedule,8198.34,19968.8,MSDRG Base Rate "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20122.49,,,,,,,fee schedule,12221.98,29769.2, "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25943.16,,,,,,,fee schedule,12221.98,29769.2, "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24807.67,,,,,,,fee schedule,12221.98,29769.2, "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29769.2,,,,,,,fee schedule,12221.98,29769.2, "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11870.7,11870.7,11870.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12710.86,,,,,,,fee schedule,12221.98,29769.2,MSDRG Base Rate "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12833.08,,,,,,,fee schedule,12221.98,29769.2,MSDRG Base Rate "Infections, Female Reproductive System With Mcc",757,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12221.98,,,,,,,fee schedule,12221.98,29769.2,MSDRG Base Rate "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13757.89,,,,,,,fee schedule,8356.25,20353.41, "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17737.52,,,,,,,fee schedule,8356.25,20353.41, "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16961.18,,,,,,,fee schedule,8356.25,20353.41, "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20353.41,,,,,,,fee schedule,8356.25,20353.41, "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13500.37,13500.37,13500.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12820.63,12820.63,12820.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8690.5,,,,,,,fee schedule,8356.25,20353.41,MSDRG Base Rate "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8774.06,,,,,,,fee schedule,8356.25,20353.41,MSDRG Base Rate "Infections, Female Reproductive System With Cc",758,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8356.25,,,,,,,fee schedule,8356.25,20353.41,MSDRG Base Rate "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9325.57,,,,,,,fee schedule,5664.16,13796.24, "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12023.1,,,,,,,fee schedule,5664.16,13796.24, "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11496.87,,,,,,,fee schedule,5664.16,13796.24, "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13796.24,,,,,,,fee schedule,5664.16,13796.24, "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],8482.62,8482.62,8482.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5890.73,,,,,,,fee schedule,5664.16,13796.24,MSDRG Base Rate "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5947.37,,,,,,,fee schedule,5664.16,13796.24,MSDRG Base Rate "Infections, Female Reproductive System Without Cc/Mcc",759,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5664.16,,,,,,,fee schedule,5664.16,13796.24,MSDRG Base Rate Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14158.4,,,,,,,fee schedule,8599.51,20945.93, Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18253.89,,,,,,,fee schedule,8599.51,20945.93, Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17454.94,,,,,,,fee schedule,8599.51,20945.93, Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20945.93,,,,,,,fee schedule,8599.51,20945.93, Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16184.43,16184.43,16184.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],7962.57,7962.57,7962.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8943.49,,,,,,,fee schedule,8599.51,20945.93,MSDRG Base Rate Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9029.49,,,,,,,fee schedule,8599.51,20945.93,MSDRG Base Rate Menstrual And Other Female Reproductive System Disorders With Cc/Mcc,760,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8599.51,,,,,,,fee schedule,8599.51,20945.93,MSDRG Base Rate Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8017.24,,,,,,,fee schedule,4869.5,11860.7, Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,10336.32,,,,,,,fee schedule,4869.5,11860.7, Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,9883.91,,,,,,,fee schedule,4869.5,11860.7, Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,11860.7,,,,,,,fee schedule,4869.5,11860.7, Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5064.28,,,,,,,fee schedule,4869.5,11860.7,MSDRG Base Rate Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5112.98,,,,,,,fee schedule,4869.5,11860.7,MSDRG Base Rate Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc,761,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,4869.5,,,,,,,fee schedule,4869.5,11860.7,MSDRG Base Rate Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W Cc/Mcc,765,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section W/O Cc/Mcc,766,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Sterilization &/Or D&C,767,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15059.19,,,,,,,fee schedule,9146.64,22278.56, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19415.25,,,,,,,fee schedule,9146.64,22278.56, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18565.47,,,,,,,fee schedule,9146.64,22278.56, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22278.56,,,,,,,fee schedule,9146.64,22278.56, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5604.39,5467.75,6801,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10035.19,10035.19,13754.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],16653.91,16653.91,16653.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21051.94,16648.91,22411.75,49,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9578,6386,9578,20,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,10982.42,10541.77,14733.11,1 through 10,percent of total billed charges,,, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,11494,11494,11494,1 through 10,percent of total billed charges,,, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,12171.79,12171.79,12171.79,1 through 10,percent of total billed charges,,, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,13969.17,13969.17,13969.17,1 through 10,percent of total billed charges,,, Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9512.51,,,,,,,fee schedule,9146.64,22278.56,MSDRG Base Rate Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9603.97,,,,,,,fee schedule,9146.64,22278.56,MSDRG Base Rate Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C,768,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9146.64,,,,,,,fee schedule,9146.64,22278.56,MSDRG Base Rate Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23746.76,,,,,,,fee schedule,14423.28,35130.94, Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30615.8,,,,,,,fee schedule,14423.28,35130.94, Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29275.79,,,,,,,fee schedule,14423.28,35130.94, Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35130.94,,,,,,,fee schedule,14423.28,35130.94, Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5757.5,5757.5,5757.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18421.99,18421.99,23310.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],24929.75,24929.75,24929.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15000.21,,,,,,,fee schedule,14423.28,35130.94,MSDRG Base Rate Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15144.44,,,,,,,fee schedule,14423.28,35130.94,MSDRG Base Rate Postpartum And Post Abortion Diagnoses With O.R. Procedures,769,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14423.28,,,,,,,fee schedule,14423.28,35130.94,MSDRG Base Rate "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14090.94,,,,,,,fee schedule,8558.54,20846.13, "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18166.92,,,,,,,fee schedule,8558.54,20846.13, "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17371.78,,,,,,,fee schedule,8558.54,20846.13, "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20846.13,,,,,,,fee schedule,8558.54,20846.13, "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10243.89,10243.89,10243.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],18221.4,18221.4,18221.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8900.88,,,,,,,fee schedule,8558.54,20846.13,MSDRG Base Rate "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8986.47,,,,,,,fee schedule,8558.54,20846.13,MSDRG Base Rate "Abortion With D&C, Aspiration Curettage Or Hysterotomy",770,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8558.54,,,,,,,fee schedule,8558.54,20846.13,MSDRG Base Rate Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W Complicating Diagnoses,774,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery W/O Complicating Diagnoses,775,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9200.5,,,,,,,fee schedule,5588.19,13611.21, Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11861.85,,,,,,,fee schedule,5588.19,13611.21, Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11342.68,,,,,,,fee schedule,5588.19,13611.21, Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13611.21,,,,,,,fee schedule,5588.19,13611.21, Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2878,2594.43,11569.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],11374.43,11374.43,11374.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11968,9458.26,11969.68,25,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],7394.93,6439.52,11237.07,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,257.19,257.19,257.19,1 through 10,percent of total billed charges,,, Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,5962.89,5962.89,5962.89,1 through 10,percent of total billed charges,,, Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5811.72,,,,,,,fee schedule,5588.19,13611.21,MSDRG Base Rate Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5867.6,,,,,,,fee schedule,5588.19,13611.21,MSDRG Base Rate Postpartum And Post Abortion Diagnoses Without O.R. Procedures,776,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5588.19,,,,,,,fee schedule,5588.19,13611.21,MSDRG Base Rate Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ectopic Pregnancy,777,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Threatened Abortion,778,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11822.79,,,,,,,fee schedule,7180.91,17490.63, Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15242.67,,,,,,,fee schedule,7180.91,17490.63, Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14575.52,,,,,,,fee schedule,7180.91,17490.63, Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17490.63,,,,,,,fee schedule,7180.91,17490.63, Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],12392.25,12392.25,12392.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],3622.63,3622.63,3622.63,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7468.15,,,,,,,fee schedule,7180.91,17490.63,MSDRG Base Rate Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7539.96,,,,,,,fee schedule,7180.91,17490.63,MSDRG Base Rate Abortion Without D&C,779,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7180.91,,,,,,,fee schedule,7180.91,17490.63,MSDRG Base Rate False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. False Labor,780,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W Medical Complications,781,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses W/O Medical Complications,782,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34501.52,,,,,,,fee schedule,20955.5,51041.53, Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,44481.5,,,,,,,fee schedule,20955.5,51041.53, Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,42534.61,,,,,,,fee schedule,20955.5,51041.53, Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,51041.53,,,,,,,fee schedule,20955.5,51041.53, Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9755,9755,10928,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],36262.35,36262.35,36262.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],35016.9,35016.9,35016.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21793.72,,,,,,,fee schedule,20955.5,51041.53,MSDRG Base Rate Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22003.28,,,,,,,fee schedule,20955.5,51041.53,MSDRG Base Rate Cesarean Section With Sterilization With Mcc,783,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20955.5,,,,,,,fee schedule,20955.5,51041.53,MSDRG Base Rate Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14897.59,,,,,,,fee schedule,9048.48,22039.48, Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19206.89,,,,,,,fee schedule,9048.48,22039.48, Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18366.23,,,,,,,fee schedule,9048.48,22039.48, Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22039.48,,,,,,,fee schedule,9048.48,22039.48, Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9755,9755,9755,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22163.91,16475.57,23527.31,22,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9579,9579,9579,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,19175.6,19175.6,19175.6,1 through 10,percent of total billed charges,,, Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9410.42,,,,,,,fee schedule,9048.48,22039.48,MSDRG Base Rate Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9500.9,,,,,,,fee schedule,9048.48,22039.48,MSDRG Base Rate Cesarean Section With Sterilization With Cc,784,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9048.48,,,,,,,fee schedule,9048.48,22039.48,MSDRG Base Rate Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13459.96,,,,,,,fee schedule,8175.3,19912.66, Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17353.42,,,,,,,fee schedule,8175.3,19912.66, Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16593.89,,,,,,,fee schedule,8175.3,19912.66, Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19912.66,,,,,,,fee schedule,8175.3,19912.66, Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9755,9754.74,15247.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],13704.08,13704.08,13704.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15719.18,13700.02,18676.06,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14367,12930.31,19156,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],22988,22988,22988,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,18134.07,18134.07,19472.32,1 through 10,percent of total billed charges,,, Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8502.31,,,,,,,fee schedule,8175.3,19912.66,MSDRG Base Rate Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8584.06,,,,,,,fee schedule,8175.3,19912.66,MSDRG Base Rate Cesarean Section With Sterilization Without Cc/Mcc,785,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8175.3,,,,,,,fee schedule,8175.3,19912.66,MSDRG Base Rate Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23180.42,,,,,,,fee schedule,14079.3,34293.11, Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29885.64,,,,,,,fee schedule,14079.3,34293.11, Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28577.59,,,,,,,fee schedule,14079.3,34293.11, Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34293.11,,,,,,,fee schedule,14079.3,34293.11, Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9747.2,9738.98,9755,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",18864.59,18864.59,18864.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17761.09,17761.09,17761.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27108.34,21055.38,32471.3,40,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],25655.6,25655.6,25655.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],19151,9579,23945,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,19218.35,14004.04,28674.27,1 through 10,percent of total billed charges,,, Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14642.47,,,,,,,fee schedule,14079.3,34293.11,MSDRG Base Rate Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14783.26,,,,,,,fee schedule,14079.3,34293.11,MSDRG Base Rate Cesarean Section Without Sterilization With Mcc,786,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14079.3,,,,,,,fee schedule,14079.3,34293.11,MSDRG Base Rate Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15694.39,,,,,,,fee schedule,9532.44,23218.27, Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20234.18,,,,,,,fee schedule,9532.44,23218.27, Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19348.56,,,,,,,fee schedule,9532.44,23218.27, Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23218.27,,,,,,,fee schedule,9532.44,23218.27, Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9754,9305,10928,52,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15461.13,15461.13,18864.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14512.33,12308.63,17761.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20923.66,16600.37,23175.72,189,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],18303.66,17256.08,18315.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],19136.84,9579,22596.65,42,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],20689.2,19156,22988,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12116.2,12116.2,12116.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,18567.6,15400.48,29374.25,24,percent of total billed charges,,, Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,20072,20072,30105.71,1 through 10,percent of total billed charges,,, Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,22982.13,22982.13,25525.36,1 through 10,percent of total billed charges,,, Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9913.74,,,,,,,fee schedule,9532.44,23218.27,MSDRG Base Rate Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10009.06,,,,,,,fee schedule,9532.44,23218.27,MSDRG Base Rate Cesarean Section Without Sterilization With Cc,787,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9532.44,,,,,,,fee schedule,9532.44,23218.27,MSDRG Base Rate Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13474.02,,,,,,,fee schedule,8183.83,19933.45, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17371.54,,,,,,,fee schedule,8183.83,19933.45, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16611.21,,,,,,,fee schedule,8183.83,19933.45, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19933.45,,,,,,,fee schedule,8183.83,19933.45, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9745.24,8502.75,9755,81,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15461.13,15461.13,15461.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14512.33,12308.63,14512.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],15171.25,13823.25,24597.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18183.7,13629.72,20540.21,248,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14367,9572.5,19156,86,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],6386,6386,6386,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,16649.25,14170.47,21239.71,35,percent of total billed charges,,, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,22773.47,22773.47,22773.47,1 through 10,percent of total billed charges,,, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,19192.81,19192.81,19567.49,1 through 10,percent of total billed charges,,, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,14367,14367,14367,1 through 10,percent of total billed charges,,, Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8511.18,,,,,,,fee schedule,8183.83,19933.45,MSDRG Base Rate Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8593.02,,,,,,,fee schedule,8183.83,19933.45,MSDRG Base Rate Cesarean Section Without Sterilization Without Cc/Mcc,788,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8183.83,,,,,,,fee schedule,8183.83,19933.45,MSDRG Base Rate "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25326.32,,,,,,,fee schedule,15382.67,37467.74, "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,32652.26,,,,,,,fee schedule,15382.67,37467.74, "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31223.12,,,,,,,fee schedule,15382.67,37467.74, "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37467.74,,,,,,,fee schedule,15382.67,37467.74, "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15997.98,,,,,,,fee schedule,15382.67,37467.74,MSDRG Base Rate "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16151.8,,,,,,,fee schedule,15382.67,37467.74,MSDRG Base Rate "Neonates, Died Or Transferred To Another Acute Care Facility",789,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15382.67,,,,,,,fee schedule,15382.67,37467.74,MSDRG Base Rate "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,83524.01,,,,,,,fee schedule,50730.73,123565.37, "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,107684.33,,,,,,,fee schedule,50730.73,123565.37, "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,102971.14,,,,,,,fee schedule,50730.73,123565.37, "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,123565.37,,,,,,,fee schedule,50730.73,123565.37, "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8010.59,8010.59,8532,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",13869.78,13869.78,13869.78,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],56645.03,56645.03,56645.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],40138.99,9252.85,61000.27,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],42015,42015,42015,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,52759.96,,,,,,,fee schedule,50730.73,123565.37,MSDRG Base Rate "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,53267.27,,,,,,,fee schedule,50730.73,123565.37,MSDRG Base Rate "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate",790,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,50730.73,,,,,,,fee schedule,50730.73,123565.37,MSDRG Base Rate Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,57041.13,,,,,,,fee schedule,34645.58,84386.61, Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,73540.96,,,,,,,fee schedule,34645.58,84386.61, Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,70322.18,,,,,,,fee schedule,34645.58,84386.61, Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,84386.61,,,,,,,fee schedule,34645.58,84386.61, Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2604,1302,22752,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17219.76,17219.76,17219.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11729.59,11729.59,11729.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],39053.85,39053.85,39053.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11375.42,2381.14,75156.77,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],4650,2650,7640,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,11188.77,9567.89,41149.67,1 through 10,percent of total billed charges,,, Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,36031.4,,,,,,,fee schedule,34645.58,84386.61,MSDRG Base Rate Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,36377.86,,,,,,,fee schedule,34645.58,84386.61,MSDRG Base Rate Prematurity With Major Problems,791,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,34645.58,,,,,,,fee schedule,34645.58,84386.61,MSDRG Base Rate Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34418.61,,,,,,,fee schedule,20905.14,50918.87, Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,44374.61,,,,,,,fee schedule,20905.14,50918.87, Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,42432.39,,,,,,,fee schedule,20905.14,50918.87, Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,50918.87,,,,,,,fee schedule,20905.14,50918.87, Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],2604,1949.06,47521.45,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7500.87,7500.87,7500.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],12828.45,7626.41,53172.16,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],7700,6328,52120.43,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,9190.45,3464.55,14847.4,1 through 10,percent of total billed charges,,, Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21741.35,,,,,,,fee schedule,20905.14,50918.87,MSDRG Base Rate Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,21950.4,,,,,,,fee schedule,20905.14,50918.87,MSDRG Base Rate Prematurity Without Major Problems,792,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20905.14,,,,,,,fee schedule,20905.14,50918.87,MSDRG Base Rate Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,58595.39,,,,,,,fee schedule,35589.61,86685.98, Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,75544.81,,,,,,,fee schedule,35589.61,86685.98, Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,72238.32,,,,,,,fee schedule,35589.61,86685.98, Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,86685.98,,,,,,,fee schedule,35589.61,86685.98, Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],1952,1106.7,5688,44,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8115.79,8115.79,12545.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11182.67,11182.67,11182.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20874.35,3809.83,54459.42,12,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],6000,3870,10000,36,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],4800,4800,4800,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,6569.68,4113.61,15427.07,1 through 10,percent of total billed charges,,, Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,7712.76,7712.76,7712.76,1 through 10,percent of total billed charges,,, Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,7650,7650,7650,1 through 10,percent of total billed charges,,, Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37013.19,,,,,,,fee schedule,35589.61,86685.98,MSDRG Base Rate Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37369.09,,,,,,,fee schedule,35589.61,86685.98,MSDRG Base Rate Full Term Neonate With Major Problems,793,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35589.61,,,,,,,fee schedule,35589.61,86685.98,MSDRG Base Rate Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20740.82,,,,,,,fee schedule,12597.54,30683.96, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26740.36,,,,,,,fee schedule,12597.54,30683.96, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25569.97,,,,,,,fee schedule,12597.54,30683.96, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30683.96,,,,,,,fee schedule,12597.54,30683.96, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],1302,1289,2604,135,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5638.84,4888.26,5638.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5136.51,4420.04,5136.51,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14514.82,9285.73,18745.92,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],19571.46,19571.46,19571.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],4000,2000,8000,125,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],6621.84,4793.49,9600,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,4309.78,3320.92,7682.9,53,percent of total billed charges,,, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,4800,4800,4800,1 through 10,percent of total billed charges,,, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,5142.21,3034.12,8051.14,1 through 10,percent of total billed charges,,, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,5816.8,5283.13,7665.15,1 through 10,percent of total billed charges,,, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,1202,1202,1202,1 through 10,percent of total billed charges,,, Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13101.44,,,,,,,fee schedule,12597.54,30683.96,MSDRG Base Rate Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13227.42,,,,,,,fee schedule,12597.54,30683.96,MSDRG Base Rate Neonate With Other Significant Problems,794,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12597.54,,,,,,,fee schedule,12597.54,30683.96,MSDRG Base Rate Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,2807.79,,,,,,,fee schedule,1705.39,4153.84, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,3619.98,,,,,,,fee schedule,1705.39,4153.84, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,3461.54,,,,,,,fee schedule,1705.39,4153.84, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,4153.84,,,,,,,fee schedule,1705.39,4153.84, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],1302,651,2604,185,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4888.26,4888.26,4888.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4420.04,4420.04,4420.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],3070.66,2114.79,4501.95,28,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],2119.16,2119.16,2119.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],4000,2328,8000,168,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],4800,3993.3,8000,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",4377.87,4377.87,4377.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,3924,1863.64,6819.97,71,percent of total billed charges,,, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,4779.56,4227.56,6455.9,1 through 10,percent of total billed charges,,, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,5832.14,3281.42,6606.67,1 through 10,percent of total billed charges,,, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,3996.5,3996.5,3996.5,1 through 10,percent of total billed charges,,, Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,1773.61,,,,,,,fee schedule,1705.39,4153.84,MSDRG Base Rate Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,1790.66,,,,,,,fee schedule,1705.39,4153.84,MSDRG Base Rate Normal Newborn,795,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,1705.39,,,,,,,fee schedule,1705.39,4153.84,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16399.85,,,,,,,fee schedule,9960.92,24261.93, Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21143.71,,,,,,,fee schedule,9960.92,24261.93, Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20218.28,,,,,,,fee schedule,9960.92,24261.93, Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24261.93,,,,,,,fee schedule,9960.92,24261.93, Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5751.14,5751.14,5751.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27855.55,27855.55,27855.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10359.36,,,,,,,fee schedule,9960.92,24261.93,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10458.97,,,,,,,fee schedule,9960.92,24261.93,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C With Mcc,796,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9960.92,,,,,,,fee schedule,9960.92,24261.93,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14058.62,,,,,,,fee schedule,8538.91,20798.32, Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18125.25,,,,,,,fee schedule,8538.91,20798.32, Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17331.93,,,,,,,fee schedule,8538.91,20798.32, Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20798.32,,,,,,,fee schedule,8538.91,20798.32, Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18914,18914,18914,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,15996.27,15996.27,15996.27,1 through 10,percent of total billed charges,,, Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8880.47,,,,,,,fee schedule,8538.91,20798.32,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8965.86,,,,,,,fee schedule,8538.91,20798.32,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C With Cc,797,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8538.91,,,,,,,fee schedule,8538.91,20798.32,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13450.13,,,,,,,fee schedule,8169.32,19898.11, Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17340.74,,,,,,,fee schedule,8169.32,19898.11, Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16581.76,,,,,,,fee schedule,8169.32,19898.11, Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19898.11,,,,,,,fee schedule,8169.32,19898.11, Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],11463.52,11463.52,11463.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18905.64,18905.64,18905.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8496.09,,,,,,,fee schedule,8169.32,19898.11,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8577.79,,,,,,,fee schedule,8169.32,19898.11,MSDRG Base Rate Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc,798,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8169.32,,,,,,,fee schedule,8169.32,19898.11,MSDRG Base Rate Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,63644.63,,,,,,,fee schedule,38656.41,94155.83, Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,82054.61,,,,,,,fee schedule,38656.41,94155.83, Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,78463.19,,,,,,,fee schedule,38656.41,94155.83, Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,94155.83,,,,,,,fee schedule,38656.41,94155.83, Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,40202.67,,,,,,,fee schedule,38656.41,94155.83,MSDRG Base Rate Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40589.23,,,,,,,fee schedule,38656.41,94155.83,MSDRG Base Rate Splenic Procedures With Mcc,799,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,38656.41,,,,,,,fee schedule,38656.41,94155.83,MSDRG Base Rate Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,39480.5,,,,,,,fee schedule,23979.62,58407.43, Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,50900.71,,,,,,,fee schedule,23979.62,58407.43, Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,48672.86,,,,,,,fee schedule,23979.62,58407.43, Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,58407.43,,,,,,,fee schedule,23979.62,58407.43, Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24938.8,,,,,,,fee schedule,23979.62,58407.43,MSDRG Base Rate Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25178.6,,,,,,,fee schedule,23979.62,58407.43,MSDRG Base Rate Splenic Procedures With Cc,800,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23979.62,,,,,,,fee schedule,23979.62,58407.43,MSDRG Base Rate Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26825.77,,,,,,,fee schedule,16293.41,39686.03, Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34585.45,,,,,,,fee schedule,16293.41,39686.03, Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33071.69,,,,,,,fee schedule,16293.41,39686.03, Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,39686.03,,,,,,,fee schedule,16293.41,39686.03, Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16945.15,,,,,,,fee schedule,16293.41,39686.03,MSDRG Base Rate Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17108.08,,,,,,,fee schedule,16293.41,39686.03,MSDRG Base Rate Splenic Procedures Without Cc/Mcc,801,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16293.41,,,,,,,fee schedule,16293.41,39686.03,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,55988.56,,,,,,,fee schedule,34006.27,82829.44, Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,72183.92,,,,,,,fee schedule,34006.27,82829.44, Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,69024.53,,,,,,,fee schedule,34006.27,82829.44, Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,82829.44,,,,,,,fee schedule,34006.27,82829.44, Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,35366.52,,,,,,,fee schedule,34006.27,82829.44,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,35706.58,,,,,,,fee schedule,34006.27,82829.44,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc,802,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,34006.27,,,,,,,fee schedule,34006.27,82829.44,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26123.12,,,,,,,fee schedule,15866.64,38646.53, Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33679.55,,,,,,,fee schedule,15866.64,38646.53, Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,32205.44,,,,,,,fee schedule,15866.64,38646.53, Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38646.53,,,,,,,fee schedule,15866.64,38646.53, Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16501.31,,,,,,,fee schedule,15866.64,38646.53,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16659.97,,,,,,,fee schedule,15866.64,38646.53,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc,803,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15866.64,,,,,,,fee schedule,15866.64,38646.53,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19055.87,,,,,,,fee schedule,11574.13,28191.24, Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24568.01,,,,,,,fee schedule,11574.13,28191.24, Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23492.7,,,,,,,fee schedule,11574.13,28191.24, Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28191.24,,,,,,,fee schedule,11574.13,28191.24, Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12037.1,,,,,,,fee schedule,11574.13,28191.24,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12152.84,,,,,,,fee schedule,11574.13,28191.24,MSDRG Base Rate Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc,804,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11574.13,,,,,,,fee schedule,11574.13,28191.24,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15166,,,,,,,fee schedule,9211.51,22436.57, Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19552.95,,,,,,,fee schedule,9211.51,22436.57, Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18697.14,,,,,,,fee schedule,9211.51,22436.57, Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22436.57,,,,,,,fee schedule,9211.51,22436.57, Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5610,5604.39,7940.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11868.71,11868.71,11868.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11083.21,11083.21,11083.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16737.77,9507.79,19620.54,29,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9568.42,9549.02,14367,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],11494,11494,11494,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,10587.1,10393.24,11555.01,1 through 10,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,16970.74,16970.74,16970.74,1 through 10,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9579.97,,,,,,,fee schedule,9211.51,22436.57,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9672.09,,,,,,,fee schedule,9211.51,22436.57,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C With Mcc,805,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9211.51,,,,,,,fee schedule,9211.51,22436.57,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10595.96,,,,,,,fee schedule,6435.76,15675.66, Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13660.97,,,,,,,fee schedule,6435.76,15675.66, Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13063.05,,,,,,,fee schedule,6435.76,15675.66, Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15675.66,,,,,,,fee schedule,6435.76,15675.66, Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5610,5510,6783,57,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9709.84,8822.35,9709.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9022.47,9022.47,11083.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],11707.65,11700.65,15221.95,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13501.15,11212.65,14820.59,183,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9573,8389.56,9578,67,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],11494,11482.51,11494.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,11004.42,10135.24,13155.14,16,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,14083.68,13695.2,15270.04,1 through 10,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,14554.32,14554.32,14985.04,1 through 10,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6693.19,,,,,,,fee schedule,6435.76,15675.66,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6757.55,,,,,,,fee schedule,6435.76,15675.66,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C With Cc,806,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6435.76,,,,,,,fee schedule,6435.76,15675.66,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9474.53,,,,,,,fee schedule,5754.63,14016.62, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12215.16,,,,,,,fee schedule,5754.63,14016.62, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11680.52,,,,,,,fee schedule,5754.63,14016.62, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14016.62,,,,,,,fee schedule,5754.63,14016.62, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5606.63,5049,5610,160,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8822.35,8822.35,9709.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9022.47,8175.32,9022.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],10567.16,9404.1,10814.03,16,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],12245.16,9709.84,13372.82,554,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9568.79,6379.02,9578,164,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9578,8447.08,17241,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8827.13,8061.62,10914.12,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,10392.48,8261.77,11992.87,65,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,13158.02,10571.35,16174.75,1 through 10,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,14780.75,11669.96,18282.68,1 through 10,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,6386,6386,9578,1 through 10,percent of total billed charges,,, Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5984.82,,,,,,,fee schedule,5754.63,14016.62,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6042.36,,,,,,,fee schedule,5754.63,14016.62,MSDRG Base Rate Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc,807,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5754.63,,,,,,,fee schedule,5754.63,14016.62,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31027.62,,,,,,,fee schedule,18845.52,45902.24, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,40002.73,,,,,,,fee schedule,18845.52,45902.24, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38251.87,,,,,,,fee schedule,18845.52,45902.24, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45902.24,,,,,,,fee schedule,18845.52,45902.24, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],28910.86,28910.86,28910.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,35324.65,35324.65,35324.65,1 through 10,percent of total billed charges,,, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19599.34,,,,,,,fee schedule,18845.52,45902.24,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19787.8,,,,,,,fee schedule,18845.52,45902.24,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,808,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18845.52,,,,,,,fee schedule,18845.52,45902.24,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17789.69,,,,,,,fee schedule,10805.09,26318.06, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22935.58,,,,,,,fee schedule,10805.09,26318.06, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21931.72,,,,,,,fee schedule,10805.09,26318.06, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26318.06,,,,,,,fee schedule,10805.09,26318.06, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20755.23,16420.03,20777.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],15920.03,15920.03,15920.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],20887.35,20887.35,20887.35,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11237.29,,,,,,,fee schedule,10805.09,26318.06,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11345.34,,,,,,,fee schedule,10805.09,26318.06,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,809,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10805.09,,,,,,,fee schedule,10805.09,26318.06,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14707.87,,,,,,,fee schedule,8933.25,21758.81, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18962.3,,,,,,,fee schedule,8933.25,21758.81, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18132.35,,,,,,,fee schedule,8933.25,21758.81, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21758.81,,,,,,,fee schedule,8933.25,21758.81, Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],12618.96,12618.96,12618.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9290.58,,,,,,,fee schedule,8933.25,21758.81,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9379.91,,,,,,,fee schedule,8933.25,21758.81,MSDRG Base Rate Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ,810,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8933.25,,,,,,,fee schedule,8933.25,21758.81,MSDRG Base Rate Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19734.63,,,,,,,fee schedule,11986.4,29195.4, Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25443.11,,,,,,,fee schedule,11986.4,29195.4, Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24329.5,,,,,,,fee schedule,11986.4,29195.4, Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29195.4,,,,,,,fee schedule,11986.4,29195.4, Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8003.4,8003.4,8003.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19810.38,19810.38,19810.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",28665.5,28665.5,28665.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],10207.28,10207.28,10207.28,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],1490.94,1490.94,1490.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],21587.25,21587.25,21587.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],940.66,940.66,940.66,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,72350.51,72350.51,72350.51,1 through 10,percent of total billed charges,,, Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12465.86,,,,,,,fee schedule,11986.4,29195.4,MSDRG Base Rate Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12585.72,,,,,,,fee schedule,11986.4,29195.4,MSDRG Base Rate Red Blood Cell Disorders With Mcc,811,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11986.4,,,,,,,fee schedule,11986.4,29195.4,MSDRG Base Rate Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12903.46,,,,,,,fee schedule,7837.29,19089.38, Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16635.95,,,,,,,fee schedule,7837.29,19089.38, Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15907.82,,,,,,,fee schedule,7837.29,19089.38, Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19089.38,,,,,,,fee schedule,7837.29,19089.38, Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11436.17,11436.17,19810.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10670.33,10670.33,10670.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],15482.57,15106.64,15482.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9229.92,9229.92,9229.92,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10509.11,10509.11,10509.11,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,6985.41,6985.41,6985.41,1 through 10,percent of total billed charges,,, Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,8313.56,8313.56,8313.56,1 through 10,percent of total billed charges,,, Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8150.78,,,,,,,fee schedule,7837.29,19089.38,MSDRG Base Rate Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8229.15,,,,,,,fee schedule,7837.29,19089.38,MSDRG Base Rate Red Blood Cell Disorders Without Mcc,812,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7837.29,,,,,,,fee schedule,7837.29,19089.38,MSDRG Base Rate Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21435.04,,,,,,,fee schedule,13019.19,31710.99, Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27635.39,,,,,,,fee schedule,13019.19,31710.99, Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26425.82,,,,,,,fee schedule,13019.19,31710.99, Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31710.99,,,,,,,fee schedule,13019.19,31710.99, Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],3290.44,3290.44,3290.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],25619.25,25619.25,25619.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",22164.1,22164.1,22164.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13539.96,,,,,,,fee schedule,13019.19,31710.99,MSDRG Base Rate Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13670.15,,,,,,,fee schedule,13019.19,31710.99,MSDRG Base Rate Coagulation Disorders,813,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13019.19,,,,,,,fee schedule,13019.19,31710.99,MSDRG Base Rate Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29886.52,,,,,,,fee schedule,18152.44,44214.09, Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38531.55,,,,,,,fee schedule,18152.44,44214.09, Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36845.08,,,,,,,fee schedule,18152.44,44214.09, Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44214.09,,,,,,,fee schedule,18152.44,44214.09, Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18878.54,,,,,,,fee schedule,18152.44,44214.09,MSDRG Base Rate Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19060.06,,,,,,,fee schedule,18152.44,44214.09,MSDRG Base Rate Reticuloendothelial And Immunity Disorders With Mcc,814,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18152.44,,,,,,,fee schedule,18152.44,44214.09,MSDRG Base Rate Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14249.74,,,,,,,fee schedule,8654.99,21081.06, Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18371.65,,,,,,,fee schedule,8654.99,21081.06, Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17567.55,,,,,,,fee schedule,8654.99,21081.06, Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21081.06,,,,,,,fee schedule,8654.99,21081.06, Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9001.19,,,,,,,fee schedule,8654.99,21081.06,MSDRG Base Rate Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9087.74,,,,,,,fee schedule,8654.99,21081.06,MSDRG Base Rate Reticuloendothelial And Immunity Disorders With Cc,815,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8654.99,,,,,,,fee schedule,8654.99,21081.06,MSDRG Base Rate Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8881.5,,,,,,,fee schedule,5394.43,13139.28, Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11450.58,,,,,,,fee schedule,5394.43,13139.28, Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10949.4,,,,,,,fee schedule,5394.43,13139.28, Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13139.28,,,,,,,fee schedule,5394.43,13139.28, Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5610.21,,,,,,,fee schedule,5394.43,13139.28,MSDRG Base Rate Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5664.15,,,,,,,fee schedule,5394.43,13139.28,MSDRG Base Rate Reticuloendothelial And Immunity Disorders Without Cc/Mcc,816,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5394.43,,,,,,,fee schedule,5394.43,13139.28,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32063.32,,,,,,,fee schedule,19474.59,47434.46, Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41338.03,,,,,,,fee schedule,19474.59,47434.46, Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,39528.72,,,,,,,fee schedule,19474.59,47434.46, Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,47434.46,,,,,,,fee schedule,19474.59,47434.46, Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,3164.28,3164.28,3164.28,1 through 10,percent of total billed charges,,, Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20253.57,,,,,,,fee schedule,19474.59,47434.46,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20448.32,,,,,,,fee schedule,19474.59,47434.46,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures With Mcc,817,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19474.59,,,,,,,fee schedule,19474.59,47434.46,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16290.24,,,,,,,fee schedule,9894.35,24099.77, Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21002.39,,,,,,,fee schedule,9894.35,24099.77, Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20083.14,,,,,,,fee schedule,9894.35,24099.77, Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24099.77,,,,,,,fee schedule,9894.35,24099.77, Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10290.12,,,,,,,fee schedule,9894.35,24099.77,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10389.07,,,,,,,fee schedule,9894.35,24099.77,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures With Cc,818,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9894.35,,,,,,,fee schedule,9894.35,24099.77,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12084.17,,,,,,,fee schedule,7339.67,17877.32, Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15579.67,,,,,,,fee schedule,7339.67,17877.32, Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14897.77,,,,,,,fee schedule,7339.67,17877.32, Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17877.32,,,,,,,fee schedule,7339.67,17877.32, Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13697.6,13697.6,13697.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7633.26,,,,,,,fee schedule,7339.67,17877.32,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7706.65,,,,,,,fee schedule,7339.67,17877.32,MSDRG Base Rate Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc,819,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7339.67,,,,,,,fee schedule,7339.67,17877.32,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,82418.03,,,,,,,fee schedule,50058.98,121929.19, Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,106258.45,,,,,,,fee schedule,50058.98,121929.19, Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,101607.66,,,,,,,fee schedule,50058.98,121929.19, Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,121929.19,,,,,,,fee schedule,50058.98,121929.19, Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,52061.34,,,,,,,fee schedule,50058.98,121929.19,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,52561.93,,,,,,,fee schedule,50058.98,121929.19,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures With Mcc,820,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,50058.98,,,,,,,fee schedule,50058.98,121929.19,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31459.05,,,,,,,fee schedule,19107.56,46540.49, Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,40558.95,,,,,,,fee schedule,19107.56,46540.49, Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38783.75,,,,,,,fee schedule,19107.56,46540.49, Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,46540.49,,,,,,,fee schedule,19107.56,46540.49, Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",37334.73,37334.73,37334.73,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19871.86,,,,,,,fee schedule,19107.56,46540.49,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20062.94,,,,,,,fee schedule,19107.56,46540.49,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures With Cc,821,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19107.56,,,,,,,fee schedule,19107.56,46540.49,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16919.81,,,,,,,fee schedule,10276.74,25031.16, Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21814.07,,,,,,,fee schedule,10276.74,25031.16, Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20859.3,,,,,,,fee schedule,10276.74,25031.16, Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25031.16,,,,,,,fee schedule,10276.74,25031.16, Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10687.81,,,,,,,fee schedule,10276.74,25031.16,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10790.58,,,,,,,fee schedule,10276.74,25031.16,MSDRG Base Rate Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc,822,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10276.74,,,,,,,fee schedule,10276.74,25031.16,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,64430.19,,,,,,,fee schedule,39133.55,95317.99, Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,83067.41,,,,,,,fee schedule,39133.55,95317.99, Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,79431.66,,,,,,,fee schedule,39133.55,95317.99, Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,95317.99,,,,,,,fee schedule,39133.55,95317.99, Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,40698.89,,,,,,,fee schedule,39133.55,95317.99,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41090.23,,,,,,,fee schedule,39133.55,95317.99,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc,823,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,39133.55,,,,,,,fee schedule,39133.55,95317.99,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31838.48,,,,,,,fee schedule,19338.02,47101.82, Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41048.14,,,,,,,fee schedule,19338.02,47101.82, Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,39251.52,,,,,,,fee schedule,19338.02,47101.82, Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,47101.82,,,,,,,fee schedule,19338.02,47101.82, Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20111.54,,,,,,,fee schedule,19338.02,47101.82,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20304.92,,,,,,,fee schedule,19338.02,47101.82,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures With Cc,824,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19338.02,,,,,,,fee schedule,19338.02,47101.82,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18963.12,,,,,,,fee schedule,11517.8,28054.03, Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,24448.43,,,,,,,fee schedule,11517.8,28054.03, Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,23378.36,,,,,,,fee schedule,11517.8,28054.03, Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28054.03,,,,,,,fee schedule,11517.8,28054.03, Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11978.51,,,,,,,fee schedule,11517.8,28054.03,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12093.69,,,,,,,fee schedule,11517.8,28054.03,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc,825,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11517.8,,,,,,,fee schedule,11517.8,28054.03,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,65737.12,,,,,,,fee schedule,39927.35,97251.46, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,84752.38,,,,,,,fee schedule,39927.35,97251.46, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,81042.89,,,,,,,fee schedule,39927.35,97251.46, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,97251.46,,,,,,,fee schedule,39927.35,97251.46, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],80108.76,80108.76,80108.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],59309,59309,59309,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,41524.44,,,,,,,fee schedule,39927.35,97251.46,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,41923.72,,,,,,,fee schedule,39927.35,97251.46,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc,826,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,39927.35,,,,,,,fee schedule,39927.35,97251.46,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32479.29,,,,,,,fee schedule,19727.24,48049.85, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,41874.32,,,,,,,fee schedule,19727.24,48049.85, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40041.54,,,,,,,fee schedule,19727.24,48049.85, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48049.85,,,,,,,fee schedule,19727.24,48049.85, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20516.33,,,,,,,fee schedule,19727.24,48049.85,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20713.6,,,,,,,fee schedule,19727.24,48049.85,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc,827,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19727.24,,,,,,,fee schedule,19727.24,48049.85,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23943.5,,,,,,,fee schedule,14542.78,35422, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30869.45,,,,,,,fee schedule,14542.78,35422, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29518.34,,,,,,,fee schedule,14542.78,35422, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35422,,,,,,,fee schedule,14542.78,35422, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],10803.1,10803.1,10803.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15124.49,,,,,,,fee schedule,14542.78,35422,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15269.92,,,,,,,fee schedule,14542.78,35422,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C,828,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14542.78,,,,,,,fee schedule,14542.78,35422,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,44407.48,,,,,,,fee schedule,26972.17,65696.4, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,57252.88,,,,,,,fee schedule,26972.17,65696.4, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,54747,,,,,,,fee schedule,26972.17,65696.4, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,65696.4,,,,,,,fee schedule,26972.17,65696.4, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],121471.59,121471.59,121471.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28051.06,,,,,,,fee schedule,26972.17,65696.4,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28320.78,,,,,,,fee schedule,26972.17,65696.4,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc,829,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,26972.17,,,,,,,fee schedule,26972.17,65696.4,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21149.77,,,,,,,fee schedule,12845.92,31288.95, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27267.59,,,,,,,fee schedule,12845.92,31288.95, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26074.13,,,,,,,fee schedule,12845.92,31288.95, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31288.95,,,,,,,fee schedule,12845.92,31288.95, Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5751.29,5751.29,5751.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],26517.33,26517.33,26517.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13359.76,,,,,,,fee schedule,12845.92,31288.95,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13488.22,,,,,,,fee schedule,12845.92,31288.95,MSDRG Base Rate Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc,830,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12845.92,,,,,,,fee schedule,12845.92,31288.95,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16898.73,,,,,,,fee schedule,10263.93,24999.98, Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21786.9,,,,,,,fee schedule,10263.93,24999.98, Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20833.31,,,,,,,fee schedule,10263.93,24999.98, Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24999.98,,,,,,,fee schedule,10263.93,24999.98, Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18959.18,14404.07,19297.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],11324.14,11324.14,11324.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",5818.85,5818.85,5818.85,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10674.49,,,,,,,fee schedule,10263.93,24999.98,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10777.13,,,,,,,fee schedule,10263.93,24999.98,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures With Mcc,831,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10263.93,,,,,,,fee schedule,10263.93,24999.98,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10140.64,,,,,,,fee schedule,6159.21,15002.06, Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13073.95,,,,,,,fee schedule,6159.21,15002.06, Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12501.72,,,,,,,fee schedule,6159.21,15002.06, Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15002.06,,,,,,,fee schedule,6159.21,15002.06, Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",8263.74,8263.74,8263.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7642.09,7642.09,7642.09,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],12533.2,12529.01,12536.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],3240.64,3240.64,3240.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],8968.8,8968.8,15299.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6405.58,,,,,,,fee schedule,6159.21,15002.06,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6467.17,,,,,,,fee schedule,6159.21,15002.06,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures With Cc,832,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6159.21,,,,,,,fee schedule,6159.21,15002.06,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,7348.31,,,,,,,fee schedule,4463.21,10871.09, Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,9473.9,,,,,,,fee schedule,4463.21,10871.09, Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,9059.24,,,,,,,fee schedule,4463.21,10871.09, Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,10871.09,,,,,,,fee schedule,4463.21,10871.09, Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5723,5723,5723,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],8715.16,4324.95,8720.16,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],8576.7,6237.6,8576.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,4641.74,,,,,,,fee schedule,4463.21,10871.09,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4686.37,,,,,,,fee schedule,4463.21,10871.09,MSDRG Base Rate Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc,833,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,4463.21,,,,,,,fee schedule,4463.21,10871.09,MSDRG Base Rate Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,77149.56,,,,,,,fee schedule,46859.02,114135.02, Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,99466.01,,,,,,,fee schedule,46859.02,114135.02, Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,95112.52,,,,,,,fee schedule,46859.02,114135.02, Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,114135.02,,,,,,,fee schedule,46859.02,114135.02, Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],73280.94,73280.94,73280.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,48733.38,,,,,,,fee schedule,46859.02,114135.02,MSDRG Base Rate Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,49201.97,,,,,,,fee schedule,46859.02,114135.02,MSDRG Base Rate Acute Leukemia With Mcc,834,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,46859.02,,,,,,,fee schedule,46859.02,114135.02,MSDRG Base Rate Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29311.75,,,,,,,fee schedule,17803.34,43363.78, Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37790.52,,,,,,,fee schedule,17803.34,43363.78, Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36136.49,,,,,,,fee schedule,17803.34,43363.78, Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43363.78,,,,,,,fee schedule,17803.34,43363.78, Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],18178.96,18178.96,18178.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],12388.44,12388.44,12388.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18515.47,,,,,,,fee schedule,17803.34,43363.78,MSDRG Base Rate Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18693.51,,,,,,,fee schedule,17803.34,43363.78,MSDRG Base Rate Acute Leukemia With Cc,835,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17803.34,,,,,,,fee schedule,17803.34,43363.78,MSDRG Base Rate Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17137.63,,,,,,,fee schedule,10409.04,25353.41, Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22094.9,,,,,,,fee schedule,10409.04,25353.41, Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21127.84,,,,,,,fee schedule,10409.04,25353.41, Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25353.41,,,,,,,fee schedule,10409.04,25353.41, Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10825.4,,,,,,,fee schedule,10409.04,25353.41,MSDRG Base Rate Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10929.49,,,,,,,fee schedule,10409.04,25353.41,MSDRG Base Rate Acute Leukemia Without Cc/Mcc,836,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10409.04,,,,,,,fee schedule,10409.04,25353.41,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,67514.83,,,,,,,fee schedule,41007.09,99881.4, Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,87044.31,,,,,,,fee schedule,41007.09,99881.4, Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,83234.5,,,,,,,fee schedule,41007.09,99881.4, Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,99881.4,,,,,,,fee schedule,41007.09,99881.4, Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],42235.46,42235.46,42235.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],66385.46,44405.7,225411.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],17546.82,17546.82,17546.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],23487.23,23487.23,102149.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,11217,11217,11217,1 through 10,percent of total billed charges,,, Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,42647.37,,,,,,,fee schedule,41007.09,99881.4,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,43057.44,,,,,,,fee schedule,41007.09,99881.4,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc,837,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,41007.09,,,,,,,fee schedule,41007.09,99881.4,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29334.23,,,,,,,fee schedule,17817,43397.05, Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37819.51,,,,,,,fee schedule,17817,43397.05, Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36164.21,,,,,,,fee schedule,17817,43397.05, Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43397.05,,,,,,,fee schedule,17817,43397.05, Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],17553.14,16820.1,17553.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],34025.08,34025.08,34025.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],32459.54,25471.03,33465.3,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18529.68,,,,,,,fee schedule,17817,43397.05,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18707.85,,,,,,,fee schedule,17817,43397.05,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent,838,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17817,,,,,,,fee schedule,17817,43397.05,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20291.13,,,,,,,fee schedule,12324.4,30018.68, Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26160.58,,,,,,,fee schedule,12324.4,30018.68, Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25015.57,,,,,,,fee schedule,12324.4,30018.68, Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30018.68,,,,,,,fee schedule,12324.4,30018.68, Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12817.38,,,,,,,fee schedule,12324.4,30018.68,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12940.62,,,,,,,fee schedule,12324.4,30018.68,MSDRG Base Rate Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,839,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12324.4,,,,,,,fee schedule,12324.4,30018.68,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45460.05,,,,,,,fee schedule,27611.48,67253.57, Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58609.92,,,,,,,fee schedule,27611.48,67253.57, Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,56044.64,,,,,,,fee schedule,27611.48,67253.57, Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,67253.57,,,,,,,fee schedule,27611.48,67253.57, Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",30739.64,30739.64,30739.64,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28715.94,,,,,,,fee schedule,27611.48,67253.57,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28992.05,,,,,,,fee schedule,27611.48,67253.57,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Mcc,840,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27611.48,,,,,,,fee schedule,27611.48,67253.57,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22926.06,,,,,,,fee schedule,13924.81,33916.81, Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29557.71,,,,,,,fee schedule,13924.81,33916.81, Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28264.01,,,,,,,fee schedule,13924.81,33916.81, Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33916.81,,,,,,,fee schedule,13924.81,33916.81, Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7987.27,7987.27,7987.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21253.34,21253.34,21253.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13409.96,13409.96,20765.91,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14481.8,,,,,,,fee schedule,13924.81,33916.81,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14621.05,,,,,,,fee schedule,13924.81,33916.81,MSDRG Base Rate Lymphoma And Non-Acute Leukemia With Cc,841,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13924.81,,,,,,,fee schedule,13924.81,33916.81,MSDRG Base Rate Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14199.15,,,,,,,fee schedule,8624.27,21006.22, Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18306.43,,,,,,,fee schedule,8624.27,21006.22, Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17505.18,,,,,,,fee schedule,8624.27,21006.22, Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21006.22,,,,,,,fee schedule,8624.27,21006.22, Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,20860.12,20860.12,20860.12,1 through 10,percent of total billed charges,,, Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8969.24,,,,,,,fee schedule,8624.27,21006.22,MSDRG Base Rate Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9055.48,,,,,,,fee schedule,8624.27,21006.22,MSDRG Base Rate Lymphoma And Non-Acute Leukemia Without Cc/Mcc,842,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8624.27,,,,,,,fee schedule,8624.27,21006.22,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28032.92,,,,,,,fee schedule,17026.61,41471.89, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36141.79,,,,,,,fee schedule,17026.61,41471.89, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34559.91,,,,,,,fee schedule,17026.61,41471.89, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41471.89,,,,,,,fee schedule,17026.61,41471.89, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21276.65,21276.65,21276.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17707.67,,,,,,,fee schedule,17026.61,41471.89,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17877.94,,,,,,,fee schedule,17026.61,41471.89,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc,843,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17026.61,,,,,,,fee schedule,17026.61,41471.89,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17108.12,,,,,,,fee schedule,10391.11,25309.75, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22056.85,,,,,,,fee schedule,10391.11,25309.75, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21091.46,,,,,,,fee schedule,10391.11,25309.75, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,25309.75,,,,,,,fee schedule,10391.11,25309.75, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10806.75,,,,,,,fee schedule,10391.11,25309.75,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10910.67,,,,,,,fee schedule,10391.11,25309.75,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc,844,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10391.11,,,,,,,fee schedule,10391.11,25309.75,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11967.53,,,,,,,fee schedule,7268.83,17704.76, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15429.29,,,,,,,fee schedule,7268.83,17704.76, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14753.97,,,,,,,fee schedule,7268.83,17704.76, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17704.76,,,,,,,fee schedule,7268.83,17704.76, Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11094.29,11094.29,11094.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7559.58,,,,,,,fee schedule,7268.83,17704.76,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7632.27,,,,,,,fee schedule,7268.83,17704.76,MSDRG Base Rate Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc,845,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7268.83,,,,,,,fee schedule,7268.83,17704.76,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,36432.4,,,,,,,fee schedule,22128.28,53898.08, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,46970.92,,,,,,,fee schedule,22128.28,53898.08, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,44915.06,,,,,,,fee schedule,22128.28,53898.08, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,53898.08,,,,,,,fee schedule,22128.28,53898.08, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",43591.04,43591.04,43591.04,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],41000.54,41000.54,42842.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,22048.78,22048.78,24016.5,1 through 10,percent of total billed charges,,, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,23013.41,,,,,,,fee schedule,22128.28,53898.08,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23234.69,,,,,,,fee schedule,22128.28,53898.08,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc,846,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22128.28,,,,,,,fee schedule,22128.28,53898.08,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18384.13,,,,,,,fee schedule,11166.14,27197.48, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23701.97,,,,,,,fee schedule,11166.14,27197.48, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22664.57,,,,,,,fee schedule,11166.14,27197.48, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27197.48,,,,,,,fee schedule,11166.14,27197.48, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],255150.74,255150.74,255150.74,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20967.26,20342.58,21317.26,13,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],9096.28,9096.28,9096.28,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,5636.32,5636.32,5636.32,1 through 10,percent of total billed charges,,, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,21545.37,21545.37,21545.37,1 through 10,percent of total billed charges,,, Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11612.79,,,,,,,fee schedule,11166.14,27197.48,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11724.45,,,,,,,fee schedule,11166.14,27197.48,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc,847,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11166.14,,,,,,,fee schedule,11166.14,27197.48,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11936.62,,,,,,,fee schedule,7250.05,17659.03, Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15389.43,,,,,,,fee schedule,7250.05,17659.03, Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14715.86,,,,,,,fee schedule,7250.05,17659.03, Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17659.03,,,,,,,fee schedule,7250.05,17659.03, Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13737.87,13737.87,13737.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7540.05,,,,,,,fee schedule,7250.05,17659.03,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7612.55,,,,,,,fee schedule,7250.05,17659.03,MSDRG Base Rate Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc,848,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7250.05,,,,,,,fee schedule,7250.05,17659.03,MSDRG Base Rate Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38076.6,,,,,,,fee schedule,23126.93,56330.51, Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,49090.72,,,,,,,fee schedule,23126.93,56330.51, Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,46942.09,,,,,,,fee schedule,23126.93,56330.51, Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,56330.51,,,,,,,fee schedule,23126.93,56330.51, Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],35413.44,35413.44,35413.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24052.01,,,,,,,fee schedule,23126.93,56330.51,MSDRG Base Rate Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24283.28,,,,,,,fee schedule,23126.93,56330.51,MSDRG Base Rate Radiotherapy,849,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23126.93,,,,,,,fee schedule,23126.93,56330.51,MSDRG Base Rate Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,121691.95,,,,,,,fee schedule,73913.14,180031.01, Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,156892.82,,,,,,,fee schedule,73913.14,180031.01, Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,150025.84,,,,,,,fee schedule,73913.14,180031.01, Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,180031.01,,,,,,,fee schedule,73913.14,180031.01, Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,76869.67,,,,,,,fee schedule,73913.14,180031.01,MSDRG Base Rate Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,77608.8,,,,,,,fee schedule,73913.14,180031.01,MSDRG Base Rate Acute Leukemia With Other Procedures,850,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,73913.14,,,,,,,fee schedule,73913.14,180031.01,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,69402.15,,,,,,,fee schedule,42153.4,102673.49, Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,89477.55,,,,,,,fee schedule,42153.4,102673.49, Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,85561.25,,,,,,,fee schedule,42153.4,102673.49, Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,102673.49,,,,,,,fee schedule,42153.4,102673.49, Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",82157.44,82157.44,82157.44,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",43399.56,22864.83,78177.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],83551.81,37621.13,83901.81,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],73961.6,73961.6,81486.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],29160.58,29160.58,29160.58,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",153501.89,153501.89,153501.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,43839.54,,,,,,,fee schedule,42153.4,102673.49,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,44261.07,,,,,,,fee schedule,42153.4,102673.49,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures With Mcc,853,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,42153.4,,,,,,,fee schedule,42153.4,102673.49,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28079.3,,,,,,,fee schedule,17054.78,41540.5, Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36201.58,,,,,,,fee schedule,17054.78,41540.5, Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34617.08,,,,,,,fee schedule,17054.78,41540.5, Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41540.5,,,,,,,fee schedule,17054.78,41540.5, Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],31853.55,11950.96,33521.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],48492.65,48492.65,48492.65,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,640.98,640.98,640.98,1 through 10,percent of total billed charges,,, Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17736.97,,,,,,,fee schedule,17054.78,41540.5,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17907.52,,,,,,,fee schedule,17054.78,41540.5,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures With Cc,854,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17054.78,,,,,,,fee schedule,17054.78,41540.5,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21040.15,,,,,,,fee schedule,12779.35,31126.79, Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27126.27,,,,,,,fee schedule,12779.35,31126.79, Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25938.99,,,,,,,fee schedule,12779.35,31126.79, Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31126.79,,,,,,,fee schedule,12779.35,31126.79, Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],13817.8,13817.8,13817.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13290.52,,,,,,,fee schedule,12779.35,31126.79,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13418.32,,,,,,,fee schedule,12779.35,31126.79,MSDRG Base Rate Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc,855,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12779.35,,,,,,,fee schedule,12779.35,31126.79,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,63922.88,,,,,,,fee schedule,38825.41,94567.47, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,82413.35,,,,,,,fee schedule,38825.41,94567.47, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,78806.23,,,,,,,fee schedule,38825.41,94567.47, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,94567.47,,,,,,,fee schedule,38825.41,94567.47, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],75231.57,75231.57,75231.57,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],50928.21,50928.21,50928.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,117067.8,117067.8,117067.8,1 through 10,percent of total billed charges,,, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,40378.43,,,,,,,fee schedule,38825.41,94567.47,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,40766.68,,,,,,,fee schedule,38825.41,94567.47,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc,856,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,38825.41,,,,,,,fee schedule,38825.41,94567.47,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,30094.5,,,,,,,fee schedule,18278.77,44521.79, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,38799.7,,,,,,,fee schedule,18278.77,44521.79, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,37101.49,,,,,,,fee schedule,18278.77,44521.79, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,44521.79,,,,,,,fee schedule,18278.77,44521.79, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,30433.59,30433.59,30433.59,1 through 10,percent of total billed charges,,, Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19009.92,,,,,,,fee schedule,18278.77,44521.79,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19192.71,,,,,,,fee schedule,18278.77,44521.79,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc,857,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18278.77,,,,,,,fee schedule,18278.77,44521.79,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19574.42,,,,,,,fee schedule,11889.09,28958.39, Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25236.56,,,,,,,fee schedule,11889.09,28958.39, Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24131.99,,,,,,,fee schedule,11889.09,28958.39, Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,28958.39,,,,,,,fee schedule,11889.09,28958.39, Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12364.65,,,,,,,fee schedule,11889.09,28958.39,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12483.54,,,,,,,fee schedule,11889.09,28958.39,MSDRG Base Rate Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc,858,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11889.09,,,,,,,fee schedule,11889.09,28958.39,MSDRG Base Rate Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25628.46,,,,,,,fee schedule,15566.19,37914.72, Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33041.8,,,,,,,fee schedule,15566.19,37914.72, Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31595.6,,,,,,,fee schedule,15566.19,37914.72, Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,37914.72,,,,,,,fee schedule,15566.19,37914.72, Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",23060.62,23060.62,23060.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],24416.74,24377.48,26557.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16188.84,,,,,,,fee schedule,15566.19,37914.72,MSDRG Base Rate Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16344.5,,,,,,,fee schedule,15566.19,37914.72,MSDRG Base Rate Postoperative And Post-Traumatic Infections With Mcc,862,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15566.19,,,,,,,fee schedule,15566.19,37914.72,MSDRG Base Rate Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14023.49,,,,,,,fee schedule,8517.57,20746.34, Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18079.95,,,,,,,fee schedule,8517.57,20746.34, Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17288.62,,,,,,,fee schedule,8517.57,20746.34, Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20746.34,,,,,,,fee schedule,8517.57,20746.34, Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",23060.62,23060.62,23060.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14609.03,14609.03,14609.03,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],16759.82,16759.82,16770.82,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8858.27,,,,,,,fee schedule,8517.57,20746.34,MSDRG Base Rate Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8943.45,,,,,,,fee schedule,8517.57,20746.34,MSDRG Base Rate Postoperative And Post-Traumatic Infections Without Mcc,863,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8517.57,,,,,,,fee schedule,8517.57,20746.34,MSDRG Base Rate Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12474.85,,,,,,,fee schedule,7576.96,18455.28, Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16083.35,,,,,,,fee schedule,7576.96,18455.28, Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15379.4,,,,,,,fee schedule,7576.96,18455.28, Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18455.28,,,,,,,fee schedule,7576.96,18455.28, Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7880.04,,,,,,,fee schedule,7576.96,18455.28,MSDRG Base Rate Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7955.81,,,,,,,fee schedule,7576.96,18455.28,MSDRG Base Rate Fever And Inflammatory Conditions,864,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7576.96,,,,,,,fee schedule,7576.96,18455.28,MSDRG Base Rate Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21055.61,,,,,,,fee schedule,12788.73,31149.66, Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27146.2,,,,,,,fee schedule,12788.73,31149.66, Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25958.05,,,,,,,fee schedule,12788.73,31149.66, Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31149.66,,,,,,,fee schedule,12788.73,31149.66, Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13300.28,,,,,,,fee schedule,12788.73,31149.66,MSDRG Base Rate Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13428.17,,,,,,,fee schedule,12788.73,31149.66,MSDRG Base Rate Viral Illness With Mcc,865,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12788.73,,,,,,,fee schedule,12788.73,31149.66,MSDRG Base Rate Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12220.49,,,,,,,fee schedule,7422.47,18078.98, Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15755.41,,,,,,,fee schedule,7422.47,18078.98, Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15065.82,,,,,,,fee schedule,7422.47,18078.98, Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18078.98,,,,,,,fee schedule,7422.47,18078.98, Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11073.38,11073.38,11073.38,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7719.37,,,,,,,fee schedule,7422.47,18078.98,MSDRG Base Rate Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7793.59,,,,,,,fee schedule,7422.47,18078.98,MSDRG Base Rate Viral Illness Without Mcc,866,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7422.47,,,,,,,fee schedule,7422.47,18078.98,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29415.74,,,,,,,fee schedule,17866.5,43517.63, Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37924.6,,,,,,,fee schedule,17866.5,43517.63, Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,36264.69,,,,,,,fee schedule,17866.5,43517.63, Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43517.63,,,,,,,fee schedule,17866.5,43517.63, Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],31444.96,31444.96,31444.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],28429.13,28429.13,28429.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,104178.76,104178.76,104178.76,1 through 10,percent of total billed charges,,, Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18581.16,,,,,,,fee schedule,17866.5,43517.63,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18759.82,,,,,,,fee schedule,17866.5,43517.63,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses With Mcc,867,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17866.5,,,,,,,fee schedule,17866.5,43517.63,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14490.05,,,,,,,fee schedule,8800.95,21436.57, Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18681.47,,,,,,,fee schedule,8800.95,21436.57, Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17863.81,,,,,,,fee schedule,8800.95,21436.57, Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21436.57,,,,,,,fee schedule,8800.95,21436.57, Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9152.99,,,,,,,fee schedule,8800.95,21436.57,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9241,,,,,,,fee schedule,8800.95,21436.57,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses With Cc,868,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8800.95,,,,,,,fee schedule,8800.95,21436.57,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,10254.47,,,,,,,fee schedule,6228.35,15170.46, Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,13220.7,,,,,,,fee schedule,6228.35,15170.46, Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,12642.05,,,,,,,fee schedule,6228.35,15170.46, Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,15170.46,,,,,,,fee schedule,6228.35,15170.46, Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],9540.46,9540.46,9540.46,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6477.48,,,,,,,fee schedule,6228.35,15170.46,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6539.77,,,,,,,fee schedule,6228.35,15170.46,MSDRG Base Rate Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc,869,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6228.35,,,,,,,fee schedule,6228.35,15170.46,MSDRG Base Rate Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,97131.53,,,,,,,fee schedule,58995.65,143696.32, Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,125227.99,,,,,,,fee schedule,58995.65,143696.32, Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,119746.94,,,,,,,fee schedule,58995.65,143696.32, Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,143696.32,,,,,,,fee schedule,58995.65,143696.32, Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],116702.24,116702.24,116702.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],156845.25,156845.25,156845.25,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,211160.8,211160.8,211160.8,1 through 10,percent of total billed charges,,, Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,61355.48,,,,,,,fee schedule,58995.65,143696.32,MSDRG Base Rate Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,61945.43,,,,,,,fee schedule,58995.65,143696.32,MSDRG Base Rate Septicemia Or Severe Sepsis With Mv >96 Hours,870,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,58995.65,,,,,,,fee schedule,58995.65,143696.32,MSDRG Base Rate Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27297.95,,,,,,,fee schedule,16580.2,40384.58, Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35194.22,,,,,,,fee schedule,16580.2,40384.58, Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33653.81,,,,,,,fee schedule,16580.2,40384.58, Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40384.58,,,,,,,fee schedule,16580.2,40384.58, Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],12124,5758,85666.28,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],12165.02,7096.3,16981.08,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21798.17,21798.17,36113.69,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",20561.33,20561.33,34226.15,23,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],26013.52,7003.44,32919.54,60,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],16604.37,11069.58,32916.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],32374.65,23545.2,112956.62,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],37566.2,37566.2,37566.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],14611.98,14611.98,14611.98,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],16228.98,10989.46,26269.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],43542.4,43542.4,61184.76,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",32830.63,20211.71,43155.06,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,29154.08,12726.2,54719.58,1 through 10,percent of total billed charges,,, Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,32950.6,19203.15,36238.55,1 through 10,percent of total billed charges,,, Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,10015.63,10015.63,10015.63,1 through 10,percent of total billed charges,,, Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17243.41,,,,,,,fee schedule,16580.2,40384.58,MSDRG Base Rate Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17409.21,,,,,,,fee schedule,16580.2,40384.58,MSDRG Base Rate Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc,871,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16580.2,,,,,,,fee schedule,16580.2,40384.58,MSDRG Base Rate Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14380.43,,,,,,,fee schedule,8734.37,21274.41, Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18540.15,,,,,,,fee schedule,8734.37,21274.41, Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17728.67,,,,,,,fee schedule,8734.37,21274.41, Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21274.41,,,,,,,fee schedule,8734.37,21274.41, Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8637,8637,14382.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8941.01,8941.01,8961.31,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15651.15,15651.15,21798.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14693.72,11916.62,20561.33,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],13669,13669,13669,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],12578.95,6419.84,17296.06,35,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],17011.5,12357,17011.5,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8337.71,8337.71,8337.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],44996,44996,44996,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,7174.56,7174.56,7174.56,1 through 10,percent of total billed charges,,, Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,23997.31,23997.31,23997.31,1 through 10,percent of total billed charges,,, Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9083.74,,,,,,,fee schedule,8734.37,21274.41,MSDRG Base Rate Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9171.09,,,,,,,fee schedule,8734.37,21274.41,MSDRG Base Rate Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc,872,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8734.37,,,,,,,fee schedule,8734.37,21274.41,MSDRG Base Rate O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,54313.44,,,,,,,fee schedule,32988.84,80351.27, O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,70024.26,,,,,,,fee schedule,32988.84,80351.27, O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,66959.39,,,,,,,fee schedule,32988.84,80351.27, O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,80351.27,,,,,,,fee schedule,32988.84,80351.27, O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],44441.26,44441.26,44441.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,34308.39,,,,,,,fee schedule,32988.84,80351.27,MSDRG Base Rate O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34638.28,,,,,,,fee schedule,32988.84,80351.27,MSDRG Base Rate O.R. Procedures With Principal Diagnosis Of Mental Illness,876,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,32988.84,,,,,,,fee schedule,32988.84,80351.27,MSDRG Base Rate Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13493.69,,,,,,,fee schedule,8195.78,19962.56, Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17396.9,,,,,,,fee schedule,8195.78,19962.56, Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16635.47,,,,,,,fee schedule,8195.78,19962.56, Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19962.56,,,,,,,fee schedule,8195.78,19962.56, Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11909.32,11909.32,11909.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22439.27,22439.27,22439.27,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8523.61,,,,,,,fee schedule,8195.78,19962.56,MSDRG Base Rate Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8605.57,,,,,,,fee schedule,8195.78,19962.56,MSDRG Base Rate Acute Adjustment Reaction And Psychosocial Dysfunction,880,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8195.78,,,,,,,fee schedule,8195.78,19962.56,MSDRG Base Rate Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13222.47,,,,,,,fee schedule,8031.05,19561.31, Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17047.23,,,,,,,fee schedule,8031.05,19561.31, Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16301.09,,,,,,,fee schedule,8031.05,19561.31, Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19561.31,,,,,,,fee schedule,8031.05,19561.31, Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9384,9384,9384,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10251.7,10251.7,10251.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",7688.18,7688.18,7688.18,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],7849.37,7849.37,7849.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],14892.94,14892.94,15890.51,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],11608.37,11608.37,11608.37,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",9400.01,9400.01,9400.01,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,28077.34,28077.34,28077.34,1 through 10,percent of total billed charges,,, Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8352.29,,,,,,,fee schedule,8031.05,19561.31,MSDRG Base Rate Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8432.6,,,,,,,fee schedule,8031.05,19561.31,MSDRG Base Rate Depressive Neuroses,881,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8031.05,,,,,,,fee schedule,8031.05,19561.31,MSDRG Base Rate Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15090.11,,,,,,,fee schedule,9165.42,22324.3, Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19455.11,,,,,,,fee schedule,9165.42,22324.3, Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18603.59,,,,,,,fee schedule,9165.42,22324.3, Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22324.3,,,,,,,fee schedule,9165.42,22324.3, Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],9383.17,9383.17,9383.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17213.57,8272.66,68646.13,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],10048,10048,10048,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],15873,15873,15873,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],15460.32,15460.32,15460.32,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9532.04,,,,,,,fee schedule,9165.42,22324.3,MSDRG Base Rate Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9623.69,,,,,,,fee schedule,9165.42,22324.3,MSDRG Base Rate Neuroses Except Depressive,882,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9165.42,,,,,,,fee schedule,9165.42,22324.3,MSDRG Base Rate Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27632.41,,,,,,,fee schedule,16783.35,40879.38, Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35625.42,,,,,,,fee schedule,16783.35,40879.38, Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34066.15,,,,,,,fee schedule,16783.35,40879.38, Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40879.38,,,,,,,fee schedule,16783.35,40879.38, Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17454.68,,,,,,,fee schedule,16783.35,40879.38,MSDRG Base Rate Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17622.52,,,,,,,fee schedule,16783.35,40879.38,MSDRG Base Rate Disorders Of Personality And Impulse Control,883,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16783.35,,,,,,,fee schedule,16783.35,40879.38,MSDRG Base Rate Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22609.87,,,,,,,fee schedule,13732.76,33449.03, Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29150.05,,,,,,,fee schedule,13732.76,33449.03, Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27874.19,,,,,,,fee schedule,13732.76,33449.03, Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33449.03,,,,,,,fee schedule,13732.76,33449.03, Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14282.07,,,,,,,fee schedule,13732.76,33449.03,MSDRG Base Rate Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14419.4,,,,,,,fee schedule,13732.76,33449.03,MSDRG Base Rate Organic Disturbances And Intellectual Disability,884,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13732.76,,,,,,,fee schedule,13732.76,33449.03,MSDRG Base Rate Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19629.23,,,,,,,fee schedule,11922.38,29039.47, Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25307.22,,,,,,,fee schedule,11922.38,29039.47, Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24199.56,,,,,,,fee schedule,11922.38,29039.47, Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29039.47,,,,,,,fee schedule,11922.38,29039.47, Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],7013.37,4492,29033.57,14,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],7115.48,3765.2,30309.33,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",12113.22,11276.75,14280.66,17,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11316.61,8950.47,13385.52,43,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18417.82,5124,41654.64,88,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],5115.93,1281,11529,11,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],17649.75,12205.69,25536.42,23,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],23619.8,23619.8,27910.08,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],11189.24,11189.24,11189.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],8657.96,8657.96,8657.96,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],31500.03,11968.9,64547.34,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11004.54,8822.01,13172.58,19,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,20805.65,14403.14,27025.99,1 through 10,percent of total billed charges,,, Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,26807.6,26807.6,26807.6,1 through 10,percent of total billed charges,,, Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,6853.28,6853.28,6853.28,1 through 10,percent of total billed charges,,, Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12399.28,,,,,,,fee schedule,11922.38,29039.47,MSDRG Base Rate Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12518.5,,,,,,,fee schedule,11922.38,29039.47,MSDRG Base Rate Psychoses,885,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11922.38,,,,,,,fee schedule,11922.38,29039.47,MSDRG Base Rate Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,29164.19,,,,,,,fee schedule,17713.72,43145.49, Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37600.29,,,,,,,fee schedule,17713.72,43145.49, Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,35954.57,,,,,,,fee schedule,17713.72,43145.49, Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,43145.49,,,,,,,fee schedule,17713.72,43145.49, Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18422.27,,,,,,,fee schedule,17713.72,43145.49,MSDRG Base Rate Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18599.41,,,,,,,fee schedule,17713.72,43145.49,MSDRG Base Rate Behavioral And Developmental Disorders,886,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17713.72,,,,,,,fee schedule,17713.72,43145.49,MSDRG Base Rate Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,15049.36,,,,,,,fee schedule,9140.66,22264.01, Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,19402.57,,,,,,,fee schedule,9140.66,22264.01, Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,18553.34,,,,,,,fee schedule,9140.66,22264.01, Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,22264.01,,,,,,,fee schedule,9140.66,22264.01, Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9506.29,,,,,,,fee schedule,9140.66,22264.01,MSDRG Base Rate Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9597.69,,,,,,,fee schedule,9140.66,22264.01,MSDRG Base Rate Other Mental Disorder Diagnoses,887,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9140.66,,,,,,,fee schedule,9140.66,22264.01,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8669.3,,,,,,,fee schedule,5265.55,12825.35, "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11176.99,,,,,,,fee schedule,5265.55,12825.35, "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10687.79,,,,,,,fee schedule,5265.55,12825.35, "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,12825.35,,,,,,,fee schedule,5265.55,12825.35, "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5476.17,,,,,,,fee schedule,5265.55,12825.35,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5528.83,,,,,,,fee schedule,5265.55,12825.35,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence, Left Ama",894,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5265.55,,,,,,,fee schedule,5265.55,12825.35,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,19893.43,,,,,,,fee schedule,12082.85,29430.32, "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,25647.84,,,,,,,fee schedule,12082.85,29430.32, "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,24525.27,,,,,,,fee schedule,12082.85,29430.32, "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,29430.32,,,,,,,fee schedule,12082.85,29430.32, "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,12566.16,,,,,,,fee schedule,12082.85,29430.32,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,12686.99,,,,,,,fee schedule,12082.85,29430.32,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy",895,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12082.85,,,,,,,fee schedule,12082.85,29430.32,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24523.89,,,,,,,fee schedule,14895.3,36280.63, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31617.72,,,,,,,fee schedule,14895.3,36280.63, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30233.86,,,,,,,fee schedule,14895.3,36280.63, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36280.63,,,,,,,fee schedule,14895.3,36280.63, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11753.02,11753.02,11753.02,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",17125.6,17125.6,35254.86,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],20964.7,20964.7,20964.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",34625.36,34625.36,34625.36,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15595.89,15595.89,15595.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15491.11,,,,,,,fee schedule,14895.3,36280.63,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15640.06,,,,,,,fee schedule,14895.3,36280.63,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc",896,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14895.3,,,,,,,fee schedule,14895.3,36280.63,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12405.99,,,,,,,fee schedule,7535.14,18353.41, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15994.57,,,,,,,fee schedule,7535.14,18353.41, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15294.51,,,,,,,fee schedule,7535.14,18353.41, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18353.41,,,,,,,fee schedule,7535.14,18353.41, "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",11753.02,10684.56,18198.84,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10972.77,8759.16,17125.6,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],3462.15,3462.15,3462.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13799.79,13153.55,14790.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],12308.89,12308.89,12308.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16841.42,16841.42,16841.42,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7836.55,,,,,,,fee schedule,7535.14,18353.41,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7911.9,,,,,,,fee schedule,7535.14,18353.41,MSDRG Base Rate "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc",897,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7535.14,,,,,,,fee schedule,7535.14,18353.41,MSDRG Base Rate Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,58974.82,,,,,,,fee schedule,35820.07,87247.31, Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,76034,,,,,,,fee schedule,35820.07,87247.31, Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,72706.1,,,,,,,fee schedule,35820.07,87247.31, Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,87247.31,,,,,,,fee schedule,35820.07,87247.31, Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],58735.59,58735.59,58735.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37252.87,,,,,,,fee schedule,35820.07,87247.31,MSDRG Base Rate Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37611.07,,,,,,,fee schedule,35820.07,87247.31,MSDRG Base Rate Wound Debridements For Injuries With Mcc,901,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35820.07,,,,,,,fee schedule,35820.07,87247.31,MSDRG Base Rate Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,26904.47,,,,,,,fee schedule,16341.21,39802.46, Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,34686.91,,,,,,,fee schedule,16341.21,39802.46, Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,33168.71,,,,,,,fee schedule,16341.21,39802.46, Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,39802.46,,,,,,,fee schedule,16341.21,39802.46, Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,32394.56,32394.56,32394.56,1 through 10,percent of total billed charges,,, Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16994.86,,,,,,,fee schedule,16341.21,39802.46,MSDRG Base Rate Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17158.27,,,,,,,fee schedule,16341.21,39802.46,MSDRG Base Rate Wound Debridements For Injuries With Cc,902,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16341.21,,,,,,,fee schedule,16341.21,39802.46,MSDRG Base Rate Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16436.39,,,,,,,fee schedule,9983.12,24315.98, Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21190.81,,,,,,,fee schedule,9983.12,24315.98, Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20263.32,,,,,,,fee schedule,9983.12,24315.98, Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24315.98,,,,,,,fee schedule,9983.12,24315.98, Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10382.44,,,,,,,fee schedule,9983.12,24315.98,MSDRG Base Rate Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10482.28,,,,,,,fee schedule,9983.12,24315.98,MSDRG Base Rate Wound Debridements For Injuries Without Cc/Mcc,903,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9983.12,,,,,,,fee schedule,9983.12,24315.98,MSDRG Base Rate Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,51618.07,,,,,,,fee schedule,31351.73,76363.75, Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,66549.23,,,,,,,fee schedule,31351.73,76363.75, Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,63636.46,,,,,,,fee schedule,31351.73,76363.75, Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,76363.75,,,,,,,fee schedule,31351.73,76363.75, Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22403.14,22403.14,22403.14,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32605.8,,,,,,,fee schedule,31351.73,76363.75,MSDRG Base Rate Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32919.32,,,,,,,fee schedule,31351.73,76363.75,MSDRG Base Rate Skin Grafts For Injuries With Cc/Mcc,904,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,31351.73,,,,,,,fee schedule,31351.73,76363.75,MSDRG Base Rate Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,20846.22,,,,,,,fee schedule,12661.56,30839.89, Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,26876.24,,,,,,,fee schedule,12661.56,30839.89, Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,25699.91,,,,,,,fee schedule,12661.56,30839.89, Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,30839.89,,,,,,,fee schedule,12661.56,30839.89, Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13168.02,,,,,,,fee schedule,12661.56,30839.89,MSDRG Base Rate Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13294.64,,,,,,,fee schedule,12661.56,30839.89,MSDRG Base Rate Skin Grafts For Injuries Without Cc/Mcc,905,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,12661.56,,,,,,,fee schedule,12661.56,30839.89,MSDRG Base Rate Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,27604.31,,,,,,,fee schedule,16766.28,40837.8, Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,35589.19,,,,,,,fee schedule,16766.28,40837.8, Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34031.5,,,,,,,fee schedule,16766.28,40837.8, Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,40837.8,,,,,,,fee schedule,16766.28,40837.8, Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17436.93,,,,,,,fee schedule,16766.28,40837.8,MSDRG Base Rate Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17604.59,,,,,,,fee schedule,16766.28,40837.8,MSDRG Base Rate Hand Procedures For Injuries,906,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,16766.28,,,,,,,fee schedule,16766.28,40837.8,MSDRG Base Rate Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,53953.68,,,,,,,fee schedule,32770.33,79819.05, Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,69560.44,,,,,,,fee schedule,32770.33,79819.05, Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,66515.87,,,,,,,fee schedule,32770.33,79819.05, Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,79819.05,,,,,,,fee schedule,32770.33,79819.05, Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],66830.55,52815.89,66830.55,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,34081.14,,,,,,,fee schedule,32770.33,79819.05,MSDRG Base Rate Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34408.85,,,,,,,fee schedule,32770.33,79819.05,MSDRG Base Rate Other O.R. Procedures For Injuries With Mcc,907,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,32770.33,,,,,,,fee schedule,32770.33,79819.05,MSDRG Base Rate Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28038.55,,,,,,,fee schedule,17030.02,41480.21, Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36149.03,,,,,,,fee schedule,17030.02,41480.21, Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,34566.84,,,,,,,fee schedule,17030.02,41480.21, Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,41480.21,,,,,,,fee schedule,17030.02,41480.21, Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8637,8637,8637,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],33738.87,33738.87,33838.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],32982.15,32982.15,32982.15,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17711.22,,,,,,,fee schedule,17030.02,41480.21,MSDRG Base Rate Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,17881.52,,,,,,,fee schedule,17030.02,41480.21,MSDRG Base Rate Other O.R. Procedures For Injuries With Cc,908,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17030.02,,,,,,,fee schedule,17030.02,41480.21,MSDRG Base Rate Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18447.37,,,,,,,fee schedule,11204.55,27291.03, Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23783.5,,,,,,,fee schedule,11204.55,27291.03, Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22742.53,,,,,,,fee schedule,11204.55,27291.03, Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,27291.03,,,,,,,fee schedule,11204.55,27291.03, Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],7518.24,7518.24,7518.24,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19877,19877,19877,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],3850,3850,3850,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11652.73,,,,,,,fee schedule,11204.55,27291.03,MSDRG Base Rate Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11764.78,,,,,,,fee schedule,11204.55,27291.03,MSDRG Base Rate Other O.R. Procedures For Injuries Without Cc/Mcc,909,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11204.55,,,,,,,fee schedule,11204.55,27291.03,MSDRG Base Rate Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22971.03,,,,,,,fee schedule,13952.12,33983.33, Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29615.68,,,,,,,fee schedule,13952.12,33983.33, Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28319.45,,,,,,,fee schedule,13952.12,33983.33, Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,33983.33,,,,,,,fee schedule,13952.12,33983.33, Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14510.2,,,,,,,fee schedule,13952.12,33983.33,MSDRG Base Rate Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14649.73,,,,,,,fee schedule,13952.12,33983.33,MSDRG Base Rate Traumatic Injury With Mcc,913,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13952.12,,,,,,,fee schedule,13952.12,33983.33,MSDRG Base Rate Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12443.93,,,,,,,fee schedule,7558.18,18409.55, Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16043.49,,,,,,,fee schedule,7558.18,18409.55, Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15341.29,,,,,,,fee schedule,7558.18,18409.55, Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18409.55,,,,,,,fee schedule,7558.18,18409.55, Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7860.51,,,,,,,fee schedule,7558.18,18409.55,MSDRG Base Rate Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7936.09,,,,,,,fee schedule,7558.18,18409.55,MSDRG Base Rate Traumatic Injury Without Mcc,914,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7558.18,,,,,,,fee schedule,7558.18,18409.55,MSDRG Base Rate Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23631.52,,,,,,,fee schedule,14353.29,34960.46, Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,30467.23,,,,,,,fee schedule,14353.29,34960.46, Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29133.72,,,,,,,fee schedule,14353.29,34960.46, Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34960.46,,,,,,,fee schedule,14353.29,34960.46, Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10293.8,10293.8,10293.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14927.42,,,,,,,fee schedule,14353.29,34960.46,MSDRG Base Rate Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15070.95,,,,,,,fee schedule,14353.29,34960.46,MSDRG Base Rate Allergic Reactions With Mcc,915,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14353.29,,,,,,,fee schedule,14353.29,34960.46,MSDRG Base Rate Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9363.51,,,,,,,fee schedule,5687.2,13852.38, Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12072.02,,,,,,,fee schedule,5687.2,13852.38, Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11543.65,,,,,,,fee schedule,5687.2,13852.38, Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13852.38,,,,,,,fee schedule,5687.2,13852.38, Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],10790.94,10790.94,10790.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5914.69,,,,,,,fee schedule,5687.2,13852.38,MSDRG Base Rate Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5971.56,,,,,,,fee schedule,5687.2,13852.38,MSDRG Base Rate Allergic Reactions Without Mcc,916,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5687.2,,,,,,,fee schedule,5687.2,13852.38,MSDRG Base Rate Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,22040.73,,,,,,,fee schedule,13387.07,32607.04, Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28416.27,,,,,,,fee schedule,13387.07,32607.04, Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,27172.53,,,,,,,fee schedule,13387.07,32607.04, Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32607.04,,,,,,,fee schedule,13387.07,32607.04, Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15712.19,15712.19,15712.19,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14751.99,14751.99,24525.41,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],18892.53,18892.53,27505.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13922.55,,,,,,,fee schedule,13387.07,32607.04,MSDRG Base Rate Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14056.42,,,,,,,fee schedule,13387.07,32607.04,MSDRG Base Rate Poisoning And Toxic Effects Of Drugs With Mcc,917,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13387.07,,,,,,,fee schedule,13387.07,32607.04,MSDRG Base Rate Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12044.83,,,,,,,fee schedule,7315.77,17819.11, Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,15528.94,,,,,,,fee schedule,7315.77,17819.11, Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,14849.26,,,,,,,fee schedule,7315.77,17819.11, Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,17819.11,,,,,,,fee schedule,7315.77,17819.11, Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14836.69,14836.69,14840.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],10498.26,10498.26,10498.26,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",10282.21,10282.21,10282.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7608.4,,,,,,,fee schedule,7315.77,17819.11,MSDRG Base Rate Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7681.56,,,,,,,fee schedule,7315.77,17819.11,MSDRG Base Rate Poisoning And Toxic Effects Of Drugs Without Mcc,918,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7315.77,,,,,,,fee schedule,7315.77,17819.11,MSDRG Base Rate Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,25728.23,,,,,,,fee schedule,15626.79,38062.33, Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,33170.43,,,,,,,fee schedule,15626.79,38062.33, Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,31718.61,,,,,,,fee schedule,15626.79,38062.33, Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,38062.33,,,,,,,fee schedule,15626.79,38062.33, Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16886.47,16886.47,16886.47,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],30592.71,30592.71,30592.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],30589.36,20740.82,30611.17,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],30089.4,30089.4,30089.4,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,16251.86,,,,,,,fee schedule,15626.79,38062.33,MSDRG Base Rate Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,16408.13,,,,,,,fee schedule,15626.79,38062.33,MSDRG Base Rate Complications Of Treatment With Mcc,919,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,15626.79,,,,,,,fee schedule,15626.79,38062.33,MSDRG Base Rate Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14085.32,,,,,,,fee schedule,8555.13,20837.82, Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18159.67,,,,,,,fee schedule,8555.13,20837.82, Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17364.85,,,,,,,fee schedule,8555.13,20837.82, Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,20837.82,,,,,,,fee schedule,8555.13,20837.82, Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],5856,5856,5856,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],12190.8,12190.8,12190.8,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,9352.69,9352.69,9352.69,1 through 10,percent of total billed charges,,, Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8897.34,,,,,,,fee schedule,8555.13,20837.82,MSDRG Base Rate Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8982.89,,,,,,,fee schedule,8555.13,20837.82,MSDRG Base Rate Complications Of Treatment With Cc,920,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8555.13,,,,,,,fee schedule,8555.13,20837.82,MSDRG Base Rate Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,9674.09,,,,,,,fee schedule,5875.84,14311.84, Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,12472.43,,,,,,,fee schedule,5875.84,14311.84, Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,11926.53,,,,,,,fee schedule,5875.84,14311.84, Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,14311.84,,,,,,,fee schedule,5875.84,14311.84, Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],11706.29,11706.29,11706.29,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,6110.87,,,,,,,fee schedule,5875.84,14311.84,MSDRG Base Rate Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,6169.63,,,,,,,fee schedule,5875.84,14311.84,MSDRG Base Rate Complications Of Treatment Without Cc/Mcc,921,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5875.84,,,,,,,fee schedule,5875.84,14311.84,MSDRG Base Rate "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24584.32,,,,,,,fee schedule,14932,36370.03, "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31695.63,,,,,,,fee schedule,14932,36370.03, "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,30308.36,,,,,,,fee schedule,14932,36370.03, "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,36370.03,,,,,,,fee schedule,14932,36370.03, "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15529.28,,,,,,,fee schedule,14932,36370.03,MSDRG Base Rate "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15678.6,,,,,,,fee schedule,14932,36370.03,MSDRG Base Rate "Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc",922,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14932,,,,,,,fee schedule,14932,36370.03,MSDRG Base Rate "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,14301.74,,,,,,,fee schedule,8686.58,21157.98, "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,18438.69,,,,,,,fee schedule,8686.58,21157.98, "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,17631.65,,,,,,,fee schedule,8686.58,21157.98, "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,21157.98,,,,,,,fee schedule,8686.58,21157.98, "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],27650.05,27650.05,27650.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8917.7,8917.7,8917.7,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,9034.04,,,,,,,fee schedule,8686.58,21157.98,MSDRG Base Rate "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,9120.91,,,,,,,fee schedule,8686.58,21157.98,MSDRG Base Rate "Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc",923,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8686.58,,,,,,,fee schedule,8686.58,21157.98,MSDRG Base Rate Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,300038.58,,,,,,,fee schedule,182237.13,443876.9, Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,386828.36,,,,,,,fee schedule,182237.13,443876.9, Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,369897.41,,,,,,,fee schedule,182237.13,443876.9, Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,443876.9,,,,,,,fee schedule,182237.13,443876.9, Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,189526.62,,,,,,,fee schedule,182237.13,443876.9,MSDRG Base Rate Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,191348.99,,,,,,,fee schedule,182237.13,443876.9,MSDRG Base Rate Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft,927,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,182237.13,,,,,,,fee schedule,182237.13,443876.9,MSDRG Base Rate Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,100797.95,,,,,,,fee schedule,61222.56,149120.43, Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,129954.98,,,,,,,fee schedule,61222.56,149120.43, Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,124267.03,,,,,,,fee schedule,61222.56,149120.43, Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,149120.43,,,,,,,fee schedule,61222.56,149120.43, Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,63671.46,,,,,,,fee schedule,61222.56,149120.43,MSDRG Base Rate Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,64283.69,,,,,,,fee schedule,61222.56,149120.43,MSDRG Base Rate Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc,928,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,61222.56,,,,,,,fee schedule,61222.56,149120.43,MSDRG Base Rate Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,45261.9,,,,,,,fee schedule,27491.13,66960.43, Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,58354.45,,,,,,,fee schedule,27491.13,66960.43, Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,55800.36,,,,,,,fee schedule,27491.13,66960.43, Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,66960.43,,,,,,,fee schedule,27491.13,66960.43, Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,28590.78,,,,,,,fee schedule,27491.13,66960.43,MSDRG Base Rate Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,28865.69,,,,,,,fee schedule,27491.13,66960.43,MSDRG Base Rate Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc,929,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,27491.13,,,,,,,fee schedule,27491.13,66960.43,MSDRG Base Rate Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,54725.19,,,,,,,fee schedule,33238.93,80960.42, Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,70555.12,,,,,,,fee schedule,33238.93,80960.42, Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,67467.02,,,,,,,fee schedule,33238.93,80960.42, Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,80960.42,,,,,,,fee schedule,33238.93,80960.42, Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,34568.49,,,,,,,fee schedule,33238.93,80960.42,MSDRG Base Rate Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,34900.88,,,,,,,fee schedule,33238.93,80960.42,MSDRG Base Rate Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft,933,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,33238.93,,,,,,,fee schedule,33238.93,80960.42,MSDRG Base Rate Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,31065.56,,,,,,,fee schedule,18868.57,45958.37, Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,40051.65,,,,,,,fee schedule,18868.57,45958.37, Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,38298.65,,,,,,,fee schedule,18868.57,45958.37, Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,45958.37,,,,,,,fee schedule,18868.57,45958.37, Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,19623.31,,,,,,,fee schedule,18868.57,45958.37,MSDRG Base Rate Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,19812,,,,,,,fee schedule,18868.57,45958.37,MSDRG Base Rate Full Thickness Burn Without Skin Graft Or Inhalation Injury,934,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,18868.57,,,,,,,fee schedule,18868.57,45958.37,MSDRG Base Rate Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28949.18,,,,,,,fee schedule,17583.12,42827.4, Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,37323.08,,,,,,,fee schedule,17583.12,42827.4, Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,35689.5,,,,,,,fee schedule,17583.12,42827.4, Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,42827.4,,,,,,,fee schedule,17583.12,42827.4, Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,18286.44,,,,,,,fee schedule,17583.12,42827.4,MSDRG Base Rate Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18462.28,,,,,,,fee schedule,17583.12,42827.4,MSDRG Base Rate Non-Extensive Burns,935,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17583.12,,,,,,,fee schedule,17583.12,42827.4,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,50991.31,,,,,,,fee schedule,30971.05,75436.52, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,65741.16,,,,,,,fee schedule,30971.05,75436.52, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,62863.76,,,,,,,fee schedule,30971.05,75436.52, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,75436.52,,,,,,,fee schedule,30971.05,75436.52, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],17223.62,17223.62,17223.62,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,32209.89,,,,,,,fee schedule,30971.05,75436.52,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,32519.6,,,,,,,fee schedule,30971.05,75436.52,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc,939,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,30971.05,,,,,,,fee schedule,30971.05,75436.52,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,32840.46,,,,,,,fee schedule,19946.6,48584.15, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,42339.95,,,,,,,fee schedule,19946.6,48584.15, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,40486.79,,,,,,,fee schedule,19946.6,48584.15, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,48584.15,,,,,,,fee schedule,19946.6,48584.15, O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,20744.46,,,,,,,fee schedule,19946.6,48584.15,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,20943.93,,,,,,,fee schedule,19946.6,48584.15,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc,940,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,19946.6,,,,,,,fee schedule,19946.6,48584.15,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,28495.27,,,,,,,fee schedule,17307.43,42155.88, O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,36737.87,,,,,,,fee schedule,17307.43,42155.88, O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,35129.9,,,,,,,fee schedule,17307.43,42155.88, O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,42155.88,,,,,,,fee schedule,17307.43,42155.88, O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,17999.73,,,,,,,fee schedule,17307.43,42155.88,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,18172.8,,,,,,,fee schedule,17307.43,42155.88,MSDRG Base Rate O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc,941,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,17307.43,,,,,,,fee schedule,17307.43,42155.88,MSDRG Base Rate Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21762.48,,,,,,,fee schedule,13218.07,32195.39, Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,28057.53,,,,,,,fee schedule,13218.07,32195.39, Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26829.5,,,,,,,fee schedule,13218.07,32195.39, Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,32195.39,,,,,,,fee schedule,13218.07,32195.39, Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13746.79,,,,,,,fee schedule,13218.07,32195.39,MSDRG Base Rate Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13878.97,,,,,,,fee schedule,13218.07,32195.39,MSDRG Base Rate Rehabilitation With Cc/Mcc,945,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13218.07,,,,,,,fee schedule,13218.07,32195.39,MSDRG Base Rate Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16115.98,,,,,,,fee schedule,9788.51,23841.97, Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,20777.72,,,,,,,fee schedule,9788.51,23841.97, Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,19868.31,,,,,,,fee schedule,9788.51,23841.97, Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,23841.97,,,,,,,fee schedule,9788.51,23841.97, Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10180.05,,,,,,,fee schedule,9788.51,23841.97,MSDRG Base Rate Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10277.94,,,,,,,fee schedule,9788.51,23841.97,MSDRG Base Rate Rehabilitation Without Cc/Mcc,946,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,9788.51,,,,,,,fee schedule,9788.51,23841.97,MSDRG Base Rate Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,17838.88,,,,,,,fee schedule,10834.96,26390.83, Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,22998.99,,,,,,,fee schedule,10834.96,26390.83, Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,21992.36,,,,,,,fee schedule,10834.96,26390.83, Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26390.83,,,,,,,fee schedule,10834.96,26390.83, Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],10877.87,10877.87,10877.87,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],21547.29,21547.29,21575.61,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],22958.1,22958.1,22958.1,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16220.59,16220.59,16220.59,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,46008.81,46008.81,46008.81,1 through 10,percent of total billed charges,,, Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11268.36,,,,,,,fee schedule,10834.96,26390.83,MSDRG Base Rate Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11376.71,,,,,,,fee schedule,10834.96,26390.83,MSDRG Base Rate Signs And Symptoms With Mcc,947,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10834.96,,,,,,,fee schedule,10834.96,26390.83,MSDRG Base Rate Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,11249.43,,,,,,,fee schedule,6832.67,16642.4, Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,14503.46,,,,,,,fee schedule,6832.67,16642.4, Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,13868.66,,,,,,,fee schedule,6832.67,16642.4, Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,16642.4,,,,,,,fee schedule,6832.67,16642.4, Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],5758,5758,5758,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",16492.72,16492.72,16492.72,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13328.53,13328.53,13328.53,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,9003.99,9003.99,9003.99,1 through 10,percent of total billed charges,,, Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,21278.07,21278.07,21278.07,1 through 10,percent of total billed charges,,, Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,7105.98,,,,,,,fee schedule,6832.67,16642.4,MSDRG Base Rate Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,7174.3,,,,,,,fee schedule,6832.67,16642.4,MSDRG Base Rate Signs And Symptoms Without Mcc,948,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,6832.67,,,,,,,fee schedule,6832.67,16642.4,MSDRG Base Rate Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16718.85,,,,,,,fee schedule,10154.68,24733.86, Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21554.98,,,,,,,fee schedule,10154.68,24733.86, Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20611.55,,,,,,,fee schedule,10154.68,24733.86, Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24733.86,,,,,,,fee schedule,10154.68,24733.86, Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],8456,8456,8456,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],8307.52,8307.52,8307.52,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],5525,5525,7650,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,162,162,162,1 through 10,percent of total billed charges,,, Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10560.87,,,,,,,fee schedule,10154.68,24733.86,MSDRG Base Rate Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10662.41,,,,,,,fee schedule,10154.68,24733.86,MSDRG Base Rate Aftercare With Cc/Mcc,949,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10154.68,,,,,,,fee schedule,10154.68,24733.86,MSDRG Base Rate Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,8821.07,,,,,,,fee schedule,5357.73,13049.88, Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,11372.67,,,,,,,fee schedule,5357.73,13049.88, Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,10874.9,,,,,,,fee schedule,5357.73,13049.88, Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,13049.88,,,,,,,fee schedule,5357.73,13049.88, Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,5572.04,,,,,,,fee schedule,5357.73,13049.88,MSDRG Base Rate Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,5625.62,,,,,,,fee schedule,5357.73,13049.88,MSDRG Base Rate Aftercare Without Cc/Mcc,950,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,5357.73,,,,,,,fee schedule,5357.73,13049.88,MSDRG Base Rate Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,7813.47,,,,,,,fee schedule,4745.74,11559.24, Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,10073.61,,,,,,,fee schedule,4745.74,11559.24, Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,9632.7,,,,,,,fee schedule,4745.74,11559.24, Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,11559.24,,,,,,,fee schedule,4745.74,11559.24, Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],9061.99,9061.99,9061.99,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,4935.57,,,,,,,fee schedule,4745.74,11559.24,MSDRG Base Rate Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,4983.03,,,,,,,fee schedule,4745.74,11559.24,MSDRG Base Rate Other Factors Influencing Health Status,951,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,4745.74,,,,,,,fee schedule,4745.74,11559.24,MSDRG Base Rate Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,94592.15,,,,,,,fee schedule,57453.28,139939.57, Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,121954.07,,,,,,,fee schedule,57453.28,139939.57, Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,116616.31,,,,,,,fee schedule,57453.28,139939.57, Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,139939.57,,,,,,,fee schedule,57453.28,139939.57, Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,59751.41,,,,,,,fee schedule,57453.28,139939.57,MSDRG Base Rate Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,60325.94,,,,,,,fee schedule,57453.28,139939.57,MSDRG Base Rate Craniotomy For Multiple Significant Trauma,955,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,57453.28,,,,,,,fee schedule,57453.28,139939.57,MSDRG Base Rate "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,52881.44,,,,,,,fee schedule,32119.07,78232.77, "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,68178.03,,,,,,,fee schedule,32119.07,78232.77, "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,65193.98,,,,,,,fee schedule,32119.07,78232.77, "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,78232.77,,,,,,,fee schedule,32119.07,78232.77, "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],37249.9,37249.9,37249.9,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,33403.83,,,,,,,fee schedule,32119.07,78232.77,MSDRG Base Rate "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,33725.02,,,,,,,fee schedule,32119.07,78232.77,MSDRG Base Rate "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma",956,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,32119.07,,,,,,,fee schedule,32119.07,78232.77,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,107082.45,,,,,,,fee schedule,65039.63,158417.72, Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,138057.35,,,,,,,fee schedule,65039.63,158417.72, Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,132014.77,,,,,,,fee schedule,65039.63,158417.72, Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,158417.72,,,,,,,fee schedule,65039.63,158417.72, Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,67641.22,,,,,,,fee schedule,65039.63,158417.72,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,68291.61,,,,,,,fee schedule,65039.63,158417.72,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma With Mcc,957,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,65039.63,,,,,,,fee schedule,65039.63,158417.72,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,59217.94,,,,,,,fee schedule,35967.73,87606.98, Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,76347.44,,,,,,,fee schedule,35967.73,87606.98, Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,73005.82,,,,,,,fee schedule,35967.73,87606.98, Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,87606.98,,,,,,,fee schedule,35967.73,87606.98, Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,37406.44,,,,,,,fee schedule,35967.73,87606.98,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,37766.12,,,,,,,fee schedule,35967.73,87606.98,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma With Cc,958,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,35967.73,,,,,,,fee schedule,35967.73,87606.98,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,41373.44,,,,,,,fee schedule,25129.36,61207.84, Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,53341.2,,,,,,,fee schedule,25129.36,61207.84, Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,51006.53,,,,,,,fee schedule,25129.36,61207.84, Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,61207.84,,,,,,,fee schedule,25129.36,61207.84, Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],14646.05,14646.05,14646.05,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,26134.53,,,,,,,fee schedule,25129.36,61207.84,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,26385.83,,,,,,,fee schedule,25129.36,61207.84,MSDRG Base Rate Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc,959,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,25129.36,,,,,,,fee schedule,25129.36,61207.84,MSDRG Base Rate Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,38418.09,,,,,,,fee schedule,23334.34,56835.7, Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,49530.99,,,,,,,fee schedule,23334.34,56835.7, Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,47363.09,,,,,,,fee schedule,23334.34,56835.7, Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,56835.7,,,,,,,fee schedule,23334.34,56835.7, Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,24267.71,,,,,,,fee schedule,23334.34,56835.7,MSDRG Base Rate Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,24501.06,,,,,,,fee schedule,23334.34,56835.7,MSDRG Base Rate Other Multiple Significant Trauma With Mcc,963,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,23334.34,,,,,,,fee schedule,23334.34,56835.7,MSDRG Base Rate Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,21537.63,,,,,,,fee schedule,13081.5,31862.75, Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,27767.65,,,,,,,fee schedule,13081.5,31862.75, Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,26552.3,,,,,,,fee schedule,13081.5,31862.75, Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,31862.75,,,,,,,fee schedule,13081.5,31862.75, Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,13604.76,,,,,,,fee schedule,13081.5,31862.75,MSDRG Base Rate Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,13735.58,,,,,,,fee schedule,13081.5,31862.75,MSDRG Base Rate Other Multiple Significant Trauma With Cc,964,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,13081.5,,,,,,,fee schedule,13081.5,31862.75,MSDRG Base Rate Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,13216.85,,,,,,,fee schedule,8027.63,19553, Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,17039.98,,,,,,,fee schedule,8027.63,19553, Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,16294.16,,,,,,,fee schedule,8027.63,19553, Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,19553,,,,,,,fee schedule,8027.63,19553, Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8348.74,,,,,,,fee schedule,8027.63,19553,MSDRG Base Rate Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8429.01,,,,,,,fee schedule,8027.63,19553,MSDRG Base Rate Other Multiple Significant Trauma Without Cc/Mcc,965,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,8027.63,,,,,,,fee schedule,8027.63,19553,MSDRG Base Rate Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,86022.63,,,,,,,fee schedule,52248.34,127261.83, Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,110905.71,,,,,,,fee schedule,52248.34,127261.83, Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,106051.52,,,,,,,fee schedule,52248.34,127261.83, Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,127261.83,,,,,,,fee schedule,52248.34,127261.83, Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",42614.93,42614.93,42614.93,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,54338.27,,,,,,,fee schedule,52248.34,127261.83,MSDRG Base Rate Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,54860.76,,,,,,,fee schedule,52248.34,127261.83,MSDRG Base Rate Hiv With Extensive O.R. Procedures With Mcc,969,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,52248.34,,,,,,,fee schedule,52248.34,127261.83,MSDRG Base Rate Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,37063.38,,,,,,,fee schedule,22511.52,54831.55, Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,47784.41,,,,,,,fee schedule,22511.52,54831.55, Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,45692.96,,,,,,,fee schedule,22511.52,54831.55, Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,54831.55,,,,,,,fee schedule,22511.52,54831.55, Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,23411.98,,,,,,,fee schedule,22511.52,54831.55,MSDRG Base Rate Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,23637.1,,,,,,,fee schedule,22511.52,54831.55,MSDRG Base Rate Hiv With Extensive O.R. Procedures Without Mcc,970,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,22511.52,,,,,,,fee schedule,22511.52,54831.55,MSDRG Base Rate Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,40556.96,,,,,,,fee schedule,24633.44,59999.94, Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,52288.55,,,,,,,fee schedule,24633.44,59999.94, Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,49999.95,,,,,,,fee schedule,24633.44,59999.94, Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,59999.94,,,,,,,fee schedule,24633.44,59999.94, Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",46300.77,46300.77,46300.77,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",65358.94,65358.94,65358.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],50096.49,50096.49,50096.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,50382.5,50382.5,50382.5,1 through 10,percent of total billed charges,,, Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,25618.78,,,,,,,fee schedule,24633.44,59999.94,MSDRG Base Rate Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,25865.11,,,,,,,fee schedule,24633.44,59999.94,MSDRG Base Rate Hiv With Major Related Condition With Mcc,974,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,24633.44,,,,,,,fee schedule,24633.44,59999.94,MSDRG Base Rate Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18198.64,,,,,,,fee schedule,11053.47,26923.05, Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23462.81,,,,,,,fee schedule,11053.47,26923.05, Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22435.88,,,,,,,fee schedule,11053.47,26923.05, Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26923.05,,,,,,,fee schedule,11053.47,26923.05, Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",15554.23,15554.23,20558.49,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",19378,19378,19378,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",21267.75,21267.75,21267.75,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11495.61,,,,,,,fee schedule,11053.47,26923.05,MSDRG Base Rate Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11606.14,,,,,,,fee schedule,11053.47,26923.05,MSDRG Base Rate Hiv With Major Related Condition With Cc,975,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11053.47,,,,,,,fee schedule,11053.47,26923.05,MSDRG Base Rate Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,12685.64,,,,,,,fee schedule,7704.99,18767.13, Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,16355.12,,,,,,,fee schedule,7704.99,18767.13, Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,15639.28,,,,,,,fee schedule,7704.99,18767.13, Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,18767.13,,,,,,,fee schedule,7704.99,18767.13, Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,8013.19,,,,,,,fee schedule,7704.99,18767.13,MSDRG Base Rate Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,8090.24,,,,,,,fee schedule,7704.99,18767.13,MSDRG Base Rate Hiv With Major Related Condition Without Cc/Mcc,976,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,7704.99,,,,,,,fee schedule,7704.99,18767.13,MSDRG Base Rate Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,18236.58,,,,,,,fee schedule,11076.51,26979.18, Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,23511.73,,,,,,,fee schedule,11076.51,26979.18, Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,22482.65,,,,,,,fee schedule,11076.51,26979.18, Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,26979.18,,,,,,,fee schedule,11076.51,26979.18, Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",14601.2,14601.2,14601.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],19116.71,19116.71,19116.71,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,11519.57,,,,,,,fee schedule,11076.51,26979.18,MSDRG Base Rate Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,11630.34,,,,,,,fee schedule,11076.51,26979.18,MSDRG Base Rate Hiv With Or Without Other Related Condition,977,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,11076.51,,,,,,,fee schedule,11076.51,26979.18,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,65933.87,,,,,,,fee schedule,40046.84,97542.52, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,85006.03,,,,,,,fee schedule,40046.84,97542.52, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,81285.44,,,,,,,fee schedule,40046.84,97542.52, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,97542.52,,,,,,,fee schedule,40046.84,97542.52, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],41161.2,41161.2,41161.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],13130.67,13130.67,13130.67,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],7635.94,7635.94,7635.94,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",39666.89,39666.89,39666.89,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,41648.71,,,,,,,fee schedule,40046.84,97542.52,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,42049.18,,,,,,,fee schedule,40046.84,97542.52,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,981,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,40046.84,,,,,,,fee schedule,40046.84,97542.52,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,34549.3,,,,,,,fee schedule,20984.52,51112.22, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,44543.1,,,,,,,fee schedule,20984.52,51112.22, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,42593.51,,,,,,,fee schedule,20984.52,51112.22, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,51112.22,,,,,,,fee schedule,20984.52,51112.22, Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,21823.9,,,,,,,fee schedule,20984.52,51112.22,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,22033.75,,,,,,,fee schedule,20984.52,51112.22,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,982,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,20984.52,,,,,,,fee schedule,20984.52,51112.22,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,24086.84,,,,,,,fee schedule,14629.84,35634.06, Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,31054.25,,,,,,,fee schedule,14629.84,35634.06, Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,29695.05,,,,,,,fee schedule,14629.84,35634.06, Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,35634.06,,,,,,,fee schedule,14629.84,35634.06, Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],22278.21,22278.21,22278.21,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,15215.03,,,,,,,fee schedule,14629.84,35634.06,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,15361.33,,,,,,,fee schedule,14629.84,35634.06,MSDRG Base Rate Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,983,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14629.84,,,,,,,fee schedule,14629.84,35634.06,MSDRG Base Rate Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc,984,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc,985,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc,986,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,48179.31,,,,,,,fee schedule,29263.1,71276.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,62115.75,,,,,,,fee schedule,29263.1,71276.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,59397.03,,,,,,,fee schedule,29263.1,71276.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,71276.44,,,,,,,fee schedule,29263.1,71276.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,30433.62,,,,,,,fee schedule,29263.1,71276.44,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,30726.26,,,,,,,fee schedule,29263.1,71276.44,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc,987,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,29263.1,,,,,,,fee schedule,29263.1,71276.44,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,23097.51,,,,,,,fee schedule,14028.94,34170.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,29778.74,,,,,,,fee schedule,14028.94,34170.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,28475.37,,,,,,,fee schedule,14028.94,34170.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,34170.44,,,,,,,fee schedule,14028.94,34170.44, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],28658.2,28658.2,28658.2,1 through 10,other,,,"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm." Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,14590.1,,,,,,,fee schedule,14028.94,34170.44,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,14730.39,,,,,,,fee schedule,14028.94,34170.44,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc,988,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,14028.94,,,,,,,fee schedule,14028.94,34170.44,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,16852.36,,,,,,,fee schedule,10235.77,24931.37, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,21727.11,,,,,,,fee schedule,10235.77,24931.37, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,20776.14,,,,,,,fee schedule,10235.77,24931.37, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,24931.37,,,,,,,fee schedule,10235.77,24931.37, Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,10645.2,,,,,,,fee schedule,10235.77,24931.37,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,10747.56,,,,,,,fee schedule,10235.77,24931.37,MSDRG Base Rate Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc,989,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,10235.77,,,,,,,fee schedule,10235.77,24931.37,MSDRG Base Rate Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Principal Diagnosis Invalid As Discharge Diagnosis,998,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Hmo,,,[Stop Loss: Total Charges > 161415 | Excess % of Charge: 0] [Medical-Per Diem: 3741] [Surgical-Per Diem: 3741] [ICU-Per Diem: 4119] [CCU-Per Diem: 4119] [Step Down-Per Diem: 3939] [C-Section 4 day stay-Case Rate: 12677 Days: 4 Additional Days: 1524] [Normal vag. Del. 2 day stay-Case Rate: 7290 Days: 2 Additional Days: 1524] [Nursery Level 1- Boarder-Per Diem: 847] [Nursery Level 2-Per Diem: 2464] [Nursery Level 3-Per Diem: 2464] [Nursery Level 4-NICU-Per Diem: 4119] [Alcohol/ Chemical Dependency-Per Diem: 1231] [Psych-Per Diem: 1524] [Rehab-Per Diem: 1617] [SNF-Per Diem: 1569] [IP High Cost Drugs ($): 0 Charge Threshold 749.99 (%BC): 60] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 1999.99 (%BC): 73],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Amerigroup - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Amerihealth Caritas - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Hmo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1358] [Psych-Per Diem: 1358],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Bcbs,Carefirst Ppo,,,[Stop Loss: Length of Stay < FeeSchedule days | Total % of Charge: -1] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Hmo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2103] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 5028] [Normal Vaginal Delivery-Per Diem: 5028] [Normal Newborn-Per Diem: 2100] [Nursery Level 1- Boarder-Per Diem: 2100] [Nursery Level 2-Per Diem: 2783] [Nursery Level 3-Per Diem: 6326] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Cigna,Ppo,,,[Stop Loss: Length of Stay > 8 days | Excess % of Charge: 2524] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 6034] [Normal Vaginal Delivery-Per Diem: 6034] [Normal Newborn-Per Diem: 2520] [Nursery Level 1- Boarder-Per Diem: 2520] [Nursery Level 2-Per Diem: 3339] [Nursery Level 3-Per Diem: 7592] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 4789 (%BC): 59.9],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,First Health/Coventry,First Health Ppo,,,[Stop Loss: Total Charges > 12500 | Total % of Charge: 77] [Lesser Than Charges paid at %: 100] [Medical-Per Diem: 950] [Nursery Level 1- Boarder-Per Diem: 400] [Nursery Level 4-NICU (%BC): 85] [Psych-Per Diem: 550] [SNF-Per Diem: 525],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Medicare Managed Care Plan,,,[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,Medicare Managed Care Plan,,,[MSDRG Base Rate: FEE SCHEDULE],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Kaiser,All Commercial Plans,,,[Stop Loss: Total Charges > 101709 | Excess % of Charge: 0] [Lesser Than Charges paid at %: 100] [C-Section 3 day stay-Case Rate: 9454 Days: 3 Additional Days: 3182] [Normal vag. Del. 2 day stay-Case Rate: 6145 Days: 2 Additional Days: 3182] [Lower Level Neonate-Per Diem: 2204] [Higher Level Neonate-Per Diem: 2752] [Severe Level Neonate-per diem: 2752] [Nursery Level 1- Boarder-Per Diem: 721] [All Other IP (%BC): 62],,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Medstar - Dc,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Priority Partners,Medicaid Managed Care Plan,,,"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://health.maryland.gov/mmcp/provider/Pages/default.aspx]",,,,0,other,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Aetna,Ppo,,54.4,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Geisinger,Ppo,,80,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Ehp Ppo,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Johns Hopkins Health Plans,Usfhp Government,,70,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Phcs,Primary Network All Commercial Plans,,66,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. Ungroupable,999,MS-DRG,,,,,facility,inpatient,,,,,,Phcs/Multiplan,Supplementary Network All Commercial Plans,,82.1,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. NDC Description Not Available,45008002,NDC,,,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7109-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7109-61,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7110-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7110-61,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Calcium Acetate: 100 Blister Pack In 1 Carton (0904-7119-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7119-61,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Colchicine: 30 Blister Pack In 1 Carton (0904-7120-04) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7120-04,NDC,,,facility,both,1,EA,,12.78,12.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7121-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7121-61,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 100 Blister Pack In 1 Carton (0904-7124-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7124-61,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 100 Blister Pack In 1 Carton (0904-7125-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7125-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin Monohydrate/ Macrocrystalline: 100 Blister Pack In 1 Carton (0904-7137-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7137-61,NDC,,,facility,both,1,EA,,4.89,4.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Benzonatate: 100 Blister Pack In 1 Carton (0904-7153-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7153-61,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 100 Blister Pack In 1 Carton (0904-7156-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7156-61,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metformin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7162-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7162-61,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 100 Blister Pack In 1 Carton (0904-7126-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7126-61,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 100 Blister Pack In 1 Carton (0904-7177-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7177-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Blister Pack In 1 Carton (0904-7108-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7108-61,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bumetanide: 100 Blister Pack In 1 Carton (0904-7016-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7016-61,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Major Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (0904-7035-88)",250,RC,0904-7035-88,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Blister Pack In 1 Carton (0904-7043-04) / 1 Capsule, Delayed Release In 1 Blister Pack",250,RC,0904-7043-04,NDC,,,facility,both,1,EA,,2.86,2.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 100 Blister Pack In 1 Carton (0904-7044-61) / 1 Capsule, Delayed Release In 1 Blister Pack",250,RC,0904-7044-61,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 100 Blister Pack In 1 Carton (0904-7045-61) / 1 Capsule, Delayed Release In 1 Blister Pack",250,RC,0904-7045-61,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 100 Blister Pack In 1 Carton (0904-7048-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7048-61,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rivastigmine Tartrate: 100 Blister Pack In 1 Carton (0904-7107-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7107-61,NDC,,,facility,both,1,EA,,5.94,5.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methocarbamol: 100 Blister Pack In 1 Carton (0904-7058-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7058-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7076-61) / 1 Capsule, Extended Release In 1 Blister Pack",250,RC,0904-7076-61,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7083-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7083-61,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Xl: 30 Blister Pack In 1 Carton (0904-7084-04) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7084-04,NDC,,,facility,both,1,EA,,2.44,2.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7084-61) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7084-61,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ezetimibe: 30 Blister Pack In 1 Carton (0904-7103-04) / 1 Tablet In 1 Blister Pack,250,RC,0904-7103-04,NDC,,,facility,both,1,EA,,19.63,19.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 100 Blister Pack In 1 Carton (0904-7178-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7178-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Docusate Sodium - Stool Softener Laxative: 10 Blister Pack In 1 Carton (0904-7183-61) / 10 Capsule, Liquid Filled In 1 Blister Pack",250,RC,0904-7183-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7243-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7243-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lacosamide: 60 Blister Pack In 1 Carton (0904-7244-68) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7244-68,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lacosamide: 60 Blister Pack In 1 Carton (0904-7245-68) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7245-68,NDC,,,facility,both,1,EA,,4.16,4.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sennosides: 100 Tablet, Film Coated In 1 Bottle (0904-7252-60)",250,RC,0904-7252-60,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sennosides: 10 Blister Pack In 1 Box, Unit-Dose (0904-7252-61) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7252-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0904-7265-41,NDC,,,facility,both,1,EA,,6.37,6.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0904-7276-41,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Stool Softener Laxative: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (0904-7280-60)",250,RC,0904-7280-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Blister Pack In 1 Carton (0904-7305-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7305-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Blister Pack In 1 Carton (0904-7306-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7306-61,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sennosides: 1000 Tablet, Film Coated In 1 Bottle (0904-7252-80)",250,RC,0904-7252-80,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atenolol: 100 Blister Pack In 1 Carton (0904-7187-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7187-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 50 Blister Pack In 1 Carton (0904-7193-06) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7193-06,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7193-61,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7193-61,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Major Bismuth Subsalicylate: 5 Blister Pack In 1 Box (0904-7205-46) / 6 Tablet, Chewable In 1 Blister Pack",250,RC,0904-7205-46,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Sr: 100 Blister Pack In 1 Carton (0904-7214-61) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-7214-61,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7216-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-7216-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7218-61) / 1 Capsule, Extended Release In 1 Blister Pack",250,RC,0904-7218-61,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7219-61) / 1 Capsule, Extended Release In 1 Blister Pack",250,RC,0904-7219-61,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Folic Acid: 100 Blister Pack In 1 Carton (0904-7224-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7224-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clonazepam: 100 Blister Pack In 1 Carton (0904-7227-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7227-61,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nifedipine: 100 Blister Pack In 1 Carton (0904-7229-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7229-61,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Megestrol Acetate: 100 Blister Pack In 1 Carton (0904-7236-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7236-61,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bumetanide: 30 Blister Pack In 1 Carton (0904-7016-04) / 1 Tablet In 1 Blister Pack,250,RC,0904-7016-04,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lamotrigine: 100 Blister Pack In 1 Carton (0904-7008-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7008-61,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61) / 10 Tablet In 1 Blister Pack",250,RC,0904-6773-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6778-61) / 1 Tablet, Coated In 1 Blister Pack",250,RC,0904-6778-61,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6781-61) / 1 Tablet, Coated In 1 Blister Pack",250,RC,0904-6781-61,NDC,,,facility,both,1,EA,,2.55,2.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol: 100 Blister Pack In 1 Carton (0904-6782-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6782-61,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aspirin Low Dose Chewable Orange: 1000 Tablet, Chewable In 1 Package (0904-6794-80)",250,RC,0904-6794-80,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Blister Pack In 1 Carton (0904-6797-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6797-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61) / 10 Tablet In 1 Blister Pack",250,RC,0904-6773-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Blister Pack In 1 Carton (0904-6798-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6798-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Blister Pack In 1 Carton (0904-6799-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6799-61,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Montelukast Sodium: 100 Blister Pack In 1 Carton (0904-6808-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6808-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6817-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6817-61,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6818-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6818-61,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Blister Pack In 1 Carton (0904-6823-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6823-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Major Medi-Pads: 100 Packet In 1 Package (0904-6829-60) / 2.9 G In 1 Packet,250,RC,0904-6829-60,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mucus Relief Er: 100 Blister Pack In 1 Carton (0904-6718-39) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6718-39,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40),250,RC,0904-6720-40,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40),250,RC,0904-6720-40,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1 Bottle In 1 Carton (0904-6730-59) / 100 Tablet In 1 Bottle,250,RC,0904-6730-59,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1 Bottle In 1 Carton (0904-6730-59) / 100 Tablet In 1 Bottle,250,RC,0904-6730-59,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nasal Decongestant: 1 Bottle, Spray In 1 Carton (0904-6761-30) / 30 Ml In 1 Bottle, Spray",250,RC,0904-6761-30,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61) / 10 Tablet In 1 Blister Pack",250,RC,0904-6730-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1000 Tablet In 1 Bottle (0904-6730-80),250,RC,0904-6730-80,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1000 Tablet In 1 Bottle (0904-6730-80),250,RC,0904-6730-80,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol: 100 Blister Pack In 1 Carton (0904-6733-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6733-61,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aspirin Low Dose: 1000 Tablet, Delayed Release In 1 Bottle, Plastic (0904-6751-80)",250,RC,0904-6751-80,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61) / 10 Tablet In 1 Blister Pack",250,RC,0904-6730-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 100 Blister Pack In 1 Carton (0904-6830-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6830-61,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6966-61,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6966-61,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hcl: 118 Ml In 1 Bottle, Plastic (0904-6985-20)",250,RC,0904-6985-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mucus Relief: 500 Tablet, Extended Release In 1 Bottle (0904-6986-40)",250,RC,0904-6986-40,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dicyclomine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6988-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6988-61,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyurea: 100 Blister Pack In 1 Carton (0904-6939-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-6939-61,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 100 Blister Pack In 1 Carton (0904-6991-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-6991-61,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amiodarone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6993-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6993-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Docusate Sodium: 1000 Capsule In 1 Bottle, Plastic (0904-6998-80)",250,RC,0904-6998-80,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 100 Blister Pack In 1 Carton (0904-7001-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7001-61,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lamotrigine: 100 Blister Pack In 1 Carton (0904-7007-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7007-61,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pseudoephedrine Hcl: 10 Blister Pack In 1 Carton (0904-6990-61) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6990-61,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86),250,RC,0904-6931-86,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loperamide Hydrochloride: 120 Ml In 1 Bottle (0904-6836-20),250,RC,0904-6836-20,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loperamide Hydrochloride: 120 Ml In 1 Bottle (0904-6836-20),250,RC,0904-6836-20,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6852-61,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6860-61) / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6860-61,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6861-61) / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6861-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 90 Blister Pack In 1 Carton (0904-6861-90) / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6861-90,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6868-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6868-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6869-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6869-61,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 80 Blister Pack In 1 Carton (0904-6870-45) / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6870-45,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 100 Blister Pack In 1 Carton (0904-6926-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6926-61,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 100 Blister Pack In 1 Carton (0904-6927-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6927-61,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Blister Pack In 1 Carton (0904-7308-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7308-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Blister Pack In 1 Carton (0904-7346-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7346-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 90 Tablet, Film Coated In 1 Bottle (13107-155-90)",250,RC,13107-155-90,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (10702-100-01),250,RC,10702-100-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexmethylphenidate Hydrochloride: 100 Tablet In 1 Bottle (10702-107-01),250,RC,10702-107-01,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle (10702-192-01),250,RC,10702-192-01,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle (10702-192-01),250,RC,10702-192-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA A And D First Aid: 1 Tube In 1 Carton (11523-7204-1) / 42.5 G In 1 Tube,250,RC,11523-7204-1,NDC,,,facility,both,1,EA,,7.74,7.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pred Forte: 1 Bottle, Dropper In 1 Carton (11980-180-05) / 5 Ml In 1 Bottle, Dropper",250,RC,11980-180-05,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ocuflox: 1 Bottle, Dropper In 1 Carton (11980-779-05) / 5 Ml In 1 Bottle, Dropper",250,RC,11980-779-05,NDC,,,facility,both,1,EA,,316.96,316.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Silver Nitrate Applicators: 10 Packet In 1 Box (12870-0001-1) / 10 Applicator In 1 Packet / 100 Mg In 1 Applicator,250,RC,12870-0001-1,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Silver Nitrate Applicators: 100 Applicator In 1 Vial (12870-0001-2) / 100 Mg In 1 Applicator,250,RC,12870-0001-2,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 500 Tablet, Film Coated In 1 Bottle (13107-001-05)",250,RC,13107-001-05,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-001-30)",250,RC,13107-001-30,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (13107-068-01)",250,RC,13107-068-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (13107-073-01)",250,RC,13107-073-01,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 500 Tablet In 1 Bottle (13107-084-05),250,RC,13107-084-05,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Tablet, Film Coated In 1 Bottle (13668-009-01)",250,RC,13668-009-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 30 Tablet, Orally Disintegrating In 1 Bottle (13668-086-30)",250,RC,13668-086-30,NDC,,,facility,both,1,EA,,5.93,5.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (13668-094-90),250,RC,13668-094-90,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (13668-189-30)",250,RC,13668-189-30,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Anagrelide: 100 Capsule In 1 Bottle (13668-462-01),250,RC,13668-462-01,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tadalafil: 30 Tablet In 1 Bottle (13668-581-30),250,RC,13668-581-30,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erythromycin: 100 Tablet, Coated In 1 Bottle (13668-606-01)",250,RC,13668-606-01,NDC,,,facility,both,1,EA,,4.92,4.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-706-10)",250,RC,13811-706-10,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (13668-091-90),250,RC,13668-091-90,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Peg-3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride: 4 L In 1 Bottle (10572-302-01)",250,RC,10572-302-01,NDC,,,facility,both,1,EA,,62.09,62.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "MONSELS SOLUTION: 8 g in 1 BOTTLE, GLASS (10481-0112-8) ",250,RC,10481-0112-8,NDC,,,facility,both,1,EA,,29.9,29.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0433-53),250,RC,0941-0433-53,NDC,,,facility,both,1,EA,,130.38,130.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0430-53),250,RC,0941-0430-53,NDC,,,facility,both,1,EA,,111.1,111.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dianeal Pd-2 With Dextrose: 2500 Ml In 1 Bag (0941-0429-53),250,RC,0941-0429-53,NDC,,,facility,both,1,EA,,84.8,84.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dianeal Pd-2 With Dextrose: 2500 Ml In 1 Bag (0941-0426-53),250,RC,0941-0426-53,NDC,,,facility,both,1,EA,,84.63,84.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 50 Blister Pack In 1 Carton (0904-7350-06) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7350-06,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 100 Blister Pack In 1 Carton (0904-7350-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7350-61,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 100 Blister Pack In 1 Carton (0904-7362-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7362-61,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 100 Blister Pack In 1 Carton (0904-7363-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7363-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7376-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-7376-61,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dianeal Pd-2 With Dextrose: 2500 Ml In 1 Bag (0941-0427-53),250,RC,0941-0427-53,NDC,,,facility,both,1,EA,,88.37,88.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Varenicline: 56 Tablet, Film Coated In 1 Bottle (0904-7413-35)",250,RC,0904-7413-35,NDC,,,facility,both,1,EA,,12.49,12.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (0904-7418-44)",250,RC,0904-7418-44,NDC,,,facility,both,1,EA,,5.51,5.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Major Nasal Decongestant: 1 Bottle, Pump In 1 Carton (0904-7427-30) / 30 Ml In 1 Bottle, Pump",250,RC,0904-7427-30,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sucralfate: 10 Ml In 1 Cup, Unit-Dose (0904-7470-66)",250,RC,0904-7470-66,NDC,,,facility,both,1,EA,,13.4,13.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acid Gone Antacid: 355 Ml In 1 Bottle (0904-7727-14),250,RC,0904-7727-14,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ibuprofen: 10 Blister Pack In 1 Carton (0904-7914-61) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-7914-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0424-53),250,RC,0941-0424-53,NDC,,,facility,both,1,EA,,111,111,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamsulosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7383-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-7383-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isopropyl Alcohol 70 Percent: 473 mL in 1 BOTTLE, PLASTIC (10135-106-08) ",250,RC,10135-106-08,NDC,,,facility,both,1,EA,,5.14,5.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sennosides: 1 Bottle In 1 Carton (10135-314-01) / 100 Tablet In 1 Bottle,250,RC,10135-314-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenazopyridine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE (10135-620-01) ",250,RC,10135-620-01,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aspirin 81 mg Enteric Coated: 120 TABLET in 1 BOTTLE (10135-689-62) ,250,RC,10135-689-62,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Menthol And Zinc Oxide: 113 G In 1 Tube (10135-701-04),250,RC,10135-701-04,NDC,,,facility,both,1,EA,,6.86,6.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Itraconazole: 30 Capsule In 1 Bottle (10147-1700-3),250,RC,10147-1700-3,NDC,,,facility,both,1,EA,,17.97,17.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Curosurf: 3 Ml In 1 Vial, Glass (10122-510-03)",250,RC,10122-510-03,NDC,,,facility,both,1,EA,,2382.58,2382.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 12 Pouch In 1 Case (0990-7990-09) / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag,250,RC,0990-7990-09,NDC,,,facility,both,1,EA,,41,41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isopto Tears: 15 Ml In 1 Bottle, Dropper (0998-0408-15)",250,RC,0998-0408-15,NDC,,,facility,both,1,EA,,64.62,64.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluorescein: 10 Vial In 1 Carton (14789-122-05) / 5 Ml In 1 Vial (14789-122-07),250,RC,14789-122-05,NDC,,,facility,both,1,EA,,400.95,400.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6717-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6717-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefpodoxime Proxetil: 100 Tablet, Film Coated In 1 Bottle (0781-5439-01)",250,RC,0781-5439-01,NDC,,,facility,both,1,EA,,12.16,12.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5637-01)",250,RC,0781-5637-01,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Voriconazole: 30 Tablet, Film Coated In 1 Bottle (0781-5668-31)",250,RC,0781-5668-31,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5669-01)",250,RC,0781-5669-01,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Ml In 1 Bottle (0781-6039-46),250,RC,0781-6039-46,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0781-7144-58,NDC,,,facility,both,1,EA,,17.23,17.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levothyroxine sodium: 90 TABLET in 1 BOTTLE (0781-5189-92) ,250,RC,0781-5189-92,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 100 TABLET in 1 BOTTLE (0781-5077-01) ,250,RC,0781-5077-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0781-3755-75,NDC,,,facility,both,1,EA,,9.13,9.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Norepinephrine Bitartrate: 10 Vial, Single-Dose In 1 Carton (0781-3755-95) / 4 Ml In 1 Vial, Single-Dose (0781-3755-75)",250,RC,0781-3755-95,NDC,,,facility,both,1,EA,,9.05,9.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0781-3494-91,NDC,,,facility,both,1,EA,,19.18,19.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexmedetomidine Hydrochloride In 0.9% Sodium Chloride: 10 Bottle In 1 Carton (0781-3494-95) / 50 Ml In 1 Bottle,250,RC,0781-3494-95,NDC,,,facility,both,1,EA,,19.73,19.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline Hyclate: 50 Blister Pack In 1 Carton (0904-0428-06) / 1 Capsule In 1 Blister Pack,250,RC,0904-0428-06,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bismatrol: 236 mL in 1 BOTTLE (0904-1313-09) ,250,RC,0904-1313-09,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 100 BLISTER PACK in 1 CARTON (0904-1453-61) / 1 TABLET in 1 BLISTER PACK,250,RC,0904-1453-61,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tri-Buffered Aspirin: 1 Bottle, Plastic In 1 Carton (0904-2015-59) / 100 Tablet, Film Coated In 1 Bottle, Plastic",250,RC,0904-2015-59,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calamine: 177 Ml In 1 Bottle, Plastic (0904-2533-21)",250,RC,0904-2533-21,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 100 Blister Pack In 1 Carton (0904-2725-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-2725-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxybutynin Chloride: 100 BLISTER PACK in 1 CARTON (0904-2821-61) / 1 TABLET in 1 BLISTER PACK,250,RC,0904-2821-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbamazepine: 100 Blister Pack In 1 Carton (0904-3854-61) / 1 Tablet, Chewable In 1 Blister Pack",250,RC,0904-3854-61,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0904-3865-75,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Captopril: 100 BLISTER PACK in 1 CARTON (0904-5045-61) / 1 TABLET in 1 BLISTER PACK,250,RC,0904-5045-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sudogest: 1 Bottle, Plastic In 1 Carton (0904-5053-59) / 100 Tablet, Film Coated In 1 Bottle, Plastic",250,RC,0904-5053-59,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrogen Peroxide: 473 Ml In 1 Bottle, Plastic (0869-0871-43)",250,RC,0869-0871-43,NDC,,,facility,both,1,EA,,26.73,26.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oil: 473 Ml In 1 Bottle, Plastic (0869-0831-43)",250,RC,0869-0831-43,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-7124-89,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Calmoseptine: 113 G In 1 Tube (0799-0001-04),250,RC,0799-0001-04,NDC,,,facility,both,1,EA,,14.04,14.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-0038-89,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bumetanide: 100 Tablet In 1 Bottle (0832-0541-11),250,RC,0832-0541-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-1211-89,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-1212-89,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-1213-89,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-1214-89,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Jantoven: 100 Tablet In 1 Bottle (0832-1215-00),250,RC,0832-1215-00,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-1215-89,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-1216-89,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Jantoven: 100 Tablet In 1 Bottle (0832-1218-00),250,RC,0832-1218-00,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Jantoven: 100 Blister Pack In 1 Carton (0832-1218-01) / 1 Tablet In 1 Blister Pack (0832-1218-89),250,RC,0832-1218-01,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-1218-89,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (0832-5323-11)",250,RC,0832-5323-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0832-7123-89,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0641-9218-01,NDC,,,facility,both,1,EA,,7.83,7.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diltiazem Hydrochloride: 10 Vial In 1 Carton (0641-9218-10) / 10 Ml In 1 Vial (0641-9218-01),250,RC,0641-9218-10,NDC,,,facility,both,1,EA,,8.39,8.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0641-9219-01,NDC,,,facility,both,1,EA,,14.63,14.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diltiazem Hydrochloride: 10 Vial In 1 Carton (0641-9217-10) / 5 Ml In 1 Vial (0641-9217-01),250,RC,0641-9217-10,NDC,,,facility,both,1,EA,,5.52,5.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bacitracin: 28.4 G In 1 Tube (0713-0280-31),250,RC,0713-0280-31,NDC,,,facility,both,1,EA,,4.39,4.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0713-0503-06,NDC,,,facility,both,1,EA,,26.54,26.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0641-9217-01,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0641-6238-01,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mometasone Furoate: 1 Tube In 1 Carton (0713-0634-15) / 15 G In 1 Tube,250,RC,0713-0634-15,NDC,,,facility,both,1,EA,,28.32,28.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 1 Tube In 1 Carton (0713-0637-37) / 45 G In 1 Tube,250,RC,0713-0637-37,NDC,,,facility,both,1,EA,,82.69,82.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0781-3150-75,NDC,,,facility,both,1,EA,,7.57,7.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cisatracurium Besylate: 10 Box In 1 Carton (0781-3150-95) / 1 Vial In 1 Box (0781-3150-75) / 5 Ml In 1 Vial,250,RC,0781-3150-95,NDC,,,facility,both,1,EA,,7.57,7.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0781-3152-70,NDC,,,facility,both,1,EA,,14.02,14.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cisatracurium Besylate: 10 Vial, Multi-Dose In 1 Carton (0781-3152-95) / 10 Ml In 1 Vial, Multi-Dose (0781-3152-70)",250,RC,0781-3152-95,NDC,,,facility,both,1,EA,,14.02,14.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0781-3269-71,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Tube In 1 Carton (0713-0655-40) / 5 G In 1 Tube,250,RC,0713-0655-40,NDC,,,facility,both,1,EA,,79.1,79.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin Sulfate: 1 Tube In 1 Carton (0713-0682-15) / 15 G In 1 Tube,250,RC,0713-0682-15,NDC,,,facility,both,1,EA,,73.12,73.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin Sulfate: 1 Tube In 1 Carton (0713-0683-15) / 15 G In 1 Tube,250,RC,0713-0683-15,NDC,,,facility,both,1,EA,,95.61,95.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin Sulfate: 1 Tube In 1 Carton (0713-0683-31) / 30 G In 1 Tube,250,RC,0713-0683-31,NDC,,,facility,both,1,EA,,199.4,199.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (0781-1061-01),250,RC,0781-1061-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamterene hydrochlorothiazide: 100 TABLET in 1 BOTTLE (0781-1123-01) ,250,RC,0781-1123-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1488-01)",250,RC,0781-1488-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1489-01)",250,RC,0781-1489-01,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Tablet In 1 Bottle (0781-1635-01),250,RC,0781-1635-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (0781-1831-20)",250,RC,0781-1831-20,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clarithromycin: 60 Tablet In 1 Bottle (0781-1962-60),250,RC,0781-1962-60,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamterene And Hydrochlorothiazide: 100 Capsule In 1 Bottle (0781-2074-01),250,RC,0781-2074-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pentoxifylline: 100 Blister Pack In 1 Carton (0904-5448-61) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-5448-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Donepezil Hydrochloride: 100 Blister Pack In 1 Carton (0904-6477-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6477-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Donepezil Hydrochloride: 100 Blister Pack In 1 Carton (0904-6478-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6478-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Major Lubrifresh Pm: 1 Tube In 1 Carton (0904-6488-38) / 3.5 G In 1 Tube,250,RC,0904-6488-38,NDC,,,facility,both,1,EA,,12.59,12.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 100 Blister Pack In 1 Carton (0904-6500-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6500-61,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 100 Blister Pack In 1 Carton (0904-6501-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6501-61,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Blister Pack In 1 Carton (0904-6503-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-6503-61,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 100 Blister Pack In 1 Carton (0904-6511-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6511-61,NDC,,,facility,both,1,EA,,51.39,51.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Blister Pack In 1 Carton (0904-6512-04) / 1 Tablet In 1 Blister Pack,250,RC,0904-6512-04,NDC,,,facility,both,1,EA,,50.58,50.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Senna-Lax: 10 Blister Pack In 1 Box (0904-6522-61) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6522-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6530-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6530-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Propranolol Hydrochloride: 100 Blister Pack In 1 Carton (0904-6550-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6550-61,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linezolid: 30 Blister Pack In 1 Carton (0904-6553-04) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6553-04,NDC,,,facility,both,1,EA,,9.69,9.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6554-61) / 1 TABLET in 1 BLISTER PACK,250,RC,0904-6554-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6506-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6506-61,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6475-61,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tizanidine: 100 Blister Pack In 1 Carton (0904-6418-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6418-61,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Blister Pack In 1 Carton (0904-6426-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6426-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Blister Pack In 1 Carton (0904-6427-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6427-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6440-61) / 1 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,0904-6440-61,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6441-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6441-61,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6449-61) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6449-61,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6450-61) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6450-61,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6452-61) / 1 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK",250,RC,0904-6452-61,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clopidogrel: 30 Blister Pack In 1 Carton (0904-6467-07) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6467-07,NDC,,,facility,both,1,EA,,20.2,20.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6469-61) / 1 CAPSULE, EXTENDED RELEASE in 1 BLISTER PACK",250,RC,0904-6469-61,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 100 Blister Pack In 1 Carton (0904-6474-61) / 1 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6474-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6442-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6442-61,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6557-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6557-61,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6558-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6558-61,NDC,,,facility,both,1,EA,,2.23,2.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 100 Blister Pack In 1 Carton (0904-6638-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6638-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 100 Blister Pack In 1 Carton (0904-6640-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6640-61,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 100 Blister Pack In 1 Carton (0904-6642-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6642-61,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetazolamide: 100 Blister Pack In 1 Carton (0904-6663-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6663-61,NDC,,,facility,both,1,EA,,6.99,6.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-6665-61,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glipizide: 100 Blister Pack In 1 Carton (0904-6637-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6637-61,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Blister Pack In 1 Carton (0904-6667-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-6667-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sildenafil: 50 Blister Pack In 1 Carton (0904-6671-06) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6671-06,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dofetilide: 40 Blister Pack In 1 Carton (0904-6681-08) / 1 Capsule In 1 Blister Pack,250,RC,0904-6681-08,NDC,,,facility,both,1,EA,,8.48,8.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sevelamer Carbonate: 100 Blister Pack In 1 Carton (0904-6707-82) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6707-82,NDC,,,facility,both,1,EA,,9.23,9.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glycopyrrolate: 100 Blister Pack In 1 Carton (0904-6709-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6709-61,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Blister Pack In 1 Carton (0904-6666-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-6666-61,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride: 100 Blister Pack In 1 Carton (0904-6636-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6636-61,NDC,,,facility,both,1,EA,,3.28,3.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 100 BLISTER PACK in 1 CARTON (0904-6564-61) / 1 CAPSULE in 1 BLISTER PACK,250,RC,0904-6564-61,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valacyclovir Hydrochloride: 100 Blister Pack In 1 Carton (0904-6565-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6565-61,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-6570-61) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6570-61,NDC,,,facility,both,1,EA,,3.11,3.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Allopurinol: 100 Blister Pack In 1 Carton (0904-6572-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6572-61,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lamivudine: 30 Blister Pack In 1 Carton (0904-6583-04) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6583-04,NDC,,,facility,both,1,EA,,13.72,13.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 30 Blister Pack In 1 Carton (0904-6592-04) / 1 Capsule, Extended Release In 1 Blister Pack",250,RC,0904-6592-04,NDC,,,facility,both,1,EA,,12.99,12.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6615-61) / 1 Capsule, Delayed Release In 1 Blister Pack",250,RC,0904-6615-61,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6618-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6618-61,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6619-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6619-61,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6620-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6620-61,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride: 100 Blister Pack In 1 Carton (0904-6635-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6635-61,NDC,,,facility,both,1,EA,,2.16,2.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Major Regular Strength Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0904-6412-92)",250,RC,0904-6412-92,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 1 Bottle In 1 Carton (0904-5309-20) / 120 Ml In 1 Bottle,250,RC,0904-5309-20,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole: 100 Blister Pack In 1 Carton (0904-6373-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6373-61,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5853-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5853-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5854-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5854-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5854-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5854-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5891-61) / 1 Tablet In 1 Blister Pack",250,RC,0904-5891-61,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5892-61) / 1 Tablet In 1 Blister Pack",250,RC,0904-5892-61,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5893-61) / 1 Tablet In 1 Blister Pack",250,RC,0904-5893-61,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Blister Pack In 1 Carton (0904-5921-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5921-61,NDC,,,facility,both,1,EA,,2.66,2.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Blister Pack In 1 Carton (0904-5922-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5922-61,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Haloperidol: 100 TABLET in 1 BOX, UNIT-DOSE (0904-5925-61) ",250,RC,0904-5925-61,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-5929-61) / 1 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,0904-5929-61,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-5959-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-5959-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6007-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5853-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5853-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxazosin: 100 Blister Pack In 1 Carton (0904-5522-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5522-61,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxazosin: 100 Blister Pack In 1 Carton (0904-5523-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5523-61,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxazosin: 100 Blister Pack In 1 Carton (0904-5524-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-5524-61,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Heartburn Relief Original Strength: 1 Bottle In 1 Carton (0904-5529-52) / 60 Tablet, Film Coated In 1 Bottle",250,RC,0904-5529-52,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Heartburn Relief Original Strength: 30 Blister Pack In 1 Carton (0904-5529-87) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5529-87,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 500 Tablet In 1 Bottle (0904-5853-40),250,RC,0904-5853-40,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5677-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5677-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Blister Pack In 1 Carton (0904-5784-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-5784-61,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Blister Pack In 1 Carton (0904-5785-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-5785-61,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acyclovir: 100 Blister Pack In 1 Carton (0904-5789-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-5789-61,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "lisinopril: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (0904-5811-61) / 1 TABLET in 1 BLISTER PACK",250,RC,0904-5811-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5676-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-5676-61,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 Blister Pack In 1 Carton (0904-6008-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6008-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bicalutamide: 30 Tablet In 1 Bottle (0904-6019-46),250,RC,0904-6019-46,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6301-61)",250,RC,0904-6301-61,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6303-61)",250,RC,0904-6303-61,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 50 Blister Pack In 1 Carton (0904-6322-06) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6322-06,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6322-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6322-61,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6323-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,0904-6323-61,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6358-61)",250,RC,0904-6358-61,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6359-61)",250,RC,0904-6359-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6369-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6369-61,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6370-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6370-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6371-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6371-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6363-61) / 1 Tablet, Extended Release In 1 Blister Pack",250,RC,0904-6363-61,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6300-61)",250,RC,0904-6300-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clopidogrel: 100 Blister Pack In 1 Carton (0904-6294-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6294-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zolpidem Tartrate: 100 Blister Pack In 1 Carton (0904-6082-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6082-61,NDC,,,facility,both,1,EA,,7.49,7.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Blister Pack In 1 Carton (0904-6084-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6084-61,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Blister Pack In 1 Carton (0904-6085-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6085-61,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 100 TABLET, FILM COATED in 1 BOX, UNIT-DOSE (0904-6088-61) ",250,RC,0904-6088-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metformin Hydrochloride: 100 TABLET in 1 BOX, UNIT-DOSE (0904-6090-61) ",250,RC,0904-6090-61,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride: 100 TABLET, FILM COATED in 1 BOX, UNIT-DOSE (0904-6093-61) ",250,RC,0904-6093-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbamazepine: 100 Blister Pack In 1 Carton (0904-6172-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6172-61,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ursodiol: 100 Blister Pack In 1 Carton (0904-6221-61) / 1 Capsule In 1 Blister Pack,250,RC,0904-6221-61,NDC,,,facility,both,1,EA,,7.35,7.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-6238-61) / 1 Tablet In 1 Blister Pack,250,RC,0904-6238-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ziprasidone: 80 Blister Pack In 1 Carton (0904-6269-45) / 1 Capsule In 1 Blister Pack,250,RC,0904-6269-45,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6290-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6290-61,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6291-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6291-61,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6292-61) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0904-6292-61,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bisacodyl: 10 Blister Pack In 1 Box (0904-6407-61) / 10 Tablet, Delayed Release In 1 Blister Pack",250,RC,0904-6407-61,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Np Thyroid 15: 100 Tablet In 1 Bottle (42192-327-01),250,RC,42192-327-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Np Thyroid 30: 100 Tablet In 1 Bottle (42192-329-01),250,RC,42192-329-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01),250,RC,42192-339-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01),250,RC,42192-339-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 6 Ml In 1 Cup, Unit-Dose (42192-608-06)",250,RC,42192-608-06,NDC,,,facility,both,1,EA,,8.43,8.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,42291-477-11,NDC,,,facility,both,1,EA,,5.8,5.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Valsartan: 90 Tablet In 1 Bottle (42291-858-90),250,RC,42291-858-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ursodiol: 100 Capsule In 1 Bottle (42291-923-01),250,RC,42291-923-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,42292-038-01,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ryanodex Dantrolene Sodium: 1 Vial In 1 Carton (42367-540-32) / 20 Ml In 1 Vial,250,RC,42367-540-32,NDC,,,facility,both,1,EA,,2851.7,2851.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metformin Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42385-947-01)",250,RC,42385-947-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,42291-495-11,NDC,,,facility,both,1,EA,,5.8,5.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-024-04) / 5.8 G In 1 Packet,250,RC,37000-024-04,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metamucil Therapy For Regularity: 5.8 G In 1 Packet (37000-024-10),250,RC,37000-024-10,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Senna: 237 Ml In 1 Bottle, Plastic (39328-020-08)",250,RC,39328-020-08,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,39328-063-25,NDC,,,facility,both,1,EA,,34.61,34.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nystatin: 15 g in 1 BOTTLE, PLASTIC (39822-3015-1) ",250,RC,39822-3015-1,NDC,,,facility,both,1,EA,,38.58,38.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,39822-4200-1,NDC,,,facility,both,1,EA,,8.05,8.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,41388-00732,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aplisol: 1 Vial In 1 Carton (42023-104-01) / 1 Ml In 1 Vial,250,RC,42023-104-01,NDC,,,facility,both,1,EA,,33.44,33.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ketalar: 10 Vial In 1 Carton (42023-113-10) / 20 Ml In 1 Vial,250,RC,42023-113-10,NDC,,,facility,both,1,EA,,6.8,6.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dorzolamide Hydrochloride Ophthalmic Solution: 1 Bottle In 1 Carton (42571-141-26) / 10 Ml In 1 Bottle,250,RC,42571-141-26,NDC,,,facility,both,1,EA,,49.15,49.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dorzolamide Hydrochloride And Timolol Maleate Ophthalmic Solution: 1 Bottle In 1 Carton (42571-147-26) / 10 Ml In 1 Bottle,250,RC,42571-147-26,NDC,,,facility,both,1,EA,,125.31,125.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Benzonatate: 100 Capsule In 1 Bottle (42806-714-01),250,RC,42806-714-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10) / 10 Tablet In 1 Blister Pack,250,RC,42858-001-10,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10) / 10 Tablet In 1 Blister Pack,250,RC,42858-001-10,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-301-01)",250,RC,42858-301-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-301-25) / 25 Tablet In 1 Blister Pack,250,RC,42858-301-25,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)",250,RC,42858-302-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)",250,RC,42858-302-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-302-25) / 25 Tablet In 1 Blister Pack,250,RC,42858-302-25,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 473 Ml In 1 Bottle, Plastic (42858-304-16)",250,RC,42858-304-16,NDC,,,facility,both,1,EA,,3.35,3.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (42858-703-03)",250,RC,42858-703-03,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate Extended Release: 100 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (42858-802-01)",250,RC,42858-802-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Allopurinol: 100 Tablet In 1 Bottle, Plastic (43063-935-01)",250,RC,43063-935-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cardene Iv: 10 Bag In 1 Carton (43066-016-10) / 200 Ml In 1 Bag,250,RC,43066-016-10,NDC,,,facility,both,1,EA,,167.34,167.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ursodiol: 100 Capsule In 1 Bottle (42806-503-01),250,RC,42806-503-01,NDC,,,facility,both,1,EA,,2.33,2.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 25 Tablet In 1 Bottle (42806-359-25),250,RC,42806-359-25,NDC,,,facility,both,1,EA,,13.81,13.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (42571-161-01)",250,RC,42571-161-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (42571-161-42)",250,RC,42571-161-42,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (42571-162-42)",250,RC,42571-162-42,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (42702-102-15) / 15 Ml In 1 Bottle, Dropper",250,RC,42702-102-15,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bumetanide: 100 Tablet In 1 Bottle (42799-119-01),250,RC,42799-119-01,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opium Tincture Deodorized: 118 Ml In 1 Bottle, Plastic (42799-217-01)",250,RC,42799-217-01,NDC,,,facility,both,1,EA,,4.35,4.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ethambutol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42806-102-01)",250,RC,42806-102-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,42806-266-98,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-339-01)",250,RC,42806-339-01,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-023-04) / 12 G In 1 Packet,250,RC,37000-023-04,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-413-01)",250,RC,29300-413-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lasix: 100 Tablet In 1 Bottle (30698-067-01),250,RC,30698-067-01,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Droxidopa: 90 Capsule In 1 Bottle (31722-014-90),250,RC,31722-014-90,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 100 Tablet, Film Coated In 1 Bottle (31722-017-01)",250,RC,31722-017-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1000 Tablet, Film Coated In 1 Bottle (31722-017-10)",250,RC,31722-017-10,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tramadol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-355-01)",250,RC,29300-355-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1000 Tablet, Film Coated In 1 Bottle (31722-017-10)",250,RC,31722-017-10,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-186-01)",250,RC,31722-186-01,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rivaroxaban: 180 Tablet, Film Coated In 1 Bottle (31722-496-18)",250,RC,31722-496-18,NDC,,,facility,both,1,EA,,8.6,8.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 30 Tablet, Film Coated In 1 Bottle (31722-526-30)",250,RC,31722-526-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methocarbamol: 12 Bottle In 1 Case (31722-534-01) / 100 Tablet In 1 Bottle,250,RC,31722-534-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Theophylline (Anhydrous): 100 Tablet, Extended Release In 1 Bottle, Plastic (29033-001-01)",250,RC,29033-001-01,NDC,,,facility,both,1,EA,,3.26,3.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (29033-020-12)",250,RC,29033-020-12,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Meloxicam: 100 Tablet In 1 Bottle (29300-124-01),250,RC,29300-124-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bisoprolol Fumarate: 100 Tablet In 1 Bottle, Plastic (29300-126-01)",250,RC,29300-126-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bisoprolol Fumarate: 30 Tablet In 1 Bottle, Plastic (29300-126-13)",250,RC,29300-126-13,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bisoprolol Fumarate: 100 Tablet In 1 Bottle, Plastic (29300-127-01)",250,RC,29300-127-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Buspirone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-245-01)",250,RC,29300-245-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonidine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-136-01)",250,RC,29300-136-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-138-01)",250,RC,29300-138-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-140-01)",250,RC,29300-140-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Memantine Hydrochloride: 60 Tablet, Film Coated In 1 Bottle, Plastic (29300-171-16)",250,RC,29300-171-16,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metronidazole: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-226-01)",250,RC,29300-226-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zaleplon: 100 Capsule In 1 Bottle, Plastic (29300-131-01)",250,RC,29300-131-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levetiracetam: 473 Ml In 1 Bottle (31722-574-47),250,RC,31722-574-47,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dabigatran Etexilate: 60 Capsule In 1 Bottle (31722-621-60),250,RC,31722-621-60,NDC,,,facility,both,1,EA,,5.57,5.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-097-09)",250,RC,33342-097-09,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-098-09)",250,RC,33342-098-09,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-256-66) / 10 Capsule In 1 Blister Pack,250,RC,33342-256-66,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-257-66) / 10 Capsule In 1 Blister Pack,250,RC,33342-257-66,NDC,,,facility,both,1,EA,,2.9,2.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-258-66) / 10 Capsule In 1 Blister Pack,250,RC,33342-258-66,NDC,,,facility,both,1,EA,,4.58,4.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,35135-01505,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,33342-093-02,NDC,,,facility,both,1,EA,,2.44,2.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,36000-162-01,NDC,,,facility,both,1,EA,,12.37,12.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,35573-428-51,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valsartan: 30 Tablet, Film Coated In 1 Bottle (33342-062-07)",250,RC,33342-062-07,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irbesartan: 90 Tablet In 1 Bottle (33342-047-10),250,RC,33342-047-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dabigatran Etexilate: 60 Capsule In 1 Bottle (31722-622-60),250,RC,31722-622-60,NDC,,,facility,both,1,EA,,5.88,5.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lacosamide: 1 Bottle In 1 Carton (31722-627-26) / 200 Ml In 1 Bottle,250,RC,31722-627-26,NDC,,,facility,both,1,EA,,23.48,23.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atovaquone: 1 Bottle In 1 Carton (31722-629-21) / 210 Ml In 1 Bottle,250,RC,31722-629-21,NDC,,,facility,both,1,EA,,3.69,3.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tadalafil: 30 Tablet, Film Coated In 1 Bottle (31722-644-30)",250,RC,31722-644-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-700-90)",250,RC,31722-700-90,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-701-90)",250,RC,31722-701-90,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (31722-712-90)",250,RC,31722-712-90,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atomoxetine: 30 Capsule In 1 Bottle (31722-717-30),250,RC,31722-717-30,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irbesartan: 90 Tablet In 1 Bottle (31722-729-90),250,RC,31722-729-90,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irbesartan: 90 Tablet In 1 Bottle (31722-730-90),250,RC,31722-730-90,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irbesartan: 90 Tablet In 1 Bottle (31722-731-90),250,RC,31722-731-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linezolid: 20 Tablet, Film Coated In 1 Bottle (31722-749-20)",250,RC,31722-749-20,NDC,,,facility,both,1,EA,,6.08,6.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexmedetomidine Hydrochloride In 0.9% Sodium Chloride: 24 Bag In 1 Carton (43066-555-24) / 50 Ml In 1 Bag,250,RC,43066-555-24,NDC,,,facility,both,1,EA,,35.06,35.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pyridostigmine Bromide: 30 Tablet, Extended Release In 1 Bottle (47781-335-30)",250,RC,47781-335-30,NDC,,,facility,both,1,EA,,13.95,13.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,47781-423-11,NDC,,,facility,both,1,EA,,13.96,13.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,47781-426-11,NDC,,,facility,both,1,EA,,17.55,17.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,47781-427-11,NDC,,,facility,both,1,EA,,39.39,39.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,47781-428-11,NDC,,,facility,both,1,EA,,42.14,42.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (47781-468-13) / 10 Capsule In 1 Blister Pack,250,RC,47781-468-13,NDC,,,facility,both,1,EA,,22.66,22.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-562-01),250,RC,47781-562-01,NDC,,,facility,both,1,EA,,18.79,18.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,47781-424-11,NDC,,,facility,both,1,EA,,11.9,11.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Polystyrene Sulfonate: 10 Bottle, Unit-Dose In 1 Carton (46287-006-60) / 60 Ml In 1 Bottle, Unit-Dose",250,RC,46287-006-60,NDC,,,facility,both,1,EA,,61.07,61.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nicotine Polacrilex: 110 Blister Pack In 1 Carton (45802-206-25) / 1 Gum, Chewing In 1 Blister Pack",250,RC,45802-206-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 1 Tube In 1 Carton (45802-276-03) / 28 G In 1 Tube,250,RC,45802-276-03,NDC,,,facility,both,1,EA,,4.24,4.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Betamethasone Dipropionate: 1 Tube In 1 Carton (45802-376-35) / 15 G In 1 Tube,250,RC,45802-376-35,NDC,,,facility,both,1,EA,,7.66,7.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxymetazoline Hcl: 1 Bottle, Spray In 1 Carton (45802-410-59) / 30 Ml In 1 Bottle, Spray",250,RC,45802-410-59,NDC,,,facility,both,1,EA,,5.52,5.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextromethorphan Polistirex Extended Release: 1 Bottle In 1 Carton (45802-433-21) / 89 Ml In 1 Bottle,250,RC,45802-433-21,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 1 Tube In 1 Carton (45802-438-03) / 28 G In 1 Tube,250,RC,45802-438-03,NDC,,,facility,both,1,EA,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ketoconazole: 120 Ml In 1 Bottle (45802-465-64),250,RC,45802-465-64,NDC,,,facility,both,1,EA,,47.29,47.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen Pain Reliever Fever Reducer: 100 Blister Pack In 1 Carton (45802-730-33) / 1 Suppository In 1 Blister Pack,250,RC,45802-730-33,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,45802-732-00,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nicotine: 110 Blister Pack In 1 Carton (45802-827-25) / 1 Gum, Chewing In 1 Blister Pack",250,RC,45802-827-25,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,45802-868-00,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enulose: 473 Ml In 1 Bottle (45963-438-64),250,RC,45963-438-64,NDC,,,facility,both,1,EA,,3.23,3.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen Pain Reliever Fever Reducer: 1 Suppository In 1 Blister Pack (45802-730-00),250,RC,45802-730-00,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-564-01),250,RC,47781-564-01,NDC,,,facility,both,1,EA,,17.89,17.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sunmark stay awake: 16 BLISTER PACK in 1 CARTON (49348-771-03) / 1 TABLET in 1 BLISTER PACK,250,RC,49348-771-03,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 100 Tablet In 1 Bottle, Plastic (49483-340-01)",250,RC,49483-340-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 100 Tablet In 1 Bottle, Plastic (49483-340-01)",250,RC,49483-340-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Epivir: 240 Ml In 1 Bottle (49702-205-48),250,RC,49702-205-48,NDC,,,facility,both,1,EA,,6.16,6.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Selzentry: 60 Tablet, Film Coated In 1 Bottle (49702-224-18)",250,RC,49702-224-18,NDC,,,facility,both,1,EA,,75.22,75.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sunmark Hydrogen Peroxide 3 Percent: 473 Ml In 1 Bottle (49348-179-38),250,RC,49348-179-38,NDC,,,facility,both,1,EA,,20.69,20.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Triumeq: 30 Tablet, Film Coated In 1 Bottle (49702-231-13)",250,RC,49702-231-13,NDC,,,facility,both,1,EA,,332.05,332.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Tablet In 1 Bottle (49884-021-01),250,RC,49884-021-01,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,49884-212-52,NDC,,,facility,both,1,EA,,5.89,5.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 5 Blister Pack In 1 Carton (49884-212-55) / 6 Tablet, Orally Disintegrating In 1 Blister Pack (49884-212-52)",250,RC,49884-212-55,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,49884-311-52,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 3 Blister Pack In 1 Carton (49884-320-55) / 10 Tablet, Orally Disintegrating In 1 Blister Pack (49884-320-52)",250,RC,49884-320-55,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,49884-465-64,NDC,,,facility,both,1,EA,,5.09,5.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyurea: 100 Capsule In 1 Bottle (49884-724-01),250,RC,49884-724-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)",250,RC,49702-228-13,NDC,,,facility,both,1,EA,,195.09,195.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-651-90),250,RC,47781-651-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Erythromycin: 50 Tube In 1 Carton (48102-057-11) / 1 G In 1 Tube,250,RC,48102-057-11,NDC,,,facility,both,1,EA,,23.73,23.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mineral Oil: 30 Ml In 1 Cup, Unit-Dose (48433-202-30)",250,RC,48433-202-30,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Strong Iodine Solution: 14 Ml In 1 Bottle (48433-230-15),250,RC,48433-230-15,NDC,,,facility,both,1,EA,,53.33,53.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Monsels Solution: 14 G In 1 Vial, Single-Dose (48783-112-08)",250,RC,48783-112-08,NDC,,,facility,both,1,EA,,36.94,36.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hemorrhoidal: 1 Tube In 1 Carton (45802-188-16) / 57 G In 1 Tube,250,RC,45802-188-16,NDC,,,facility,both,1,EA,,5.26,5.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triple Antibiotic: 1 Tube In 1 Carton (45802-143-03) / 28 G In 1 Tube,250,RC,45802-143-03,NDC,,,facility,both,1,EA,,6.92,6.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciprofloxacin: 100 Tablet In 1 Bottle (43547-688-10),250,RC,43547-688-10,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ssd Cream: 400 G In 1 Jar (43598-210-40),250,RC,43598-210-40,NDC,,,facility,both,1,EA,,140.91,140.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ssd Cream: 50 G In 1 Jar (43598-210-55),250,RC,43598-210-55,NDC,,,facility,both,1,EA,,24.32,24.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (43598-163-60)",250,RC,43598-163-60,NDC,,,facility,both,1,EA,,6.3,6.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (43547-545-10),250,RC,43547-545-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 60 Tablet, Film Coated, Extended Release In 1 Bottle (43547-345-06)",250,RC,43547-345-06,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,43066-997-01,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Norepinephrine Bitartrate: 10 Vial, Single-Dose In 1 Carton (43066-997-10) / 4 Ml In 1 Vial, Single-Dose (43066-997-01)",250,RC,43066-997-10,NDC,,,facility,both,1,EA,,6.07,6.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clobetasol Propionate: 1 Tube In 1 Carton (43386-096-60) / 15 G In 1 Tube,250,RC,43386-096-60,NDC,,,facility,both,1,EA,,30.99,30.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Misoprostol: 100 Tablet In 1 Bottle (43386-161-01),250,RC,43386-161-01,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-270-10)",250,RC,43547-270-10,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-272-10)",250,RC,43547-272-10,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Tablet, Film Coated In 1 Bottle (43547-280-10)",250,RC,43547-280-10,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Tablet, Film Coated In 1 Bottle (43547-282-10)",250,RC,43547-282-10,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Sr: 100 Tablet, Film Coated, Extended Release In 1 Bottle (43547-288-10)",250,RC,43547-288-10,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Risperidone: 60 Tablet In 1 Bottle (43547-342-06),250,RC,43547-342-06,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-268-10)",250,RC,43547-268-10,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,43598-447-71,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nystatin: 1 Tube In 1 Carton (45802-048-35) / 15 G In 1 Tube,250,RC,45802-048-35,NDC,,,facility,both,1,EA,,19.17,19.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-054-35) / 15 G In 1 Tube,250,RC,45802-054-35,NDC,,,facility,both,1,EA,,9.47,9.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin Sulfate: 1 Tube In 1 Carton (45802-056-11) / 30 G In 1 Tube,250,RC,45802-056-11,NDC,,,facility,both,1,EA,,127.82,127.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin Sulfate: 1 Tube In 1 Carton (45802-056-35) / 15 G In 1 Tube,250,RC,45802-056-35,NDC,,,facility,both,1,EA,,76.12,76.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nystatin: 1 Tube In 1 Carton (45802-059-35) / 15 G In 1 Tube,250,RC,45802-059-35,NDC,,,facility,both,1,EA,,37.06,37.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,45802-143-00,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Citrate: 100 Tablet In 1 Bottle (44523-410-01),250,RC,44523-410-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carboprost Tromethamine: 1 Vial, Single-Dose In 1 Carton (43598-698-11) / 1 Ml In 1 Vial, Single-Dose",250,RC,43598-698-11,NDC,,,facility,both,1,EA,,108.45,108.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,43598-725-11,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,43598-891-16,NDC,,,facility,both,1,EA,,15.2,15.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,43598-917-11,NDC,,,facility,both,1,EA,,111.77,111.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (43598-965-30),250,RC,43598-965-30,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triple Antibiotic: 144 Packet In 1 Carton (45802-143-70) / .9 G In 1 Packet (45802-143-00),250,RC,45802-143-70,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline: 50 Capsule In 1 Bottle (27808-233-01),250,RC,27808-233-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Febuxostat: 30 Tablet In 1 Bottle (27808-207-01),250,RC,27808-207-01,NDC,,,facility,both,1,EA,,2.83,2.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (16714-733-01),250,RC,16714-733-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atomoxetine: 30 Capsule In 1 Bottle (16714-758-01),250,RC,16714-758-01,NDC,,,facility,both,1,EA,,4.98,4.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atomoxetine: 30 Capsule In 1 Bottle (16714-759-01),250,RC,16714-759-01,NDC,,,facility,both,1,EA,,5.27,5.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Terbinafine: 30 Tablet In 1 Bottle (16714-795-01),250,RC,16714-795-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sumatriptan: 1 Blister Pack In 1 Carton (16714-797-01) / 9 Tablet In 1 Blister Pack,250,RC,16714-797-01,NDC,,,facility,both,1,EA,,3.55,3.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (16714-732-01),250,RC,16714-732-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ezetimibe: 90 Tablet In 1 Bottle (16714-813-02),250,RC,16714-813-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (16714-820-01)",250,RC,16714-820-01,NDC,,,facility,both,1,EA,,3.55,3.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Budesonide: 100 Capsule, Coated Pellets In 1 Bottle (16714-829-01)",250,RC,16714-829-01,NDC,,,facility,both,1,EA,,4.41,4.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paliperidone: 30 Tablet, Extended Release In 1 Bottle (16714-867-01)",250,RC,16714-867-01,NDC,,,facility,both,1,EA,,7.86,7.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine: 1 Tube In 1 Carton (16714-878-01) / 35.44 G In 1 Tube,250,RC,16714-878-01,NDC,,,facility,both,1,EA,,20.8,20.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ezetimibe: 30 Tablet In 1 Bottle (16714-813-01),250,RC,16714-813-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Permethrin: 1 Tube In 1 Container (16714-897-01) / 60 G In 1 Tube,250,RC,16714-897-01,NDC,,,facility,both,1,EA,,40.2,40.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Capsule In 1 Bottle (16714-721-02),250,RC,16714-721-02,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Capsule In 1 Bottle (16714-720-02),250,RC,16714-720-02,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-621-01)",250,RC,16714-621-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-622-01)",250,RC,16714-622-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Capsule In 1 Bottle (16714-661-01),250,RC,16714-661-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Capsule In 1 Bottle (16714-662-01),250,RC,16714-662-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Capsule In 1 Bottle (16714-663-01),250,RC,16714-663-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-681-02)",250,RC,16714-681-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-682-02)",250,RC,16714-682-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-683-02)",250,RC,16714-683-02,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-684-02)",250,RC,16714-684-02,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 100 Tablet In 1 Bottle (16714-691-02),250,RC,16714-691-02,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 1 Bottle In 1 Carton (16714-696-01) / 35 Ml In 1 Bottle,250,RC,16714-696-01,NDC,,,facility,both,1,EA,,7.85,7.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lamotrigine: 100 Tablet In 1 Bottle (16714-700-01),250,RC,16714-700-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "imatinib mesylate: 90 TABLET, FILM COATED in 1 BOTTLE (16714-704-01) ",250,RC,16714-704-01,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-717-01)",250,RC,16714-717-01,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (16714-948-01)",250,RC,16714-948-01,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aspirin And Dipyridamole: 60 Capsule, Extended Release In 1 Bottle (16714-964-01)",250,RC,16714-964-01,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phytonadione: 1 Bottle In 1 Carton (16714-973-02) / 30 Tablet In 1 Bottle,250,RC,16714-973-02,NDC,,,facility,both,1,EA,,72.64,72.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ezetimibe: 30 Tablet In 1 Bottle (16729-433-10),250,RC,16729-433-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cinacalcet: 90 Tablet, Film Coated In 1 Bottle, Plastic (16729-440-15)",250,RC,16729-440-15,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levothyroxine Sodium: 90 Tablet In 1 Bottle (16729-456-15),250,RC,16729-456-15,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (16729-478-01),250,RC,16729-478-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (16729-479-01),250,RC,16729-479-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cinacalcet: 30 Tablet, Film Coated In 1 Bottle, Plastic (16729-440-10)",250,RC,16729-440-10,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 Tablet In 1 Bottle (16729-183-01),250,RC,16729-183-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-989-01)",250,RC,16714-989-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-990-01)",250,RC,16714-990-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (16714-991-01)",250,RC,16714-991-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bicalutamide: 100 Tablet In 1 Bottle (16729-023-01),250,RC,16729-023-01,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bicalutamide: 30 Tablet In 1 Bottle (16729-023-10),250,RC,16729-023-10,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Anastrozole: 30 Tablet In 1 Bottle, Plastic (16729-035-10)",250,RC,16729-035-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Capecitabine: 120 Tablet, Film Coated In 1 Bottle, Plastic (16729-073-29)",250,RC,16729-073-29,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-136-00)",250,RC,16729-136-00,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)",250,RC,16729-136-16,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-137-00)",250,RC,16729-137-00,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dermoplast Pain Relieving: 78 G In 1 Can (16864-680-01),250,RC,16864-680-01,NDC,,,facility,both,1,EA,,16.15,16.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (16714-613-05)",250,RC,16714-613-05,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-613-04)",250,RC,16714-613-04,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (16714-035-01)",250,RC,16714-035-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clopidogrel: 90 Tablet In 1 Bottle (16714-052-02),250,RC,16714-052-02,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (16714-081-10),250,RC,16714-081-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,16714-116-01,NDC,,,facility,both,1,EA,,6.2,6.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,16714-117-01,NDC,,,facility,both,1,EA,,6.05,6.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (16714-142-01),250,RC,16714-142-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Tablet In 1 Bottle (16714-009-01),250,RC,16714-009-01,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Tablet In 1 Bottle (16714-008-01),250,RC,16714-008-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Tablet, Film Coated In 1 Bottle, Plastic (16252-515-01)",250,RC,16252-515-01,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atorvastatin Calcium: 1000 Tablet In 1 Bottle (16571-137-10),250,RC,16571-137-10,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10),250,RC,16571-401-10,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10),250,RC,16571-401-10,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa, Levodopa And Entacapone: 100 Tablet, Film Coated In 1 Bottle (16571-693-01)",250,RC,16571-693-01,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (16714-145-01),250,RC,16714-145-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liothyronine Sodium: 100 Tablet In 1 Bottle (16714-166-01),250,RC,16714-166-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (16714-444-01),250,RC,16714-444-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 1000 Tablet, Film Coated In 1 Bottle (16714-452-02)",250,RC,16714-452-02,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 100 Tablet, Film Coated In 1 Bottle (16714-454-01)",250,RC,16714-454-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Palmitate Hydrochloride (Pediatric): 1 Bottle In 1 Carton (16714-483-01) / 100 Ml In 1 Bottle,250,RC,16714-483-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Film Coated, Extended Release In 1 Bottle (16714-485-01)",250,RC,16714-485-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan: 1 BLISTER PACK in 1 CARTON (16714-532-11) / 9 TABLET, FILM COATED in 1 BLISTER PACK (16714-532-10) ",250,RC,16714-532-11,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (16714-443-01),250,RC,16714-443-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metronidazole: 1 Tube, With Applicator In 1 Carton (16714-557-01) / 70 G In 1 Tube, With Applicator",250,RC,16714-557-01,NDC,,,facility,both,1,EA,,164.13,164.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Allopurinol: 100 Tablet In 1 Bottle (16714-577-01),250,RC,16714-577-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Tablet In 1 Bottle (16714-590-01),250,RC,16714-590-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Tablet In 1 Bottle (16714-591-01),250,RC,16714-591-01,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 1 Bottle, Plastic In 1 Carton (16714-601-02) / 60 Ml In 1 Bottle, Plastic",250,RC,16714-601-02,NDC,,,facility,both,1,EA,,3.2,3.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-612-04)",250,RC,16714-612-04,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pravastatin Sodium: 90 Tablet In 1 Bottle (16714-559-01),250,RC,16714-559-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefuroxime Axetil: 60 Tablet In 1 Bottle (16714-401-02),250,RC,16714-401-02,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefuroxime Axetil: 20 Tablet In 1 Bottle (16714-401-01),250,RC,16714-401-01,NDC,,,facility,both,1,EA,,5.21,5.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liothyronine Sodium: 100 Tablet In 1 Bottle (16714-167-01),250,RC,16714-167-01,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,16714-186-01,NDC,,,facility,both,1,EA,,21.58,21.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Voriconazole: 30 Tablet, Film Coated In 1 Bottle (16714-199-01)",250,RC,16714-199-01,NDC,,,facility,both,1,EA,,13.51,13.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (16714-234-01)",250,RC,16714-234-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mesalamine: 5 Blister Pack In 1 Pouch (16714-245-30) / 6 Suppository In 1 Blister Pack (16714-245-01),250,RC,16714-245-30,NDC,,,facility,both,1,EA,,9.92,9.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-257-01)",250,RC,16714-257-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Capsule In 1 Bottle (16714-298-01),250,RC,16714-298-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Capsule In 1 Bottle (16714-299-03),250,RC,16714-299-03,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 473 Ml In 1 Bottle, Plastic (16714-358-01)",250,RC,16714-358-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefadroxil: 50 Capsule In 1 Bottle (16714-388-01),250,RC,16714-388-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefadroxil: 75 Ml In 1 Bottle (16714-390-01),250,RC,16714-390-01,NDC,,,facility,both,1,EA,,9.48,9.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dermoplast Pain Relieving: 85 G In 1 Can (16864-680-03),250,RC,16864-680-03,NDC,,,facility,both,1,EA,,14.8,14.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neomycin And Polymyxin B Sulfates And Gramicidin: 1 Bottle, Dropper In 1 Carton (24208-790-62) / 10 Ml In 1 Bottle, Dropper",250,RC,24208-790-62,NDC,,,facility,both,1,EA,,96.56,96.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neomycin And Polymyxin B Sulfates And Dexamethasone: 1 Tube In 1 Carton (24208-795-35) / 3.5 G In 1 Tube,250,RC,24208-795-35,NDC,,,facility,both,1,EA,,32.21,32.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Erythromycin: 50 Tube In 1 Box (24208-910-19) / 1 G In 1 Tube,250,RC,24208-910-19,NDC,,,facility,both,1,EA,,15.48,15.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ery-Ped: 100 Ml In 1 Bottle (24338-132-13),250,RC,24338-132-13,NDC,,,facility,both,1,EA,,60.75,60.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Donepezil Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (24979-004-06)",250,RC,24979-004-06,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Guanfacine Hydrochloride: 100 Tablet In 1 Bottle (24979-198-01),250,RC,24979-198-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mephyton: 1 BOTTLE in 1 CARTON (25010-405-15) / 100 TABLET in 1 BOTTLE,250,RC,25010-405-15,NDC,,,facility,both,1,EA,,13.84,13.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Risperidone: 60 Tablet In 1 Bottle (27241-003-06),250,RC,27241-003-06,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Entacapone: 100 Tablet In 1 Bottle (27241-049-10),250,RC,27241-049-10,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 90 Capsule, Delayed Release In 1 Bottle (27241-098-09)",250,RC,27241-098-09,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,27241-134-21,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 30 Ml In 1 Bottle, Unit-Dose (27808-002-01)",250,RC,27808-002-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle, Plastic (27808-114-01)",250,RC,27808-114-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diltiazem Hydrochloride: 10 Vial In 1 Carton (25021-319-05) / 5 Ml In 1 Vial,250,RC,25021-319-05,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Heparin Sodium: 25 Vial In 1 Carton (25021-402-01) / 1 Ml In 1 Vial,250,RC,25021-402-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glydo: 10 Syringe In 1 Carton (25021-673-76) / 6 Ml In 1 Syringe,250,RC,25021-673-76,NDC,,,facility,both,1,EA,,9.13,9.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glydo: 10 Syringe In 1 Carton (25021-673-77) / 11 Ml In 1 Syringe,250,RC,25021-673-77,NDC,,,facility,both,1,EA,,11.59,11.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glydo: 10 Syringe In 1 Carton (25021-673-77) / 11 Ml In 1 Syringe,250,RC,25021-673-77,NDC,,,facility,both,1,EA,,11.46,11.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neomycin And Polymyxin B Sulfates And Bacitracin Zinc: 1 Tube In 1 Carton (24208-780-55) / 3.5 G In 1 Tube,250,RC,24208-780-55,NDC,,,facility,both,1,EA,,121.31,121.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclopentolate Hydrochloride: 1 Bottle, Dropper In 1 Carton (24208-735-01) / 2 Ml In 1 Bottle, Dropper",250,RC,24208-735-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Proparacaine Hydrochloride: 1 Bottle, Dropper In 1 Carton (24208-730-06) / 15 Ml In 1 Bottle, Dropper",250,RC,24208-730-06,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-720-02) / 5 Ml In 1 Bottle, Dropper",250,RC,24208-720-02,NDC,,,facility,both,1,EA,,106.24,106.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (23155-002-01)",250,RC,23155-002-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Verapamil Hydrochloride: 100 Tablet In 1 Bottle (23155-026-01),250,RC,23155-026-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leflunomide: 30 Tablet In 1 Bottle (23155-043-03),250,RC,23155-043-03,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methimazole: 100 Tablet In 1 Bottle (23155-070-01),250,RC,23155-070-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methimazole: 100 Tablet In 1 Bottle (23155-071-01),250,RC,23155-071-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,23155-166-31,NDC,,,facility,both,1,EA,,6.61,6.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tranexamic Acid: 10 Vial, Glass In 1 Carton (23155-166-41) / 10 Ml In 1 Vial, Glass (23155-166-31)",250,RC,23155-166-41,NDC,,,facility,both,1,EA,,6.88,6.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (23155-178-01)",250,RC,23155-178-01,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nifedipine: 100 Capsule In 1 Bottle (23155-194-01),250,RC,23155-194-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,17238-424-25,NDC,,,facility,both,1,EA,,126.22,126.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bioglo: 100 Packet In 1 Box (17238-900-11) / 1 Mg In 1 Packet (17238-900-99),250,RC,17238-900-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,17238-900-99,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (17271-701-05),250,RC,17271-701-05,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tetracaine: 25 AMPULE in 1 CARTON (17478-045-32) / 2 mL in 1 AMPULE,250,RC,17478-045-32,NDC,,,facility,both,1,EA,,47.59,47.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atropine: 1 BOTTLE, DROPPER in 1 CARTON (17478-215-02) / 2 mL in 1 BOTTLE, DROPPER",250,RC,17478-215-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Timolol Maleate: 1 BOTTLE, DROPPER in 1 CARTON (17478-288-10) / 5 mL in 1 BOTTLE, DROPPER",250,RC,17478-288-10,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dehydrated Alcohol: 10 VIAL in 1 CARTON (17478-503-05) / 5 mL in 1 VIAL,250,RC,17478-503-05,NDC,,,facility,both,1,EA,,715.32,715.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ofloxacin: 1 BOTTLE, DROPPER in 1 CARTON (17478-713-10) / 5 mL in 1 BOTTLE, DROPPER",250,RC,17478-713-10,NDC,,,facility,both,1,EA,,26.22,26.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brimonidine: 1 BOTTLE, DROPPER in 1 CARTON (17478-715-10) / 5 mL in 1 BOTTLE, DROPPER",250,RC,17478-715-10,NDC,,,facility,both,1,EA,,38.36,38.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sucralfate: 72 Cup, Unit-Dose In 1 Box, Unit-Dose (17856-0306-1) / 10 Ml In 1 Cup, Unit-Dose",250,RC,17856-0306-1,NDC,,,facility,both,1,EA,,10.37,10.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (23155-772-01),250,RC,23155-772-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-833-01),250,RC,23155-833-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-834-01),250,RC,23155-834-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (23155-858-78) / 10 Capsule In 1 Blister Pack,250,RC,23155-858-78,NDC,,,facility,both,1,EA,,5.12,5.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Muro 128: 1 Bottle In 1 Carton (24208-277-15) / 15 Ml In 1 Bottle,250,RC,24208-277-15,NDC,,,facility,both,1,EA,,48.3,48.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tobramycin: 1 Bottle, Dropper In 1 Carton (24208-290-05) / 5 Ml In 1 Bottle, Dropper",250,RC,24208-290-05,NDC,,,facility,both,1,EA,,28.54,28.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brimonidine Tartrate: 1 Bottle, Dropper In 1 Carton (24208-411-05) / 5 Ml In 1 Bottle, Dropper",250,RC,24208-411-05,NDC,,,facility,both,1,EA,,36.82,36.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dorzolamide Hcl: 1 Bottle, Dropper In 1 Carton (24208-485-10) / 10 Ml In 1 Bottle, Dropper",250,RC,24208-485-10,NDC,,,facility,both,1,EA,,28.85,28.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (24208-486-10) / 10 Ml In 1 Bottle, Dropper",250,RC,24208-486-10,NDC,,,facility,both,1,EA,,55.87,55.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gentamicin Sulfate: 1 Bottle, Dropper In 1 Carton (24208-580-60) / 5 Ml In 1 Bottle, Dropper",250,RC,24208-580-60,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neomycin And Polymyxin B Sulfates And Hydrocortisone: 1 Bottle, Dropper In 1 Carton (24208-635-62) / 10 Ml In 1 Bottle, Dropper",250,RC,24208-635-62,NDC,,,facility,both,1,EA,,163.78,163.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tobramycin And Dexamethasone: 1 Bottle, Dropper In 1 Carton (24208-295-25) / 2.5 Ml In 1 Bottle, Dropper",250,RC,24208-295-25,NDC,,,facility,both,1,EA,,97.94,97.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-767-01),250,RC,23155-767-01,NDC,,,facility,both,1,EA,,4.37,4.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (23155-500-01),250,RC,23155-500-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (23155-501-01),250,RC,23155-501-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desipramine Hydrochloride: 100 Tablet In 1 Bottle (23155-579-01),250,RC,23155-579-01,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glycopyrrolate: 100 Tablet In 1 Bottle (23155-606-01),250,RC,23155-606-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2127-10),250,RC,0228-2127-10,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Mononitrate: 100 Tablet In 1 Bottle (0228-2620-11),250,RC,0228-2620-11,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Tablet, Film Coated In 1 Bottle (0228-2637-11)",250,RC,0228-2637-11,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2891-03)",250,RC,0228-2891-03,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2892-03)",250,RC,0228-2892-03,NDC,,,facility,both,1,EA,,3.55,3.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temazepam: 100 Capsule In 1 Bottle (0228-2076-10),250,RC,0228-2076-10,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (0228-3059-11)",250,RC,0228-3059-11,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-0036-89,NDC,,,facility,both,1,EA,,5.46,5.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Citrate: 100 Tablet In 1 Bottle (0245-0071-11),250,RC,0245-0071-11,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pacerone: 100 Blister Pack In 1 Carton (0245-0144-01) / 1 Tablet In 1 Blister Pack (0245-0144-89),250,RC,0245-0144-01,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pacerone: 100 Blister Pack In 1 Carton (0245-0147-01) / 1 Tablet In 1 Blister Pack (0245-0147-89),250,RC,0245-0147-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pacerone: 60 Tablet In 1 Bottle (0245-0147-60),250,RC,0245-0147-60,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-0147-89,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prevalite: 42 Packet In 1 Carton (0245-0036-42) / 5.5 G In 1 Packet (0245-0036-89),250,RC,0245-0036-42,NDC,,,facility,both,1,EA,,5.48,5.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0211-11),250,RC,0245-0211-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfadiazine: 100 TABLET in 1 BOTTLE (0185-0757-01) ,250,RC,0185-0757-01,NDC,,,facility,both,1,EA,,8.84,8.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Symbicort: 1 Pouch In 1 Carton (0186-0370-28) / 1 Canister In 1 Pouch / 60 Aerosol In 1 Canister,250,RC,0186-0370-28,NDC,,,facility,both,1,EA,,55.28,55.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Symbicort: 1 Pouch In 1 Carton (0186-0372-20) / 1 Canister In 1 Pouch / 120 Aerosol In 1 Canister,250,RC,0186-0372-20,NDC,,,facility,both,1,EA,,4.14,4.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Symbicort: 1 Pouch In 1 Carton (0186-0372-28) / 1 Canister In 1 Pouch / 60 Aerosol In 1 Canister,250,RC,0186-0372-28,NDC,,,facility,both,1,EA,,9.36,9.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Brilinta: 60 Tablet In 1 Bottle (0186-0776-60),250,RC,0186-0776-60,NDC,,,facility,both,1,EA,,20.52,20.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brilinta: 10 Blister Pack In 1 Box, Unit-Dose (0186-0777-39) / 10 Tablet In 1 Blister Pack",250,RC,0186-0777-39,NDC,,,facility,both,1,EA,,19.43,19.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Wellbutrin Xl: 30 Tablet, Extended Release In 1 Bottle (0187-0730-30)",250,RC,0187-0730-30,NDC,,,facility,both,1,EA,,167.86,167.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cardizem Cd: 90 Capsule, Coated, Extended Release In 1 Bottle, Plastic (0187-0798-42)",250,RC,0187-0798-42,NDC,,,facility,both,1,EA,,152.47,152.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 TABLET in 1 BOTTLE (0228-2057-10) ,250,RC,0228-2057-10,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0206-8860-01,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zosyn In Galaxy Containers: 24 Bag In 1 Box (0206-8860-02) / 50 Ml In 1 Bag (0206-8860-01),250,RC,0206-8860-02,NDC,,,facility,both,1,EA,,6.75,6.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0223-1760-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neo-Synephrine Mild: 15 Ml In 1 Bottle, Spray (0225-0800-47)",250,RC,0225-0800-47,NDC,,,facility,both,1,EA,,9.1,9.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (0228-2027-10),250,RC,0228-2027-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (0228-2031-10),250,RC,0228-2031-10,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0245-0212-01) / 1 Tablet In 1 Blister Pack (0245-0212-89),250,RC,0245-0212-01,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0212-11),250,RC,0245-0212-11,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 84 Container In 1 Case (0264-1800-31) / 50 Ml In 1 Container,250,RC,0264-1800-31,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trophamine: 12 Container In 1 Case (0264-1933-10) / 500 Ml In 1 Container,250,RC,0264-1933-10,NDC,,,facility,both,1,EA,,393.75,393.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 16 Container In 1 Case (0264-2101-00) / 1000 Ml In 1 Container,250,RC,0264-2101-00,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 16 Container In 1 Case (0264-2101-10) / 500 Ml In 1 Container,250,RC,0264-2101-10,NDC,,,facility,both,1,EA,,37.54,37.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 16 Container In 1 Case (0264-2201-10) / 500 Ml In 1 Container,250,RC,0264-2201-10,NDC,,,facility,both,1,EA,,44.49,44.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetic Acid: 16 Container In 1 Case (0264-2304-10) / 500 Ml In 1 Container,250,RC,0264-2304-10,NDC,,,facility,both,1,EA,,51.7,51.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 64 Container In 1 Case (0264-1800-32) / 100 Ml In 1 Container,250,RC,0264-1800-32,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-0212-89,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0213-11),250,RC,0245-0213-11,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-0360-89,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-0360-89,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-5316-89,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-5316-89,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-5317-89,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Klor-Con M: 1000 Tablet, Extended Release In 1 Bottle (0245-5319-10)",250,RC,0245-5319-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-5319-89,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0245-5319-89,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0254-3012-78,NDC,,,facility,both,1,EA,,298.55,298.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3028-02)",250,RC,0254-3028-02,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3029-02)",250,RC,0254-3029-02,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methimazole: 100 TABLET in 1 BOTTLE (0185-0210-01) ,250,RC,0185-0210-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (0185-0122-01),250,RC,0185-0122-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Folic Acid: 100 TABLET in 1 BOTTLE (0143-9717-01) ,250,RC,0143-9717-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0143-9785-01,NDC,,,facility,both,1,EA,,5.31,5.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (0143-9803-50)",250,RC,0143-9803-50,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0143-9595-01,NDC,,,facility,both,1,EA,,2.44,2.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0143-9633-01,NDC,,,facility,both,1,EA,,138.91,138.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0143-9637-01,NDC,,,facility,both,1,EA,,4.75,4.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valproate Sodium: 10 Vial, Single-Dose In 1 Tray (0143-9637-10) / 5 Ml In 1 Vial, Single-Dose (0143-9637-01)",250,RC,0143-9637-10,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 500 Tablet In 1 Bottle (0172-3925-70),250,RC,0172-3925-70,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 100 Tablet In 1 Bottle (0172-3926-60),250,RC,0172-3926-60,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 100 Tablet In 1 Bottle (0172-3927-60),250,RC,0172-3927-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 500 Tablet, Film Coated In 1 Bottle (0172-5728-70)",250,RC,0172-5728-70,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1000 Tablet, Film Coated In 1 Bottle (0172-5728-80)",250,RC,0172-5728-80,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1000 Tablet, Film Coated In 1 Bottle (0172-5728-80)",250,RC,0172-5728-80,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Wellbutrin Sr: 60 Tablet, Film Coated In 1 Bottle (0173-0135-55)",250,RC,0173-0135-55,NDC,,,facility,both,1,EA,,18.87,18.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 100 Tablet In 1 Bottle (0172-3925-60),250,RC,0172-3925-60,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ventolin Hfa: 1 Inhaler In 1 Carton (0173-0682-24) / 60 Aerosol, Metered In 1 Inhaler",250,RC,0173-0682-24,NDC,,,facility,both,1,EA,,56.53,56.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "RYTHMOL: 100 TABLET, FILM COATED in 1 BOTTLE (0173-0792-20) ",250,RC,0173-0792-20,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Breo Ellipta: 1 Tray In 1 Carton (0173-0859-10) / 1 Inhaler In 1 Tray / 30 Powder In 1 Inhaler,250,RC,0173-0859-10,NDC,,,facility,both,1,EA,,985.64,985.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Breo Ellipta: 1 Tray In 1 Carton (0173-0859-14) / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler,250,RC,0173-0859-14,NDC,,,facility,both,1,EA,,160.46,160.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Anoro Ellipta: 1 Tray In 1 Carton (0173-0869-06) / 1 Inhaler In 1 Tray / 7 Powder In 1 Inhaler,250,RC,0173-0869-06,NDC,,,facility,both,1,EA,,193.89,193.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0874-14) / 14 Powder In 1 Inhaler,250,RC,0173-0874-14,NDC,,,facility,both,1,EA,,174.51,174.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0876-14) / 14 Powder In 1 Inhaler,250,RC,0173-0876-14,NDC,,,facility,both,1,EA,,237.05,237.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Breo Ellipta: 1 Tray In 1 Carton (0173-0882-14) / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler,250,RC,0173-0882-14,NDC,,,facility,both,1,EA,,160.17,160.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 BLISTER PACK in 1 BOX (0182-0905-89) / 1 TABLET in 1 BLISTER PACK (0182-0905-00) ,250,RC,0182-0905-89,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2089-60),250,RC,0172-2089-60,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0002-15) / 15 G In 1 Tube,250,RC,0168-0002-15,NDC,,,facility,both,1,EA,,14.04,14.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0003-15) / 15 G In 1 Tube,250,RC,0168-0003-15,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0004-15) / 15 G In 1 Tube,250,RC,0168-0004-15,NDC,,,facility,both,1,EA,,6.73,6.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 15 G In 1 Tube (0168-0006-15),250,RC,0168-0006-15,NDC,,,facility,both,1,EA,,6.68,6.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 1 Tube In 1 Carton (0168-0020-31) / 28.35 G In 1 Tube,250,RC,0168-0020-31,NDC,,,facility,both,1,EA,,9.46,9.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Betamethasone Valerate: 15 G In 1 Tube (0168-0033-15),250,RC,0168-0033-15,NDC,,,facility,both,1,EA,,21.52,21.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clobetasol Propionate: 15 G In 1 Tube (0168-0163-15),250,RC,0168-0163-15,NDC,,,facility,both,1,EA,,39.1,39.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10) / 3 Ml In 1 Syringe, Plastic",250,RC,0169-6339-10,NDC,,,facility,both,1,EA,,42.3,42.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2083-60),250,RC,0172-2083-60,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),250,RC,0338-0049-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04),250,RC,0338-0049-04,NDC,,,facility,both,1,EA,,38,38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-11) / 50 Ml In 1 Bag,250,RC,0338-0049-11,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-18) / 100 Ml In 1 Bag,250,RC,0338-0049-18,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 500 Ml In 1 Bag (0338-0017-03),250,RC,0338-0017-03,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 1000 Ml In 1 Bag (0338-0017-04),250,RC,0338-0017-04,NDC,,,facility,both,1,EA,,38,38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 4 Bag In 1 Pouch (0338-0017-18) / 100 Ml In 1 Bag,250,RC,0338-0017-18,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04),250,RC,0338-0043-04,NDC,,,facility,both,1,EA,,44.61,44.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Carton (0338-0047-27) / 3000 Ml In 1 Bag,250,RC,0338-0047-27,NDC,,,facility,both,1,EA,,50.47,50.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03) / 500 Ml In 1 Bottle, Plastic",250,RC,0338-0048-03,NDC,,,facility,both,1,EA,,40.56,40.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0051-44),250,RC,0338-0051-44,NDC,,,facility,both,1,EA,,127.6,127.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Plasma-Lyte A: 1000 Ml In 1 Bag (0338-0221-04),250,RC,0338-0221-04,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glycine: 3000 Ml In 1 Bag (0338-0289-47),250,RC,0338-0289-47,NDC,,,facility,both,1,EA,,4.76,4.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Recothrom: 1 Kit In 1 Kit (0338-0322-01) * 5 Ml In 1 Vial (0338-0324-01) * 5 Ml In 1 Syringe,250,RC,0338-0322-01,NDC,,,facility,both,1,EA,,102.5,102.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0338-0324-01,NDC,,,facility,both,1,EA,,168.78,168.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Intralipid: 500 Ml In 1 Bag (0338-0519-13),250,RC,0338-0519-13,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Osmitrol: 500 Ml In 1 Bag (0338-0357-03),250,RC,0338-0357-03,NDC,,,facility,both,1,EA,,107.45,107.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 20 Bag In 1 Carton (0338-0066-20) / 500 Ml In 1 Bag,250,RC,0338-0066-20,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "9 BOTTLE, PLASTIC in 1 CARTON (0338-0004-05) / 1500 mL in 1 BOTTLE, PLASTIC",250,RC,0338-0004-05,NDC,,,facility,both,1,EA,,43.68,43.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7635-00) / 1000 Ml In 1 Container,250,RC,0264-7635-00,NDC,,,facility,both,1,EA,,44.96,44.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7638-00) / 1000 Ml In 1 Container,250,RC,0264-7638-00,NDC,,,facility,both,1,EA,,51.47,51.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7652-00) / 1000 Ml In 1 Container,250,RC,0264-7652-00,NDC,,,facility,both,1,EA,,45.89,45.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-20) / 250 Ml In 1 Container,250,RC,0264-7510-20,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nutrilipid I.V. Fat Emulsion: 8 Carton In 1 Case (0264-4460-00) / 1 Container In 1 Carton / 1000 Ml In 1 Container,250,RC,0264-4460-00,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 12 Container In 1 Case (0264-5802-00) / 1000 Ml In 1 Container,250,RC,0264-5802-00,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 4 Container In 1 Case (0264-7386-50) / 2000 Ml In 1 Container,250,RC,0264-7386-50,NDC,,,facility,both,1,EA,,57.09,57.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 4 Container In 1 Case (0264-7386-60) / 3000 Ml In 1 Container,250,RC,0264-7386-60,NDC,,,facility,both,1,EA,,66,66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-10) / 500 Ml In 1 Container,250,RC,0264-7510-10,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 12 Container In 1 Case (0264-5804-00) / 1000 Ml In 1 Container,250,RC,0264-5804-00,NDC,,,facility,both,1,EA,,46.16,46.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-7800-20) / 250 Ml In 1 Container,250,RC,0264-7800-20,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Farxiga: 30 Tablet, Film Coated In 1 Bottle, Plastic (0310-6205-30)",250,RC,0310-6205-30,NDC,,,facility,both,1,EA,,33.2,33.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Farxiga: 30 Tablet, Film Coated In 1 Bottle, Plastic (0310-6210-30)",250,RC,0310-6210-30,NDC,,,facility,both,1,EA,,32.84,32.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 14 Bag In 1 Carton (0338-0003-44) / 1000 Ml In 1 Bag,250,RC,0338-0003-44,NDC,,,facility,both,1,EA,,51.06,51.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sterile Water: 24 Bottle, Plastic In 1 Carton (0338-0004-02) / 250 Ml In 1 Bottle, Plastic",250,RC,0338-0004-02,NDC,,,facility,both,1,EA,,36.81,36.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sterile Water: 18 Bottle, Plastic In 1 Carton (0338-0004-03) / 500 Ml In 1 Bottle, Plastic",250,RC,0338-0004-03,NDC,,,facility,both,1,EA,,40.43,40.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sterile Water: 12 Bottle, Plastic In 1 Carton (0338-0004-04) / 1000 Ml In 1 Bottle, Plastic",250,RC,0338-0004-04,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0310-1110-01,NDC,,,facility,both,1,EA,,21.36,21.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 12 Container In 1 Case (0264-7850-00) / 1000 Ml In 1 Container,250,RC,0264-7850-00,NDC,,,facility,both,1,EA,,37.86,37.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitro-Bid: 48 Packet In 1 Box (0281-0326-08) / 1 G In 1 Packet,250,RC,0281-0326-08,NDC,,,facility,both,1,EA,,5.61,5.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitro-Bid: 30 G In 1 Tube (0281-0326-30),250,RC,0281-0326-30,NDC,,,facility,both,1,EA,,85.41,85.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitro-Bid: 60 G In 1 Tube (0281-0326-60),250,RC,0281-0326-60,NDC,,,facility,both,1,EA,,181.4,181.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hurricaine Topical Anesthetic: 59.7 G In 1 Can (0283-0679-02),250,RC,0283-0679-02,NDC,,,facility,both,1,EA,,82.56,82.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "100 BLISTER PACK in 1 CARTON (0310-0275-39) / 1 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,0310-0275-39,NDC,,,facility,both,1,EA,,5.17,5.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0310-1105-01,NDC,,,facility,both,1,EA,,22.94,22.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0310-1105-01,NDC,,,facility,both,1,EA,,20.9,20.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0310-1110-01,NDC,,,facility,both,1,EA,,22.94,22.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sterile Water: 1000 Ml In 1 Bag (0338-0013-04),250,RC,0338-0013-04,NDC,,,facility,both,1,EA,,36.26,36.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0143-9508-01,NDC,,,facility,both,1,EA,,14.24,14.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lopressor: 100 TABLET in 1 BOTTLE (0078-0458-05) ,250,RC,0078-0458-05,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tegretol: 100 Tablet In 1 Bottle (0078-0509-05),250,RC,0078-0509-05,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0659-20)",250,RC,0078-0659-20,NDC,,,facility,both,1,EA,,27.32,27.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Promacta: 30 Tablet, Film Coated In 1 Bottle (0078-0685-15)",250,RC,0078-0685-15,NDC,,,facility,both,1,EA,,753.29,753.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trileptal: 100 Tablet, Film Coated In 1 Bottle (0078-0456-05)",250,RC,0078-0456-05,NDC,,,facility,both,1,EA,,15.5,15.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Promacta: 14 Tablet, Film Coated In 1 Bottle (0078-0686-55)",250,RC,0078-0686-55,NDC,,,facility,both,1,EA,,1167.91,1167.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0078-0697-19,NDC,,,facility,both,1,EA,,753.33,753.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0777-20)",250,RC,0078-0777-20,NDC,,,facility,both,1,EA,,22.1,22.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0696-20)",250,RC,0078-0696-20,NDC,,,facility,both,1,EA,,29.3,29.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diovan: 90 Tablet In 1 Bottle (0078-0358-34),250,RC,0078-0358-34,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-5182-11) / 10 Tablet In 1 Blister Pack",250,RC,0074-5182-11,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-5182-90),250,RC,0074-5182-90,NDC,,,facility,both,1,EA,,4.29,4.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-6594-90),250,RC,0074-6594-90,NDC,,,facility,both,1,EA,,4.11,4.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-6624-11) / 10 Tablet In 1 Blister Pack",250,RC,0074-6624-11,NDC,,,facility,both,1,EA,,4.16,4.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-6624-90),250,RC,0074-6624-90,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7068-11) / 10 Tablet In 1 Blister Pack",250,RC,0074-7068-11,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-7069-90),250,RC,0074-7069-90,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-7070-90),250,RC,0074-7070-90,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7148-11) / 10 Tablet In 1 Blister Pack",250,RC,0074-7148-11,NDC,,,facility,both,1,EA,,4.18,4.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-9296-90),250,RC,0074-9296-90,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7069-11) / 10 Tablet In 1 Blister Pack",250,RC,0074-7069-11,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sotalol Hydrochloride: 100 Tablet In 1 Bottle (0093-1061-01),250,RC,0093-1061-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neomycin Sulfate: 100 Tablet In 1 Bottle (0093-1177-01),250,RC,0093-1177-01,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Warfarin Sodium: 100 Tablet In 1 Bottle (0093-1714-01),250,RC,0093-1714-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Warfarin Sodium: 100 Tablet In 1 Bottle (0093-1715-01),250,RC,0093-1715-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Warfarin Sodium: 100 Tablet In 1 Bottle (0093-1721-01),250,RC,0093-1721-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cilostazol: 60 Tablet In 1 Bottle (0093-2064-06),250,RC,0093-2064-06,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cilostazol: 60 Tablet In 1 Bottle (0093-2065-06),250,RC,0093-2065-06,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liothyronine Sodium: 100 Tablet In 1 Bottle (0093-2178-01),250,RC,0093-2178-01,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0812-01),250,RC,0093-0812-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liothyronine Sodium: 100 Tablet In 1 Bottle (0093-2179-01),250,RC,0093-2179-01,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),250,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoclopramide: 100 Tablet In 1 Bottle (0093-2204-01),250,RC,0093-2204-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoclopramide: 500 Tablet In 1 Bottle (0093-2204-05),250,RC,0093-2204-05,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sucralfate: 100 Tablet In 1 Bottle (0093-2210-01),250,RC,0093-2210-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (0093-2274-34)",250,RC,0093-2274-34,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0811-01),250,RC,0093-0811-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciloxan: 3.5 G In 1 Tube (0078-0841-01),250,RC,0078-0841-01,NDC,,,facility,both,1,EA,,658.01,658.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tobradex: 3.5 G In 1 Tube (0078-0876-01),250,RC,0078-0876-01,NDC,,,facility,both,1,EA,,707.04,707.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Noxafil: 60 Tablet, Coated In 1 Bottle (0085-4324-02)",250,RC,0085-4324-02,NDC,,,facility,both,1,EA,,182.47,182.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA AVAPRO: 90 TABLET in 1 BOTTLE (0087-2771-32) ,250,RC,0087-2771-32,NDC,,,facility,both,1,EA,,3.55,3.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0088-2219-01,NDC,,,facility,both,1,EA,,48.67,48.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33) / 10 Ml In 1 Vial, Glass",250,RC,0088-2220-33,NDC,,,facility,both,1,EA,,161.05,161.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 5 SYRINGE in 1 PACKAGE (0088-5020-05) / 3 mL in 1 SYRINGE (0088-5020-01) ,250,RC,0088-5020-05,NDC,,,facility,both,1,EA,,214.76,214.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (0093-0018-06)",250,RC,0093-0018-06,NDC,,,facility,both,1,EA,,6.6,6.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lamotrigine: 100 TABLET in 1 BOTTLE (0093-0039-01) ,250,RC,0093-0039-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-0053-01),250,RC,0093-0053-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0318-01)",250,RC,0093-0318-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0319-01)",250,RC,0093-0319-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0810-01),250,RC,0093-0810-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zithromax: 50 Blister Pack In 1 Box, Unit-Dose (0069-4061-89) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0069-4061-89,NDC,,,facility,both,1,EA,,8.36,8.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paxlovid: 10 Blister Pack In 1 Carton (0069-5045-30) / 1 Kit In 1 Blister Pack (0069-5045-06) * 2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02) * 1 Tablet, Film Coated In 1 Blister Pack (0069-1345-11)",250,RC,0069-5045-30,NDC,,,facility,both,1,EA,,132.76,132.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vicodin: 500 TABLET in 1 BOTTLE (0074-3041-53) ,250,RC,0074-3041-53,NDC,,,facility,both,1,EA,,8.12,8.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rinvoq: 30 Tablet, Extended Release In 1 Bottle (0074-2310-30)",250,RC,0074-2310-30,NDC,,,facility,both,1,EA,,547.2,547.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-4341-90),250,RC,0074-4341-90,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nimbex: 5 mL in 1 VIAL, SINGLE-DOSE (0074-4378-05) ",250,RC,0074-4378-05,NDC,,,facility,both,1,EA,,30.11,30.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-4552-11) / 10 Tablet In 1 Blister Pack",250,RC,0074-4552-11,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-4552-90),250,RC,0074-4552-90,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rinvoq: 30 Tablet, Extended Release In 1 Bottle (0074-2306-30)",250,RC,0074-2306-30,NDC,,,facility,both,1,EA,,556.48,556.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venclexta: 1 Bottle In 1 Carton (0074-0576-30) / 28 Tablet, Film Coated In 1 Bottle",250,RC,0074-0576-30,NDC,,,facility,both,1,EA,,337.29,337.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venclexta: 120 Tablet, Film Coated In 1 Bottle (0074-0576-22)",250,RC,0074-0576-22,NDC,,,facility,both,1,EA,,375.88,375.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0069-5321-03,NDC,,,facility,both,1,EA,,122.73,122.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paxlovid: 10 Blister Pack In 1 Carton (0069-5321-30) / 1 Kit In 1 Blister Pack (0069-5321-03) * 2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02) * 1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",250,RC,0069-5321-30,NDC,,,facility,both,1,EA,,125.68,125.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tikosyn: 40 Blister Pack In 1 Carton (0069-5800-43) / 1 Capsule In 1 Blister Pack,250,RC,0069-5800-43,NDC,,,facility,both,1,EA,,29.09,29.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tikosyn: 40 Blister Pack In 1 Carton (0069-5810-43) / 1 Capsule In 1 Blister Pack,250,RC,0069-5810-43,NDC,,,facility,both,1,EA,,31.42,31.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tikosyn: 60 Capsule In 1 Bottle (0069-5810-60),250,RC,0069-5810-60,NDC,,,facility,both,1,EA,,28.3,28.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilantin: 100 Capsule In 1 Bottle (0071-0369-24),250,RC,0071-0369-24,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrostat: 4 Bottle In 1 Carton (0071-0418-13) / 25 Tablet In 1 Bottle,250,RC,0071-0418-13,NDC,,,facility,both,1,EA,,100.3,100.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venclexta: 1 Blister Pack In 1 Carton (0074-0561-14) / 14 Tablet, Film Coated In 1 Blister Pack",250,RC,0074-0561-14,NDC,,,facility,both,1,EA,,36.45,36.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venclexta: 1 Blister Pack In 1 Carton (0074-0566-07) / 7 Tablet, Film Coated In 1 Blister Pack",250,RC,0074-0566-07,NDC,,,facility,both,1,EA,,186.04,186.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venclexta: 1 Blister Pack In 1 Carton (0074-0566-11) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0074-0566-11,NDC,,,facility,both,1,EA,,187.95,187.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venclexta: 1 Blister Pack In 1 Carton (0074-0576-11) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0074-0576-11,NDC,,,facility,both,1,EA,,354.23,354.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dicloxacillin Sodium: 100 Capsule In 1 Bottle (0093-3123-01),250,RC,0093-3123-01,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Capsule In 1 Bottle (0093-3147-01),250,RC,0093-3147-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fleet: 12 SUPPOSITORY in 1 JAR (0132-0079-12) ,250,RC,0132-0079-12,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0201-40)",250,RC,0132-0201-40,NDC,,,facility,both,1,EA,,2.92,2.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Abreva: 2 G In 1 Tube (0135-0200-01),250,RC,0135-0200-01,NDC,,,facility,both,1,EA,,51.11,51.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Captopril: 100 Tablet In 1 Bottle (0143-1172-01),250,RC,0143-1172-01,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenobarbital: 500 TABLET in 1 BOTTLE (0143-1450-05) ,250,RC,0143-1450-05,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenobarbital: 100 Tablet In 1 Bottle (0143-1500-01),250,RC,0143-1500-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosorbide Dinitrate: 100 Tablet In 1 Bottle, Plastic (0143-1769-01)",250,RC,0143-1769-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "465 mL in 1 BOTTLE, PLASTIC (0131-5410-70) ",250,RC,0131-5410-70,NDC,,,facility,both,1,EA,,80.78,80.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vimpat: 60 Tablet, Film Coated In 1 Bottle, Plastic (0131-2480-35)",250,RC,0131-2480-35,NDC,,,facility,both,1,EA,,47.22,47.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Childrens Acetaminophen: 10 Tray In 1 Case (0121-1781-00) / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1781-05)",250,RC,0121-1781-00,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-1870-10,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-4577-15,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-4577-15,NDC,,,facility,both,1,EA,,2.33,2.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-4675-05,NDC,,,facility,both,1,EA,,3.31,3.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vimpat: 6 Blister Pack In 1 Carton (0131-2479-60) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2479-60,NDC,,,facility,both,1,EA,,52.88,52.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-4827-05,NDC,,,facility,both,1,EA,,12.36,12.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-4948-15,NDC,,,facility,both,1,EA,,11.01,11.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vimpat: 6 Blister Pack In 1 Carton (0131-2477-60) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2477-60,NDC,,,facility,both,1,EA,,32.15,32.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vimpat: 6 Blister Pack In 1 Carton (0131-2478-60) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0131-2478-60,NDC,,,facility,both,1,EA,,50.14,50.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-4721-05,NDC,,,facility,both,1,EA,,7.92,7.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0143-9162-01,NDC,,,facility,both,1,EA,,4.56,4.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0143-9392-01,NDC,,,facility,both,1,EA,,232.85,232.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-1775-05,NDC,,,facility,both,1,EA,,6.76,6.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mag-Al Plus: 10 Tray In 1 Case (0121-1761-30) / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",250,RC,0121-1761-30,NDC,,,facility,both,1,EA,,2.38,2.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-1744-05,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (0093-5907-86)",250,RC,0093-5907-86,NDC,,,facility,both,1,EA,,8.17,8.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 90 TABLET, FILM COATED in 1 BOTTLE (0093-7114-98) ",250,RC,0093-7114-98,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pioglitazone: 30 Tablet In 1 Bottle (0093-7271-56),250,RC,0093-7271-56,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pioglitazone: 90 Tablet In 1 Bottle (0093-7272-98),250,RC,0093-7272-98,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-7296-01)",250,RC,0093-7296-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 TABLET, FILM COATED in 1 BOTTLE (0093-5850-01) ",250,RC,0093-5850-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (0093-7384-98)",250,RC,0093-7384-98,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Imatinib Mesylate: 30 Tablet, Film Coated In 1 Bottle (0093-7630-56)",250,RC,0093-7630-56,NDC,,,facility,both,1,EA,,9.2,9.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (0093-7704-56)",250,RC,0093-7704-56,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famciclovir: 30 Tablet, Film Coated In 1 Bottle (0093-8117-56)",250,RC,0093-8117-56,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (0093-8739-01),250,RC,0093-8739-01,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Tablet In 1 Bottle (0093-9701-01),250,RC,0093-9701-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Good Sense Acid Reducer: 30 Blister Pack In 1 Carton (0113-0141-65) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0113-0141-65,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0093-5417-19,NDC,,,facility,both,1,EA,,6.39,6.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0093-5245-19,NDC,,,facility,both,1,EA,,3.79,3.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 500 Capsule In 1 Bottle (0093-3147-05),250,RC,0093-3147-05,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-3422-01)",250,RC,0093-3422-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3425-01)",250,RC,0093-3425-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3425-01)",250,RC,0093-3425-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3426-01)",250,RC,0093-3426-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefadroxil: 50 Tablet In 1 Bottle (0093-4059-53),250,RC,0093-4059-53,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Penicillin V Potassium: 100 Ml In 1 Bottle (0093-4127-73),250,RC,0093-4127-73,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0093-4145-45,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levalbuterol: 6 Pouch In 1 Carton (0093-4145-56) / 5 Vial, Single-Dose In 1 Pouch (0093-4145-45) / 3 Ml In 1 Vial, Single-Dose",250,RC,0093-4145-56,NDC,,,facility,both,1,EA,,3.24,3.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Ml In 1 Bottle (0093-4155-73),250,RC,0093-4155-73,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Ml In 1 Bottle (0093-4177-73),250,RC,0093-4177-73,NDC,,,facility,both,1,EA,,5.35,5.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-5061-01)",250,RC,0093-5061-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Primidone: 100 TABLET in 1 BOTTLE (0115-1030-01) ,250,RC,0115-1030-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0671-04),250,RC,0338-0671-04,NDC,,,facility,both,1,EA,,43.63,43.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Primidone: 100 TABLET in 1 BOTTLE (0115-1031-01) ,250,RC,0115-1031-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0904-05,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0914-05,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0917-05,NDC,,,facility,both,1,EA,,1.37,1.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 473 Ml In 1 Bottle (0121-0948-16),250,RC,0121-0948-16,NDC,,,facility,both,1,EA,,3.08,3.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0974-10,NDC,,,facility,both,1,EA,,15.85,15.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-1012-05,NDC,,,facility,both,1,EA,,62.04,62.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nystatin: 473 Ml In 1 Bottle (0121-1045-16),250,RC,0121-1045-16,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lactulose: 4 Tray In 1 Case (0121-1154-40) / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose (0121-1154-30)",250,RC,0121-1154-40,NDC,,,facility,both,1,EA,,4.73,4.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-1276-10,NDC,,,facility,both,1,EA,,4.71,4.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-1488-10,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0904-05,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0893-15,NDC,,,facility,both,1,EA,,3.27,3.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0115-1757-01)",250,RC,0115-1757-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0115-1800-01)",250,RC,0115-1800-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0115-1801-01)",250,RC,0115-1801-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dantrolene Sodium: 100 Capsule In 1 Bottle (0115-4411-01),250,RC,0115-4411-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Tablet In 1 Bottle (0115-9811-01),250,RC,0115-9811-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlorhexidine Gluconate: 473 Ml In 1 Bottle (0116-2001-16),250,RC,0116-2001-16,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lactulose: 15 Ml In 1 Cup, Unit-Dose (0116-4005-15)",250,RC,0116-4005-15,NDC,,,facility,both,1,EA,,3.28,3.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Milk Of Magnesia: 10 Tray In 1 Case (0121-0431-30) / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",250,RC,0121-0431-30,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol: 120 Ml In 1 Bottle (0121-0581-04),250,RC,0121-0581-04,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0638-05,NDC,,,facility,both,1,EA,,4.32,4.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amantadine Hydrochloride: 10 Tray In 1 Case (0121-0646-10) / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose",250,RC,0121-0646-10,NDC,,,facility,both,1,EA,,9.46,9.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 1 Bottle, Dropper In 1 Carton (0121-0770-01) / 30 Ml In 1 Bottle, Dropper",250,RC,0121-0770-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Guaifenesin And Codeine Phosphate: 473 Ml In 1 Bottle (0121-0775-16),250,RC,0121-0775-16,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0121-0868-05,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nystatin: 473 Ml In 1 Bottle (0121-0868-16),250,RC,0121-0868-16,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactulose: 473 Ml In 1 Bottle (0121-0873-16),250,RC,0121-0873-16,NDC,,,facility,both,1,EA,,10.05,10.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,49884-768-52,NDC,,,facility,both,1,EA,,116.19,116.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0673-04),250,RC,0338-0673-04,NDC,,,facility,both,1,EA,,45,45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 473 Ml In 1 Bottle, Plastic (0472-0235-16)",250,RC,0472-0235-16,NDC,,,facility,both,1,EA,,1.87,1.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Asthmanefrin: 30 Pouch In 1 Carton (0487-2784-01) / 1 Vial, Single-Use In 1 Pouch / .5 Ml In 1 Vial, Single-Use",250,RC,0487-2784-01,NDC,,,facility,both,1,EA,,5.09,5.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "S2: 30 Pouch In 1 Carton (0487-5901-99) / 1 Vial, Single-Use In 1 Pouch / .5 Ml In 1 Vial, Single-Use",250,RC,0487-5901-99,NDC,,,facility,both,1,EA,,5.06,5.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0487-9301-33,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Cal-Gest Antacid Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0536-1007-15)",250,RC,0536-1007-15,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Cal-Gest Antacid Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0536-1007-15)",250,RC,0536-1007-15,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby: 150 Tablet, Chewable In 1 Bottle, Plastic (0536-1048-15)",250,RC,0536-1048-15,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nicotine Transdermal System Step 3: 14 Patch In 1 Carton (0536-1106-88) / 24 H In 1 Patch,250,RC,0536-1106-88,NDC,,,facility,both,1,EA,,4.02,4.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rugby Hemorrhoidal: 12 Blister Pack In 1 Carton (0536-1186-12) / 1 Suppository In 1 Blister Pack,250,RC,0536-1186-12,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dibucaine Topical Anesthetic 1% Hemorrhoidal: 1 Tube In 1 Box (0536-1211-95) / 28 G In 1 Tube,250,RC,0536-1211-95,NDC,,,facility,both,1,EA,,9.07,9.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Eye Wash: 1 Bottle, Dropper In 1 Box (0536-1224-97) / 118 Ml In 1 Bottle, Dropper",250,RC,0536-1224-97,NDC,,,facility,both,1,EA,,6.72,6.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Cherry Flavor: 177 Ml In 1 Bottle, Spray (0536-1228-58)",250,RC,0536-1228-58,NDC,,,facility,both,1,EA,,6.39,6.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chlorode Hypertonicity Ophthalmic Solution: 1 Bottle In 1 Carton (0536-1254-94) / 15 Ml In 1 Bottle,250,RC,0536-1254-94,NDC,,,facility,both,1,EA,,8.82,8.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Anti-Itch: 212 G In 1 Bottle, Pump (0536-1268-12)",250,RC,0536-1268-12,NDC,,,facility,both,1,EA,,10.11,10.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Stomach Relief Regular Strength: 237 Ml In 1 Bottle, Plastic (0536-1286-36)",250,RC,0536-1286-36,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Antacid: 355 Ml In 1 Bottle (0536-1293-83),250,RC,0536-1293-83,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine: 100 Tablet In 1 Bottle, Plastic (0536-1297-01)",250,RC,0536-1297-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Valproic Acid: 473 Ml In 1 Bottle (0527-5250-70),250,RC,0527-5250-70,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0527-1790-01)",250,RC,0527-1790-01,NDC,,,facility,both,1,EA,,8,8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zinc Sulfate: 25 Vial In 1 Tray (0517-6101-25) / 10 Ml In 1 Vial (0517-6101-01),250,RC,0517-6101-25,NDC,,,facility,both,1,EA,,4.18,4.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0517-6560-01,NDC,,,facility,both,1,EA,,5.77,5.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0527-0765-37)",250,RC,0527-0765-37,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pilocarpine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0527-1313-01)",250,RC,0527-1313-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levothyroxine Sodium: 100 TABLET in 1 BOTTLE, PLASTIC (0527-1346-01) ",250,RC,0527-1346-01,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pilocarpine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0527-1407-01)",250,RC,0527-1407-01,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0527-1789-01)",250,RC,0527-1789-01,NDC,,,facility,both,1,EA,,6.14,6.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyloy: 1 Vial In 1 Box (0469-4425-30) / 15 Ml In 1 Vial,250,RC,0469-4425-30,NDC,,,facility,both,1,EA,,16152.71,16152.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 10 VIAL, SINGLE-DOSE in 1 CARTON (0409-6778-02) / 1 mL in 1 VIAL, SINGLE-DOSE (0409-6778-11) ",250,RC,0409-6778-02,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Phosphates: 25 Vial, Single-Dose In 1 Tray (0409-7295-01) / 15 Ml In 1 Vial, Single-Dose (0409-7295-11)",250,RC,0409-7295-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-7295-11,NDC,,,facility,both,1,EA,,24.79,24.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (0409-7391-72) / 15 Ml In 1 Vial, Single-Dose (0409-7391-82)",250,RC,0409-7391-72,NDC,,,facility,both,1,EA,,18.26,18.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (0409-7391-72) / 15 Ml In 1 Vial, Single-Dose (0409-7391-82)",250,RC,0409-7391-72,NDC,,,facility,both,1,EA,,12.1,12.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-7391-82,NDC,,,facility,both,1,EA,,18.23,18.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-7391-82,NDC,,,facility,both,1,EA,,16.07,16.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-8183-11,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-8183-15,NDC,,,facility,both,1,EA,,9.2,9.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-6533-59,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Bicarbonate: 25 VIAL in 1 TRAY (0409-6625-02) / 50 mL in 1 VIAL,250,RC,0409-6625-02,NDC,,,facility,both,1,EA,,22.75,22.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-6625-22,NDC,,,facility,both,1,EA,,22.6,22.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-6625-30,NDC,,,facility,both,1,EA,,22.61,22.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Bicarbonate: 25 Vial, Single-Dose In 1 Tray (0409-6625-35) / 50 Ml In 1 Vial, Single-Dose (0409-6625-30)",250,RC,0409-6625-35,NDC,,,facility,both,1,EA,,22.04,22.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-6637-24,NDC,,,facility,both,1,EA,,46.07,46.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Bicarbonate: 10 CARTON in 1 PACKAGE (0409-6637-34) / 1 SYRINGE in 1 CARTON / 50 mL in 1 SYRINGE,250,RC,0409-6637-34,NDC,,,facility,both,1,EA,,17.98,17.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride And Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-9042-01) / 10 Ml In 1 Vial, Single-Dose (0409-9042-11)",250,RC,0409-9042-01,NDC,,,facility,both,1,EA,,8.95,8.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linzess: 1 Bottle In 1 Carton (0456-1202-30) / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1202-30,NDC,,,facility,both,1,EA,,47.86,47.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linzess: 1 Bottle In 1 Carton (0456-1203-30) / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1203-30,NDC,,,facility,both,1,EA,,47.21,47.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lexapro: 100 Tablet, Film Coated In 1 Bottle (0456-2005-01)",250,RC,0456-2005-01,NDC,,,facility,both,1,EA,,5.64,5.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 60 TABLET in 1 BOTTLE (0456-3210-60) ,250,RC,0456-3210-60,NDC,,,facility,both,1,EA,,5.49,5.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cresemba: 2 Blister Pack In 1 Carton (0469-0520-02) / 7 Capsule In 1 Blister Pack,250,RC,0469-0520-02,NDC,,,facility,both,1,EA,,232.93,232.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Xospata: 1 Bottle In 1 Carton (0469-1425-90) / 90 Tablet In 1 Bottle,250,RC,0469-1425-90,NDC,,,facility,both,1,EA,,871.33,871.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myrbetriq: 1 Bottle In 1 Carton (0469-2601-30) / 30 Tablet, Film Coated, Extended Release In 1 Bottle",250,RC,0469-2601-30,NDC,,,facility,both,1,EA,,37.16,37.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myrbetriq: 1 Bottle In 1 Carton (0469-2601-90) / 90 Tablet, Film Coated, Extended Release In 1 Bottle",250,RC,0469-2601-90,NDC,,,facility,both,1,EA,,40.18,40.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myrbetriq: 1 Bottle In 1 Carton (0469-2602-30) / 30 Tablet, Film Coated, Extended Release In 1 Bottle",250,RC,0469-2602-30,NDC,,,facility,both,1,EA,,37.77,37.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linzess: 1 Bottle In 1 Carton (0456-1201-30) / 30 Capsule, Gelatin Coated In 1 Bottle",250,RC,0456-1201-30,NDC,,,facility,both,1,EA,,47.25,47.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Viibryd: 30 Tablet In 1 Bottle (0456-1120-30),250,RC,0456-1120-30,NDC,,,facility,both,1,EA,,30.85,30.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Box (0409-9558-10) / 10 Ml In 1 Vial, Multi-Dose (0409-9558-31)",250,RC,0409-9558-10,NDC,,,facility,both,1,EA,,15.34,15.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dakins Quarter: 473 Ml In 1 Bottle (0436-0672-16),250,RC,0436-0672-16,NDC,,,facility,both,1,EA,,26.1,26.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dakins Half: 473 Ml In 1 Bottle (0436-0936-16),250,RC,0436-0936-16,NDC,,,facility,both,1,EA,,39.91,39.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Armour Thyroid: 100 Tablet In 1 Bottle (0456-0458-01),250,RC,0456-0458-01,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Viibryd: 30 Tablet In 1 Bottle (0456-1110-30),250,RC,0456-1110-30,NDC,,,facility,both,1,EA,,30.12,30.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine Hydrochloride: 100 Tablet, Chewable In 1 Bottle (0536-1299-01)",250,RC,0536-1299-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0603-1880-10,NDC,,,facility,both,1,EA,,5.62,5.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Benztropine Mesylate: 100 Tablet In 1 Bottle, Plastic (0603-2434-21)",250,RC,0603-2434-21,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0603-3078-21) ",250,RC,0603-3078-21,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jardiance: 30 Tablet, Film Coated In 1 Bottle (0597-0152-30)",250,RC,0597-0152-30,NDC,,,facility,both,1,EA,,32.55,32.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jardiance: 30 Blister Pack In 1 Carton (0597-0152-37) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0597-0152-37,NDC,,,facility,both,1,EA,,35.26,35.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jardiance: 90 Tablet, Film Coated In 1 Bottle (0597-0152-90)",250,RC,0597-0152-90,NDC,,,facility,both,1,EA,,32.57,32.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jardiance: 30 Blister Pack In 1 Carton (0597-0153-37) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,0597-0153-37,NDC,,,facility,both,1,EA,,34.73,34.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0603-1554-10,NDC,,,facility,both,1,EA,,8.26,8.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pradaxa: 60 Blister Pack In 1 Carton (0597-0355-56) / 1 Capsule In 1 Blister Pack,250,RC,0597-0355-56,NDC,,,facility,both,1,EA,,8.37,8.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pradaxa: 60 Blister Pack In 1 Carton (0597-0360-82) / 1 Capsule In 1 Blister Pack,250,RC,0597-0360-82,NDC,,,facility,both,1,EA,,7.91,7.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Oxide: 120 Tablet In 1 Bottle (0603-0209-22),250,RC,0603-0209-22,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dicyclomine Hydrochloride: 473 Ml In 1 Bottle, Plastic (0603-1161-58)",250,RC,0603-1161-58,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Iophen C NR: 473 mL in 1 BOTTLE, PLASTIC (0603-1329-58) ",250,RC,0603-1329-58,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 473 Ml In 1 Bottle, Plastic (0603-1542-58)",250,RC,0603-1542-58,NDC,,,facility,both,1,EA,,8.27,8.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0641-6061-01,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0641-6013-01,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diltiazem Hydrochloride: 10 Vial In 1 Carton (0641-6013-10) / 5 Ml In 1 Vial (0641-6013-01),250,RC,0641-6013-10,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0641-6015-01,NDC,,,facility,both,1,EA,,14.96,14.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diltiazem Hydrochloride: 10 Vial In 1 Carton (0641-6015-10) / 25 Ml In 1 Vial (0641-6015-01),250,RC,0641-6015-10,NDC,,,facility,both,1,EA,,14.96,14.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spiriva Respimat: 1 Cartridge In 1 Carton (0597-0100-51) / 10 Spray, Metered In 1 Cartridge",250,RC,0597-0100-51,NDC,,,facility,both,1,EA,,94.15,94.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infants: 1 Bottle, Dropper In 1 Carton (0536-1303-75) / 30 Ml In 1 Bottle, Dropper",250,RC,0536-1303-75,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atrovent Hfa: 1 Canister In 1 Carton (0597-0087-17) / 200 Aerosol, Metered In 1 Canister",250,RC,0597-0087-17,NDC,,,facility,both,1,EA,,852.37,852.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Allopurinol: 100 Tablet In 1 Bottle, Plastic (0591-5543-01)",250,RC,0591-5543-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nicotine: 14 Pouch In 1 Carton (0536-5895-88) / 1 H In 1 Pouch,250,RC,0536-5895-88,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nicotine: 14 Pouch In 1 Carton (0536-5896-88) / 1 H In 1 Pouch,250,RC,0536-5896-88,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0033-02),250,RC,0555-0033-02,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isoniazid: 100 Tablet In 1 Bottle (0555-0066-02),250,RC,0555-0066-02,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nicotine: 14 Pouch In 1 Carton (0536-5894-88) / 1 H In 1 Pouch,250,RC,0536-5894-88,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isoniazid: 100 Tablet In 1 Bottle (0555-0071-02),250,RC,0555-0071-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0159-02),250,RC,0555-0159-02,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 30 Tablet In 1 Bottle (0555-0484-01),250,RC,0555-0484-01,NDC,,,facility,both,1,EA,,3.11,3.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 25 Tablet In 1 Bottle (0555-0485-27),250,RC,0555-0485-27,NDC,,,facility,both,1,EA,,23.59,23.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Megestrol Acetate: 100 Tablet In 1 Bottle (0555-0606-02),250,RC,0555-0606-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0779-02),250,RC,0555-0779-02,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0872-02),250,RC,0555-0872-02,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0158-02),250,RC,0555-0158-02,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fiber Lax: 90 Tablet, Film Coated In 1 Bottle (0536-4306-11)",250,RC,0536-4306-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Antacid/Antigas: 355 Ml In 1 Bottle (0536-1317-83),250,RC,0536-1317-83,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 100 Tablet In 1 Bottle, Plastic (0536-1327-01)",250,RC,0536-1327-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 100 Tablet In 1 Bottle, Plastic (0536-1327-01)",250,RC,0536-1327-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 1000 Tablet In 1 Bottle, Plastic (0536-1327-10)",250,RC,0536-1327-10,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 1000 Tablet In 1 Bottle, Plastic (0536-1327-10)",250,RC,0536-1327-10,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Bicarbonate: 1000 TABLET in 1 BOTTLE (0536-4544-10) ,250,RC,0536-4544-10,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rugby Muscle Rub Cream: 1 Tube In 1 Carton (0536-1349-57) / 85 G In 1 Tube,250,RC,0536-1349-57,NDC,,,facility,both,1,EA,,6.63,6.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Nicotine Polacrilex Gum, Mint Flavor: 11 Blister Pack In 1 Carton (0536-1362-23) / 10 Gum, Chewing In 1 Blister Pack",250,RC,0536-1362-23,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0536-1362-25,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Polyvinyl Alcohol 1.4% Lubricating Eye Drops: 1 Bottle, Dropper In 1 Box (0536-1408-94) / 15 Ml In 1 Bottle, Dropper",250,RC,0536-1408-94,NDC,,,facility,both,1,EA,,13.74,13.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Anti-Dandruff: 207 Ml In 1 Bottle, Plastic (0536-1995-53)",250,RC,0536-1995-53,NDC,,,facility,both,1,EA,,5.44,5.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0536-2506-76,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Capsaicin: 1 Tube In 1 Carton (0536-2525-25) / 60 G In 1 Tube,250,RC,0536-2525-25,NDC,,,facility,both,1,EA,,13.96,13.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Estradiol: 100 Tablet In 1 Bottle (0555-0886-02),250,RC,0555-0886-02,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrochlorothiazide: 100 Capsule, Gelatin Coated In 1 Bottle (0591-0347-01)",250,RC,0591-0347-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle, Plastic (0591-0348-01)",250,RC,0591-0348-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Verapamil Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0404-01)",250,RC,0591-0404-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0591-2312-45,NDC,,,facility,both,1,EA,,301.35,301.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tamoxifen Citrate: 90 Tablet In 1 Bottle, Plastic (0591-2473-19)",250,RC,0591-2473-19,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0591-2679-11,NDC,,,facility,both,1,EA,,3.75,3.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0591-3525-11,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Sr: 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0591-3541-60)",250,RC,0591-3541-60,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desvenlafaxine: 30 Tablet, Extended Release In 1 Bottle (0591-3659-30)",250,RC,0591-3659-30,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Budesonide: 1 Bottle In 1 Carton (0574-9855-10) / 100 Capsule In 1 Bottle,250,RC,0574-9855-10,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone Acetate: 12 Packet In 1 Box (0574-7090-12) / 1 Suppository In 1 Packet,250,RC,0574-7090-12,NDC,,,facility,both,1,EA,,7.64,7.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Estradiol: 100 Tablet In 1 Bottle (0555-0887-02),250,RC,0555-0887-02,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0555-0973-02)",250,RC,0555-0973-02,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fludrocortisone Acetate: 100 Tablet In 1 Bottle (0555-0997-02),250,RC,0555-0997-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Preparation H: 1 Tube In 1 Carton (0573-2871-93) / 28 G In 1 Tube,250,RC,0573-2871-93,NDC,,,facility,both,1,EA,,18.23,18.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bromocriptine Mesylate: 100 Tablet In 1 Bottle, Plastic (0574-0106-01)",250,RC,0574-0106-01,NDC,,,facility,both,1,EA,,4.49,4.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0574-0107-70)",250,RC,0574-0107-70,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midazolam Hydrochloride: 1 Bottle, Glass In 1 Carton (0574-0150-04) / 118 Ml In 1 Bottle, Glass",250,RC,0574-0150-04,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Liothyronine Sodium: 100 TABLET in 1 BOTTLE, PLASTIC (0574-0222-01) ",250,RC,0574-0222-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amiloride Hydrochloride: 100 Tablet In 1 Bottle (0574-0292-01),250,RC,0574-0292-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Actidose Aqua: 120 Ml In 1 Tube (0574-0521-74),250,RC,0574-0521-74,NDC,,,facility,both,1,EA,,26.13,26.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclosporine: 10 AMPULE in 1 CARTON (0574-0866-10) / 5 mL in 1 AMPULE,250,RC,0574-0866-10,NDC,,,facility,both,1,EA,,29.63,29.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine And Prilocaine: 1 Tube In 1 Carton (0574-2042-30) / 30 G In 1 Tube,250,RC,0574-2042-30,NDC,,,facility,both,1,EA,,31.36,31.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tobramycin And Dexamethasone: 2.5 Ml In 1 Bottle, Plastic (0574-4031-25)",250,RC,0574-4031-25,NDC,,,facility,both,1,EA,,91.09,91.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aspirin: 12 Packet In 1 Carton (0574-7034-12) / 1 Suppository In 1 Packet,250,RC,0574-7034-12,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12) / 1 Suppository In 1 Blister Pack,250,RC,0574-7050-12,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Minocycline Hydrochloride: 60 Capsule In 1 Bottle, Plastic (0591-5694-60)",250,RC,0591-5694-60,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),250,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Tablet In 1 Blister Pack (0406-0552-62),250,RC,0406-0552-62,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Tablet In 1 Blister Pack (0406-0552-62),250,RC,0406-0552-62,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (0406-1142-01),250,RC,0406-1142-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (0406-1144-01),250,RC,0406-1144-01,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (0406-1236-01),250,RC,0406-1236-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01),250,RC,0406-3243-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01),250,RC,0406-3244-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5755-23),250,RC,0406-5755-23,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5771-23),250,RC,0406-5771-23,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (0406-1236-01),250,RC,0406-1236-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 100 Tablet, Extended Release In 1 Bottle (0406-8315-01)",250,RC,0406-8315-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),250,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9070-16,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9071-16,NDC,,,facility,both,1,EA,,4.44,4.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9104-16,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9112-16,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9119-16,NDC,,,facility,both,1,EA,,32.04,32.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9121-16,NDC,,,facility,both,1,EA,,15.19,15.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)",250,RC,0406-0527-10,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl: 5 Pouch In 1 Carton (0378-9122-98) / 1 Patch In 1 Pouch (0378-9122-16) / 72 H In 1 Patch,250,RC,0378-9122-98,NDC,,,facility,both,1,EA,,26.97,26.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9123-16,NDC,,,facility,both,1,EA,,39.55,39.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9125-16,NDC,,,facility,both,1,EA,,101.62,101.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mesalamine: 5 PACKAGE in 1 CARTON (0378-9230-93) / 6 SUPPOSITORY in 1 PACKAGE,250,RC,0378-9230-93,NDC,,,facility,both,1,EA,,38.63,38.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levalbuterol: 1 Pouch In 1 Carton (0378-9691-52) / 25 Ampule In 1 Pouch (0378-9691-62) / 3 Ml In 1 Ampule,250,RC,0378-9691-52,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9691-62,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle (0406-0376-01),250,RC,0406-0376-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-9122-16,NDC,,,facility,both,1,EA,,25.02,25.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8315-23)",250,RC,0406-8315-23,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8330-23)",250,RC,0406-8330-23,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-0040-05,NDC,,,facility,both,1,EA,,18.42,18.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8530-23),250,RC,0406-8530-23,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA FENTANYL TRANSDERMAL: 5 POUCH in 1 CARTON (0406-9025-76) / 1 PATCH in 1 POUCH / 72 h in 1 PATCH,250,RC,0406-9025-76,NDC,,,facility,both,1,EA,,14.04,14.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA FENTANYL TRANSDERMAL: 5 POUCH in 1 CARTON (0406-9075-76) / 1 PATCH in 1 POUCH / 72 h in 1 PATCH,250,RC,0406-9075-76,NDC,,,facility,both,1,EA,,38.61,38.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9100-76) / 1 Patch In 1 Pouch / 72 H In 1 Patch,250,RC,0406-9100-76,NDC,,,facility,both,1,EA,,73.38,73.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9112-76) / 1 Patch In 1 Pouch / 72 H In 1 Patch,250,RC,0406-9112-76,NDC,,,facility,both,1,EA,,33.63,33.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9125-76) / 1 Patch In 1 Pouch / 72 H In 1 Patch,250,RC,0406-9125-76,NDC,,,facility,both,1,EA,,17.73,17.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9150-76) / 1 Patch In 1 Pouch / 72 H In 1 Patch,250,RC,0406-9150-76,NDC,,,facility,both,1,EA,,32.07,32.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temazepam: 100 Capsule In 1 Bottle (0406-9960-01),250,RC,0406-9960-01,NDC,,,facility,both,1,EA,,4.89,4.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Celecoxib: 100 CAPSULE in 1 BOTTLE, PLASTIC (0378-7150-01) ",250,RC,0378-7150-01,NDC,,,facility,both,1,EA,,4.02,4.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0338-7034-01,NDC,,,facility,both,1,EA,,393.75,393.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0803-04),250,RC,0338-0803-04,NDC,,,facility,both,1,EA,,47.93,47.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0807-04),250,RC,0338-0807-04,NDC,,,facility,both,1,EA,,47.41,47.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clinimix E: 1000 Ml In 1 Bag (0338-1148-03),250,RC,0338-1148-03,NDC,,,facility,both,1,EA,,393.75,393.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Imatinib Mesylate: 30 Tablet, Film Coated In 1 Bottle, Plastic (0378-2246-93)",250,RC,0378-2246-93,NDC,,,facility,both,1,EA,,12.38,12.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Capecitabine: 120 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-2512-78) ",250,RC,0378-2512-78,NDC,,,facility,both,1,EA,,21.81,21.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-2586-01) ",250,RC,0378-2586-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amitriptyline Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-2675-01) ",250,RC,0378-2675-01,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fenofibrate: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-3065-77)",250,RC,0378-3065-77,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mercaptopurine: 25 Tablet In 1 Bottle, Plastic (0378-3547-52)",250,RC,0378-3547-52,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-3632-01)",250,RC,0378-3632-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesalamine: 120 Capsule, Extended Release In 1 Bottle, Plastic (0378-1375-78)",250,RC,0378-1375-78,NDC,,,facility,both,1,EA,,9.52,9.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-3635-01)",250,RC,0378-3635-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxepin Hydrochloride: 100 Capsule In 1 Bottle, Plastic (0378-4250-01)",250,RC,0378-4250-01,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-4640-16,NDC,,,facility,both,1,EA,,18.69,18.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-4643-16,NDC,,,facility,both,1,EA,,20.36,20.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5814-77)",250,RC,0378-5814-77,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-6232-01)",250,RC,0378-6232-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-6985-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-6987-89,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Buspirone Hydrochloride: 60 Tablet In 1 Bottle, Plastic (0378-1175-91)",250,RC,0378-1175-91,NDC,,,facility,both,1,EA,,3.53,3.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Buspirone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-1145-01)",250,RC,0378-1145-01,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexmedetomidine Hydrochloride: 24 Bag In 1 Carton (0338-9555-24) / 50 Ml In 1 Bag,250,RC,0338-9555-24,NDC,,,facility,both,1,EA,,37.39,37.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-01)",250,RC,0378-0018-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 500 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-05)",250,RC,0378-0018-05,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0032-01)",250,RC,0378-0032-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa And Levodopa: 100 Tablet, Extended Release In 1 Bottle, Plastic (0378-0088-01)",250,RC,0378-0088-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Allopurinol: 100 Tablet In 1 Bottle (0378-0181-01),250,RC,0378-0181-01,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Propranolol Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-0182-01)",250,RC,0378-0182-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Chlorthalidone: 100 Tablet In 1 Bottle, Plastic (0378-0222-01)",250,RC,0378-0222-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamoxifen Citrate: 30 Tablet In 1 Bottle (0378-0274-93),250,RC,0378-0274-93,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluvoxamine Maleate: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-0412-01) ",250,RC,0378-0412-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenoxylate Hydrochloride and Atropine Sulfate: 100 TABLET in 1 BOTTLE, PLASTIC (0378-0415-01) ",250,RC,0378-0415-01,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-0871-16,NDC,,,facility,both,1,EA,,33.69,33.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-0872-16,NDC,,,facility,both,1,EA,,53.13,53.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-0873-16,NDC,,,facility,both,1,EA,,74.5,74.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0378-7272-85,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Copper: 25 Vial, Single-Dose In 1 Tray (0409-4092-01) / 10 Ml In 1 Vial, Single-Dose (0409-4092-11)",250,RC,0409-4092-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-4279-02) / 30 Ml In 1 Vial, Single-Dose (0409-4279-16)",250,RC,0409-4279-02,NDC,,,facility,both,1,EA,,3.62,3.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-3977-01,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-4279-02) / 30 Ml In 1 Vial, Single-Dose (0409-4279-16)",250,RC,0409-4279-02,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levophed: 10 Vial, Single-Dose In 1 Carton (0409-3375-04) / 4 Ml In 1 Vial, Single-Dose (0409-3375-14)",250,RC,0409-3375-04,NDC,,,facility,both,1,EA,,19.11,19.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3177-01) / 50 Ml In 1 Vial, Multi-Dose (0409-3177-16)",250,RC,0409-3177-01,NDC,,,facility,both,1,EA,,5.02,5.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3178-01) / 20 Ml In 1 Vial, Multi-Dose (0409-3178-16)",250,RC,0409-3178-01,NDC,,,facility,both,1,EA,,4.67,4.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3178-02) / 30 Ml In 1 Vial, Multi-Dose (0409-3178-17)",250,RC,0409-3178-02,NDC,,,facility,both,1,EA,,10.01,10.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3178-03) / 50 Ml In 1 Vial, Multi-Dose (0409-3178-18)",250,RC,0409-3178-03,NDC,,,facility,both,1,EA,,7.4,7.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-3178-17,NDC,,,facility,both,1,EA,,9.56,9.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-3189-05,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4279-16,NDC,,,facility,both,1,EA,,4.54,4.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 25 Ampule In 1 Carton (0409-4282-02) / 10 Ml In 1 Ampule (0409-4282-12),250,RC,0409-4282-02,NDC,,,facility,both,1,EA,,10.53,10.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4888-01,NDC,,,facility,both,1,EA,,6.03,6.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4888-02,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4888-02,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4888-06,NDC,,,facility,both,1,EA,,7.59,7.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4888-06,NDC,,,facility,both,1,EA,,7.55,7.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-4888-20) / 20 Ml In 1 Vial, Single-Dose (0409-4888-03)",250,RC,0409-4888-20,NDC,,,facility,both,1,EA,,4.83,4.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-4888-50) / 50 Ml In 1 Vial, Single-Dose (0409-4888-06)",250,RC,0409-4888-50,NDC,,,facility,both,1,EA,,7.3,7.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sterile Water: 25 Vial, Glass In 1 Case (0409-4887-99) / 100 Ml In 1 Vial, Glass (0409-4887-25)",250,RC,0409-4887-99,NDC,,,facility,both,1,EA,,10.06,10.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-5534-24,NDC,,,facility,both,1,EA,,53.03,53.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-5738-01,NDC,,,facility,both,1,EA,,8.96,8.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4887-25,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4887-25,NDC,,,facility,both,1,EA,,42.75,42.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4887-24,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4282-12,NDC,,,facility,both,1,EA,,6.04,6.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)",250,RC,0409-4332-01,NDC,,,facility,both,1,EA,,19.67,19.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 5 Cello Pack In 1 Package (0409-4713-02) / 5 Ampule In 1 Cello Pack (0409-4713-26) / 5 Ml In 1 Ampule (0409-4713-12),250,RC,0409-4713-02,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4713-42,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sterile Water: 25 Vial, Plastic In 1 Tray (0409-4887-10) / 10 Ml In 1 Vial, Plastic (0409-4887-17)",250,RC,0409-4887-10,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sterile Water: 25 Vial, Plastic In 1 Tray (0409-4887-10) / 10 Ml In 1 Vial, Plastic (0409-4887-17)",250,RC,0409-4887-10,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-4887-24,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-1208-11,NDC,,,facility,both,1,EA,,42.45,42.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride And Epinephrine: 10 Ampule In 1 Tray (0409-1209-01) / 5 Ml In 1 Ampule (0409-1209-10),250,RC,0409-1209-01,NDC,,,facility,both,1,EA,,8.42,8.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0675-04),250,RC,0338-0675-04,NDC,,,facility,both,1,EA,,46.1,46.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-1966-02,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine With Epinephrine: 1 Vial, Multi-Dose In 1 Carton (0409-1752-50) / 50 Ml In 1 Vial, Multi-Dose",250,RC,0409-1752-50,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1749-10) / 10 Ml In 1 Vial, Single-Dose (0409-1749-70)",250,RC,0409-1749-10,NDC,,,facility,both,1,EA,,8.57,8.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Precedex: 20 Bottle In 1 Tray (0409-1660-50) / 50 Ml In 1 Bottle (0409-1660-55),250,RC,0409-1660-50,NDC,,,facility,both,1,EA,,29.12,29.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-1660-55,NDC,,,facility,both,1,EA,,26.47,26.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-10) / 10 Ml In 1 Vial, Single-Dose (0409-1746-70)",250,RC,0409-1746-10,NDC,,,facility,both,1,EA,,7.77,7.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0409-1746-71,NDC,,,facility,both,1,EA,,15.34,15.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-328-01),250,RC,50111-328-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-398-01),250,RC,50111-398-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamterene: 100 Capsule In 1 Bottle (66993-831-02),250,RC,66993-831-02,NDC,,,facility,both,1,EA,,21.61,21.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxycycline: 60 mL in 1 BOTTLE, GLASS (67405-475-62) ",250,RC,67405-475-62,NDC,,,facility,both,1,EA,,17.8,17.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,67457-163-00,NDC,,,facility,both,1,EA,,212.44,212.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-457-30)",250,RC,66993-457-30,NDC,,,facility,both,1,EA,,31.56,31.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,67457-197-00,NDC,,,facility,both,1,EA,,212.32,212.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultiva: 10 Vial, Glass In 1 Carton (67457-198-03) / 3 Ml In 1 Vial, Glass (67457-198-00)",250,RC,67457-198-03,NDC,,,facility,both,1,EA,,22,22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluticasone Propionate Hfa: 1 Inhaler In 1 Carton (66993-078-96) / 120 Aerosol, Metered In 1 Inhaler",250,RC,66993-078-96,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexmedetomidine: 25 Vial, Glass In 1 Carton (66794-233-42) / 2 Ml In 1 Vial, Glass (66794-233-02)",250,RC,66794-233-42,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66689-020-01,NDC,,,facility,both,1,EA,,4.35,4.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66689-037-01,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66689-039-01,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66689-047-01,NDC,,,facility,both,1,EA,,11.54,11.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 5 Tray In 1 Case (66689-048-50) / 10 Cup In 1 Tray / 30 Ml In 1 Cup (66689-048-01),250,RC,66689-048-50,NDC,,,facility,both,1,EA,,51.43,51.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66689-062-01,NDC,,,facility,both,1,EA,,22.32,22.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insta-Char Aqueous Cherry: 120 Ml In 1 Bottle, Plastic (66689-202-04)",250,RC,66689-202-04,NDC,,,facility,both,1,EA,,69.65,69.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66689-401-01,NDC,,,facility,both,1,EA,,3.3,3.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atovaquone And Proguanil Hcl: 24 Tablet, Film Coated In 1 Dose Pack (66993-060-27)",250,RC,66993-060-27,NDC,,,facility,both,1,EA,,14.95,14.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycodone Hydrochloride: 5 Tray In 1 Case (66689-401-50) / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (66689-401-01)",250,RC,66689-401-50,NDC,,,facility,both,1,EA,,3.26,3.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciloxan: 3.5 G In 1 Tube (66758-071-38),250,RC,66758-071-38,NDC,,,facility,both,1,EA,,705.07,705.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Betadine Solution: 14.8 Ml In 1 Bottle (67618-150-05),250,RC,67618-150-05,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Silver Sulfadiazine: 50 G In 1 Jar (67877-124-50),250,RC,67877-124-50,NDC,,,facility,both,1,EA,,32.65,32.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (67877-197-90),250,RC,67877-197-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (67877-198-90),250,RC,67877-198-90,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 454 G In 1 Jar (67877-251-45),250,RC,67877-251-45,NDC,,,facility,both,1,EA,,41.3,41.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,67457-419-00,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (66685-1002-2)",250,RC,66685-1002-2,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kineret: 7 Syringe, Glass In 1 Carton (66658-234-07) / .67 Ml In 1 Syringe, Glass",250,RC,66658-234-07,NDC,,,facility,both,1,EA,,568.32,568.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zetia: 100 BLISTER PACK in 1 CARTON (66582-414-28) / 1 TABLET in 1 BLISTER PACK (66582-414-29) ,250,RC,66582-414-28,NDC,,,facility,both,1,EA,,5.97,5.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-202-90)",250,RC,65862-202-90,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefdinir: 1 Bottle In 1 Carton (65862-218-01) / 100 Ml In 1 Bottle,250,RC,65862-218-01,NDC,,,facility,both,1,EA,,6.06,6.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefdinir: 1 Bottle In 1 Carton (65862-218-60) / 60 Ml In 1 Bottle,250,RC,65862-218-60,NDC,,,facility,both,1,EA,,7.75,7.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (65862-296-90)",250,RC,65862-296-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Emtricitabine: 30 Capsule In 1 Bottle (65862-301-30),250,RC,65862-301-30,NDC,,,facility,both,1,EA,,30.63,30.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 90 Tablet, Film Coated In 1 Bottle (65862-149-90)",250,RC,65862-149-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clopidogrel: 90 Tablet, Film Coated In 1 Bottle (65862-357-90)",250,RC,65862-357-90,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Tablet, Film Coated In 1 Bottle (65862-373-01)",250,RC,65862-373-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-419-01),250,RC,65862-419-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-420-01),250,RC,65862-420-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 473 Ml In 1 Bottle (65862-496-47),250,RC,65862-496-47,NDC,,,facility,both,1,EA,,3.56,3.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (65862-503-01)",250,RC,65862-503-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zidovudine: 100 Capsule In 1 Bottle (65862-107-01),250,RC,65862-107-01,NDC,,,facility,both,1,EA,,3.67,3.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Tablet, Film Coated In 1 Bottle (65862-076-01)",250,RC,65862-076-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hydrochloride And Lidocaine Hydrochloride And Aluminum Hydroxide And Magnesium Hydro: 1 Kit In 1 Container (65628-050-04) * 118 Ml In 1 Bottle, Plastic * .1 G In 1 Bottle, Glass * .8 G In 1 Bottle, Glass",250,RC,65628-050-04,NDC,,,facility,both,1,EA,,18.3,18.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Xifaxan: 6 Blister Pack In 1 Carton (65649-303-03) / 10 Tablet In 1 Blister Pack,250,RC,65649-303-03,NDC,,,facility,both,1,EA,,142.79,142.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Relistor: 1 Vial, Single-Dose In 1 Carton (65649-551-02) / .6 Ml In 1 Vial, Single-Dose",250,RC,65649-551-02,NDC,,,facility,both,1,EA,,314.03,314.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Capsule In 1 Bottle (65862-018-01),250,RC,65862-018-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Capsule In 1 Bottle (65862-019-01),250,RC,65862-019-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 5 Blister Pack In 1 Carton (65862-021-06) / 6 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,65862-021-06,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lansoprazole: 1 Kit In 1 Container (65628-080-03) * .27 G In 1 Bottle, Plastic * 90 Ml In 1 Bottle, Plastic",250,RC,65628-080-03,NDC,,,facility,both,1,EA,,49.43,49.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (65862-528-90)",250,RC,65862-528-90,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (65862-909-01),250,RC,65862-909-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65862-921-27)",250,RC,65862-921-27,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 30 Tablet, Film Coated In 1 Bottle (65862-927-30)",250,RC,65862-927-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,65862-930-08,NDC,,,facility,both,1,EA,,3.77,3.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sevelamer Carbonate: 90 Pouch In 1 Carton (65862-930-90) / 1 Powder, For Suspension In 1 Pouch (65862-930-08)",250,RC,65862-930-90,NDC,,,facility,both,1,EA,,3.76,3.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (65862-908-01),250,RC,65862-908-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (65862-946-01) / 10 Ml In 1 Bottle, Dropper",250,RC,65862-946-01,NDC,,,facility,both,1,EA,,53.25,53.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sancuso: 168 H In 1 Pouch (66220-637-31),250,RC,66220-637-31,NDC,,,facility,both,1,EA,,1651,1651,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66259-146-01,NDC,,,facility,both,1,EA,,356.83,356.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66553-002-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66553-004-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66553-004-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66553-008-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,65862-898-28,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levofloxacin: 50 Tablet, Film Coated In 1 Bottle (65862-536-50)",250,RC,65862-536-50,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-559-90)",250,RC,65862-559-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-560-90)",250,RC,65862-560-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Montelukast Sodium: 90 Tablet, Film Coated In 1 Bottle (65862-574-90)",250,RC,65862-574-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Montelukast Sodium: 90 Tablet, Film Coated In 1 Bottle (65862-574-90)",250,RC,65862-574-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamsulosin Hydrochloride: 100 Capsule In 1 Bottle (65862-598-01),250,RC,65862-598-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Modafinil: 30 Tablet In 1 Bottle (65862-601-30),250,RC,65862-601-30,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-603-30)",250,RC,65862-603-30,NDC,,,facility,both,1,EA,,5.96,5.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (65862-664-30),250,RC,65862-664-30,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ritonavir: 30 Tablet, Film Coated In 1 Bottle (65862-687-30)",250,RC,65862-687-30,NDC,,,facility,both,1,EA,,4.63,4.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Ml In 1 Bottle (65862-707-01),250,RC,65862-707-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Valganciclovir Hydrochloride: 60 Tablet In 1 Bottle (65862-753-60),250,RC,65862-753-60,NDC,,,facility,both,1,EA,,7.76,7.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Esomeprazole Magnesium: 30 Capsule, Delayed Release In 1 Bottle (65862-784-30)",250,RC,65862-784-30,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prasugrel: 30 Tablet, Film Coated In 1 Bottle (65862-830-30)",250,RC,65862-830-30,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,66658-234-01,NDC,,,facility,both,1,EA,,609.44,609.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linezolid: 1 Blister Pack In 1 Carton (67877-419-33) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,67877-419-33,NDC,,,facility,both,1,EA,,6.89,6.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Colchicine: 100 Tablet In 1 Bottle (67877-589-01),250,RC,67877-589-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-753-95,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-755-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-775-95,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-776-11,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-782-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-790-95,NDC,,,facility,both,1,EA,,25.55,25.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-805-11,NDC,,,facility,both,1,EA,,4.97,4.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 80 Blister Pack In 1 Box, Unit-Dose (68084-813-09) / 1 Tablet, Delayed Release In 1 Blister Pack (68084-813-11)",250,RC,68084-813-09,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-843-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-844-11,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-854-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-808-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-856-11,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-750-95,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-654-11,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-655-11,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-675-21) / 1 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK (68084-675-11) ",250,RC,68084-675-21,NDC,,,facility,both,1,EA,,4.21,4.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-683-11,NDC,,,facility,both,1,EA,,3.81,3.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-692-11,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-697-11,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-698-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (68084-753-25) / 1 Tablet, Film Coated In 1 Blister Pack (68084-753-95)",250,RC,68084-753-25,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-713-11,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-722-11,NDC,,,facility,both,1,EA,,29.23,29.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-728-11,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-729-11,NDC,,,facility,both,1,EA,,8.06,8.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-735-11,NDC,,,facility,both,1,EA,,5.18,5.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-737-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-708-95,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 100 Blister Pack In 1 Box, Unit-Dose (68084-882-01) / 1 Tablet, Film Coated In 1 Blister Pack (68084-882-11)",250,RC,68084-882-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-896-95,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 60 Capsule, Delayed Release In 1 Bottle (68180-294-07)",250,RC,68180-294-07,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Capsule, Delayed Release In 1 Bottle (68180-295-06)",250,RC,68180-295-06,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 90 Capsule, Delayed Release In 1 Bottle (68180-296-09)",250,RC,68180-296-09,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Xl: 90 Tablet, Extended Release In 1 Bottle (68180-319-09)",250,RC,68180-319-09,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Losartan Potassium: 90 Tablet In 1 Bottle (68180-377-09),250,RC,68180-377-09,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirabegron: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-152-06)",250,RC,68180-152-06,NDC,,,facility,both,1,EA,,28.23,28.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desvenlafaxine Succinate: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-604-06)",250,RC,68180-604-06,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline: 60 Ml In 1 Bottle (68180-657-01),250,RC,68180-657-01,NDC,,,facility,both,1,EA,,10.11,10.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rifampin: 30 Capsule In 1 Bottle (68180-658-06),250,RC,68180-658-06,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levothyroxine Sodium: 90 Tablet In 1 Bottle (68180-966-09),250,RC,68180-966-09,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Tablet In 1 Bottle (68180-980-01),250,RC,68180-980-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Tablet In 1 Bottle (68180-981-01),250,RC,68180-981-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Ml In 1 Bottle (68180-441-01),250,RC,68180-441-01,NDC,,,facility,both,1,EA,,3.51,3.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Naltrexone Hydrochloride: 3 Blister Pack In 1 Carton (68094-853-62) / 10 Tablet, Film Coated In 1 Blister Pack (68094-853-59)",250,RC,68094-853-62,NDC,,,facility,both,1,EA,,5.52,5.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-964-95,NDC,,,facility,both,1,EA,,5.09,5.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-965-95,NDC,,,facility,both,1,EA,,30.87,30.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-996-11,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-001-59,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-001-59,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-034-59,NDC,,,facility,both,1,EA,,4.6,4.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-043-59,NDC,,,facility,both,1,EA,,21.84,21.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-063-59,NDC,,,facility,both,1,EA,,9.58,9.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-231-59,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-330-59,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-330-59,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-494-59,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68094-750-59,NDC,,,facility,both,1,EA,,3.93,3.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-640-11,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-636-95,NDC,,,facility,both,1,EA,,7.25,7.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-119-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-202-11,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-203-11,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-214-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-215-11,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 100 Blister Pack In 1 Box, Unit-Dose (68084-119-01) / 1 Tablet, Film Coated In 1 Blister Pack (68084-119-11)",250,RC,68084-119-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-248-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-269-11,NDC,,,facility,both,1,EA,,3.79,3.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-270-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-282-11,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-284-11,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-288-11,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-248-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-291-11,NDC,,,facility,both,1,EA,,6.16,6.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-638-30)",250,RC,67877-638-30,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesalamine: 120 Capsule, Extended Release In 1 Bottle (67877-717-12)",250,RC,67877-717-12,NDC,,,facility,both,1,EA,,3.04,3.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lacosamide Oral Solution: 200 Ml In 1 Bottle (67877-732-95),250,RC,67877-732-95,NDC,,,facility,both,1,EA,,8.08,8.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Entereg: 6 BLISTER PACK in 1 CARTON (67919-020-10) / 5 CAPSULE in 1 BLISTER PACK,250,RC,67919-020-10,NDC,,,facility,both,1,EA,,515.52,515.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-109-11,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-040-11,NDC,,,facility,both,1,EA,,4.77,4.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-046-11,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-097-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-098-11,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-099-11,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-299-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-313-11,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-494-11,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-511-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-512-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-536-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-597-11,NDC,,,facility,both,1,EA,,2.92,2.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-479-11,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-603-11,NDC,,,facility,both,1,EA,,5.98,5.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-605-11,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-617-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-618-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-621-11,NDC,,,facility,both,1,EA,,23.07,23.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-632-11,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-598-11,NDC,,,facility,both,1,EA,,4.62,4.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-447-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-415-11,NDC,,,facility,both,1,EA,,2.76,2.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-342-11,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-343-11,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-344-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 100 Blister Pack In 1 Box, Unit-Dose (68084-346-01) / 1 Tablet, Film Coated In 1 Blister Pack (68084-346-11)",250,RC,68084-346-01,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-346-11,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-347-11,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-354-11,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-381-11,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-388-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-389-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68084-411-11,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-724-01,NDC,,,facility,both,1,EA,,349.43,349.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Proctozone-Hc: 1 Tube In 1 Carton (63629-8847-1) / 30 G In 1 Tube,250,RC,63629-8847-1,NDC,,,facility,both,1,EA,,40.29,40.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pravastatin Sodium: 90 Tablet In 1 Bottle (63629-8910-1),250,RC,63629-8910-1,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Plavix: 10 BLISTER PACK in 1 CARTON (63653-1171-3) / 10 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,63653-1171-3,NDC,,,facility,both,1,EA,,9.31,9.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-046-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-046-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-881-01,NDC,,,facility,both,1,EA,,22.73,22.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-881-01,NDC,,,facility,both,1,EA,,16.99,16.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-884-01,NDC,,,facility,both,1,EA,,20.12,20.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levothyroxine Sodium: 1 Vial, Single-Dose In 1 Carton (63323-885-10) / 5 Ml In 1 Vial, Single-Dose",250,RC,63323-885-10,NDC,,,facility,both,1,EA,,110.96,110.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Provigil: 30 Tablet In 1 Bottle (63459-101-30),250,RC,63459-101-30,NDC,,,facility,both,1,EA,,30.74,30.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-047-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-047-10,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sensorcaine Mpf: 5 Vial, Single-Dose In 1 Box (63323-462-31) / 30 Ml In 1 Vial, Single-Dose (63323-462-02)",250,RC,63323-462-31,NDC,,,facility,both,1,EA,,23.58,23.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol: 25 Vial In 1 Tray (63323-474-01) / 1 Ml In 1 Vial (63323-474-00),250,RC,63323-474-01,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-481-01,NDC,,,facility,both,1,EA,,4.95,4.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-482-03,NDC,,,facility,both,1,EA,,7.11,7.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-482-05,NDC,,,facility,both,1,EA,,17.17,17.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-482-26) / 20 Ml In 1 Vial, Multi-Dose (63323-482-41)",250,RC,63323-482-26,NDC,,,facility,both,1,EA,,4.56,4.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-483-03,NDC,,,facility,both,1,EA,,7.11,7.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-377-00,NDC,,,facility,both,1,EA,,24.43,24.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-417-01,NDC,,,facility,both,1,EA,,10.94,10.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-483-27) / 20 Ml In 1 Vial, Multi-Dose (63323-483-03)",250,RC,63323-483-27,NDC,,,facility,both,1,EA,,13.98,13.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-487-07,NDC,,,facility,both,1,EA,,9.46,9.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-487-37) / 30 Ml In 1 Vial, Single-Dose (63323-487-07)",250,RC,63323-487-37,NDC,,,facility,both,1,EA,,18.44,18.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-489-01,NDC,,,facility,both,1,EA,,28.4,28.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-489-02,NDC,,,facility,both,1,EA,,34.92,34.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-489-17) / 10 Ml In 1 Vial, Single-Dose (63323-489-01)",250,RC,63323-489-17,NDC,,,facility,both,1,EA,,12.87,12.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-489-27) / 20 Ml In 1 Vial, Single-Dose (63323-489-02)",250,RC,63323-489-27,NDC,,,facility,both,1,EA,,40.03,40.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-492-04,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-492-07,NDC,,,facility,both,1,EA,,21.99,21.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-492-07,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-492-09,NDC,,,facility,both,1,EA,,10.38,10.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-27) / 2 Ml In 1 Vial, Single-Dose (63323-492-04)",250,RC,63323-492-27,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 5 Vial, Single-Dose In 1 Carton (63323-492-31) / 30 Ml In 1 Vial, Single-Dose (63323-492-03)",250,RC,63323-492-31,NDC,,,facility,both,1,EA,,17.66,17.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-36) / 5 Ml In 1 Vial, Single-Dose (63323-492-43)",250,RC,63323-492-36,NDC,,,facility,both,1,EA,,4.29,4.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-494-01,NDC,,,facility,both,1,EA,,16.39,16.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valproate Sodium: 10 Vial, Single-Dose In 1 Tray (63323-494-16) / 5 Ml In 1 Vial, Single-Dose (63323-494-41)",250,RC,63323-494-16,NDC,,,facility,both,1,EA,,47.1,47.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-495-04,NDC,,,facility,both,1,EA,,5.17,5.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-495-07) / 5 Ml In 1 Vial, Single-Dose (63323-495-04)",250,RC,63323-495-07,NDC,,,facility,both,1,EA,,3.79,3.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-496-03,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Xylocaine Mpf: 5 Ampule In 1 Box (63323-496-97) / 10 Ml In 1 Ampule (63323-496-03),250,RC,63323-496-97,NDC,,,facility,both,1,EA,,9.6,9.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-048-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-048-10,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amiodarone Hydrochloride: 10 Blister Pack In 1 Box (63739-051-10) / 10 Tablet In 1 Blister Pack,250,RC,63739-051-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-664-01)",250,RC,64896-664-01,NDC,,,facility,both,1,EA,,12.9,12.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,64950-354-05,NDC,,,facility,both,1,EA,,14.28,14.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cocaine Hydrochloride: 1 Bottle, Glass In 1 Carton (64950-362-04) / 4 Ml In 1 Bottle, Glass",250,RC,64950-362-04,NDC,,,facility,both,1,EA,,568.43,568.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pyridostigmine Bromide: 30 Tablet In 1 Bottle (64980-220-03),250,RC,64980-220-03,NDC,,,facility,both,1,EA,,16.06,16.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Proctozone-Hc: 1 Tube In 1 Carton (64980-324-30) / 30 G In 1 Tube,250,RC,64980-324-30,NDC,,,facility,both,1,EA,,49.8,49.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcitriol: 1 Bottle, Glass In 1 Carton (64980-447-15) / 15 Ml In 1 Bottle, Glass",250,RC,64980-447-15,NDC,,,facility,both,1,EA,,32.28,32.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Palmitate Hydrochloride (Pediatric): 100 Ml In 1 Bottle (64980-511-10),250,RC,64980-511-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-663-01)",250,RC,64896-663-01,NDC,,,facility,both,1,EA,,10.28,10.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ofloxacin: 1 Bottle, Plastic In 1 Carton (64980-515-05) / 5 Ml In 1 Bottle, Plastic",250,RC,64980-515-05,NDC,,,facility,both,1,EA,,32.11,32.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Bicarbonate: 1000 Tablet In 1 Bottle (64980-528-10),250,RC,64980-528-10,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactulose Solution: 473 Ml In 1 Bottle (64980-592-48),250,RC,64980-592-48,NDC,,,facility,both,1,EA,,4.98,4.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-024-09),250,RC,65162-024-09,NDC,,,facility,both,1,EA,,6.61,6.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Capsule In 1 Bottle (65162-102-10),250,RC,65162-102-10,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Timolol Maleate: 1 Bottle In 1 Carton (64980-514-05) / 5 Ml In 1 Bottle,250,RC,64980-514-05,NDC,,,facility,both,1,EA,,12.63,12.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naproxen: 100 Tablet In 1 Bottle (65162-188-10),250,RC,65162-188-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-662-01)",250,RC,64896-662-01,NDC,,,facility,both,1,EA,,10.15,10.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-883-04)",250,RC,64380-883-04,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrocortisone: 100 Tablet In 1 Bottle, Plastic (64380-971-06)",250,RC,64380-971-06,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "CARBIDOPA, LEVODOPA AND ENTACAPONE: 100 TABLET, FILM COATED in 1 BOTTLE (64679-787-04) ",250,RC,64679-787-04,NDC,,,facility,both,1,EA,,7.29,7.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Colcrys: 100 Tablet, Film Coated In 1 Bottle, Plastic (64764-119-01)",250,RC,64764-119-01,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amitiza: 60 Capsule, Gelatin Coated In 1 Bottle (64764-240-60)",250,RC,64764-240-60,NDC,,,facility,both,1,EA,,14.98,14.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-720-30)",250,RC,64764-720-30,NDC,,,facility,both,1,EA,,45.09,45.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-730-30)",250,RC,64764-730-30,NDC,,,facility,both,1,EA,,44.67,44.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (64850-511-01)",250,RC,64850-511-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-661-01)",250,RC,64896-661-01,NDC,,,facility,both,1,EA,,10.51,10.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naproxen: 100 Tablet In 1 Bottle (65162-189-10),250,RC,65162-189-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Niacin: 90 Tablet, Extended Release In 1 Bottle (65162-321-09)",250,RC,65162-321-09,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 90 Tablet In 1 Bottle (65162-896-09),250,RC,65162-896-09,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 90 Tablet In 1 Bottle (65162-898-09),250,RC,65162-898-09,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,65162-993-04,NDC,,,facility,both,1,EA,,16.53,16.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ad First Aid Multipurpose: 1 Tube In 1 Box (65197-400-10) / 42.5 G In 1 Tube,250,RC,65197-400-10,NDC,,,facility,both,1,EA,,7.21,7.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 1 Bottle In 1 Carton (65162-893-74) / 150 Ml In 1 Bottle,250,RC,65162-893-74,NDC,,,facility,both,1,EA,,8.88,8.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ad Prevent Original: 1 Tube In 1 Box (65197-401-01) / 113 G In 1 Tube,250,RC,65197-401-01,NDC,,,facility,both,1,EA,,8.28,8.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Phosphates: 25 Vial, Single-Dose In 1 Tray (65219-054-29) / 15 Ml In 1 Vial, Single-Dose (65219-054-09)",250,RC,65219-054-29,NDC,,,facility,both,1,EA,,84.35,84.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,65219-119-01,NDC,,,facility,both,1,EA,,47.79,47.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,65219-658-01,NDC,,,facility,both,1,EA,,69.25,69.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 25 Ampule In 1 Carton (65282-1605-1) / 5 Ml In 1 Ampule,250,RC,65282-1605-1,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Savaysa: 30 Tablet, Film Coated In 1 Bottle (65597-201-30)",250,RC,65597-201-30,NDC,,,facility,both,1,EA,,34.96,34.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-880-03)",250,RC,65162-880-03,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sildenafil: 90 Tablet In 1 Bottle (65162-351-09),250,RC,65162-351-09,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Tablet In 1 Bottle (65162-464-10),250,RC,65162-464-10,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10),250,RC,65162-465-10,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Risperidone: 30 Ml In 1 Bottle (65162-673-84),250,RC,65162-673-84,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-681-10),250,RC,65162-681-10,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-682-10),250,RC,65162-682-10,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Colchicine: 30 Tablet In 1 Bottle (65162-710-03),250,RC,65162-710-03,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rivastigmine: 30 Patch In 1 Carton (65162-749-34) / 24 H In 1 Patch,250,RC,65162-749-34,NDC,,,facility,both,1,EA,,10.3,10.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Budesonide: 100 Capsule, Delayed Release In 1 Bottle (65162-778-10)",250,RC,65162-778-10,NDC,,,facility,both,1,EA,,5.4,5.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine: 30 Pouch In 1 Carton (65162-791-08) / 1 Patch In 1 Pouch (65162-791-04),250,RC,65162-791-08,NDC,,,facility,both,1,EA,,5.52,5.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lubiprostone: 60 Capsule In 1 Bottle (65162-841-06),250,RC,65162-841-06,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-799-01),250,RC,64380-799-01,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-797-01),250,RC,64380-797-01,NDC,,,facility,both,1,EA,,2.86,2.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 100 TABLET in 1 BOTTLE (63739-413-10) ,250,RC,63739-413-10,NDC,,,facility,both,1,EA,,53.09,53.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Baclofen: 10 Blister Pack In 1 Box, Unit-Dose (63739-479-10) / 10 Tablet In 1 Blister Pack",250,RC,63739-479-10,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-483-10) / 10 Tablet In 1 Blister Pack",250,RC,63739-483-10,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-484-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-484-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-486-10) / 10 Tablet In 1 Blister Pack",250,RC,63739-486-10,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63739-354-10,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zolpidem Tartrate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-526-10) / 10 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,63739-526-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10) / 10 Tablet In 1 Blister Pack",250,RC,63739-544-10,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 10 Blister Pack In 1 Box, Unit-Dose (63739-560-10) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-560-10,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-564-10) / 10 Tablet, Delayed Release In 1 Blister Pack",250,RC,63739-564-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10) / 10 Capsule In 1 Blister Pack",250,RC,63739-567-10,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-570-10) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-570-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-571-10) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-571-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-328-10) / 10 Tablet In 1 Blister Pack,250,RC,63739-328-10,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sky Oral Rinse: 600 Ml In 1 Package (63739-052-57),250,RC,63739-052-57,NDC,,,facility,both,1,EA,,4.51,4.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sky Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (63739-052-74)",250,RC,63739-052-74,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonidine Hydrochloride: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-060-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-060-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diazepam: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-073-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-073-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valacyclovir: 10 Blister Pack In 1 Box, Unit-Dose (63739-077-10) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-077-10,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63739-159-77,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63739-159-77,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sky Peg3350: 30 Pouch In 1 Carton (63739-198-61) / 17 G In 1 Pouch (63739-198-62),250,RC,63739-198-61,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Low Dose Aspirin: 30 Blister Pack In 1 Box (63739-212-02) / 10 Tablet, Coated In 1 Blister Pack",250,RC,63739-212-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63739-225-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-263-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-263-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-264-10) / 10 TABLET in 1 BLISTER PACK",250,RC,63739-264-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-327-10) / 10 Tablet In 1 Blister Pack,250,RC,63739-327-10,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10) / 10 Tablet In 1 Blister Pack",250,RC,63739-645-10,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mucinex: 500 Tablet, Extended Release In 1 Bottle (63824-008-50)",250,RC,63824-008-50,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sterile Water: 60 Syringe, Plastic In 1 Box (64253-020-30) / 10 Ml In 1 Syringe, Plastic",250,RC,64253-020-30,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Calcitriol: 100 Capsule In 1 Container (64380-723-06),250,RC,64380-723-06,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vitamin D: 100 Capsule In 1 Bottle, Plastic (64380-737-06)",250,RC,64380-737-06,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buspirone Hydrochloride: 100 Tablet In 1 Bottle (64380-787-06),250,RC,64380-787-06,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-995-10) / 10 Capsule In 1 Blister Pack",250,RC,63739-995-10,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-988-32) / 10 Capsule In 1 Blister Pack",250,RC,63739-988-32,NDC,,,facility,both,1,EA,,6.03,6.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-984-10) / 10 CAPSULE in 1 BLISTER PACK",250,RC,63739-984-10,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losortan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-673-10) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-673-10,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 25 BLISTER PACK in 1 BOX (63739-684-01) / 30 TABLET in 1 BLISTER PACK,250,RC,63739-684-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-686-10) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-686-10,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63739-724-01,NDC,,,facility,both,1,EA,,18.95,18.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 10 Blister Pack In 1 Carton (63739-902-10) / 10 Capsule In 1 Blister Pack,250,RC,63739-902-10,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 10 Blister Pack In 1 Carton (63739-903-10) / 10 Capsule In 1 Blister Pack,250,RC,63739-903-10,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10) / 10 Capsule In 1 Blister Pack,250,RC,63739-904-10,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-963-10) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,63739-963-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-972-10) / 10 Tablet, Extended Release In 1 Blister Pack",250,RC,63739-972-10,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-972-10) / 10 Tablet, Extended Release In 1 Blister Pack",250,RC,63739-972-10,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-973-10) / 10 Tablet, Extended Release In 1 Blister Pack",250,RC,63739-973-10,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63739-976-01,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10) / 10 Tablet In 1 Blister Pack",250,RC,63739-645-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atenolol: 1000 Tablet In 1 Bottle (68382-023-10),250,RC,68382-023-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,72603-203-01,NDC,,,facility,both,1,EA,,3.09,3.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,72603-209-01,NDC,,,facility,both,1,EA,,19.67,19.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atovaquone: 1 Bottle In 1 Carton (72603-248-01) / 210 Ml In 1 Bottle,250,RC,72603-248-01,NDC,,,facility,both,1,EA,,3.56,3.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fludrocortisone Acetate: 100 Tablet In 1 Bottle (72603-170-01),250,RC,72603-170-01,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,72603-350-01,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tibsovo: 1 Bottle In 1 Carton (72694-617-60) / 60 Tablet, Film Coated In 1 Bottle",250,RC,72694-617-60,NDC,,,facility,both,1,EA,,1494.02,1494.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Baclofen: 100 Tablet In 1 Bottle (72888-009-01),250,RC,72888-009-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (72888-014-01)",250,RC,72888-014-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,72888-024-06,NDC,,,facility,both,1,EA,,3.04,3.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clobetasol Propionate Cream Usp, 0.05% Clobetasol Propionate Cream Usp, 0.05%: 15 G In 1 Tube (72603-323-01)",250,RC,72603-323-01,NDC,,,facility,both,1,EA,,13.92,13.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 500 Tablet, Extended Release In 1 Bottle (72516-030-50)",250,RC,72516-030-50,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acyclovir: 100 Capsule In 1 Bottle (72578-002-01),250,RC,72578-002-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Memantine: 500 Tablet In 1 Bottle (72603-119-02),250,RC,72603-119-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Spironolactone: 100 Tablet In 1 Bottle (72603-134-01),250,RC,72603-134-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 500 Tablet, Film Coated, Extended Release In 1 Bottle (72603-142-02)",250,RC,72603-142-02,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (72603-144-01)",250,RC,72603-144-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dofetilide: 60 Capsule In 1 Bottle (72603-130-01),250,RC,72603-130-01,NDC,,,facility,both,1,EA,,9.45,9.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,72888-024-06,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-034-01)",250,RC,72888-034-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15) / 3 Ml In 1 Syringe, Plastic (73070-103-10)",250,RC,73070-103-15,NDC,,,facility,both,1,EA,,78.27,78.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,73177-101-02,NDC,,,facility,both,1,EA,,11.41,11.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,73177-123-02,NDC,,,facility,both,1,EA,,22.62,22.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,73293-0001-1,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-110-01)",250,RC,73562-110-01,NDC,,,facility,both,1,EA,,11.79,11.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-111-01)",250,RC,73562-111-01,NDC,,,facility,both,1,EA,,15.48,15.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-113-01)",250,RC,73562-113-01,NDC,,,facility,both,1,EA,,5.64,5.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemtesa: 30 Tablet, Film Coated In 1 Bottle (73336-075-30)",250,RC,73336-075-30,NDC,,,facility,both,1,EA,,36.38,36.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,73070-103-10,NDC,,,facility,both,1,EA,,66.17,66.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-035-01)",250,RC,72888-035-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Tablet In 1 Bottle (72888-085-01),250,RC,72888-085-01,NDC,,,facility,both,1,EA,,8.45,8.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26),250,RC,72888-125-26,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 Tablet In 1 Bottle (72888-178-30),250,RC,72888-178-30,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Orgovyx: 30 Tablet, Film Coated In 1 Bottle, Plastic (72974-120-01)",250,RC,72974-120-01,NDC,,,facility,both,1,EA,,265.88,265.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-114-01)",250,RC,73562-114-01,NDC,,,facility,both,1,EA,,43.32,43.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 10 Vial In 1 Carton (72485-510-10) / 10 Ml In 1 Vial (72485-510-01),250,RC,72485-510-10,NDC,,,facility,both,1,EA,,7.9,7.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hemorrhoidal Hygiene Pads: 175 Ml In 1 Jar (71399-0110-1),250,RC,71399-0110-1,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Medpura Vitamin A And D Vitamin A And D: 113 G In 1 Tube (71399-0122-4),250,RC,71399-0122-4,NDC,,,facility,both,1,EA,,8.61,8.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,71656-072-05,NDC,,,facility,both,1,EA,,28.94,28.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-025-30)",250,RC,71699-025-30,NDC,,,facility,both,1,EA,,101.37,101.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-100-30)",250,RC,71699-100-30,NDC,,,facility,both,1,EA,,99.65,99.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-150-30)",250,RC,71699-150-30,NDC,,,facility,both,1,EA,,105.42,105.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-200-30)",250,RC,71699-200-30,NDC,,,facility,both,1,EA,,98.07,98.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dorzolamide Hydrochloride Timolol Maleate: 1 Bottle, Dispensing In 1 Carton (71921-226-10) / 10 Ml In 1 Bottle, Dispensing",250,RC,71921-226-10,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultiva: 10 Vial, Glass In 1 Carton (72078-035-02) / 5 Ml In 1 Vial, Glass (72078-035-00)",250,RC,72078-035-02,NDC,,,facility,both,1,EA,,159.81,159.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (72205-011-90),250,RC,72205-011-90,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (72205-012-90),250,RC,72205-012-90,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Febuxostat: 30 Tablet, Film Coated In 1 Bottle (72205-028-30)",250,RC,72205-028-30,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (71288-700-06) / 5 Ml In 1 Vial, Multi-Dose (71288-700-05)",250,RC,71288-700-06,NDC,,,facility,both,1,EA,,2.66,2.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,71288-700-05,NDC,,,facility,both,1,EA,,3.7,3.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dofetilide: 60 Capsule In 1 Bottle (72205-039-60),250,RC,72205-039-60,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-042-11) / 10 Capsule In 1 Blister Pack,250,RC,72205-042-11,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tolvaptan: 1 Blister Pack In 1 Carton (72205-130-11) / 10 Tablet In 1 Blister Pack,250,RC,72205-130-11,NDC,,,facility,both,1,EA,,159.72,159.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (72205-208-30)",250,RC,72205-208-30,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-260-30),250,RC,72205-260-30,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (72241-023-05),250,RC,72241-023-05,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (72241-024-05),250,RC,72241-024-05,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Erythromycin: 50 Tube In 1 Carton (72485-670-31) / 1 G In 1 Tube,250,RC,72485-670-31,NDC,,,facility,both,1,EA,,10.26,10.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-116-01)",250,RC,73562-116-01,NDC,,,facility,both,1,EA,,28.24,28.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Viokace: 1 Bottle In 1 Carton (73562-208-10) / 100 Tablet In 1 Bottle,250,RC,73562-208-10,NDC,,,facility,both,1,EA,,21.22,21.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine 5%: 30 Pouch In 1 Package (82347-0505-5) / 14 G In 1 Pouch (82347-0505-4),250,RC,82347-0505-5,NDC,,,facility,both,1,EA,,5.52,5.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 10 Ampule In 1 Carton (83090-003-10) / 10 Ml In 1 Ampule (83090-003-01),250,RC,83090-003-10,NDC,,,facility,both,1,EA,,10.91,10.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Tablet In 1 Bottle (82293-004-10),250,RC,82293-004-10,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isoniazid: 100 Tablet In 1 Bottle, Plastic (81665-108-10)",250,RC,81665-108-10,NDC,,,facility,both,1,EA,,6.93,6.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,80830-1691-1,NDC,,,facility,both,1,EA,,19.94,19.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,81033-220-15,NDC,,,facility,both,1,EA,,6.04,6.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,81033-412-15,NDC,,,facility,both,1,EA,,6.06,6.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin And Clavulanate Potassium: 75 Ml In 1 Bottle (81964-204-07),250,RC,81964-204-07,NDC,,,facility,both,1,EA,,16.38,16.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,81284-612-00,NDC,,,facility,both,1,EA,,5.28,5.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tranexamic Acid: 10 Vial, Single-Dose In 1 Carton (81284-612-10) / 10 Ml In 1 Vial, Single-Dose (81284-612-00)",250,RC,81284-612-10,NDC,,,facility,both,1,EA,,6.23,6.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tranexamic Acid: 10 Vial, Single-Dose In 1 Carton (81284-611-10) / 10 Ml In 1 Vial, Single-Dose (81284-611-00)",250,RC,81284-611-10,NDC,,,facility,both,1,EA,,6.01,6.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6177-00,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6177-02,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6177-04,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6177-08,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6181-37,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,99999-0100-75,NDC,,,facility,both,1,EA,,6.94,6.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6176-98,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,99999-4707-09,NDC,,,facility,both,1,EA,,66,66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,99999-4707-12,NDC,,,facility,both,1,EA,,66,66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6176-94,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6176-92,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6169-29,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA C20H10Na2O5 Fluorescein Sodium Ophthalmic Strips: 300 Packet In 1 Box (83851-100-30) / 1 Mg In 1 Packet,250,RC,83851-100-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-1014-51,NDC,,,facility,both,1,EA,,100,100,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-1700-22,NDC,,,facility,both,1,EA,,90.96,90.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-1700-23,NDC,,,facility,both,1,EA,,71.57,71.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-1701-26,NDC,,,facility,both,1,EA,,66,66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-2003-51,NDC,,,facility,both,1,EA,,107.78,107.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6144-49,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6165-49,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9999-6165-51,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenobarbital: 100 Tablet In 1 Bottle, Plastic (75826-138-10)",250,RC,75826-138-10,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-158-01),250,RC,75834-158-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-159-01),250,RC,75834-159-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nivagen Zinc Oxide: 28.4 G In 1 Tube (75834-170-01),250,RC,75834-170-01,NDC,,,facility,both,1,EA,,8.54,8.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erythromycin: 30 Tablet, Film Coated In 1 Bottle (75834-242-30)",250,RC,75834-242-30,NDC,,,facility,both,1,EA,,10.84,10.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Erythromycin Ethylsuccinate: 100 Ml In 1 Bottle (75834-295-01),250,RC,75834-295-01,NDC,,,facility,both,1,EA,,27.29,27.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (75907-069-01)",250,RC,75907-069-01,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Iodide: 30 Ml In 1 Bottle, With Applicator (75834-280-30)",250,RC,75834-280-30,NDC,,,facility,both,1,EA,,11.18,11.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nadolol: 100 Tablet In 1 Bottle (76385-134-01),250,RC,76385-134-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,77333-031-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,77333-812-25,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,77333-827-25,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,77333-844-25,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nadolol: 100 Tablet In 1 Bottle (76385-133-01),250,RC,76385-133-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Bicarbonate: 1 Syringe In 1 Carton (76329-3352-1) / 50 Ml In 1 Syringe,250,RC,76329-3352-1,NDC,,,facility,both,1,EA,,34.19,34.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,76204-800-11,NDC,,,facility,both,1,EA,,2.72,2.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,76204-900-11,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diclofenac Sodium: 1 Tube In 1 Carton (76282-663-39) / 100 G In 1 Tube,250,RC,76282-663-39,NDC,,,facility,both,1,EA,,8.67,8.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Single-Use In 1 Box (76329-3011-5) / 5 Ml In 1 Vial, Single-Use",250,RC,76329-3011-5,NDC,,,facility,both,1,EA,,12.26,12.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Single-Use In 1 Box (76329-3012-5) / 5 Ml In 1 Vial, Single-Use",250,RC,76329-3012-5,NDC,,,facility,both,1,EA,,11.51,11.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Single-Use In 1 Box (76329-3013-5) / 10 Ml In 1 Vial, Single-Use",250,RC,76329-3013-5,NDC,,,facility,both,1,EA,,16.33,16.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Single-Use In 1 Box (76329-3013-5) / 10 Ml In 1 Vial, Single-Use",250,RC,76329-3013-5,NDC,,,facility,both,1,EA,,16.12,16.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)",250,RC,69315-306-15,NDC,,,facility,both,1,EA,,20.71,20.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)",250,RC,69315-306-15,NDC,,,facility,both,1,EA,,19.18,19.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Procto-Med Hc: 1 Tube In 1 Carton (69315-312-28) / 28 G In 1 Tube,250,RC,69315-312-28,NDC,,,facility,both,1,EA,,73.88,73.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 Tablet In 1 Bottle (69315-904-01),250,RC,69315-904-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dash Chlorhexidine Gluconate 0.12% Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (69339-138-15)",250,RC,69339-138-15,NDC,,,facility,both,1,EA,,3.74,3.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,69339-150-01,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Indocin: 30 Suppository In 1 Box (69344-102-33),250,RC,69344-102-33,NDC,,,facility,both,1,EA,,508.15,508.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (69367-302-01),250,RC,69367-302-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valproic Acid: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-150-20)",250,RC,69452-150-20,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,69452-156-74,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (69452-206-20)",250,RC,69452-206-20,NDC,,,facility,both,1,EA,,3.81,3.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (69452-390-98)",250,RC,69452-390-98,NDC,,,facility,both,1,EA,,3.89,3.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nifedipine: 100 Capsule In 1 Bottle, Plastic (69315-211-01)",250,RC,69315-211-01,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Benztropine Mesylate: 100 Tablet In 1 Bottle (69315-138-01),250,RC,69315-138-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diclofenac Sodium: 1 Tube In 1 Carton (69097-524-44) / 100 G In 1 Tube,250,RC,69097-524-44,NDC,,,facility,both,1,EA,,38.04,38.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phytonadione: 30 Tablet In 1 Bottle (69097-999-02),250,RC,69097-999-02,NDC,,,facility,both,1,EA,,22.37,22.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1 Bottle In 1 Carton (69230-326-01) / 100 Tablet, Film Coated In 1 Bottle",250,RC,69230-326-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (69238-1065-1)",250,RC,69238-1065-1,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline Hyclate: 50 Capsule In 1 Bottle (69238-1100-2),250,RC,69238-1100-2,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-5) / 15 G In 1 Tube,250,RC,69238-1532-5,NDC,,,facility,both,1,EA,,10.18,10.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylergonovine Maleate: 12 Tablet In 1 Bottle (69238-1605-2),250,RC,69238-1605-2,NDC,,,facility,both,1,EA,,35.13,35.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylergonovine Maleate: 28 Tablet In 1 Bottle (69238-1605-8),250,RC,69238-1605-8,NDC,,,facility,both,1,EA,,33.81,33.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nitrofurantoin: 1 Bottle, Glass In 1 Carton (69238-2512-9) / 230 Ml In 1 Bottle, Glass",250,RC,69238-2512-9,NDC,,,facility,both,1,EA,,113.28,113.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Imipramine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69315-134-01)",250,RC,69315-134-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Imipramine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69315-135-01)",250,RC,69315-135-01,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 100 Tablet In 1 Bottle (70010-162-01),250,RC,70010-162-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine Hydrochloride: 90 Tablet, Coated In 1 Bottle (70010-163-09)",250,RC,70010-163-09,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine Hydrochloride: 90 Tablet, Coated In 1 Bottle (70010-163-09)",250,RC,70010-163-09,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-491-01)",250,RC,70010-491-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-492-01)",250,RC,70010-492-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)",250,RC,70010-135-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle In 1 Carton (70069-051-01) / 10 Ml In 1 Bottle,250,RC,70069-051-01,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tobramycin: 1 Bottle In 1 Carton (70069-131-01) / 5 Ml In 1 Bottle,250,RC,70069-131-01,NDC,,,facility,both,1,EA,,9.84,9.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cisatracurium Besylate: 1 Vial In 1 Carton (70069-161-01) / 10 Ml In 1 Vial,250,RC,70069-161-01,NDC,,,facility,both,1,EA,,20.12,20.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (70069-181-01) / 15 Ml In 1 Bottle,250,RC,70069-181-01,NDC,,,facility,both,1,EA,,126.65,126.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)",250,RC,70010-135-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metformin Hydrochloride: 100 Tablet In 1 Bottle (70010-064-01),250,RC,70010-064-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Olanzapine: 90 Tablet In 1 Bottle (69543-383-90),250,RC,69543-383-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Primidone: 100 Tablet In 1 Bottle, Plastic (69584-684-10)",250,RC,69584-684-10,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine Hcl 12.5 Mg: 100 Tablet In 1 Bottle, Plastic (69618-027-01)",250,RC,69618-027-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infants Gas Relief Drops: 1 Bottle, Dropper In 1 Carton (69618-059-51) / 30 Ml In 1 Bottle, Dropper",250,RC,69618-059-51,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 Tablet In 1 Bottle (69918-301-30),250,RC,69918-301-30,NDC,,,facility,both,1,EA,,4.98,4.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mesalamine Rectal: 30 Suppository In 1 Box (69918-560-30),250,RC,69918-560-30,NDC,,,facility,both,1,EA,,12,12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (70010-006-01)",250,RC,70010-006-01,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (70010-007-01)",250,RC,70010-007-01,NDC,,,facility,both,1,EA,,4.4,4.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metformin Hydrochloride: 100 Tablet In 1 Bottle (70010-063-01),250,RC,70010-063-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01) / 5 Ml In 1 Bottle,250,RC,70069-231-01,NDC,,,facility,both,1,EA,,11.42,11.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lithium Carbonate Er: 100 Tablet In 1 Bottle (68462-224-01),250,RC,68462-224-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-254-01)",250,RC,68462-254-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (68462-264-30)",250,RC,68462-264-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atomoxetine: 30 Capsule In 1 Bottle (68462-265-30),250,RC,68462-265-30,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-292-01)",250,RC,68462-292-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-293-01)",250,RC,68462-293-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-331-90),250,RC,68462-331-90,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Indomethacin: 100 Capsule In 1 Bottle (68462-406-01),250,RC,68462-406-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atovaquone: 210 Ml In 1 Bottle (68462-421-21),250,RC,68462-421-21,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atovaquone: 42 Pouch In 1 Carton (68462-421-69) / 5 Ml In 1 Pouch,250,RC,68462-421-69,NDC,,,facility,both,1,EA,,71.4,71.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sevelamer Hydrochloride: 360 Tablet, Film Coated In 1 Bottle (68462-446-26)",250,RC,68462-446-26,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tacrolimus: 1 Tube In 1 Carton (68462-534-35) / 30 G In 1 Tube,250,RC,68462-534-35,NDC,,,facility,both,1,EA,,212.5,212.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Norethindrone Acetate: 50 Tablet In 1 Bottle (68462-304-50),250,RC,68462-304-50,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mupirocin: 22 G In 1 Tube (68462-180-22),250,RC,68462-180-22,NDC,,,facility,both,1,EA,,16.34,16.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-092-01)",250,RC,68382-092-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (68382-121-16),250,RC,68382-121-16,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-398-01)",250,RC,68382-398-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (68382-537-01)",250,RC,68382-537-01,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (68382-538-01)",250,RC,68382-538-01,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68382-771-30,NDC,,,facility,both,1,EA,,9.14,9.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68382-772-30,NDC,,,facility,both,1,EA,,12.37,12.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 500 Tablet In 1 Bottle (68382-805-05),250,RC,68382-805-05,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle (68382-856-01),250,RC,68382-856-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zonisamide: 100 Capsule In 1 Bottle (68462-129-01),250,RC,68462-129-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68462-639-25,NDC,,,facility,both,1,EA,,4.88,4.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myambutol: 10 Blister Pack In 1 Box, Unit-Dose (68850-012-02) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,68850-012-02,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68968-3425-1,NDC,,,facility,both,1,EA,,19.15,19.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,68968-3437-1,NDC,,,facility,both,1,EA,,20.77,20.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin And Clavulanate Potassium: 100 Ml In 1 Bottle (69097-098-44),250,RC,69097-098-44,NDC,,,facility,both,1,EA,,13.42,13.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (69097-128-05),250,RC,69097-128-05,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pyridostigmine Bromide: 100 Tablet In 1 Bottle (68682-302-10),250,RC,68682-302-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tetracaine Hydrochloride: 1 Bottle In 1 Carton (68682-920-05) / 5 Ml In 1 Bottle,250,RC,68682-920-05,NDC,,,facility,both,1,EA,,68.26,68.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Exemestane: 30 Tablet In 1 Bottle (69097-316-02),250,RC,69097-316-02,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 VIAL in 1 CARTON (70860-105-20) / 20 mL in 1 VIAL (70860-105-41) ,250,RC,70860-105-20,NDC,,,facility,both,1,EA,,20.03,20.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tekturna: 30 Tablet, Film Coated In 1 Bottle (70839-150-30)",250,RC,70839-150-30,NDC,,,facility,both,1,EA,,27.86,27.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxybutynin Chloride: 100 Tablet In 1 Bottle (70954-005-10),250,RC,70954-005-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dapsone: 30 Tablet In 1 Bottle (70954-135-10),250,RC,70954-135-10,NDC,,,facility,both,1,EA,,1.98,1.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle (70954-212-10),250,RC,70954-212-10,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbamazepine: 1 Bottle In 1 Carton (70954-240-10) / 450 Ml In 1 Bottle,250,RC,70954-240-10,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Misoprostol: 100 Tablet In 1 Bottle (70954-444-20),250,RC,70954-444-20,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin: 230 Ml In 1 Bottle (70954-496-10),250,RC,70954-496-10,NDC,,,facility,both,1,EA,,150.36,150.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70756-611-82,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Indomethacin: 5 Blister Pack In 1 Carton (70710-1852-7) / 6 Suppository In 1 Blister Pack (70710-1852-6),250,RC,70710-1852-7,NDC,,,facility,both,1,EA,,480.39,480.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Varenicline: 56 Tablet, Film Coated In 1 Bottle (70748-128-49)",250,RC,70748-128-49,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (70748-258-07)",250,RC,70748-258-07,NDC,,,facility,both,1,EA,,15.19,15.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisolone Acetate: 1 Bottle In 1 Carton (70748-332-03) / 10 Ml In 1 Bottle,250,RC,70748-332-03,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-130-06)",250,RC,70748-130-06,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenobarbital: 60 Tablet In 1 Bottle (71205-890-60),250,RC,71205-890-60,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,71285-0422-1,NDC,,,facility,both,1,EA,,130.7,130.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,71285-6060-1,NDC,,,facility,both,1,EA,,61.52,61.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70710-1852-6,NDC,,,facility,both,1,EA,,513.96,513.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Norepinephrine Bitartrate: 10 Vial In 1 Carton (70121-1576-7) / 4 Ml In 1 Vial (70121-1576-1),250,RC,70121-1576-7,NDC,,,facility,both,1,EA,,10.95,10.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70121-1722-1,NDC,,,facility,both,1,EA,,86.65,86.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70127-100-01,NDC,,,facility,both,1,EA,,98.76,98.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Latanoprost: 1 Bottle In 1 Carton (70069-421-01) / 2.5 Ml In 1 Bottle,250,RC,70069-421-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride For Oral Solution: 1.58 G In 1 Pouch (70069-823-01),250,RC,70069-823-01,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70092-1202-75,NDC,,,facility,both,1,EA,,106.04,106.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70092-1433-50,NDC,,,facility,both,1,EA,,59.47,59.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70092-1612-43,NDC,,,facility,both,1,EA,,31.32,31.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70095-050-01,NDC,,,facility,both,1,EA,,28.96,28.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70100-424-01,NDC,,,facility,both,1,EA,,301.38,301.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Indocyanine Green: 6 Package In 1 Carton (70100-424-02) / 1 Kit In 1 Package * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial * 10 Ml In 1 Vial, Plastic (0409-4887-17)",250,RC,70100-424-02,NDC,,,facility,both,1,EA,,307.06,307.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70100-725-01,NDC,,,facility,both,1,EA,,542.22,542.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Loqtorzi: 1 Vial, Glass In 1 Carton (70114-340-01) / 6 Ml In 1 Vial, Glass",250,RC,70114-340-01,NDC,,,facility,both,1,EA,,35249.85,35249.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epidiolex: 1 Bottle, Glass In 1 Carton (70127-100-10) / 100 Ml In 1 Bottle, Glass (70127-100-01)",250,RC,70127-100-10,NDC,,,facility,both,1,EA,,98.76,98.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phytonadione: 1 Bottle In 1 Carton (70710-1014-1) / 100 Tablet In 1 Bottle,250,RC,70710-1014-1,NDC,,,facility,both,1,EA,,72.86,72.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle (70710-1110-1),250,RC,70710-1110-1,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirabegron: 30 Tablet, Extended Release In 1 Bottle (70710-1159-3)",250,RC,70710-1159-3,NDC,,,facility,both,1,EA,,22.67,22.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fosfomycin Tromethamine: 1 Powder In 1 Packet (70700-268-99),250,RC,70700-268-99,NDC,,,facility,both,1,EA,,194.41,194.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 1 Bottle In 1 Carton (70436-227-48) / 35 Ml In 1 Bottle,250,RC,70436-227-48,NDC,,,facility,both,1,EA,,3.05,3.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70594-112-01,NDC,,,facility,both,1,EA,,110.09,110.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Foster And Thrive Nasal: 1 Bottle, Spray In 1 Carton (70677-1037-1) / 30 Ml In 1 Bottle, Spray",250,RC,70677-1037-1,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Foster And Thrive Nasal: 1 Bottle, Spray In 1 Carton (70677-1037-1) / 30 Ml In 1 Bottle, Spray",250,RC,70677-1037-1,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1111-1)",250,RC,70677-1111-1,NDC,,,facility,both,1,EA,,4.67,4.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stay Awake: 2 Blister Pack In 1 Carton (70677-1126-1) / 8 Tablet In 1 Blister Pack,250,RC,70677-1126-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Foster And Thrive Earwax Removal Kit Ear Wax Drops: 1 Kit In 1 Kit (70677-1153-1) * 1 Bottle In 1 Box (70677-1154-1) / 15 Ml In 1 Bottle,250,RC,70677-1153-1,NDC,,,facility,both,1,EA,,7.13,7.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Foster And Thrive Earwax Removal Drops: 1 Bottle In 1 Box (70677-1154-1) / 15 Ml In 1 Bottle,250,RC,70677-1154-1,NDC,,,facility,both,1,EA,,5.49,5.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Foster And Thrive Regular Strength Stomach Relief 527: 236 Ml In 1 Bottle (70677-1191-1),250,RC,70677-1191-1,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Foster And Thrive Nicotine: 110 Blister Pack In 1 Carton (70677-1192-1) / 1 Gum, Chewing In 1 Blister Pack",250,RC,70677-1192-1,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrogen Peroxide: 473 Ml In 1 Bottle, Plastic (70677-1248-1)",250,RC,70677-1248-1,NDC,,,facility,both,1,EA,,19.87,19.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,70700-116-84,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle, Plastic (70377-006-12)",250,RC,70377-006-12,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05) / 5 Ml In 1 Vial, Single-Dose",250,RC,55150-162-05,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30) / 30 Ml In 1 Vial, Single-Dose",250,RC,55150-163-30,NDC,,,facility,both,1,EA,,3.46,3.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-164-02) / 2 Ml In 1 Vial, Single-Dose",250,RC,55150-164-02,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-165-05) / 5 Ml In 1 Vial, Single-Dose",250,RC,55150-165-05,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-01) / .5 Ml In 1 Vial, Single-Dose",250,RC,55150-173-01,NDC,,,facility,both,1,EA,,10.12,10.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-161-02) / 2 Ml In 1 Vial, Single-Dose",250,RC,55150-161-02,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Haloperidol: 120 Ml In 1 Bottle, Dropper (54838-501-40)",250,RC,54838-501-40,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hyosyne: 15 Ml In 1 Bottle, Plastic (54838-506-15)",250,RC,54838-506-15,NDC,,,facility,both,1,EA,,3.03,3.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxepin Hydrochloride: 120 Ml In 1 Bottle, Plastic (54838-512-40)",250,RC,54838-512-40,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tizanidine: 150 Tablet In 1 Bottle (55111-180-15),250,RC,55111-180-15,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ziprasidone: 60 Capsule In 1 Bottle (55111-257-60),250,RC,55111-257-60,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rivastigmine Tartrate: 60 Capsule In 1 Bottle (55111-353-60),250,RC,55111-353-60,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Montelukast Sodium: 90 Tablet, Coated In 1 Bottle (55111-725-90)",250,RC,55111-725-90,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Capsule, Delayed Release In 1 Bottle (55111-532-01)",250,RC,55111-532-01,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-05) / .5 Ml In 1 Vial, Single-Dose",250,RC,55150-173-05,NDC,,,facility,both,1,EA,,10.71,10.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tranexamic Acid: 10 Vial, Single-Dose In 1 Carton (55150-188-10) / 10 Ml In 1 Vial, Single-Dose",250,RC,55150-188-10,NDC,,,facility,both,1,EA,,6.49,6.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diclegis: 100 Tablet, Delayed Release In 1 Bottle (55494-100-10)",250,RC,55494-100-10,NDC,,,facility,both,1,EA,,5.86,5.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketamine Hydrochloride: 10 Vial, Multi-Dose In 1 Carton (55150-439-10) / 10 Ml In 1 Vial, Multi-Dose",250,RC,55150-439-10,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexmedetomidine: 25 Vial In 1 Carton (55150-209-02) / 2 Ml In 1 Vial,250,RC,55150-209-02,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polymyxin B: 10 Vial In 1 Carton (55150-234-10) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",250,RC,55150-234-10,NDC,,,facility,both,1,EA,,9.27,9.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pediatric Infuvite Multiple Vitamins: 10 Vial In 1 Carton (54643-9023-1) / 5 Ml In 1 Vial,250,RC,54643-9023-1,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,54643-5659-1,NDC,,,facility,both,1,EA,,19.81,19.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,54643-5657-1,NDC,,,facility,both,1,EA,,22.57,22.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Tube In 1 Carton (51672-1267-5) / 5 G In 1 Tube,250,RC,51672-1267-5,NDC,,,facility,both,1,EA,,166.43,166.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nystatin: 1 Tube In 1 Carton (51672-1289-1) / 15 G In 1 Tube,250,RC,51672-1289-1,NDC,,,facility,both,1,EA,,22.11,22.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mupirocin: 1 Tube In 1 Carton (51672-1312-0) / 22 G In 1 Tube,250,RC,51672-1312-0,NDC,,,facility,both,1,EA,,16.32,16.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Miconazole Nitrate: 1 Tube In 1 Carton (51672-2001-2) / 30 G In 1 Tube,250,RC,51672-2001-2,NDC,,,facility,both,1,EA,,6.72,6.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Miconazole Nitrate: 1 Tube, With Applicator In 1 Carton (51672-2035-6) / 45 G In 1 Tube, With Applicator",250,RC,51672-2035-6,NDC,,,facility,both,1,EA,,8.12,8.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Terbinafine Hydrochloride: 1 Tube In 1 Carton (51672-2080-1) / 15 G In 1 Tube,250,RC,51672-2080-1,NDC,,,facility,both,1,EA,,13.15,13.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Antabuse: 100 TABLET in 1 BOTTLE (51285-523-02) ,250,RC,51285-523-02,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triple Antibiotic: 1 Tube In 1 Carton (51672-2120-2) / 28.4 G In 1 Tube,250,RC,51672-2120-2,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clomipramine Hydrochloride: 30 Capsule In 1 Bottle (51672-4012-6),250,RC,51672-4012-6,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetazolamide: 100 Tablet In 1 Bottle (51672-4022-1),250,RC,51672-4022-1,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4037-1),250,RC,51672-4037-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4038-1),250,RC,51672-4038-1,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenytoin: 237 Ml In 1 Bottle (51672-4069-1),250,RC,51672-4069-1,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (51672-4111-1)",250,RC,51672-4111-1,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 1 Tube In 1 Carton (51672-4116-6) / 45 G In 1 Tube,250,RC,51672-4116-6,NDC,,,facility,both,1,EA,,96.63,96.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine: 1 Tube In 1 Carton (51672-3020-9) / 35.44 G In 1 Tube,250,RC,51672-3020-9,NDC,,,facility,both,1,EA,,22.98,22.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-994-01,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4245-1),250,RC,51672-4245-1,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51754-0103-1,NDC,,,facility,both,1,EA,,20.6,20.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51754-0204-1,NDC,,,facility,both,1,EA,,40.69,40.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isopropyl Alcohol: 473 Ml In 1 Bottle (53329-800-06),250,RC,53329-800-06,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle, Plastic (53489-145-01)",250,RC,53489-145-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 100 Tablet, Film Coated In 1 Bottle, Plastic (53489-329-01)",250,RC,53489-329-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Minoxidil: 100 Tablet In 1 Bottle (53489-386-01),250,RC,53489-386-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Spironolactone: 1000 Tablet In 1 Bottle (53746-511-10),250,RC,53746-511-10,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pentasa: 120 Capsule In 1 Bottle (54092-191-12),250,RC,54092-191-12,NDC,,,facility,both,1,EA,,16.17,16.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adderall Xr: 100 Capsule, Extended Release In 1 Bottle (54092-383-01)",250,RC,54092-383-01,NDC,,,facility,both,1,EA,,17.25,17.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,54288-105-02,NDC,,,facility,both,1,EA,,1886.91,1886.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Infuvite Adult: 1 Kit In 1 Carton (54643-5649-1) * 5 Ml In 1 Vial (54643-5657-1) * 5 Ml In 1 Vial (54643-5659-1),250,RC,54643-5649-1,NDC,,,facility,both,1,EA,,29.46,29.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Infuvite Adult: 1 Kit In 1 Carton (54643-5649-1) * 5 Ml In 1 Vial (54643-5657-1) * 5 Ml In 1 Vial (54643-5659-1),250,RC,54643-5649-1,NDC,,,facility,both,1,EA,,27.73,27.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,54643-5657-1,NDC,,,facility,both,1,EA,,23.94,23.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pure And Gentle: 1 Bottle In 1 Box (53329-013-11) / 133 Ml In 1 Bottle,250,RC,53329-013-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,53276-1010-09,NDC,,,facility,both,1,EA,,688.4,688.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aminocaproic Acid: 236.5 Ml In 1 Bottle, Plastic (52817-815-08)",250,RC,52817-815-08,NDC,,,facility,both,1,EA,,14.92,14.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Acetate: 25 Vial, Single-Dose In 1 Carton (51754-2001-4) / 20 Ml In 1 Vial, Single-Dose",250,RC,51754-2001-4,NDC,,,facility,both,1,EA,,12.61,12.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Akovaz: 25 Vial, Single-Dose In 1 Carton (51754-4200-4) / 1 Ml In 1 Vial, Single-Dose",250,RC,51754-4200-4,NDC,,,facility,both,1,EA,,29.56,29.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51754-5001-1,NDC,,,facility,both,1,EA,,15.02,15.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine Delayed-Release: 90 Capsule, Delayed Release Pellets In 1 Bottle (51991-746-90)",250,RC,51991-746-90,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-877-33)",250,RC,51991-877-33,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clobazam: 100 Tablet In 1 Bottle (51991-900-01),250,RC,51991-900-01,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tetracycline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (51991-907-01)",250,RC,51991-907-01,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dificid: 1 Bottle In 1 Carton (52015-080-01) / 20 Tablet, Film Coated In 1 Bottle",250,RC,52015-080-01,NDC,,,facility,both,1,EA,,324.59,324.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,52268-011-01,NDC,,,facility,both,1,EA,,148.04,148.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Suprep Bowel Prep: 2 Bottle, Plastic In 1 Carton (52268-012-01) / 177.4 Ml In 1 Bottle, Plastic",250,RC,52268-012-01,NDC,,,facility,both,1,EA,,148.86,148.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 60 mL in 1 BOTTLE (52380-1905-2) ,250,RC,52380-1905-2,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Baclofen: 100 Tablet In 1 Bottle (52817-319-10),250,RC,52817-319-10,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,54643-5659-1,NDC,,,facility,both,1,EA,,20.27,20.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (57237-058-60)",250,RC,57237-058-60,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefdinir: 60 Capsule In 1 Bottle (57237-099-60),250,RC,57237-099-60,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Modafinil: 90 Tablet In 1 Bottle (57237-154-90),250,RC,57237-154-90,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (57237-156-30)",250,RC,57237-156-30,NDC,,,facility,both,1,EA,,14.12,14.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "VERAPAMIL HYDROCHLORIDE: 100 TABLET, EXTENDED RELEASE in 1 BOTTLE (57664-118-88) ",250,RC,57664-118-88,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mirtazapine: 30 Tablet In 1 Bottle (57664-510-83),250,RC,57664-510-83,NDC,,,facility,both,1,EA,,5.61,5.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Galantamine: 60 Tablet, Film Coated In 1 Bottle (57237-049-60)",250,RC,57237-049-60,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (57237-047-01)",250,RC,57237-047-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,55566-2800-0,NDC,,,facility,both,1,EA,,1386.53,1386.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cervidil: 1 Pouch In 1 Carton (55566-2800-1) / 10 Mg In 1 Pouch (55566-2800-0),250,RC,55566-2800-1,NDC,,,facility,both,1,EA,,1380.01,1380.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (57237-008-30)",250,RC,57237-008-30,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (57237-041-01)",250,RC,57237-041-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (57237-042-90)",250,RC,57237-042-90,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 TABLET in 1 BOTTLE (57896-101-01) ,250,RC,57896-101-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 TABLET in 1 BOTTLE (57896-101-01) ,250,RC,57896-101-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 Tablet In 1 Bottle (57896-102-01),250,RC,57896-102-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 Tablet In 1 Bottle (57896-102-01),250,RC,57896-102-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Analgesic Balm: 1 Tube In 1 Box (57896-116-03) / 85 G In 1 Tube,250,RC,57896-116-03,NDC,,,facility,both,1,EA,,7.36,7.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stimulant Laxative Enteric Coated: 100 Tablet In 1 Bottle (57896-441-01),250,RC,57896-441-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA BISACODYL: 4 BLISTER PACK in 1 CARTON (57896-444-01) / 25 SUPPOSITORY in 1 BLISTER PACK,250,RC,57896-444-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gericare Senna Syrup: 237 Ml In 1 Bottle (57896-472-08),250,RC,57896-472-08,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aspirin: 100 Tablet In 1 Bottle (57896-901-01),250,RC,57896-901-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Regular Strength Enteric Coated Aspirin: 1000 Tablet, Coated In 1 Bottle (57896-921-10)",250,RC,57896-921-10,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-800-60)",250,RC,55513-800-60,NDC,,,facility,both,1,EA,,12.01,12.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ",250,RC,51079-991-20,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-991-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-105-11,NDC,,,facility,both,1,EA,,3.04,3.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-131-11,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-151-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-191-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-095-11,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Capsaicin External Analgesic: 1 Tube In 1 Carton (50268-195-60) / 60 G In 1 Tube,250,RC,50268-195-60,NDC,,,facility,both,1,EA,,8.77,8.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-278-11,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-299-11,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-299-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-362-11,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-405-11,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-277-11,NDC,,,facility,both,1,EA,,3.25,3.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-430-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-089-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-062-11,NDC,,,facility,both,1,EA,,1.87,1.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-069-11,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "30 BLISTER PACK in 1 BOX (50268-074-13) / 1 TABLET, FILM COATED in 1 BLISTER PACK (50268-074-11) ",250,RC,50268-074-13,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-075-11,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-087-11,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-088-11,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-431-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-604-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nortriptyline Hydrochloride: 50 Blister Pack In 1 Box, Unit-Dose (50268-604-15) / 1 Capsule In 1 Blister Pack (50268-604-11)",250,RC,50268-604-15,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-630-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Quetiapine Fumarate: 50 Blister Pack In 1 Box (50268-630-15) / 1 Tablet In 1 Blister Pack (50268-630-11),250,RC,50268-630-15,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-640-11,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-663-11,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-597-11,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Polyvinyl Alcohol: 15 Ml In 1 Bottle (50268-678-15),250,RC,50268-678-15,NDC,,,facility,both,1,EA,,20.99,20.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-709-11,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-710-11,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-728-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-665-11,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-594-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-476-11,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-504-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-505-11,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-522-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine Hydrochloride: 50 Blister Pack In 1 Box, Unit-Dose (50268-522-15) / 1 Tablet In 1 Blister Pack (50268-522-11)",250,RC,50268-522-15,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-525-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-526-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-541-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 50 Blister Pack In 1 Box, Unit-Dose (50268-541-15) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (50268-541-11)",250,RC,50268-541-15,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-576-11,NDC,,,facility,both,1,EA,,13.15,13.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-584-11,NDC,,,facility,both,1,EA,,3.55,3.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-585-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50242-901-18,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 Tablet In 1 Bottle (50111-561-01),250,RC,50111-561-01,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Torsemide: 100 Tablet In 1 Bottle (50111-915-01),250,RC,50111-915-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-192-60)",250,RC,50228-192-60,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ranolazine: 60 Tablet, Film Coated, Extended Release In 1 Package (50228-423-60)",250,RC,50228-423-60,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Tablet In 1 Bottle (50228-458-01),250,RC,50228-458-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Tablet In 1 Bottle (50228-459-01),250,RC,50228-459-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diltiazem Hydrochloride: 100 Tablet In 1 Bottle (50228-481-01),250,RC,50228-481-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sucralfate: 20 CUP in 1 BOX (50268-732-12) / 10 mL in 1 CUP (50268-732-11) ,250,RC,50268-732-12,NDC,,,facility,both,1,EA,,14,14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-745-11,NDC,,,facility,both,1,EA,,10.66,10.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-294-01,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-374-01,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-375-01,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temazepam: 100 BLISTER PACK in 1 CARTON (51079-418-20) / 1 CAPSULE in 1 BLISTER PACK (51079-418-01) ,250,RC,51079-418-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-434-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-436-01,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-437-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-440-01,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-453-01,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-455-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-499-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-574-01,NDC,,,facility,both,1,EA,,4.41,4.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-597-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-286-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-103-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-118-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-131-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-141-01,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-164-01,NDC,,,facility,both,1,EA,,13.02,13.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 100 Blister Pack In 1 Carton (51079-285-20) / 1 Tablet In 1 Blister Pack (51079-285-01),250,RC,51079-285-20,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-169-01,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-206-01,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-209-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-255-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-284-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-285-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-205-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-597-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-789-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-801-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-821-01,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clonazepam: 100 BLISTER PACK in 1 CARTON (51079-882-20) / 1 TABLET in 1 BLISTER PACK (51079-882-01) ,250,RC,51079-882-20,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-888-01,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-922-01,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol HCl: 100 BLISTER PACK in 1 CARTON (51079-928-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-928-01) ",250,RC,51079-928-20,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-930-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-943-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-943-01) ",250,RC,51079-943-20,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-978-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-985-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-986-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-921-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 BLISTER PACK in 1 CARTON (51079-776-20) / 1 CAPSULE in 1 BLISTER PACK (51079-776-01) ,250,RC,51079-776-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-759-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-608-01,NDC,,,facility,both,1,EA,,5.44,5.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-630-01,NDC,,,facility,both,1,EA,,3.16,3.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-632-01,NDC,,,facility,both,1,EA,,7.23,7.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-644-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-644-01) ",250,RC,51079-644-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-684-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-685-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-690-01,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-690-01,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-724-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-733-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-734-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-735-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine Hydrochloride: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (51079-090-20) / 1 TABLET in 1 BLISTER PACK (51079-090-01) ",250,RC,51079-090-20,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-086-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50458-578-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50458-579-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50458-580-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xarelto: 10 Blister Pack In 1 Carton (50458-580-10) / 10 Tablet, Film Coated In 1 Blister Pack (50458-580-01)",250,RC,50458-580-10,NDC,,,facility,both,1,EA,,15.75,15.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-754-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-755-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-756-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50268-757-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Urea: 28.35 G In 1 Tube (50268-872-28),250,RC,50268-872-28,NDC,,,facility,both,1,EA,,66.61,66.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50383-363-15,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 1 BOTTLE in 1 CARTON (50383-705-30) / 30 mL in 1 BOTTLE,250,RC,50383-705-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactulose: 473 mL in 1 BOTTLE (50383-795-16) ,250,RC,50383-795-16,NDC,,,facility,both,1,EA,,11.82,11.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adempas: 90 Tablet, Film Coated In 1 Bottle (50419-252-01)",250,RC,50419-252-01,NDC,,,facility,both,1,EA,,380.66,380.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dilantin: 100 Capsule, Extended Release In 1 Bottle, Plastic (58151-118-01)",250,RC,58151-118-01,NDC,,,facility,both,1,EA,,3.98,3.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Briviact: 100 Blister Pack In 1 Carton (50474-470-09) / 1 Tablet, Film Coated In 1 Blister Pack",250,RC,50474-470-09,NDC,,,facility,both,1,EA,,63.65,63.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 100 Tablet, Extended Release In 1 Bottle (50742-615-01)",250,RC,50742-615-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 1000 Tablet, Extended Release In 1 Bottle (50742-616-10)",250,RC,50742-616-10,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jakafi: 60 Tablet In 1 Bottle, Plastic (50881-005-60)",250,RC,50881-005-60,NDC,,,facility,both,1,EA,,803.02,803.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-023-01,NDC,,,facility,both,1,EA,,5.5,5.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-051-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-074-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-075-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-076-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-083-01,NDC,,,facility,both,1,EA,,2.75,2.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,51079-024-01,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Scopolamine: 24 Pouch In 1 Carton (50742-505-24) / 1 Patch, Extended Release In 1 Pouch",250,RC,50742-505-24,NDC,,,facility,both,1,EA,,13.29,13.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Keppra: 120 Tablet, Film Coated In 1 Bottle, Plastic (50474-595-40)",250,RC,50474-595-40,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Collagenase Santyl: 1 Tube In 1 Carton (50484-010-30) / 30 G In 1 Tube,250,RC,50484-010-30,NDC,,,facility,both,1,EA,,772.01,772.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imodium A-D: 120 Ml In 1 Bottle (50580-134-44),250,RC,50580-134-44,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tylenol Extra Strength: 10 Blister Pack In 1 Carton (50580-457-11) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,50580-457-11,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tylenol Regular Strength: 10 Blister Pack In 1 Carton (50580-458-11) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,50580-458-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desipramine Hydrochloride: 100 Tablet In 1 Bottle (50742-113-01),250,RC,50742-113-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 25 Tablet In 1 Bottle (50742-184-25),250,RC,50742-184-25,NDC,,,facility,both,1,EA,,5.33,5.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (50742-249-90)",250,RC,50742-249-90,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,50742-505-01,NDC,,,facility,both,1,EA,,23,23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Latanoprost: 1 Bottle In 1 Carton (61314-547-01) / 2.5 Ml In 1 Bottle,250,RC,61314-547-01,NDC,,,facility,both,1,EA,,25.93,25.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neomycin And Polymyxin B Sulfates And Dexamethasone: 3.5 G In 1 Tube (61314-631-36),250,RC,61314-631-36,NDC,,,facility,both,1,EA,,39.13,39.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisolone Acetate: 1 Bottle, Plastic In 1 Carton (61314-637-05) / 5 Ml In 1 Bottle, Plastic",250,RC,61314-637-05,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisolone Acetate: 1 Bottle, Plastic In 1 Carton (61314-637-05) / 5 Ml In 1 Bottle, Plastic",250,RC,61314-637-05,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neomycin And Polymyxin B Sulfates And Hydrocortisone: 7.5 Ml In 1 Bottle, Plastic (61314-641-75)",250,RC,61314-641-75,NDC,,,facility,both,1,EA,,362.31,362.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tobramycin And Dexamethasone: 1 Bottle In 1 Carton (61314-647-25) / 2.5 Ml In 1 Bottle,250,RC,61314-647-25,NDC,,,facility,both,1,EA,,76.76,76.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-656-05) / 5 Ml In 1 Bottle, Plastic",250,RC,61314-656-05,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-656-25) / 2.5 Ml In 1 Bottle, Plastic",250,RC,61314-656-25,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Famotidine: 24 Bottle In 1 Box (61442-121-01) / 100 Tablet In 1 Bottle,250,RC,61442-121-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neomycin And Polymyxin B Sulfates And Dexamethasone: 5 Ml In 1 Bottle, Plastic (61314-630-06)",250,RC,61314-630-06,NDC,,,facility,both,1,EA,,30.02,30.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (62175-310-37)",250,RC,62175-310-37,NDC,,,facility,both,1,EA,,7.98,7.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,62327-222-02,NDC,,,facility,both,1,EA,,136.5,136.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leflunomide: 30 Tablet In 1 Bottle (62332-061-30),250,RC,62332-061-30,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (62332-119-90),250,RC,62332-119-90,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (62332-122-90),250,RC,62332-122-90,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine And Prilocaine: 1 Tube In 1 Carton (62332-582-04) / 5 G In 1 Tube,250,RC,62332-582-04,NDC,,,facility,both,1,EA,,20.64,20.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Guanfacine: 100 Tablet, Extended Release In 1 Bottle (62332-745-31)",250,RC,62332-745-31,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pancreaze: 1 Bottle, Glass In 1 Carton (62541-402-10) / 100 Capsule, Delayed Release In 1 Bottle, Glass",250,RC,62541-402-10,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Opium Tincture Deodorized: 118 Ml In 1 Bottle (62559-153-04),250,RC,62559-153-04,NDC,,,facility,both,1,EA,,5.25,5.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoclopramide: 473 Ml In 1 Bottle, Plastic (62559-190-16)",250,RC,62559-190-16,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 Tablet In 1 Bottle (62559-265-30),250,RC,62559-265-30,NDC,,,facility,both,1,EA,,6.6,6.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine And Prilocaine: 1 Tube In 1 Carton (62332-582-04) / 5 G In 1 Tube,250,RC,62332-582-04,NDC,,,facility,both,1,EA,,21.99,21.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ethambutol Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (61748-011-01) ",250,RC,61748-011-01,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vraylar: 30 Capsule, Gelatin Coated In 1 Bottle (61874-115-30)",250,RC,61874-115-30,NDC,,,facility,both,1,EA,,129.5,129.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,61874-130-11,NDC,,,facility,both,1,EA,,127.7,127.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truvada: 30 Tablet, Film Coated In 1 Bottle, Plastic (61958-0701-1)",250,RC,61958-0701-1,NDC,,,facility,both,1,EA,,151.91,151.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Stribild: 30 Tablet, Film Coated In 1 Bottle, Plastic (61958-1201-1)",250,RC,61958-1201-1,NDC,,,facility,both,1,EA,,392.53,392.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tybost: 30 Tablet, Film Coated In 1 Bottle (61958-1401-1)",250,RC,61958-1401-1,NDC,,,facility,both,1,EA,,23.98,23.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Genvoya: 30 Tablet In 1 Bottle, Plastic (61958-1901-1)",250,RC,61958-1901-1,NDC,,,facility,both,1,EA,,360.54,360.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Descovy: 30 Tablet In 1 Bottle, Plastic (61958-2002-1)",250,RC,61958-2002-1,NDC,,,facility,both,1,EA,,184.56,184.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vemlidy: 30 Tablet In 1 Bottle, Plastic (61958-2301-1)",250,RC,61958-2301-1,NDC,,,facility,both,1,EA,,116.32,116.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Biktarvy: 30 Tablet In 1 Bottle, Plastic (61958-2501-1)",250,RC,61958-2501-1,NDC,,,facility,both,1,EA,,355.32,355.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-701-11,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-709-11,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-711-11,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-717-11,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-720-11,NDC,,,facility,both,1,EA,,11.95,11.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-721-11,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-723-11,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-725-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-728-11,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-730-11,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-733-11,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-690-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-683-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-634-11,NDC,,,facility,both,1,EA,,2.92,2.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-638-11,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-640-11,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-657-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-661-11,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-669-11,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-675-11,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-676-11,NDC,,,facility,both,1,EA,,4.76,4.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-680-11,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Folic Acid: 100 Blister Pack In 1 Carton (60687-681-01) / 1 Tablet In 1 Blister Pack (60687-681-11),250,RC,60687-681-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-681-11,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-736-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorometholone: 1 Bottle, Dropper In 1 Carton (60758-880-05) / 5 Ml In 1 Bottle, Dropper",250,RC,60758-880-05,NDC,,,facility,both,1,EA,,196.08,196.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cytomel: 100 Tablet In 1 Bottle (60793-115-01),250,RC,60793-115-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triple Antibiotic: 1 TUBE in 1 CARTON (61269-179-34) / 14 g in 1 TUBE,250,RC,61269-179-34,NDC,,,facility,both,1,EA,,5.22,5.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Miconazole Nitrate: 1 Tube In 1 Carton (61269-735-56) / 28 G In 1 Tube,250,RC,61269-735-56,NDC,,,facility,both,1,EA,,4.64,4.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Miconazole 7: 7 Suppository In 1 Box (61269-736-07),250,RC,61269-736-07,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Docosanol: 2 G In 1 Tube (61269-881-35),250,RC,61269-881-35,NDC,,,facility,both,1,EA,,28.45,28.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Docosanol: 1 Tube In 1 Package (61269-981-35) / 2 G In 1 Tube,250,RC,61269-981-35,NDC,,,facility,both,1,EA,,29.5,29.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisolone Acetate: 1 Bottle, Dropper In 1 Carton (60758-119-10) / 10 Ml In 1 Bottle, Dropper",250,RC,60758-119-10,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Proparacaine Hydrochloride: 1 Bottle In 1 Carton (61314-016-01) / 15 Ml In 1 Bottle,250,RC,61314-016-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (61314-203-15) / 15 Ml In 1 Bottle,250,RC,61314-203-15,NDC,,,facility,both,1,EA,,162.74,162.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Timolol Maleate: 5 Ml In 1 Bottle, Plastic (61314-226-05)",250,RC,61314-226-05,NDC,,,facility,both,1,EA,,6.43,6.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Timolol Maleate: 5 Ml In 1 Bottle, Plastic (61314-227-05)",250,RC,61314-227-05,NDC,,,facility,both,1,EA,,12.22,12.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Timolol Maleate: 15 Ml In 1 Bottle, Plastic (61314-227-15)",250,RC,61314-227-15,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Betaxolol Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-245-01) / 5 Ml In 1 Bottle, Plastic",250,RC,61314-245-01,NDC,,,facility,both,1,EA,,115.75,115.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ketorolac Tromethamine: 1 Bottle In 1 Carton (61314-126-05) / 5 Ml In 1 Bottle,250,RC,61314-126-05,NDC,,,facility,both,1,EA,,29.37,29.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisolone Acetate: 1 Bottle, Dropper In 1 Carton (60758-119-10) / 10 Ml In 1 Bottle, Dropper",250,RC,60758-119-10,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-882-11,NDC,,,facility,both,1,EA,,9.92,9.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-742-11,NDC,,,facility,both,1,EA,,3.46,3.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-745-11,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-746-11,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-760-40,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-782-11,NDC,,,facility,both,1,EA,,4.77,4.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-788-11,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-795-11,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-795-11,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-807-11,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-822-11,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-833-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-836-11,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-633-11,NDC,,,facility,both,1,EA,,7.26,7.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (62559-390-50),250,RC,62559-390-50,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (62559-821-01),250,RC,62559-821-01,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-185-07,NDC,,,facility,both,1,EA,,12.21,12.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-186-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-186-01,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-187-30) / 30 Ml In 1 Vial, Single-Dose",250,RC,63323-187-30,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-185-07,NDC,,,facility,both,1,EA,,10.96,10.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-130-02,NDC,,,facility,both,1,EA,,48.86,48.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-285-51,NDC,,,facility,both,1,EA,,105,105,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan Succinate: 1 Vial, Single-Dose In 1 Carton (63323-273-01) / .5 Ml In 1 Vial, Single-Dose",250,RC,63323-273-01,NDC,,,facility,both,1,EA,,15.86,15.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 Vial In 1 Tray (63323-284-26) / 20 Ml In 1 Vial (63323-284-42),250,RC,63323-284-26,NDC,,,facility,both,1,EA,,11.59,11.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nuplazid: 30 Capsule In 1 Bottle, Plastic (63090-340-30)",250,RC,63090-340-30,NDC,,,facility,both,1,EA,,337.23,337.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (63304-451-01)",250,RC,63304-451-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,62584-266-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,62584-267-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,62584-339-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,62584-733-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,62584-734-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-796-88)",250,RC,62756-796-88,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-798-88)",250,RC,62756-798-88,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-797-88)",250,RC,62756-797-88,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-113-01,NDC,,,facility,both,1,EA,,100.06,100.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-089-25,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Bicarbonate: 25 Vial, Single-Dose In 1 Tray (63323-089-50) / 50 Ml In 1 Vial, Single-Dose (63323-089-25)",250,RC,63323-089-50,NDC,,,facility,both,1,EA,,72.08,72.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,63323-093-01,NDC,,,facility,both,1,EA,,9.1,9.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin (Monohydrate/Macrocrystals): 100 Blister Pack In 1 Carton (60687-633-01) / 1 Capsule In 1 Blister Pack (60687-633-11),250,RC,60687-633-01,NDC,,,facility,both,1,EA,,7.84,7.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA OXYBUTYNIN CHLORIDE: 473 mL in 1 BOTTLE (60432-092-16) ,250,RC,60432-092-16,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0165-1),250,RC,60505-0165-1,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desmopressin Acetate: 100 Tablet In 1 Bottle (60505-0258-1),250,RC,60505-0258-1,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olopatadine Hydrochloride: 1 BOTTLE, PLASTIC in 1 CARTON (60505-0575-1) / 5 mL in 1 BOTTLE, PLASTIC",250,RC,60505-0575-1,NDC,,,facility,both,1,EA,,96,96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brimonidine Tartrate: 1 Bottle, Dropper In 1 Carton (60505-0577-3) / 15 Ml In 1 Bottle, Dropper",250,RC,60505-0577-3,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desmopressin Acetate: 1 Bottle, Spray In 1 Carton (60505-0815-0) / 50 Spray In 1 Bottle, Spray",250,RC,60505-0815-0,NDC,,,facility,both,1,EA,,238.33,238.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 75 Ml In 1 Bottle, Plastic (60432-065-75)",250,RC,60432-065-75,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluticasone Propionate: 1 Bottle, Spray In 1 Carton (60505-0829-1) / 120 Spray, Metered In 1 Bottle, Spray",250,RC,60505-0829-1,NDC,,,facility,both,1,EA,,44.46,44.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (60505-0833-5) / 200 Spray, Metered In 1 Bottle, Spray",250,RC,60505-0833-5,NDC,,,facility,both,1,EA,,39.4,39.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (60505-2805-7)",250,RC,60505-2805-7,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3110-0) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,60505-3110-0,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3111-0) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,60505-3111-0,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3113-0) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,60505-3113-0,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcitonin Salmon: 1 Bottle, Glass In 1 Carton (60505-0823-6) / 30 Spray, Metered In 1 Bottle, Glass",250,RC,60505-0823-6,NDC,,,facility,both,1,EA,,144.84,144.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Thiosulfate: 50 Ml In 1 Vial, Single-Dose (60267-705-50)",250,RC,60267-705-50,NDC,,,facility,both,1,EA,,296.34,296.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sulfasalazine: 1 Bottle In 1 Carton (59762-0104-5) / 100 Tablet, Delayed Release In 1 Bottle",250,RC,59762-0104-5,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (59762-0117-1)",250,RC,59762-0117-1,NDC,,,facility,both,1,EA,,3.57,3.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Donepezil Hydrochloride: 10 BLISTER PACK in 1 CARTON (59762-0245-3) / 10 TABLET, FILM COATED in 1 BLISTER PACK",250,RC,59762-0245-3,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Latanoprost: 1 Bottle, Dropper In 1 Carton (59762-0333-2) / 2.5 Ml In 1 Bottle, Dropper",250,RC,59762-0333-2,NDC,,,facility,both,1,EA,,5.13,5.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rifabutin: 100 Capsule In 1 Bottle (59762-1350-1),250,RC,59762-1350-1,NDC,,,facility,both,1,EA,,33.88,33.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atropine: 1 Bottle, Dropper In 1 Carton (60219-1748-2) / 2 Ml In 1 Bottle, Dropper",250,RC,60219-1748-2,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (59762-3720-1),250,RC,59762-3720-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (59762-3720-1),250,RC,59762-3720-1,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (59762-3721-1),250,RC,59762-3721-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfasalazine: 1 Bottle In 1 Carton (59762-5000-5) / 100 Tablet In 1 Bottle,250,RC,59762-5000-5,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Misoprostol: 120 Tablet In 1 Bottle (59762-5007-2),250,RC,59762-5007-2,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Misoprostol: 100 Tablet In 1 Bottle (59762-5008-2),250,RC,59762-5008-2,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (60219-1266-1) / 10 Capsule In 1 Blister Pack,250,RC,60219-1266-1,NDC,,,facility,both,1,EA,,20.99,20.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3275-0) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,60505-3275-0,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 30 Tablet, Orally Disintegrating In 1 Bottle (60505-3275-3)",250,RC,60505-3275-3,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60505-7010-0,NDC,,,facility,both,1,EA,,41.7,41.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60505-7061-0,NDC,,,facility,both,1,EA,,4.73,4.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60505-7063-0,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-100-11,NDC,,,facility,both,1,EA,,7.61,7.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-112-11,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-113-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-121-95,NDC,,,facility,both,1,EA,,4.36,4.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Selegiline Hydrochloride: 60 Tablet In 1 Bottle (60505-3438-3),250,RC,60505-3438-3,NDC,,,facility,both,1,EA,,2.69,2.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 TABLET in 1 BOTTLE (60505-3638-3) ,250,RC,60505-3638-3,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 100 Tablet In 1 Bottle (59762-0075-1),250,RC,59762-0075-1,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,58980-415-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stratuscare Bisacodyl: 1 Blister Pack In 1 Box (58980-415-50) / 50 Suppository In 1 Blister Pack,250,RC,58980-415-50,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycontin: 2 Blister Pack In 1 Carton (59011-410-20) / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,59011-410-20,NDC,,,facility,both,1,EA,,12.59,12.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycontin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (59011-420-10)",250,RC,59011-420-10,NDC,,,facility,both,1,EA,,23.07,23.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycontin: 2 Blister Pack In 1 Carton (59011-420-20) / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,59011-420-20,NDC,,,facility,both,1,EA,,23.86,23.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycontin: 2 Blister Pack In 1 Carton (59011-440-20) / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",250,RC,59011-440-20,NDC,,,facility,both,1,EA,,37.28,37.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rexulti: 1 Bottle In 1 Carton (59148-036-13) / 30 Tablet In 1 Bottle,250,RC,59148-036-13,NDC,,,facility,both,1,EA,,117.61,117.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rexulti: 1 Bottle In 1 Carton (59148-037-13) / 30 Tablet In 1 Bottle,250,RC,59148-037-13,NDC,,,facility,both,1,EA,,129.92,129.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rexulti: 1 Bottle In 1 Carton (59148-039-13) / 30 Tablet In 1 Bottle,250,RC,59148-039-13,NDC,,,facility,both,1,EA,,122.3,122.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Qvar Redihaler: 1 Inhaler In 1 Carton (59310-302-40) / 1 Canister In 1 Inhaler / 120 Aerosol, Metered In 1 Canister",250,RC,59310-302-40,NDC,,,facility,both,1,EA,,536.64,536.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Qvar Redihaler: 1 Inhaler In 1 Carton (59310-304-80) / 1 Canister In 1 Inhaler / 120 Aerosol, Metered In 1 Canister",250,RC,59310-304-80,NDC,,,facility,both,1,EA,,720.53,720.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyvanse: 100 Capsule In 1 Bottle (59417-101-10),250,RC,59417-101-10,NDC,,,facility,both,1,EA,,31.7,31.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Samsca: 1 Blister Pack In 1 Carton (59148-020-50) / 10 Tablet In 1 Blister Pack,250,RC,59148-020-50,NDC,,,facility,both,1,EA,,472.68,472.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stratuscare Adult Glycerin: 12 Suppository In 1 Jar (58980-410-12),250,RC,58980-410-12,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,58914-501-01,NDC,,,facility,both,1,EA,,93.74,93.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stratuscare Glycerin Laxative Pediatric: 12 Suppository In 1 Jar (58980-409-12),250,RC,58980-409-12,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desitin Maximum Strength: 1 TUBE in 1 CARTON (58232-0721-3) / 56 g in 1 TUBE,250,RC,58232-0721-3,NDC,,,facility,both,1,EA,,11.43,11.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olopatadine Hydrochloride: 1 Bottle, Plastic In 1 Carton (58602-006-40) / 5 Ml In 1 Bottle, Plastic",250,RC,58602-006-40,NDC,,,facility,both,1,EA,,19.46,19.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diclofenac Sodium: 1 Tube In 1 Carton (58602-604-07) / 100 G In 1 Tube,250,RC,58602-604-07,NDC,,,facility,both,1,EA,,20.06,20.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 1 Blister Pack In 1 Carton (58602-702-83) / 10 Tablet In 1 Blister Pack,250,RC,58602-702-83,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Guaifenesin: 473 Ml In 1 Bottle (58657-509-16),250,RC,58657-509-16,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Tablet, Coated In 1 Bottle (58657-675-01)",250,RC,58657-675-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyvanse: 100 Capsule In 1 Bottle (59417-103-10),250,RC,59417-103-10,NDC,,,facility,both,1,EA,,31.55,31.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Idhifa: 30 Tablet, Film Coated In 1 Bottle (59572-710-30)",250,RC,59572-710-30,NDC,,,facility,both,1,EA,,2486.98,2486.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Exemestane: 30 Tablet, Film Coated In 1 Bottle (59651-516-30)",250,RC,59651-516-30,NDC,,,facility,both,1,EA,,3.44,3.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Edurant: 30 Tablet, Film Coated In 1 Bottle (59676-278-01)",250,RC,59676-278-01,NDC,,,facility,both,1,EA,,124.95,124.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prezista: 60 Tablet, Film Coated In 1 Bottle, Plastic (59676-562-01)",250,RC,59676-562-01,NDC,,,facility,both,1,EA,,93.94,93.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Intelence: 120 Tablet In 1 Bottle, Plastic (59676-570-01)",250,RC,59676-570-01,NDC,,,facility,both,1,EA,,33.23,33.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-457-01),250,RC,59651-457-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 3 Blister Pack In 1 Carton (59746-010-32) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,59746-010-32,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 7 Blister Pack In 1 Carton (59746-020-22) / 4 Tablet, Orally Disintegrating In 1 Blister Pack",250,RC,59746-020-22,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 100 Tablet, Film Coated In 1 Bottle (59746-216-01)",250,RC,59746-216-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prezcobix: 30 Tablet, Film Coated In 1 Bottle (59676-575-30)",250,RC,59676-575-30,NDC,,,facility,both,1,EA,,206.65,206.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Colchicine: 100 Tablet In 1 Bottle (59651-455-01),250,RC,59651-455-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tamoxifen Citrate: 60 Tablet, Film Coated In 1 Bottle (59651-299-60)",250,RC,59651-299-60,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Candin: 1 Ml In 1 Vial, Multi-Dose (59584-138-01)",250,RC,59584-138-01,NDC,,,facility,both,1,EA,,82.16,82.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin And Clavulanate Potassium: 100 Ml In 1 Bottle (59651-026-01),250,RC,59651-026-01,NDC,,,facility,both,1,EA,,13.21,13.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 100 Tablet In 1 Bottle (59762-0074-1),250,RC,59762-0074-1,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-124-11,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-484-01) / 1 Capsule In 1 Blister Pack (60687-484-11)",250,RC,60687-484-01,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-484-11,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-496-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-506-11,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-507-11,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-518-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-526-11,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-544-11,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-550-11,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-513-11,NDC,,,facility,both,1,EA,,3.28,3.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-468-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ibuprofen: 100 Blister Pack In 1 Box, Unit-Dose (60687-468-01) / 1 Tablet In 1 Blister Pack (60687-468-11)",250,RC,60687-468-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Blister Pack In 1 Carton (60687-436-01) / 1 Capsule In 1 Blister Pack (60687-436-11),250,RC,60687-436-01,NDC,,,facility,both,1,EA,,4.5,4.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-436-11,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-437-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-439-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-443-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-444-11,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-446-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-447-11,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-450-01) / 1 Tablet, Film Coated In 1 Blister Pack (60687-450-11)",250,RC,60687-450-01,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-450-11,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-451-11,NDC,,,facility,both,1,EA,,7.15,7.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-457-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-555-11,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methocarbamol: 100 Blister Pack In 1 Box, Unit-Dose (60687-559-01) / 1 Tablet In 1 Blister Pack (60687-559-11)",250,RC,60687-559-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-593-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-595-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-595-11,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-598-11,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-602-11,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-607-11,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-609-11,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-612-11,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-618-11,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-627-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-628-44,NDC,,,facility,both,1,EA,,15.4,15.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-631-01) / 1 Tablet In 1 Blister Pack (60687-631-11)",250,RC,60687-631-01,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-591-11,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-587-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-559-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-566-40,NDC,,,facility,both,1,EA,,11.32,11.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-568-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-570-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-578-11,NDC,,,facility,both,1,EA,,9.97,9.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-579-11,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Blister Pack In 1 Box, Unit-Dose (60687-580-01) / 1 Capsule In 1 Blister Pack (60687-580-11)",250,RC,60687-580-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-580-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-581-11,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-584-11,NDC,,,facility,both,1,EA,,7.22,7.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-585-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-586-11,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-433-11,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-423-11,NDC,,,facility,both,1,EA,,6.24,6.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-195-11,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-202-11,NDC,,,facility,both,1,EA,,25.11,25.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-206-11,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 100 Blister Pack In 1 Box, Unit-Dose (60687-210-01) / 1 Tablet, Film Coated In 1 Blister Pack (60687-210-11)",250,RC,60687-210-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-210-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-192-11,NDC,,,facility,both,1,EA,,9.1,9.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-215-11,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-217-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-227-11,NDC,,,facility,both,1,EA,,17.97,17.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-228-11,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-229-11,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-230-11,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-211-11,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aripiprazole: 30 Blister Pack In 1 Box, Unit-Dose (60687-191-21) / 1 Tablet In 1 Blister Pack (60687-191-11)",250,RC,60687-191-21,NDC,,,facility,both,1,EA,,26.88,26.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-143-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-152-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-155-11,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-157-11,NDC,,,facility,both,1,EA,,16.07,16.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Haloperidol: 100 Blister Pack In 1 Box, Unit-Dose (60687-161-01) / 1 Tablet In 1 Blister Pack (60687-161-11)",250,RC,60687-161-01,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-161-11,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-163-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-169-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-173-11,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-178-11,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-190-11,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-191-11,NDC,,,facility,both,1,EA,,19.84,19.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-231-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-327-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-340-11,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-345-11,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Benztropine Mesylate: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-356-01) / 1 TABLET in 1 BLISTER PACK (60687-356-11) ",250,RC,60687-356-01,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-369-11,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-373-11,NDC,,,facility,both,1,EA,,18.81,18.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-325-11,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-398-11,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-404-11,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midodrine Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (60687-409-25) / 1 Tablet In 1 Blister Pack (60687-409-95)",250,RC,60687-409-25,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-409-95,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-377-11,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-319-11,NDC,,,facility,both,1,EA,,12.91,12.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-317-95,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-242-11,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-245-11,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-249-40,NDC,,,facility,both,1,EA,,9.87,9.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 5 Tray In 1 Case (60687-249-67) / 10 Cup, Unit-Dose In 1 Tray (60687-249-46) / 5 Ml In 1 Cup, Unit-Dose (60687-249-40)",250,RC,60687-249-67,NDC,,,facility,both,1,EA,,10.21,10.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-253-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-256-01) / 1 Tablet, Film Coated In 1 Blister Pack (60687-256-11)",250,RC,60687-256-01,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-256-11,NDC,,,facility,both,1,EA,,2.78,2.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefuroxime Axetil: 20 Blister Pack In 1 Box, Unit-Dose (60687-272-94) / 1 Tablet, Film Coated In 1 Blister Pack (60687-272-11)",250,RC,60687-272-94,NDC,,,facility,both,1,EA,,7.24,7.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-281-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Donepezil: 100 Blister Pack In 1 Box, Unit-Dose (60687-292-01) / 1 Tablet In 1 Blister Pack (60687-292-11)",250,RC,60687-292-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-292-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-303-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,60687-234-11,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068109800,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068105700,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068104100,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068102500,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068102000,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068101000,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7985410005,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7811273623,NDC,,,facility,both,1,EA,,10.14,10.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7733398325,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7733395125,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068113801,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8290306547,NDC,,,facility,both,1,EA,,12.65,12.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8290306546,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8290306544,NDC,,,facility,both,1,EA,,16.81,16.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068116900,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068114000,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8068109900,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7733394810,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7733394025,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6373612301,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6373612002,NDC,,,facility,both,1,EA,,18.74,18.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6373603751,NDC,,,facility,both,1,EA,,11.24,11.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6332325410,NDC,,,facility,both,1,EA,,53.82,53.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6498033901,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6498033990,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7733383110,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7620430003,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7583416724,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7583401060,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7431202832,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7430000071,NDC,,,facility,both,1,EA,,11.65,11.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7430000070,NDC,,,facility,both,1,EA,,7.81,7.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7214045231,NDC,,,facility,both,1,EA,,13.06,13.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,7214000021,NDC,,,facility,both,1,EA,,29.8,29.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6817600015,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6817600011,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8290306553,NDC,,,facility,both,1,EA,,18.03,18.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,8765176030,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reyataz: 30 Capsule, Gelatin Coated In 1 Bottle, Plastic (0003-3622-12)",250,RC,0003-3622-12,NDC,,,facility,both,1,EA,,116.95,116.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cymbalta: 30 Capsule, Delayed Release In 1 Bottle (0002-3240-30)",250,RC,0002-3240-30,NDC,,,facility,both,1,EA,,22.64,22.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0002-1495-01,NDC,,,facility,both,1,EA,,718.59,718.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,9697400005,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17) / 3 Ml In 1 Vial, Multi-Dose",250,RC,0002-8215-17,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin N: 1 Vial, Multi-Dose In 1 Carton (0002-8315-01) / 10 Ml In 1 Vial, Multi-Dose",250,RC,0002-8315-01,NDC,,,facility,both,1,EA,,52,52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 60 Tablet, Film Coated In 1 Bottle, Plastic (0003-0894-21)",250,RC,0003-0894-21,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 10 Blister Pack In 1 Carton (0003-0893-31) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0003-0893-31,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 60 Tablet, Film Coated In 1 Bottle, Plastic (0003-0893-21)",250,RC,0003-0893-21,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sprycel: 1 Bottle In 1 Carton (0003-0528-11) / 60 Tablet In 1 Bottle,250,RC,0003-0528-11,NDC,,,facility,both,1,EA,,898.51,898.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31) / 10 Tablet, Film Coated In 1 Blister Pack",250,RC,0003-0894-31,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Humulin N: 5 Syringe In 1 Carton (0002-8805-59) / 3 Ml In 1 Syringe (0002-8805-01),250,RC,0002-8805-59,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0002-8805-01,NDC,,,facility,both,1,EA,,35.64,35.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0002-8803-01,NDC,,,facility,both,1,EA,,35.26,35.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6253000011,NDC,,,facility,both,1,EA,,10.23,10.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6025816001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904598426,NDC,,,facility,both,1,EA,,7.99,7.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904582360,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904530016,NDC,,,facility,both,1,EA,,7.64,7.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904522452,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904506260,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904227260,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904208560,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904188260,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904113213,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904053061,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904719106,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904723961,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1284313105,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1184505651,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1093995734,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1093976144,NDC,,,facility,both,1,EA,,16.11,16.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1093913944,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904052361,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1000670028,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904775127,NDC,,,facility,both,1,EA,,8.68,8.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904759161,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,904759160,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1785600102,NDC,,,facility,both,1,EA,,3.98,3.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,574031116,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,574030216,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,149003908,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,149003904,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,132030140,NDC,,,facility,both,1,EA,,4.4,4.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,121119030,NDC,,,facility,both,1,EA,,12.56,12.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,121067716,NDC,,,facility,both,1,EA,,2.51,2.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,121059515,NDC,,,facility,both,1,EA,,11.05,11.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,121053005,NDC,,,facility,both,1,EA,,5.15,5.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,87074002,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,87040501,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,87040203,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,225052547,NDC,,,facility,both,1,EA,,7.46,7.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,281020536,NDC,,,facility,both,1,EA,,1.33,1.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,378699789,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,573475652,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,573287194,NDC,,,facility,both,1,EA,,32.02,32.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,573286898,NDC,,,facility,both,1,EA,,32.64,32.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,573051330,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,538800924,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,574030316,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,536440801,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,536143607,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,536141501,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,487900330,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,486112501,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,536730001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2055500100,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5093009802,NDC,,,facility,both,1,EA,,14.29,14.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026886311,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026886011,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026885911,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026885411,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026885311,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026885211,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026885111,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026852411,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5155200556,NDC,,,facility,both,1,EA,,3.03,3.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5164576099,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5475800628,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5483801150,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6025800615,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,6025800601,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5865731216,NDC,,,facility,both,1,EA,,5.39,5.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5865717001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026837511,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5848700672,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5789686406,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5789675201,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5789645101,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5618412041,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5789687503,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,1990301021,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026834611,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,3700074108,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,3660219209,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2113076062,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2055503601,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2055503600,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2055503300,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2055502700,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2055502500,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,2055501900,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,3786486001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,3786486001,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,3848514001,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026818330,NDC,,,facility,both,1,EA,,3.27,3.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5026818311,NDC,,,facility,both,1,EA,,7.33,7.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,5019014263,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4898500153,NDC,,,facility,both,1,EA,,3.25,3.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4601701840,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4601701816,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4110081163,NDC,,,facility,both,1,EA,,5.5,5.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4110081125,NDC,,,facility,both,1,EA,,7.85,7.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4110081124,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4110081123,NDC,,,facility,both,1,EA,,13.39,13.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,3932806412,NDC,,,facility,both,1,EA,,34.73,34.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,4138800730,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glucotrol: 100 TABLET in 1 BOTTLE (0049-4110-66) ,250,RC,0049-4110-66,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diflucan: 30 Tablet In 1 Bottle (0049-3420-30),250,RC,0049-3420-30,NDC,,,facility,both,1,EA,,19.51,19.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vfend: 30 Tablet, Film Coated In 1 Bottle (0049-3170-30)",250,RC,0049-3170-30,NDC,,,facility,both,1,EA,,37.1,37.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0010-25),250,RC,0054-0010-25,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0011-25),250,RC,0054-0011-25,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0244-24) / 10 Tablet In 1 Blister Pack,250,RC,0054-0244-24,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0243-24) / 10 Tablet In 1 Blister Pack,250,RC,0054-0243-24,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Morphine Sulfate: 500 Ml In 1 Bottle (0054-0237-63),250,RC,0054-0237-63,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Morphine Sulfate: 100 Tablet In 1 Bottle (0054-0235-25),250,RC,0054-0235-25,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Morphine Sulfate: 100 Blister Pack In 1 Carton (0054-0235-24) / 1 Tablet In 1 Blister Pack,250,RC,0054-0235-24,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxcarbazepine: 10 BLISTER PACK in 1 BOX (0054-0097-20) / 10 TABLET in 1 BLISTER PACK,250,RC,0054-0097-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Premarin: 100 Tablet, Film Coated In 1 Bottle (0046-1100-81)",250,RC,0046-1100-81,NDC,,,facility,both,1,EA,,16.72,16.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Multaq: 60 Tablet, Film Coated In 1 Bottle (0024-4142-60)",250,RC,0024-4142-60,NDC,,,facility,both,1,EA,,32.53,32.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Primaquine Phosphate: 100 Tablet, Film Coated In 1 Bottle (0024-1596-01)",250,RC,0024-1596-01,NDC,,,facility,both,1,EA,,4.96,4.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Plaquenil: 100 TABLET, FILM COATED in 1 BOTTLE (0024-1562-10) ",250,RC,0024-1562-10,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Alphagan P: 1 Bottle, Dropper In 1 Carton (0023-9321-05) / 5 Ml In 1 Bottle, Dropper",250,RC,0023-9321-05,NDC,,,facility,both,1,EA,,5.18,5.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Premarin Vaginal: 1 Tube, With Applicator In 1 Carton (0046-0872-21) / 30 G In 1 Tube, With Applicator",250,RC,0046-0872-21,NDC,,,facility,both,1,EA,,1197.25,1197.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lasix: 100 TABLET in 1 BOTTLE (0039-0067-10) ,250,RC,0039-0067-10,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Proctofoam Hc: 1 Canister In 1 Carton (0037-6822-10) / 10 G In 1 Canister,250,RC,0037-6822-10,NDC,,,facility,both,1,EA,,456.9,456.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-13)",250,RC,0032-3016-13,NDC,,,facility,both,1,EA,,34.01,34.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-2636-01)",250,RC,0032-2636-01,NDC,,,facility,both,1,EA,,23.08,23.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0046-70)",250,RC,0032-0046-70,NDC,,,facility,both,1,EA,,5.77,5.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 70 Capsule, Delayed Release In 1 Bottle (0032-0045-70)",250,RC,0032-0045-70,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytotec: 60 Tablet In 1 Bottle, Unit-Dose (0025-1451-60)",250,RC,0025-1451-60,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aldactone: 100 Tablet, Film Coated In 1 Bottle (0025-1001-31)",250,RC,0025-1001-31,NDC,,,facility,both,1,EA,,7.29,7.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-1224-01)",250,RC,0032-1224-01,NDC,,,facility,both,1,EA,,23.06,23.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Codeine Sulfate: 100 Tablet In 1 Bottle (0054-0244-25),250,RC,0054-0244-25,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 1000 Ml In 1 Bottle (0054-0391-68),250,RC,0054-0391-68,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Posaconazole: 1 Bottle, Glass In 1 Carton (0054-0449-49) / 105 Ml In 1 Bottle, Glass",250,RC,0054-0449-49,NDC,,,facility,both,1,EA,,103.7,103.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Genteal Tears Severe: 1 Tube In 1 Carton (0065-8064-01) / 10 G In 1 Tube,250,RC,0065-8064-01,NDC,,,facility,both,1,EA,,18.77,18.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Genteal Tears Moderate Preservative Free: 36 Vial, Single-Dose In 1 Carton (0065-8063-01) / .9 Ml In 1 Vial, Single-Dose",250,RC,0065-8063-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bss: 15 Ml In 1 Bottle (0065-0795-15),250,RC,0065-0795-15,NDC,,,facility,both,1,EA,,10.98,10.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tetracaine Hydrochloride: 12 Blister Pack In 1 Carton (0065-0741-14) / 1 Bottle, Dropper In 1 Blister Pack / 4 Ml In 1 Bottle, Dropper",250,RC,0065-0741-14,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0065-0416-63,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA COUMADIN: 1 BOTTLE in 1 CARTON (0056-0172-70) / 100 TABLET in 1 BOTTLE,250,RC,0056-0172-70,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA COUMADIN: 1 BOTTLE in 1 CARTON (0056-0170-70) / 100 TABLET in 1 BOTTLE,250,RC,0056-0170-70,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA METHADONE HYDROCHLORIDE: 100 BLISTER PACK in 1 CARTON (0054-8553-24) / 1 TABLET in 1 BLISTER PACK,250,RC,0054-8553-24,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lithium Carbonate: 10 Tablet In 1 Blister Pack (0054-8528-25),250,RC,0054-8528-25,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8526-25)",250,RC,0054-8526-25,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Transderm Scop: 4 POUCH in 1 BOX (0067-4346-04) / 1 PATCH in 1 POUCH / 3 d in 1 PATCH,250,RC,0067-4346-04,NDC,,,facility,both,1,EA,,32.01,32.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA HALOPERIDOL: 25 VIAL in 1 CARTON (0069-0113-02) / 1 mL in 1 VIAL (0069-0113-01) ,250,RC,0069-0113-02,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25) / 10 Tablet In 1 Blister Pack,250,RC,0054-8299-25,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25) / 10 Tablet In 1 Blister Pack,250,RC,0054-8299-25,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluticasone Propionate: 1 Bottle, Glass In 1 Carton (0054-3270-99) / 120 Spray, Metered In 1 Bottle, Glass",250,RC,0054-3270-99,NDC,,,facility,both,1,EA,,21.35,21.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcitriol: 1 Bottle, Glass In 1 Carton (0054-3120-41) / 15 Ml In 1 Bottle, Glass",250,RC,0054-3120-41,NDC,,,facility,both,1,EA,,32.81,32.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lithium Carbonate: 1000 Capsule, Gelatin Coated In 1 Bottle (0054-2527-31)",250,RC,0054-2527-31,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lithium Carbonate: 100 Capsule, Gelatin Coated In 1 Bottle (0054-2527-25)",250,RC,0054-2527-25,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aminocaproic Acid: 236.5 Ml In 1 Bottle, Plastic (0054-1100-58)",250,RC,0054-1100-58,NDC,,,facility,both,1,EA,,30.5,30.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 1 Blister Pack In 1 Carton (0054-0709-20) / 100 Tablet In 1 Blister Pack,250,RC,0054-0709-20,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0054-0660-25),250,RC,0054-0660-25,NDC,,,facility,both,1,EA,,7.39,7.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desvenlafaxine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (0054-0603-13)",250,RC,0054-0603-13,NDC,,,facility,both,1,EA,,2.38,2.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Droxidopa: 90 CAPSULE in 1 BOTTLE (0054-0532-22) ,250,RC,0054-0532-22,NDC,,,facility,both,1,EA,,3.7,3.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 60 Ml In 1 Bottle (0054-3294-46),250,RC,0054-3294-46,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Viscous: 1 Bottle In 1 Carton (0054-3500-49) / 100 Ml In 1 Bottle,250,RC,0054-3500-49,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 50 Ml In 1 Bottle (0054-3505-47),250,RC,0054-3505-47,NDC,,,facility,both,1,EA,,101.05,101.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25) / 10 Tablet In 1 Blister Pack,250,RC,0054-8297-25,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mercaptopurine: 25 Tablet In 1 Bottle, Plastic (0054-4581-11)",250,RC,0054-4581-11,NDC,,,facility,both,1,EA,,7.01,7.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lithium Carbonate: 100 Tablet In 1 Bottle (0054-4527-25),250,RC,0054-4527-25,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Propranolol Hydrochloride: 500 Ml In 1 Bottle, Plastic (0054-3727-63)",250,RC,0054-3727-63,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pifeltro: 30 Tablet, Film Coated In 1 Bottle (0006-3069-01)",250,RC,0006-3069-01,NDC,,,facility,both,1,EA,,159.31,159.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0006-3075-03,NDC,,,facility,both,1,EA,,720.28,720.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0006-5425-05,NDC,,,facility,both,1,EA,,655.04,655.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bridion: 10 Vial, Single-Dose In 1 Carton (0006-5423-12) / 2 Ml In 1 Vial, Single-Dose (0006-5423-02)",250,RC,0006-5423-12,NDC,,,facility,both,1,EA,,350.19,350.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0006-5423-02,NDC,,,facility,both,1,EA,,348.12,348.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamiflu: 1 Blister Pack In 1 Carton (0004-0802-85) / 10 Capsule In 1 Blister Pack,250,RC,0004-0802-85,NDC,,,facility,both,1,EA,,33.73,33.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamiflu: 1 Blister Pack In 1 Carton (0004-0801-85) / 10 Capsule In 1 Blister Pack,250,RC,0004-0801-85,NDC,,,facility,both,1,EA,,33.83,33.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamiflu: 1 Blister Pack In 1 Carton (0004-0800-85) / 10 Capsule In 1 Blister Pack,250,RC,0004-0800-85,NDC,,,facility,both,1,EA,,37.01,37.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0112-31)",250,RC,0006-0112-31,NDC,,,facility,both,1,EA,,29.52,29.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "COZAAR: 90 TABLET, FILM COATED in 1 BOTTLE (0006-0951-54) ",250,RC,0006-0951-54,NDC,,,facility,both,1,EA,,2.16,2.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0277-31)",250,RC,0006-0277-31,NDC,,,facility,both,1,EA,,32.89,32.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isentress: 60 Tablet, Film Coated In 1 Bottle (0006-0227-61)",250,RC,0006-0227-61,NDC,,,facility,both,1,EA,,90.95,90.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,250,RC,0006-0221-01,NDC,,,facility,both,1,EA,,28.6,28.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 1 TUBE in 1 CARTON (0023-0240-04) / 3.5 g in 1 TUBE,250,RC,0023-0240-04,NDC,,,facility,both,1,EA,,22.67,22.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 1 TUBE in 1 CARTON (0023-0240-04) / 3.5 g in 1 TUBE,250,RC,0023-0240-04,NDC,,,facility,both,1,EA,,24.78,24.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Detrol: 60 Tablet, Film Coated In 1 Bottle (0009-4541-02)",250,RC,0009-4541-02,NDC,,,facility,both,1,EA,,9.22,9.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Refresh Plus: 30 Vial, Single-Use In 1 Carton (0023-0403-30) / .4 Ml In 1 Vial, Single-Use",250,RC,0023-0403-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Delzicol: 180 Capsule, Delayed Release In 1 Bottle (0023-5853-18)",250,RC,0023-5853-18,NDC,,,facility,both,1,EA,,9.39,9.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Refresh Tears: 1 Bottle, Dropper In 1 Carton (0023-0798-15) / 15 Ml In 1 Bottle, Dropper",250,RC,0023-0798-15,NDC,,,facility,both,1,EA,,22.91,22.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Refresh Classic: 50 Vial, Single-Use In 1 Carton (0023-0506-50) / .4 Ml In 1 Vial, Single-Use",250,RC,0023-0506-50,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cortef: 50 Tablet In 1 Bottle (0009-0012-01),250,RC,0009-0012-01,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liquid Polibar Plus: 1900 mL in 1 JUG (32909-168-02) ,255,RC,32909-168-02,NDC,,,facility,both,1,EA,,51.98,51.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1414-91) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-1414-91,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1414-91) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-1414-91,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1414-91) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-1414-91,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1416-12) / 500 Ml In 1 Bottle, Plastic",255,RC,0407-1416-12,NDC,,,facility,both,1,EA,,24.02,24.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "10 BOTTLE, GLASS in 1 BOX (0407-2223-04) / 200 mL in 1 BOTTLE, GLASS",255,RC,0407-2223-04,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "10 BOTTLE, GLASS in 1 BOX (0407-2223-04) / 200 mL in 1 BOTTLE, GLASS",255,RC,0407-2223-04,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "10 BOTTLE, GLASS in 1 BOX (0407-2223-06) / 50 mL in 1 BOTTLE, GLASS",255,RC,0407-2223-06,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "10 BOTTLE, GLASS in 1 BOX (0407-2223-06) / 50 mL in 1 BOTTLE, GLASS",255,RC,0407-2223-06,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Visipaque: 10 Bottle, Plastic In 1 Box (0407-2223-17) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-2223-17,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1414-91) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-1414-91,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Visipaque: 10 Bottle, Plastic In 1 Box (0407-2223-17) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-2223-17,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Visipaque: 10 Bottle, Plastic In 1 Box (0407-2223-17) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-2223-17,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-65) / 150 Ml In 1 Bottle, Plastic",255,RC,0407-1413-65,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-63) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-1413-63,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-63) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-1413-63,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Vial, Glass In 1 Box (0407-1411-20) / 20 Ml In 1 Vial, Glass",255,RC,0407-1411-20,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Vial, Glass In 1 Box (0407-1411-20) / 20 Ml In 1 Vial, Glass",255,RC,0407-1411-20,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Vial, Glass In 1 Box (0407-1412-10) / 10 Ml In 1 Vial, Glass",255,RC,0407-1412-10,NDC,,,facility,both,1,EA,,8.97,8.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Vial, Glass In 1 Box (0407-1412-20) / 20 Ml In 1 Vial, Glass",255,RC,0407-1412-20,NDC,,,facility,both,1,EA,,4.9,4.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Vial, Glass In 1 Box (0407-1413-10) / 10 Ml In 1 Vial, Glass",255,RC,0407-1413-10,NDC,,,facility,both,1,EA,,9.02,9.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-59) / 30 Ml In 1 Bottle, Plastic",255,RC,0407-1413-59,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-59) / 30 Ml In 1 Bottle, Plastic",255,RC,0407-1413-59,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-59) / 30 Ml In 1 Bottle, Plastic",255,RC,0407-1413-59,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-61) / 50 Ml In 1 Bottle, Plastic",255,RC,0407-1413-61,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-61) / 50 Ml In 1 Bottle, Plastic",255,RC,0407-1413-61,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1413-63) / 100 Ml In 1 Bottle, Plastic",255,RC,0407-1413-63,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lipiodol: 1 Vial In 1 Carton (67684-1901-2) / 10 Ml In 1 Vial,255,RC,67684-1901-2,NDC,,,facility,both,1,EA,,4603.99,4603.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,255,RC,50419-325-02,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-11) / 10 Vial, Single-Dose In 1 Carton / 7.5 Ml In 1 Vial, Single-Dose",255,RC,50419-325-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-11) / 10 Vial, Single-Dose In 1 Carton / 7.5 Ml In 1 Vial, Single-Dose",255,RC,50419-325-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-11) / 10 Vial, Single-Dose In 1 Carton / 7.5 Ml In 1 Vial, Single-Dose",255,RC,50419-325-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-12) / 10 Vial, Single-Dose In 1 Carton / 10 Ml In 1 Vial, Single-Dose",255,RC,50419-325-12,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-12) / 10 Vial, Single-Dose In 1 Carton / 10 Ml In 1 Vial, Single-Dose",255,RC,50419-325-12,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-12) / 10 Vial, Single-Dose In 1 Carton / 10 Ml In 1 Vial, Single-Dose",255,RC,50419-325-12,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-13) / 10 Vial, Single-Dose In 1 Carton / 15 Ml In 1 Vial, Single-Dose",255,RC,50419-325-13,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-13) / 10 Vial, Single-Dose In 1 Carton / 15 Ml In 1 Vial, Single-Dose",255,RC,50419-325-13,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gadavist: 2 Carton In 1 Box (50419-325-13) / 10 Vial, Single-Dose In 1 Carton / 15 Ml In 1 Vial, Single-Dose",255,RC,50419-325-13,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,255,RC,50419-325-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,255,RC,50419-325-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eovist: 5 Vial, Single-Dose In 1 Box (50419-320-05) / 10 Ml In 1 Vial, Single-Dose",255,RC,50419-320-05,NDC,,,facility,both,1,EA,,39.47,39.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eovist: 5 Vial, Single-Dose In 1 Box (50419-320-05) / 10 Ml In 1 Vial, Single-Dose",255,RC,50419-320-05,NDC,,,facility,both,1,EA,,41.57,41.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnevist: 20 CARTON in 1 BOX (50419-188-01) / 1 VIAL, SINGLE-DOSE in 1 CARTON / 10 mL in 1 VIAL, SINGLE-DOSE",255,RC,50419-188-01,NDC,,,facility,both,1,EA,,5.57,5.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnevist: 20 CARTON in 1 BOX (50419-188-05) / 1 VIAL, SINGLE-DOSE in 1 CARTON / 5 mL in 1 VIAL, SINGLE-DOSE",255,RC,50419-188-05,NDC,,,facility,both,1,EA,,5.55,5.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnevist: 2 CARTON in 1 BOX (50419-188-81) / 10 VIAL, SINGLE-DOSE in 1 CARTON / 5 mL in 1 VIAL, SINGLE-DOSE",255,RC,50419-188-81,NDC,,,facility,both,1,EA,,24.45,24.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,255,RC,1513702127,NDC,,,facility,both,1,EA,,21.51,21.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Optiray 320: 12 Bottle, Glass In 1 Carton (0019-1323-11) / 100 Ml In 1 Bottle, Glass",255,RC,0019-1323-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,255,RC,0019-0953-15,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Conray 30: 12 BOTTLE, GLASS in 1 BOX (0019-0952-11) / 150 mL in 1 BOTTLE, GLASS",255,RC,0019-0952-11,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Conray 43: 12 BOTTLE, GLASS in 1 BOX (0019-3183-09) / 250 mL in 1 BOTTLE, GLASS",255,RC,0019-3183-09,NDC,,,facility,both,1,EA,,3.32,3.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nutrilipid I.V. Fat Emulsion: 8 Carton In 1 Case (0264-4460-00) / 1 Container In 1 Carton / 1000 Ml In 1 Container,258,RC,0264-4460-00,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Intralipid: 250 Ml In 1 Bag (0338-0519-09),258,RC,0338-0519-09,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Intralipid: 500 Ml In 1 Bag (0338-0519-13),258,RC,0338-0519-13,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nutrilipid I.V. Fat Emulsion: 12 Carton In 1 Case (0264-4460-10) / 1 Container In 1 Carton / 500 Ml In 1 Container,258,RC,0264-4460-10,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nutrilipid I.V. Fat Emulsion: 12 Carton In 1 Case (0264-4460-30) / 1 Container In 1 Carton / 250 Ml In 1 Container,258,RC,0264-4460-30,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,258,RC,0517-9305-01,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Smoflipid: 10 Bag In 1 Case (63323-820-00) / 100 Ml In 1 Bag (63323-820-01),258,RC,63323-820-00,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Smoflipid: 12 Bag In 1 Case (63323-820-50) / 500 Ml In 1 Bag (63323-820-03),258,RC,63323-820-50,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Smoflipid: 10 Bag In 1 Case (63323-820-74) / 250 Ml In 1 Bag (63323-820-04),258,RC,63323-820-74,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,258,RC,65219-531-01,NDC,,,facility,both,1,EA,,300,300,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carnitor: 5 Vial In 1 Carton (54482-147-01) / 5 Ml In 1 Vial,258,RC,54482-147-01,NDC,,,facility,both,1,EA,,160,160,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17) / 3 Ml In 1 Vial, Multi-Dose",258,RC,0002-8215-17,NDC,,,facility,both,1,EA,,212.5,212.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,0781-3113-90,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 64 Container In 1 Case (0264-1800-32) / 100 Ml In 1 Container,279,RC,0264-1800-32,NDC,,,facility,both,1,EA,,39.6,39.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-18) / 100 Ml In 1 Bag,279,RC,0338-0049-18,NDC,,,facility,both,1,EA,,40.4,40.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Myxredlin: 12 Container In 1 Carton (0338-0126-12) / 100 Ml In 1 Container,279,RC,0338-0126-12,NDC,,,facility,both,1,EA,,2.78,2.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Dextrose: 24 Container In 1 Case (0264-4400-54) / 100 Ml In 1 Container,279,RC,0264-4400-54,NDC,,,facility,both,1,EA,,2.87,2.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00) / 1000 Ml In 1 Container,279,RC,0264-7610-00,NDC,,,facility,both,1,EA,,21,21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 12 Container In 1 Case (0264-5802-00) / 1000 Ml In 1 Container,279,RC,0264-5802-00,NDC,,,facility,both,1,EA,,24,24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,0409-7517-66,NDC,,,facility,both,1,EA,,32.62,32.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25) / 1 Ml In 1 Vial (0641-0376-21),279,RC,0641-0376-25,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,0641-6125-01,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,0641-6080-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,0338-3612-50,NDC,,,facility,both,1,EA,,7.02,7.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30),279,RC,0338-9159-30,NDC,,,facility,both,1,EA,,41.8,41.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48) / 100 Ml In 1 Bag,279,RC,0338-0709-48,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 24 Bag In 1 Carton (0338-3503-41) / 50 Ml In 1 Bag,279,RC,0338-3503-41,NDC,,,facility,both,1,EA,,8.52,8.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial, Single-Use In 1 Carton (0409-3385-13) / 15 Ml In 1 Vial, Single-Use (0409-3385-11)",279,RC,0409-3385-13,NDC,,,facility,both,1,EA,,8.07,8.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,63323-452-00,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,72196-6074-1,NDC,,,facility,both,1,EA,,8.13,8.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,71288-433-82,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,72485-507-01,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,68382-910-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,71285-6176-1,NDC,,,facility,both,1,EA,,18.12,18.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-120-30) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",279,RC,55150-120-30,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,60505-6157-0,NDC,,,facility,both,1,EA,,3.08,3.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,279,RC,60505-6145-0,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (59651-488-01),279,RC,59651-488-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01) / 10 Ml In 1 Vial, Multi-Dose",279,RC,0002-8215-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)",343,RC,49609-101-01,NDC,,,facility,both,1,EA,,420.08,420.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)",343,RC,49609-101-01,NDC,,,facility,both,1,EA,,413.93,413.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)",343,RC,49609-101-01,NDC,,,facility,both,1,EA,,400.58,400.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kit For The Preparation Of Technetium Tc 99M Medronate: 5 Vial, Multi-Dose In 1 Kit (45567-0040-1) / 10 Ml In 1 Vial, Multi-Dose",343,RC,45567-0040-1,NDC,,,facility,both,1,EA,,39.63,39.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Kit For The Prepartion Of Technetium Tc99M Sulfur Colloid: 1 Kit In 1 Package (45567-0030-1) * 3 Ml In 1 Vial * 3 Ml In 1 Vial * 10 Ml In 1 Vial,343,RC,45567-0030-1,NDC,,,facility,both,1,EA,,366.71,366.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Indium In 111 Oxyquinoline: 1 Vial In 1 Box (17156-021-01) / 1 Ml In 1 Vial,343,RC,17156-021-01,NDC,,,facility,both,1,EA,,3520.71,3520.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Indium In 111 Oxyquinoline: 1 Vial In 1 Box (17156-021-01) / 1 Ml In 1 Vial,343,RC,17156-021-01,NDC,,,facility,both,1,EA,,3121.37,3121.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myoview: 5 Vial In 1 Kit (17156-024-05) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",343,RC,17156-024-05,NDC,,,facility,both,1,EA,,117,117,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Iodide: 1 CAPSULE in 1 BOX (17156-522-05) ,343,RC,17156-522-05,NDC,,,facility,both,1,EA,,44.92,44.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Draximage Maa: 30 Injection, Powder, For Solution In 1 Kit (65174-270-30)",343,RC,65174-270-30,NDC,,,facility,both,1,EA,,510.07,510.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,65174-288-05,NDC,,,facility,both,1,EA,,526.47,526.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-46,NDC,,,facility,both,1,EA,,358.71,358.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-50,NDC,,,facility,both,1,EA,,107.93,107.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-51,NDC,,,facility,both,1,EA,,1340.62,1340.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-52,NDC,,,facility,both,1,EA,,83.08,83.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-56,NDC,,,facility,both,1,EA,,276.12,276.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-62,NDC,,,facility,both,1,EA,,34.34,34.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-63,NDC,,,facility,both,1,EA,,59,59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-64,NDC,,,facility,both,1,EA,,66.53,66.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1003-69,NDC,,,facility,both,1,EA,,2982.22,2982.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1003-70,NDC,,,facility,both,1,EA,,5350.21,5350.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1003-71,NDC,,,facility,both,1,EA,,142.71,142.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1006-33,NDC,,,facility,both,1,EA,,1160.34,1160.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1006-34,NDC,,,facility,both,1,EA,,733.06,733.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,99999-1002-57,NDC,,,facility,both,1,EA,,387.91,387.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Illuccix: 1 Kit In 1 Carton (74725-100-64) * 2.5 Ml In 1 Vial, Multi-Dose (74725-102-25) * 6.4 Ml In 1 Vial, Multi-Dose (74725-103-64) * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Multi-Dose (74725-101-25)",343,RC,74725-100-64,NDC,,,facility,both,1,EA,,2580.85,2580.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Illuccix: 1 Kit In 1 Carton (74725-100-64) * 2.5 Ml In 1 Vial, Multi-Dose (74725-102-25) * 6.4 Ml In 1 Vial, Multi-Dose (74725-103-64) * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Multi-Dose (74725-101-25)",343,RC,74725-100-64,NDC,,,facility,both,1,EA,,2463.54,2463.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Illuccix: 1 Kit In 1 Carton (74725-100-64) * 2.5 Ml In 1 Vial, Multi-Dose (74725-102-25) * 6.4 Ml In 1 Vial, Multi-Dose (74725-103-64) * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Multi-Dose (74725-101-25)",343,RC,74725-100-64,NDC,,,facility,both,1,EA,,2346.23,2346.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Netspot: 1 Kit In 1 Kit (69488-001-40) * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",343,RC,69488-001-40,NDC,,,facility,both,1,EA,,191.9,191.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Netspot: 1 Kit In 1 Kit (69488-001-40) * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",343,RC,69488-001-40,NDC,,,facility,both,1,EA,,190.76,190.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Netspot: 1 Kit In 1 Kit (69488-001-40) * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",343,RC,69488-001-40,NDC,,,facility,both,1,EA,,190.57,190.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Netspot: 1 Kit In 1 Kit (69488-001-40) * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",343,RC,69488-001-40,NDC,,,facility,both,1,EA,,187.7,187.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pluvicto: 1 Vial, Glass In 1 Package (69488-010-61) / 7.5 Ml In 1 Vial, Glass",343,RC,69488-010-61,NDC,,,facility,both,1,EA,,643.73,643.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pluvicto: 1 Vial, Glass In 1 Package (69488-010-61) / 7.5 Ml In 1 Vial, Glass",343,RC,69488-010-61,NDC,,,facility,both,1,EA,,563.8,563.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pluvicto: 1 Vial, Glass In 1 Package (69488-010-61) / 7.5 Ml In 1 Vial, Glass",343,RC,69488-010-61,NDC,,,facility,both,1,EA,,563.8,563.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,71258-022-00,NDC,,,facility,both,1,EA,,1656.23,1656.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,71258-022-00,NDC,,,facility,both,1,EA,,1641.61,1641.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,71258-022-00,NDC,,,facility,both,1,EA,,1494.34,1494.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,71258-022-00,NDC,,,facility,both,1,EA,,1487.1,1487.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,343,RC,71258-022-00,NDC,,,facility,both,1,EA,,1423.55,1423.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xofigo: 6 Ml In 1 Vial, Single-Dose (50419-208-01)",344,RC,50419-208-01,NDC,,,facility,both,1,EA,,380.77,380.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xofigo: 6 Ml In 1 Vial, Single-Dose (50419-208-01)",344,RC,50419-208-01,NDC,,,facility,both,1,EA,,355.69,355.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (0904-7237-61) / 10 Capsule In 1 Blister Pack",632,RC,0904-7237-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61) / 1 Tablet In 1 Blister Pack,632,RC,0904-6923-61,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,13533-318-50,NDC,,,facility,both,1,EA,,705.86,705.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flexbumin: 12 Bag In 1 Carton (0944-0493-01) / 50 Ml In 1 Bag (0944-0493-03),632,RC,0944-0493-01,NDC,,,facility,both,1,EA,,90.85,90.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0944-0493-03,NDC,,,facility,both,1,EA,,90.85,90.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0703-4502-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0641-6244-01,NDC,,,facility,both,1,EA,,33.77,33.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0781-3156-06,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0781-3289-91,NDC,,,facility,both,1,EA,,10.23,10.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tacrolimus: 100 Capsule In 1 Bottle (0781-2103-01),632,RC,0781-2103-01,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,42494-415-01,NDC,,,facility,both,1,EA,,37.63,37.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (47781-586-29) / 20 Ml In 1 Vial, Multi-Dose",632,RC,47781-586-29,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (43598-051-11) / 2 Ml In 1 Vial, Multi-Dose",632,RC,43598-051-11,NDC,,,facility,both,1,EA,,897.4,897.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Phosphate: 24 Bag In 1 Case (43066-995-24) / 50 Ml In 1 Bag,632,RC,43066-995-24,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-420-24) / 1 Bag In 1 Pouch / 50 Ml In 1 Bag,632,RC,44567-420-24,NDC,,,facility,both,1,EA,,2.79,2.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Succinylcholine Chloride: 1 VIAL, MULTI-DOSE in 1 CARTON (16729-493-03) / 10 mL in 1 VIAL, MULTI-DOSE",632,RC,16729-493-03,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 25 VIAL in 1 CARTON (25021-101-67) / 3 mL in 1 VIAL,632,RC,25021-101-67,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic Acid: 1 Bag In 1 Carton (25021-826-67) / 100 Ml In 1 Bag,632,RC,25021-826-67,NDC,,,facility,both,1,EA,,17,17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,19515-904-41,NDC,,,facility,both,1,EA,,42.49,42.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,23155-240-31,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,23155-294-31,NDC,,,facility,both,1,EA,,3.63,3.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 64 Container In 1 Case (0264-1800-32) / 100 Ml In 1 Container,632,RC,0264-1800-32,NDC,,,facility,both,1,EA,,42.24,42.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03),632,RC,0338-0049-03,NDC,,,facility,both,1,EA,,44,44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04),632,RC,0338-0049-04,NDC,,,facility,both,1,EA,,42.89,42.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),632,RC,0338-0049-02,NDC,,,facility,both,1,EA,,43,43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-18) / 100 Ml In 1 Bag,632,RC,0338-0049-18,NDC,,,facility,both,1,EA,,38.8,38.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-11) / 50 Ml In 1 Bag,632,RC,0338-0049-11,NDC,,,facility,both,1,EA,,52.93,52.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03) / 500 Ml In 1 Bottle, Plastic",632,RC,0338-0048-03,NDC,,,facility,both,1,EA,,39,39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04),632,RC,0338-0117-04,NDC,,,facility,both,1,EA,,38.26,38.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers And Dextrose: 1000 Ml In 1 Bag (0338-0125-04),632,RC,0338-0125-04,NDC,,,facility,both,1,EA,,38,38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 50 Ml In 1 Bag (0338-0551-11),632,RC,0338-0551-11,NDC,,,facility,both,1,EA,,6.73,6.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0051-44),632,RC,0338-0051-44,NDC,,,facility,both,1,EA,,58,58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 12 Container In 1 Case (0264-7750-07) / 1000 Ml In 1 Container,632,RC,0264-7750-07,NDC,,,facility,both,1,EA,,41.71,41.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose In Lactated Ringers: 12 Container In 1 Case (0264-7751-00) / 1000 Ml In 1 Container,632,RC,0264-7751-00,NDC,,,facility,both,1,EA,,46.2,46.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-7800-20) / 250 Ml In 1 Container,632,RC,0264-7800-20,NDC,,,facility,both,1,EA,,38.85,38.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 12 Container In 1 Case (0264-5802-00) / 1000 Ml In 1 Container,632,RC,0264-5802-00,NDC,,,facility,both,1,EA,,30.29,30.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-5802-10) / 500 Ml In 1 Container,632,RC,0264-5802-10,NDC,,,facility,both,1,EA,,44,44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9164-01) / 10.25 G In 1 Vial, Pharmacy Bulk Package",632,RC,0143-9164-01,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0093-7334-01),632,RC,0093-7334-01,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Betamethasone Sodium Phosphate And Betamethasone Acetate: 1 Vial, Multi-Dose In 1 Carton (0517-0720-01) / 5 Ml In 1 Vial, Multi-Dose",632,RC,0517-0720-01,NDC,,,facility,both,1,EA,,13.05,13.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-24) / 1 Bag In 1 Pouch / 50 Ml In 1 Bag (0409-6729-11),632,RC,0409-6729-24,NDC,,,facility,both,1,EA,,2.83,2.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-9094-12,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22) / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",632,RC,0409-9094-22,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0641-0367-21,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25) / 1 Ml In 1 Vial (0641-0376-21),632,RC,0641-0376-25,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "GlucaGen: 1 KIT in 1 KIT (0597-0260-10) * 1 mL in 1 VIAL, GLASS (0597-0053-01) * 1 mL in 1 VIAL, GLASS (0597-0265-94) ",632,RC,0597-0260-10,NDC,,,facility,both,1,EA,,453.97,453.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0641-6080-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0641-6125-01,NDC,,,facility,both,1,EA,,6.9,6.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0641-6044-01,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (0591-5052-01),632,RC,0591-5052-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 12 Bag In 1 Carton (0338-3508-41) / 100 Ml In 1 Bag,632,RC,0338-3508-41,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 200 Ml In 1 Bag (0338-3552-48),632,RC,0338-3552-48,NDC,,,facility,both,1,EA,,11.16,11.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0338-3612-50,NDC,,,facility,both,1,EA,,7.02,7.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30),632,RC,0338-9159-30,NDC,,,facility,both,1,EA,,41.8,41.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 24 Bag In 1 Carton (0338-9541-24) / 100 Ml In 1 Bag,632,RC,0338-9541-24,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48) / 100 Ml In 1 Bag,632,RC,0338-0709-48,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 24 Bag In 1 Carton (0338-1055-48) / 100 Ml In 1 Bag,632,RC,0338-1055-48,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-3414-21,NDC,,,facility,both,1,EA,,3.61,3.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 5 Vial, Glass In 1 Carton (0409-3815-12) / 10 Ml In 1 Vial, Glass (0409-3815-11)",632,RC,0409-3815-12,NDC,,,facility,both,1,EA,,5.48,5.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2723-01) / 1 Ml In 1 Vial, Single-Dose (0409-2723-30)",632,RC,0409-2723-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-2723-30,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 25 Ampule In 1 Carton (0409-4282-02) / 10 Ml In 1 Ampule (0409-4282-12),632,RC,0409-4282-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 25 Vial, Single-Dose In 1 Tray (0409-4755-03) / 2 Ml In 1 Vial, Single-Dose (0409-4755-18)",632,RC,0409-4755-03,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-1273-03,NDC,,,facility,both,1,EA,,34.53,34.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-1162-19,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01) / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",632,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01) / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",632,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nalbuphine Hydrochloride: 10 Ampule In 1 Tray (0409-1463-01) / 1 Ml In 1 Ampule (0409-1463-71),632,RC,0409-1463-01,NDC,,,facility,both,1,EA,,9.9,9.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-1886-22,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17) / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",632,RC,0409-2305-17,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-1746-71,NDC,,,facility,both,1,EA,,28.67,28.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0409-1463-69,NDC,,,facility,both,1,EA,,9.9,9.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosulfan Blue: 6 Vial, Glass In 1 Carton (67457-220-05) / 5 Ml In 1 Vial, Glass (67457-220-00)",632,RC,67457-220-05,NDC,,,facility,both,1,EA,,1385.52,1385.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (67457-418-05) / 5 Ml In 1 Vial (67457-418-00),632,RC,67457-418-05,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 25 Vial, Single-Use In 1 Tray (63323-739-16) / 2 Ml In 1 Vial, Single-Use (63323-739-41)",632,RC,63323-739-16,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenylephrine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (63323-751-01) / 1 Ml In 1 Vial, Single-Dose (63323-751-00)",632,RC,63323-751-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetylcysteine: 25 Vial In 1 Carton (63323-694-04) / 4 Ml In 1 Vial (63323-694-22),632,RC,63323-694-04,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,63323-452-00,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,63323-434-41,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,63323-474-00,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neostigmine Methylsulfate: 10 Vial, Multi-Dose In 1 Tray (63323-415-10) / 10 Ml In 1 Vial, Multi-Dose (63323-415-01)",632,RC,63323-415-10,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,63323-564-21,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,64253-900-30,NDC,,,facility,both,1,EA,,21.12,21.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ropivacaine Hydrochloride: 25 Vial In 1 Carton (72603-216-25) / 20 Ml In 1 Vial (72603-216-01),632,RC,72603-216-25,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,71288-433-82,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,72266-118-01,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,72485-507-01,NDC,,,facility,both,1,EA,,3.98,3.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phytonadione: 1 Syringe In 1 Carton (76329-1240-1) / .5 Ml In 1 Syringe,632,RC,76329-1240-1,NDC,,,facility,both,1,EA,,65.08,65.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,68462-157-40,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 VIAL in 1 CARTON (70860-105-20) / 20 mL in 1 VIAL (70860-105-41) ,632,RC,70860-105-20,NDC,,,facility,both,1,EA,,9.52,9.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 10 Vial, Single-Dose In 1 Carton (70860-125-66) / 5 Ml In 1 Vial, Single-Dose (70860-125-41)",632,RC,70860-125-66,NDC,,,facility,both,1,EA,,8.5,8.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,71285-6176-1,NDC,,,facility,both,1,EA,,18.12,18.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,70092-1068-07,NDC,,,facility,both,1,EA,,20.46,20.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,70092-1552-07,NDC,,,facility,both,1,EA,,18.6,18.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,70700-902-22,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,63323-360-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,55150-202-00,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meropenem: 10 Vial In 1 Carton (55150-208-30) / 1 Injection, Powder, For Solution In 1 Vial",632,RC,55150-208-30,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01)",632,RC,50632-010-01,NDC,,,facility,both,1,EA,,864.72,864.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-165-01) / 1 Ml In 1 Vial (63323-165-02),632,RC,63323-165-01,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10) / 10 Ml In 1 Vial, Multi-Dose",632,RC,63323-184-10,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-01) / 1 Ml In 1 Vial, Single-Use (63323-162-00)",632,RC,63323-162-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-29) / 20 Ml In 1 Vial (63323-269-22),632,RC,63323-269-29,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Naropin: 25 Vial, Single-Dose In 1 Tray (63323-286-95) / 30 Ml In 1 Vial, Single-Dose (63323-286-93)",632,RC,63323-286-95,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-37) / 20 Ml In 1 Vial (63323-269-25),632,RC,63323-269-37,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-65) / 100 Ml In 1 Vial (63323-269-35),632,RC,63323-269-65,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,632,RC,62935-461-50,NDC,,,facility,both,1,EA,,300.78,300.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxytocin: 25 Vial In 1 Tray (63323-012-07) / 1 Ml In 1 Vial (63323-012-17),632,RC,63323-012-07,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,63323-012-17,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,63323-106-02,NDC,,,facility,both,1,EA,,2.46,2.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,60505-6231-0,NDC,,,facility,both,1,EA,,3.2,3.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,60505-6145-0,NDC,,,facility,both,1,EA,,3.06,3.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,58160-842-43,NDC,,,facility,both,1,EA,,118.84,118.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (59651-488-01),632,RC,59651-488-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,60687-145-11,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,58160-820-43,NDC,,,facility,both,1,EA,,58.73,58.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,632,RC,0009-0011-03,NDC,,,facility,both,1,EA,,29.91,29.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Inflectra: 1 Vial, Single-Use In 1 Carton (0069-0809-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0069-0809-01,NDC,,,facility,both,1,EA,,140.45,140.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Blister Pack In 1 Carton (0904-7127-61) / 1 Tablet In 1 Blister Pack,636,RC,0904-7127-61,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dronabinol: 30 Blister Pack In 1 Carton (0904-7145-04) / 1 Capsule In 1 Blister Pack,636,RC,0904-7145-04,NDC,,,facility,both,1,EA,,12.22,12.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyzine Pamoate: 100 Blister Pack In 1 Carton (0904-7065-61) / 1 Capsule In 1 Blister Pack,636,RC,0904-7065-61,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (0904-7237-61) / 10 Capsule In 1 Blister Pack",636,RC,0904-7237-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (0904-7237-61) / 10 Capsule In 1 Blister Pack",636,RC,0904-7237-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 100 Capsule In 1 Bottle (0904-7237-60),636,RC,0904-7237-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 100 Capsule In 1 Bottle (0904-7237-60),636,RC,0904-7237-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hcl: 118 Ml In 1 Bottle, Plastic (0904-6985-20)",636,RC,0904-6985-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hcl: 118 Ml In 1 Bottle, Plastic (0904-6985-20)",636,RC,0904-6985-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61) / 1 Tablet In 1 Blister Pack,636,RC,0904-6923-61,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61) / 1 Tablet In 1 Blister Pack,636,RC,0904-6923-61,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyperrab: 1 Vial In 1 Carton (13533-318-05) / 5 Ml In 1 Vial (13533-318-50),636,RC,13533-318-05,NDC,,,facility,both,1,EA,,653.43,653.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyperrab: 1 Vial In 1 Carton (13533-318-05) / 5 Ml In 1 Vial (13533-318-50),636,RC,13533-318-05,NDC,,,facility,both,1,EA,,607.47,607.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-318-10,NDC,,,facility,both,1,EA,,1142.22,1142.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-318-10,NDC,,,facility,both,1,EA,,619.13,619.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-318-10,NDC,,,facility,both,1,EA,,112.94,112.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-318-50,NDC,,,facility,both,1,EA,,911.21,911.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-318-50,NDC,,,facility,both,1,EA,,662.47,662.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-318-50,NDC,,,facility,both,1,EA,,651.15,651.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hypertet: 1 Syringe, Glass In 1 Box (13533-634-02) / 1 Ml In 1 Syringe, Glass (13533-634-20)",636,RC,13533-634-02,NDC,,,facility,both,1,EA,,1503.59,1503.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyperrab: 1 Vial In 1 Carton (13533-318-05) / 5 Ml In 1 Vial (13533-318-50),636,RC,13533-318-05,NDC,,,facility,both,1,EA,,781.59,781.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hyperhep B: 1 Syringe, Glass In 1 Carton (13533-636-03) / .5 Ml In 1 Syringe, Glass (13533-636-30)",636,RC,13533-636-03,NDC,,,facility,both,1,EA,,226.62,226.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12) / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12) / 10 Ml In 1 Vial, Glass (13533-800-13)",636,RC,13533-800-12,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15) / 25 Ml In 1 Vial, Glass (13533-800-16)",636,RC,13533-800-15,NDC,,,facility,both,1,EA,,102,102,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15) / 25 Ml In 1 Vial, Glass (13533-800-16)",636,RC,13533-800-15,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,108.03,108.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,106.33,106.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,105.75,105.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,105.27,105.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-636-30,NDC,,,facility,both,1,EA,,226.62,226.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,99.87,99.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyperrab: 1 Vial In 1 Carton (13533-318-01) / 1 Ml In 1 Vial (13533-318-10),636,RC,13533-318-01,NDC,,,facility,both,1,EA,,604.6,604.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Promethazine Hydrochloride: 100 Tablet In 1 Bottle (10702-003-01),636,RC,10702-003-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyperrab: 1 Vial In 1 Carton (13533-318-01) / 1 Ml In 1 Vial (13533-318-10),636,RC,13533-318-01,NDC,,,facility,both,1,EA,,655.3,655.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,99.67,99.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,99.38,99.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,99.88,99.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,99.61,99.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,99.49,99.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-800-72,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,14789-116-07,NDC,,,facility,both,1,EA,,265.46,265.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,104.51,104.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,105.79,105.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,106.66,106.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20) / 50 Ml In 1 Vial, Glass (13533-800-21)",636,RC,13533-800-20,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-800-21,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,110.8,110.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,110.8,110.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,106.96,106.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,106.47,106.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,106.28,106.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,105.68,105.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,100.73,100.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,99.67,99.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,99.64,99.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,99.55,99.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,99.43,99.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24) / 200 Ml In 1 Vial, Glass (13533-800-25)",636,RC,13533-800-24,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-800-25,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-800-25,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,13533-800-25,NDC,,,facility,both,1,EA,,99.24,99.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,110.81,110.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71) / 100 Ml In 1 Vial, Glass (13533-800-72)",636,RC,13533-800-71,NDC,,,facility,both,1,EA,,106.66,106.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flexbumin: 12 Bag In 1 Carton (0944-0493-01) / 50 Ml In 1 Bag (0944-0493-03),636,RC,0944-0493-01,NDC,,,facility,both,1,EA,,95.52,95.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flexbumin: 12 Bag In 1 Carton (0944-0493-01) / 50 Ml In 1 Bag (0944-0493-03),636,RC,0944-0493-01,NDC,,,facility,both,1,EA,,95.16,95.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-0493-03,NDC,,,facility,both,1,EA,,95.19,95.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-0493-03,NDC,,,facility,both,1,EA,,94.49,94.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-0493-03,NDC,,,facility,both,1,EA,,90.85,90.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flexbumin: 2 Bag In 1 Carton (0944-0495-05) / 250 Ml In 1 Bag (0944-0495-06),636,RC,0944-0495-05,NDC,,,facility,both,1,EA,,49.32,49.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flexbumin: 2 Bag In 1 Carton (0944-0495-05) / 250 Ml In 1 Bag (0944-0495-06),636,RC,0944-0495-05,NDC,,,facility,both,1,EA,,39.98,39.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gammagard S/D: 1 Kit In 1 Carton (0944-2658-04) * 192 Ml In 1 Bottle (0338-0001-37) * 192 Ml In 1 Bottle (64764-511-92) * 200 Ml In 1 Bottle (0944-2659-08),636,RC,0944-2658-04,NDC,,,facility,both,1,EA,,214.64,214.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2659-08,NDC,,,facility,both,1,EA,,215.44,215.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04) / 50 Ml In 1 Bottle, Glass (0944-2700-10)",636,RC,0944-2700-04,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04) / 50 Ml In 1 Bottle, Glass (0944-2700-10)",636,RC,0944-2700-04,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04) / 50 Ml In 1 Bottle, Glass (0944-2700-10)",636,RC,0944-2700-04,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04) / 50 Ml In 1 Bottle, Glass (0944-2700-10)",636,RC,0944-2700-04,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05) / 100 Ml In 1 Bottle, Glass (0944-2700-11)",636,RC,0944-2700-05,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05) / 100 Ml In 1 Bottle, Glass (0944-2700-11)",636,RC,0944-2700-05,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05) / 100 Ml In 1 Bottle, Glass (0944-2700-11)",636,RC,0944-2700-05,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05) / 100 Ml In 1 Bottle, Glass (0944-2700-11)",636,RC,0944-2700-05,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05) / 100 Ml In 1 Bottle, Glass (0944-2700-11)",636,RC,0944-2700-05,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2659-08,NDC,,,facility,both,1,EA,,226.21,226.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06) / 200 Ml In 1 Bottle, Glass (0944-2700-12)",636,RC,0944-2700-06,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06) / 200 Ml In 1 Bottle, Glass (0944-2700-12)",636,RC,0944-2700-06,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06) / 200 Ml In 1 Bottle, Glass (0944-2700-12)",636,RC,0944-2700-06,NDC,,,facility,both,1,EA,,89.29,89.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06) / 200 Ml In 1 Bottle, Glass (0944-2700-12)",636,RC,0944-2700-06,NDC,,,facility,both,1,EA,,85.93,85.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-926-16,NDC,,,facility,both,1,EA,,114.2,114.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-926-16,NDC,,,facility,both,1,EA,,114.2,114.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-926-16,NDC,,,facility,both,1,EA,,111.58,111.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-926-16,NDC,,,facility,both,1,EA,,110.55,110.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (10019-939-01) / 50 Ml In 1 Vial, Single-Dose (10019-939-50)",636,RC,10019-939-01,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (10019-939-01) / 50 Ml In 1 Vial, Single-Dose (10019-939-50)",636,RC,10019-939-01,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-939-50,NDC,,,facility,both,1,EA,,2.32,2.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-939-50,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-939-50,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-939-50,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-926-16,NDC,,,facility,both,1,EA,,122.06,122.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-944-50,NDC,,,facility,both,1,EA,,6.45,6.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-926-02) / 60 Ml In 1 Vial, Single-Dose (10019-926-16)",636,RC,10019-926-02,NDC,,,facility,both,1,EA,,83.44,83.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-926-02) / 60 Ml In 1 Vial, Single-Dose (10019-926-16)",636,RC,10019-926-02,NDC,,,facility,both,1,EA,,95.99,95.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-926-02) / 60 Ml In 1 Vial, Single-Dose (10019-926-16)",636,RC,10019-926-02,NDC,,,facility,both,1,EA,,107.4,107.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06) / 200 Ml In 1 Bottle, Glass (0944-2700-12)",636,RC,0944-2700-06,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06) / 200 Ml In 1 Bottle, Glass (0944-2700-12)",636,RC,0944-2700-06,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-07) / 300 Ml In 1 Bottle, Glass (0944-2700-13)",636,RC,0944-2700-07,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2700-10,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2700-10,NDC,,,facility,both,1,EA,,89.29,89.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2700-10,NDC,,,facility,both,1,EA,,89.29,89.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2700-12,NDC,,,facility,both,1,EA,,172.63,172.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2700-12,NDC,,,facility,both,1,EA,,89.29,89.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2700-12,NDC,,,facility,both,1,EA,,87.72,87.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0944-2700-12,NDC,,,facility,both,1,EA,,84.59,84.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Lactated Ringers And Dextrose: 12 Pouch In 1 Case (0990-7111-09) / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag,636,RC,0990-7111-09,NDC,,,facility,both,1,EA,,58,58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Sodium Chloride: 12 Pouch In 1 Case (0990-7116-09) / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag,636,RC,0990-7116-09,NDC,,,facility,both,1,EA,,2.84,2.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0990-7715-13,NDC,,,facility,both,1,EA,,6.92,6.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bendamustine Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (10019-079-01) / 1 Injection In 1 Vial, Multi-Dose",636,RC,10019-079-01,NDC,,,facility,both,1,EA,,43.73,43.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-925-01) / 20 Ml In 1 Vial, Single-Dose (10019-925-82)",636,RC,10019-925-01,NDC,,,facility,both,1,EA,,119.85,119.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-925-01) / 20 Ml In 1 Vial, Single-Dose (10019-925-82)",636,RC,10019-925-01,NDC,,,facility,both,1,EA,,80.38,80.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-925-82,NDC,,,facility,both,1,EA,,68.57,68.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-925-82,NDC,,,facility,both,1,EA,,27,27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,10019-925-82,NDC,,,facility,both,1,EA,,27,27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-926-02) / 60 Ml In 1 Vial, Single-Dose (10019-926-16)",636,RC,10019-926-02,NDC,,,facility,both,1,EA,,108.38,108.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cysview: 1 Kit In 1 Carton (10511-3001-2) * 50 Ml In 1 Syringe, Plastic * 50 Ml In 1 Vial, Glass",636,RC,10511-3001-2,NDC,,,facility,both,1,EA,,3599.1,3599.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-5239-06,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Penicillin G Potassium: 1 Vial In 1 Carton (0781-6136-94) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,0781-6136-94,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fulvestrant: 2 Syringe, Glass In 1 Carton (0781-9055-12) / 5 Ml In 1 Syringe, Glass (0781-9055-01)",636,RC,0781-9055-12,NDC,,,facility,both,1,EA,,18.85,18.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fulvestrant: 2 Syringe, Glass In 1 Carton (0781-9055-12) / 5 Ml In 1 Syringe, Glass (0781-9055-01)",636,RC,0781-9055-12,NDC,,,facility,both,1,EA,,18.54,18.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-9210-90,NDC,,,facility,both,1,EA,,6.84,6.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial, Single-Use In 1 Carton (0781-9210-95) / 10 Ml In 1 Vial, Single-Use (0781-9210-90)",636,RC,0781-9210-95,NDC,,,facility,both,1,EA,,7.11,7.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-9214-91,NDC,,,facility,both,1,EA,,4.83,4.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ampicillin: 10 Vial, Glass In 1 Package (0781-9250-95) / 1 Injection, Powder, For Solution In 1 Vial, Glass (0781-9250-78)",636,RC,0781-9250-95,NDC,,,facility,both,1,EA,,9.69,9.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-9315-70) / 10 Ml In 1 Vial, Single-Use",636,RC,0781-9315-70,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-9315-70) / 10 Ml In 1 Vial, Single-Use",636,RC,0781-9315-70,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-9315-70) / 10 Ml In 1 Vial, Single-Use",636,RC,0781-9315-70,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-9315-70) / 10 Ml In 1 Vial, Single-Use",636,RC,0781-9315-70,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-9053-70,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-9317-80) / 20 Ml In 1 Vial, Single-Use",636,RC,0781-9317-80,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3407-78,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3408-80,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3411-70,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Palonosetron Hydrochloride: 1 Vial, Single-Dose In 1 Carton (0781-3415-75) / 5 Ml In 1 Vial, Single-Dose",636,RC,0781-3415-75,NDC,,,facility,both,1,EA,,4.35,4.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3440-71,NDC,,,facility,both,1,EA,,85.71,85.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3440-71,NDC,,,facility,both,1,EA,,84.04,84.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)",636,RC,0781-3491-94,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)",636,RC,0781-3491-94,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)",636,RC,0781-3491-94,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)",636,RC,0781-3491-94,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)",636,RC,0781-3491-94,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,33.69,33.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,32.94,32.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,32.48,32.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,27.83,27.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,26.81,26.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,26.72,26.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,26.11,26.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91) / 20 Ml In 1 Vial, Single-Dose",636,RC,0781-3531-91,NDC,,,facility,both,1,EA,,26.09,26.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)",636,RC,0781-3491-94,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-9404-85,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-9407-78,NDC,,,facility,both,1,EA,,7.83,7.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-9408-80,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box (0904-2056-61) / 10 Capsule In 1 Blister Pack,636,RC,0904-2056-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box (0904-2056-61) / 10 Capsule In 1 Blister Pack,636,RC,0904-2056-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 100 Capsule In 1 Bottle (0904-5306-60),636,RC,0904-5306-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-3315-70) / 10 Ml In 1 Vial, Single-Use",636,RC,0781-3315-70,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 100 Capsule In 1 Bottle (0904-5306-60),636,RC,0904-5306-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-3315-70) / 10 Ml In 1 Vial, Single-Use",636,RC,0781-3315-70,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3290-91,NDC,,,facility,both,1,EA,,8.3,8.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01) / 50 Ml In 1 Vial,636,RC,0703-0018-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01) / 50 Ml In 1 Vial,636,RC,0703-0018-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0703-0113-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0703-0113-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Octreotide Acetate: 25 VIAL, SINGLE-USE in 1 TRAY (0703-3301-04) / 1 mL in 1 VIAL, SINGLE-USE (0703-3301-01) ",636,RC,0703-3301-04,NDC,,,facility,both,1,EA,,5.96,5.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,0703-3671-01,NDC,,,facility,both,1,EA,,84.09,84.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,0703-3671-01,NDC,,,facility,both,1,EA,,81.7,81.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,0703-3671-01,NDC,,,facility,both,1,EA,,51.63,51.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0703-3985-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0703-3985-01,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carboplatin: 1 Vial, Multi-Dose In 1 Carton (0703-4246-01) / 15 Ml In 1 Vial, Multi-Dose",636,RC,0703-4246-01,NDC,,,facility,both,1,EA,,32.02,32.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0703-4502-01,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enoxaparin Sodium: 10 SYRINGE in 1 CARTON (0703-8580-23) / 1 mL in 1 SYRINGE (0703-8580-21) ,636,RC,0703-8580-23,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0703-9514-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0703-9514-81,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0703-9514-91,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,0703-3671-01,NDC,,,facility,both,1,EA,,42.47,42.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6267-01,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6145-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6145-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6149-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6151-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6174-01,NDC,,,facility,both,1,EA,,3.27,3.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 20 Ml In 1 Vial, Multi-Dose (0641-6286-01)",636,RC,0641-6286-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6174-01,NDC,,,facility,both,1,EA,,3.26,3.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6175-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6184-01,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6184-01,NDC,,,facility,both,1,EA,,4.18,4.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenylephrine Hydrochloride: 10 Vial, Pharmacy Bulk Package In 1 Carton (0641-6188-10) / 5 Ml In 1 Vial, Pharmacy Bulk Package (0641-6188-01)",636,RC,0641-6188-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6190-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6228-01,NDC,,,facility,both,1,EA,,5,5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Thiamine Hydrochloride: 25 Vial In 1 Carton (0641-6228-25) / 2 Ml In 1 Vial (0641-6228-01),636,RC,0641-6228-25,NDC,,,facility,both,1,EA,,5.01,5.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6244-01,NDC,,,facility,both,1,EA,,31.09,31.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6175-01,NDC,,,facility,both,1,EA,,0.99,0.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial, Single-Use In 1 Carton (0781-3114-95) / 20 Ml In 1 Vial, Single-Use (0781-3114-91)",636,RC,0781-3114-95,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3156-06,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3156-06,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3209-90,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3233-94) / 25 Ml In 1 Vial, Single-Dose",636,RC,0781-3233-94,NDC,,,facility,both,1,EA,,2.26,2.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3114-91,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3233-94) / 25 Ml In 1 Vial, Single-Dose",636,RC,0781-3233-94,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94) / 50 Ml In 1 Vial, Single-Dose",636,RC,0781-3244-94,NDC,,,facility,both,1,EA,,2.97,2.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94) / 50 Ml In 1 Vial, Single-Dose",636,RC,0781-3244-94,NDC,,,facility,both,1,EA,,2.66,2.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94) / 50 Ml In 1 Vial, Single-Dose",636,RC,0781-3244-94,NDC,,,facility,both,1,EA,,2.33,2.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94) / 50 Ml In 1 Vial, Single-Dose",636,RC,0781-3244-94,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94) / 50 Ml In 1 Vial, Single-Dose",636,RC,0781-3244-94,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3289-91,NDC,,,facility,both,1,EA,,10.24,10.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3289-91,NDC,,,facility,both,1,EA,,10.23,10.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3290-91,NDC,,,facility,both,1,EA,,8.33,8.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3233-94) / 25 Ml In 1 Vial, Single-Dose",636,RC,0781-3233-94,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3113-90,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3110-90,NDC,,,facility,both,1,EA,,3.32,3.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tacrolimus: 100 Capsule In 1 Bottle (0781-2103-01),636,RC,0781-2103-01,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3059-72,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3059-72,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3098-94,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0781-3110-90,NDC,,,facility,both,1,EA,,3.6,3.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxaliplatin: 1 Vial, Single-Use In 1 Carton (0781-3315-70) / 10 Ml In 1 Vial, Single-Use",636,RC,0781-3315-70,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box (0904-5306-61) / 10 Capsule In 1 Blister Pack,636,RC,0904-5306-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perphenazine: 100 Blister Pack In 1 Carton (0904-6599-61) / 1 Tablet, Film Coated In 1 Blister Pack",636,RC,0904-6599-61,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tacrolimus: 100 Blister Pack In 1 Carton (0904-6624-61) / 1 Capsule In 1 Blister Pack,636,RC,0904-6624-61,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,14789-136-07,NDC,,,facility,both,1,EA,,4.02,4.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,14789-137-07,NDC,,,facility,both,1,EA,,2.9,2.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,14789-137-07,NDC,,,facility,both,1,EA,,2.87,2.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,42494-415-01,NDC,,,facility,both,1,EA,,34.23,34.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,42023-230-01,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Adrenalin: 1 Vial In 1 Carton (42023-168-99) / 30 Ml In 1 Vial,636,RC,42023-168-99,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetazolamide: 1 Vial, Glass In 1 Carton (39822-0190-1) / 5 Ml In 1 Vial, Glass",636,RC,39822-0190-1,NDC,,,facility,both,1,EA,,52.31,52.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetazolamide: 1 Vial, Glass In 1 Carton (39822-0190-1) / 5 Ml In 1 Vial, Glass",636,RC,39822-0190-1,NDC,,,facility,both,1,EA,,47.13,47.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tobramycin: 1 Vial In 1 Carton (39822-0412-1) / 30 Ml In 1 Vial,636,RC,39822-0412-1,NDC,,,facility,both,1,EA,,9.57,9.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Folic Acid: 1 Vial, Multi-Dose In 1 Carton (39822-1100-1) / 10 Ml In 1 Vial, Multi-Dose",636,RC,39822-1100-1,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,42023-173-01,NDC,,,facility,both,1,EA,,86.94,86.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dactinomycin: 1 Vial, Single-Dose In 1 Carton (39822-2100-2) / 1 Ml In 1 Vial, Single-Dose (39822-2100-1)",636,RC,39822-2100-2,NDC,,,facility,both,1,EA,,1012.08,1012.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pitocin: 25 Vial In 1 Tray (42023-116-25) / 1 Ml In 1 Vial,636,RC,42023-116-25,NDC,,,facility,both,1,EA,,9.5,9.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Adrenalin: 25 Vial In 1 Carton (42023-159-25) / 1 Ml In 1 Vial (42023-159-01),636,RC,42023-159-25,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,42023-164-01,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Adrenalin: 1 Vial In 1 Carton (42023-168-01) / 30 Ml In 1 Vial,636,RC,42023-168-01,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cladribine: 1 Ml In 1 Vial, Single-Dose (42658-010-01)",636,RC,42658-010-01,NDC,,,facility,both,1,EA,,37.42,37.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Daunorubicin Hydrochloride: 1 Vial In 1 Box (42658-021-01) / 4 Ml In 1 Vial,636,RC,42658-021-01,NDC,,,facility,both,1,EA,,103.76,103.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Daunorubicin Hydrochloride: 1 Vial In 1 Box (42658-021-01) / 4 Ml In 1 Vial,636,RC,42658-021-01,NDC,,,facility,both,1,EA,,85.69,85.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Daunorubicin Hydrochloride: 10 Vial In 1 Carton (42658-021-02) / 4 Ml In 1 Vial,636,RC,42658-021-02,NDC,,,facility,both,1,EA,,52.08,52.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Daunorubicin Hydrochloride: 10 Vial In 1 Carton (42658-021-02) / 4 Ml In 1 Vial,636,RC,42658-021-02,NDC,,,facility,both,1,EA,,52.07,52.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01) / 5 Ml In 1 Vial, Glass",636,RC,42747-761-01,NDC,,,facility,both,1,EA,,799.35,799.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01) / 5 Ml In 1 Vial, Glass",636,RC,42747-761-01,NDC,,,facility,both,1,EA,,751.5,751.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01) / 5 Ml In 1 Vial, Glass",636,RC,42747-761-01,NDC,,,facility,both,1,EA,,751.5,751.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nexterone: 200 Ml In 1 Bag (43066-360-20),636,RC,43066-360-20,NDC,,,facility,both,1,EA,,5.98,5.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,36000-308-01,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25) / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,31722-203-32,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Olanzapine: 1 Vial In 1 Carton (31722-308-01) / 2 Ml In 1 Vial,636,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Olanzapine: 1 Vial In 1 Carton (31722-308-01) / 2 Ml In 1 Vial,636,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Olanzapine: 1 Vial In 1 Carton (31722-308-01) / 2 Ml In 1 Vial,636,RC,31722-308-01,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciprofloxacin: 100 Ml In 1 Bag (36000-008-24),636,RC,36000-008-24,NDC,,,facility,both,1,EA,,8.34,8.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoprolol: 10 Vial In 1 Carton (36000-033-10) / 5 Ml In 1 Vial,636,RC,36000-033-10,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoprolol: 10 Vial In 1 Carton (36000-033-10) / 5 Ml In 1 Vial,636,RC,36000-033-10,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25) / 2 Ml In 1 Vial, Single-Dose",636,RC,36000-282-25,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25) / 2 Ml In 1 Vial, Single-Dose",636,RC,36000-282-25,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25) / 2 Ml In 1 Vial, Single-Dose",636,RC,36000-282-25,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25) / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25) / 10 Ml In 1 Vial, Single-Dose",636,RC,36000-284-25,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acyclovir: 473 Ml In 1 Bottle (31722-681-47),636,RC,31722-681-47,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciprofloxacin: 200 Ml In 1 Bag (36000-298-24),636,RC,36000-298-24,NDC,,,facility,both,1,EA,,3.28,3.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Phosphate: 24 Bag In 1 Case (43066-995-24) / 50 Ml In 1 Bag,636,RC,43066-995-24,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-049-40) / 10 Ml In 1 Vial, Single-Dose",636,RC,47335-049-40,NDC,,,facility,both,1,EA,,534.28,534.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-049-40) / 10 Ml In 1 Vial, Single-Dose",636,RC,47335-049-40,NDC,,,facility,both,1,EA,,501.03,501.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-050-40) / 25 Ml In 1 Vial, Single-Dose",636,RC,47335-050-40,NDC,,,facility,both,1,EA,,978.35,978.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-050-40) / 25 Ml In 1 Vial, Single-Dose",636,RC,47335-050-40,NDC,,,facility,both,1,EA,,678.41,678.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-050-40) / 25 Ml In 1 Vial, Single-Dose",636,RC,47335-050-40,NDC,,,facility,both,1,EA,,659.59,659.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-050-40) / 25 Ml In 1 Vial, Single-Dose",636,RC,47335-050-40,NDC,,,facility,both,1,EA,,647.81,647.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,47335-703-48,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 1 Bag In 1 Pouch (47335-993-01) / 100 Ml In 1 Bag,636,RC,47335-993-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 1 Bag In 1 Pouch (47335-993-01) / 100 Ml In 1 Bag,636,RC,47335-993-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (47335-049-40) / 10 Ml In 1 Vial, Single-Dose",636,RC,47335-049-40,NDC,,,facility,both,1,EA,,1044.81,1044.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vinorelbine: 1 Vial, Single-Dose In 1 Carton (45963-607-55) / 1 Ml In 1 Vial, Single-Dose",636,RC,45963-607-55,NDC,,,facility,both,1,EA,,54.04,54.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fludarabine Phosphate: 1 Vial, Glass In 1 Carton (45963-609-55) / 2 Ml In 1 Vial, Glass",636,RC,45963-609-55,NDC,,,facility,both,1,EA,,201.97,201.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,45802-758-00,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,45802-759-00,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (47781-586-29) / 20 Ml In 1 Vial, Multi-Dose",636,RC,47781-586-29,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-860-78,NDC,,,facility,both,1,EA,,129.52,129.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-123-88,NDC,,,facility,both,1,EA,,145.03,145.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-124-88,NDC,,,facility,both,1,EA,,193.81,193.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-124-88,NDC,,,facility,both,1,EA,,189.21,189.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-125-65) / .5 Ml In 1 Syringe, Glass (49281-125-88)",636,RC,49281-125-65,NDC,,,facility,both,1,EA,,162.94,162.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-125-88,NDC,,,facility,both,1,EA,,162.94,162.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-215-88,NDC,,,facility,both,1,EA,,113.87,113.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-286-58,NDC,,,facility,both,1,EA,,83.98,83.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Beyfortus: 1 Syringe In 1 Carton (49281-575-00) / .5 Ml In 1 Syringe,636,RC,49281-575-00,NDC,,,facility,both,1,EA,,1576.13,1576.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-590-58,NDC,,,facility,both,1,EA,,444.17,444.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,49281-590-58,NDC,,,facility,both,1,EA,,431.29,431.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ipol: 1 Vial, Multi-Dose In 1 Package (49281-860-10) / 5 Ml In 1 Vial, Multi-Dose (49281-860-78)",636,RC,49281-860-10,NDC,,,facility,both,1,EA,,120.94,120.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Phosphate: 24 Bag In 1 Case (43066-993-24) / 50 Ml In 1 Bag,636,RC,43066-993-24,NDC,,,facility,both,1,EA,,7.02,7.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43547-639-01,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43547-639-01,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (43598-051-11) / 2 Ml In 1 Vial, Multi-Dose",636,RC,43598-051-11,NDC,,,facility,both,1,EA,,1889.76,1889.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43598-078-11,NDC,,,facility,both,1,EA,,18.01,18.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43598-106-11,NDC,,,facility,both,1,EA,,18.5,18.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-128-11) / 8 Ml In 1 Vial, Multi-Dose",636,RC,43598-128-11,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-130-74) / 16 Ml In 1 Vial, Multi-Dose",636,RC,43598-130-74,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43547-639-01,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-130-74) / 16 Ml In 1 Vial, Multi-Dose",636,RC,43598-130-74,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (43598-283-35) / 10 Ml In 1 Vial, Single-Dose",636,RC,43598-283-35,NDC,,,facility,both,1,EA,,593.63,593.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed Disodium: 1 Vial, Single-Dose In 1 Carton (43598-387-11) / 20 Ml In 1 Vial, Single-Dose",636,RC,43598-387-11,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43598-405-11,NDC,,,facility,both,1,EA,,5.01,5.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,43598-426-60,NDC,,,facility,both,1,EA,,4.84,4.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,43598-426-60,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,43598-426-60,NDC,,,facility,both,1,EA,,4.41,4.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,43598-426-60,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Phosphate: 24 Bag In 1 Case (43066-995-24) / 50 Ml In 1 Bag,636,RC,43066-995-24,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43528-003-01,NDC,,,facility,both,1,EA,,414.78,414.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43528-003-01,NDC,,,facility,both,1,EA,,388.33,388.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43547-543-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (43598-541-25) / 25 Ml In 1 Vial, Single-Dose",636,RC,43598-541-25,NDC,,,facility,both,1,EA,,611.62,611.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nafcillin: 10 Vial In 1 Carton (44567-221-10) / 1 Powder, For Solution In 1 Vial",636,RC,44567-221-10,NDC,,,facility,both,1,EA,,25.44,25.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ceftazidime: 25 Vial In 1 Carton (44567-235-25) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-235-25,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ceftazidime: 10 Vial In 1 Carton (44567-236-10) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-236-10,NDC,,,facility,both,1,EA,,3.95,3.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefepime: 10 Vial In 1 Carton (44567-240-10) / 20 Ml In 1 Vial,636,RC,44567-240-10,NDC,,,facility,both,1,EA,,3.56,3.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Dextrose: 24 Bag In 1 Carton (44567-410-24) / 100 Ml In 1 Bag,636,RC,44567-410-24,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-420-24) / 1 Bag In 1 Pouch / 50 Ml In 1 Bag,636,RC,44567-420-24,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cisplatin: 1 Vial, Multi-Dose In 1 Carton (44567-510-01) / 100 Ml In 1 Vial, Multi-Dose",636,RC,44567-510-01,NDC,,,facility,both,1,EA,,15.03,15.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,44567-621-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial In 1 Box (44567-803-10) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,44567-803-10,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ampicillin And Sulbactam: 10 Vial In 1 Carton (44567-210-10) / 10 Ml In 1 Vial,636,RC,44567-210-10,NDC,,,facility,both,1,EA,,5.97,5.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,44567-820-01,NDC,,,facility,both,1,EA,,24.33,24.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,44206-438-92,NDC,,,facility,both,1,EA,,101.83,101.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Privigen: 1 Vial, Glass In 1 Carton (44206-438-20) / 200 Ml In 1 Vial, Glass (44206-438-92)",636,RC,44206-438-20,NDC,,,facility,both,1,EA,,101.83,101.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,43598-549-52,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carmustine: 1 Kit In 1 Carton (43598-628-57) * 3 Ml In 1 Vial (43598-860-11) * 30 Ml In 1 Vial, Single-Dose (43598-861-11)",636,RC,43598-628-57,NDC,,,facility,both,1,EA,,1229.99,1229.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Triamcinolone Acetonide: 1 Vial, Multi-Dose In 1 Carton (43598-676-11) / 5 Ml In 1 Vial, Multi-Dose",636,RC,43598-676-11,NDC,,,facility,both,1,EA,,6.5,6.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (43598-682-35) / 10 Ml In 1 Vial, Single-Dose",636,RC,43598-682-35,NDC,,,facility,both,1,EA,,237.46,237.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (43598-683-25) / 25 Ml In 1 Vial, Single-Dose",636,RC,43598-683-25,NDC,,,facility,both,1,EA,,659.59,659.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (43598-683-25) / 25 Ml In 1 Vial, Single-Dose",636,RC,43598-683-25,NDC,,,facility,both,1,EA,,593.63,593.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naloxone Hydrochloride: 1 Syringe In 1 Box (43598-750-11) / 2 Ml In 1 Syringe,636,RC,43598-750-11,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ofirmev: 24 VIAL, GLASS in 1 CARTON (43825-102-01) / 100 mL in 1 VIAL, GLASS",636,RC,43825-102-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rhophylac: 1 Syringe, Glass In 1 Carton (44206-300-01) / 2 Ml In 1 Syringe, Glass (44206-300-90)",636,RC,44206-300-01,NDC,,,facility,both,1,EA,,214.32,214.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,44206-300-90,NDC,,,facility,both,1,EA,,213.49,213.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Alburx: 1 Vial, Glass In 1 Carton (44206-310-50) / 500 Ml In 1 Vial, Glass (44206-310-91)",636,RC,44206-310-50,NDC,,,facility,both,1,EA,,104.66,104.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,44206-310-91,NDC,,,facility,both,1,EA,,104.66,104.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,44206-310-91,NDC,,,facility,both,1,EA,,104.66,104.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,44206-310-91,NDC,,,facility,both,1,EA,,104.66,104.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Privigen: 1 Vial, Glass In 1 Carton (44206-438-20) / 200 Ml In 1 Vial, Glass (44206-438-92)",636,RC,44206-438-20,NDC,,,facility,both,1,EA,,107.1,107.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mycophenolic Acid: 120 Tablet, Delayed Release In 1 Bottle (16729-189-29)",636,RC,16729-189-29,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mycophenolic Acid: 120 Tablet, Delayed Release In 1 Bottle (16729-261-29)",636,RC,16729-261-29,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methotrexate: 1 Vial In 1 Carton (16729-277-30) / 2 Ml In 1 Vial,636,RC,16729-277-30,NDC,,,facility,both,1,EA,,79.44,79.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methotrexate: 1 Vial In 1 Carton (16729-277-30) / 2 Ml In 1 Vial,636,RC,16729-277-30,NDC,,,facility,both,1,EA,,52.3,52.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methotrexate: 1 Vial In 1 Carton (16729-277-30) / 2 Ml In 1 Vial,636,RC,16729-277-30,NDC,,,facility,both,1,EA,,51.75,51.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methotrexate: 1 Vial In 1 Carton (16729-277-30) / 2 Ml In 1 Vial,636,RC,16729-277-30,NDC,,,facility,both,1,EA,,39.46,39.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cisplatin: 50 Ml In 1 Vial (16729-288-11),636,RC,16729-288-11,NDC,,,facility,both,1,EA,,23.1,23.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cisplatin: 50 Ml In 1 Vial (16729-288-11),636,RC,16729-288-11,NDC,,,facility,both,1,EA,,20.38,20.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cisplatin: 100 Ml In 1 Vial (16729-288-38),636,RC,16729-288-38,NDC,,,facility,both,1,EA,,16.14,16.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cisplatin: 100 Ml In 1 Vial (16729-288-38),636,RC,16729-288-38,NDC,,,facility,both,1,EA,,14.11,14.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Succinylcholine Chloride: 1 VIAL, MULTI-DOSE in 1 CARTON (16729-493-03) / 10 mL in 1 VIAL, MULTI-DOSE",636,RC,16729-493-03,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Topotecan Hydrochloride: 1 Vial In 1 Package (16729-151-31) / 4 Ml In 1 Vial,636,RC,16729-151-31,NDC,,,facility,both,1,EA,,10.84,10.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Topotecan Hydrochloride: 1 Vial In 1 Package (16729-151-31) / 4 Ml In 1 Vial,636,RC,16729-151-31,NDC,,,facility,both,1,EA,,12.84,12.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mycophenolate Mofetil: 100 Capsule In 1 Bottle (16729-094-01),636,RC,16729-094-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-08) / 25 Ml In 1 Vial, Multi-Dose",636,RC,16729-114-08,NDC,,,facility,both,1,EA,,7.76,7.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-11) / 50 Ml In 1 Vial, Multi-Dose",636,RC,16729-114-11,NDC,,,facility,both,1,EA,,8.77,8.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-11) / 50 Ml In 1 Vial, Multi-Dose",636,RC,16729-114-11,NDC,,,facility,both,1,EA,,7.31,7.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,16714-016-01,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-016-10) / .4 Ml In 1 Syringe (16714-016-01),636,RC,16714-016-10,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,16714-026-01,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 1 Vial, Single-Dose In 1 Carton (16714-027-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,16714-027-01,NDC,,,facility,both,1,EA,,27.77,27.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 1 Vial, Single-Dose In 1 Carton (16714-027-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,16714-027-01,NDC,,,facility,both,1,EA,,12.67,12.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 1 Vial, Single-Dose In 1 Carton (16714-027-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,16714-027-01,NDC,,,facility,both,1,EA,,9.89,9.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-049-01)",636,RC,16714-049-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (16714-137-01) / 50 Ml In 1 Vial, Multi-Dose",636,RC,16714-137-01,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (16714-137-01) / 50 Ml In 1 Vial, Multi-Dose",636,RC,16714-137-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,15054-0043-1,NDC,,,facility,both,1,EA,,151.81,151.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,15054-0043-1,NDC,,,facility,both,1,EA,,150.7,150.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,15054-0043-1,NDC,,,facility,both,1,EA,,147.05,147.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,15054-0043-1,NDC,,,facility,both,1,EA,,142.36,142.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,15054-0043-1,NDC,,,facility,both,1,EA,,140.12,140.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,15054-0043-1,NDC,,,facility,both,1,EA,,139.18,139.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dysport: 1 Vial In 1 Carton (15054-0530-6) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,15054-0530-6,NDC,,,facility,both,1,EA,,27.09,27.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dysport: 1 Vial In 1 Carton (15054-0530-6) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,15054-0530-6,NDC,,,facility,both,1,EA,,25.2,25.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4) / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe,636,RC,15054-1120-4,NDC,,,facility,both,1,EA,,227.99,227.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4) / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe,636,RC,15054-1120-4,NDC,,,facility,both,1,EA,,227.99,227.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4) / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe,636,RC,15054-1120-4,NDC,,,facility,both,1,EA,,145.64,145.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,16714-006-01,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4) / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe,636,RC,15054-1120-4,NDC,,,facility,both,1,EA,,140.89,140.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,16714-200-10,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 1 Blister Pack In 1 Carton (16714-201-10) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,16714-201-10,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 1 Blister Pack In 1 Carton (16714-201-10) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,16714-201-10,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,16714-301-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-87) / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,636,RC,25021-192-87,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vinorelbine: 1 Vial In 1 Carton (25021-204-05) / 5 Ml In 1 Vial,636,RC,25021-204-05,NDC,,,facility,both,1,EA,,34.91,34.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vinorelbine: 1 Vial In 1 Carton (25021-204-05) / 5 Ml In 1 Vial,636,RC,25021-204-05,NDC,,,facility,both,1,EA,,32.79,32.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vinorelbine: 1 Vial In 1 Carton (25021-204-05) / 5 Ml In 1 Vial,636,RC,25021-204-05,NDC,,,facility,both,1,EA,,23.16,23.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxorubicin Hydrochloride: 1 Vial In 1 Carton (25021-207-51) / 100 Ml In 1 Vial,636,RC,25021-207-51,NDC,,,facility,both,1,EA,,26.15,26.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxorubicin Hydrochloride: 1 Vial In 1 Carton (25021-207-51) / 100 Ml In 1 Vial,636,RC,25021-207-51,NDC,,,facility,both,1,EA,,12.9,12.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluorouracil: 1 Bottle In 1 Carton (25021-215-98) / 50 Ml In 1 Bottle,636,RC,25021-215-98,NDC,,,facility,both,1,EA,,31.77,31.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluorouracil: 1 Bottle In 1 Carton (25021-215-98) / 50 Ml In 1 Bottle,636,RC,25021-215-98,NDC,,,facility,both,1,EA,,26.96,26.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluorouracil: 1 Bottle In 1 Carton (25021-215-99) / 100 Ml In 1 Bottle,636,RC,25021-215-99,NDC,,,facility,both,1,EA,,26.39,26.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluorouracil: 1 Bottle In 1 Carton (25021-215-99) / 100 Ml In 1 Bottle,636,RC,25021-215-99,NDC,,,facility,both,1,EA,,23.99,23.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-82) / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,25021-192-82,NDC,,,facility,both,1,EA,,6.25,6.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Decitabine: 1 Vial In 1 Carton (25021-219-20) / 20 Ml In 1 Vial,636,RC,25021-219-20,NDC,,,facility,both,1,EA,,7.77,7.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irinotecan Hydrochloride: 1 Vial In 1 Carton (25021-230-02) / 2 Ml In 1 Vial,636,RC,25021-230-02,NDC,,,facility,both,1,EA,,39.72,39.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irinotecan Hydrochloride: 1 Vial In 1 Carton (25021-230-02) / 2 Ml In 1 Vial,636,RC,25021-230-02,NDC,,,facility,both,1,EA,,33.98,33.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irinotecan Hydrochloride: 1 Vial In 1 Carton (25021-230-02) / 2 Ml In 1 Vial,636,RC,25021-230-02,NDC,,,facility,both,1,EA,,30.59,30.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irinotecan Hydrochloride: 1 Vial In 1 Carton (25021-230-02) / 2 Ml In 1 Vial,636,RC,25021-230-02,NDC,,,facility,both,1,EA,,30.52,30.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51) / 50 Ml In 1 Vial,636,RC,25021-248-51,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51) / 50 Ml In 1 Vial,636,RC,25021-248-51,NDC,,,facility,both,1,EA,,2.01,2.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51) / 50 Ml In 1 Vial,636,RC,25021-248-51,NDC,,,facility,both,1,EA,,1.84,1.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51) / 50 Ml In 1 Vial,636,RC,25021-248-51,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51) / 50 Ml In 1 Vial,636,RC,25021-248-51,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51) / 50 Ml In 1 Vial,636,RC,25021-248-51,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Decitabine: 1 Vial In 1 Carton (25021-219-20) / 20 Ml In 1 Vial,636,RC,25021-219-20,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-66) / 18 Ml In 1 Vial,636,RC,25021-305-66,NDC,,,facility,both,1,EA,,91.75,91.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Micafungin: 1 Vial In 1 Carton (25021-191-10) / 5 Ml In 1 Vial,636,RC,25021-191-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 10 Pouch In 1 Carton (25021-184-87) / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,636,RC,25021-184-87,NDC,,,facility,both,1,EA,,5.92,5.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mycophenolic Acid: 120 Tablet, Delayed Release In 1 Bottle (24979-161-44)",636,RC,24979-161-44,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ganciclovir: 25 Vial In 1 Carton (25021-185-10) / 10 Ml In 1 Vial,636,RC,25021-185-10,NDC,,,facility,both,1,EA,,56.3,56.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 25 VIAL in 1 CARTON (25021-101-67) / 3 mL in 1 VIAL,636,RC,25021-101-67,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 25 VIAL in 1 CARTON (25021-101-67) / 3 mL in 1 VIAL,636,RC,25021-101-67,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciprofloxacin: 24 Pouch In 1 Carton (25021-114-87) / 1 Bag In 1 Pouch / 200 Ml In 1 Bag,636,RC,25021-114-87,NDC,,,facility,both,1,EA,,3.87,3.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin: 25 Vial In 1 Carton (25021-115-04) / 4 Ml In 1 Vial,636,RC,25021-115-04,NDC,,,facility,both,1,EA,,5.58,5.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefepime: 10 Vial In 1 Carton (25021-121-20) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,25021-121-20,NDC,,,facility,both,1,EA,,6.03,6.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levofloxacin: 24 Pouch In 1 Carton (25021-132-83) / 1 Bag In 1 Pouch / 150 Ml In 1 Bag,636,RC,25021-132-83,NDC,,,facility,both,1,EA,,6.26,6.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin: 1 Bottle In 1 Carton (25021-157-99) / 100 Ml In 1 Bottle,636,RC,25021-157-99,NDC,,,facility,both,1,EA,,12.1,12.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin, Tazobactam: 10 VIAL in 1 CARTON (25021-164-30) / 10 mL in 1 VIAL",636,RC,25021-164-30,NDC,,,facility,both,1,EA,,9.24,9.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Azithromycin: 10 Vial In 1 Carton (25021-180-66) / 5 Ml In 1 Vial,636,RC,25021-180-66,NDC,,,facility,both,1,EA,,8.23,8.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 10 Pouch In 1 Carton (25021-184-66) / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,25021-184-66,NDC,,,facility,both,1,EA,,9.83,9.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 10 Pouch In 1 Carton (25021-184-82) / 1 Bag In 1 Pouch / 100 Ml In 1 Bag,636,RC,25021-184-82,NDC,,,facility,both,1,EA,,9.69,9.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-66) / 18 Ml In 1 Vial,636,RC,25021-305-66,NDC,,,facility,both,1,EA,,91.73,91.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Milrinone Lactate In Dextrose: 10 Bag In 1 Carton (25021-313-82) / 100 Ml In 1 Bag,636,RC,25021-313-82,NDC,,,facility,both,1,EA,,5.43,5.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Adenosine: 10 Vial In 1 Carton (25021-318-02) / 2 Ml In 1 Vial,636,RC,25021-318-02,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Soliris: 1 Vial In 1 Carton (25682-001-01) / 30 Ml In 1 Vial,636,RC,25682-001-01,NDC,,,facility,both,1,EA,,622.13,622.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Soliris: 1 Vial In 1 Carton (25682-001-01) / 30 Ml In 1 Vial,636,RC,25682-001-01,NDC,,,facility,both,1,EA,,142.75,142.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-025-01) / 3 Ml In 1 Vial, Glass",636,RC,25682-025-01,NDC,,,facility,both,1,EA,,685.3,685.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-025-01) / 3 Ml In 1 Vial, Glass",636,RC,25682-025-01,NDC,,,facility,both,1,EA,,638.57,638.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-025-01) / 3 Ml In 1 Vial, Glass",636,RC,25682-025-01,NDC,,,facility,both,1,EA,,623,623,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-025-01) / 3 Ml In 1 Vial, Glass",636,RC,25682-025-01,NDC,,,facility,both,1,EA,,623,623,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-025-01) / 3 Ml In 1 Vial, Glass",636,RC,25682-025-01,NDC,,,facility,both,1,EA,,623,623,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01) / 11 Ml In 1 Vial, Glass",636,RC,25682-028-01,NDC,,,facility,both,1,EA,,685.3,685.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01) / 11 Ml In 1 Vial, Glass",636,RC,25682-028-01,NDC,,,facility,both,1,EA,,645.65,645.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01) / 11 Ml In 1 Vial, Glass",636,RC,25682-028-01,NDC,,,facility,both,1,EA,,623,623,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Soliris: 1 Vial In 1 Carton (25682-001-01) / 30 Ml In 1 Vial,636,RC,25682-001-01,NDC,,,facility,both,1,EA,,622.13,622.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01) / 11 Ml In 1 Vial, Glass",636,RC,25682-028-01,NDC,,,facility,both,1,EA,,623,623,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Soliris: 1 Vial In 1 Carton (25682-001-01) / 30 Ml In 1 Vial,636,RC,25682-001-01,NDC,,,facility,both,1,EA,,622.13,622.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fomepizole: 1 Vial In 1 Carton (25021-829-02) / 1.5 Ml In 1 Vial,636,RC,25021-829-02,NDC,,,facility,both,1,EA,,8.53,8.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic Acid: 1 Bag In 1 Carton (25021-826-67) / 100 Ml In 1 Bag,636,RC,25021-826-67,NDC,,,facility,both,1,EA,,16.45,16.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Heparin Sodium: 25 Vial In 1 Carton (25021-402-01) / 1 Ml In 1 Vial,636,RC,25021-402-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Thiamine Hydrochloride: 25 Vial In 1 Carton (25021-500-02) / 2 Ml In 1 Vial,636,RC,25021-500-02,NDC,,,facility,both,1,EA,,4.71,4.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Caffeine Citrate: 1 Vial In 1 Carton (25021-601-03) / 3 Ml In 1 Vial,636,RC,25021-601-03,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Caffeine Citrate: 10 Vial In 1 Carton (25021-602-03) / 3 Ml In 1 Vial,636,RC,25021-602-03,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lacosamide: 10 Vial, Glass In 1 Carton (25021-791-20) / 20 Ml In 1 Vial, Glass",636,RC,25021-791-20,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetylcysteine: 4 Vial In 1 Carton (25021-812-30) / 30 Ml In 1 Vial,636,RC,25021-812-30,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetylcysteine: 4 Vial In 1 Carton (25021-812-30) / 30 Ml In 1 Vial,636,RC,25021-812-30,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Carton (25021-814-30) / 10 Ml In 1 Vial,636,RC,25021-814-30,NDC,,,facility,both,1,EA,,10.01,10.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Carton (25021-814-30) / 10 Ml In 1 Vial,636,RC,25021-814-30,NDC,,,facility,both,1,EA,,5.01,5.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 VIAL in 1 CARTON (25021-814-67) / 10 mL in 1 VIAL,636,RC,25021-814-67,NDC,,,facility,both,1,EA,,3.76,3.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Carton (25021-816-30) / 17.5 Ml In 1 Vial,636,RC,25021-816-30,NDC,,,facility,both,1,EA,,5.44,5.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Carton (25021-816-30) / 17.5 Ml In 1 Vial,636,RC,25021-816-30,NDC,,,facility,both,1,EA,,5.27,5.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Carton (25021-816-30) / 17.5 Ml In 1 Vial,636,RC,25021-816-30,NDC,,,facility,both,1,EA,,5.04,5.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Carton (25021-816-30) / 17.5 Ml In 1 Vial,636,RC,25021-816-30,NDC,,,facility,both,1,EA,,5.01,5.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Carton (25021-816-30) / 17.5 Ml In 1 Vial,636,RC,25021-816-30,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic Acid: 1 Bag In 1 Carton (25021-826-67) / 100 Ml In 1 Bag,636,RC,25021-826-67,NDC,,,facility,both,1,EA,,17.12,17.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic Acid: 1 Bag In 1 Carton (25021-826-67) / 100 Ml In 1 Bag,636,RC,25021-826-67,NDC,,,facility,both,1,EA,,17.07,17.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,19515-810-41,NDC,,,facility,both,1,EA,,41.64,41.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,19515-810-41,NDC,,,facility,both,1,EA,,41.64,41.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,19515-904-41,NDC,,,facility,both,1,EA,,42.49,42.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,19515-904-41,NDC,,,facility,both,1,EA,,42.49,42.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flulaval 2025/2026: 10 Syringe In 1 Carton (19515-904-52) / .5 Ml In 1 Syringe (19515-904-41),636,RC,19515-904-52,NDC,,,facility,both,1,EA,,42.49,42.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-240-31,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,18657-117-02,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,18657-117-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (17271-701-05),636,RC,17271-701-05,NDC,,,facility,both,1,EA,,46.42,46.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (17271-701-05),636,RC,17271-701-05,NDC,,,facility,both,1,EA,,42.47,42.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA FENTANYL CITRATE: 10 AMPULE in 1 CARTON (17478-030-05) / 5 mL in 1 AMPULE,636,RC,17478-030-05,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA FENTANYL CITRATE: 25 AMPULE in 1 CARTON (17478-030-55) / 5 mL in 1 AMPULE,636,RC,17478-030-55,NDC,,,facility,both,1,EA,,12.35,12.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylergonovine Maleate: 10 AMPULE in 1 CARTON (17478-501-01) / 1 mL in 1 AMPULE,636,RC,17478-501-01,NDC,,,facility,both,1,EA,,8.19,8.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Adenosine: 10 Vial In 1 Carton (17478-542-02) / 2 Ml In 1 Vial,636,RC,17478-542-02,NDC,,,facility,both,1,EA,,2.89,2.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dronabinol: 1 BOTTLE in 1 CARTON (17478-761-06) / 60 CAPSULE in 1 BOTTLE,636,RC,17478-761-06,NDC,,,facility,both,1,EA,,3.92,3.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Adenosine: 10 VIAL in 1 CARTON (17478-953-02) / 2 mL in 1 VIAL,636,RC,17478-953-02,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-240-31,NDC,,,facility,both,1,EA,,2.77,2.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6142-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-294-31,NDC,,,facility,both,1,EA,,4.98,4.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,24201-100-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,24201-110-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (24201-400-02) / 2 Ml In 1 Vial, Multi-Dose",636,RC,24201-400-02,NDC,,,facility,both,1,EA,,1661.97,1661.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-687-31,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-687-31,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetazolamide: 5 Ml In 1 Vial, Glass (23155-313-31)",636,RC,23155-313-31,NDC,,,facility,both,1,EA,,52.46,52.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prochlorperazine Edisylate: 10 Vial In 1 Package (23155-497-42) / 2 Ml In 1 Vial (23155-497-31),636,RC,23155-497-42,NDC,,,facility,both,1,EA,,12.82,12.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prochlorperazine Edisylate: 10 Vial In 1 Package (23155-497-42) / 2 Ml In 1 Vial (23155-497-31),636,RC,23155-497-42,NDC,,,facility,both,1,EA,,9.1,9.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-547-31,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-548-31,NDC,,,facility,both,1,EA,,1.27,1.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 1 Vial In 1 Carton (23155-549-31) / 20 Ml In 1 Vial,636,RC,23155-549-31,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 1 Vial In 1 Carton (23155-549-31) / 20 Ml In 1 Vial,636,RC,23155-549-31,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amphotericin B: 1 Vial, Single-Dose In 1 Carton (23155-594-31) / 1 Injectable, Liposomal In 1 Vial, Single-Dose",636,RC,23155-594-31,NDC,,,facility,both,1,EA,,48.54,48.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amphotericin B: 1 Vial, Single-Dose In 1 Carton (23155-594-31) / 1 Injectable, Liposomal In 1 Vial, Single-Dose",636,RC,23155-594-31,NDC,,,facility,both,1,EA,,47.59,47.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-600-31,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midazolam Hydrochloride: 25 Vial, Single-Dose In 1 Carton (23155-600-41) / 2 Ml In 1 Vial, Single-Dose (23155-600-31)",636,RC,23155-600-41,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-647-31,NDC,,,facility,both,1,EA,,583.96,583.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carmustine: 1 Kit In 1 Carton (23155-649-41) * 3 Ml In 1 Vial (23155-648-31) * 30 Ml In 1 Vial, Single-Dose (23155-647-31)",636,RC,23155-649-41,NDC,,,facility,both,1,EA,,558.6,558.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carmustine: 1 Kit In 1 Carton (23155-649-41) * 3 Ml In 1 Vial (23155-648-31) * 30 Ml In 1 Vial, Single-Dose (23155-647-31)",636,RC,23155-649-41,NDC,,,facility,both,1,EA,,550.52,550.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-687-31,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,23155-294-31,NDC,,,facility,both,1,EA,,6.66,6.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6137-01,NDC,,,facility,both,1,EA,,3.17,3.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 25 Vial, Single-Dose In 1 Package (0641-6125-25) / 1 Ml In 1 Vial, Single-Dose (0641-6125-01)",636,RC,0641-6125-25,NDC,,,facility,both,1,EA,,6.18,6.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6125-01,NDC,,,facility,both,1,EA,,4.18,4.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zosyn In Galaxy Containers: 24 Bag In 1 Box (0206-8860-02) / 50 Ml In 1 Bag (0206-8860-01),636,RC,0206-8860-02,NDC,,,facility,both,1,EA,,6.75,6.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0206-8860-01,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 84 Container In 1 Case (0264-1510-31) / 50 Ml In 1 Container,636,RC,0264-1510-31,NDC,,,facility,both,1,EA,,41.93,41.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 64 Container In 1 Case (0264-1510-32) / 100 Ml In 1 Container,636,RC,0264-1510-32,NDC,,,facility,both,1,EA,,41.61,41.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 64 Container In 1 Case (0264-1510-32) / 100 Ml In 1 Container,636,RC,0264-1510-32,NDC,,,facility,both,1,EA,,41.59,41.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 84 Container In 1 Case (0264-1800-31) / 50 Ml In 1 Container,636,RC,0264-1800-31,NDC,,,facility,both,1,EA,,44.65,44.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 84 Container In 1 Case (0264-1800-31) / 50 Ml In 1 Container,636,RC,0264-1800-31,NDC,,,facility,both,1,EA,,41.32,41.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 84 Container In 1 Case (0264-1800-31) / 50 Ml In 1 Container,636,RC,0264-1800-31,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 64 Container In 1 Case (0264-1800-32) / 100 Ml In 1 Container,636,RC,0264-1800-32,NDC,,,facility,both,1,EA,,42.69,42.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 84 Container In 1 Case (0264-1510-31) / 50 Ml In 1 Container,636,RC,0264-1510-31,NDC,,,facility,both,1,EA,,43.28,43.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 64 Container In 1 Case (0264-1800-32) / 100 Ml In 1 Container,636,RC,0264-1800-32,NDC,,,facility,both,1,EA,,38.94,38.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 116 Container In 1 Case (0264-1800-36) / 25 Ml In 1 Container,636,RC,0264-1800-36,NDC,,,facility,both,1,EA,,45.87,45.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 16 Container In 1 Case (0264-2201-00) / 1000 Ml In 1 Container,636,RC,0264-2201-00,NDC,,,facility,both,1,EA,,32.31,32.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 16 Container In 1 Case (0264-2201-10) / 500 Ml In 1 Container,636,RC,0264-2201-10,NDC,,,facility,both,1,EA,,41.35,41.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin Sodium: 24 Container In 1 Case (0264-3103-11) / 50 Ml In 1 Container,636,RC,0264-3103-11,NDC,,,facility,both,1,EA,,11.25,11.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 24 Container In 1 Case (0264-4100-90) / 100 Ml In 1 Container,636,RC,0264-4100-90,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0259-1610-01,NDC,,,facility,both,1,EA,,14.62,14.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0259-1610-01,NDC,,,facility,both,1,EA,,14.62,14.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Water: 24 Container In 1 Case (0264-4204-52) / 50 Ml In 1 Container,636,RC,0264-4204-52,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9719-01,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9722-01,NDC,,,facility,both,1,EA,,4.25,4.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9729-01,NDC,,,facility,both,1,EA,,34.39,34.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9744-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9744-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9746-01,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9753-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9753-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9784-01,NDC,,,facility,both,1,EA,,7.1,7.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 2 Ml In 1 Vial, Glass (0143-9702-01)",636,RC,0143-9702-01,NDC,,,facility,both,1,EA,,13.34,13.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalaprilat: 10 Vial In 1 Carton (0143-9786-10) / 2 Ml In 1 Vial (0143-9786-01),636,RC,0143-9786-10,NDC,,,facility,both,1,EA,,11.04,11.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9787-01,NDC,,,facility,both,1,EA,,18.32,18.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9851-01)",636,RC,0143-9851-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9851-01)",636,RC,0143-9851-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9856-01,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9857-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9786-01,NDC,,,facility,both,1,EA,,17.51,17.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cladribine: 1 Vial In 1 Box, Unit-Dose (0143-9871-01) / 10 Ml In 1 Vial",636,RC,0143-9871-01,NDC,,,facility,both,1,EA,,36.78,36.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 2 Ml In 1 Vial, Glass (0143-9702-01)",636,RC,0143-9702-01,NDC,,,facility,both,1,EA,,14.01,14.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9682-01,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9519-01,NDC,,,facility,both,1,EA,,86.68,86.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9519-01,NDC,,,facility,both,1,EA,,21.39,21.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Leucovorin Calcium: 1 Vial In 1 Box, Unit-Dose (0143-9552-01) / 17.5 Ml In 1 Vial",636,RC,0143-9552-01,NDC,,,facility,both,1,EA,,9.32,9.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Leucovorin Calcium: 1 Vial In 1 Box, Unit-Dose (0143-9552-01) / 17.5 Ml In 1 Vial",636,RC,0143-9552-01,NDC,,,facility,both,1,EA,,9.14,9.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Box (0143-9554-01) / 10 Ml In 1 Vial,636,RC,0143-9554-01,NDC,,,facility,both,1,EA,,4.66,4.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leucovorin Calcium: 1 Vial In 1 Box (0143-9555-01) / 5 Ml In 1 Vial,636,RC,0143-9555-01,NDC,,,facility,both,1,EA,,15.74,15.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01) / 1 Ml In 1 Vial,636,RC,0143-9564-01,NDC,,,facility,both,1,EA,,1289.35,1289.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01) / 1 Ml In 1 Vial,636,RC,0143-9564-01,NDC,,,facility,both,1,EA,,1228.08,1228.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Thiotepa: 1 Vial In 1 Box, Unit-Dose (0143-9565-01) / 1.5 Ml In 1 Vial",636,RC,0143-9565-01,NDC,,,facility,both,1,EA,,416.84,416.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 2 Ml In 1 Vial, Glass (0143-9702-01)",636,RC,0143-9702-01,NDC,,,facility,both,1,EA,,33.25,33.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9595-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial In 1 Carton (0143-9606-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9606-01,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Testosterone Cypionate: 1 Ml In 1 Vial (0143-9659-01),636,RC,0143-9659-01,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Testosterone Cypionate: 1 Ml In 1 Vial (0143-9659-01),636,RC,0143-9659-01,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9660-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9660-01,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9680-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9680-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial In 1 Carton (0143-9606-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9606-01,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cladribine: 1 Vial In 1 Box, Unit-Dose (0143-9871-01) / 10 Ml In 1 Vial",636,RC,0143-9871-01,NDC,,,facility,both,1,EA,,32.48,32.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cladribine: 1 Vial In 1 Box, Unit-Dose (0143-9871-01) / 10 Ml In 1 Vial",636,RC,0143-9871-01,NDC,,,facility,both,1,EA,,31.93,31.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9875-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Jemperli: 1 Vial In 1 Carton (0173-0898-03) / 10 Ml In 1 Vial,636,RC,0173-0898-03,NDC,,,facility,both,1,EA,,856.34,856.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Jemperli: 1 Vial In 1 Carton (0173-0898-03) / 10 Ml In 1 Vial,636,RC,0173-0898-03,NDC,,,facility,both,1,EA,,784.92,784.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 3 Ml In 1 Vial (0143-9924-90),636,RC,0143-9924-90,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9983-91,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10) / 3 Ml In 1 Syringe, Plastic",636,RC,0169-6339-10,NDC,,,facility,both,1,EA,,7.45,7.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10) / 3 Ml In 1 Syringe, Plastic",636,RC,0169-6339-10,NDC,,,facility,both,1,EA,,7.18,7.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novoseven Rt: 1 Kit In 1 Kit (0169-7201-01) * 1 Ml In 1 Vial, Glass (0169-7211-11) * 1 Ml In 1 Syringe, Glass (0169-7011-98)",636,RC,0169-7201-01,NDC,,,facility,both,1,EA,,6.27,6.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novoseven Rt: 1 Kit In 1 Kit (0169-7202-01) * 2 Ml In 1 Vial, Glass (0169-7212-11) * 2 Ml In 1 Syringe, Glass (0169-7012-98)",636,RC,0169-7202-01,NDC,,,facility,both,1,EA,,6.27,6.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novoseven Rt: 1 Kit In 1 Kit (0169-7205-01) * 5 Ml In 1 Vial, Glass (0169-7215-11) * 5 Ml In 1 Syringe, Glass (0169-7015-98)",636,RC,0169-7205-01,NDC,,,facility,both,1,EA,,6.27,6.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0169-7211-11,NDC,,,facility,both,1,EA,,6.27,6.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11) / 10 Ml In 1 Vial, Glass",636,RC,0169-7501-11,NDC,,,facility,both,1,EA,,6.12,6.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9519-01,NDC,,,facility,both,1,EA,,86.68,86.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Dextrose: 24 Container In 1 Case (0264-4400-54) / 100 Ml In 1 Container,636,RC,0264-4400-54,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),636,RC,0338-0049-02,NDC,,,facility,both,1,EA,,43,43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),636,RC,0338-0049-02,NDC,,,facility,both,1,EA,,41.22,41.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02),636,RC,0338-0049-02,NDC,,,facility,both,1,EA,,40.51,40.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03),636,RC,0338-0049-03,NDC,,,facility,both,1,EA,,41.46,41.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03),636,RC,0338-0049-03,NDC,,,facility,both,1,EA,,40.94,40.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04),636,RC,0338-0049-04,NDC,,,facility,both,1,EA,,41.32,41.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04),636,RC,0338-0049-04,NDC,,,facility,both,1,EA,,41.25,41.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-11) / 50 Ml In 1 Bag,636,RC,0338-0049-11,NDC,,,facility,both,1,EA,,41.24,41.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-11) / 50 Ml In 1 Bag,636,RC,0338-0049-11,NDC,,,facility,both,1,EA,,41.17,41.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-18) / 100 Ml In 1 Bag,636,RC,0338-0049-18,NDC,,,facility,both,1,EA,,44.92,44.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Package (0338-0049-18) / 100 Ml In 1 Bag,636,RC,0338-0049-18,NDC,,,facility,both,1,EA,,38.2,38.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 16 Bag In 1 Package (0338-0049-38) / 100 Ml In 1 Bag,636,RC,0338-0049-38,NDC,,,facility,both,1,EA,,15.39,15.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1 Bag In 1 Package (0338-0049-41) / 50 Ml In 1 Bag,636,RC,0338-0049-41,NDC,,,facility,both,1,EA,,38.66,38.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1 Bag In 1 Package (0338-0049-41) / 50 Ml In 1 Bag,636,RC,0338-0049-41,NDC,,,facility,both,1,EA,,38.4,38.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03) / 500 Ml In 1 Bottle, Plastic",636,RC,0338-0048-03,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 500 Ml In 1 Bag (0338-0017-03),636,RC,0338-0017-03,NDC,,,facility,both,1,EA,,44.78,44.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 500 Ml In 1 Bag (0338-0017-03),636,RC,0338-0017-03,NDC,,,facility,both,1,EA,,38,38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 1000 Ml In 1 Bag (0338-0017-04),636,RC,0338-0017-04,NDC,,,facility,both,1,EA,,38.27,38.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 4 Bag In 1 Pouch (0338-0017-11) / 50 Ml In 1 Bag,636,RC,0338-0017-11,NDC,,,facility,both,1,EA,,43.07,43.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 4 Bag In 1 Pouch (0338-0017-11) / 50 Ml In 1 Bag,636,RC,0338-0017-11,NDC,,,facility,both,1,EA,,38.1,38.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 4 Bag In 1 Pouch (0338-0017-18) / 100 Ml In 1 Bag,636,RC,0338-0017-18,NDC,,,facility,both,1,EA,,39.07,39.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 4 Bag In 1 Pouch (0338-0017-18) / 100 Ml In 1 Bag,636,RC,0338-0017-18,NDC,,,facility,both,1,EA,,38.2,38.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03) / 500 Ml In 1 Bottle, Plastic",636,RC,0338-0048-03,NDC,,,facility,both,1,EA,,38.17,38.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 16 Bag In 1 Pouch (0338-0017-31) / 50 Ml In 1 Bag,636,RC,0338-0017-31,NDC,,,facility,both,1,EA,,43.1,43.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 1 Bag In 1 Package (0338-0017-41) / 50 Ml In 1 Bag,636,RC,0338-0017-41,NDC,,,facility,both,1,EA,,37.1,37.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 1 Bag In 1 Package (0338-0017-48) / 100 Ml In 1 Bag,636,RC,0338-0017-48,NDC,,,facility,both,1,EA,,38.26,38.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 1 Bag In 1 Package (0338-0017-48) / 100 Ml In 1 Bag,636,RC,0338-0017-48,NDC,,,facility,both,1,EA,,38.25,38.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 250 Ml In 1 Bag (0338-0023-02),636,RC,0338-0023-02,NDC,,,facility,both,1,EA,,40.23,40.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 500 Ml In 1 Bag (0338-0023-03),636,RC,0338-0023-03,NDC,,,facility,both,1,EA,,40.11,40.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 1000 Ml In 1 Bag (0338-0023-04),636,RC,0338-0023-04,NDC,,,facility,both,1,EA,,21.33,21.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 4 Bag In 1 Carton (0338-0047-27) / 3000 Ml In 1 Bag,636,RC,0338-0047-27,NDC,,,facility,both,1,EA,,8.22,8.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 1 Bag In 1 Package (0338-0017-41) / 50 Ml In 1 Bag,636,RC,0338-0017-41,NDC,,,facility,both,1,EA,,38.14,38.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1 Bag In 1 Package (0338-0049-48) / 100 Ml In 1 Bag,636,RC,0338-0049-48,NDC,,,facility,both,1,EA,,42.61,42.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1 Bag In 1 Package (0338-0049-48) / 100 Ml In 1 Bag,636,RC,0338-0049-48,NDC,,,facility,both,1,EA,,37.84,37.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04),636,RC,0338-0117-04,NDC,,,facility,both,1,EA,,38.37,38.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04),636,RC,0338-0117-04,NDC,,,facility,both,1,EA,,38,38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers And Dextrose: 1000 Ml In 1 Bag (0338-0125-04),636,RC,0338-0125-04,NDC,,,facility,both,1,EA,,38.3,38.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Myxredlin: 12 Container In 1 Carton (0338-0126-12) / 100 Ml In 1 Container,636,RC,0338-0126-12,NDC,,,facility,both,1,EA,,2.87,2.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04),636,RC,0338-0117-04,NDC,,,facility,both,1,EA,,38.91,38.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin Sulfate In Sodium Chloride: 100 Ml In 1 Bag (0338-0503-48),636,RC,0338-0503-48,NDC,,,facility,both,1,EA,,9.85,9.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 50 Ml In 1 Bag (0338-0551-11),636,RC,0338-0551-11,NDC,,,facility,both,1,EA,,6.74,6.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 100 Ml In 1 Bag (0338-0551-18),636,RC,0338-0551-18,NDC,,,facility,both,1,EA,,6.3,6.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 50 Ml In 1 Bag (0338-0553-11),636,RC,0338-0553-11,NDC,,,facility,both,1,EA,,40.8,40.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 100 Ml In 1 Bag (0338-0553-18),636,RC,0338-0553-18,NDC,,,facility,both,1,EA,,40.8,40.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 100 Ml In 1 Bag (0338-0553-18),636,RC,0338-0553-18,NDC,,,facility,both,1,EA,,40.79,40.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 500 Ml In 1 Bag (0338-0117-03),636,RC,0338-0117-03,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 500 Ml In 1 Bag (0338-0117-03),636,RC,0338-0117-03,NDC,,,facility,both,1,EA,,41.68,41.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 250 Ml In 1 Bag (0338-0117-02),636,RC,0338-0117-02,NDC,,,facility,both,1,EA,,36.62,36.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-0051-44),636,RC,0338-0051-44,NDC,,,facility,both,1,EA,,59.6,59.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Bag In 1 Carton (0338-0054-03) / 500 Ml In 1 Bag,636,RC,0338-0054-03,NDC,,,facility,both,1,EA,,37.81,37.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 30 Bag In 1 Carton (0338-0062-30) / 250 Ml In 1 Bag,636,RC,0338-0062-30,NDC,,,facility,both,1,EA,,38.59,38.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 30 Bag In 1 Carton (0338-0062-30) / 250 Ml In 1 Bag,636,RC,0338-0062-30,NDC,,,facility,both,1,EA,,36.68,36.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxil: 1 Vial, Single-Use In 1 Carton (0338-0063-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0338-0063-01,NDC,,,facility,both,1,EA,,241.01,241.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxil: 1 Vial, Single-Use In 1 Carton (0338-0063-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0338-0063-01,NDC,,,facility,both,1,EA,,159.24,159.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxil: 1 Vial, Single-Use In 1 Carton (0338-0063-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0338-0063-01,NDC,,,facility,both,1,EA,,150.63,150.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 20 Bag In 1 Carton (0338-0066-20) / 500 Ml In 1 Bag,636,RC,0338-0066-20,NDC,,,facility,both,1,EA,,43.33,43.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 20 Bag In 1 Carton (0338-0066-20) / 500 Ml In 1 Bag,636,RC,0338-0066-20,NDC,,,facility,both,1,EA,,36.21,36.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxil: 1 Vial, Single-Use In 1 Carton (0338-0067-01) / 25 Ml In 1 Vial, Single-Use",636,RC,0338-0067-01,NDC,,,facility,both,1,EA,,225.95,225.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxil: 1 Vial, Single-Use In 1 Carton (0338-0067-01) / 25 Ml In 1 Vial, Single-Use",636,RC,0338-0067-01,NDC,,,facility,both,1,EA,,170.2,170.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxil: 1 Vial, Single-Use In 1 Carton (0338-0067-01) / 25 Ml In 1 Vial, Single-Use",636,RC,0338-0067-01,NDC,,,facility,both,1,EA,,160.8,160.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 10 Bag In 1 Carton (0338-0070-10) / 1000 Ml In 1 Bag,636,RC,0338-0070-10,NDC,,,facility,both,1,EA,,42,42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25) / 1 Ml In 1 Vial,636,RC,0338-0072-25,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25) / 1 Ml In 1 Vial,636,RC,0338-0072-25,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0077-04) / 1000 Ml In 1 Bag,636,RC,0338-0077-04,NDC,,,facility,both,1,EA,,41.8,41.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 24 Bag In 1 Carton (0338-0085-03) / 500 Ml In 1 Bag,636,RC,0338-0085-03,NDC,,,facility,both,1,EA,,39,39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0085-04) / 1000 Ml In 1 Bag,636,RC,0338-0085-04,NDC,,,facility,both,1,EA,,41.8,41.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0085-04) / 1000 Ml In 1 Bag,636,RC,0338-0085-04,NDC,,,facility,both,1,EA,,38.11,38.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0089-04) / 1000 Ml In 1 Bag,636,RC,0338-0089-04,NDC,,,facility,both,1,EA,,19.01,19.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 250 Ml In 1 Bag (0338-0117-02),636,RC,0338-0117-02,NDC,,,facility,both,1,EA,,47.65,47.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 250 Ml In 1 Bag (0338-0017-02),636,RC,0338-0017-02,NDC,,,facility,both,1,EA,,38.23,38.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 250 Ml In 1 Bag (0338-0017-02),636,RC,0338-0017-02,NDC,,,facility,both,1,EA,,40.21,40.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7520-20) / 250 Ml In 1 Container,636,RC,0264-7520-20,NDC,,,facility,both,1,EA,,45.97,45.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00) / 1000 Ml In 1 Container,636,RC,0264-7610-00,NDC,,,facility,both,1,EA,,22.14,22.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7612-00) / 1000 Ml In 1 Container,636,RC,0264-7612-00,NDC,,,facility,both,1,EA,,45.08,45.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7612-00) / 1000 Ml In 1 Container,636,RC,0264-7612-00,NDC,,,facility,both,1,EA,,44.18,44.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7612-10) / 500 Ml In 1 Container,636,RC,0264-7612-10,NDC,,,facility,both,1,EA,,41,41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7616-00) / 1000 Ml In 1 Container,636,RC,0264-7616-00,NDC,,,facility,both,1,EA,,48.4,48.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose: 12 Container In 1 Case (0264-7625-00) / 1000 Ml In 1 Container,636,RC,0264-7625-00,NDC,,,facility,both,1,EA,,5.16,5.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7520-10) / 500 Ml In 1 Container,636,RC,0264-7520-10,NDC,,,facility,both,1,EA,,43.85,43.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 12 Container In 1 Case (0264-7750-07) / 1000 Ml In 1 Container,636,RC,0264-7750-07,NDC,,,facility,both,1,EA,,41.49,41.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 24 Container In 1 Case (0264-7750-10) / 500 Ml In 1 Container,636,RC,0264-7750-10,NDC,,,facility,both,1,EA,,67.65,67.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 24 Container In 1 Case (0264-7750-10) / 500 Ml In 1 Container,636,RC,0264-7750-10,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose In Lactated Ringers: 12 Container In 1 Case (0264-7751-00) / 1000 Ml In 1 Container,636,RC,0264-7751-00,NDC,,,facility,both,1,EA,,44.63,44.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose In Lactated Ringers: 24 Container In 1 Case (0264-7751-10) / 500 Ml In 1 Container,636,RC,0264-7751-10,NDC,,,facility,both,1,EA,,43.69,43.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 12 Container In 1 Case (0264-7800-09) / 1000 Ml In 1 Container,636,RC,0264-7800-09,NDC,,,facility,both,1,EA,,26.67,26.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-7800-20) / 250 Ml In 1 Container,636,RC,0264-7800-20,NDC,,,facility,both,1,EA,,39.31,39.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-7800-20) / 250 Ml In 1 Container,636,RC,0264-7800-20,NDC,,,facility,both,1,EA,,38.95,38.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactated Ringers: 12 Container In 1 Case (0264-7750-07) / 1000 Ml In 1 Container,636,RC,0264-7750-07,NDC,,,facility,both,1,EA,,43.14,43.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-20) / 250 Ml In 1 Container,636,RC,0264-7510-20,NDC,,,facility,both,1,EA,,40.48,40.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 12 Container In 1 Case (0264-5802-00) / 1000 Ml In 1 Container,636,RC,0264-5802-00,NDC,,,facility,both,1,EA,,39.43,39.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 12 Container In 1 Case (0264-5802-00) / 1000 Ml In 1 Container,636,RC,0264-5802-00,NDC,,,facility,both,1,EA,,29.27,29.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-5802-10) / 500 Ml In 1 Container,636,RC,0264-5802-10,NDC,,,facility,both,1,EA,,42.25,42.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-20) / 250 Ml In 1 Container,636,RC,0264-7510-20,NDC,,,facility,both,1,EA,,40.32,40.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-5802-10) / 500 Ml In 1 Container,636,RC,0264-5802-10,NDC,,,facility,both,1,EA,,40.73,40.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-50) / 2000 Ml In 1 Container,636,RC,0264-7388-50,NDC,,,facility,both,1,EA,,14.47,14.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-60) / 3000 Ml In 1 Container,636,RC,0264-7388-60,NDC,,,facility,both,1,EA,,9.9,9.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 12 Container In 1 Case (0264-7510-00) / 1000 Ml In 1 Container,636,RC,0264-7510-00,NDC,,,facility,both,1,EA,,44.87,44.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-10) / 500 Ml In 1 Container,636,RC,0264-7510-10,NDC,,,facility,both,1,EA,,45.07,45.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-10) / 500 Ml In 1 Container,636,RC,0264-7510-10,NDC,,,facility,both,1,EA,,42.97,42.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-10) / 500 Ml In 1 Container,636,RC,0264-7510-10,NDC,,,facility,both,1,EA,,40.23,40.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 24 Container In 1 Case (0264-7510-20) / 250 Ml In 1 Container,636,RC,0264-7510-20,NDC,,,facility,both,1,EA,,44,44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-7800-20) / 250 Ml In 1 Container,636,RC,0264-7800-20,NDC,,,facility,both,1,EA,,37,37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 24 Container In 1 Case (0264-7805-10) / 500 Ml In 1 Container,636,RC,0264-7805-10,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Andexxa: 5 Vial, Single-Use In 1 Carton (0310-3200-05) / 20 Ml In 1 Vial, Single-Use (0310-3200-01)",636,RC,0310-3200-05,NDC,,,facility,both,1,EA,,347.68,347.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4500-12) / 2.4 Ml In 1 Vial,636,RC,0310-4500-12,NDC,,,facility,both,1,EA,,302.42,302.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4500-12) / 2.4 Ml In 1 Vial,636,RC,0310-4500-12,NDC,,,facility,both,1,EA,,296.81,296.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4500-12) / 2.4 Ml In 1 Vial,636,RC,0310-4500-12,NDC,,,facility,both,1,EA,,278.69,278.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4500-12) / 2.4 Ml In 1 Vial,636,RC,0310-4500-12,NDC,,,facility,both,1,EA,,277.17,277.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4500-12) / 2.4 Ml In 1 Vial,636,RC,0310-4500-12,NDC,,,facility,both,1,EA,,277.17,277.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imjudo: 1 Vial In 1 Carton (0310-4535-30) / 15 Ml In 1 Vial,636,RC,0310-4535-30,NDC,,,facility,both,1,EA,,509.74,509.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,317.76,317.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,303.73,303.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,300.05,300.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0310-3200-01,NDC,,,facility,both,1,EA,,347.68,347.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,295.79,295.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,279.88,279.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,279.51,279.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,277.16,277.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Imfinzi: 1 Vial In 1 Carton (0310-4611-50) / 10 Ml In 1 Vial,636,RC,0310-4611-50,NDC,,,facility,both,1,EA,,282.71,282.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0310-3200-01,NDC,,,facility,both,1,EA,,365.07,365.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tagrisso: 30 Tablet, Film Coated In 1 Bottle (0310-1350-30)",636,RC,0310-1350-30,NDC,,,facility,both,1,EA,,1521.63,1521.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Sodium Chloride: 12 Container In 1 Case (0264-7865-00) / 1000 Ml In 1 Container,636,RC,0264-7865-00,NDC,,,facility,both,1,EA,,7.7,7.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Heparin Sodium In Dextrose: 24 Container In 1 Case (0264-9587-20) / 250 Ml In 1 Container,636,RC,0264-9587-20,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9594-10) / 500 Ml In 1 Container,636,RC,0264-9594-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9594-10) / 500 Ml In 1 Container,636,RC,0264-9594-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9594-10) / 500 Ml In 1 Container,636,RC,0264-9594-10,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Kinevac: 10 Vial In 1 Package (0270-0556-15) / 5 Ml In 1 Vial,636,RC,0270-0556-15,NDC,,,facility,both,1,EA,,114.35,114.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Kinevac: 10 Vial In 1 Package (0270-0556-15) / 5 Ml In 1 Vial,636,RC,0270-0556-15,NDC,,,facility,both,1,EA,,101.67,101.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Etoposide: 1 Vial In 1 Box, Unit-Dose (0143-9510-01) / 5 Ml In 1 Vial",636,RC,0143-9510-01,NDC,,,facility,both,1,EA,,6.65,6.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetazolamide: 1 Vial In 1 Box, Unit-Dose (0143-9503-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9503-01,NDC,,,facility,both,1,EA,,55.38,55.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0078-0467-61,NDC,,,facility,both,1,EA,,100.75,100.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desferal: 4 Vial In 1 Carton (0078-0467-91) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0078-0467-61)",636,RC,0078-0467-91,NDC,,,facility,both,1,EA,,94.66,94.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81) * 6 Ml In 1 Vial (0078-0797-61) * 2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,663.17,663.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81) * 6 Ml In 1 Vial (0078-0797-61) * 2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,663.03,663.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81) * 6 Ml In 1 Vial (0078-0797-61) * 2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,663.03,663.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81) * 6 Ml In 1 Vial (0078-0797-61) * 2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,636.1,636.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81) * 6 Ml In 1 Vial (0078-0797-61) * 2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,608.36,608.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81) * 6 Ml In 1 Vial (0078-0797-61) * 2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,602.88,602.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81) * 6 Ml In 1 Vial (0078-0797-61) * 2 Ml In 1 Syringe,636,RC,0078-0818-81,NDC,,,facility,both,1,EA,,602.88,602.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0075-8020-01,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0078-0246-61,NDC,,,facility,both,1,EA,,6.96,6.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0075-0621-01,NDC,,,facility,both,1,EA,,6.55,6.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81) * 2 Ml In 1 Syringe * 6 Ml In 1 Vial (0078-0804-61),636,RC,0078-0825-81,NDC,,,facility,both,1,EA,,662.03,662.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81) * 2 Ml In 1 Syringe * 6 Ml In 1 Vial (0078-0804-61),636,RC,0078-0825-81,NDC,,,facility,both,1,EA,,638.96,638.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81) * 2 Ml In 1 Syringe * 6 Ml In 1 Vial (0078-0804-61),636,RC,0078-0825-81,NDC,,,facility,both,1,EA,,634.1,634.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81) * 2 Ml In 1 Syringe * 6 Ml In 1 Vial (0078-0804-61),636,RC,0078-0825-81,NDC,,,facility,both,1,EA,,601.85,601.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81) * 2 Ml In 1 Syringe * 6 Ml In 1 Vial (0078-0804-61),636,RC,0078-0825-81,NDC,,,facility,both,1,EA,,601.85,601.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,0074-5015-01,NDC,,,facility,both,1,EA,,46.89,46.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,20.31,20.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,12.72,12.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,12.72,12.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,8.99,8.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,7.24,7.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,4.64,4.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,4.32,4.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,24.67,24.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Retacrit: 4 Vial, Single-Dose In 1 Carton (0069-1309-04) / 1 Ml In 1 Vial, Single-Dose (0069-1309-01)",636,RC,0069-1309-04,NDC,,,facility,both,1,EA,,24.67,24.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Retacrit: 4 Vial, Single-Dose In 1 Carton (0069-1309-04) / 1 Ml In 1 Vial, Single-Dose (0069-1309-01)",636,RC,0069-1309-04,NDC,,,facility,both,1,EA,,24.67,24.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Retacrit: 4 Vial, Single-Dose In 1 Carton (0069-1309-04) / 1 Ml In 1 Vial, Single-Dose (0069-1309-01)",636,RC,0069-1309-04,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (0069-1542-20) / 100 Ml In 1 Vial, Multi-Dose",636,RC,0069-1542-20,NDC,,,facility,both,1,EA,,20.02,20.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-2432-01,NDC,,,facility,both,1,EA,,286.22,286.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-2432-01,NDC,,,facility,both,1,EA,,280,280,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-2528-01,NDC,,,facility,both,1,EA,,265.2,265.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-2528-01,NDC,,,facility,both,1,EA,,265.2,265.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Comirnaty: 10 Syringe, Glass In 1 Carton (0069-2528-10) / .418 Ml In 1 Syringe, Glass (0069-2528-01)",636,RC,0069-2528-10,NDC,,,facility,both,1,EA,,262.11,262.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (0069-3034-20) / 100 Ml In 1 Vial, Multi-Dose",636,RC,0069-3034-20,NDC,,,facility,both,1,EA,,17.95,17.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,2.75,2.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zithromax: 1 Bottle In 1 Carton (0069-3120-19) / 15 Ml In 1 Bottle,636,RC,0069-3120-19,NDC,,,facility,both,1,EA,,102.38,102.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,25.31,25.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1308-10) / 1 Ml In 1 Vial, Single-Dose (0069-1308-01)",636,RC,0069-1308-10,NDC,,,facility,both,1,EA,,24.67,24.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Inflectra: 1 Vial, Single-Use In 1 Carton (0069-0809-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0069-0809-01,NDC,,,facility,both,1,EA,,124.25,124.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,3.01,3.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1305-01,NDC,,,facility,both,1,EA,,2.67,2.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1307-01,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,25.31,25.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,24.67,24.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,4.71,4.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,3.45,3.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1309-01,NDC,,,facility,both,1,EA,,48.92,48.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.83,2.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.75,2.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.71,2.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-1308-01,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zithromax: 10 Vial In 1 Carton (0069-3150-83) / 5 Ml In 1 Vial (0069-3150-84),636,RC,0069-3150-83,NDC,,,facility,both,1,EA,,15.65,15.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gengraf: 5 Blister Pack In 1 Carton (0074-3109-32) / 6 Capsule In 1 Blister Pack,636,RC,0074-3109-32,NDC,,,facility,both,1,EA,,8.55,8.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3641-03) * 1 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3641-03,NDC,,,facility,both,1,EA,,6217.14,6217.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3641-03) * 1 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3641-03,NDC,,,facility,both,1,EA,,6216.25,6216.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3641-03) * 1 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3641-03,NDC,,,facility,both,1,EA,,6215.81,6215.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3641-03) * 1 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3641-03,NDC,,,facility,both,1,EA,,6215.81,6215.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3641-03) * 1 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3641-03,NDC,,,facility,both,1,EA,,5949.83,5949.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3641-03) * 1 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3641-03,NDC,,,facility,both,1,EA,,5466.1,5466.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3663-03) * 1.5 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3663-03,NDC,,,facility,both,1,EA,,6159.91,6159.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3663-03) * 1.5 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3663-03,NDC,,,facility,both,1,EA,,5973.95,5973.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3663-03) * 1.5 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3663-03,NDC,,,facility,both,1,EA,,5335.62,5335.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,0074-5015-01,NDC,,,facility,both,1,EA,,47.98,47.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,0074-5015-01,NDC,,,facility,both,1,EA,,47.01,47.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lupron Depot: 1 Kit In 1 Carton (0074-3663-03) * 1.5 Ml In 1 Syringe * 1 Ml In 1 Packet,636,RC,0074-3663-03,NDC,,,facility,both,1,EA,,5335.62,5335.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cerebyx: 10 Vial, Single-Dose In 1 Package (0069-5474-02) / 10 Ml In 1 Vial, Single-Dose (0069-5474-01)",636,RC,0069-5474-02,NDC,,,facility,both,1,EA,,21.62,21.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-6001-02,NDC,,,facility,both,1,EA,,27.21,27.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-6001-02,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,0074-5015-01,NDC,,,facility,both,1,EA,,42.65,42.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetazolamide: 1 Vial In 1 Carton (0143-9006-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9006-01,NDC,,,facility,both,1,EA,,50.95,50.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9022-01,NDC,,,facility,both,1,EA,,9.82,9.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fulvestrant: 2 Syringe, Glass In 1 Carton (0143-9022-02) / 5 Ml In 1 Syringe, Glass (0143-9022-01)",636,RC,0143-9022-02,NDC,,,facility,both,1,EA,,10.58,10.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fulvestrant: 2 Syringe, Glass In 1 Carton (0143-9022-02) / 5 Ml In 1 Syringe, Glass (0143-9022-01)",636,RC,0143-9022-02,NDC,,,facility,both,1,EA,,10.1,10.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fulvestrant: 2 Syringe, Glass In 1 Carton (0143-9022-02) / 5 Ml In 1 Syringe, Glass (0143-9022-01)",636,RC,0143-9022-02,NDC,,,facility,both,1,EA,,10.06,10.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial In 1 Carton (0143-9098-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9098-01,NDC,,,facility,both,1,EA,,4.83,4.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial In 1 Carton (0143-9098-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9098-01,NDC,,,facility,both,1,EA,,4.6,4.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial In 1 Carton (0143-9098-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9098-01,NDC,,,facility,both,1,EA,,4.55,4.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial In 1 Carton (0143-9098-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9098-01,NDC,,,facility,both,1,EA,,4.29,4.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial In 1 Carton (0143-9098-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9098-01,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial In 1 Carton (0143-9098-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9098-01,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9139-01,NDC,,,facility,both,1,EA,,2.27,2.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9022-01,NDC,,,facility,both,1,EA,,9.81,9.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9140-01,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vimpat: 10 Vial, Glass In 1 Carton (0131-1810-67) / 20 Ml In 1 Vial, Glass",636,RC,0131-1810-67,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9140-01,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9162-01,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9333-10) / 30 Ml In 1 Vial, Single-Dose (0143-9333-01)",636,RC,0143-9333-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9338-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9357-01,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9375-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Terbutaline Sulfate: 10 Vial In 1 Carton (0143-9375-10) / 1 Ml In 1 Vial (0143-9375-01),636,RC,0143-9375-10,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9384-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9384-01,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9384-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9384-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,0143-9385-01,NDC,,,facility,both,1,EA,,5.44,5.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9333-10) / 30 Ml In 1 Vial, Single-Dose (0143-9333-01)",636,RC,0143-9333-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,0143-9385-01,NDC,,,facility,both,1,EA,,4.96,4.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,0143-9385-01,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,0143-9385-01,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9398-01,NDC,,,facility,both,1,EA,,29.93,29.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9428-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9428-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9428-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9428-01,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9428-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9428-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9428-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0143-9428-01,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9431-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9431-01,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,0143-9385-01,NDC,,,facility,both,1,EA,,4.16,4.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9333-10) / 30 Ml In 1 Vial, Single-Dose (0143-9333-01)",636,RC,0143-9333-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9330-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9316-01,NDC,,,facility,both,1,EA,,2.86,2.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 Vial In 1 Package (0143-9162-10) / 1025 Mg In 1 Vial (0143-9162-01),636,RC,0143-9162-10,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9164-01) / 10.25 G In 1 Vial, Pharmacy Bulk Package",636,RC,0143-9164-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9218-01) / 10 Ml In 1 Vial, Glass",636,RC,0143-9218-01,NDC,,,facility,both,1,EA,,102.94,102.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9218-01) / 10 Ml In 1 Vial, Glass",636,RC,0143-9218-01,NDC,,,facility,both,1,EA,,68.63,68.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9219-01) / 20 Ml In 1 Vial, Glass",636,RC,0143-9219-01,NDC,,,facility,both,1,EA,,104,104,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bleomycin: 1 Vial In 1 Box, Unit-Dose (0143-9240-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0143-9240-01,NDC,,,facility,both,1,EA,,128.02,128.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9245-01,NDC,,,facility,both,1,EA,,24.42,24.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9245-01,NDC,,,facility,both,1,EA,,24.18,24.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9245-01,NDC,,,facility,both,1,EA,,23.88,23.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9262-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9262-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin In 5 Percent Dextrose: 1 Vial In 1 Carton (0143-9269-01) / 50 Ml In 1 Vial,636,RC,0143-9269-01,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9279-01) / 40 Ml In 1 Vial",636,RC,0143-9279-01,NDC,,,facility,both,1,EA,,66.54,66.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9279-01) / 40 Ml In 1 Vial",636,RC,0143-9279-01,NDC,,,facility,both,1,EA,,62.2,62.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9279-01) / 40 Ml In 1 Vial",636,RC,0143-9279-01,NDC,,,facility,both,1,EA,,57.17,57.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9280-01) / 80 Ml In 1 Vial",636,RC,0143-9280-01,NDC,,,facility,both,1,EA,,51.25,51.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9300-01,NDC,,,facility,both,1,EA,,7.39,7.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9300-01,NDC,,,facility,both,1,EA,,7.39,7.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9308-01) / 20 Ml In 1 Vial, Glass",636,RC,0143-9308-01,NDC,,,facility,both,1,EA,,91.12,91.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9310-01,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9311-01,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0143-9315-01,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0093-7334-01),636,RC,0093-7334-01,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefotan: 10 Vial In 1 Tray (0121-0977-10) / 20 Ml In 1 Vial (0121-0977-55),636,RC,0121-0977-10,NDC,,,facility,both,1,EA,,49.13,49.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0121-0977-55,NDC,,,facility,both,1,EA,,51.27,51.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0121-0978-10,NDC,,,facility,both,1,EA,,10.03,10.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0121-0978-10,NDC,,,facility,both,1,EA,,7.48,7.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0121-0978-10,NDC,,,facility,both,1,EA,,20.01,20.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisolone Sodium Phosphate: 237 Ml In 1 Bottle (0121-0759-08),636,RC,0121-0759-08,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Dextrose: 1000 Ml In 1 Bag (0338-0683-04),636,RC,0338-0683-04,NDC,,,facility,both,1,EA,,4.2,4.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atropine Sulfate: 25 VIAL, SINGLE-DOSE in 1 TRAY (0517-1010-25) / 1 mL in 1 VIAL, SINGLE-DOSE",636,RC,0517-1010-25,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-1980-01,NDC,,,facility,both,1,EA,,77.32,77.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-2310-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-2310-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-10,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atropine Sulfate: 25 VIAL, SINGLE-DOSE in 1 TRAY (0517-1010-25) / 1 mL in 1 VIAL, SINGLE-DOSE",636,RC,0517-1010-25,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-10,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 10 Vial, Single-Dose In 1 Carton (0517-2340-99) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-99,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,9361.27,9361.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,42.97,42.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,41.83,41.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,41.37,41.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,40.97,40.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.62,34.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.62,34.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.42,34.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.41,34.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venofer: 10 Vial, Single-Dose In 1 Carton (0517-2340-99) / 5 Ml In 1 Vial, Single-Dose",636,RC,0517-2340-99,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.39,34.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-1001-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-0740-01,NDC,,,facility,both,1,EA,,60.95,60.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyloy: 1 Vial In 1 Box (0469-4425-30) / 15 Ml In 1 Vial,636,RC,0469-4425-30,NDC,,,facility,both,1,EA,,118.36,118.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lexiscan: 5 Ml In 1 Syringe, Plastic (0469-6501-89)",636,RC,0469-6501-89,NDC,,,facility,both,1,EA,,177.03,177.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lexiscan: 5 Ml In 1 Syringe, Plastic (0469-6501-89)",636,RC,0469-6501-89,NDC,,,facility,both,1,EA,,170.02,170.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Octreotide Acetate: 1 Kit In 1 Kit (0480-9259-08) * 8 Ml In 1 Vial, Single-Dose (0480-9258-01) * 2 Ml In 1 Syringe (0480-9263-21)",636,RC,0480-9259-08,NDC,,,facility,both,1,EA,,578.64,578.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (0487-0201-01) / 1 Vial, Single-Use In 1 Pouch / 3 Ml In 1 Vial, Single-Use",636,RC,0487-0201-01,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0487-9501-00,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-1001-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9501-01) / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose",636,RC,0487-9501-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ipratropium Bromide: 30 Pouch In 1 Carton (0487-9801-01) / 1 Vial, Single-Dose In 1 Pouch / 2.5 Ml In 1 Vial, Single-Dose",636,RC,0487-9801-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9901-30) / 1 Vial, Single-Dose In 1 Pouch / .5 Ml In 1 Vial, Single-Dose",636,RC,0487-9901-30,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyanocobalamin: 25 Vial, Multi-Dose In 1 Tray (0517-0031-25) / 1 Ml In 1 Vial, Multi-Dose (0517-0031-01)",636,RC,0517-0031-25,NDC,,,facility,both,1,EA,,20.29,20.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-0374-01,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-0374-01,NDC,,,facility,both,1,EA,,5.23,5.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-0374-01,NDC,,,facility,both,1,EA,,5.15,5.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Injectafer: 1 Vial, Single-Dose In 1 Box (0517-0650-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,0517-0650-01,NDC,,,facility,both,1,EA,,3.77,3.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fomepizole: 1 Vial In 1 Carton (0517-0710-01) / 1.5 Ml In 1 Vial,636,RC,0517-0710-01,NDC,,,facility,both,1,EA,,14.82,14.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Betamethasone Sodium Phosphate And Betamethasone Acetate: 1 Vial, Multi-Dose In 1 Carton (0517-0720-01) / 5 Ml In 1 Vial, Multi-Dose",636,RC,0517-0720-01,NDC,,,facility,both,1,EA,,13.77,13.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Budesonide: 6 Pouch In 1 Carton (0487-9701-01) / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,636,RC,0487-9701-01,NDC,,,facility,both,1,EA,,26.62,26.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.39,34.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.36,34.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01) / 20 Ml In 1 Vial,636,RC,0517-4300-01,NDC,,,facility,both,1,EA,,34.1,34.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25) / 1 Ml In 1 Vial, Single-Dose",636,RC,0517-4601-25,NDC,,,facility,both,1,EA,,14.21,14.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25) / 1 Ml In 1 Vial, Single-Dose",636,RC,0517-4601-25,NDC,,,facility,both,1,EA,,13.67,13.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25) / 1 Ml In 1 Vial, Single-Dose",636,RC,0517-4601-25,NDC,,,facility,both,1,EA,,13.06,13.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nitroglycerin: 25 Vial, Single-Dose In 1 Tray (0517-4810-25) / 10 Ml In 1 Vial, Single-Dose (0517-4810-01)",636,RC,0517-4810-25,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-5601-01,NDC,,,facility,both,1,EA,,32.46,32.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0517-5601-25) / 1 Ml In 1 Vial, Single-Dose (0517-5601-01)",636,RC,0517-5601-25,NDC,,,facility,both,1,EA,,29.45,29.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-5602-01,NDC,,,facility,both,1,EA,,17.46,17.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-6710-01,NDC,,,facility,both,1,EA,,26.76,26.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetylcysteine: 25 Vial, Glass In 1 Tray (0517-7504-25) / 4 Ml In 1 Vial, Glass",636,RC,0517-7504-25,NDC,,,facility,both,1,EA,,20.7,20.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-7604-01,NDC,,,facility,both,1,EA,,10.36,10.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-9120-01,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-9191-01,NDC,,,facility,both,1,EA,,4.55,4.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0517-9702-01,NDC,,,facility,both,1,EA,,6.22,6.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyloy: 1 Vial In 1 Box (0469-4425-30) / 15 Ml In 1 Vial,636,RC,0469-4425-30,NDC,,,facility,both,1,EA,,118.45,118.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyloy: 1 Vial In 1 Box (0469-3425-10) / 5 Ml In 1 Vial,636,RC,0469-3425-10,NDC,,,facility,both,1,EA,,69.41,69.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6729-41,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6729-41,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 10 VIAL, SINGLE-DOSE in 1 CARTON (0409-6778-02) / 1 mL in 1 VIAL, SINGLE-DOSE (0409-6778-11) ",636,RC,0409-6778-02,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-7299-83,NDC,,,facility,both,1,EA,,33.05,33.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-7332-11,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-7332-11,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ceftriaxone Sodium: 10 Vial, Single-Use In 1 Carton (0409-7332-20) / 1 Injection, Powder, For Solution In 1 Vial, Single-Use (0409-7332-21)",636,RC,0409-7332-20,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ceftriaxone Sodium: 10 Vial, Single-Use In 1 Carton (0409-7335-03) / 1 Injection, Powder, For Solution In 1 Vial, Single-Use (0409-7335-13)",636,RC,0409-7335-03,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextrose: 10 Carton In 1 Container (0409-7517-16) / 1 Syringe, Plastic In 1 Carton / 50 Ml In 1 Syringe, Plastic (0409-7517-66)",636,RC,0409-7517-16,NDC,,,facility,both,1,EA,,41.69,41.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-7517-66,NDC,,,facility,both,1,EA,,39.97,39.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dopamine Hydrochloride In Dextrose: 12 Bag In 1 Carton (0409-7809-22) / 250 Ml In 1 Bag (0409-7809-11),636,RC,0409-7809-22,NDC,,,facility,both,1,EA,,3.28,3.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-7335-13,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride And Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-9042-01) / 10 Ml In 1 Vial, Single-Dose (0409-9042-11)",636,RC,0409-9042-01,NDC,,,facility,both,1,EA,,20.56,20.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-24) / 1 Bag In 1 Pouch / 50 Ml In 1 Bag (0409-6729-11),636,RC,0409-6729-24,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6729-11,NDC,,,facility,both,1,EA,,2.54,2.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-35,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-35,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-35,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-35,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-37,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-37,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-37,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Erythrocin Lactobionate: 10 Vial In 1 Tray (0409-6482-01) / 10 Ml In 1 Vial (0409-6482-11),636,RC,0409-6482-01,NDC,,,facility,both,1,EA,,83.27,83.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6482-11,NDC,,,facility,both,1,EA,,89.16,89.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-23) / 1 Bag In 1 Pouch / 100 Ml In 1 Bag (0409-6729-41),636,RC,0409-6729-23,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6533-59,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6651-19,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6727-11,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 24 POUCH in 1 CASE (0409-6729-03) / 1 BAG in 1 POUCH / 500 mL in 1 BAG (0409-6729-21) ,636,RC,0409-6729-03,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6729-11,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Testosterone Cypionate: 1 Vial In 1 Carton (0409-6557-01) / 10 Ml In 1 Vial,636,RC,0409-6557-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Citrate: 10 Ampule In 1 Cello Pack (0409-9093-35) / 5 Ml In 1 Ampule (0409-9093-45),636,RC,0409-9093-35,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-9094-12,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0456-2700-01,NDC,,,facility,both,1,EA,,241.82,241.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cresemba: 1 Vial, Single-Dose In 1 Carton (0469-0420-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0469-0420-01,NDC,,,facility,both,1,EA,,2.34,2.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cresemba: 1 Vial, Single-Dose In 1 Carton (0469-0420-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0469-0420-01,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ambisome: 12.5 Ml In 1 Vial, Single-Dose (0469-3051-30)",636,RC,0469-3051-30,NDC,,,facility,both,1,EA,,58.08,58.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cresemba: 10 Carton In 1 Carton (0469-0420-99) / 1 Vial, Single-Dose In 1 Carton (0469-0420-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0469-0420-99,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-9094-12,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-9094-16,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-9094-18,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22) / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",636,RC,0409-9094-22,NDC,,,facility,both,1,EA,,5.36,5.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22) / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",636,RC,0409-9094-22,NDC,,,facility,both,1,EA,,3.15,3.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22) / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)",636,RC,0409-9094-22,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-25) / 5 Ml In 1 Vial, Single-Dose (0409-9094-18)",636,RC,0409-9094-25,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-9158-31,NDC,,,facility,both,1,EA,,6.76,6.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-9735-01,NDC,,,facility,both,1,EA,,4.2,4.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0456-0400-01,NDC,,,facility,both,1,EA,,13.42,13.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0456-0400-01,NDC,,,facility,both,1,EA,,13.21,13.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0456-0600-01,NDC,,,facility,both,1,EA,,8.8,8.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0456-0600-01,NDC,,,facility,both,1,EA,,8.76,8.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyloy: 1 Vial In 1 Box (0469-3425-10) / 5 Ml In 1 Vial,636,RC,0469-3425-10,NDC,,,facility,both,1,EA,,53.77,53.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-35,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methylprednisolone: 100 Tablet In 1 Bottle, Plastic (0603-4593-21)",636,RC,0603-4593-21,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 100 Tablet In 1 Bottle, Plastic (0603-5338-21)",636,RC,0603-5338-21,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 500 Tablet In 1 Bottle, Plastic (0603-5339-28)",636,RC,0603-5339-28,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0367-21,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0367-21,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (0641-0367-25) / 1 Ml In 1 Vial (0641-0367-21),636,RC,0641-0367-25,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (0641-0367-25) / 1 Ml In 1 Vial (0641-0367-21),636,RC,0641-0367-25,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0376-21,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25) / 1 Ml In 1 Vial (0641-0376-21),636,RC,0641-0376-25,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25) / 1 Ml In 1 Vial (0641-0376-21),636,RC,0641-0376-25,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0476-21,NDC,,,facility,both,1,EA,,77.82,77.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0928-21,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0948-31,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Promethazine Hydrochloride: 25 Ampule In 1 Carton (0641-0948-35) / 1 Ml In 1 Ampule (0641-0948-31),636,RC,0641-0948-35,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0955-21,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-0376-21,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-1398-31,NDC,,,facility,both,1,EA,,52.16,52.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "GlucaGen: 1 KIT in 1 KIT (0597-0260-10) * 1 mL in 1 VIAL, GLASS (0597-0053-01) * 1 mL in 1 VIAL, GLASS (0597-0265-94) ",636,RC,0597-0260-10,NDC,,,facility,both,1,EA,,499.37,499.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "GlucaGen: 1 KIT in 1 KIT (0597-0260-10) * 1 mL in 1 VIAL, GLASS (0597-0053-01) * 1 mL in 1 VIAL, GLASS (0597-0265-94) ",636,RC,0597-0260-10,NDC,,,facility,both,1,EA,,355.02,355.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "GlucaGen: 1 KIT in 1 KIT (0597-0260-10) * 1 mL in 1 VIAL, GLASS (0597-0053-01) * 1 mL in 1 VIAL, GLASS (0597-0265-94) ",636,RC,0597-0260-10,NDC,,,facility,both,1,EA,,323.54,323.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "GlucaGen: 1 KIT in 1 KIT (0597-0260-10) * 1 mL in 1 VIAL, GLASS (0597-0053-01) * 1 mL in 1 VIAL, GLASS (0597-0265-94) ",636,RC,0597-0260-10,NDC,,,facility,both,1,EA,,249.69,249.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-1410-31,NDC,,,facility,both,1,EA,,4.55,4.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-1410-31,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-1495-31,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6052-01,NDC,,,facility,both,1,EA,,6.27,6.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6059-01,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6060-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6071-01,NDC,,,facility,both,1,EA,,10.06,10.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6078-01,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 20 Ml In 1 Carton (0641-6079-01),636,RC,0641-6079-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6052-01,NDC,,,facility,both,1,EA,,7.52,7.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 20 Ml In 1 Carton (0641-6079-01),636,RC,0641-6079-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6080-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6080-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6084-01,NDC,,,facility,both,1,EA,,4.14,4.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenergan: 25 Vial In 1 Carton (0641-6084-25) / 1 Ml In 1 Vial (0641-6084-01),636,RC,0641-6084-25,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6116-01,NDC,,,facility,both,1,EA,,5.54,5.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6117-01,NDC,,,facility,both,1,EA,,4.67,4.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6125-01,NDC,,,facility,both,1,EA,,6.26,6.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6044-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6044-01,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6001-01,NDC,,,facility,both,1,EA,,3.25,3.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6001-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6007-01,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6007-01,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6007-01,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6008-01,NDC,,,facility,both,1,EA,,2.74,2.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6008-01,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6008-01,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6019-01,NDC,,,facility,both,1,EA,,17.35,17.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6022-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6027-01,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0641-6027-01,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Citrate: 20 Ml In 1 Vial (0641-6029-01),636,RC,0641-6029-01,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Citrate: 50 Ml In 1 Vial (0641-6030-01),636,RC,0641-6030-01,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cortrosyn: 10 Vial In 1 Carton (0548-5900-00) / 1 Ml In 1 Vial,636,RC,0548-5900-00,NDC,,,facility,both,1,EA,,58.05,58.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cortrosyn: 10 Vial In 1 Carton (0548-5900-00) / 1 Ml In 1 Vial,636,RC,0548-5900-00,NDC,,,facility,both,1,EA,,56.18,56.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cortrosyn: 10 Vial In 1 Carton (0548-5900-00) / 1 Ml In 1 Vial,636,RC,0548-5900-00,NDC,,,facility,both,1,EA,,55.15,55.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cortrosyn: 10 Vial In 1 Carton (0548-5900-00) / 1 Ml In 1 Vial,636,RC,0548-5900-00,NDC,,,facility,both,1,EA,,52.77,52.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (0591-5052-01),636,RC,0591-5052-01,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-35,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-20,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-20,NDC,,,facility,both,1,EA,,2.85,2.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Omnipaque: 10 Bottle, Plastic In 1 Box (0407-1414-91) / 100 Ml In 1 Bottle, Plastic",636,RC,0407-1414-91,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-0001-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-0125-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-0152-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-0152-01,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-01) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-01,NDC,,,facility,both,1,EA,,35.55,35.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-01) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-01,NDC,,,facility,both,1,EA,,33.92,33.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-25,NDC,,,facility,both,1,EA,,29.39,29.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-25,NDC,,,facility,both,1,EA,,28.46,28.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-25,NDC,,,facility,both,1,EA,,28.28,28.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0378-8270-31,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-25,NDC,,,facility,both,1,EA,,27.84,27.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 30 TABLET, ORALLY DISINTEGRATING in 1 BOTTLE, PLASTIC (0378-7734-93) ",636,RC,0378-7734-93,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 12 Bag In 1 Carton (0338-3508-41) / 100 Ml In 1 Bag,636,RC,0338-3508-41,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 12 Bag In 1 Carton (0338-3508-41) / 100 Ml In 1 Bag,636,RC,0338-3508-41,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 12 Bag In 1 Carton (0338-3508-41) / 100 Ml In 1 Bag,636,RC,0338-3508-41,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 100 Ml In 1 Bag (0338-3551-48),636,RC,0338-3551-48,NDC,,,facility,both,1,EA,,17.74,17.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 200 Ml In 1 Bag (0338-3552-48),636,RC,0338-3552-48,NDC,,,facility,both,1,EA,,2.74,2.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0338-3612-50,NDC,,,facility,both,1,EA,,7.37,7.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 12 Bag In 1 Carton (0338-3508-41) / 100 Ml In 1 Bag,636,RC,0338-3508-41,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0338-3612-50,NDC,,,facility,both,1,EA,,7.02,7.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0338-3814-50,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30),636,RC,0338-9159-30,NDC,,,facility,both,1,EA,,41.8,41.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30),636,RC,0338-9159-30,NDC,,,facility,both,1,EA,,41.79,41.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 24 Bag In 1 Carton (0338-9541-24) / 100 Ml In 1 Bag,636,RC,0338-9541-24,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 24 Bag In 1 Carton (0338-9541-24) / 100 Ml In 1 Bag,636,RC,0338-9541-24,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 250 Ml In 1 Bag (0338-9543-02),636,RC,0338-9543-02,NDC,,,facility,both,1,EA,,45.36,45.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0338-3814-50,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 500 Ml In 1 Bag (0338-9543-04),636,RC,0338-9543-04,NDC,,,facility,both,1,EA,,47.34,47.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 24 Bag In 1 Carton (0338-3503-41) / 50 Ml In 1 Bag,636,RC,0338-3503-41,NDC,,,facility,both,1,EA,,8.51,8.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefazolin: 24 Bag In 1 Carton (0338-3503-41) / 50 Ml In 1 Bag,636,RC,0338-3503-41,NDC,,,facility,both,1,EA,,8.58,8.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0691-04) / 1000 Ml In 1 Bag,636,RC,0338-0691-04,NDC,,,facility,both,1,EA,,4.53,4.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0695-04) / 1000 Ml In 1 Bag,636,RC,0338-0695-04,NDC,,,facility,both,1,EA,,2.68,2.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 24 Bag In 1 Carton (0338-0705-41) / 50 Ml In 1 Bag,636,RC,0338-0705-41,NDC,,,facility,both,1,EA,,1.74,1.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 24 Bag In 1 Carton (0338-0705-41) / 50 Ml In 1 Bag,636,RC,0338-0705-41,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48) / 100 Ml In 1 Bag,636,RC,0338-0709-48,NDC,,,facility,both,1,EA,,2.14,2.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48) / 100 Ml In 1 Bag,636,RC,0338-0709-48,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose: 2000 Ml In 1 Bag (0338-0719-06),636,RC,0338-0719-06,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1007-02) / 250 Ml In 1 Bag,636,RC,0338-1007-02,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nitroglycerin In Dextrose: 12 Bottle, Glass In 1 Box (0338-1051-02) / 250 Ml In 1 Bottle, Glass",636,RC,0338-1051-02,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 24 Bag In 1 Carton (0338-1055-48) / 100 Ml In 1 Bag,636,RC,0338-1055-48,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 24 Bag In 1 Carton (0338-1055-48) / 100 Ml In 1 Bag,636,RC,0338-1055-48,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02) / 250 Ml In 1 Bag,636,RC,0338-1075-02,NDC,,,facility,both,1,EA,,55.87,55.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02) / 250 Ml In 1 Bag,636,RC,0338-1075-02,NDC,,,facility,both,1,EA,,55.87,55.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesnex: 1 Vial, Multi-Dose In 1 Box (0338-1305-01) / 10 Ml In 1 Vial, Multi-Dose",636,RC,0338-1305-01,NDC,,,facility,both,1,EA,,4.45,4.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesnex: 1 Vial, Multi-Dose In 1 Box (0338-1305-01) / 10 Ml In 1 Vial, Multi-Dose",636,RC,0338-1305-01,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride In Lactated Ringers And Dextrose: 1000 Ml In 1 Bag (0338-0811-04),636,RC,0338-0811-04,NDC,,,facility,both,1,EA,,50.28,50.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 500 Ml In 1 Bag (0338-9543-04),636,RC,0338-9543-04,NDC,,,facility,both,1,EA,,46.96,46.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-9543-06),636,RC,0338-9543-06,NDC,,,facility,both,1,EA,,24,24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Chloride: 1000 Ml In 1 Bag (0338-9543-06),636,RC,0338-9543-06,NDC,,,facility,both,1,EA,,23.57,23.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lenalidomide: 100 Capsule In 1 Bottle, Plastic (0378-1937-01)",636,RC,0378-1937-01,NDC,,,facility,both,1,EA,,2574.36,2574.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-25,NDC,,,facility,both,1,EA,,8.49,8.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,0409-0181-25,NDC,,,facility,both,1,EA,,7.69,7.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01) / 52.6 Ml In 1 Vial, Single-Dose",636,RC,0409-0182-01,NDC,,,facility,both,1,EA,,25.06,25.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3414-21,NDC,,,facility,both,1,EA,,3.28,3.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3414-21,NDC,,,facility,both,1,EA,,3.22,3.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3578-11,NDC,,,facility,both,1,EA,,7.1,7.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Dose In 1 Tray (0409-3795-01) / 1 Ml In 1 Vial, Single-Dose (0409-3795-19)",636,RC,0409-3795-01,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3795-19,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Dose In 1 Tray (0409-3796-01) / 2 Ml In 1 Vial, Single-Dose (0409-3796-19)",636,RC,0409-3796-01,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Dose In 1 Tray (0409-3796-01) / 2 Ml In 1 Vial, Single-Dose (0409-3796-19)",636,RC,0409-3796-01,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3815-11,NDC,,,facility,both,1,EA,,7.91,7.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3414-18,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 5 Vial, Glass In 1 Carton (0409-3815-12) / 10 Ml In 1 Vial, Glass (0409-3815-11)",636,RC,0409-3815-12,NDC,,,facility,both,1,EA,,3.4,3.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4031-16,NDC,,,facility,both,1,EA,,8.3,8.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4264-11,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4264-11,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4264-11,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4275-16,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-02) / 50 Ml In 1 Vial, Multi-Dose (0409-4276-17)",636,RC,0409-4276-02,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4277-01) / 20 Ml In 1 Vial, Multi-Dose (0409-4277-16)",636,RC,0409-4277-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4277-17,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-2347-32) / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-2347-31),636,RC,0409-2347-32,NDC,,,facility,both,1,EA,,28.55,28.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-2347-32) / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-2347-31),636,RC,0409-2347-32,NDC,,,facility,both,1,EA,,6.49,6.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefazolin: 25 Vial In 1 Carton (0409-2585-01) / 1 Injection, Powder, For Solution In 1 Vial (0409-2585-11)",636,RC,0409-2585-01,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midazolam: 10 Vial, Multi-Dose In 1 Carton (0409-2596-05) / 10 Ml In 1 Vial, Multi-Dose (0409-2596-15)",636,RC,0409-2596-05,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2596-15,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,0409-2634-50,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,0409-2634-50,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,0409-2634-50,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2723-01) / 1 Ml In 1 Vial, Single-Dose (0409-2723-30)",636,RC,0409-2723-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial, Single-Use In 1 Carton (0409-3385-13) / 15 Ml In 1 Vial, Single-Use (0409-3385-11)",636,RC,0409-3385-13,NDC,,,facility,both,1,EA,,8.41,8.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2723-30,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3299-15,NDC,,,facility,both,1,EA,,20.07,20.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3300-01,NDC,,,facility,both,1,EA,,6.15,6.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3365-11,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-3365-11,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4888-02,NDC,,,facility,both,1,EA,,113.22,113.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4888-02,NDC,,,facility,both,1,EA,,45.91,45.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4888-06,NDC,,,facility,both,1,EA,,37.84,37.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 10 Carton In 1 Container (0409-4903-34) / 1 Syringe In 1 Carton / 5 Ml In 1 Syringe (0409-4903-11),636,RC,0409-4903-34,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atropine Sulfate: 10 Carton In 1 Package (0409-4911-34) / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4911-11)",636,RC,0409-4911-34,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atropine Sulfate: 10 Carton In 1 Package (0409-4911-34) / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4911-11)",636,RC,0409-4911-34,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4928-11,NDC,,,facility,both,1,EA,,1128.41,1128.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-5738-01,NDC,,,facility,both,1,EA,,18.03,18.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-19,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-6102-20,NDC,,,facility,both,1,EA,,3.21,3.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atropine Sulfate: 10 Carton In 1 Package (0409-4911-34) / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4911-11)",636,RC,0409-4911-34,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 25 Ampule In 1 Carton (0409-4282-02) / 10 Ml In 1 Ampule (0409-4282-12),636,RC,0409-4282-02,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4282-12,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4283-11,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aminocaproic Acid: 25 Vial, Single-Dose In 1 Tray (0409-4346-73) / 20 Ml In 1 Vial, Single-Dose (0409-4346-16)",636,RC,0409-4346-73,NDC,,,facility,both,1,EA,,3.54,3.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4520-02,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4688-22,NDC,,,facility,both,1,EA,,17.77,17.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4699-54,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 25 Vial, Single-Dose In 1 Tray (0409-4755-03) / 2 Ml In 1 Vial, Single-Dose (0409-4755-18)",636,RC,0409-4755-03,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 25 Vial, Single-Dose In 1 Tray (0409-4755-03) / 2 Ml In 1 Vial, Single-Dose (0409-4755-18)",636,RC,0409-4755-03,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 25 Vial, Single-Dose In 1 Tray (0409-4755-03) / 2 Ml In 1 Vial, Single-Dose (0409-4755-18)",636,RC,0409-4755-03,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 25 Vial, Single-Dose In 1 Tray (0409-4755-03) / 2 Ml In 1 Vial, Single-Dose (0409-4755-18)",636,RC,0409-4755-03,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4755-18,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-4755-18,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 1 Vial, Multi-Dose In 1 Carton (0409-4759-01) / 20 Ml In 1 Vial, Multi-Dose",636,RC,0409-4759-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 1 Vial, Multi-Dose In 1 Carton (0409-4759-01) / 20 Ml In 1 Vial, Multi-Dose",636,RC,0409-4759-01,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2347-31,NDC,,,facility,both,1,EA,,15.03,15.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2347-31,NDC,,,facility,both,1,EA,,15.03,15.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2339-24,NDC,,,facility,both,1,EA,,4.59,4.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2305-55,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1162-19,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gentamicin Sulfate: 25 Vial, Single-Dose In 1 Tray (0409-1207-03) / 2 Ml In 1 Vial, Single-Dose (0409-1207-13)",636,RC,0409-1207-03,NDC,,,facility,both,1,EA,,9.2,9.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gentamicin Sulfate: 25 Vial, Single-Dose In 1 Tray (0409-1207-03) / 2 Ml In 1 Vial, Single-Dose (0409-1207-13)",636,RC,0409-1207-03,NDC,,,facility,both,1,EA,,8.71,8.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1207-13,NDC,,,facility,both,1,EA,,7.94,7.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1273-03,NDC,,,facility,both,1,EA,,30.34,30.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1162-19,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1283-03,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1283-17,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1283-17,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1283-31) / 1 Ml In 1 Cartridge (0409-1283-03),636,RC,0409-1283-31,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1283-31) / 1 Ml In 1 Cartridge (0409-1283-03),636,RC,0409-1283-31,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30) / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30) / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30) / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30) / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30) / 1 Ml In 1 Cartridge (0409-1312-03),636,RC,0409-1312-30,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 10 Carton In 1 Container (0409-1323-05) / 1 Syringe, Plastic In 1 Carton / 5 Ml In 1 Syringe, Plastic (0409-1323-15)",636,RC,0409-1323-05,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1283-17,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1162-19,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1162-18,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01) / 52.6 Ml In 1 Vial, Single-Dose",636,RC,0409-0182-01,NDC,,,facility,both,1,EA,,24.29,24.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01) / 52.6 Ml In 1 Vial, Single-Dose",636,RC,0409-0182-01,NDC,,,facility,both,1,EA,,23.25,23.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01) / 52.6 Ml In 1 Vial, Single-Dose",636,RC,0409-0182-01,NDC,,,facility,both,1,EA,,18.57,18.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0183-01) / 5.26 Ml In 1 Vial, Single-Dose",636,RC,0409-0183-01,NDC,,,facility,both,1,EA,,21.21,21.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0183-25) / 5.26 Ml In 1 Vial, Single-Dose",636,RC,0409-0183-25,NDC,,,facility,both,1,EA,,54.31,54.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0183-25) / 5.26 Ml In 1 Vial, Single-Dose",636,RC,0409-0183-25,NDC,,,facility,both,1,EA,,22.53,22.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0183-25) / 5.26 Ml In 1 Vial, Single-Dose",636,RC,0409-0183-25,NDC,,,facility,both,1,EA,,20.54,20.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0183-25) / 5.26 Ml In 1 Vial, Single-Dose",636,RC,0409-0183-25,NDC,,,facility,both,1,EA,,20.18,20.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Topotecan: 1 Vial, Single-Dose In 1 Carton (0409-0302-01) / 4 Ml In 1 Vial, Single-Dose",636,RC,0409-0302-01,NDC,,,facility,both,1,EA,,12.98,12.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Topotecan: 1 Vial, Single-Dose In 1 Carton (0409-0302-01) / 4 Ml In 1 Vial, Single-Dose",636,RC,0409-0302-01,NDC,,,facility,both,1,EA,,8.39,8.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Topotecan: 1 Vial, Single-Dose In 1 Carton (0409-0302-01) / 4 Ml In 1 Vial, Single-Dose",636,RC,0409-0302-01,NDC,,,facility,both,1,EA,,7.06,7.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Topotecan: 1 Vial, Single-Dose In 1 Carton (0409-0302-01) / 4 Ml In 1 Vial, Single-Dose",636,RC,0409-0302-01,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01) / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",636,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01) / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",636,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01) / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)",636,RC,0409-1159-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02) / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)",636,RC,0409-1159-02,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1159-09,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1159-18,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1159-19,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02) / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)",636,RC,0409-1162-02,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1162-18,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nalbuphine Hydrochloride: 10 Ampule In 1 Tray (0409-1463-01) / 1 Ml In 1 Ampule (0409-1463-71),636,RC,0409-1463-01,NDC,,,facility,both,1,EA,,8.57,8.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1463-69,NDC,,,facility,both,1,EA,,8.74,8.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1775-40,NDC,,,facility,both,1,EA,,5.57,5.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1778-05) / 5 Ml In 1 Vial, Single-Dose (0409-1778-15)",636,RC,0409-1778-05,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1778-05) / 5 Ml In 1 Vial, Single-Dose (0409-1778-15)",636,RC,0409-1778-05,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1778-15,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1778-15,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1886-22,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Morphine Sulfate: 10 Cartridge In 1 Carton (0409-1890-01) / 1 Ml In 1 Cartridge (0409-1890-03),636,RC,0409-1890-01,NDC,,,facility,both,1,EA,,3.91,3.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1890-03,NDC,,,facility,both,1,EA,,3.68,3.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1893-03,NDC,,,facility,both,1,EA,,4.11,4.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 10 Cartridge In 1 Carton (0409-1985-30) / 1 Ml In 1 Cartridge (0409-1985-03),636,RC,0409-1985-30,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2011-05,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2045-01,NDC,,,facility,both,1,EA,,10.75,10.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2050-01,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2305-04,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-2305-16,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17) / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",636,RC,0409-2305-17,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17) / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)",636,RC,0409-2305-17,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 1 Vial, Single-Dose In 1 Carton (0409-1896-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,0409-1896-20,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1761-18,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1463-71,NDC,,,facility,both,1,EA,,8.46,8.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine: 10 Vial, Single-Dose In 1 Tray (0409-1559-10) / 10 Ml In 1 Vial, Single-Dose (0409-1559-18)",636,RC,0409-1559-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine: 10 Vial, Single-Dose In 1 Tray (0409-1559-10) / 10 Ml In 1 Vial, Single-Dose (0409-1559-18)",636,RC,0409-1559-10,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine: 10 Vial, Single-Dose In 1 Tray (0409-1560-10) / 10 Ml In 1 Vial, Single-Dose (0409-1560-18)",636,RC,0409-1560-10,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine: 10 Vial, Single-Dose In 1 Tray (0409-1560-10) / 10 Ml In 1 Vial, Single-Dose (0409-1560-18)",636,RC,0409-1560-10,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine: 10 Vial, Single-Dose In 1 Tray (0409-1560-10) / 10 Ml In 1 Vial, Single-Dose (0409-1560-18)",636,RC,0409-1560-10,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1560-18,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine: 10 Vial, Single-Dose In 1 Tray (0409-1582-10) / 10 Ml In 1 Vial, Single-Dose (0409-1582-18)",636,RC,0409-1582-10,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine: 10 Vial, Single-Dose In 1 Tray (0409-1582-10) / 10 Ml In 1 Vial, Single-Dose (0409-1582-18)",636,RC,0409-1582-10,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1626-21,NDC,,,facility,both,1,EA,,10.5,10.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1630-15,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1630-15,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1630-15,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcium Chloride: 10 Carton In 1 Container (0409-1631-10) / 1 Syringe, Plastic In 1 Carton (0409-1631-40) / 10 Ml In 1 Syringe, Plastic",636,RC,0409-1631-10,NDC,,,facility,both,1,EA,,33.28,33.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1632-21,NDC,,,facility,both,1,EA,,20.82,20.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-10) / 10 Ml In 1 Vial, Single-Dose (0409-1746-70)",636,RC,0409-1746-10,NDC,,,facility,both,1,EA,,32.95,32.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0409-1746-71,NDC,,,facility,both,1,EA,,16.74,16.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1749-10) / 10 Ml In 1 Vial, Single-Dose (0409-1749-70)",636,RC,0409-1749-10,NDC,,,facility,both,1,EA,,12.55,12.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)",636,RC,67066-005-01,NDC,,,facility,both,1,EA,,124.12,124.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)",636,RC,67066-005-01,NDC,,,facility,both,1,EA,,122.93,122.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-153-00,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amiodarone Hydrochloride: 10 Vial, Glass In 1 Carton (67457-153-03) / 3 Ml In 1 Vial, Glass (67457-153-00)",636,RC,67457-153-03,NDC,,,facility,both,1,EA,,2.17,2.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amiodarone Hydrochloride: 1 Vial, Glass In 1 Carton (67457-153-18) / 18 Ml In 1 Vial, Glass",636,RC,67457-153-18,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-182-00,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cidofovir: 1 Vial, Glass In 1 Carton (67457-210-05) / 5 Ml In 1 Vial, Glass",636,RC,67457-210-05,NDC,,,facility,both,1,EA,,669.11,669.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methadone Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (67457-217-20) / 20 Ml In 1 Vial, Multi-Dose",636,RC,67457-217-20,NDC,,,facility,both,1,EA,,67.66,67.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-220-00,NDC,,,facility,both,1,EA,,2438.51,2438.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosulfan Blue: 6 Vial, Glass In 1 Carton (67457-220-05) / 5 Ml In 1 Vial, Glass (67457-220-00)",636,RC,67457-220-05,NDC,,,facility,both,1,EA,,1405.93,1405.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosulfan Blue: 6 Vial, Glass In 1 Carton (67457-220-05) / 5 Ml In 1 Vial, Glass (67457-220-00)",636,RC,67457-220-05,NDC,,,facility,both,1,EA,,1353.95,1353.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-292-00,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-299-00,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Naloxone Hydrochloride: 10 Vial, Multi-Dose In 1 Carton (67457-299-10) / 10 Ml In 1 Vial, Multi-Dose (67457-299-00)",636,RC,67457-299-10,NDC,,,facility,both,1,EA,,26.05,26.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Moxifloxacin Hydrochloride: 1 Bag In 1 Carton (67457-323-25) / 250 Ml In 1 Bag,636,RC,67457-323-25,NDC,,,facility,both,1,EA,,30.25,30.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-339-00,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-948-23) / 50 Ml In 1 Vial, Single-Dose",636,RC,66733-948-23,NDC,,,facility,both,1,EA,,248.32,248.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-948-23) / 50 Ml In 1 Vial, Single-Dose",636,RC,66733-948-23,NDC,,,facility,both,1,EA,,230.85,230.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-948-23) / 50 Ml In 1 Vial, Single-Dose",636,RC,66733-948-23,NDC,,,facility,both,1,EA,,223.34,223.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23) / 100 Ml In 1 Vial, Single-Dose",636,RC,66733-958-23,NDC,,,facility,both,1,EA,,257.63,257.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23) / 100 Ml In 1 Vial, Single-Dose",636,RC,66733-958-23,NDC,,,facility,both,1,EA,,239.43,239.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23) / 100 Ml In 1 Vial, Single-Dose",636,RC,66733-958-23,NDC,,,facility,both,1,EA,,223.16,223.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23) / 100 Ml In 1 Vial, Single-Dose",636,RC,66733-958-23,NDC,,,facility,both,1,EA,,223.16,223.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23) / 100 Ml In 1 Vial, Single-Dose",636,RC,66733-958-23,NDC,,,facility,both,1,EA,,223.16,223.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,66794-219-63,NDC,,,facility,both,1,EA,,7.52,7.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-340-00,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 Vial In 1 Carton (67457-340-01) / 20 Ml In 1 Vial (67457-340-00),636,RC,67457-340-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-351-01,NDC,,,facility,both,1,EA,,6.43,6.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Miacalcin: 1 Vial, Multi-Dose In 1 Carton (67457-675-02) / 2 Ml In 1 Vial, Multi-Dose",636,RC,67457-675-02,NDC,,,facility,both,1,EA,,2030.41,2030.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Docetaxel: 1 Vial, Multi-Dose In 1 Carton (67457-781-08) / 8 Ml In 1 Vial, Multi-Dose",636,RC,67457-781-08,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Docetaxel: 1 Vial, Multi-Dose In 1 Carton (67457-781-08) / 8 Ml In 1 Vial, Multi-Dose",636,RC,67457-781-08,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-815-00,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetazolamide: 1 Vial In 1 Carton (67457-853-50) / 5 Ml In 1 Vial,636,RC,67457-853-50,NDC,,,facility,both,1,EA,,105.63,105.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-855-00,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-903-00,NDC,,,facility,both,1,EA,,6.95,6.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Etomidate: 10 Vial In 1 Carton (67457-903-20) / 20 Ml In 1 Vial (67457-903-00),636,RC,67457-903-20,NDC,,,facility,both,1,EA,,6.42,6.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic acid: 1 VIAL in 1 CARTON (67457-920-05) / 5 mL in 1 VIAL,636,RC,67457-920-05,NDC,,,facility,both,1,EA,,23.97,23.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 24 Bag In 1 Carton (67457-940-10) / 100 Ml In 1 Bag,636,RC,67457-940-10,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Esmolol Hydrochloride In Sodium Chloride: 1 Bag In 1 Pouch (67457-657-25) / 250 Ml In 1 Bag,636,RC,67457-657-25,NDC,,,facility,both,1,EA,,2.77,2.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mycophenolate Mofetil: 100 Tablet, Film Coated In 1 Bottle (67877-225-01)",636,RC,67877-225-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mycophenolate Mofetil: 100 Capsule In 1 Bottle (67877-266-01),636,RC,67877-266-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-645-00,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-582-00,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Leucovorin Calcium: 1 Vial, Single-Dose In 1 Carton (67457-530-35) / 17.5 Ml In 1 Vial, Single-Dose",636,RC,67457-530-35,NDC,,,facility,both,1,EA,,7.54,7.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (67457-418-05) / 5 Ml In 1 Vial (67457-418-00),636,RC,67457-418-05,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (67457-418-05) / 5 Ml In 1 Vial (67457-418-00),636,RC,67457-418-05,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-419-00,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-419-00,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-422-00,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-422-00,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-423-00,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-423-00,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (67457-423-12) / 1 Ml In 1 Vial (67457-423-00),636,RC,67457-423-12,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-426-00,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pamidronate Disodium: 1 Vial In 1 Carton (67457-430-10) / 10 Ml In 1 Vial,636,RC,67457-430-10,NDC,,,facility,both,1,EA,,25.62,25.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxorubicin Hydrochloride: 1 Vial In 1 Carton (67457-436-50) / 25 Ml In 1 Vial,636,RC,67457-436-50,NDC,,,facility,both,1,EA,,134.02,134.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxorubicin Hydrochloride: 1 Vial In 1 Carton (67457-436-50) / 25 Ml In 1 Vial,636,RC,67457-436-50,NDC,,,facility,both,1,EA,,119.12,119.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-437-00,NDC,,,facility,both,1,EA,,51.32,51.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,67457-438-00,NDC,,,facility,both,1,EA,,10.07,10.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron Hydrochloride: 1 VIAL, MULTI-DOSE in 1 CARTON (67457-441-20) / 20 mL in 1 VIAL, MULTI-DOSE",636,RC,67457-441-20,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron Hydrochloride: 1 VIAL, MULTI-DOSE in 1 CARTON (67457-441-20) / 20 mL in 1 VIAL, MULTI-DOSE",636,RC,67457-441-20,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rifampin: 1 Vial In 1 Carton (67457-445-60) / 10 Ml In 1 Vial,636,RC,67457-445-60,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pamidronate Disodium: 1 Vial In 1 Carton (67457-446-10) / 10 Ml In 1 Vial,636,RC,67457-446-10,NDC,,,facility,both,1,EA,,24.67,24.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pamidronate Disodium: 1 Vial In 1 Carton (67457-446-10) / 10 Ml In 1 Vial,636,RC,67457-446-10,NDC,,,facility,both,1,EA,,24.67,24.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Leucovorin Calcium: 1 Vial, Single-Dose In 1 Carton (67457-530-35) / 17.5 Ml In 1 Vial, Single-Dose",636,RC,67457-530-35,NDC,,,facility,both,1,EA,,7.86,7.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,65862-390-10,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,65862-390-10,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 3 Blister Pack In 1 Carton (65862-391-10) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,65862-391-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ondansetron: 3 Blister Pack In 1 Carton (65862-391-10) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",636,RC,65862-391-10,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,98.83,98.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,98.53,98.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,96.01,96.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,95.85,95.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,95.15,95.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,65.04,65.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,65.04,65.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Datroway: 1 Vial, Single-Dose In 1 Carton (65597-801-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-801-01,NDC,,,facility,both,1,EA,,180.78,180.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Datroway: 1 Vial, Single-Dose In 1 Carton (65597-801-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-801-01,NDC,,,facility,both,1,EA,,180.62,180.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetadote: 4 Vial In 1 Carton (66220-207-30) / 30 Ml In 1 Vial,636,RC,66220-207-30,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,106.81,106.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68084-907-11,NDC,,,facility,both,1,EA,,7.85,7.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temozolomide: 5 Capsule In 1 Bottle (67877-539-07),636,RC,67877-539-07,NDC,,,facility,both,1,EA,,4.28,4.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68084-229-11,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acyclovir: 100 Blister Pack In 1 Box, Unit-Dose (68084-108-01) / 1 Tablet In 1 Blister Pack (68084-108-11)",636,RC,68084-108-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dronabinol: 60 Capsule In 1 Bottle (67877-754-60),636,RC,67877-754-60,NDC,,,facility,both,1,EA,,4.18,4.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cubicin Rf: 1 Vial, Single-Use In 1 Carton (67919-012-01) / 10 Ml In 1 Vial, Single-Use",636,RC,67919-012-01,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cubicin Rf: 1 Vial, Single-Use In 1 Carton (67919-012-01) / 10 Ml In 1 Vial, Single-Use",636,RC,67919-012-01,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,67919-030-01,NDC,,,facility,both,1,EA,,24.49,24.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,67919-030-01,NDC,,,facility,both,1,EA,,23.92,23.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68084-607-11,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68084-450-11,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,107.08,107.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,107.7,107.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,114.21,114.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12) / 2 Ml In 1 Vial, Single-Dose (63323-739-11)",636,RC,63323-739-12,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12) / 2 Ml In 1 Vial, Single-Dose (63323-739-11)",636,RC,63323-739-12,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 25 Vial, Single-Use In 1 Tray (63323-739-16) / 2 Ml In 1 Vial, Single-Use (63323-739-41)",636,RC,63323-739-16,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 25 Vial, Single-Use In 1 Tray (63323-739-16) / 2 Ml In 1 Vial, Single-Use (63323-739-41)",636,RC,63323-739-16,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenylephrine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (63323-751-01) / 1 Ml In 1 Vial, Single-Dose (63323-751-00)",636,RC,63323-751-01,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenylephrine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (63323-751-01) / 1 Ml In 1 Vial, Single-Dose (63323-751-00)",636,RC,63323-751-01,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-751-03,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Topotecan Hydrochloride: 1 Vial In 1 Box (63323-762-10) / 4 Ml In 1 Vial,636,RC,63323-762-10,NDC,,,facility,both,1,EA,,10.59,10.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12) / 2 Ml In 1 Vial, Single-Dose (63323-739-11)",636,RC,63323-739-12,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Topotecan Hydrochloride: 1 Vial In 1 Box (63323-762-10) / 4 Ml In 1 Vial,636,RC,63323-762-10,NDC,,,facility,both,1,EA,,5.07,5.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (63323-763-50) / 50 Ml In 1 Vial, Multi-Dose",636,RC,63323-763-50,NDC,,,facility,both,1,EA,,1.75,1.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fentanyl Citrate: 25 Vial, Single-Dose In 1 Carton (63323-806-01) / 1 Ml In 1 Vial, Single-Dose (63323-806-11)",636,RC,63323-806-01,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-806-11,NDC,,,facility,both,1,EA,,5.05,5.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-806-12,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-850-74,NDC,,,facility,both,1,EA,,22.18,22.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-852-03,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-852-03,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Topotecan Hydrochloride: 1 Vial In 1 Box (63323-762-10) / 4 Ml In 1 Vial,636,RC,63323-762-10,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-852-03,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12) / 2 Ml In 1 Vial, Single-Dose (63323-739-11)",636,RC,63323-739-12,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-739-11,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-604-00,NDC,,,facility,both,1,EA,,4.62,4.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-614-00,NDC,,,facility,both,1,EA,,4.47,4.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-614-21,NDC,,,facility,both,1,EA,,4.27,4.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (63323-614-55) / 1 Ml In 1 Vial, Single-Dose (63323-614-21)",636,RC,63323-614-55,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (63323-614-55) / 1 Ml In 1 Vial, Single-Dose (63323-614-21)",636,RC,63323-614-55,NDC,,,facility,both,1,EA,,4.09,4.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-616-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amiodarone Hydrochloride: 25 Vial, Single-Dose In 1 Tray (63323-616-03) / 3 Ml In 1 Vial, Single-Dose (63323-616-01)",636,RC,63323-616-03,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-642-02,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-651-00,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adenosine: 10 Vial, Single-Use In 1 Tray (63323-651-02) / 2 Ml In 1 Vial, Single-Use (63323-651-00)",636,RC,63323-651-02,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-739-11,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlorothiazide: 1 Vial In 1 Box (63323-658-20) / 18 Ml In 1 Vial,636,RC,63323-658-20,NDC,,,facility,both,1,EA,,112.14,112.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine: 25 Vial In 1 Tray (63323-664-16) / 1 Ml In 1 Vial (63323-664-41),636,RC,63323-664-16,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-665-00,NDC,,,facility,both,1,EA,,2,2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetylcysteine: 25 Vial In 1 Carton (63323-694-04) / 4 Ml In 1 Vial (63323-694-22),636,RC,63323-694-04,NDC,,,facility,both,1,EA,,27.35,27.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-713-03,NDC,,,facility,both,1,EA,,7.15,7.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-729-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-729-01,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesna: 1 Vial, Multi-Dose In 1 Box (63323-733-11) / 10 Ml In 1 Vial, Multi-Dose",636,RC,63323-733-11,NDC,,,facility,both,1,EA,,29.82,29.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-739-11,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-664-00,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,165.01,165.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,109.36,109.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,180.79,180.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,175.48,175.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,174.41,174.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,173.92,173.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,172.25,172.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,170.79,170.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,165.67,165.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,165.55,165.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,165.12,165.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,163.72,163.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bendeka: 1 Vial, Multi-Dose In 1 Carton (63459-348-04) / 4 Ml In 1 Vial, Multi-Dose",636,RC,63459-348-04,NDC,,,facility,both,1,EA,,48.17,48.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bendeka: 1 Vial, Multi-Dose In 1 Carton (63459-348-04) / 4 Ml In 1 Vial, Multi-Dose",636,RC,63459-348-04,NDC,,,facility,both,1,EA,,48.15,48.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bendeka: 1 Vial, Multi-Dose In 1 Carton (63459-348-04) / 4 Ml In 1 Vial, Multi-Dose",636,RC,63459-348-04,NDC,,,facility,both,1,EA,,47.5,47.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bendeka: 1 Vial, Multi-Dose In 1 Carton (63459-348-04) / 4 Ml In 1 Vial, Multi-Dose",636,RC,63459-348-04,NDC,,,facility,both,1,EA,,46.38,46.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50) / 50 Ml In 1 Vial, Single-Use",636,RC,63459-104-50,NDC,,,facility,both,1,EA,,110.36,110.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,166.27,166.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,169.58,169.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,169.63,169.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-853-03,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-925-17,NDC,,,facility,both,1,EA,,97.83,97.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Romidepsin: 1 Kit In 1 Carton (63323-926-88) * 2 Ml In 1 Vial, Single-Dose (63323-925-17) * 2.2 Ml In 1 Vial, Single-Dose (63323-922-03)",636,RC,63323-926-88,NDC,,,facility,both,1,EA,,104.42,104.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Romidepsin: 1 Kit In 1 Carton (63323-926-88) * 2 Ml In 1 Vial, Single-Dose (63323-925-17) * 2.2 Ml In 1 Vial, Single-Dose (63323-922-03)",636,RC,63323-926-88,NDC,,,facility,both,1,EA,,103.59,103.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Romidepsin: 1 Kit In 1 Carton (63323-926-88) * 2 Ml In 1 Vial, Single-Dose (63323-925-17) * 2.2 Ml In 1 Vial, Single-Dose (63323-922-03)",636,RC,63323-926-88,NDC,,,facility,both,1,EA,,97.83,97.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Romidepsin: 1 Kit In 1 Carton (63323-926-88) * 2 Ml In 1 Vial, Single-Dose (63323-925-17) * 2.2 Ml In 1 Vial, Single-Dose (63323-922-03)",636,RC,63323-926-88,NDC,,,facility,both,1,EA,,97.83,97.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Romidepsin: 1 Kit In 1 Carton (63323-926-88) * 2 Ml In 1 Vial, Single-Dose (63323-925-17) * 2.2 Ml In 1 Vial, Single-Dose (63323-922-03)",636,RC,63323-926-88,NDC,,,facility,both,1,EA,,97.51,97.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-930-00,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-965-02,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-965-03,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-965-03,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brovana: 30 POUCH in 1 CARTON (63402-911-30) / 1 VIAL, SINGLE-DOSE in 1 POUCH (63402-911-01) / 2 mL in 1 VIAL, SINGLE-DOSE",636,RC,63402-911-30,NDC,,,facility,both,1,EA,,12.53,12.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,184.99,184.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,175.2,175.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,174.86,174.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10) / 10 Ml In 1 Vial, Single-Use",636,RC,63459-103-10,NDC,,,facility,both,1,EA,,173.39,173.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Deferoxamine: 1 Vial In 1 Box (63323-599-30) / 21.1 Ml In 1 Vial,636,RC,63323-599-30,NDC,,,facility,both,1,EA,,17.82,17.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Deferoxamine: 1 Vial In 1 Box (63323-597-10) / 5.3 Ml In 1 Vial,636,RC,63323-597-10,NDC,,,facility,both,1,EA,,34.14,34.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-596-06,NDC,,,facility,both,1,EA,,341.73,341.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-434-41,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 25 Vial, Single-Dose In 1 Box (63323-451-01) / 1 Ml In 1 Vial, Single-Dose (63323-451-00)",636,RC,63323-451-01,NDC,,,facility,both,1,EA,,2.93,2.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-452-00,NDC,,,facility,both,1,EA,,5.06,5.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sensorcaine Mpf: 5 Vial, Single-Dose In 1 Box (63323-462-31) / 30 Ml In 1 Vial, Single-Dose (63323-462-02)",636,RC,63323-462-31,NDC,,,facility,both,1,EA,,21.97,21.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-466-01,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sensorcaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-466-37) / 30 Ml In 1 Vial, Single-Dose (63323-466-01)",636,RC,63323-466-37,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-468-01,NDC,,,facility,both,1,EA,,8.85,8.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol Decanoate: 1 Vial In 1 Carton (63323-469-01) / 1 Ml In 1 Vial,636,RC,63323-469-01,NDC,,,facility,both,1,EA,,19.83,19.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-474-00,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol: 25 Vial In 1 Tray (63323-474-01) / 1 Ml In 1 Vial (63323-474-00),636,RC,63323-474-01,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nesacaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-477-27) / 20 Ml In 1 Vial, Single-Dose (63323-477-01)",636,RC,63323-477-27,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-478-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nesacaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-478-27) / 20 Ml In 1 Vial, Single-Dose (63323-478-01)",636,RC,63323-478-27,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Flumazenil: 10 Vial, Multi-Dose In 1 Tray (63323-424-05) / 5 Ml In 1 Vial, Multi-Dose (63323-424-01)",636,RC,63323-424-05,NDC,,,facility,both,1,EA,,19.56,19.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-376-00,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-376-00,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-376-00,NDC,,,facility,both,1,EA,,1.81,1.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-377-00,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-385-01,NDC,,,facility,both,1,EA,,27.5,27.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefotetan: 10 Vial In 1 Carton (63323-385-10) / 10 Ml In 1 Vial (63323-385-01),636,RC,63323-385-10,NDC,,,facility,both,1,EA,,34.08,34.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-386-01,NDC,,,facility,both,1,EA,,53.43,53.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefotetan: 10 Vial In 1 Carton (63323-386-20) / 20 Ml In 1 Vial (63323-386-01),636,RC,63323-386-20,NDC,,,facility,both,1,EA,,54.49,54.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 10 Vial, Single-Use In 1 Tray (63323-400-05) / 5 Ml In 1 Vial, Single-Use (63323-400-01)",636,RC,63323-400-05,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aztreonam: 10 Vial In 1 Tray (63323-401-20) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (63323-401-01)",636,RC,63323-401-20,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-401-21,NDC,,,facility,both,1,EA,,6.33,6.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-402-03,NDC,,,facility,both,1,EA,,6.22,6.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aztreonam: 10 Vial In 1 Tray (63323-402-30) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (63323-402-03)",636,RC,63323-402-30,NDC,,,facility,both,1,EA,,6.54,6.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-406-01,NDC,,,facility,both,1,EA,,4.43,4.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Caffeine Citrate: 5 Vial In 1 Carton (63323-406-03) / 3 Ml In 1 Vial (63323-406-01),636,RC,63323-406-03,NDC,,,facility,both,1,EA,,4.43,4.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midazolam: 25 Vial In 1 Tray (63323-411-12) / 2 Ml In 1 Vial (63323-411-15),636,RC,63323-411-12,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midazolam: 25 Vial In 1 Tray (63323-411-25) / 5 Ml In 1 Vial (63323-411-18),636,RC,63323-411-25,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neostigmine Methylsulfate: 10 Vial, Multi-Dose In 1 Tray (63323-415-10) / 10 Ml In 1 Vial, Multi-Dose (63323-415-01)",636,RC,63323-415-10,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neostigmine Methylsulfate: 10 Vial, Multi-Dose In 1 Tray (63323-415-10) / 10 Ml In 1 Vial, Multi-Dose (63323-415-01)",636,RC,63323-415-10,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-401-01,NDC,,,facility,both,1,EA,,6.07,6.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-486-02,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-26) / 20 Ml In 1 Vial, Multi-Dose (63323-486-41)",636,RC,63323-486-26,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Meropenem: 25 Vial In 1 Carton (63323-507-25) / 10 Ml In 1 Vial (63323-507-43),636,RC,63323-507-25,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-508-21,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-523-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-530-21,NDC,,,facility,both,1,EA,,36,36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enoxaparin Sodium: 10 Cello Pack In 1 Carton (63323-531-90) / 1 Syringe In 1 Cello Pack (63323-531-01) / .8 Ml In 1 Syringe,636,RC,63323-531-90,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-540-03,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Heparin Sodium: 25 Vial In 1 Tray (63323-540-13) / 1 Ml In 1 Vial (63323-540-03),636,RC,63323-540-13,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-559-63,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-564-21,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-506-01) / 1 Ml In 1 Vial (63323-506-00),636,RC,63323-506-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-564-63,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enoxaparin Sodium: 10 Blister Pack In 1 Carton (63323-566-98) / 1 Syringe In 1 Blister Pack (63323-566-21) / .6 Ml In 1 Syringe,636,RC,63323-566-98,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-584-63,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-586-21,NDC,,,facility,both,1,EA,,2.24,2.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-586-63,NDC,,,facility,both,1,EA,,2.23,2.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Glucagon: 1 Kit In 1 Carton (63323-593-03) * 1 Ml In 1 Vial, Single-Dose (63323-596-03) * 1 Ml In 1 Vial, Single-Dose (63323-185-03)",636,RC,63323-593-03,NDC,,,facility,both,1,EA,,347.14,347.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Glucagon: 1 Kit In 1 Carton (63323-593-03) * 1 Ml In 1 Vial, Single-Dose (63323-596-03) * 1 Ml In 1 Vial, Single-Dose (63323-185-03)",636,RC,63323-593-03,NDC,,,facility,both,1,EA,,325.47,325.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Glucagon: 1 Kit In 1 Carton (63323-594-03) * 1 Ml In 1 Vial, Single-Dose (63323-596-06) * 1 Ml In 1 Vial, Single-Dose (63323-185-03)",636,RC,63323-594-03,NDC,,,facility,both,1,EA,,333.59,333.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Glucagon: 1 Kit In 1 Carton (63323-594-03) * 1 Ml In 1 Vial, Single-Dose (63323-596-06) * 1 Ml In 1 Vial, Single-Dose (63323-185-03)",636,RC,63323-594-03,NDC,,,facility,both,1,EA,,325.47,325.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-596-03,NDC,,,facility,both,1,EA,,339.39,339.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-596-03,NDC,,,facility,both,1,EA,,338.47,338.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-566-63,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-506-01) / 1 Ml In 1 Vial (63323-506-00),636,RC,63323-506-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-506-00,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-506-00,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-491-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-491-57) / 50 Ml In 1 Vial, Single-Dose (63323-491-01)",636,RC,63323-491-57,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-27) / 2 Ml In 1 Vial, Single-Dose (63323-492-04)",636,RC,63323-492-27,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-495-04,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-596-06,NDC,,,facility,both,1,EA,,325.47,325.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone: 237 Ml In 1 Bottle, Plastic (64980-509-24)",636,RC,64980-509-24,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,65145-151-01,NDC,,,facility,both,1,EA,,5.03,5.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phytonadione: 2 Tray In 1 Carton (65145-151-10) / 5 Vial, Single-Dose In 1 Tray (65145-151-05) / 1 Ml In 1 Vial, Single-Dose (65145-151-01)",636,RC,65145-151-10,NDC,,,facility,both,1,EA,,5.03,5.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20) / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,115.5,115.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20) / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,110.67,110.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20) / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,109.43,109.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20) / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,99.26,99.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20) / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,98.27,98.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,64875-001-01,NDC,,,facility,both,1,EA,,124.17,124.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20) / 5 Ml In 1 Vial, Single-Dose",636,RC,64764-300-20,NDC,,,facility,both,1,EA,,105,105,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tobramycin: 56 Ampule In 1 Carton (65162-914-46) / 5 Ml In 1 Ampule,636,RC,65162-914-46,NDC,,,facility,both,1,EA,,36.13,36.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,65219-020-03,NDC,,,facility,both,1,EA,,5.53,5.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tyenne: 1 Vial, Single-Dose In 1 Carton (65219-592-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,65219-592-10,NDC,,,facility,both,1,EA,,14.56,14.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tyenne: 1 Vial, Single-Dose In 1 Carton (65219-594-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,65219-594-20,NDC,,,facility,both,1,EA,,14.57,14.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,65597-406-01,NDC,,,facility,both,1,EA,,114.28,114.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temozolomide: 1 Bottle In 1 Carton (65162-802-51) / 5 Capsule In 1 Bottle,636,RC,65162-802-51,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temozolomide: 1 Bottle In 1 Carton (65162-803-51) / 5 Capsule In 1 Bottle,636,RC,65162-803-51,NDC,,,facility,both,1,EA,,3.33,3.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-518-10) / 10 TABLET in 1 BLISTER PACK",636,RC,63739-518-10,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-519-10) / 10 TABLET in 1 BLISTER PACK",636,RC,63739-519-10,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 10 Blister Pack In 1 Box, Unit-Dose (63739-588-10) / 10 Tablet In 1 Blister Pack",636,RC,63739-588-10,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Promethazine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-213-10) / 10 Tablet In 1 Blister Pack",636,RC,63739-213-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kcentra: 1 Kit In 1 Carton (63833-386-02) * 20 Ml In 1 Vial, Single-Use (63833-396-01) * 20 Ml In 1 Vial, Single-Use (63833-761-20)",636,RC,63833-386-02,NDC,,,facility,both,1,EA,,6.79,6.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kcentra: 1 Kit In 1 Carton (63833-386-02) * 20 Ml In 1 Vial, Single-Use (63833-396-01) * 20 Ml In 1 Vial, Single-Use (63833-761-20)",636,RC,63833-386-02,NDC,,,facility,both,1,EA,,6.24,6.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kcentra: 1 Kit In 1 Carton (63833-387-02) * 40 Ml In 1 Vial, Single-Use (63833-397-01) * 40 Ml In 1 Vial, Single-Use (63833-761-40)",636,RC,63833-387-02,NDC,,,facility,both,1,EA,,6.6,6.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kcentra: 1 Kit In 1 Carton (63833-387-02) * 40 Ml In 1 Vial, Single-Use (63833-397-01) * 40 Ml In 1 Vial, Single-Use (63833-761-40)",636,RC,63833-387-02,NDC,,,facility,both,1,EA,,6.43,6.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63833-396-01,NDC,,,facility,both,1,EA,,6.24,6.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63833-397-01,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63833-397-01,NDC,,,facility,both,1,EA,,6.55,6.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humate-P: 1 Kit In 1 Carton (63833-615-02) * 5 Ml In 1 Vial (63833-625-01) * 5 Ml In 1 Vial, Single-Dose (63833-765-53)",636,RC,63833-615-02,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humate-P: 1 Kit In 1 Carton (63833-616-02) * 10 Ml In 1 Vial (63833-626-01) * 10 Ml In 1 Vial, Single-Dose (63833-765-54)",636,RC,63833-616-02,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humate-P: 1 Kit In 1 Carton (63833-617-02) * 15 Ml In 1 Vial (63833-627-01) * 15 Ml In 1 Vial, Single-Dose (63833-765-55)",636,RC,63833-617-02,NDC,,,facility,both,1,EA,,3.43,3.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,64253-900-30,NDC,,,facility,both,1,EA,,21.04,21.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tacrolimus: 100 Capsule In 1 Container (64380-720-06),636,RC,64380-720-06,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tacrolimus: 100 Capsule In 1 Container (64380-722-06),636,RC,64380-722-06,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Feiba: 1 Kit In 1 Carton (64193-424-02) * 20 Ml In 1 Vial, Glass (64193-324-01) * 20 Ml In 1 Vial, Glass (64764-517-20)",636,RC,64193-424-02,NDC,,,facility,both,1,EA,,6.29,6.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 1 Vial In 1 Box (63323-374-20) / 20 Ml In 1 Vial,636,RC,63323-374-20,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68180-984-05,NDC,,,facility,both,1,EA,,2.16,2.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone: 100 Tablet In 1 Bottle (72603-187-01),636,RC,72603-187-01,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (72603-200-01) / 25 Ml In 1 Vial, Single-Dose",636,RC,72603-200-01,NDC,,,facility,both,1,EA,,228.37,228.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone: 100 Mg In 1 Bottle (72603-212-01),636,RC,72603-212-01,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ropivacaine Hydrochloride: 25 Vial In 1 Carton (72603-216-25) / 20 Ml In 1 Vial (72603-216-01),636,RC,72603-216-25,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72603-221-01,NDC,,,facility,both,1,EA,,1.98,1.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72603-412-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72603-590-01,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prochlorperazine Maleate: 100 Tablet In 1 Bottle (72603-169-01),636,RC,72603-169-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-152-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72493-101-40,NDC,,,facility,both,1,EA,,835.01,835.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jelmyto: 1 Kit In 1 Carton (72493-103-03) * 1 Powder, For Solution In 1 Vial, Single-Dose (72493-101-40) * 20 Ml In 1 Vial, Single-Dose (72493-102-20)",636,RC,72493-103-03,NDC,,,facility,both,1,EA,,692.92,692.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (72603-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-103-01,NDC,,,facility,both,1,EA,,329.6,329.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (72603-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-103-01,NDC,,,facility,both,1,EA,,188.13,188.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (72603-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-103-01,NDC,,,facility,both,1,EA,,181.36,181.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prochlorperazine Maleate: 100 Tablet In 1 Bottle (72603-169-01),636,RC,72603-169-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72603-128-01,NDC,,,facility,both,1,EA,,5.08,5.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72603-133-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72603-133-01,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72603-139-01,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72603-146-01) / 20 Ml In 1 Vial, Multi-Dose",636,RC,72603-146-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72603-152-01,NDC,,,facility,both,1,EA,,0.07,0.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,73070-103-10,NDC,,,facility,both,1,EA,,6.41,6.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,73070-103-10,NDC,,,facility,both,1,EA,,6.41,6.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,73070-103-10,NDC,,,facility,both,1,EA,,6.2,6.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15) / 3 Ml In 1 Syringe, Plastic (73070-103-10)",636,RC,73070-103-15,NDC,,,facility,both,1,EA,,6.2,6.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sylvant: 1 Vial, Single-Dose In 1 Box (73090-420-01) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,73090-420-01,NDC,,,facility,both,1,EA,,500.84,500.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sylvant: 1 Vial, Single-Dose In 1 Box (73090-421-01) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,73090-421-01,NDC,,,facility,both,1,EA,,504.94,504.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (73535-208-01) / 5 Ml In 1 Vial,636,RC,73535-208-01,NDC,,,facility,both,1,EA,,46.17,46.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (73535-208-01) / 5 Ml In 1 Vial,636,RC,73535-208-01,NDC,,,facility,both,1,EA,,45.94,45.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (73535-208-01) / 5 Ml In 1 Vial,636,RC,73535-208-01,NDC,,,facility,both,1,EA,,45.94,45.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (73535-208-01) / 5 Ml In 1 Vial,636,RC,73535-208-01,NDC,,,facility,both,1,EA,,45.62,45.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (73535-208-01) / 5 Ml In 1 Vial,636,RC,73535-208-01,NDC,,,facility,both,1,EA,,45.4,45.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Evomela: 1 Vial In 1 Carton (72893-001-01) / 20 Ml In 1 Vial,636,RC,72893-001-01,NDC,,,facility,both,1,EA,,72.83,72.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Evomela: 1 Vial In 1 Carton (72893-001-01) / 20 Ml In 1 Vial,636,RC,72893-001-01,NDC,,,facility,both,1,EA,,71.46,71.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Evomela: 1 Vial In 1 Carton (72893-001-01) / 20 Ml In 1 Vial,636,RC,72893-001-01,NDC,,,facility,both,1,EA,,71.2,71.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Folotyn: 1 Vial In 1 Carton (72893-003-01) / 1 Ml In 1 Vial,636,RC,72893-003-01,NDC,,,facility,both,1,EA,,1247.62,1247.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Folotyn: 1 Vial In 1 Carton (72893-005-01) / 2 Ml In 1 Vial,636,RC,72893-005-01,NDC,,,facility,both,1,EA,,1243.81,1243.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01) / 20 Ml In 1 Vial, Single-Use",636,RC,72903-853-01,NDC,,,facility,both,1,EA,,250.42,250.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01) / 20 Ml In 1 Vial, Single-Use",636,RC,72903-853-01,NDC,,,facility,both,1,EA,,250.22,250.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01) / 20 Ml In 1 Vial, Single-Use",636,RC,72903-853-01,NDC,,,facility,both,1,EA,,247.37,247.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01) / 20 Ml In 1 Vial, Single-Use",636,RC,72903-853-01,NDC,,,facility,both,1,EA,,240.1,240.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01) / 20 Ml In 1 Vial, Single-Use",636,RC,72903-853-01,NDC,,,facility,both,1,EA,,221.17,221.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01) / 20 Ml In 1 Vial, Single-Use",636,RC,72903-853-01,NDC,,,facility,both,1,EA,,217.39,217.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11) / 10 Ml In 1 Vial, Glass",636,RC,73070-100-11,NDC,,,facility,both,1,EA,,6.96,6.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11) / 10 Ml In 1 Vial, Glass",636,RC,73070-100-11,NDC,,,facility,both,1,EA,,6.21,6.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72493-101-40,NDC,,,facility,both,1,EA,,898.95,898.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72493-101-40,NDC,,,facility,both,1,EA,,898.95,898.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1027-1),636,RC,71399-1027-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1027-1),636,RC,71399-1027-1,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71506-028-59,NDC,,,facility,both,1,EA,,14.78,14.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-719-10,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71837-5843-1,NDC,,,facility,both,1,EA,,161.73,161.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Docetaxel: 1 Vial, Multi-Dose In 1 Carton (72078-040-08) / 8 Ml In 1 Vial, Multi-Dose",636,RC,72078-040-08,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72196-6074-1,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71837-5843-1,NDC,,,facility,both,1,EA,,172.13,172.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-716-11,NDC,,,facility,both,1,EA,,7.39,7.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,3.99,3.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,3.19,3.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-95) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-95,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-95) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-95,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-203-10,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (71288-402-31) / 30 Ml In 1 Vial, Multi-Dose (71288-402-30)",636,RC,71288-402-31,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-716-11,NDC,,,facility,both,1,EA,,12.72,12.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-410-83) / .4 Ml In 1 Syringe (71288-410-82),636,RC,71288-410-83,NDC,,,facility,both,1,EA,,3.97,3.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-427-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-432-80,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-433-82,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-434-84,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-435-86,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-436-88,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-600-10,NDC,,,facility,both,1,EA,,2.93,2.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enoxaparin Sodium: 1 Vial, Multi-Dose In 1 Carton (71288-426-03) / 3 Ml In 1 Vial, Multi-Dose",636,RC,71288-426-03,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Use In 1 Carton (72205-031-01) / 20 Ml In 1 Vial, Single-Use",636,RC,72205-031-01,NDC,,,facility,both,1,EA,,8.28,8.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72205-036-01,NDC,,,facility,both,1,EA,,15.35,15.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 1 Vial In 1 Carton (72266-124-01) / 20 Ml In 1 Vial,636,RC,72266-124-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 1 Vial In 1 Carton (72266-124-01) / 20 Ml In 1 Vial,636,RC,72266-124-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-127-01,NDC,,,facility,both,1,EA,,20.71,20.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,72266-131-01,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,72266-131-01,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic Acid: 1 Bag In 1 Carton (72266-152-01) / 100 Ml In 1 Bag,636,RC,72266-152-01,NDC,,,facility,both,1,EA,,15.27,15.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic Acid: 1 Bag In 1 Carton (72266-152-01) / 100 Ml In 1 Bag,636,RC,72266-152-01,NDC,,,facility,both,1,EA,,11.34,11.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-160-01,NDC,,,facility,both,1,EA,,17.13,17.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-160-41,NDC,,,facility,both,1,EA,,16.56,16.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-237-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline: 5 Vial In 1 Carton (72266-237-05) / 10 Ml In 1 Vial (72266-237-01),636,RC,72266-237-05,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72485-422-01,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72485-507-01,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72485-507-01,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Thiamine: 25 Vial, Multi-Dose In 1 Carton (72485-507-25) / 2 Ml In 1 Vial, Multi-Dose (72485-507-01)",636,RC,72485-507-25,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoledronic Acid: 1 Bag In 1 Carton (72266-152-01) / 100 Ml In 1 Bag,636,RC,72266-152-01,NDC,,,facility,both,1,EA,,11.32,11.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72266-118-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72266-102-01) / 20 Ml In 1 Vial, Multi-Dose",636,RC,72266-102-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexrazoxane: 1 Vial In 1 Carton (72266-101-01) / 50 Ml In 1 Vial,636,RC,72266-101-01,NDC,,,facility,both,1,EA,,179.09,179.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72205-036-01,NDC,,,facility,both,1,EA,,14.81,14.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72205-036-01,NDC,,,facility,both,1,EA,,14.28,14.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72205-036-01,NDC,,,facility,both,1,EA,,14.18,14.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72205-036-01,NDC,,,facility,both,1,EA,,12.26,12.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,72205-036-01,NDC,,,facility,both,1,EA,,10.97,10.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72205-101-01,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72205-101-01,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carmustine: 1 Kit In 1 Carton (72205-198-01) * 3 Ml In 1 Vial (72205-196-01) * 30 Ml In 1 Vial, Single-Dose (72205-197-01)",636,RC,72205-198-01,NDC,,,facility,both,1,EA,,297.33,297.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,72205-205-01,NDC,,,facility,both,1,EA,,15.45,15.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexrazoxane: 1 Vial In 1 Carton (72266-101-01) / 50 Ml In 1 Vial,636,RC,72266-101-01,NDC,,,facility,both,1,EA,,196.45,196.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexrazoxane: 1 Vial In 1 Carton (72266-101-01) / 50 Ml In 1 Vial,636,RC,72266-101-01,NDC,,,facility,both,1,EA,,182.62,182.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,4.26,4.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-002-01,NDC,,,facility,both,1,EA,,286.8,286.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-002-01,NDC,,,facility,both,1,EA,,210.19,210.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-002-01,NDC,,,facility,both,1,EA,,202.87,202.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-002-01,NDC,,,facility,both,1,EA,,202.7,202.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-002-01,NDC,,,facility,both,1,EA,,202.7,202.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,203.15,203.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,191.2,191.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,188.43,188.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,181.06,181.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,179.29,179.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,177.52,177.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,177.52,177.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-111-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,82959-111-01,NDC,,,facility,both,1,EA,,189.07,189.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-111-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,82959-111-01,NDC,,,facility,both,1,EA,,184.77,184.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-111-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,82959-111-01,NDC,,,facility,both,1,EA,,181.91,181.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-112-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,82959-112-01,NDC,,,facility,both,1,EA,,182.61,182.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-112-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,82959-112-01,NDC,,,facility,both,1,EA,,182.2,182.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,83090-011-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,83090-011-01,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01) / .8 Ml In 1 Vial, Glass",636,RC,82705-010-01,NDC,,,facility,both,1,EA,,179.29,179.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,83257-003-11,NDC,,,facility,both,1,EA,,146.31,146.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fyarro: 1 Vial, Single-Use In 1 Carton (80803-153-50) / 20 Ml In 1 Vial, Single-Use",636,RC,80803-153-50,NDC,,,facility,both,1,EA,,245.05,245.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fyarro: 1 Vial, Single-Use In 1 Carton (80803-153-50) / 20 Ml In 1 Vial, Single-Use",636,RC,80803-153-50,NDC,,,facility,both,1,EA,,241.75,241.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,80830-1188-1,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,80830-2365-1,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Propofol: 10 Vial In 1 Carton (80830-2365-7) / 100 Ml In 1 Vial (80830-2365-1),636,RC,80830-2365-7,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,81284-411-00,NDC,,,facility,both,1,EA,,131.16,131.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (81298-3890-1) / 2 Ml In 1 Vial, Single-Dose",636,RC,81298-3890-1,NDC,,,facility,both,1,EA,,261.94,261.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (81298-3890-1) / 2 Ml In 1 Vial, Single-Dose",636,RC,81298-3890-1,NDC,,,facility,both,1,EA,,260.04,260.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (81298-3890-1) / 2 Ml In 1 Vial, Single-Dose",636,RC,81298-3890-1,NDC,,,facility,both,1,EA,,195.02,195.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (81298-3890-1) / 2 Ml In 1 Vial, Single-Dose",636,RC,81298-3890-1,NDC,,,facility,both,1,EA,,191.29,191.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,81298-8552-1,NDC,,,facility,both,1,EA,,21.28,21.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,81298-8552-1,NDC,,,facility,both,1,EA,,3.23,3.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vasopressin In 0.9% Sodium Chloride: 10 Vial, Single-Dose In 1 Carton (81298-8552-3) / 100 Ml In 1 Vial, Single-Dose (81298-8552-1)",636,RC,81298-8552-3,NDC,,,facility,both,1,EA,,26.56,26.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Anktiva: 1 Vial, Glass In 1 Box (81481-803-01) / .4 Ml In 1 Vial, Glass",636,RC,81481-803-01,NDC,,,facility,both,1,EA,,330.73,330.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ogivri: 1 Kit In 1 Carton (83257-004-12) * 20 Ml In 1 Vial, Multi-Dose (83257-003-11) * 20 Ml In 1 Vial (83257-002-11)",636,RC,83257-004-12,NDC,,,facility,both,1,EA,,151.39,151.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,405.09,405.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,405.09,405.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,389.58,389.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,389.31,389.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,386.68,386.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,384.51,384.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,383.88,383.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,369.42,369.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,368.26,368.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,368.26,368.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,368.26,368.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fulphila: 1 Syringe In 1 Carton (83257-005-41) / .6 Ml In 1 Syringe,636,RC,83257-005-41,NDC,,,facility,both,1,EA,,350.02,350.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,83634-500-41,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fosaprepitant: 1 Vial In 1 Carton (83634-776-10) / 5 Ml In 1 Vial,636,RC,83634-776-10,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fosaprepitant: 1 Vial In 1 Carton (83634-776-10) / 5 Ml In 1 Vial,636,RC,83634-776-10,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fosaprepitant: 1 Vial In 1 Carton (83634-776-10) / 5 Ml In 1 Vial,636,RC,83634-776-10,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fyarro: 1 Vial, Single-Use In 1 Carton (80803-153-50) / 20 Ml In 1 Vial, Single-Use",636,RC,80803-153-50,NDC,,,facility,both,1,EA,,250.68,250.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Enjaymo: 1 Vial, Single-Dose In 1 Carton (80203-347-01) / 22 Ml In 1 Vial, Single-Dose",636,RC,80203-347-01,NDC,,,facility,both,1,EA,,51.38,51.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zynlonta: 1 Vial, Single-Dose In 1 Carton (79952-110-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,79952-110-01,NDC,,,facility,both,1,EA,,6532.85,6532.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilaudid: 10 Syringe In 1 Carton (76045-009-11) / 1 Ml In 1 Syringe (76045-009-01),636,RC,76045-009-11,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilaudid: 10 Syringe In 1 Carton (76045-009-11) / 1 Ml In 1 Syringe (76045-009-01),636,RC,76045-009-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-009-96,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-204-00,NDC,,,facility,both,1,EA,,17.66,17.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,219.09,219.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,208.42,208.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilaudid: 10 Syringe In 1 Carton (76045-009-11) / 1 Ml In 1 Syringe (76045-009-01),636,RC,76045-009-11,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,207.8,207.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,197.9,197.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,188.27,188.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,188.22,188.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,183.24,183.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,76075-102-01,NDC,,,facility,both,1,EA,,217.69,217.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,76075-102-01,NDC,,,facility,both,1,EA,,207.62,207.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,76075-102-01,NDC,,,facility,both,1,EA,,207.05,207.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,76075-102-01,NDC,,,facility,both,1,EA,,200.44,200.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,76075-102-01,NDC,,,facility,both,1,EA,,187.54,187.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,76075-102-01,NDC,,,facility,both,1,EA,,186.71,186.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01) / 30 Ml In 1 Vial, Single-Use",636,RC,76075-101-01,NDC,,,facility,both,1,EA,,198.53,198.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,76075-103-01,NDC,,,facility,both,1,EA,,217.69,217.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilaudid: 24 SYRINGE in 1 CARTON (76045-009-05) / .5 mL in 1 SYRINGE (76045-009-03) ,636,RC,76045-009-05,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilaudid: 24 SYRINGE in 1 CARTON (76045-009-05) / .5 mL in 1 SYRINGE (76045-009-03) ,636,RC,76045-009-05,NDC,,,facility,both,1,EA,,2.16,2.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilaudid: 24 SYRINGE in 1 CARTON (76045-009-05) / .5 mL in 1 SYRINGE (76045-009-03) ,636,RC,76045-009-05,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-004-01,NDC,,,facility,both,1,EA,,5.83,5.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-005-01,NDC,,,facility,both,1,EA,,5.32,5.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-005-01,NDC,,,facility,both,1,EA,,2.98,2.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76045-009-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,76075-103-01,NDC,,,facility,both,1,EA,,210.71,210.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,76075-103-01,NDC,,,facility,both,1,EA,,208.24,208.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,76075-103-01,NDC,,,facility,both,1,EA,,197.9,197.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Renflexis: 1 Vial In 1 Carton (78206-162-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,111.68,111.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Renflexis: 1 Vial In 1 Carton (78206-162-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,109.99,109.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Renflexis: 1 Vial In 1 Carton (78206-162-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,104.94,104.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Renflexis: 1 Vial In 1 Carton (78206-162-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,104.94,104.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Renflexis: 1 Vial In 1 Carton (78206-162-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,104.94,104.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Renflexis: 1 Vial In 1 Carton (78206-162-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,104.94,104.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,78206-162-99,NDC,,,facility,both,1,EA,,117.31,117.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,78206-162-99,NDC,,,facility,both,1,EA,,117.31,117.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,78206-162-99,NDC,,,facility,both,1,EA,,110.44,110.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zynlonta: 1 Vial, Single-Dose In 1 Carton (79952-110-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,79952-110-01,NDC,,,facility,both,1,EA,,6991.3,6991.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Renflexis: 1 Vial In 1 Carton (78206-162-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)",636,RC,78206-162-01,NDC,,,facility,both,1,EA,,112.3,112.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naloxone Hydrochloride: 10 Syringe In 1 Box (76329-3469-1) / 2 Ml In 1 Syringe,636,RC,76329-3469-1,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,76075-103-01,NDC,,,facility,both,1,EA,,190.6,190.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,76075-103-01,NDC,,,facility,both,1,EA,,185.72,185.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ipratropium Bromide: 30 Pouch In 1 Carton (76204-100-01) / 1 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule,636,RC,76204-100-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ipratropium Bromide: 1 Pouch In 1 Carton (76204-100-30) / 30 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule,636,RC,76204-100-30,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Albuterol Sulfate: 30 Pouch In 1 Carton (76204-200-01) / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,636,RC,76204-200-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (76204-600-01) / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule,636,RC,76204-600-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,76310-024-15,NDC,,,facility,both,1,EA,,128.77,128.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Foscavir: 10 Carton In 1 Carton (76310-024-25) / 1 Bottle In 1 Carton (76310-024-15) / 250 Ml In 1 Bottle,636,RC,76310-024-25,NDC,,,facility,both,1,EA,,143.44,143.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phytonadione: 1 Syringe In 1 Carton (76329-1240-1) / .5 Ml In 1 Syringe,636,RC,76329-1240-1,NDC,,,facility,both,1,EA,,65.56,65.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naloxone Hydrochloride: 10 Syringe In 1 Box (76329-1469-1) / 2 Ml In 1 Syringe,636,RC,76329-1469-1,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextrose Monohydrate: 1 Syringe In 1 Carton (76329-3302-1) / 50 Ml In 1 Syringe,636,RC,76329-3302-1,NDC,,,facility,both,1,EA,,36.07,36.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Calcium Chloride: 10 Syringe In 1 Package (76329-3304-1) / 10 Ml In 1 Syringe,636,RC,76329-3304-1,NDC,,,facility,both,1,EA,,25.07,25.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Epinephrine: 10 Carton In 1 Package (76329-3318-1) / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3318-1,NDC,,,facility,both,1,EA,,3.03,3.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1) / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3340-1,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1) / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe,636,RC,76329-3340-1,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zynlonta: 1 Vial, Single-Dose In 1 Carton (79952-110-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,79952-110-01,NDC,,,facility,both,1,EA,,1135.46,1135.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50) / 50 Ml In 1 Vial, Single-Dose",636,RC,71288-167-50,NDC,,,facility,both,1,EA,,5.02,5.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,69339-136-03,NDC,,,facility,both,1,EA,,19.16,19.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,69374-925-10,NDC,,,facility,both,1,EA,,1.48,1.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,69097-708-31,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69238-1056-1)",636,RC,69238-1056-1,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prochlorperazine Maleate: 100 Tablet In 1 Bottle (69452-472-20),636,RC,69452-472-20,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70069-005-01,NDC,,,facility,both,1,EA,,2.64,2.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70069-021-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70069-021-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (70069-021-25) / 1 Ml In 1 Vial (70069-021-01),636,RC,70069-021-25,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (70069-021-25) / 1 Ml In 1 Vial (70069-021-01),636,RC,70069-021-25,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70069-005-01,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desmopressin Acetate: 1 Ml In 1 Ampule (69918-899-01),636,RC,69918-899-01,NDC,,,facility,both,1,EA,,15.15,15.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desmopressin Acetate: 1 Ml In 1 Ampule (69918-899-01),636,RC,69918-899-01,NDC,,,facility,both,1,EA,,14.65,14.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desmopressin Acetate: 1 Ml In 1 Ampule (69918-899-01),636,RC,69918-899-01,NDC,,,facility,both,1,EA,,14.42,14.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desmopressin Acetate: 10 Ampule In 1 Carton (69918-899-10) / 1 Ml In 1 Ampule,636,RC,69918-899-10,NDC,,,facility,both,1,EA,,15.53,15.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desmopressin Acetate: 10 Ampule In 1 Carton (69918-899-10) / 1 Ml In 1 Ampule,636,RC,69918-899-10,NDC,,,facility,both,1,EA,,13.91,13.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70004-085-44,NDC,,,facility,both,1,EA,,20.17,20.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Budesonide Inhalation Suspension: 6 Pouch In 1 Carton (69097-319-87) / 5 Ampule In 1 Pouch (69097-319-86) / 2 Ml In 1 Ampule,636,RC,69097-319-87,NDC,,,facility,both,1,EA,,4.71,4.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,69097-319-86,NDC,,,facility,both,1,EA,,4.68,4.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Arformoterol Tartrate: 6 Pouch In 1 Carton (69097-168-87) / 5 Vial, Single-Dose In 1 Pouch (69097-168-48) / 2 Ml In 1 Vial, Single-Dose",636,RC,69097-168-87,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-469-40,NDC,,,facility,both,1,EA,,2.18,2.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-469-40,NDC,,,facility,both,1,EA,,2.12,2.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-470-40,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-584-40,NDC,,,facility,both,1,EA,,16.09,16.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-158-40,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68382-910-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylprednisolone: 50 Tablet In 1 Bottle (68382-918-18),636,RC,68382-918-18,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-157-40,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-157-40,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fosphenytoin Sodium: 10 Vial, Single-Dose In 1 Carton (68462-622-10) / 10 Ml In 1 Vial, Single-Dose (68462-622-64)",636,RC,68462-622-10,NDC,,,facility,both,1,EA,,3.38,3.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 40 Ml In 1 Carton (68727-745-02),636,RC,68727-745-02,NDC,,,facility,both,1,EA,,839.17,839.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 40 Ml In 1 Carton (68727-745-02),636,RC,68727-745-02,NDC,,,facility,both,1,EA,,816.61,816.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68727-900-01,NDC,,,facility,both,1,EA,,176.02,176.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68727-900-01,NDC,,,facility,both,1,EA,,172.38,172.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68727-900-01,NDC,,,facility,both,1,EA,,172.33,172.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rylaze: 3 Vial, Single-Dose In 1 Carton (68727-900-03) / .5 Ml In 1 Vial, Single-Dose (68727-900-01)",636,RC,68727-900-03,NDC,,,facility,both,1,EA,,175.76,175.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rylaze: 3 Vial, Single-Dose In 1 Carton (68727-900-03) / .5 Ml In 1 Vial, Single-Dose (68727-900-01)",636,RC,68727-900-03,NDC,,,facility,both,1,EA,,172.34,172.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 40 Ml In 1 Carton (68727-745-02),636,RC,68727-745-02,NDC,,,facility,both,1,EA,,846.56,846.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Albumin (Human): 50 Ml In 1 Bottle, Glass (68982-643-01)",636,RC,68982-643-01,NDC,,,facility,both,1,EA,,99.49,99.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Envarsus Xr: 1 Pouch In 1 Carton (68992-3010-3) / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3010-3,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Envarsus Xr: 1 Pouch In 1 Carton (68992-3040-3) / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3040-3,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Envarsus Xr: 1 Pouch In 1 Carton (68992-3075-3) / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic",636,RC,68992-3075-3,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,69097-168-32,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,69097-168-48,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Albumin (Human): 50 Ml In 1 Bottle, Glass (68982-643-01)",636,RC,68982-643-01,NDC,,,facility,both,1,EA,,106.3,106.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 40 Ml In 1 Carton (68727-745-02),636,RC,68727-745-02,NDC,,,facility,both,1,EA,,917.47,917.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 40 Ml In 1 Carton (68727-745-02),636,RC,68727-745-02,NDC,,,facility,both,1,EA,,954.08,954.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 20 Ml In 1 Vial (68727-745-01),636,RC,68727-745-01,NDC,,,facility,both,1,EA,,774.61,774.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Epinephrine: 1 Vial, Multi-Dose In 1 Carton (68462-760-10) / 10 Ml In 1 Vial, Multi-Dose",636,RC,68462-760-10,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-897-01,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-897-01,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68462-897-01,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Octreotide Acetate: 10 Vial In 1 Carton (68462-897-10) / 1 Ml In 1 Vial (68462-897-01),636,RC,68462-897-10,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Albutein: 1 Vial In 1 Carton (68516-5214-2) / 500 Ml In 1 Vial (68516-5214-4),636,RC,68516-5214-2,NDC,,,facility,both,1,EA,,114.45,114.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Albutein: 1 Vial In 1 Carton (68516-5214-2) / 500 Ml In 1 Vial (68516-5214-4),636,RC,68516-5214-2,NDC,,,facility,both,1,EA,,49.05,49.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Albutein: 1 Vial In 1 Carton (68516-5214-2) / 500 Ml In 1 Vial (68516-5214-4),636,RC,68516-5214-2,NDC,,,facility,both,1,EA,,22.89,22.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68516-5214-4,NDC,,,facility,both,1,EA,,35.69,35.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68516-5214-4,NDC,,,facility,both,1,EA,,33.89,33.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68516-5214-4,NDC,,,facility,both,1,EA,,32.57,32.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Albutein: 1 Vial In 1 Carton (68516-5214-5) / 50 Ml In 1 Vial (68516-5214-6),636,RC,68516-5214-5,NDC,,,facility,both,1,EA,,347.36,347.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Albutein: 1 Vial In 1 Carton (68516-5214-5) / 50 Ml In 1 Vial (68516-5214-6),636,RC,68516-5214-5,NDC,,,facility,both,1,EA,,186.09,186.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68516-5214-6,NDC,,,facility,both,1,EA,,110.72,110.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68516-5214-6,NDC,,,facility,both,1,EA,,87.38,87.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,68516-5218-0,NDC,,,facility,both,1,EA,,125.9,125.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zepzelca: 8 Ml In 1 Vial, Single-Dose (68727-712-01)",636,RC,68727-712-01,NDC,,,facility,both,1,EA,,744.94,744.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zepzelca: 8 Ml In 1 Vial, Single-Dose (68727-712-01)",636,RC,68727-712-01,NDC,,,facility,both,1,EA,,744.12,744.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 20 Ml In 1 Vial (68727-745-01),636,RC,68727-745-01,NDC,,,facility,both,1,EA,,917.47,917.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 20 Ml In 1 Vial (68727-745-01),636,RC,68727-745-01,NDC,,,facility,both,1,EA,,857.69,857.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyxeos: 20 Ml In 1 Vial (68727-745-01),636,RC,68727-745-01,NDC,,,facility,both,1,EA,,843.47,843.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 10 Vial In 1 Carton (70069-362-10) / 10 Ml In 1 Vial (70069-362-01),636,RC,70069-362-10,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Haloperidol Decanoate: 1 Vial, Single-Dose In 1 Carton (70069-381-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,70069-381-01,NDC,,,facility,both,1,EA,,18.93,18.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70842-120-01,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vabomere: 6 Vial, Single-Dose In 1 Carton (70842-120-06) / 2 G In 1 Vial, Single-Dose (70842-120-01)",636,RC,70842-120-06,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70842-160-01,NDC,,,facility,both,1,EA,,7.36,7.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70860-100-41,NDC,,,facility,both,1,EA,,7.71,7.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 VIAL in 1 CARTON (70860-105-20) / 20 mL in 1 VIAL (70860-105-41) ,636,RC,70860-105-20,NDC,,,facility,both,1,EA,,9.2,9.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 10 Vial, Single-Dose In 1 Carton (70860-125-66) / 5 Ml In 1 Vial, Single-Dose (70860-125-41)",636,RC,70860-125-66,NDC,,,facility,both,1,EA,,8.07,8.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paclitaxel: 1 Vial In 1 Carton (70860-215-67) / 16.7 Ml In 1 Vial,636,RC,70860-215-67,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70860-405-41,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70860-405-41,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acyclovir: 473 Ml In 1 Bottle (70954-188-10),636,RC,70954-188-10,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70860-405-41,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70756-621-82,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-950-36) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-950-36,NDC,,,facility,both,1,EA,,3360.62,3360.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-950-36) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-950-36,NDC,,,facility,both,1,EA,,3360.62,3360.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-950-36) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-950-36,NDC,,,facility,both,1,EA,,3360.62,3360.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-950-36) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-950-36,NDC,,,facility,both,1,EA,,3108.92,3108.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-950-36) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-950-36,NDC,,,facility,both,1,EA,,2857.91,2857.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-950-36) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-950-36,NDC,,,facility,both,1,EA,,2742.69,2742.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-951-30) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-951-30,NDC,,,facility,both,1,EA,,2903.58,2903.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-951-30) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-951-30,NDC,,,facility,both,1,EA,,2645.72,2645.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zoladex: 1 Pouch In 1 Carton (70720-951-30) / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe,636,RC,70720-951-30,NDC,,,facility,both,1,EA,,2522.15,2522.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70756-612-12,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70748-175-01,NDC,,,facility,both,1,EA,,5.96,5.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70748-323-02,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Use In 1 Carton (70748-339-01) / 10 Ml In 1 Vial, Single-Use",636,RC,70748-339-01,NDC,,,facility,both,1,EA,,593.64,593.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Promethazine Hydrochloride: 473 Ml In 1 Bottle, Plastic (70752-138-12)",636,RC,70752-138-12,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70756-604-44,NDC,,,facility,both,1,EA,,12.61,12.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tobramycin: 14 Pouch In 1 Carton (70756-604-56) / 4 Ampule In 1 Pouch (70756-604-44) / 5 Ml In 1 Ampule,636,RC,70756-604-56,NDC,,,facility,both,1,EA,,10.86,10.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71127-1100-1,NDC,,,facility,both,1,EA,,5.99,5.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-28) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,71288-117-28,NDC,,,facility,both,1,EA,,23.9,23.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-28) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,71288-117-28,NDC,,,facility,both,1,EA,,21.29,21.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-28) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,71288-117-28,NDC,,,facility,both,1,EA,,15.99,15.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-28) / 26.3 Ml In 1 Vial, Single-Dose",636,RC,71288-117-28,NDC,,,facility,both,1,EA,,12.92,12.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-54) / 52.6 Ml In 1 Vial, Single-Dose",636,RC,71288-117-54,NDC,,,facility,both,1,EA,,24.36,24.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-54) / 52.6 Ml In 1 Vial, Single-Dose",636,RC,71288-117-54,NDC,,,facility,both,1,EA,,18.69,18.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (71288-119-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,71288-119-20,NDC,,,facility,both,1,EA,,5.82,5.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Decitabine: 1 Vial, Single-Dose In 1 Carton (71288-119-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,71288-119-20,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mitomycin: 1 Vial, Single-Dose In 1 Carton (71288-138-50) / 40 Ml In 1 Vial, Single-Dose",636,RC,71288-138-50,NDC,,,facility,both,1,EA,,344.71,344.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mitomycin: 1 Vial, Single-Dose In 1 Carton (71288-138-50) / 40 Ml In 1 Vial, Single-Dose",636,RC,71288-138-50,NDC,,,facility,both,1,EA,,323.81,323.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-06) / 5.26 Ml In 1 Vial, Single-Dose",636,RC,71288-117-06,NDC,,,facility,both,1,EA,,9.18,9.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-153-95) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-153-95,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-153-95) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-153-95,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-153-95) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-153-95,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-153-95) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-153-95,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-153-95) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-153-95,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Thiotepa: 1 Vial, Single-Dose In 1 Carton (71288-156-05) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,71288-156-05,NDC,,,facility,both,1,EA,,489.06,489.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Thiotepa: 1 Vial, Single-Dose In 1 Carton (71288-157-10) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,71288-157-10,NDC,,,facility,both,1,EA,,18.93,18.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,4.13,4.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,3.96,3.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,3.87,3.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-166-10,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-153-95) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,71288-153-95,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Carton (71288-117-06) / 5.26 Ml In 1 Vial, Single-Dose",636,RC,71288-117-06,NDC,,,facility,both,1,EA,,17.05,17.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,71288-109-20,NDC,,,facility,both,1,EA,,3.19,3.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,71288-109-20,NDC,,,facility,both,1,EA,,6.1,6.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71266-5103-1,NDC,,,facility,both,1,EA,,15.63,15.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71285-6044-1,NDC,,,facility,both,1,EA,,10.34,10.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71285-6074-1,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71285-6176-1,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71285-7060-1,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ampicillin And Sulbactam: 10 Vial, Single-Dose In 1 Carton (71288-006-30) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (71288-006-31)",636,RC,71288-006-30,NDC,,,facility,both,1,EA,,11.45,11.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-15,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-15,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-95) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-95,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-95) / 10 Ml In 1 Vial, Single-Dose",636,RC,71288-016-95,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,71288-031-20,NDC,,,facility,both,1,EA,,5.76,5.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,71288-109-20,NDC,,,facility,both,1,EA,,47.6,47.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,71288-109-20,NDC,,,facility,both,1,EA,,6.41,6.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylene Blue: 5 Vial In 1 Carton (70710-1838-5) / 10 Ml In 1 Vial (70710-1838-1),636,RC,70710-1838-5,NDC,,,facility,both,1,EA,,3.77,3.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70710-1838-1,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Micafungin: 1 Vial In 1 Carton (70710-1725-1) / 5 Ml In 1 Vial,636,RC,70710-1725-1,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1570-1) / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1570-1) / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1568-1) / .5 Ml In 1 Syringe,636,RC,70121-1568-1,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1570-1) / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1570-1) / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1570-1) / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Vial In 1 Carton (70121-1651-1) / 1 Ml In 1 Vial,636,RC,70121-1651-1,NDC,,,facility,both,1,EA,,2.23,2.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Plerixafor: 1 Vial, Single-Dose In 1 Carton (70121-1694-2) / 1.2 Ml In 1 Vial, Single-Dose",636,RC,70121-1694-2,NDC,,,facility,both,1,EA,,23.82,23.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Plerixafor: 1 Vial, Single-Dose In 1 Carton (70121-1694-2) / 1.2 Ml In 1 Vial, Single-Dose",636,RC,70121-1694-2,NDC,,,facility,both,1,EA,,22.47,22.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70121-1705-1,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70121-2309-1,NDC,,,facility,both,1,EA,,24.72,24.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Releuko: 1 Syringe In 1 Box (70121-1570-1) / .8 Ml In 1 Syringe,636,RC,70121-1570-1,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Vial In 1 Carton (70121-1049-2) / 1 Ml In 1 Vial (70121-1049-1),636,RC,70121-1049-2,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70121-1049-1,NDC,,,facility,both,1,EA,,1.72,1.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Loqtorzi: 1 Vial, Glass In 1 Carton (70114-340-01) / 6 Ml In 1 Vial, Glass",636,RC,70114-340-01,NDC,,,facility,both,1,EA,,33654,33654,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70069-773-01,NDC,,,facility,both,1,EA,,21.03,21.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70092-1068-07,NDC,,,facility,both,1,EA,,20.15,20.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70092-1086-44,NDC,,,facility,both,1,EA,,12.26,12.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70092-1094-36,NDC,,,facility,both,1,EA,,65.16,65.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70092-1133-43,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70092-1475-50,NDC,,,facility,both,1,EA,,12.81,12.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70092-1518-75,NDC,,,facility,both,1,EA,,10.42,10.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70092-1552-07,NDC,,,facility,both,1,EA,,18.91,18.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70095-025-01,NDC,,,facility,both,1,EA,,8.99,8.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Udenyca: 1 Syringe In 1 Carton (70114-101-01) / .6 Ml In 1 Syringe,636,RC,70114-101-01,NDC,,,facility,both,1,EA,,518.66,518.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Budesonide Inhalation: 6 Pouch In 1 Carton (68180-984-30) / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule,636,RC,68180-984-30,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vancomycin Hydrochloride: 10 Vial In 1 Carton (70436-020-82) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,70436-020-82,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Testosterone Cypionate: 1 Vial In 1 Carton (70700-289-22) / 1 Ml In 1 Vial,636,RC,70700-289-22,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Testosterone Cypionate: 1 Vial In 1 Carton (70700-289-22) / 1 Ml In 1 Vial,636,RC,70700-289-22,NDC,,,facility,both,1,EA,,0.12,0.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70700-902-22,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70700-902-22,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70700-902-22,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,70710-1530-1,NDC,,,facility,both,1,EA,,226.55,226.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,70710-1530-1,NDC,,,facility,both,1,EA,,144.33,144.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,70710-1530-1,NDC,,,facility,both,1,EA,,122.32,122.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1) / 10 Ml In 1 Vial, Single-Dose",636,RC,70710-1530-1,NDC,,,facility,both,1,EA,,102.5,102.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1531-1) / 25 Ml In 1 Vial, Single-Dose",636,RC,70710-1531-1,NDC,,,facility,both,1,EA,,169.77,169.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1531-1) / 25 Ml In 1 Vial, Single-Dose",636,RC,70710-1531-1,NDC,,,facility,both,1,EA,,148.83,148.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1531-1) / 25 Ml In 1 Vial, Single-Dose",636,RC,70710-1531-1,NDC,,,facility,both,1,EA,,142.21,142.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1531-1) / 25 Ml In 1 Vial, Single-Dose",636,RC,70710-1531-1,NDC,,,facility,both,1,EA,,141.45,141.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Micafungin: 1 Vial In 1 Carton (70710-1724-1) / 5 Ml In 1 Vial,636,RC,70710-1724-1,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Micafungin: 1 Vial In 1 Carton (70710-1724-1) / 5 Ml In 1 Vial,636,RC,70710-1724-1,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70710-1359-1,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70700-167-22,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70700-167-22,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vancomycin Hydrochloride: 10 Vial In 1 Carton (70436-021-82) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,70436-021-82,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ganciclovir: 25 Vial In 1 Carton (70436-089-55) / 10 Ml In 1 Vial,636,RC,70436-089-55,NDC,,,facility,both,1,EA,,40.96,40.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lanoxin: 10 Ampule In 1 Box (70515-260-10) / 2 Ml In 1 Ampule,636,RC,70515-260-10,NDC,,,facility,both,1,EA,,191.79,191.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lanoxin: 10 Ampule In 1 Box (70515-260-10) / 2 Ml In 1 Ampule,636,RC,70515-260-10,NDC,,,facility,both,1,EA,,183.97,183.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lanoxin: 10 Ampule In 1 Box (70515-262-10) / 1 Ml In 1 Ampule,636,RC,70515-262-10,NDC,,,facility,both,1,EA,,1998.17,1998.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,70700-167-22,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Inflectra: 1 Vial, Single-Use In 1 Carton (0069-0809-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0069-0809-01,NDC,,,facility,both,1,EA,,136.68,136.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ondansetron: 1 Vial In 1 Box (63323-374-20) / 20 Ml In 1 Vial,636,RC,63323-374-20,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,114.89,114.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ampicillin: 10 Vial In 1 Box (55150-114-20) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-114-20,NDC,,,facility,both,1,EA,,1.64,1.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-116-20) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-116-20,NDC,,,facility,both,1,EA,,5.26,5.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-117-20) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-117-20,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-119-30) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,55150-119-30,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-120-30) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,55150-120-30,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-121-50) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,55150-121-50,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nafcillin: 10 Vial In 1 Box (55150-123-16) / 8 Ml In 1 Vial,636,RC,55150-123-16,NDC,,,facility,both,1,EA,,24.85,24.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-154-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-154-10,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,115.19,115.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-155-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,55150-155-20,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-165-05) / 5 Ml In 1 Vial, Single-Dose",636,RC,55150-165-05,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-169-10,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-169-10,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-170-30) / 30 Ml In 1 Vial, Single-Dose",636,RC,55150-170-30,NDC,,,facility,both,1,EA,,0.01,0.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,115.88,115.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,122.97,122.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone: 237 Ml In 1 Bottle, Glass (54879-003-08)",636,RC,54879-003-08,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,121.92,121.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-678-10) / .5 Ml In 1 Syringe (55111-678-11),636,RC,55111-678-10,NDC,,,facility,both,1,EA,,4.6,4.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07) / 5 Ml In 1 Vial, Glass",636,RC,55111-685-07,NDC,,,facility,both,1,EA,,4.28,4.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07) / 5 Ml In 1 Vial, Glass",636,RC,55111-685-07,NDC,,,facility,both,1,EA,,4.03,4.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07) / 5 Ml In 1 Vial, Glass",636,RC,55111-685-07,NDC,,,facility,both,1,EA,,3.86,3.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07) / 5 Ml In 1 Vial, Glass",636,RC,55111-685-07,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Palonosetron: 1 Vial, Single-Use In 1 Carton (55111-694-07) / 5 Ml In 1 Vial, Single-Use",636,RC,55111-694-07,NDC,,,facility,both,1,EA,,5.22,5.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,131.87,131.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,131.77,131.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trodelvy: 1 Vial In 1 Box (55135-132-01) / 1 Powder, For Solution In 1 Vial",636,RC,55135-132-01,NDC,,,facility,both,1,EA,,131.77,131.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 10 Vial, Single-Dose In 1 Carton (55150-174-10) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-174-10,NDC,,,facility,both,1,EA,,5.5,5.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,22.48,22.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,19.45,19.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,16.37,16.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-021-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,22.18,22.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,19.06,19.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,16.91,16.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,16.37,16.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-028-01) / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe,636,RC,55513-028-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-032-01) / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe,636,RC,55513-032-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-025-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midazolam: 10 VIAL in 1 BOX (55390-137-05) / 5 mL in 1 VIAL,636,RC,55390-137-05,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55150-435-01,NDC,,,facility,both,1,EA,,126.68,126.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55150-202-00,NDC,,,facility,both,1,EA,,3.71,3.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55150-202-00,NDC,,,facility,both,1,EA,,3.66,3.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 10 Vial, Single-Dose In 1 Carton (55150-202-10) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (55150-202-00)",636,RC,55150-202-10,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meropenem: 10 Vial In 1 Carton (55150-207-20) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-207-20,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meropenem: 10 Vial In 1 Carton (55150-208-30) / 1 Injection, Powder, For Solution In 1 Vial",636,RC,55150-208-30,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,55150-223-10,NDC,,,facility,both,1,EA,,9.57,9.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55150-235-01,NDC,,,facility,both,1,EA,,6.4,6.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ertapenem: 10 Vial, Single-Dose In 1 Carton (55150-282-09) / 1 Injection In 1 Vial, Single-Dose",636,RC,55150-282-09,NDC,,,facility,both,1,EA,,34.87,34.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ertapenem: 10 Vial, Single-Dose In 1 Carton (55150-282-20) / 1 Injection In 1 Vial, Single-Dose",636,RC,55150-282-20,NDC,,,facility,both,1,EA,,35.12,35.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (55150-337-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-337-01,NDC,,,facility,both,1,EA,,6.7,6.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (55150-337-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-337-01,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (55150-337-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-337-01,NDC,,,facility,both,1,EA,,5.49,5.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (55150-337-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-337-01,NDC,,,facility,both,1,EA,,5.35,5.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bortezomib: 1 Vial, Single-Dose In 1 Carton (55150-337-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,55150-337-01,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01) / 12.5 Ml In 1 Vial, Single-Dose",636,RC,55150-365-01,NDC,,,facility,both,1,EA,,59.4,59.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01) / 12.5 Ml In 1 Vial, Single-Dose",636,RC,55150-365-01,NDC,,,facility,both,1,EA,,57.34,57.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01) / 12.5 Ml In 1 Vial, Single-Dose",636,RC,55150-365-01,NDC,,,facility,both,1,EA,,48.62,48.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dactinomycin: 1 Vial, Single-Dose In 1 Carton (55150-431-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,55150-431-01,NDC,,,facility,both,1,EA,,1315,1315,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55150-435-01,NDC,,,facility,both,1,EA,,143.66,143.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-032-01) / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe,636,RC,55513-032-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,441.47,441.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,441.98,441.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tivdak: 1 Vial In 1 Carton (51144-003-01) / 4 Ml In 1 Vial,636,RC,51144-003-01,NDC,,,facility,both,1,EA,,609.58,609.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tivdak: 1 Vial In 1 Carton (51144-003-01) / 4 Ml In 1 Vial,636,RC,51144-003-01,NDC,,,facility,both,1,EA,,605.65,605.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,51144-020-01,NDC,,,facility,both,1,EA,,126.2,126.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,51144-020-01,NDC,,,facility,both,1,EA,,125.27,125.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,51144-020-01,NDC,,,facility,both,1,EA,,123.75,123.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,51144-020-01,NDC,,,facility,both,1,EA,,118.13,118.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,51144-020-01,NDC,,,facility,both,1,EA,,118.09,118.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,51144-020-01,NDC,,,facility,both,1,EA,,117.88,117.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,441.98,441.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,51144-030-01,NDC,,,facility,both,1,EA,,125.67,125.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,51144-030-01,NDC,,,facility,both,1,EA,,123.35,123.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,51144-030-01,NDC,,,facility,both,1,EA,,118.12,118.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,51144-030-01,NDC,,,facility,both,1,EA,,118.08,118.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,51144-030-01,NDC,,,facility,both,1,EA,,117.88,117.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,486.18,486.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,468.75,468.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,465.5,465.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,450.02,450.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,442.14,442.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01) / 10.5 Ml In 1 Vial, Single-Dose",636,RC,51144-050-01,NDC,,,facility,both,1,EA,,441.98,441.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,51144-030-01,NDC,,,facility,both,1,EA,,124.95,124.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,54288-103-01,NDC,,,facility,both,1,EA,,2.35,2.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Epinephrine: 10 Ampule In 1 Box (54288-103-10) / 1 Ml In 1 Ampule,636,RC,54288-103-10,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Epinephrine: 1 Vial In 1 Carton (54288-120-01) / 10 Ml In 1 Vial,636,RC,54288-120-01,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Papaverine Hydrochloride: 10 Vial In 1 Carton (54288-142-10) / 2 Ml In 1 Vial (54288-142-01),636,RC,54288-142-10,NDC,,,facility,both,1,EA,,38.57,38.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Epinephrine: 1 Vial In 1 Carton (54288-600-01) / 10 Ml In 1 Vial,636,RC,54288-600-01,NDC,,,facility,both,1,EA,,1.31,1.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,54288-103-01,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Caffeine Citrate: 10 Vial In 1 Carton (51754-0501-3) / 3 Ml In 1 Vial,636,RC,51754-0501-3,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,51991-144-99,NDC,,,facility,both,1,EA,,45.07,45.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,51991-735-99,NDC,,,facility,both,1,EA,,9.01,9.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-032-01) / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe,636,RC,55513-032-01,NDC,,,facility,both,1,EA,,21.76,21.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-032-01) / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe,636,RC,55513-032-01,NDC,,,facility,both,1,EA,,16.37,16.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Stelara: 1 Vial, Single-Use In 1 Box (57894-054-27) / 26 Ml In 1 Vial, Single-Use",636,RC,57894-054-27,NDC,,,facility,both,1,EA,,44.54,44.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01) / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,136.47,136.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01) / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,131.77,131.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01) / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,131.77,131.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,57894-449-01,NDC,,,facility,both,1,EA,,91.13,91.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,57894-449-01,NDC,,,facility,both,1,EA,,88.8,88.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,57894-449-01,NDC,,,facility,both,1,EA,,85.86,85.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01) / 3 Ml In 1 Vial, Single-Dose",636,RC,57894-449-01,NDC,,,facility,both,1,EA,,81.88,81.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,87.44,87.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,84.68,84.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,84.14,84.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,84.05,84.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,79.7,79.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infliximab: 1 Vial, Single-Use In 1 Box (57894-160-01) / 10 Ml In 1 Vial, Single-Use",636,RC,57894-160-01,NDC,,,facility,both,1,EA,,131.77,131.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,78.94,78.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,55513-956-01,NDC,,,facility,both,1,EA,,589.9,589.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,55513-956-01,NDC,,,facility,both,1,EA,,563.72,563.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,55513-956-01,NDC,,,facility,both,1,EA,,561.82,561.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,55513-956-01,NDC,,,facility,both,1,EA,,460.92,460.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55566-1050-0,NDC,,,facility,both,1,EA,,207810.68,207810.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55566-1050-0,NDC,,,facility,both,1,EA,,204032.3,204032.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55566-1050-0,NDC,,,facility,both,1,EA,,188918.8,188918.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Firmagon: 1 Kit In 1 Carton (55566-8303-1) * 4 Ml In 1 Vial, Glass * 4.2 Ml In 1 Syringe",636,RC,55566-8303-1,NDC,,,facility,both,1,EA,,14.75,14.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Firmagon: 1 Kit In 1 Carton (55566-8303-1) * 4 Ml In 1 Vial, Glass * 4.2 Ml In 1 Syringe",636,RC,55566-8303-1,NDC,,,facility,both,1,EA,,14.46,14.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Firmagon: 1 Kit In 1 Carton (55566-8403-1) * 3 Ml In 1 Syringe * 3 Ml In 1 Vial, Glass",636,RC,55566-8403-1,NDC,,,facility,both,1,EA,,15.74,15.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Firmagon: 1 Kit In 1 Carton (55566-8403-1) * 3 Ml In 1 Syringe * 3 Ml In 1 Vial, Glass",636,RC,55566-8403-1,NDC,,,facility,both,1,EA,,15.74,15.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Firmagon: 1 Kit In 1 Carton (55566-8403-1) * 3 Ml In 1 Syringe * 3 Ml In 1 Vial, Glass",636,RC,55566-8403-1,NDC,,,facility,both,1,EA,,14.79,14.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Firmagon: 1 Kit In 1 Carton (55566-8303-1) * 4 Ml In 1 Vial, Glass * 4.2 Ml In 1 Syringe",636,RC,55566-8303-1,NDC,,,facility,both,1,EA,,15.16,15.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,78.82,78.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,78.51,78.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01) / 1.7 Ml In 1 Vial, Single-Dose",636,RC,57894-450-01,NDC,,,facility,both,1,EA,,78.47,78.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,180.31,180.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-05) / 5 Ml In 1 Vial, Single-Dose",636,RC,57894-505-05,NDC,,,facility,both,1,EA,,285,285,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,57894-505-20,NDC,,,facility,both,1,EA,,286.05,286.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,186.33,186.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,186.42,186.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,186.42,186.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,186.42,186.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-469-01) / 1.5 Ml In 1 Vial, Single-Dose",636,RC,57894-469-01,NDC,,,facility,both,1,EA,,185.23,185.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-469-01) / 1.5 Ml In 1 Vial, Single-Dose",636,RC,57894-469-01,NDC,,,facility,both,1,EA,,169.13,169.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-469-01) / 1.5 Ml In 1 Vial, Single-Dose",636,RC,57894-469-01,NDC,,,facility,both,1,EA,,168.01,168.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,57894-470-01,NDC,,,facility,both,1,EA,,183.88,183.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,57894-470-01,NDC,,,facility,both,1,EA,,182.47,182.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,57894-470-01,NDC,,,facility,both,1,EA,,175.46,175.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,57894-470-01,NDC,,,facility,both,1,EA,,169.51,169.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,57894-470-01,NDC,,,facility,both,1,EA,,168.91,168.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,57894-470-01,NDC,,,facility,both,1,EA,,168.8,168.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,57894-501-00,NDC,,,facility,both,1,EA,,70.04,70.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rybrevant: 1 Vial, Single-Use In 1 Carton (57894-501-01) / 1 Injection In 1 Vial, Single-Use (57894-501-00)",636,RC,57894-501-01,NDC,,,facility,both,1,EA,,77.28,77.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rybrevant: 1 Vial, Single-Use In 1 Carton (57894-501-01) / 1 Injection In 1 Vial, Single-Use (57894-501-00)",636,RC,57894-501-01,NDC,,,facility,both,1,EA,,77.26,77.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rybrevant: 1 Vial, Single-Use In 1 Carton (57894-501-01) / 1 Injection In 1 Vial, Single-Use (57894-501-00)",636,RC,57894-501-01,NDC,,,facility,both,1,EA,,70.04,70.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,216.28,216.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,216.28,216.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,216.28,216.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,216.28,216.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,209.72,209.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,208.42,208.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,206.87,206.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,203.99,203.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,186.7,186.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,57894-503-01,NDC,,,facility,both,1,EA,,186.42,186.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,55513-956-01,NDC,,,facility,both,1,EA,,600.03,600.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-032-01) / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe,636,RC,55513-032-01,NDC,,,facility,both,1,EA,,16.73,16.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,55513-956-01,NDC,,,facility,both,1,EA,,610.01,610.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,55513-954-01,NDC,,,facility,both,1,EA,,561.81,561.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neulasta: 1 Syringe In 1 Carton (55513-190-01) / .6 Ml In 1 Syringe,636,RC,55513-190-01,NDC,,,facility,both,1,EA,,1048.46,1048.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neulasta: 1 Syringe In 1 Carton (55513-190-01) / .6 Ml In 1 Syringe,636,RC,55513-190-01,NDC,,,facility,both,1,EA,,994.52,994.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neulasta: 1 Syringe In 1 Carton (55513-190-01) / .6 Ml In 1 Syringe,636,RC,55513-190-01,NDC,,,facility,both,1,EA,,625.65,625.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,224.07,224.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,174.74,174.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,174.62,174.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,173.35,173.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,171.95,171.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,171.02,171.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,170.83,170.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Neulasta: 1 Syringe In 1 Carton (55513-190-01) / .6 Ml In 1 Syringe,636,RC,55513-190-01,NDC,,,facility,both,1,EA,,1093.98,1093.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,170.72,170.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,158.02,158.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,157,157,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,155.47,155.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,188.5,188.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,175.99,175.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,172.42,172.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,172.36,172.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,171.79,171.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,170.62,170.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,170.29,170.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-206-01) / 4 Ml In 1 Vial,636,RC,55513-206-01,NDC,,,facility,both,1,EA,,170.34,170.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,170.19,170.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Blincyto: 1 Kit In 1 Package (55513-160-01) * 3.088 Ml In 1 Vial (55513-150-01) * 10.6 Ml In 1 Vial (55513-155-01),636,RC,55513-160-01,NDC,,,facility,both,1,EA,,510.78,510.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Blincyto: 1 Kit In 1 Package (55513-160-01) * 3.088 Ml In 1 Vial (55513-150-01) * 10.6 Ml In 1 Vial (55513-155-01),636,RC,55513-160-01,NDC,,,facility,both,1,EA,,536.83,536.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-057-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-057-01,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-057-01,NDC,,,facility,both,1,EA,,18.41,18.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-057-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,55513-057-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,23.61,23.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,23.39,23.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Blincyto: 1 Kit In 1 Package (55513-160-01) * 3.088 Ml In 1 Vial (55513-150-01) * 10.6 Ml In 1 Vial (55513-155-01),636,RC,55513-160-01,NDC,,,facility,both,1,EA,,535.68,535.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,22.53,22.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,22.18,22.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,22.15,22.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,20.52,20.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,18.78,18.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,11.28,11.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kanjinti: 1 Vial, Multi-Dose In 1 Carton (55513-132-01) / 20 Ml In 1 Vial, Multi-Dose",636,RC,55513-132-01,NDC,,,facility,both,1,EA,,222.09,222.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kanjinti: 1 Vial, Multi-Dose In 1 Carton (55513-132-01) / 20 Ml In 1 Vial, Multi-Dose",636,RC,55513-132-01,NDC,,,facility,both,1,EA,,216.7,216.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kanjinti: 1 Vial, Multi-Dose In 1 Carton (55513-132-01) / 20 Ml In 1 Vial, Multi-Dose",636,RC,55513-132-01,NDC,,,facility,both,1,EA,,205.15,205.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aranesp: 1 Blister Pack In 1 Package (55513-111-01) / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe,636,RC,55513-111-01,NDC,,,facility,both,1,EA,,22.32,22.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,167.98,167.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,160.39,160.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mvasi: 1 Vial In 1 Carton (55513-207-01) / 16 Ml In 1 Vial,636,RC,55513-207-01,NDC,,,facility,both,1,EA,,156.42,156.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,82.62,82.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-21) / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,95.42,95.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-21) / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,91.08,91.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-21) / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,90.82,90.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-21) / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,86.75,86.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-21) / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,86.74,86.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-21) / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,85.37,85.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-21) / 1 Ml In 1 Syringe,636,RC,55513-710-21,NDC,,,facility,both,1,EA,,83.56,83.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,87.76,87.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,87.76,87.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,82.62,82.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,84.18,84.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,82.97,82.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,79.78,79.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,79.78,79.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,77.11,77.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,76.72,76.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,55513-954-01,NDC,,,facility,both,1,EA,,633.55,633.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,55513-954-01,NDC,,,facility,both,1,EA,,617.26,617.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,55513-954-01,NDC,,,facility,both,1,EA,,574.57,574.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,55513-954-01,NDC,,,facility,both,1,EA,,568.06,568.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01) / 1.7 Ml In 1 Vial, Single-Use",636,RC,55513-730-01,NDC,,,facility,both,1,EA,,83.86,83.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,82.62,82.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,82.62,82.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,82.62,82.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-221-01) / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,40.06,40.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-221-01) / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,34.66,34.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-221-01) / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,34.52,34.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-221-01) / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,33.12,33.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-221-01) / .5 Ml In 1 Vial,636,RC,55513-221-01,NDC,,,facility,both,1,EA,,31.51,31.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-222-01) / 1 Ml In 1 Vial,636,RC,55513-222-01,NDC,,,facility,both,1,EA,,34.66,34.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-222-01) / 1 Ml In 1 Vial,636,RC,55513-222-01,NDC,,,facility,both,1,EA,,34.4,34.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nplate: 1 Vial In 1 Carton (55513-222-01) / 1 Ml In 1 Vial,636,RC,55513-222-01,NDC,,,facility,both,1,EA,,33.35,33.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01) / .25 Ml In 1 Vial, Single-Dose",636,RC,55513-223-01,NDC,,,facility,both,1,EA,,300.05,300.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01) / .25 Ml In 1 Vial, Single-Dose",636,RC,55513-223-01,NDC,,,facility,both,1,EA,,288.51,288.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01) / .25 Ml In 1 Vial, Single-Dose",636,RC,55513-223-01,NDC,,,facility,both,1,EA,,38.75,38.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01) / .25 Ml In 1 Vial, Single-Dose",636,RC,55513-223-01,NDC,,,facility,both,1,EA,,34.66,34.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01) / .25 Ml In 1 Vial, Single-Dose",636,RC,55513-223-01,NDC,,,facility,both,1,EA,,33.63,33.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Riabni: 1 Vial, Single-Dose In 1 Carton (55513-224-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-224-01,NDC,,,facility,both,1,EA,,161.25,161.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Riabni: 1 Vial, Single-Dose In 1 Carton (55513-326-01) / 50 Ml In 1 Vial, Single-Dose",636,RC,55513-326-01,NDC,,,facility,both,1,EA,,162.51,162.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Riabni: 1 Vial, Single-Dose In 1 Carton (55513-326-01) / 50 Ml In 1 Vial, Single-Dose",636,RC,55513-326-01,NDC,,,facility,both,1,EA,,155.59,155.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-670-01,NDC,,,facility,both,1,EA,,132.84,132.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-670-01,NDC,,,facility,both,1,EA,,128.87,128.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,55513-670-01,NDC,,,facility,both,1,EA,,124.25,124.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,95.42,95.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,95.42,95.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,91.7,91.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prolia: 1 Syringe In 1 Carton (55513-710-01) / 1 Ml In 1 Syringe,636,RC,55513-710-01,NDC,,,facility,both,1,EA,,86.85,86.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,55513-954-01,NDC,,,facility,both,1,EA,,496.48,496.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,290.9,290.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,283.76,283.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,263.51,263.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,262.74,262.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,260.47,260.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-917-01,NDC,,,facility,both,1,EA,,260.47,260.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,293.26,293.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,289.61,289.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,268.29,268.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,268.29,268.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,263.6,263.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50268-061-11,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-918-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-918-01,NDC,,,facility,both,1,EA,,263.31,263.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50268-684-11,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50268-685-11,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50268-685-11,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50268-718-11,NDC,,,facility,both,1,EA,,19.44,19.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,50242-260-01,NDC,,,facility,both,1,EA,,239.81,239.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,50242-260-01,NDC,,,facility,both,1,EA,,261.8,261.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06) / 50 Ml In 1 Vial, Single-Use",636,RC,50242-053-06,NDC,,,facility,both,1,EA,,268.87,268.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06) / 50 Ml In 1 Vial, Single-Use",636,RC,50242-053-06,NDC,,,facility,both,1,EA,,115.54,115.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01) / 4 Ml In 1 Vial, Single-Use",636,RC,50242-060-01,NDC,,,facility,both,1,EA,,258.99,258.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Avastin: 1 Vial, Single-Use In 1 Carton (50242-061-01) / 16 Ml In 1 Vial, Single-Use",636,RC,50242-061-01,NDC,,,facility,both,1,EA,,267.41,267.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,299.98,299.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,280.02,280.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,272.84,272.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,266.52,266.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,260.23,260.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,259.3,259.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06) / 50 Ml In 1 Vial, Single-Use",636,RC,50242-053-06,NDC,,,facility,both,1,EA,,293.73,293.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,254.82,254.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Herceptin Hylecta: 1 Vial, Single-Dose In 1 Carton (50242-077-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,50242-077-01,NDC,,,facility,both,1,EA,,254.62,254.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-085-25,NDC,,,facility,both,1,EA,,256.46,256.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-085-25,NDC,,,facility,both,1,EA,,248.32,248.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-085-25,NDC,,,facility,both,1,EA,,244.25,244.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Activase: 1 Kit In 1 Carton (50242-085-27) * 100 Ml In 1 Vial, Single-Use * 100 Ml In 1 Vial, Single-Use",636,RC,50242-085-27,NDC,,,facility,both,1,EA,,244.25,244.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,107.63,107.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,107.63,107.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,107.63,107.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,107.24,107.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,103.12,103.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use",636,RC,50242-070-01,NDC,,,facility,both,1,EA,,252.76,252.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,102.25,102.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rituxan: 1 Vial, Single-Use In 1 Carton (50242-051-21) / 10 Ml In 1 Vial, Single-Use",636,RC,50242-051-21,NDC,,,facility,both,1,EA,,306.37,306.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Activase: 1 Kit In 1 Carton (50242-044-13) * 50 Ml In 1 Vial, Single-Use * 50 Ml In 1 Vial, Single-Use",636,RC,50242-044-13,NDC,,,facility,both,1,EA,,244.25,244.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-789-10)",636,RC,50111-789-10,NDC,,,facility,both,1,EA,,11.15,11.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Activase: 1 Kit In 1 Carton (50242-044-13) * 50 Ml In 1 Vial, Single-Use * 50 Ml In 1 Vial, Single-Use",636,RC,50242-044-13,NDC,,,facility,both,1,EA,,244.25,244.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-037-06,NDC,,,facility,both,1,EA,,474.42,474.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-037-06,NDC,,,facility,both,1,EA,,473.89,473.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cathflo Activase: 1 Vial In 1 Carton (50242-041-64) / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,282.66,282.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cathflo Activase: 1 Vial In 1 Carton (50242-041-64) / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,270.96,270.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cathflo Activase: 1 Vial In 1 Carton (50242-041-64) / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,268.2,268.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cathflo Activase: 1 Vial In 1 Carton (50242-041-64) / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,267.79,267.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cathflo Activase: 1 Vial In 1 Carton (50242-041-64) / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,261.43,261.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cathflo Activase: 1 Vial In 1 Carton (50242-041-64) / 2 Ml In 1 Vial,636,RC,50242-041-64,NDC,,,facility,both,1,EA,,244.73,244.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-044-06,NDC,,,facility,both,1,EA,,262.56,262.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-044-06,NDC,,,facility,both,1,EA,,250.09,250.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-037-06,NDC,,,facility,both,1,EA,,489.74,489.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,101.01,101.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,97.84,97.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,97.77,97.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01) / 10 Ml In 1 Vial, Single-Use",636,RC,50242-136-01,NDC,,,facility,both,1,EA,,18.84,18.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01) / 10 Ml In 1 Vial, Single-Use",636,RC,50242-136-01,NDC,,,facility,both,1,EA,,18.24,18.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,20.23,20.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,18.41,18.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01) / 20 Ml In 1 Vial, Single-Use",636,RC,50242-137-01,NDC,,,facility,both,1,EA,,18.4,18.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,60.17,60.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,60.17,60.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,60.1,60.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,57.74,57.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,57.74,57.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01) / 4 Ml In 1 Vial, Single-Use",636,RC,50242-135-01,NDC,,,facility,both,1,EA,,18.43,18.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,53.17,53.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tnkase: 1 Kit In 1 Carton (50242-176-01) * 1 Vial, Single-Use In 1 Carton (50242-037-06) / 10 Ml In 1 Vial, Single-Use * 1 Vial, Single-Use In 1 Carton (50242-901-09) / 10 Ml In 1 Vial, Single-Use",636,RC,50242-176-01,NDC,,,facility,both,1,EA,,506.62,506.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tnkase: 1 Kit In 1 Carton (50242-176-01) * 1 Vial, Single-Use In 1 Carton (50242-037-06) / 10 Ml In 1 Vial, Single-Use * 1 Vial, Single-Use In 1 Carton (50242-901-09) / 10 Ml In 1 Vial, Single-Use",636,RC,50242-176-01,NDC,,,facility,both,1,EA,,506.62,506.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-245-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-245-01,NDC,,,facility,both,1,EA,,271.71,271.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-245-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-245-01,NDC,,,facility,both,1,EA,,265.73,265.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-245-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-245-01,NDC,,,facility,both,1,EA,,259.35,259.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-245-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-245-01,NDC,,,facility,both,1,EA,,236.39,236.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,50242-260-01,NDC,,,facility,both,1,EA,,271.93,271.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,50242-260-01,NDC,,,facility,both,1,EA,,271.93,271.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,50242-260-01,NDC,,,facility,both,1,EA,,271.93,271.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,50242-260-01,NDC,,,facility,both,1,EA,,271.93,271.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01) / 14 Ml In 1 Vial, Single-Use",636,RC,50242-145-01,NDC,,,facility,both,1,EA,,52.94,52.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-132-01,NDC,,,facility,both,1,EA,,294.93,294.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-132-01,NDC,,,facility,both,1,EA,,296.99,296.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-132-01,NDC,,,facility,both,1,EA,,300.22,300.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01) / 8 Ml In 1 Vial, Single-Use",636,RC,50242-087-01,NDC,,,facility,both,1,EA,,97.37,97.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,107.52,107.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,107.1,107.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,107.1,107.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,107.1,107.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,105.17,105.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,103.56,103.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,102.69,102.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,97.69,97.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,97.37,97.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01) / 5 Ml In 1 Vial, Single-Use",636,RC,50242-088-01,NDC,,,facility,both,1,EA,,97.37,97.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50242-100-39,NDC,,,facility,both,1,EA,,140.98,140.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pulmozyme: 5 Pouch In 1 Carton (50242-100-40) / 6 Ampule In 1 Pouch (50242-100-39) / 2.5 Ml In 1 Ampule,636,RC,50242-100-40,NDC,,,facility,both,1,EA,,143.06,143.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,50242-105-01,NDC,,,facility,both,1,EA,,407.08,407.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,50242-105-01,NDC,,,facility,both,1,EA,,397.43,397.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,50242-105-01,NDC,,,facility,both,1,EA,,395.41,395.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,50242-105-01,NDC,,,facility,both,1,EA,,372.36,372.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,50242-105-01,NDC,,,facility,both,1,EA,,371.68,371.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01) / 20 Ml In 1 Vial, Single-Dose",636,RC,50242-105-01,NDC,,,facility,both,1,EA,,371.15,371.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tnkase: 1 Kit In 1 Carton (50242-120-47) * 1 Vial, Single-Use In 1 Carton (50242-037-06) / 10 Ml In 1 Vial, Single-Use * 1 Vial, Single-Use In 1 Carton (50242-901-09) / 10 Ml In 1 Vial, Single-Use",636,RC,50242-120-47,NDC,,,facility,both,1,EA,,460.57,460.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-132-01,NDC,,,facility,both,1,EA,,311.99,311.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-132-01,NDC,,,facility,both,1,EA,,310.7,310.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01) / 15 Ml In 1 Vial, Single-Dose",636,RC,50242-132-01,NDC,,,facility,both,1,EA,,308.72,308.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,50242-260-01,NDC,,,facility,both,1,EA,,260.37,260.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,51079-542-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,51079-542-01,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tacrolimus: 100 Blister Pack In 1 Carton (51079-817-20) / 1 Capsule In 1 Blister Pack (51079-817-01),636,RC,51079-817-20,NDC,,,facility,both,1,EA,,2.67,2.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,51079-670-01,NDC,,,facility,both,1,EA,,5.03,5.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,51079-721-01,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01),636,RC,50419-423-01,NDC,,,facility,both,1,EA,,3152.57,3152.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Kyleena: 1 Intrauterine Device In 1 Carton (50419-424-01),636,RC,50419-424-01,NDC,,,facility,both,1,EA,,3427.54,3427.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01),636,RC,50419-423-01,NDC,,,facility,both,1,EA,,2216.71,2216.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buprenorphine Hydrochloride: 30 Tablet In 1 Bottle (50383-924-93),636,RC,50383-924-93,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buprenorphine Hydrochloride: 30 Tablet In 1 Bottle (50383-930-93),636,RC,50383-930-93,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zynyz: 1 Vial, Single-Use In 1 Carton (50881-006-03) / 20 Ml In 1 Vial, Single-Use",636,RC,50881-006-03,NDC,,,facility,both,1,EA,,109.06,109.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jakafi: 60 Tablet In 1 Bottle, Plastic (50881-010-60)",636,RC,50881-010-60,NDC,,,facility,both,1,EA,,730.02,730.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (50881-013-03) / 5 Ml In 1 Vial,636,RC,50881-013-03,NDC,,,facility,both,1,EA,,51.32,51.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (50881-013-03) / 5 Ml In 1 Vial,636,RC,50881-013-03,NDC,,,facility,both,1,EA,,49.87,49.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Monjuvi: 1 Vial In 1 Carton (50881-013-03) / 5 Ml In 1 Vial,636,RC,50881-013-03,NDC,,,facility,both,1,EA,,49.6,49.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01)",636,RC,50632-010-01,NDC,,,facility,both,1,EA,,1002.76,1002.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01)",636,RC,50632-010-01,NDC,,,facility,both,1,EA,,965.15,965.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50632-013-01,NDC,,,facility,both,1,EA,,1326.85,1326.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,50632-013-01,NDC,,,facility,both,1,EA,,1122.03,1122.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Crofab: 2 Vial, Glass In 1 Carton (50633-110-12) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass (50633-110-11)",636,RC,50633-110-12,NDC,,,facility,both,1,EA,,11071.86,11071.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-360-01,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-820-43,NDC,,,facility,both,1,EA,,59.32,59.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-821-01,NDC,,,facility,both,1,EA,,147,147,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-06,NDC,,,facility,both,1,EA,,17.5,17.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-16) / 2 Ml In 1 Vial, Single-Dose",636,RC,61703-309-16,NDC,,,facility,both,1,EA,,69.61,69.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-16) / 2 Ml In 1 Vial, Single-Dose",636,RC,61703-309-16,NDC,,,facility,both,1,EA,,65.44,65.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-25) / 2 Ml In 1 Vial, Single-Dose",636,RC,61703-309-25,NDC,,,facility,both,1,EA,,56.86,56.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-25) / 2 Ml In 1 Vial, Single-Dose",636,RC,61703-309-25,NDC,,,facility,both,1,EA,,56.52,56.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-26) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-26,NDC,,,facility,both,1,EA,,88.37,88.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-26) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-26,NDC,,,facility,both,1,EA,,86.84,86.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-26) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-26,NDC,,,facility,both,1,EA,,80.13,80.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-26) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-26,NDC,,,facility,both,1,EA,,61.1,61.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (61703-319-22) / 20 Ml In 1 Vial, Single-Dose",636,RC,61703-319-22,NDC,,,facility,both,1,EA,,44.3,44.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-06,NDC,,,facility,both,1,EA,,75.59,75.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (61703-319-22) / 20 Ml In 1 Vial, Single-Dose",636,RC,61703-319-22,NDC,,,facility,both,1,EA,,3.2,3.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18) / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-324-18,NDC,,,facility,both,1,EA,,38.74,38.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18) / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-324-18,NDC,,,facility,both,1,EA,,38.64,38.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18) / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-324-18,NDC,,,facility,both,1,EA,,37.1,37.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-326-18) / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-326-18,NDC,,,facility,both,1,EA,,36.21,36.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-326-18) / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-326-18,NDC,,,facility,both,1,EA,,35.82,35.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-326-18) / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-326-18,NDC,,,facility,both,1,EA,,35.22,35.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bleomycin: 1 Vial, Single-Dose In 1 Carton (61703-332-18) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61703-332-18,NDC,,,facility,both,1,EA,,184.74,184.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-50) / 45 Ml In 1 Vial, Multi-Dose",636,RC,61703-339-50,NDC,,,facility,both,1,EA,,15.09,15.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-50) / 45 Ml In 1 Vial, Multi-Dose",636,RC,61703-339-50,NDC,,,facility,both,1,EA,,14.79,14.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-56) / 60 Ml In 1 Vial, Multi-Dose",636,RC,61703-339-56,NDC,,,facility,both,1,EA,,18.62,18.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18) / 10 Ml In 1 Vial, Single-Dose",636,RC,61703-324-18,NDC,,,facility,both,1,EA,,41.77,41.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-56) / 60 Ml In 1 Vial, Multi-Dose",636,RC,61703-339-56,NDC,,,facility,both,1,EA,,16.18,16.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-06,NDC,,,facility,both,1,EA,,88.97,88.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61703-305-58,NDC,,,facility,both,1,EA,,81.89,81.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zarxio: 1 Blister Pack In 1 Carton (61314-326-01) / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe,636,RC,61314-326-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zarxio: 1 Blister Pack In 1 Carton (61314-326-01) / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe,636,RC,61314-326-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zarxio: 1 Blister Pack In 1 Carton (61314-326-01) / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe,636,RC,61314-326-01,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zarxio: 1 Blister Pack In 1 Carton (61314-326-01) / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe,636,RC,61314-326-01,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zarxio: 1 Blister Pack In 1 Carton (61314-326-01) / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe,636,RC,61314-326-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zarxio: 1 Blister Pack In 1 Carton (61314-326-01) / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe,636,RC,61314-326-01,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-326-05,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-326-05,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-326-05,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06) / 1 Ml In 1 Vial, Single-Dose",636,RC,61703-309-06,NDC,,,facility,both,1,EA,,101.62,101.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (61703-342-50) / 50 Ml In 1 Vial, Multi-Dose",636,RC,61703-342-50,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (61703-342-50) / 50 Ml In 1 Vial, Multi-Dose",636,RC,61703-342-50,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methotrexate: 1 Vial, Single-Dose In 1 Carton (61703-408-41) / 40 Ml In 1 Vial, Single-Dose",636,RC,61703-408-41,NDC,,,facility,both,1,EA,,2.36,2.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,19.65,19.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,18.98,18.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,17.34,17.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,17.29,17.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1723,1723,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cyclophosphamide: 100 Capsule In 1 Bottle (62332-618-31),636,RC,62332-618-31,NDC,,,facility,both,1,EA,,3.27,3.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1816.5,1816.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,1942.81,1942.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,61958-2901-2,NDC,,,facility,both,1,EA,,2001.75,2001.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methotrexate: 1 Vial, Single-Dose In 1 Carton (61703-408-41) / 40 Ml In 1 Vial, Single-Dose",636,RC,61703-408-41,NDC,,,facility,both,1,EA,,2.32,2.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01) / 7 Ml In 1 Vial, Single-Use",636,RC,61755-008-01,NDC,,,facility,both,1,EA,,115.51,115.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01) / 7 Ml In 1 Vial, Single-Use",636,RC,61755-008-01,NDC,,,facility,both,1,EA,,115.51,115.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01) / 7 Ml In 1 Vial, Single-Use",636,RC,61755-008-01,NDC,,,facility,both,1,EA,,112.34,112.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01) / 7 Ml In 1 Vial, Single-Use",636,RC,61755-008-01,NDC,,,facility,both,1,EA,,102.47,102.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01) / 7 Ml In 1 Vial, Single-Use",636,RC,61755-008-01,NDC,,,facility,both,1,EA,,101.96,101.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01) / 7 Ml In 1 Vial, Single-Use",636,RC,61755-008-01,NDC,,,facility,both,1,EA,,101.96,101.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-696-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-660-11,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60793-701-02,NDC,,,facility,both,1,EA,,71.08,71.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60793-702-04,NDC,,,facility,both,1,EA,,81.92,81.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zarxio: 1 Blister Pack In 1 Carton (61314-318-01) / 1 Syringe In 1 Blister Pack / .5 Ml In 1 Syringe,636,RC,61314-318-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,2.07,2.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,61314-318-05,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-165-01) / 1 Ml In 1 Vial (63323-165-02),636,RC,63323-165-01,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-165-01) / 1 Ml In 1 Vial (63323-165-02),636,RC,63323-165-01,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-165-01) / 1 Ml In 1 Vial (63323-165-02),636,RC,63323-165-01,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-173-01,NDC,,,facility,both,1,EA,,3.73,3.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin: 25 Vial In 1 Tray (63323-173-02) / 2 Ml In 1 Vial (63323-173-01),636,RC,63323-173-02,NDC,,,facility,both,1,EA,,3.1,3.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-180-00,NDC,,,facility,both,1,EA,,23.04,23.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10) / 10 Ml In 1 Vial, Multi-Dose",636,RC,63323-184-10,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10) / 10 Ml In 1 Vial, Multi-Dose",636,RC,63323-184-10,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-25,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-186-01,NDC,,,facility,both,1,EA,,70.46,70.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-186-01,NDC,,,facility,both,1,EA,,66.75,66.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine: 25 Vial In 1 Tray (63323-201-10) / 10 Ml In 1 Vial (63323-201-03),636,RC,63323-201-10,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-229-01,NDC,,,facility,both,1,EA,,5.83,5.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-262-09,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-10) / 10 Ml In 1 Vial (63323-269-01),636,RC,63323-269-10,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-269-25,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-29) / 20 Ml In 1 Vial (63323-269-22),636,RC,63323-269-29,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-25,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-23,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-130-03,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxy 100: 10 Vial In 1 Tray (63323-130-11) / 10 Ml In 1 Vial (63323-130-02),636,RC,63323-130-11,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxy 100: 10 Vial In 1 Tray (63323-130-11) / 10 Ml In 1 Vial (63323-130-02),636,RC,63323-130-11,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cladribine: 1 Vial, Single-Dose In 1 Carton (63323-140-10) / 10 Ml In 1 Vial, Single-Dose",636,RC,63323-140-10,NDC,,,facility,both,1,EA,,43.33,43.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Box (63323-142-10) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,63323-142-10,NDC,,,facility,both,1,EA,,170.57,170.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Box (63323-142-10) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,63323-142-10,NDC,,,facility,both,1,EA,,110.72,110.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ifosfamide: 1 Vial, Single-Dose In 1 Box (63323-142-10) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,63323-142-10,NDC,,,facility,both,1,EA,,57.21,57.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-00,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-00,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-23,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-01) / 1 Ml In 1 Vial, Single-Use (63323-162-00)",636,RC,63323-162-01,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-01) / 1 Ml In 1 Vial, Single-Use (63323-162-00)",636,RC,63323-162-01,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-02) / 2 Ml In 1 Vial, Single-Use (63323-162-03)",636,RC,63323-162-02,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-02) / 2 Ml In 1 Vial, Single-Use (63323-162-03)",636,RC,63323-162-02,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-02) / 2 Ml In 1 Vial, Single-Use (63323-162-03)",636,RC,63323-162-02,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-03,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-03,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-16) / 1 Ml In 1 Vial, Single-Use (63323-162-43)",636,RC,63323-162-16,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-16) / 1 Ml In 1 Vial, Single-Use (63323-162-43)",636,RC,63323-162-16,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-162-23,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-01) / 1 Ml In 1 Vial, Single-Use (63323-162-00)",636,RC,63323-162-01,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-29) / 20 Ml In 1 Vial (63323-269-22),636,RC,63323-269-29,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-29) / 20 Ml In 1 Vial (63323-269-22),636,RC,63323-269-29,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Naropin: 25 Vial, Single-Dose In 1 Carton (63323-286-23) / 20 Ml In 1 Vial, Single-Dose (63323-286-05)",636,RC,63323-286-23,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-286-93,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Naropin: 25 Vial, Single-Dose In 1 Tray (63323-286-95) / 30 Ml In 1 Vial, Single-Dose (63323-286-93)",636,RC,63323-286-95,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Polocaine-Mpf: 25 Vial, Single-Dose In 1 Tray (63323-294-27) / 20 Ml In 1 Vial, Single-Dose (63323-294-01)",636,RC,63323-294-27,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-303-01,NDC,,,facility,both,1,EA,,9.06,9.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-303-21,NDC,,,facility,both,1,EA,,9.12,9.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tobramycin: 6 Vial, Pharmacy Bulk Package In 1 Tray (63323-303-55) / 30 Ml In 1 Vial, Pharmacy Bulk Package (63323-303-21)",636,RC,63323-303-55,NDC,,,facility,both,1,EA,,9.6,9.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-306-01,NDC,,,facility,both,1,EA,,3.29,3.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tobramycin: 25 Vial, Multi-Dose In 1 Tray (63323-306-02) / 2 Ml In 1 Vial, Multi-Dose (63323-306-01)",636,RC,63323-306-02,NDC,,,facility,both,1,EA,,3.21,3.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naropin: 12 Bottle In 1 Case (63323-285-65) / 100 Ml In 1 Bottle (63323-285-51),636,RC,63323-285-65,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "25 VIAL, MULTI-DOSE in 1 TRAY (63323-306-26) / 2 mL in 1 VIAL, MULTI-DOSE",636,RC,63323-306-26,NDC,,,facility,both,1,EA,,4.06,4.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 1 Bottle In 1 Carton (63323-314-66) / 100 Ml In 1 Bottle,636,RC,63323-314-66,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-315-01,NDC,,,facility,both,1,EA,,82.14,82.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Piperacillin And Tazobactam: 10 Vial In 1 Box (63323-320-56) / 20 Ml In 1 Vial,636,RC,63323-320-56,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acyclovir: 10 Vial, Single-Dose In 1 Tray (63323-325-10) / 10 Ml In 1 Vial, Single-Dose (63323-325-03)",636,RC,63323-325-10,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acyclovir: 10 Vial, Single-Dose In 1 Tray (63323-325-24) / 20 Ml In 1 Vial, Single-Dose (63323-325-43)",636,RC,63323-325-24,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-327-21,NDC,,,facility,both,1,EA,,70.71,70.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-328-21,NDC,,,facility,both,1,EA,,68.6,68.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bacitracin: 10 VIAL in 1 CARTON (63323-329-31) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL",636,RC,63323-329-31,NDC,,,facility,both,1,EA,,26.21,26.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-360-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-360-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Piperacillin And Tazobactam: 10 Vial In 1 Box (63323-309-26) / 10 Ml In 1 Vial,636,RC,63323-309-26,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-285-55,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-285-51,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-37) / 20 Ml In 1 Vial (63323-269-25),636,RC,63323-269-37,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-65) / 100 Ml In 1 Vial (63323-269-35),636,RC,63323-269-65,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-65) / 100 Ml In 1 Vial (63323-269-35),636,RC,63323-269-65,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-67) / 100 Ml In 1 Vial (63323-269-21),636,RC,63323-269-67,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-69) / 100 Ml In 1 Vial (63323-269-41),636,RC,63323-269-69,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diprivan: 10 Vial In 1 Box (63323-269-94) / 20 Ml In 1 Vial (63323-269-43),636,RC,63323-269-94,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vinblastine Sulfate: 1 Vial, Multi-Dose In 1 Box (63323-278-10) / 10 Ml In 1 Vial, Multi-Dose",636,RC,63323-278-10,NDC,,,facility,both,1,EA,,24.96,24.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-280-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-280-01,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 25 Vial In 1 Tray (63323-280-10) / 10 Ml In 1 Vial (63323-280-05),636,RC,63323-280-10,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 25 Vial In 1 Tray (63323-280-10) / 10 Ml In 1 Vial (63323-280-05),636,RC,63323-280-10,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-284-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 Vial In 1 Tray (63323-284-20) / 20 Ml In 1 Vial (63323-284-01),636,RC,63323-284-20,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 10 Vial In 1 Tray (63323-284-26) / 20 Ml In 1 Vial (63323-284-42),636,RC,63323-284-26,NDC,,,facility,both,1,EA,,5.27,5.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-285-03,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-285-07,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Naropin: 25 Vial, Single-Dose In 1 Carton (63323-285-13) / 10 Ml In 1 Vial, Single-Dose (63323-285-03)",636,RC,63323-285-13,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Naropin: 25 Vial, Single-Dose In 1 Carton (63323-285-23) / 20 Ml In 1 Vial, Single-Dose (63323-285-07)",636,RC,63323-285-23,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dacarbazine: 10 Vial, Single-Dose In 1 Tray (63323-128-20) / 20 Ml In 1 Vial, Single-Dose (63323-128-00)",636,RC,63323-128-20,NDC,,,facility,both,1,EA,,21.68,21.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-128-00,NDC,,,facility,both,1,EA,,22.73,22.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-128-00,NDC,,,facility,both,1,EA,,29.44,29.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-306-40) / .5 Ml In 1 Syringe,636,RC,62935-306-40,NDC,,,facility,both,1,EA,,377.29,377.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-306-40) / .5 Ml In 1 Syringe,636,RC,62935-306-40,NDC,,,facility,both,1,EA,,300.78,300.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,377.2,377.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,336.8,336.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,332.17,332.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,325.82,325.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,96402,HCPCS,62935-461-50,NDC,facility,both,1,EA,,288,288,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,248.01,248.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-756-80) / .25 Ml In 1 Syringe,636,RC,62935-756-80,NDC,,,facility,both,1,EA,,377.22,377.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Velcade: 1 Vial In 1 Carton (63020-049-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,63020-049-01,NDC,,,facility,both,1,EA,,164.48,164.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-461-50) / .375 Ml In 1 Syringe,636,RC,62935-461-50,NDC,,,facility,both,1,EA,,318.16,318.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-010-01,NDC,,,facility,both,1,EA,,3.51,3.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,274.39,274.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,335.25,335.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,327.77,327.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Halaven: 1 Vial, Single-Dose In 1 Carton (62856-389-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-389-01,NDC,,,facility,both,1,EA,,477,477,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Halaven: 1 Vial, Single-Dose In 1 Carton (62856-389-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-389-01,NDC,,,facility,both,1,EA,,476.57,476.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Halaven: 1 Vial, Single-Dose In 1 Carton (62856-389-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-389-01,NDC,,,facility,both,1,EA,,473.37,473.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Halaven: 1 Vial, Single-Dose In 1 Carton (62856-389-01) / 2 Ml In 1 Vial, Single-Dose",636,RC,62856-389-01,NDC,,,facility,both,1,EA,,473.37,473.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,377.29,377.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,340.32,340.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,339.02,339.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Eligard: 1 Syringe In 1 Carton (62935-227-10) / .375 Ml In 1 Syringe,636,RC,62935-227-10,NDC,,,facility,both,1,EA,,337.76,337.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-010-03,NDC,,,facility,both,1,EA,,6.24,6.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-012-03,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-117-00,NDC,,,facility,both,1,EA,,22.53,22.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-10) / 10 Ml In 1 Vial, Single-Dose (63323-117-00)",636,RC,63323-117-10,NDC,,,facility,both,1,EA,,25.6,25.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-10) / 10 Ml In 1 Vial, Single-Dose (63323-117-00)",636,RC,63323-117-10,NDC,,,facility,both,1,EA,,24.65,24.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-10) / 10 Ml In 1 Vial, Single-Dose (63323-117-00)",636,RC,63323-117-10,NDC,,,facility,both,1,EA,,17,17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-61,NDC,,,facility,both,1,EA,,26.55,26.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-61,NDC,,,facility,both,1,EA,,15.53,15.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-61,NDC,,,facility,both,1,EA,,14.9,14.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-61,NDC,,,facility,both,1,EA,,5.88,5.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-69) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-69,NDC,,,facility,both,1,EA,,22.76,22.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-69) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-69,NDC,,,facility,both,1,EA,,21.94,21.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-117-00,NDC,,,facility,both,1,EA,,26.38,26.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-69) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-69,NDC,,,facility,both,1,EA,,15.01,15.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-69) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-69,NDC,,,facility,both,1,EA,,6.25,6.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,63323-120-20,NDC,,,facility,both,1,EA,,49.39,49.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,63323-120-20,NDC,,,facility,both,1,EA,,12.7,12.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,63323-120-20,NDC,,,facility,both,1,EA,,6.78,6.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,63323-120-20,NDC,,,facility,both,1,EA,,2.04,2.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20) / 20 Ml In 1 Vial, Single-Dose",636,RC,63323-120-20,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methotrexate: 1 Vial In 1 Carton (63323-122-50) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,63323-122-50,NDC,,,facility,both,1,EA,,10.3,10.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gemcitabine: 1 Vial, Single-Dose In 1 Box (63323-125-53) / 25 Ml In 1 Vial, Single-Dose",636,RC,63323-125-53,NDC,,,facility,both,1,EA,,37.05,37.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-127-00,NDC,,,facility,both,1,EA,,39.5,39.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-128-00,NDC,,,facility,both,1,EA,,29.81,29.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-69) / 100 Ml In 1 Vial, Pharmacy Bulk Package",636,RC,63323-117-69,NDC,,,facility,both,1,EA,,14.9,14.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Sulfate: 24 Bag In 1 Case (63323-106-15) / 500 Ml In 1 Bag,636,RC,63323-106-15,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-106-02,NDC,,,facility,both,1,EA,,2.41,2.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxytocin: 25 Vial In 1 Tray (63323-012-07) / 1 Ml In 1 Vial (63323-012-17),636,RC,63323-012-07,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-012-17,NDC,,,facility,both,1,EA,,2.63,2.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-013-01,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-024-01,NDC,,,facility,both,1,EA,,16.03,16.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-044-00,NDC,,,facility,both,1,EA,,3.6,3.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-044-00,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-064-01,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-064-01,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Sulfate: 25 Vial, Single-Dose In 1 Tray (63323-064-02) / 2 Ml In 1 Vial, Single-Dose",636,RC,63323-064-02,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Sulfate: 25 Vial, Single-Dose In 1 Carton (63323-064-03) / 2 Ml In 1 Vial, Single-Dose (63323-064-01)",636,RC,63323-064-03,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Sulfate: 25 Vial, Single-Dose In 1 Carton (63323-064-03) / 2 Ml In 1 Vial, Single-Dose (63323-064-01)",636,RC,63323-064-03,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-064-04,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-064-04,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-064-21,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (63323-101-61) / 100 Ml In 1 Vial, Multi-Dose",636,RC,63323-101-61,NDC,,,facility,both,1,EA,,17.95,17.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-106-00,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-106-00,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-106-02,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,63323-128-00,NDC,,,facility,both,1,EA,,29.21,29.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enoxaparin Sodium: 10 SYRINGE in 1 CARTON (60505-0791-4) / .3 mL in 1 SYRINGE,636,RC,60505-0791-4,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 100 Tablet In 1 Bottle, Plastic (60219-1708-1)",636,RC,60219-1708-1,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sirolimus: 100 Tablet, Sugar Coated In 1 Bottle (59762-1001-1)",636,RC,59762-1001-1,NDC,,,facility,both,1,EA,,8.44,8.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Azithromycin: 1 Bottle In 1 Carton (59762-3120-1) / 15 Ml In 1 Bottle,636,RC,59762-3120-1,NDC,,,facility,both,1,EA,,15.53,15.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Azithromycin: 1 Bottle In 1 Carton (59762-3130-1) / 22.5 Ml In 1 Bottle,636,RC,59762-3130-1,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 100 Tablet In 1 Bottle, Plastic (60219-1708-1)",636,RC,60219-1708-1,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60505-6156-0,NDC,,,facility,both,1,EA,,3.77,3.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60505-6157-0,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60505-6231-0,NDC,,,facility,both,1,EA,,3.2,3.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6287-2) / 10 Ml In 1 Vial,636,RC,60505-6287-2,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (60505-6289-0) / 2 Ml In 1 Vial, Single-Dose",636,RC,60505-6289-0,NDC,,,facility,both,1,EA,,204.96,204.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (60505-6289-0) / 2 Ml In 1 Vial, Single-Dose",636,RC,60505-6289-0,NDC,,,facility,both,1,EA,,201.79,201.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (60505-6289-0) / 2 Ml In 1 Vial, Single-Dose",636,RC,60505-6289-0,NDC,,,facility,both,1,EA,,189.12,189.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (60505-6289-0) / 2 Ml In 1 Vial, Single-Dose",636,RC,60505-6289-0,NDC,,,facility,both,1,EA,,182.07,182.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,60505-6147-0,NDC,,,facility,both,1,EA,,10.26,10.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6146-0) / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose",636,RC,60505-6146-0,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1) / 5 Ml In 1 Vial, Single-Use",636,RC,60505-6128-1,NDC,,,facility,both,1,EA,,12.18,12.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1) / 5 Ml In 1 Vial, Single-Use",636,RC,60505-6128-1,NDC,,,facility,both,1,EA,,10.19,10.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1) / 5 Ml In 1 Vial, Single-Use",636,RC,60505-6128-1,NDC,,,facility,both,1,EA,,9.68,9.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1) / 5 Ml In 1 Vial, Single-Use",636,RC,60505-6128-1,NDC,,,facility,both,1,EA,,4.05,4.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6) / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6) / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6) / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6) / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.18,0.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6) / 10 Ml In 1 Vial,636,RC,60505-6132-6,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7) / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7) / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7) / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7) / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7) / 20 Ml In 1 Vial,636,RC,60505-6132-7,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60505-6144-0,NDC,,,facility,both,1,EA,,3.41,3.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60505-6144-0,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60505-6145-0,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60505-6145-0,NDC,,,facility,both,1,EA,,3.19,3.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-122-11,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Feraheme: 1 Vial, Single-Use In 1 Carton (59338-775-01) / 17 Ml In 1 Vial, Single-Use",636,RC,59338-775-01,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Feraheme: 1 Vial, Single-Use In 1 Carton (59338-775-01) / 17 Ml In 1 Vial, Single-Use",636,RC,59338-775-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Paragard T 380A: 1 Pouch In 1 Carton (59365-5129-1) / 1 Intrauterine Device In 1 Pouch,636,RC,59365-5129-1,NDC,,,facility,both,1,EA,,3288.87,3288.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-821-43,NDC,,,facility,both,1,EA,,140.32,140.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-827-03,NDC,,,facility,both,1,EA,,336.8,336.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-828-03,NDC,,,facility,both,1,EA,,582.42,582.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-842-05,NDC,,,facility,both,1,EA,,88.05,88.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-842-43,NDC,,,facility,both,1,EA,,111.85,111.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-842-43,NDC,,,facility,both,1,EA,,111.78,111.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Boostrix: 10 Syringe In 1 Carton (58160-842-52) / .5 Ml In 1 Syringe (58160-842-43),636,RC,58160-842-52,NDC,,,facility,both,1,EA,,113.44,113.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-976-02,NDC,,,facility,both,1,EA,,253.35,253.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,58160-976-02,NDC,,,facility,both,1,EA,,240.01,240.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-711-01,NDC,,,facility,both,1,EA,,123.83,123.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (59651-484-01),636,RC,59651-484-01,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (59651-488-01),636,RC,59651-488-01,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yondelis: 20 Ml In 1 Vial, Single-Use (59676-610-01)",636,RC,59676-610-01,NDC,,,facility,both,1,EA,,970.11,970.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yondelis: 20 Ml In 1 Vial, Single-Use (59676-610-01)",636,RC,59676-610-01,NDC,,,facility,both,1,EA,,802.84,802.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yondelis: 20 Ml In 1 Vial, Single-Use (59676-610-01)",636,RC,59676-610-01,NDC,,,facility,both,1,EA,,317.89,317.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylprednisolone: 100 Tablet In 1 Bottle (59746-001-06),636,RC,59746-001-06,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-113-06),636,RC,59746-113-06,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (59746-175-06),636,RC,59746-175-06,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-711-01,NDC,,,facility,both,1,EA,,122.33,122.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-711-01,NDC,,,facility,both,1,EA,,120.45,120.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-711-01,NDC,,,facility,both,1,EA,,114.09,114.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-711-01,NDC,,,facility,both,1,EA,,113.12,113.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-711-01,NDC,,,facility,both,1,EA,,113.12,113.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-775-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-775-01,NDC,,,facility,both,1,EA,,122.47,122.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-775-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-775-01,NDC,,,facility,both,1,EA,,120.52,120.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-775-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-775-01,NDC,,,facility,both,1,EA,,118.69,118.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-775-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-775-01,NDC,,,facility,both,1,EA,,113.93,113.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-775-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-775-01,NDC,,,facility,both,1,EA,,113.12,113.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Reblozyl: 1 Vial, Glass In 1 Carton (59572-775-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass",636,RC,59572-775-01,NDC,,,facility,both,1,EA,,113.12,113.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Istodax: 1 Kit In 1 Carton (59572-984-01) * 2.2 Ml In 1 Vial, Glass (59572-962-10) * 2.4 Ml In 1 Vial, Glass (59572-973-02)",636,RC,59572-984-01,NDC,,,facility,both,1,EA,,118.47,118.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Istodax: 1 Kit In 1 Carton (59572-984-01) * 2.2 Ml In 1 Vial, Glass (59572-962-10) * 2.4 Ml In 1 Vial, Glass (59572-973-02)",636,RC,59572-984-01,NDC,,,facility,both,1,EA,,118.12,118.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Istodax: 1 Kit In 1 Carton (59572-984-01) * 2.2 Ml In 1 Vial, Glass (59572-962-10) * 2.4 Ml In 1 Vial, Glass (59572-973-02)",636,RC,59572-984-01,NDC,,,facility,both,1,EA,,107.77,107.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Istodax: 1 Kit In 1 Carton (59572-984-01) * 2.2 Ml In 1 Vial, Glass (59572-962-10) * 2.4 Ml In 1 Vial, Glass (59572-973-02)",636,RC,59572-984-01,NDC,,,facility,both,1,EA,,107.39,107.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Istodax: 1 Kit In 1 Carton (59572-984-01) * 2.2 Ml In 1 Vial, Glass (59572-962-10) * 2.4 Ml In 1 Vial, Glass (59572-973-02)",636,RC,59572-984-01,NDC,,,facility,both,1,EA,,107.39,107.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,59630-266-01,NDC,,,facility,both,1,EA,,6.76,6.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,59630-266-01,NDC,,,facility,both,1,EA,,6.52,6.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fetroja: 10 Vial, Single-Use In 1 Carton (59630-266-10) / 10 Ml In 1 Vial, Single-Use (59630-266-01)",636,RC,59630-266-10,NDC,,,facility,both,1,EA,,6.76,6.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fetroja: 10 Vial, Single-Use In 1 Carton (59630-266-10) / 10 Ml In 1 Vial, Single-Use (59630-266-01)",636,RC,59630-266-10,NDC,,,facility,both,1,EA,,6.58,6.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-134-11,NDC,,,facility,both,1,EA,,0.05,0.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-481-11,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-524-79,NDC,,,facility,both,1,EA,,19.72,19.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Budesonide Inhalation: 30 Pouch In 1 Carton (60687-524-83) / 1 Ampule In 1 Pouch (60687-524-79) / 2 Ml In 1 Ampule,636,RC,60687-524-83,NDC,,,facility,both,1,EA,,25.02,25.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-438-11,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-419-11,NDC,,,facility,both,1,EA,,3.79,3.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-145-11,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-145-11,NDC,,,facility,both,1,EA,,0.02,0.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-375-11,NDC,,,facility,both,1,EA,,17.13,17.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-386-11,NDC,,,facility,both,1,EA,,17.33,17.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-394-79,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,60687-405-79,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,ZZ61553-Z685-88,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,ZZ61553-Z685-88,NDC,,,facility,both,1,EA,,0.11,0.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Abrysvo: 1 Tray In 1 Carton (0069-0344-01) / 1 Kit In 1 Tray (0069-0344-21) * .5 Ml In 1 Vial, Glass (0069-0207-01) * .69 Ml In 1 Syringe, Glass (0069-0250-01)",636,RC,0069-0344-01,NDC,,,facility,both,1,EA,,783.36,783.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306546,NDC,,,facility,both,1,EA,,1.89,1.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306544,NDC,,,facility,both,1,EA,,12.76,12.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306424,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306424,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306423,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306423,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306413,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,6425344425,NDC,,,facility,both,1,EA,,2.29,2.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,6425333333,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,6425333333,NDC,,,facility,both,1,EA,,0.06,0.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,6425322233,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,6425322223,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,6425311135,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,6425311130,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306547,NDC,,,facility,both,1,EA,,7.32,7.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,8290306553,NDC,,,facility,both,1,EA,,18.57,18.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22) / 40 Ml In 1 Vial, Single-Use",636,RC,0003-2328-22,NDC,,,facility,both,1,EA,,596.46,596.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22) / 40 Ml In 1 Vial, Single-Use",636,RC,0003-2328-22,NDC,,,facility,both,1,EA,,604.67,604.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22) / 40 Ml In 1 Vial, Single-Use",636,RC,0003-2328-22,NDC,,,facility,both,1,EA,,616.9,616.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11) / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,584.36,584.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11) / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,586.94,586.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11) / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,589.51,589.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11) / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,596.05,596.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11) / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,615.23,615.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11) / 10 Ml In 1 Vial, Single-Use",636,RC,0003-2327-11,NDC,,,facility,both,1,EA,,619.62,619.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-2291-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-2291-11,NDC,,,facility,both,1,EA,,25.09,25.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-2291-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-2291-11,NDC,,,facility,both,1,EA,,25.17,25.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-2291-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-2291-11,NDC,,,facility,both,1,EA,,25.24,25.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-2291-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-2291-11,NDC,,,facility,both,1,EA,,26.21,26.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-2291-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-2291-11,NDC,,,facility,both,1,EA,,27.05,27.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-2291-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-2291-11,NDC,,,facility,both,1,EA,,28.57,28.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22) / 40 Ml In 1 Vial, Single-Use",636,RC,0003-2328-22,NDC,,,facility,both,1,EA,,587.79,587.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22) / 40 Ml In 1 Vial, Single-Use",636,RC,0003-2328-22,NDC,,,facility,both,1,EA,,585.03,585.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22) / 40 Ml In 1 Vial, Single-Use",636,RC,0003-2328-22,NDC,,,facility,both,1,EA,,584.74,584.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22) / 40 Ml In 1 Vial, Single-Use",636,RC,0003-2328-22,NDC,,,facility,both,1,EA,,584.73,584.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11) / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,107.69,107.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11) / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,108.2,108.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11) / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,112.23,112.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11) / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,112.89,112.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11) / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,114.5,114.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,107.58,107.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,107.83,107.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13) / 15 Ml In 1 Vial, Single-Use",636,RC,0003-2187-13,NDC,,,facility,both,1,EA,,2640.95,2640.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,108.93,108.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,116.89,116.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,122.4,122.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,122.4,122.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,122.45,122.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,122.57,122.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,122.57,122.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13) / 24 Ml In 1 Vial, Single-Dose",636,RC,0003-3734-13,NDC,,,facility,both,1,EA,,115.64,115.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17) / 3 Ml In 1 Vial, Multi-Dose",636,RC,0002-8215-17,NDC,,,facility,both,1,EA,,4.93,4.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01) / 10 Ml In 1 Vial, Multi-Dose",636,RC,0002-8215-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01) / 10 Ml In 1 Vial, Multi-Dose",636,RC,0002-8215-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01) / 10 Ml In 1 Vial, Multi-Dose",636,RC,0002-8215-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7678-01) / 50 Ml In 1 Vial, Single-Dose",636,RC,0002-7678-01,NDC,,,facility,both,1,EA,,254.02,254.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7678-01) / 50 Ml In 1 Vial, Single-Dose",636,RC,0002-7678-01,NDC,,,facility,both,1,EA,,268.08,268.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7678-01) / 50 Ml In 1 Vial, Single-Dose",636,RC,0002-7678-01,NDC,,,facility,both,1,EA,,277.12,277.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7669-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,0002-7669-01,NDC,,,facility,both,1,EA,,245.93,245.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7669-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,0002-7669-01,NDC,,,facility,both,1,EA,,271.87,271.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-0213-01) / 3 Ml In 1 Vial, Multi-Dose",636,RC,0002-0213-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0002-8799-01,NDC,,,facility,both,1,EA,,2.02,2.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kenalog-10: 1 Vial, Multi-Dose In 1 Carton (0003-0494-20) / 5 Ml In 1 Vial, Multi-Dose",636,RC,0003-0494-20,NDC,,,facility,both,1,EA,,5.04,5.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nulojix: 1 Vial, Single-Use In 1 Carton (0003-0371-13) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-0371-13,NDC,,,facility,both,1,EA,,8.87,8.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kenalog-40: 1 Vial, Single-Dose In 1 Carton (0003-0293-05) / 1 Ml In 1 Vial, Single-Dose",636,RC,0003-0293-05,NDC,,,facility,both,1,EA,,6.43,6.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Humalog Kwikpen: 5 Syringe In 1 Carton (0002-8799-59) / 3 Ml In 1 Syringe (0002-8799-01),636,RC,0002-8799-59,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Kenalog-10: 1 Vial, Multi-Dose In 1 Carton (0003-0494-20) / 5 Ml In 1 Vial, Multi-Dose",636,RC,0003-0494-20,NDC,,,facility,both,1,EA,,6.47,6.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11) / 4 Ml In 1 Vial, Single-Dose",636,RC,0003-3772-11,NDC,,,facility,both,1,EA,,107.44,107.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12) / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,113.7,113.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Abrysvo: 5 Tray In 1 Carton (0069-0344-05) / 1 Kit In 1 Tray (0069-0344-21) * .5 Ml In 1 Vial, Glass (0069-0207-01) * .69 Ml In 1 Syringe, Glass (0069-0250-01)",636,RC,0069-0344-05,NDC,,,facility,both,1,EA,,783.37,783.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12) / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,107.66,107.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Albuminar-25: 1 VIAL, GLASS in 1 CARTON (0053-7680-32) / 50 mL in 1 VIAL, GLASS (0053-7680-91) ",636,RC,0053-7680-32,NDC,,,facility,both,1,EA,,95,95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Albuminar-25: 1 VIAL, GLASS in 1 CARTON (0053-7680-32) / 50 mL in 1 VIAL, GLASS (0053-7680-91) ",636,RC,0053-7680-32,NDC,,,facility,both,1,EA,,95,95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tice Bcg: 1 Vial In 1 Carton (0052-0602-02) / 50 Ml In 1 Vial (0052-0602-01),636,RC,0052-0602-02,NDC,,,facility,both,1,EA,,365.24,365.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tice Bcg: 1 Vial In 1 Carton (0052-0602-02) / 50 Ml In 1 Vial (0052-0602-01),636,RC,0052-0602-02,NDC,,,facility,both,1,EA,,369.06,369.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vfend: 1 Vial, Single-Use In 1 Carton (0049-3190-01) / 20 Ml In 1 Vial, Single-Use",636,RC,0049-3190-01,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pfizerpen: 1 Vial In 1 Carton (0049-0530-28) / 1 Powder, For Solution In 1 Vial",636,RC,0049-0530-28,NDC,,,facility,both,1,EA,,2.89,2.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pfizerpen: 1 Vial In 1 Carton (0049-0530-22) / 1 Powder, For Solution In 1 Vial",636,RC,0049-0530-22,NDC,,,facility,both,1,EA,,3.78,3.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0049-0520-84,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pfizerpen: 10 Vial In 1 Carton (0049-0520-22) / 1 Powder, For Solution In 1 Vial",636,RC,0049-0520-22,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0049-0013-81,NDC,,,facility,both,1,EA,,20.82,20.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buprenorphine: 30 Tablet In 1 Bottle (0054-0177-13),636,RC,0054-0177-13,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buprenorphine: 30 Tablet In 1 Bottle (0054-0176-13),636,RC,0054-0176-13,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 10 Blister Pack In 1 Carton (0054-0018-20) / 10 Tablet In 1 Blister Pack,636,RC,0054-0018-20,NDC,,,facility,both,1,EA,,0.03,0.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jevtana: 1 Kit In 1 Carton (0024-5824-11) * 5.7 Ml In 1 Vial, Glass (0024-5823-15) * 5.7 Ml In 1 Vial, Glass (0024-5822-01)",636,RC,0024-5824-11,NDC,,,facility,both,1,EA,,827.1,827.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jevtana: 1 Kit In 1 Carton (0024-5824-11) * 5.7 Ml In 1 Vial, Glass (0024-5823-15) * 5.7 Ml In 1 Vial, Glass (0024-5822-01)",636,RC,0024-5824-11,NDC,,,facility,both,1,EA,,899.12,899.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0024-5823-15,NDC,,,facility,both,1,EA,,791.55,791.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0024-5154-11,NDC,,,facility,both,1,EA,,1040.19,1040.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0024-5154-11,NDC,,,facility,both,1,EA,,1100.79,1100.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0024-5154-11,NDC,,,facility,both,1,EA,,1161.38,1161.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elitek: 3 Kit In 1 Carton (0024-5150-10) / 1 Kit In 1 Kit * 1 Ml In 1 Vial, Single-Use (0024-5154-11) * 1 Ml In 1 Ampule (0024-5152-11)",636,RC,0024-5150-10,NDC,,,facility,both,1,EA,,1032.51,1032.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Elitek: 3 Kit In 1 Carton (0024-5150-10) / 1 Kit In 1 Kit * 1 Ml In 1 Vial, Single-Use (0024-5154-11) * 1 Ml In 1 Ampule (0024-5152-11)",636,RC,0024-5150-10,NDC,,,facility,both,1,EA,,1059.27,1059.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10) / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,48.56,48.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jevtana: 1 Kit In 1 Carton (0024-5824-11) * 5.7 Ml In 1 Vial, Glass (0024-5823-15) * 5.7 Ml In 1 Vial, Glass (0024-5822-01)",636,RC,0024-5824-11,NDC,,,facility,both,1,EA,,825.85,825.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jevtana: 1 Kit In 1 Carton (0024-5824-11) * 5.7 Ml In 1 Vial, Glass (0024-5823-15) * 5.7 Ml In 1 Vial, Glass (0024-5822-01)",636,RC,0024-5824-11,NDC,,,facility,both,1,EA,,798.66,798.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jevtana: 1 Kit In 1 Carton (0024-5824-11) * 5.7 Ml In 1 Vial, Glass (0024-5823-15) * 5.7 Ml In 1 Vial, Glass (0024-5822-01)",636,RC,0024-5824-11,NDC,,,facility,both,1,EA,,797.22,797.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jevtana: 1 Kit In 1 Carton (0024-5824-11) * 5.7 Ml In 1 Vial, Glass (0024-5823-15) * 5.7 Ml In 1 Vial, Glass (0024-5822-01)",636,RC,0024-5824-11,NDC,,,facility,both,1,EA,,796.39,796.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 100 Tablet In 1 Bottle (0054-9817-25),636,RC,0054-9817-25,NDC,,,facility,both,1,EA,,0.04,0.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prednisone: 10 Blister Pack In 1 Carton (0054-8724-25) / 10 Tablet In 1 Blister Pack,636,RC,0054-8724-25,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rifadin Iv: 1 Vial, Glass In 1 Carton (0068-0597-01) / 10 Ml In 1 Vial, Glass",636,RC,0068-0597-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rifadin Iv Novaplus: 1 Vial, Glass In 1 Carton (0068-0599-01) / 10 Ml In 1 Vial, Glass",636,RC,0068-0599-01,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zirabev: 1 Vial, Single-Use In 1 Carton (0069-0342-01) / 16 Ml In 1 Vial, Single-Use",636,RC,0069-0342-01,NDC,,,facility,both,1,EA,,169.86,169.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nyvepria: 1 Carton In 1 Carton (0069-0324-01) / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,390.96,390.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nyvepria: 1 Carton In 1 Carton (0069-0324-01) / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,450.91,450.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nyvepria: 1 Carton In 1 Carton (0069-0324-01) / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,471.7,471.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nyvepria: 1 Carton In 1 Carton (0069-0324-01) / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,471.7,471.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nyvepria: 1 Carton In 1 Carton (0069-0324-01) / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,518.87,518.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nyvepria: 1 Carton In 1 Carton (0069-0324-01) / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,518.87,518.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nyvepria: 1 Carton In 1 Carton (0069-0324-01) / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe,636,RC,0069-0324-01,NDC,,,facility,both,1,EA,,530.99,530.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ruxience: 1 Vial, Single-Use In 1 Carton (0069-0249-01) / 50 Ml In 1 Vial, Single-Use",636,RC,0069-0249-01,NDC,,,facility,both,1,EA,,189.27,189.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Propofol: 10 Vial In 1 Carton (0069-0248-10) / 100 Ml In 1 Vial,636,RC,0069-0248-10,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 1 VIAL in 1 CARTON (0069-0248-01) / 100 mL in 1 VIAL,636,RC,0069-0248-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ruxience: 1 Vial, Single-Use In 1 Carton (0069-0238-01) / 10 Ml In 1 Vial, Single-Use",636,RC,0069-0238-01,NDC,,,facility,both,1,EA,,183.95,183.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-0207-01,NDC,,,facility,both,1,EA,,717.74,717.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0069-0207-01,NDC,,,facility,both,1,EA,,758.75,758.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA HALOPERIDOL: 25 VIAL in 1 CARTON (0069-0113-02) / 1 mL in 1 VIAL (0069-0113-01) ,636,RC,0069-0113-02,NDC,,,facility,both,1,EA,,1.5,1.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zirabev: 1 Vial, Single-Use In 1 Carton (0069-0315-01) / 4 Ml In 1 Vial, Single-Use",636,RC,0069-0315-01,NDC,,,facility,both,1,EA,,164.52,164.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10) / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,49.09,49.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone Intensol: 30 Ml In 1 Bottle, Glass (0054-3176-44)",636,RC,0054-3176-44,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone: 100 Blister Pack In 1 Carton (0054-8179-25) / 1 Tablet In 1 Blister Pack,636,RC,0054-8179-25,NDC,,,facility,both,1,EA,,0.21,0.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone: 100 Blister Pack In 1 Carton (0054-8176-25) / 1 Tablet In 1 Blister Pack,636,RC,0054-8176-25,NDC,,,facility,both,1,EA,,0.19,0.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone: 100 Blister Pack In 1 Carton (0054-8175-25) / 1 Tablet In 1 Blister Pack,636,RC,0054-8175-25,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dexamethasone: 100 Blister Pack In 1 Carton (0054-8175-25) / 1 Tablet In 1 Blister Pack,636,RC,0054-8175-25,NDC,,,facility,both,1,EA,,0.13,0.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 100 Tablet In 1 Bottle, Plastic (0054-4741-25)",636,RC,0054-4741-25,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)",636,RC,0054-4183-25,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)",636,RC,0054-4183-25,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4182-25)",636,RC,0054-4182-25,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prednisone: 100 Tablet In 1 Bottle, Plastic (0054-4741-25)",636,RC,0054-4741-25,NDC,,,facility,both,1,EA,,0.29,0.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10) / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,49.94,49.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0024-5823-15,NDC,,,facility,both,1,EA,,793.43,793.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10) / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,73.97,73.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3061-01,NDC,,,facility,both,1,EA,,5.89,5.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,174.79,174.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,186.5,186.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,188.76,188.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,190.31,190.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,192.4,192.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,194.37,194.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,194.57,194.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,198.76,198.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,202.58,202.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,203.39,203.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 2 Vial In 1 Carton (0006-3026-04) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-04,NDC,,,facility,both,1,EA,,213.15,213.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 1 Vial In 1 Carton (0006-3026-02) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-02,NDC,,,facility,both,1,EA,,193.58,193.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 1 Vial In 1 Carton (0006-3026-02) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-02,NDC,,,facility,both,1,EA,,203.24,203.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Keytruda: 1 Vial In 1 Carton (0006-3026-02) / 4 Ml In 1 Vial (0006-3026-01),636,RC,0006-3026-02,NDC,,,facility,both,1,EA,,218.22,218.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Invanz: 10 Vial, Single-Dose In 1 Package (0006-3843-71) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,0006-3843-71,NDC,,,facility,both,1,EA,,187.21,187.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-4897-01,NDC,,,facility,both,1,EA,,80.8,80.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-4897-01,NDC,,,facility,both,1,EA,,84.6,84.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,181.83,181.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-4837-01,NDC,,,facility,both,1,EA,,338.59,338.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Varivax: 10 Vial, Single-Dose In 1 Carton (0006-4827-00) / .5 Ml In 1 Vial, Single-Dose (0006-4827-01)",636,RC,0006-4827-00,NDC,,,facility,both,1,EA,,523.57,523.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10) / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)",636,RC,0023-6082-10,NDC,,,facility,both,1,EA,,50.54,50.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-4681-01,NDC,,,facility,both,1,EA,,267.05,267.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-4121-01,NDC,,,facility,both,1,EA,,818.18,818.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Invanz: 10 Vial, Single-Dose In 1 Package (0006-3843-71) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose",636,RC,0006-3843-71,NDC,,,facility,both,1,EA,,170.19,170.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-4827-01,NDC,,,facility,both,1,EA,,497.54,497.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Protonix I.V.: 1 Vial In 1 Carton (0008-0923-51) / 10 Ml In 1 Vial,636,RC,0008-0923-51,NDC,,,facility,both,1,EA,,13.81,13.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,194.31,194.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,194.5,194.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0005-2000-01,NDC,,,facility,both,1,EA,,659.18,659.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdualag: 1 Vial, Single-Dose In 1 Carton (0003-7125-11) / 20 Ml In 1 Vial, Single-Dose",636,RC,0003-7125-11,NDC,,,facility,both,1,EA,,682.99,682.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-4522-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-4522-11,NDC,,,facility,both,1,EA,,24.97,24.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-4522-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-4522-11,NDC,,,facility,both,1,EA,,25.19,25.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-4522-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-4522-11,NDC,,,facility,both,1,EA,,25.25,25.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-4522-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-4522-11,NDC,,,facility,both,1,EA,,26.39,26.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Empliciti: 1 Vial, Single-Use In 1 Carton (0003-4522-11) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use",636,RC,0003-4522-11,NDC,,,facility,both,1,EA,,27.29,27.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12) / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,85.14,85.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12) / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,107.26,107.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12) / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,107.58,107.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0005-2000-01,NDC,,,facility,both,1,EA,,659.18,659.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01),636,RC,0005-2000-02,NDC,,,facility,both,1,EA,,693.37,693.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02) / .5 Ml In 1 Syringe (0005-2000-01),636,RC,0005-2000-02,NDC,,,facility,both,1,EA,,691.1,691.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,198,198,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,204.68,204.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,209.15,209.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,210.17,210.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,218.09,218.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,218.22,218.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,220.4,220.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-3026-01,NDC,,,facility,both,1,EA,,194.44,194.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mylotarg: 1 Vial, Single-Dose In 1 Carton (0008-4510-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0008-4510-01,NDC,,,facility,both,1,EA,,838.57,838.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0006-4681-01,NDC,,,facility,both,1,EA,,263.59,263.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mylotarg: 1 Vial, Single-Dose In 1 Carton (0008-4510-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0008-4510-01,NDC,,,facility,both,1,EA,,745.56,745.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mylotarg: 1 Vial, Single-Dose In 1 Carton (0008-4510-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0008-4510-01,NDC,,,facility,both,1,EA,,794.84,794.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Idamycin Pfs: 1 Vial, Single-Dose In 1 Carton (0013-2576-91) / 5 Ml In 1 Vial, Single-Dose",636,RC,0013-2576-91,NDC,,,facility,both,1,EA,,230.67,230.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atgam: 5 Ampule In 1 Carton (0009-7224-02) / 5 Ml In 1 Ampule (0009-7224-01),636,RC,0009-7224-02,NDC,,,facility,both,1,EA,,11633.17,11633.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-7224-01,NDC,,,facility,both,1,EA,,11633.17,11633.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Corvert: 1 Vial, Single-Dose In 1 Carton (0009-3794-22) / 10 Ml In 1 Vial, Single-Dose",636,RC,0009-3794-22,NDC,,,facility,both,1,EA,,232.34,232.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Corvert: 1 Vial, Single-Dose In 1 Carton (0009-3794-22) / 10 Ml In 1 Vial, Single-Dose",636,RC,0009-3794-22,NDC,,,facility,both,1,EA,,232.34,232.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Corvert: 1 Vial, Single-Dose In 1 Carton (0009-3794-01) / 10 Ml In 1 Vial, Single-Dose",636,RC,0009-3794-01,NDC,,,facility,both,1,EA,,232.34,232.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3475-01) / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3475-01,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Depo-Medrol: 25 Vial, Single-Dose In 1 Package (0009-3073-03) / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-03,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,46.93,46.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,49.6,49.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,50.27,50.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,51.95,51.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0023-6082-01,NDC,,,facility,both,1,EA,,76.45,76.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Botox: 1 Vial In 1 Carton (0023-3921-02) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-3921-02,NDC,,,facility,both,1,EA,,18.48,18.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Botox: 1 Vial In 1 Carton (0023-3921-02) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-3921-02,NDC,,,facility,both,1,EA,,19.26,19.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Botox: 1 Vial In 1 Carton (0023-3921-02) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-3921-02,NDC,,,facility,both,1,EA,,20.49,20.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Botox: 1 Vial In 1 Carton (0023-1145-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,18.48,18.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Botox: 1 Vial In 1 Carton (0023-1145-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,20.02,20.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Botox: 1 Vial In 1 Carton (0023-1145-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,20.06,20.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Botox: 1 Vial In 1 Carton (0023-1145-01) / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial",636,RC,0023-1145-01,NDC,,,facility,both,1,EA,,20.49,20.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Depo-Medrol: 25 Vial, Single-Dose In 1 Package (0009-3073-03) / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-03,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cleocin Phosphate: 25 Vial In 1 Carton (0009-0902-18) / 6 Ml In 1 Vial (0009-0902-11),636,RC,0009-0902-18,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0039-33,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0039-33,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.76,1.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0039-30,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Solu-Cortef: 25 Vial, Single-Dose In 1 Carton (0009-0011-04) / 2 Ml In 1 Vial, Single-Dose (0009-0011-03)",636,RC,0009-0011-04,NDC,,,facility,both,1,EA,,37.7,37.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Solu-Cortef: 25 Vial, Single-Dose In 1 Carton (0009-0011-04) / 2 Ml In 1 Vial, Single-Dose (0009-0011-03)",636,RC,0009-0011-04,NDC,,,facility,both,1,EA,,59.35,59.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Depo-Medrol: 25 Vial, Single-Dose In 1 Package (0009-3073-03) / 1 Ml In 1 Vial, Single-Dose",636,RC,0009-3073-03,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0011-03,NDC,,,facility,both,1,EA,,35.89,35.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0011-03,NDC,,,facility,both,1,EA,,57.53,57.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0011-03,NDC,,,facility,both,1,EA,,59.77,59.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mylotarg: 1 Vial, Single-Dose In 1 Carton (0008-4510-01) / 5 Ml In 1 Vial, Single-Dose",636,RC,0008-4510-01,NDC,,,facility,both,1,EA,,740.02,740.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0039-33,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0011-03,NDC,,,facility,both,1,EA,,33.28,33.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cleocin Phosphate: 25 Vial In 1 Carton (0009-0902-18) / 6 Ml In 1 Vial (0009-0902-11),636,RC,0009-0902-18,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Solu-Cortef: 1 Vial In 1 Carton (0009-0825-01) / 2 Ml In 1 Vial,636,RC,0009-0825-01,NDC,,,facility,both,1,EA,,23.32,23.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Solu-Cortef: 1 Vial In 1 Carton (0009-0825-01) / 2 Ml In 1 Vial,636,RC,0009-0825-01,NDC,,,facility,both,1,EA,,32.76,32.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Solu-Medrol: 1 Vial In 1 Carton (0009-0758-01) / 8 Ml In 1 Vial,636,RC,0009-0758-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Solu-Medrol: 1 Vial In 1 Carton (0009-0758-01) / 8 Ml In 1 Vial,636,RC,0009-0758-01,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Depo-Provera: 1 Vial In 1 Carton (0009-0746-30) / 1 Ml In 1 Vial,636,RC,0009-0746-30,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Solu-Medrol: 1 Vial In 1 Carton (0009-0698-01) / 16 Ml In 1 Vial,636,RC,0009-0698-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Solu-Medrol: 1 Vial In 1 Carton (0009-0698-01) / 16 Ml In 1 Vial,636,RC,0009-0698-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12) / 10 Ml In 1 Vial, Single-Dose",636,RC,0003-3774-12,NDC,,,facility,both,1,EA,,110.14,110.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-27,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,636,RC,0009-0047-25,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Calcium Acetate: 100 Blister Pack In 1 Carton (0904-7119-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-7119-61,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7121-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7121-61,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 100 Blister Pack In 1 Carton (0904-7124-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7124-61,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 100 Blister Pack In 1 Carton (0904-7125-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7125-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Blister Pack In 1 Carton (0904-7108-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7108-61,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin Monohydrate/ Macrocrystalline: 100 Blister Pack In 1 Carton (0904-7137-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-7137-61,NDC,,,facility,both,1,EA,,4.75,4.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Benzonatate: 100 Blister Pack In 1 Carton (0904-7153-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-7153-61,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 100 Blister Pack In 1 Carton (0904-7156-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7156-61,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metformin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7162-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7162-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Captopril: 100 Blister Pack In 1 Carton (0904-7105-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7105-61,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Major Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (0904-7035-88)",637,RC,0904-7035-88,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Blister Pack In 1 Carton (0904-7043-04) / 1 Capsule, Delayed Release In 1 Blister Pack",637,RC,0904-7043-04,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 100 Blister Pack In 1 Carton (0904-7044-61) / 1 Capsule, Delayed Release In 1 Blister Pack",637,RC,0904-7044-61,NDC,,,facility,both,1,EA,,3.21,3.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 100 Blister Pack In 1 Carton (0904-7045-61) / 1 Capsule, Delayed Release In 1 Blister Pack",637,RC,0904-7045-61,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 100 Blister Pack In 1 Carton (0904-7048-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7048-61,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7076-61) / 1 Capsule, Extended Release In 1 Blister Pack",637,RC,0904-7076-61,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7084-61) / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-7084-61,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ezetimibe: 30 Blister Pack In 1 Carton (0904-7103-04) / 1 Tablet In 1 Blister Pack,637,RC,0904-7103-04,NDC,,,facility,both,1,EA,,19.52,19.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methocarbamol: 100 Blister Pack In 1 Carton (0904-7058-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7058-61,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Docusate Sodium - Stool Softener Laxative: 10 Blister Pack In 1 Carton (0904-7183-61) / 10 Capsule, Liquid Filled In 1 Blister Pack",637,RC,0904-7183-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7243-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7243-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lacosamide: 60 Blister Pack In 1 Carton (0904-7244-68) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7244-68,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lacosamide: 60 Blister Pack In 1 Carton (0904-7245-68) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7245-68,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sennosides: 100 Tablet, Film Coated In 1 Bottle (0904-7252-60)",637,RC,0904-7252-60,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sennosides: 10 Blister Pack In 1 Box, Unit-Dose (0904-7252-61) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7252-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sennosides: 1000 Tablet, Film Coated In 1 Bottle (0904-7252-80)",637,RC,0904-7252-80,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0904-7276-41,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Stool Softener Laxative: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (0904-7280-60)",637,RC,0904-7280-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Blister Pack In 1 Carton (0904-7305-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7305-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Blister Pack In 1 Carton (0904-7306-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7306-61,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atenolol: 100 Blister Pack In 1 Carton (0904-7187-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7187-61,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 50 Blister Pack In 1 Carton (0904-7193-06) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7193-06,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7193-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7193-61,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Major Bismuth Subsalicylate: 5 Blister Pack In 1 Box (0904-7205-46) / 6 Tablet, Chewable In 1 Blister Pack",637,RC,0904-7205-46,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7218-61) / 1 Capsule, Extended Release In 1 Blister Pack",637,RC,0904-7218-61,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7219-61) / 1 Capsule, Extended Release In 1 Blister Pack",637,RC,0904-7219-61,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Folic Acid: 100 Blister Pack In 1 Carton (0904-7224-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7224-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clonazepam: 100 Blister Pack In 1 Carton (0904-7227-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7227-61,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nifedipine: 100 Blister Pack In 1 Carton (0904-7229-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-7229-61,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bumetanide: 100 Blister Pack In 1 Carton (0904-7016-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7016-61,NDC,,,facility,both,1,EA,,1.92,1.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Blister Pack In 1 Carton (0904-7308-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7308-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61) / 10 Tablet In 1 Blister Pack",637,RC,0904-6773-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol: 100 Blister Pack In 1 Carton (0904-6782-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6782-61,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aspirin Low Dose Chewable Orange: 1000 Tablet, Chewable In 1 Package (0904-6794-80)",637,RC,0904-6794-80,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Blister Pack In 1 Carton (0904-6797-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6797-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Blister Pack In 1 Carton (0904-6799-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6799-61,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Montelukast Sodium: 100 Blister Pack In 1 Carton (0904-6808-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6808-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6817-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6817-61,NDC,,,facility,both,1,EA,,2.26,2.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6818-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6818-61,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Blister Pack In 1 Carton (0904-6823-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6823-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Blister Pack In 1 Carton (0904-6798-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6798-61,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61) / 10 Tablet In 1 Blister Pack",637,RC,0904-6773-61,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aspirin Low Dose: 1000 Tablet, Delayed Release In 1 Bottle, Plastic (0904-6751-80)",637,RC,0904-6751-80,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mucus Relief Er: 100 Blister Pack In 1 Carton (0904-6718-39) / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-6718-39,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40),637,RC,0904-6720-40,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40),637,RC,0904-6720-40,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1 Bottle In 1 Carton (0904-6730-59) / 100 Tablet In 1 Bottle,637,RC,0904-6730-59,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1 Bottle In 1 Carton (0904-6730-59) / 100 Tablet In 1 Bottle,637,RC,0904-6730-59,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 100 Tablet In 1 Bottle (0904-6730-60),637,RC,0904-6730-60,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61) / 10 Tablet In 1 Blister Pack",637,RC,0904-6730-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61) / 10 Tablet In 1 Blister Pack",637,RC,0904-6730-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1000 Tablet In 1 Bottle (0904-6730-80),637,RC,0904-6730-80,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen: 1000 Tablet In 1 Bottle (0904-6730-80),637,RC,0904-6730-80,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Haloperidol: 100 Blister Pack In 1 Carton (0904-6733-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6733-61,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Major Medi-Pads: 100 Packet In 1 Package (0904-6829-60) / 2.9 G In 1 Packet,637,RC,0904-6829-60,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 100 Blister Pack In 1 Carton (0904-6830-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6830-61,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6966-61,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6966-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mucus Relief: 500 Tablet, Extended Release In 1 Bottle (0904-6986-40)",637,RC,0904-6986-40,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dicyclomine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6988-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6988-61,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pseudoephedrine Hcl: 10 Blister Pack In 1 Carton (0904-6990-61) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6990-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 100 Blister Pack In 1 Carton (0904-6991-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-6991-61,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Docusate Sodium: 1000 Capsule In 1 Bottle, Plastic (0904-6998-80)",637,RC,0904-6998-80,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 100 Blister Pack In 1 Carton (0904-7001-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-7001-61,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lamotrigine: 100 Blister Pack In 1 Carton (0904-7007-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7007-61,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86),637,RC,0904-6931-86,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86),637,RC,0904-6931-86,NDC,,,facility,both,1,EA,,2.94,2.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6852-61,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6852-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6860-61) / 1 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6860-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 90 Blister Pack In 1 Carton (0904-6861-90) / 1 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6861-90,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6868-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6868-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6869-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6869-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 80 Blister Pack In 1 Carton (0904-6870-45) / 1 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6870-45,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbamazepine: 30 Blister Pack In 1 Carton (0904-6885-04) / 1 Capsule, Extended Release In 1 Blister Pack",637,RC,0904-6885-04,NDC,,,facility,both,1,EA,,5.78,5.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 100 Blister Pack In 1 Carton (0904-6927-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6927-61,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lamotrigine: 100 Blister Pack In 1 Carton (0904-7008-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7008-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6717-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle (10702-192-01),637,RC,10702-192-01,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Silver Nitrate Applicators: 10 Packet In 1 Box (12870-0001-1) / 10 Applicator In 1 Packet / 100 Mg In 1 Applicator,637,RC,12870-0001-1,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 500 Tablet, Film Coated In 1 Bottle (13107-001-05)",637,RC,13107-001-05,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-001-30)",637,RC,13107-001-30,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 500 Tablet In 1 Bottle (13107-084-05),637,RC,13107-084-05,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 90 Tablet, Film Coated In 1 Bottle (13107-155-90)",637,RC,13107-155-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Silver Nitrate Applicators: 100 Applicator In 1 Vial (12870-0001-2) / 100 Mg In 1 Applicator,637,RC,12870-0001-2,NDC,,,facility,both,1,EA,,1.79,1.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Tablet, Film Coated In 1 Bottle (13668-009-01)",637,RC,13668-009-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 30 Tablet, Orally Disintegrating In 1 Bottle (13668-086-30)",637,RC,13668-086-30,NDC,,,facility,both,1,EA,,5.93,5.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (13668-091-90),637,RC,13668-091-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (13668-094-90),637,RC,13668-094-90,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (13668-189-30)",637,RC,13668-189-30,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tadalafil: 30 Tablet In 1 Bottle (13668-581-30),637,RC,13668-581-30,NDC,,,facility,both,1,EA,,2.88,2.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Blister Pack In 1 Carton (0904-7346-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-7346-61,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Peg-3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride: 4 L In 1 Bottle (10572-302-01)",637,RC,10572-302-01,NDC,,,facility,both,1,EA,,63,63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 50 Blister Pack In 1 Carton (0904-7350-06) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7350-06,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azithromycin: 100 Blister Pack In 1 Carton (0904-7350-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7350-61,NDC,,,facility,both,1,EA,,3.44,3.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 100 Blister Pack In 1 Carton (0904-7362-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7362-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 100 Blister Pack In 1 Carton (0904-7363-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7363-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7376-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-7376-61,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamsulosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7383-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-7383-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (0904-7418-44)",637,RC,0904-7418-44,NDC,,,facility,both,1,EA,,5.83,5.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sucralfate: 10 Ml In 1 Cup, Unit-Dose (0904-7470-66)",637,RC,0904-7470-66,NDC,,,facility,both,1,EA,,13.34,13.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ibuprofen: 10 Blister Pack In 1 Carton (0904-7914-61) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-7914-61,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isopropyl Alcohol 70 Percent: 473 mL in 1 BOTTLE, PLASTIC (10135-106-08) ",637,RC,10135-106-08,NDC,,,facility,both,1,EA,,5.16,5.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sennosides: 1 Bottle In 1 Carton (10135-314-01) / 100 Tablet In 1 Bottle,637,RC,10135-314-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenazopyridine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE (10135-620-01) ",637,RC,10135-620-01,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aspirin 81 mg Enteric Coated: 120 TABLET in 1 BOTTLE (10135-689-62) ,637,RC,10135-689-62,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Irbesartan: 90 TABLET, FILM COATED in 1 BOTTLE (0955-1042-90) ",637,RC,0955-1042-90,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefpodoxime Proxetil: 100 Tablet, Film Coated In 1 Bottle (0781-5439-01)",637,RC,0781-5439-01,NDC,,,facility,both,1,EA,,14.15,14.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Ml In 1 Bottle (0781-6039-46),637,RC,0781-6039-46,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0781-7144-58,NDC,,,facility,both,1,EA,,16.75,16.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0869-4706-10,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline Hyclate: 50 Blister Pack In 1 Carton (0904-0428-06) / 1 Capsule In 1 Blister Pack,637,RC,0904-0428-06,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tri-Buffered Aspirin: 1 Bottle, Plastic In 1 Carton (0904-2015-59) / 100 Tablet, Film Coated In 1 Bottle, Plastic",637,RC,0904-2015-59,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrogen Peroxide: 473 Ml In 1 Bottle, Plastic (0869-0871-43)",637,RC,0869-0871-43,NDC,,,facility,both,1,EA,,26.08,26.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calamine: 177 Ml In 1 Bottle, Plastic (0904-2533-21)",637,RC,0904-2533-21,NDC,,,facility,both,1,EA,,2.93,2.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbamazepine: 100 Blister Pack In 1 Carton (0904-3854-61) / 1 Tablet, Chewable In 1 Blister Pack",637,RC,0904-3854-61,NDC,,,facility,both,1,EA,,1.29,1.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0904-3865-75,NDC,,,facility,both,1,EA,,1.8,1.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sudogest: 1 Bottle, Plastic In 1 Carton (0904-5053-59) / 100 Tablet, Film Coated In 1 Bottle, Plastic",637,RC,0904-5053-59,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 100 Blister Pack In 1 Carton (0904-2725-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-2725-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0832-0038-89,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bumetanide: 100 Tablet In 1 Bottle (0832-0541-11),637,RC,0832-0541-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0832-1213-89,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0832-1215-89,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0832-1216-89,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Jantoven: 100 Tablet In 1 Bottle (0832-1218-00),637,RC,0832-1218-00,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0832-1218-89,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (0832-5323-11)",637,RC,0832-5323-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0713-0503-06,NDC,,,facility,both,1,EA,,21.3,21.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mometasone Furoate: 1 Tube In 1 Carton (0713-0634-15) / 15 G In 1 Tube,637,RC,0713-0634-15,NDC,,,facility,both,1,EA,,31.15,31.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (0781-1061-01),637,RC,0781-1061-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamterene hydrochlorothiazide: 100 TABLET in 1 BOTTLE (0781-1123-01) ,637,RC,0781-1123-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0781-1489-01)",637,RC,0781-1489-01,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (0781-1831-20)",637,RC,0781-1831-20,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamterene And Hydrochlorothiazide: 100 Capsule In 1 Bottle (0781-2074-01),637,RC,0781-2074-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6717-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Donepezil Hydrochloride: 100 Blister Pack In 1 Carton (0904-6477-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6477-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 100 Blister Pack In 1 Carton (0904-6500-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6500-61,NDC,,,facility,both,1,EA,,2.58,2.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 100 Blister Pack In 1 Carton (0904-6501-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6501-61,NDC,,,facility,both,1,EA,,4.13,4.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Blister Pack In 1 Carton (0904-6503-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-6503-61,NDC,,,facility,both,1,EA,,4.85,4.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6475-61,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6506-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6506-61,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Blister Pack In 1 Carton (0904-6512-04) / 1 Tablet In 1 Blister Pack,637,RC,0904-6512-04,NDC,,,facility,both,1,EA,,50.43,50.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Senna-Lax: 10 Blister Pack In 1 Box (0904-6522-61) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6522-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Propranolol Hydrochloride: 100 Blister Pack In 1 Carton (0904-6550-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6550-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6554-61) / 1 TABLET in 1 BLISTER PACK,637,RC,0904-6554-61,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 100 Blister Pack In 1 Carton (0904-6474-61) / 1 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6474-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tizanidine: 100 Blister Pack In 1 Carton (0904-6418-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6418-61,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Blister Pack In 1 Carton (0904-6426-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6426-61,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Blister Pack In 1 Carton (0904-6427-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6427-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temazepam: 30 Blister Pack In 1 Carton (0904-6436-04) / 1 Capsule In 1 Blister Pack,637,RC,0904-6436-04,NDC,,,facility,both,1,EA,,6.79,6.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6441-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6441-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6475-61,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6442-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6442-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6449-61) / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-6449-61,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6450-61) / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-6450-61,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clopidogrel: 30 Blister Pack In 1 Carton (0904-6467-07) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6467-07,NDC,,,facility,both,1,EA,,19.18,19.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6469-61) / 1 CAPSULE, EXTENDED RELEASE in 1 BLISTER PACK",637,RC,0904-6469-61,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6557-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,0904-6557-61,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 100 Blister Pack In 1 Carton (0904-6638-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6638-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 100 Blister Pack In 1 Carton (0904-6640-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6640-61,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 100 Blister Pack In 1 Carton (0904-6642-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6642-61,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetazolamide: 100 Blister Pack In 1 Carton (0904-6663-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6663-61,NDC,,,facility,both,1,EA,,7.7,7.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-6665-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-6665-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Blister Pack In 1 Carton (0904-6666-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-6666-61,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Blister Pack In 1 Carton (0904-6667-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-6667-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sildenafil: 30 Blister Pack In 1 Carton (0904-6671-04) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6671-04,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sildenafil: 50 Blister Pack In 1 Carton (0904-6671-06) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6671-06,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glycopyrrolate: 100 Blister Pack In 1 Carton (0904-6709-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6709-61,NDC,,,facility,both,1,EA,,2.89,2.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glipizide: 100 Blister Pack In 1 Carton (0904-6637-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6637-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride: 100 Blister Pack In 1 Carton (0904-6636-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6636-61,NDC,,,facility,both,1,EA,,3.24,3.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 100 BLISTER PACK in 1 CARTON (0904-6564-61) / 1 CAPSULE in 1 BLISTER PACK,637,RC,0904-6564-61,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valacyclovir Hydrochloride: 100 Blister Pack In 1 Carton (0904-6565-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6565-61,NDC,,,facility,both,1,EA,,2.61,2.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-6570-61) / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-6570-61,NDC,,,facility,both,1,EA,,3.07,3.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Allopurinol: 100 Blister Pack In 1 Carton (0904-6572-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6572-61,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lamivudine: 30 Blister Pack In 1 Carton (0904-6583-04) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6583-04,NDC,,,facility,both,1,EA,,12.52,12.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 30 Blister Pack In 1 Carton (0904-6592-04) / 1 Capsule, Extended Release In 1 Blister Pack",637,RC,0904-6592-04,NDC,,,facility,both,1,EA,,13.05,13.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6615-61) / 1 Capsule, Delayed Release In 1 Blister Pack",637,RC,0904-6615-61,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6619-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6619-61,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6620-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6620-61,NDC,,,facility,both,1,EA,,1.38,1.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride: 100 Blister Pack In 1 Carton (0904-6635-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6635-61,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bisacodyl: 10 Blister Pack In 1 Box (0904-6407-61) / 10 Tablet, Delayed Release In 1 Blister Pack",637,RC,0904-6407-61,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5853-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5853-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5854-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5854-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5854-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5854-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5891-61) / 1 Tablet In 1 Blister Pack",637,RC,0904-5891-61,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5892-61) / 1 Tablet In 1 Blister Pack",637,RC,0904-5892-61,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Blister Pack In 1 Carton (0904-5853-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5853-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Blister Pack In 1 Carton (0904-5921-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5921-61,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Blister Pack In 1 Carton (0904-5922-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5922-61,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-5929-61) / 1 TABLET, FILM COATED in 1 BLISTER PACK",637,RC,0904-5929-61,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-5959-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-5959-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6007-61,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5893-61) / 1 Tablet In 1 Blister Pack",637,RC,0904-5893-61,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 500 Tablet In 1 Bottle (0904-5853-40),637,RC,0904-5853-40,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxazosin: 100 Blister Pack In 1 Carton (0904-5522-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5522-61,NDC,,,facility,both,1,EA,,2.06,2.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxazosin: 100 Blister Pack In 1 Carton (0904-5523-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5523-61,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxazosin: 100 Blister Pack In 1 Carton (0904-5524-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-5524-61,NDC,,,facility,both,1,EA,,2.23,2.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Heartburn Relief Original Strength: 1 Bottle In 1 Carton (0904-5529-52) / 60 Tablet, Film Coated In 1 Bottle",637,RC,0904-5529-52,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Heartburn Relief Original Strength: 30 Blister Pack In 1 Carton (0904-5529-87) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-5529-87,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5676-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-5676-61,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5677-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-5677-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Blister Pack In 1 Carton (0904-5784-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-5784-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Blister Pack In 1 Carton (0904-5785-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-5785-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acyclovir: 100 Blister Pack In 1 Carton (0904-5789-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-5789-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "lisinopril: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (0904-5811-61) / 1 TABLET in 1 BLISTER PACK",637,RC,0904-5811-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6007-61,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6301-61)",637,RC,0904-6301-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6303-61)",637,RC,0904-6303-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6322-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,0904-6322-61,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6323-61) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,0904-6323-61,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6300-61)",637,RC,0904-6300-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6363-61) / 1 Tablet, Extended Release In 1 Blister Pack",637,RC,0904-6363-61,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6369-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6369-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6370-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6370-61,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6371-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6371-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6371-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6371-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clopidogrel: 100 Blister Pack In 1 Carton (0904-6294-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6294-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Zolpidem Tartrate: 100 Blister Pack In 1 Carton (0904-6082-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6082-61,NDC,,,facility,both,1,EA,,7.26,7.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Blister Pack In 1 Carton (0904-6084-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6084-61,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Blister Pack In 1 Carton (0904-6085-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6085-61,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 100 TABLET, FILM COATED in 1 BOX, UNIT-DOSE (0904-6088-61) ",637,RC,0904-6088-61,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbamazepine: 100 Blister Pack In 1 Carton (0904-6172-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6172-61,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ursodiol: 100 Blister Pack In 1 Carton (0904-6221-61) / 1 Capsule In 1 Blister Pack,637,RC,0904-6221-61,NDC,,,facility,both,1,EA,,7.18,7.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-6238-61) / 1 Tablet In 1 Blister Pack,637,RC,0904-6238-61,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6290-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6290-61,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6291-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6291-61,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6292-61) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0904-6292-61,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Np Thyroid 30: 100 Tablet In 1 Bottle (42192-329-01),637,RC,42192-329-01,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01),637,RC,42192-339-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01),637,RC,42192-339-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 6 Ml In 1 Cup, Unit-Dose (42192-608-06)",637,RC,42192-608-06,NDC,,,facility,both,1,EA,,7.27,7.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Np Thyroid 15: 100 Tablet In 1 Bottle (42192-327-01),637,RC,42192-327-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,42291-477-11,NDC,,,facility,both,1,EA,,5.8,5.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,42291-495-11,NDC,,,facility,both,1,EA,,5.8,5.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,42291-495-11,NDC,,,facility,both,1,EA,,5.8,5.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,42292-038-01,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metformin Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42385-947-01)",637,RC,42385-947-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-024-04) / 5.8 G In 1 Packet,637,RC,37000-024-04,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metamucil Therapy For Regularity: 5.8 G In 1 Packet (37000-024-10),637,RC,37000-024-10,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,41388-00732,NDC,,,facility,both,1,EA,,0.22,0.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nystatin: 15 g in 1 BOTTLE, PLASTIC (39822-3015-1) ",637,RC,39822-3015-1,NDC,,,facility,both,1,EA,,39.94,39.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dorzolamide Hydrochloride And Timolol Maleate Ophthalmic Solution: 1 Bottle In 1 Carton (42571-147-26) / 10 Ml In 1 Bottle,637,RC,42571-147-26,NDC,,,facility,both,1,EA,,133.15,133.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Benzonatate: 100 Capsule In 1 Bottle (42806-714-01),637,RC,42806-714-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10) / 10 Tablet In 1 Blister Pack,637,RC,42858-001-10,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10) / 10 Tablet In 1 Blister Pack,637,RC,42858-001-10,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-301-01)",637,RC,42858-301-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-301-25) / 25 Tablet In 1 Blister Pack,637,RC,42858-301-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ursodiol: 100 Capsule In 1 Bottle (42806-503-01),637,RC,42806-503-01,NDC,,,facility,both,1,EA,,2.25,2.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-302-25) / 25 Tablet In 1 Blister Pack,637,RC,42858-302-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paroxetine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (42858-703-03)",637,RC,42858-703-03,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate Extended Release: 100 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (42858-802-01)",637,RC,42858-802-01,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)",637,RC,42858-302-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-339-01)",637,RC,42806-339-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (42571-161-01)",637,RC,42571-161-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (42571-162-42)",637,RC,42571-162-42,NDC,,,facility,both,1,EA,,1.58,1.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bumetanide: 100 Tablet In 1 Bottle (42799-119-01),637,RC,42799-119-01,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ivermectin: 2 Blister Pack In 1 Carton (42799-806-01) / 10 Tablet In 1 Blister Pack,637,RC,42799-806-01,NDC,,,facility,both,1,EA,,10.02,10.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ethambutol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42806-102-01)",637,RC,42806-102-01,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,42806-266-98,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-413-01)",637,RC,29300-413-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lasix: 100 Tablet In 1 Bottle (30698-067-01),637,RC,30698-067-01,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 100 Tablet, Film Coated In 1 Bottle (31722-017-01)",637,RC,31722-017-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1000 Tablet, Film Coated In 1 Bottle (31722-017-10)",637,RC,31722-017-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1000 Tablet, Film Coated In 1 Bottle (31722-017-10)",637,RC,31722-017-10,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-186-01)",637,RC,31722-186-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 30 Tablet, Film Coated In 1 Bottle (31722-526-30)",637,RC,31722-526-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Captopril: 100 Tablet In 1 Bottle (31722-141-01),637,RC,31722-141-01,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levetiracetam: 473 Ml In 1 Bottle (31722-574-47),637,RC,31722-574-47,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tramadol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-355-01)",637,RC,29300-355-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Buspirone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-245-01)",637,RC,29300-245-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Theophylline (Anhydrous): 100 Tablet, Extended Release In 1 Bottle, Plastic (29033-001-01)",637,RC,29033-001-01,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (29033-020-12)",637,RC,29033-020-12,NDC,,,facility,both,1,EA,,2.67,2.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Meloxicam: 100 Tablet In 1 Bottle (29300-124-01),637,RC,29300-124-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bisoprolol Fumarate: 30 Tablet In 1 Bottle, Plastic (29300-126-13)",637,RC,29300-126-13,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bisoprolol Fumarate: 100 Tablet In 1 Bottle, Plastic (29300-127-01)",637,RC,29300-127-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zaleplon: 100 Capsule In 1 Bottle, Plastic (29300-131-01)",637,RC,29300-131-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-138-01)",637,RC,29300-138-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-140-01)",637,RC,29300-140-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Memantine Hydrochloride: 60 Tablet, Film Coated In 1 Bottle, Plastic (29300-171-16)",637,RC,29300-171-16,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metronidazole: 100 Tablet, Film Coated In 1 Bottle, Plastic (29300-226-01)",637,RC,29300-226-01,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dabigatran Etexilate: 60 Capsule In 1 Bottle (31722-621-60),637,RC,31722-621-60,NDC,,,facility,both,1,EA,,4.26,4.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,33342-093-02,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-098-09)",637,RC,33342-098-09,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-256-66) / 10 Capsule In 1 Blister Pack,637,RC,33342-256-66,NDC,,,facility,both,1,EA,,2.86,2.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-258-66) / 10 Capsule In 1 Blister Pack,637,RC,33342-258-66,NDC,,,facility,both,1,EA,,4.58,4.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,35135-01505,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,35573-428-51,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valsartan: 30 Tablet, Film Coated In 1 Bottle (33342-062-07)",637,RC,33342-062-07,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dabigatran Etexilate: 60 Capsule In 1 Bottle (31722-622-60),637,RC,31722-622-60,NDC,,,facility,both,1,EA,,7.31,7.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atovaquone: 1 Bottle In 1 Carton (31722-629-21) / 210 Ml In 1 Bottle,637,RC,31722-629-21,NDC,,,facility,both,1,EA,,3.69,3.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-700-90)",637,RC,31722-700-90,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-701-90)",637,RC,31722-701-90,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (31722-712-90)",637,RC,31722-712-90,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atomoxetine: 30 Capsule In 1 Bottle (31722-717-30),637,RC,31722-717-30,NDC,,,facility,both,1,EA,,4.29,4.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irbesartan: 90 Tablet In 1 Bottle (31722-729-90),637,RC,31722-729-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irbesartan: 90 Tablet In 1 Bottle (31722-730-90),637,RC,31722-730-90,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Irbesartan: 90 Tablet In 1 Bottle (31722-731-90),637,RC,31722-731-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline: 50 Capsule In 1 Bottle (27808-233-01),637,RC,27808-233-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,47781-426-11,NDC,,,facility,both,1,EA,,17.07,17.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,47781-427-11,NDC,,,facility,both,1,EA,,41.78,41.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,47781-428-11,NDC,,,facility,both,1,EA,,42.33,42.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (47781-468-13) / 10 Capsule In 1 Blister Pack,637,RC,47781-468-13,NDC,,,facility,both,1,EA,,22.66,22.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-562-01),637,RC,47781-562-01,NDC,,,facility,both,1,EA,,19.17,19.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-564-01),637,RC,47781-564-01,NDC,,,facility,both,1,EA,,19.65,19.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 1 Tube In 1 Carton (45802-276-03) / 28 G In 1 Tube,637,RC,45802-276-03,NDC,,,facility,both,1,EA,,4.22,4.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dextromethorphan Polistirex Extended Release: 1 Bottle In 1 Carton (45802-433-21) / 89 Ml In 1 Bottle,637,RC,45802-433-21,NDC,,,facility,both,1,EA,,1.32,1.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 1 Tube In 1 Carton (45802-438-03) / 28 G In 1 Tube,637,RC,45802-438-03,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen Pain Reliever Fever Reducer: 1 Suppository In 1 Blister Pack (45802-730-00),637,RC,45802-730-00,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Acetaminophen Pain Reliever Fever Reducer: 100 Blister Pack In 1 Carton (45802-730-33) / 1 Suppository In 1 Blister Pack,637,RC,45802-730-33,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nicotine: 110 Blister Pack In 1 Carton (45802-827-25) / 1 Gum, Chewing In 1 Blister Pack",637,RC,45802-827-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,45802-868-00,NDC,,,facility,both,1,EA,,3.84,3.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 100 Tablet In 1 Bottle, Plastic (49483-340-01)",637,RC,49483-340-01,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Acetaminophen: 100 Tablet In 1 Bottle, Plastic (49483-340-01)",637,RC,49483-340-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)",637,RC,49702-228-13,NDC,,,facility,both,1,EA,,200.06,200.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Triumeq: 30 Tablet, Film Coated In 1 Bottle (49702-231-13)",637,RC,49702-231-13,NDC,,,facility,both,1,EA,,345.88,345.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 3 Blister Pack In 1 Carton (49884-320-55) / 10 Tablet, Orally Disintegrating In 1 Blister Pack (49884-320-52)",637,RC,49884-320-55,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sunmark Hydrogen Peroxide 3 Percent: 473 Ml In 1 Bottle (49348-179-38),637,RC,49348-179-38,NDC,,,facility,both,1,EA,,20.86,20.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hemorrhoidal: 1 Tube In 1 Carton (45802-188-16) / 57 G In 1 Tube,637,RC,45802-188-16,NDC,,,facility,both,1,EA,,5.19,5.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ciprofloxacin: 100 Tablet In 1 Bottle (43547-688-10),637,RC,43547-688-10,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (43598-163-60)",637,RC,43598-163-60,NDC,,,facility,both,1,EA,,5.99,5.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ssd Cream: 50 G In 1 Jar (43598-210-55),637,RC,43598-210-55,NDC,,,facility,both,1,EA,,25.9,25.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clobetasol Propionate: 1 Tube In 1 Carton (43386-096-60) / 15 G In 1 Tube,637,RC,43386-096-60,NDC,,,facility,both,1,EA,,31.96,31.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Misoprostol: 100 Tablet In 1 Bottle (43386-161-01),637,RC,43386-161-01,NDC,,,facility,both,1,EA,,2.38,2.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-268-10)",637,RC,43547-268-10,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-270-10)",637,RC,43547-270-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-272-10)",637,RC,43547-272-10,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Tablet, Film Coated In 1 Bottle (43547-282-10)",637,RC,43547-282-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Risperidone: 60 Tablet In 1 Bottle (43547-342-06),637,RC,43547-342-06,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,43598-447-71,NDC,,,facility,both,1,EA,,3.85,3.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nystatin: 1 Tube In 1 Carton (45802-048-35) / 15 G In 1 Tube,637,RC,45802-048-35,NDC,,,facility,both,1,EA,,18.82,18.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gentamicin Sulfate: 1 Tube In 1 Carton (45802-056-35) / 15 G In 1 Tube,637,RC,45802-056-35,NDC,,,facility,both,1,EA,,76.12,76.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mesalamine: 60 Ml In 1 Bottle (45802-098-46),637,RC,45802-098-46,NDC,,,facility,both,1,EA,,34.83,34.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,43598-891-16,NDC,,,facility,both,1,EA,,15.24,15.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,43598-891-16,NDC,,,facility,both,1,EA,,15.24,15.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (43598-965-30),637,RC,43598-965-30,NDC,,,facility,both,1,EA,,1.7,1.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Febuxostat: 30 Tablet In 1 Bottle (27808-207-01),637,RC,27808-207-01,NDC,,,facility,both,1,EA,,2.97,2.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (16714-732-01),637,RC,16714-732-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (16714-733-01),637,RC,16714-733-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atomoxetine: 30 Capsule In 1 Bottle (16714-758-01),637,RC,16714-758-01,NDC,,,facility,both,1,EA,,5.1,5.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atomoxetine: 30 Capsule In 1 Bottle (16714-759-01),637,RC,16714-759-01,NDC,,,facility,both,1,EA,,5.79,5.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Terbinafine: 30 Tablet In 1 Bottle (16714-795-01),637,RC,16714-795-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sumatriptan: 1 Blister Pack In 1 Carton (16714-797-01) / 9 Tablet In 1 Blister Pack,637,RC,16714-797-01,NDC,,,facility,both,1,EA,,3.5,3.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ezetimibe: 30 Tablet In 1 Bottle (16714-813-01),637,RC,16714-813-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ezetimibe: 90 Tablet In 1 Bottle (16714-813-02),637,RC,16714-813-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Budesonide: 100 Capsule, Coated Pellets In 1 Bottle (16714-829-01)",637,RC,16714-829-01,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paliperidone: 30 Tablet, Extended Release In 1 Bottle (16714-867-01)",637,RC,16714-867-01,NDC,,,facility,both,1,EA,,7.66,7.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Permethrin: 1 Tube In 1 Container (16714-897-01) / 60 G In 1 Tube,637,RC,16714-897-01,NDC,,,facility,both,1,EA,,40.75,40.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-622-01)",637,RC,16714-622-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Capsule In 1 Bottle (16714-661-01),637,RC,16714-661-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Capsule In 1 Bottle (16714-662-01),637,RC,16714-662-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Capsule In 1 Bottle (16714-721-02),637,RC,16714-721-02,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-682-02)",637,RC,16714-682-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 100 Tablet In 1 Bottle (16714-691-02),637,RC,16714-691-02,NDC,,,facility,both,1,EA,,1.71,1.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluconazole: 1 Bottle In 1 Carton (16714-696-01) / 35 Ml In 1 Bottle,637,RC,16714-696-01,NDC,,,facility,both,1,EA,,6.57,6.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluoxetine: 100 Capsule In 1 Bottle (16714-720-02),637,RC,16714-720-02,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 90 Tablet, Film Coated In 1 Bottle (16714-683-02)",637,RC,16714-683-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 Tablet In 1 Bottle (16729-183-01),637,RC,16729-183-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cinacalcet: 90 Tablet, Film Coated In 1 Bottle, Plastic (16729-440-15)",637,RC,16729-440-15,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levothyroxine Sodium: 90 Tablet In 1 Bottle (16729-456-15),637,RC,16729-456-15,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (16729-478-01),637,RC,16729-478-01,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (16729-479-01),637,RC,16729-479-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-989-01)",637,RC,16714-989-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-990-01)",637,RC,16714-990-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (16714-991-01)",637,RC,16714-991-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bicalutamide: 30 Tablet In 1 Bottle (16729-023-10),637,RC,16729-023-10,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Capecitabine: 120 Tablet, Film Coated In 1 Bottle, Plastic (16729-073-29)",637,RC,16729-073-29,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-136-00)",637,RC,16729-136-00,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)",637,RC,16729-136-16,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)",637,RC,16729-136-16,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-137-00)",637,RC,16729-137-00,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-621-01)",637,RC,16714-621-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (16714-035-01)",637,RC,16714-035-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Tablet In 1 Bottle (16714-009-01),637,RC,16714-009-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clopidogrel: 90 Tablet In 1 Bottle (16714-052-02),637,RC,16714-052-02,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (16714-081-10),637,RC,16714-081-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,16714-116-01,NDC,,,facility,both,1,EA,,6,6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,16714-117-01,NDC,,,facility,both,1,EA,,6.41,6.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (16714-142-01),637,RC,16714-142-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mupirocin: 1 Tube In 1 Carton (16714-055-01) / 15 G In 1 Tube,637,RC,16714-055-01,NDC,,,facility,both,1,EA,,273.98,273.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (16714-145-01),637,RC,16714-145-01,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isosorbide Dinitrate: 100 Tablet In 1 Bottle (16714-008-01),637,RC,16714-008-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Tablet, Film Coated In 1 Bottle, Plastic (16252-515-01)",637,RC,16252-515-01,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atorvastatin Calcium: 1000 Tablet In 1 Bottle (16571-137-10),637,RC,16571-137-10,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10),637,RC,16571-401-10,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10),637,RC,16571-401-10,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liothyronine Sodium: 100 Tablet In 1 Bottle (16714-166-01),637,RC,16714-166-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (16714-444-01),637,RC,16714-444-01,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Quetiapine: 1000 Tablet, Film Coated In 1 Bottle (16714-452-02)",637,RC,16714-452-02,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Film Coated, Extended Release In 1 Bottle (16714-485-01)",637,RC,16714-485-01,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan: 1 BLISTER PACK in 1 CARTON (16714-532-11) / 9 TABLET, FILM COATED in 1 BLISTER PACK (16714-532-10) ",637,RC,16714-532-11,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pravastatin Sodium: 90 Tablet In 1 Bottle (16714-559-01),637,RC,16714-559-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Allopurinol: 100 Tablet In 1 Bottle (16714-577-01),637,RC,16714-577-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Digoxin: 100 Tablet In 1 Bottle (16714-590-01),637,RC,16714-590-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 1 Bottle, Plastic In 1 Carton (16714-601-02) / 60 Ml In 1 Bottle, Plastic",637,RC,16714-601-02,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-612-04)",637,RC,16714-612-04,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefuroxime Axetil: 60 Tablet In 1 Bottle (16714-401-02),637,RC,16714-401-02,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liothyronine Sodium: 100 Tablet In 1 Bottle (16714-167-01),637,RC,16714-167-01,NDC,,,facility,both,1,EA,,1.19,1.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,16714-186-01,NDC,,,facility,both,1,EA,,21.58,21.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (16714-234-01)",637,RC,16714-234-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-257-01)",637,RC,16714-257-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Capsule In 1 Bottle (16714-298-01),637,RC,16714-298-01,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Capsule In 1 Bottle (16714-299-03),637,RC,16714-299-03,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefadroxil: 50 Capsule In 1 Bottle (16714-388-01),637,RC,16714-388-01,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefuroxime Axetil: 20 Tablet In 1 Bottle (16714-401-01),637,RC,16714-401-01,NDC,,,facility,both,1,EA,,5.69,5.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sertraline Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (16714-613-05)",637,RC,16714-613-05,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dermoplast Pain Relieving: 85 G In 1 Can (16864-680-03),637,RC,16864-680-03,NDC,,,facility,both,1,EA,,14.69,14.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Guanfacine Hydrochloride: 100 Tablet In 1 Bottle (24979-198-01),637,RC,24979-198-01,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mephyton: 1 BOTTLE in 1 CARTON (25010-405-15) / 100 TABLET in 1 BOTTLE,637,RC,25010-405-15,NDC,,,facility,both,1,EA,,11,11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Entacapone: 100 Tablet In 1 Bottle (27241-049-10),637,RC,27241-049-10,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 90 Capsule, Delayed Release In 1 Bottle (27241-098-09)",637,RC,27241-098-09,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,27241-134-21,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle, Plastic (27808-114-01)",637,RC,27808-114-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Risperidone: 60 Tablet In 1 Bottle (27241-003-06),637,RC,27241-003-06,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Leflunomide: 30 Tablet In 1 Bottle (23155-043-03),637,RC,23155-043-03,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methimazole: 100 Tablet In 1 Bottle (23155-071-01),637,RC,23155-071-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (23155-178-01)",637,RC,23155-178-01,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nifedipine: 100 Capsule In 1 Bottle (23155-194-01),637,RC,23155-194-01,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methimazole: 100 Tablet In 1 Bottle (23155-070-01),637,RC,23155-070-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brimonidine: 1 BOTTLE, DROPPER in 1 CARTON (17478-715-10) / 5 mL in 1 BOTTLE, DROPPER",637,RC,17478-715-10,NDC,,,facility,both,1,EA,,39.25,39.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-833-01),637,RC,23155-833-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-834-01),637,RC,23155-834-01,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Enalapril Maleate: 100 Tablet In 1 Bottle (23155-772-01),637,RC,23155-772-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brimonidine Tartrate: 1 Bottle, Dropper In 1 Carton (24208-411-05) / 5 Ml In 1 Bottle, Dropper",637,RC,24208-411-05,NDC,,,facility,both,1,EA,,36.27,36.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brimonidine Tartrate: 1 Bottle, Dropper In 1 Carton (24208-411-05) / 5 Ml In 1 Bottle, Dropper",637,RC,24208-411-05,NDC,,,facility,both,1,EA,,35.6,35.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (24208-486-10) / 10 Ml In 1 Bottle, Dropper",637,RC,24208-486-10,NDC,,,facility,both,1,EA,,55.47,55.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zirgan: 1 Tube, With Applicator In 1 Carton (24208-535-35) / 5 G In 1 Tube, With Applicator",637,RC,24208-535-35,NDC,,,facility,both,1,EA,,1149.18,1149.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dexamethasone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-720-02) / 5 Ml In 1 Bottle, Dropper",637,RC,24208-720-02,NDC,,,facility,both,1,EA,,109.55,109.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (23155-500-01),637,RC,23155-500-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (23155-501-01),637,RC,23155-501-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glycopyrrolate: 100 Tablet In 1 Bottle (23155-606-01),637,RC,23155-606-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2127-10),637,RC,0228-2127-10,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Propylthiouracil: 100 Tablet In 1 Bottle (0228-2348-10),637,RC,0228-2348-10,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Tablet, Film Coated In 1 Bottle (0228-2637-11)",637,RC,0228-2637-11,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2891-03)",637,RC,0228-2891-03,NDC,,,facility,both,1,EA,,3.66,3.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2892-03)",637,RC,0228-2892-03,NDC,,,facility,both,1,EA,,3.5,3.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pacerone: 100 Blister Pack In 1 Carton (0245-0144-01) / 1 Tablet In 1 Blister Pack (0245-0144-89),637,RC,0245-0144-01,NDC,,,facility,both,1,EA,,1.02,1.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pacerone: 100 Blister Pack In 1 Carton (0245-0147-01) / 1 Tablet In 1 Blister Pack (0245-0147-89),637,RC,0245-0147-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0245-0147-89,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0211-11),637,RC,0245-0211-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Temazepam: 100 Capsule In 1 Bottle (0228-2076-10),637,RC,0228-2076-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 TABLET in 1 BOTTLE (0228-2057-10) ,637,RC,0228-2057-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Brilinta: 10 Blister Pack In 1 Box, Unit-Dose (0186-0777-39) / 10 Tablet In 1 Blister Pack",637,RC,0186-0777-39,NDC,,,facility,both,1,EA,,19.53,19.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mephyton: 1 BOTTLE in 1 CARTON (0187-1704-05) / 100 TABLET in 1 BOTTLE,637,RC,0187-1704-05,NDC,,,facility,both,1,EA,,120.5,120.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0223-1760-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Neo-Synephrine Mild: 15 Ml In 1 Bottle, Spray (0225-0800-47)",637,RC,0225-0800-47,NDC,,,facility,both,1,EA,,9.33,9.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (0228-2027-10),637,RC,0228-2027-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (0228-2031-10),637,RC,0228-2031-10,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0212-11),637,RC,0245-0212-11,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3029-02)",637,RC,0254-3029-02,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0213-11),637,RC,0245-0213-11,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0245-0360-89,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0245-0360-89,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0245-5316-89,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0245-5317-89,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Klor-Con M: 1000 Tablet, Extended Release In 1 Bottle (0245-5319-10)",637,RC,0245-5319-10,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Klor-Con M: 1000 Tablet, Extended Release In 1 Bottle (0245-5319-10)",637,RC,0245-5319-10,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0245-5319-89,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0245-5319-89,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0254-3012-78,NDC,,,facility,both,1,EA,,331.78,331.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methimazole: 100 TABLET in 1 BOTTLE (0185-0210-01) ,637,RC,0185-0210-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (0143-9803-50)",637,RC,0143-9803-50,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (0143-9803-50)",637,RC,0143-9803-50,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (0143-9837-01)",637,RC,0143-9837-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 100 Tablet In 1 Bottle (0172-3926-60),637,RC,0172-3926-60,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 500 Tablet, Film Coated In 1 Bottle (0172-5728-70)",637,RC,0172-5728-70,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1000 Tablet, Film Coated In 1 Bottle (0172-5728-80)",637,RC,0172-5728-80,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "RYTHMOL: 100 TABLET, FILM COATED in 1 BOTTLE (0173-0792-20) ",637,RC,0173-0792-20,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 100 Tablet In 1 Bottle (0172-3925-60),637,RC,0172-3925-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2089-60),637,RC,0172-2089-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0004-15) / 15 G In 1 Tube,637,RC,0168-0004-15,NDC,,,facility,both,1,EA,,6.59,6.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamcinolone Acetonide: 15 G In 1 Tube (0168-0006-15),637,RC,0168-0006-15,NDC,,,facility,both,1,EA,,7.02,7.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10) / 3 Ml In 1 Syringe, Plastic",637,RC,0169-6339-10,NDC,,,facility,both,1,EA,,41.7,41.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11) / 10 Ml In 1 Vial, Glass",637,RC,0169-7501-11,NDC,,,facility,both,1,EA,,184.2,184.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2083-60),637,RC,0172-2083-60,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (0185-0122-01),637,RC,0185-0122-01,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Farxiga: 30 Tablet, Film Coated In 1 Bottle, Plastic (0310-6205-30)",637,RC,0310-6205-30,NDC,,,facility,both,1,EA,,33.93,33.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitro-Bid: 48 Packet In 1 Box (0281-0326-08) / 1 G In 1 Packet,637,RC,0281-0326-08,NDC,,,facility,both,1,EA,,5.61,5.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitro-Bid: 30 G In 1 Tube (0281-0326-30),637,RC,0281-0326-30,NDC,,,facility,both,1,EA,,86.34,86.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitro-Bid: 60 G In 1 Tube (0281-0326-60),637,RC,0281-0326-60,NDC,,,facility,both,1,EA,,181.4,181.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "100 BLISTER PACK in 1 CARTON (0310-0275-39) / 1 TABLET, FILM COATED in 1 BLISTER PACK",637,RC,0310-0275-39,NDC,,,facility,both,1,EA,,5.11,5.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0310-1105-01,NDC,,,facility,both,1,EA,,39.21,39.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0310-1110-01,NDC,,,facility,both,1,EA,,25.24,25.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0310-1110-01,NDC,,,facility,both,1,EA,,22.28,22.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lopressor: 100 TABLET in 1 BOTTLE (0078-0458-05) ,637,RC,0078-0458-05,NDC,,,facility,both,1,EA,,2.42,2.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tegretol: 100 Tablet In 1 Bottle (0078-0509-05),637,RC,0078-0509-05,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Coartem: 24 Tablet In 1 Bottle (0078-0568-45),637,RC,0078-0568-45,NDC,,,facility,both,1,EA,,14.95,14.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0659-20)",637,RC,0078-0659-20,NDC,,,facility,both,1,EA,,29.8,29.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0696-20)",637,RC,0078-0696-20,NDC,,,facility,both,1,EA,,28.32,28.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0777-20)",637,RC,0078-0777-20,NDC,,,facility,both,1,EA,,29.53,29.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-5182-90),637,RC,0074-5182-90,NDC,,,facility,both,1,EA,,4.41,4.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-6594-90),637,RC,0074-6594-90,NDC,,,facility,both,1,EA,,4.19,4.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-6624-11) / 10 Tablet In 1 Blister Pack",637,RC,0074-6624-11,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-6624-90),637,RC,0074-6624-90,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7068-11) / 10 Tablet In 1 Blister Pack",637,RC,0074-7068-11,NDC,,,facility,both,1,EA,,4.14,4.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7069-11) / 10 Tablet In 1 Blister Pack",637,RC,0074-7069-11,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-7069-90),637,RC,0074-7069-90,NDC,,,facility,both,1,EA,,4.02,4.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-7070-90),637,RC,0074-7070-90,NDC,,,facility,both,1,EA,,4.25,4.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7148-11) / 10 Tablet In 1 Blister Pack",637,RC,0074-7148-11,NDC,,,facility,both,1,EA,,4.17,4.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-9296-90),637,RC,0074-9296-90,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sotalol Hydrochloride: 100 Tablet In 1 Bottle (0093-1061-01),637,RC,0093-1061-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cilostazol: 60 Tablet In 1 Bottle (0093-2064-06),637,RC,0093-2064-06,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),637,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01),637,RC,0093-2203-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoclopramide: 100 Tablet In 1 Bottle (0093-2204-01),637,RC,0093-2204-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metoclopramide: 500 Tablet In 1 Bottle (0093-2204-05),637,RC,0093-2204-05,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sucralfate: 100 Tablet In 1 Bottle (0093-2210-01),637,RC,0093-2210-01,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Liothyronine Sodium: 100 Tablet In 1 Bottle (0093-2179-01),637,RC,0093-2179-01,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0812-01),637,RC,0093-0812-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0811-01),637,RC,0093-0811-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0088-2219-01,NDC,,,facility,both,1,EA,,48.76,48.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33) / 10 Ml In 1 Vial, Glass",637,RC,0088-2220-33,NDC,,,facility,both,1,EA,,171.78,171.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33) / 10 Ml In 1 Vial, Glass",637,RC,0088-2220-33,NDC,,,facility,both,1,EA,,161.85,161.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 5 SYRINGE in 1 PACKAGE (0088-5020-05) / 3 mL in 1 SYRINGE (0088-5020-01) ,637,RC,0088-5020-05,NDC,,,facility,both,1,EA,,206.5,206.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lamotrigine: 100 TABLET in 1 BOTTLE (0093-0039-01) ,637,RC,0093-0039-01,NDC,,,facility,both,1,EA,,0.23,0.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-0053-01),637,RC,0093-0053-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0318-01)",637,RC,0093-0318-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0810-01),637,RC,0093-0810-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-5182-11) / 10 Tablet In 1 Blister Pack",637,RC,0074-5182-11,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (0093-2274-34)",637,RC,0093-2274-34,NDC,,,facility,both,1,EA,,3.42,3.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-5182-11) / 10 Tablet In 1 Blister Pack",637,RC,0074-5182-11,NDC,,,facility,both,1,EA,,4.41,4.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vicodin: 500 TABLET in 1 BOTTLE (0074-3041-53) ,637,RC,0074-3041-53,NDC,,,facility,both,1,EA,,8.66,8.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-4341-90),637,RC,0074-4341-90,NDC,,,facility,both,1,EA,,4.11,4.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-4552-11) / 10 Tablet In 1 Blister Pack",637,RC,0074-4552-11,NDC,,,facility,both,1,EA,,4.11,4.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Synthroid: 90 Tablet In 1 Bottle (0074-4552-90),637,RC,0074-4552-90,NDC,,,facility,both,1,EA,,4.01,4.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paxlovid: 10 Blister Pack In 1 Carton (0069-5045-30) / 1 Kit In 1 Blister Pack (0069-5045-06) * 2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02) * 1 Tablet, Film Coated In 1 Blister Pack (0069-1345-11)",637,RC,0069-5045-30,NDC,,,facility,both,1,EA,,132.76,132.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0069-5317-02,NDC,,,facility,both,1,EA,,199.15,199.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paxlovid: 10 Blister Pack In 1 Carton (0069-5317-20) / 1 Kit In 1 Blister Pack (0069-5317-02) * 1 Tablet, Film Coated In 1 Blister Pack (0069-2085-11) * 1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",637,RC,0069-5317-20,NDC,,,facility,both,1,EA,,199.15,199.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0069-5321-03,NDC,,,facility,both,1,EA,,117.2,117.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Paxlovid: 10 Blister Pack In 1 Carton (0069-5321-30) / 1 Kit In 1 Blister Pack (0069-5321-03) * 2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02) * 1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)",637,RC,0069-5321-30,NDC,,,facility,both,1,EA,,120.71,120.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tikosyn: 60 Capsule In 1 Bottle (0069-5810-60),637,RC,0069-5810-60,NDC,,,facility,both,1,EA,,28.17,28.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dilantin: 100 Capsule In 1 Bottle (0071-0369-24),637,RC,0071-0369-24,NDC,,,facility,both,1,EA,,4.08,4.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrostat: 4 Bottle In 1 Carton (0071-0418-13) / 25 Tablet In 1 Bottle,637,RC,0071-0418-13,NDC,,,facility,both,1,EA,,107.64,107.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venclexta: 1 Blister Pack In 1 Carton (0074-0576-11) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0074-0576-11,NDC,,,facility,both,1,EA,,341.65,341.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dicloxacillin Sodium: 100 Capsule In 1 Bottle (0093-3123-01),637,RC,0093-3123-01,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fleet: 12 SUPPOSITORY in 1 JAR (0132-0079-12) ,637,RC,0132-0079-12,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0201-40)",637,RC,0132-0201-40,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vimpat: 6 Blister Pack In 1 Carton (0131-2479-60) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0131-2479-60,NDC,,,facility,both,1,EA,,58.55,58.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-1775-05,NDC,,,facility,both,1,EA,,6.61,6.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Childrens Acetaminophen: 10 Tray In 1 Case (0121-1781-00) / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1781-05)",637,RC,0121-1781-00,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-1870-10,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-4577-15,NDC,,,facility,both,1,EA,,3.87,3.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-4675-05,NDC,,,facility,both,1,EA,,3.47,3.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-4721-05,NDC,,,facility,both,1,EA,,10.44,10.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-4827-05,NDC,,,facility,both,1,EA,,12.98,12.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-4827-05,NDC,,,facility,both,1,EA,,12,12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-4948-15,NDC,,,facility,both,1,EA,,11.15,11.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-4948-15,NDC,,,facility,both,1,EA,,11.07,11.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vimpat: 6 Blister Pack In 1 Carton (0131-2478-60) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0131-2478-60,NDC,,,facility,both,1,EA,,50.26,50.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mag-Al Plus: 10 Tray In 1 Case (0121-1761-30) / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",637,RC,0121-1761-30,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (0093-5907-86)",637,RC,0093-5907-86,NDC,,,facility,both,1,EA,,6.53,6.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pioglitazone: 90 Tablet In 1 Bottle (0093-7272-98),637,RC,0093-7272-98,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-7296-01)",637,RC,0093-7296-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (0093-7704-56)",637,RC,0093-7704-56,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glyburide: 100 Tablet In 1 Bottle (0093-8344-01),637,RC,0093-8344-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (0093-8739-01),637,RC,0093-8739-01,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Good Sense Acid Reducer: 30 Blister Pack In 1 Carton (0113-0141-65) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0113-0141-65,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (0093-7384-98)",637,RC,0093-7384-98,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 100 TABLET, FILM COATED in 1 BOTTLE (0093-5767-01) ",637,RC,0093-5767-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Capsule In 1 Bottle (0093-3147-01),637,RC,0093-3147-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 500 Capsule In 1 Bottle (0093-3147-05),637,RC,0093-3147-05,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-3422-01)",637,RC,0093-3422-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3425-01)",637,RC,0093-3425-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3425-01)",637,RC,0093-3425-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3426-01)",637,RC,0093-3426-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefadroxil: 50 Tablet In 1 Bottle (0093-4059-53),637,RC,0093-4059-53,NDC,,,facility,both,1,EA,,6.43,6.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Penicillin V Potassium: 100 Ml In 1 Bottle (0093-4127-73),637,RC,0093-4127-73,NDC,,,facility,both,1,EA,,1.45,1.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin: 100 Ml In 1 Bottle (0093-4155-73),637,RC,0093-4155-73,NDC,,,facility,both,1,EA,,0.09,0.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Ml In 1 Bottle (0093-4177-73),637,RC,0093-4177-73,NDC,,,facility,both,1,EA,,5.57,5.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0093-5245-19,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Primidone: 100 TABLET in 1 BOTTLE (0115-1030-01) ,637,RC,0115-1030-01,NDC,,,facility,both,1,EA,,0.14,0.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0914-05,NDC,,,facility,both,1,EA,,1.78,1.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0917-05,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0974-10,NDC,,,facility,both,1,EA,,16.59,16.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0974-10,NDC,,,facility,both,1,EA,,16.45,16.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0904-05,NDC,,,facility,both,1,EA,,1.65,1.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-1276-10,NDC,,,facility,both,1,EA,,1.54,1.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-1488-10,NDC,,,facility,both,1,EA,,4.03,4.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-1488-10,NDC,,,facility,both,1,EA,,3.89,3.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0893-15,NDC,,,facility,both,1,EA,,3.34,3.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lactulose: 15 Ml In 1 Cup, Unit-Dose (0116-4005-15)",637,RC,0116-4005-15,NDC,,,facility,both,1,EA,,3.36,3.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Milk Of Magnesia: 10 Tray In 1 Case (0121-0431-30) / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose",637,RC,0121-0431-30,NDC,,,facility,both,1,EA,,3.27,3.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0638-05,NDC,,,facility,both,1,EA,,3.72,3.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0868-05,NDC,,,facility,both,1,EA,,4.57,4.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0121-0868-05,NDC,,,facility,both,1,EA,,4.2,4.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lactulose: 473 Ml In 1 Bottle (0121-0873-16),637,RC,0121-0873-16,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Primidone: 100 TABLET in 1 BOTTLE (0115-1031-01) ,637,RC,0115-1031-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Cal-Gest Antacid Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0536-1007-15)",637,RC,0536-1007-15,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby: 150 Tablet, Chewable In 1 Bottle, Plastic (0536-1048-15)",637,RC,0536-1048-15,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nicotine Transdermal System Step 3: 14 Patch In 1 Carton (0536-1106-88) / 24 H In 1 Patch,637,RC,0536-1106-88,NDC,,,facility,both,1,EA,,4.02,4.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dibucaine Topical Anesthetic 1% Hemorrhoidal: 1 Tube In 1 Box (0536-1211-95) / 28 G In 1 Tube,637,RC,0536-1211-95,NDC,,,facility,both,1,EA,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Cal-Gest Antacid Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0536-1007-15)",637,RC,0536-1007-15,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aspirin Regular Strength: 1 Bottle, Plastic In 1 Carton (0536-1232-01) / 100 Tablet, Delayed Release In 1 Bottle, Plastic",637,RC,0536-1232-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Stomach Relief Regular Strength: 237 Ml In 1 Bottle, Plastic (0536-1286-36)",637,RC,0536-1286-36,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Antacid: 355 Ml In 1 Bottle (0536-1293-83),637,RC,0536-1293-83,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Antacid: 355 Ml In 1 Bottle (0536-1293-83),637,RC,0536-1293-83,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Cherry Flavor: 177 Ml In 1 Bottle, Spray (0536-1228-58)",637,RC,0536-1228-58,NDC,,,facility,both,1,EA,,6.5,6.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0527-1790-01)",637,RC,0527-1790-01,NDC,,,facility,both,1,EA,,7.6,7.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0527-0765-37)",637,RC,0527-0765-37,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pilocarpine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0527-1313-01)",637,RC,0527-1313-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine: 100 Tablet In 1 Bottle, Plastic (0536-1297-01)",637,RC,0536-1297-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linzess: 1 Bottle In 1 Carton (0456-1202-30) / 30 Capsule, Gelatin Coated In 1 Bottle",637,RC,0456-1202-30,NDC,,,facility,both,1,EA,,47.12,47.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linzess: 1 Bottle In 1 Carton (0456-1203-30) / 30 Capsule, Gelatin Coated In 1 Bottle",637,RC,0456-1203-30,NDC,,,facility,both,1,EA,,50.38,50.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lexapro: 100 Tablet, Film Coated In 1 Bottle (0456-2005-01)",637,RC,0456-2005-01,NDC,,,facility,both,1,EA,,6.03,6.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 60 TABLET in 1 BOTTLE (0456-3210-60) ,637,RC,0456-3210-60,NDC,,,facility,both,1,EA,,6.76,6.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linzess: 1 Bottle In 1 Carton (0456-1201-30) / 30 Capsule, Gelatin Coated In 1 Bottle",637,RC,0456-1201-30,NDC,,,facility,both,1,EA,,43.83,43.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Xospata: 1 Bottle In 1 Carton (0469-1425-90) / 90 Tablet In 1 Bottle,637,RC,0469-1425-90,NDC,,,facility,both,1,EA,,845.23,845.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myrbetriq: 1 Bottle In 1 Carton (0469-2601-30) / 30 Tablet, Film Coated, Extended Release In 1 Bottle",637,RC,0469-2601-30,NDC,,,facility,both,1,EA,,37.14,37.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myrbetriq: 1 Bottle In 1 Carton (0469-2601-90) / 90 Tablet, Film Coated, Extended Release In 1 Bottle",637,RC,0469-2601-90,NDC,,,facility,both,1,EA,,40.85,40.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Myrbetriq: 1 Bottle In 1 Carton (0469-2602-30) / 30 Tablet, Film Coated, Extended Release In 1 Bottle",637,RC,0469-2602-30,NDC,,,facility,both,1,EA,,37.23,37.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Viibryd: 30 Tablet In 1 Bottle (0456-1120-30),637,RC,0456-1120-30,NDC,,,facility,both,1,EA,,29.45,29.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dakins Half: 473 Ml In 1 Bottle (0436-0936-16),637,RC,0436-0936-16,NDC,,,facility,both,1,EA,,40.98,40.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Armour Thyroid: 100 Tablet In 1 Bottle (0456-0458-01),637,RC,0456-0458-01,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Viibryd: 30 Tablet In 1 Bottle (0456-1110-30),637,RC,0456-1110-30,NDC,,,facility,both,1,EA,,29.43,29.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Infants: 1 Bottle, Dropper In 1 Carton (0536-1303-75) / 30 Ml In 1 Bottle, Dropper",637,RC,0536-1303-75,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0603-1880-10,NDC,,,facility,both,1,EA,,5.64,5.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0603-1554-10,NDC,,,facility,both,1,EA,,8,8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 473 Ml In 1 Bottle, Plastic (0603-1542-58)",637,RC,0603-1542-58,NDC,,,facility,both,1,EA,,7.09,7.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jardiance: 30 Blister Pack In 1 Carton (0597-0152-37) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0597-0152-37,NDC,,,facility,both,1,EA,,34.55,34.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jardiance: 90 Tablet, Film Coated In 1 Bottle (0597-0152-90)",637,RC,0597-0152-90,NDC,,,facility,both,1,EA,,32.55,32.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Jardiance: 30 Blister Pack In 1 Carton (0597-0153-37) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,0597-0153-37,NDC,,,facility,both,1,EA,,33.33,33.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pradaxa: 60 Blister Pack In 1 Carton (0597-0360-82) / 1 Capsule In 1 Blister Pack,637,RC,0597-0360-82,NDC,,,facility,both,1,EA,,8.22,8.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Magnesium Oxide: 120 Tablet In 1 Bottle (0603-0209-22),637,RC,0603-0209-22,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dicyclomine Hydrochloride: 473 Ml In 1 Bottle, Plastic (0603-1161-58)",637,RC,0603-1161-58,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Iophen C NR: 473 mL in 1 BOTTLE, PLASTIC (0603-1329-58) ",637,RC,0603-1329-58,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nicotine: 14 Pouch In 1 Carton (0536-5896-88) / 1 H In 1 Pouch,637,RC,0536-5896-88,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0033-02),637,RC,0555-0033-02,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0158-02),637,RC,0555-0158-02,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0159-02),637,RC,0555-0159-02,NDC,,,facility,both,1,EA,,0.37,0.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0779-02),637,RC,0555-0779-02,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0872-02),637,RC,0555-0872-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0873-02),637,RC,0555-0873-02,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nicotine: 14 Pouch In 1 Carton (0536-5894-88) / 1 H In 1 Pouch,637,RC,0536-5894-88,NDC,,,facility,both,1,EA,,3.65,3.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Antacid/Antigas: 355 Ml In 1 Bottle (0536-1317-83),637,RC,0536-1317-83,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 100 Tablet In 1 Bottle, Plastic (0536-1327-01)",637,RC,0536-1327-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 100 Tablet In 1 Bottle, Plastic (0536-1327-01)",637,RC,0536-1327-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 1000 Tablet In 1 Bottle, Plastic (0536-1327-10)",637,RC,0536-1327-10,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Regular Strength Acetaminophen: 1000 Tablet In 1 Bottle, Plastic (0536-1327-10)",637,RC,0536-1327-10,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0536-1362-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rugby Polyvinyl Alcohol 1.4% Lubricating Eye Drops: 1 Bottle, Dropper In 1 Box (0536-1408-94) / 15 Ml In 1 Bottle, Dropper",637,RC,0536-1408-94,NDC,,,facility,both,1,EA,,13.88,13.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0536-2506-76,NDC,,,facility,both,1,EA,,3.12,3.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Capsaicin: 1 Tube In 1 Carton (0536-2525-25) / 60 G In 1 Tube,637,RC,0536-2525-25,NDC,,,facility,both,1,EA,,13.92,13.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rugby Muscle Rub Cream: 1 Tube In 1 Carton (0536-1349-57) / 85 G In 1 Tube,637,RC,0536-1349-57,NDC,,,facility,both,1,EA,,6.63,6.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Estradiol: 100 Tablet In 1 Bottle (0555-0886-02),637,RC,0555-0886-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Estradiol: 100 Tablet In 1 Bottle (0555-0887-02),637,RC,0555-0887-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrochlorothiazide: 100 Capsule, Gelatin Coated In 1 Bottle (0591-0347-01)",637,RC,0591-0347-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle, Plastic (0591-0348-01)",637,RC,0591-0348-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Verapamil Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0404-01)",637,RC,0591-0404-01,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0591-2312-45,NDC,,,facility,both,1,EA,,301.35,301.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tamoxifen Citrate: 90 Tablet In 1 Bottle, Plastic (0591-2473-19)",637,RC,0591-2473-19,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Budesonide: 1 Bottle In 1 Carton (0574-9855-10) / 100 Capsule In 1 Bottle,637,RC,0574-9855-10,NDC,,,facility,both,1,EA,,2.39,2.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0591-3525-11,NDC,,,facility,both,1,EA,,3.9,3.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Sr: 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0591-3541-60)",637,RC,0591-3541-60,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desvenlafaxine: 30 Tablet, Extended Release In 1 Bottle (0591-3659-30)",637,RC,0591-3659-30,NDC,,,facility,both,1,EA,,2.47,2.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Probenecid: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-5347-01)",637,RC,0591-5347-01,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Allopurinol: 100 Tablet In 1 Bottle, Plastic (0591-5543-01)",637,RC,0591-5543-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0591-2679-11,NDC,,,facility,both,1,EA,,3.75,3.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Compro: 12 Packet In 1 Carton (0574-7226-12) / 1 Suppository In 1 Packet,637,RC,0574-7226-12,NDC,,,facility,both,1,EA,,16.88,16.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0555-0973-02)",637,RC,0555-0973-02,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fludrocortisone Acetate: 100 Tablet In 1 Bottle (0555-0997-02),637,RC,0555-0997-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Preparation H: 12 Blister Pack In 1 Carton (0573-2883-11) / 1 Suppository In 1 Blister Pack,637,RC,0573-2883-11,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amiloride Hydrochloride: 100 Tablet In 1 Bottle (0574-0292-01),637,RC,0574-0292-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Actidose Aqua: 120 Ml In 1 Tube (0574-0521-74),637,RC,0574-0521-74,NDC,,,facility,both,1,EA,,27.98,27.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aspirin: 12 Packet In 1 Carton (0574-7034-12) / 1 Suppository In 1 Packet,637,RC,0574-7034-12,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12) / 1 Suppository In 1 Blister Pack,637,RC,0574-7050-12,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12) / 1 Suppository In 1 Blister Pack,637,RC,0574-7050-12,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),637,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),637,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Tablet In 1 Blister Pack (0406-0552-62),637,RC,0406-0552-62,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 100 Tablet In 1 Blister Pack (0406-0552-62),637,RC,0406-0552-62,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (0406-1236-01),637,RC,0406-1236-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23),637,RC,0406-0552-23,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01),637,RC,0406-3243-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01),637,RC,0406-3243-01,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01),637,RC,0406-3244-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01),637,RC,0406-3244-01,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5755-23),637,RC,0406-5755-23,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5771-23),637,RC,0406-5771-23,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)",637,RC,0406-0527-10,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Buprenorphine And Naloxone: 30 Pouch In 1 Carton (0378-8767-93) / 1 Film In 1 Pouch (0378-8767-16),637,RC,0378-8767-93,NDC,,,facility,both,1,EA,,5.76,5.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0378-9070-16,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0378-9104-16,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0378-9119-16,NDC,,,facility,both,1,EA,,32.04,32.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0378-9121-16,NDC,,,facility,both,1,EA,,15.18,15.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0378-9125-16,NDC,,,facility,both,1,EA,,102.76,102.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle (0406-0376-01),637,RC,0406-0376-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocodone Bitartrate And Acetaminophen: 100 Tablet In 1 Bottle (0406-0376-01),637,RC,0406-0376-01,NDC,,,facility,both,1,EA,,0.8,0.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8315-23)",637,RC,0406-8315-23,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8330-23)",637,RC,0406-8330-23,NDC,,,facility,both,1,EA,,2.31,2.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9112-76) / 1 Patch In 1 Pouch / 72 H In 1 Patch,637,RC,0406-9112-76,NDC,,,facility,both,1,EA,,39.32,39.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9125-76) / 1 Patch In 1 Pouch / 72 H In 1 Patch,637,RC,0406-9125-76,NDC,,,facility,both,1,EA,,17.69,17.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9150-76) / 1 Patch In 1 Pouch / 72 H In 1 Patch,637,RC,0406-9150-76,NDC,,,facility,both,1,EA,,32.7,32.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesalamine: 120 Capsule, Extended Release In 1 Bottle, Plastic (0378-1375-78)",637,RC,0378-1375-78,NDC,,,facility,both,1,EA,,9.27,9.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-3632-01)",637,RC,0378-3632-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valsartan: 90 Tablet, Film Coated In 1 Bottle, Plastic (0378-5814-77)",637,RC,0378-5814-77,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Citalopram: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-6232-01)",637,RC,0378-6232-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Celecoxib: 100 CAPSULE in 1 BOTTLE, PLASTIC (0378-7150-01) ",637,RC,0378-7150-01,NDC,,,facility,both,1,EA,,4.1,4.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-3635-01)",637,RC,0378-3635-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Buspirone Hydrochloride: 60 Tablet In 1 Bottle, Plastic (0378-1175-91)",637,RC,0378-1175-91,NDC,,,facility,both,1,EA,,3.53,3.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-01)",637,RC,0378-0018-01,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 500 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-05)",637,RC,0378-0018-05,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0032-01)",637,RC,0378-0032-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa And Levodopa: 100 Tablet, Extended Release In 1 Bottle, Plastic (0378-0088-01)",637,RC,0378-0088-01,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Allopurinol: 100 Tablet In 1 Bottle (0378-0181-01),637,RC,0378-0181-01,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Propranolol Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-0182-01)",637,RC,0378-0182-01,NDC,,,facility,both,1,EA,,0.15,0.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamoxifen Citrate: 30 Tablet In 1 Bottle (0378-0274-93),637,RC,0378-0274-93,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0378-0873-16,NDC,,,facility,both,1,EA,,72.31,72.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Buspirone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-1145-01)",637,RC,0378-1145-01,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50111-398-01),637,RC,50111-398-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-457-30)",637,RC,66993-457-30,NDC,,,facility,both,1,EA,,31.25,31.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (66685-1002-2)",637,RC,66685-1002-2,NDC,,,facility,both,1,EA,,2.3,2.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insta-Char Aqueous Cherry: 120 Ml In 1 Bottle, Plastic (66689-202-04)",637,RC,66689-202-04,NDC,,,facility,both,1,EA,,58.59,58.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycodone Hydrochloride: 5 Tray In 1 Case (66689-401-50) / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (66689-401-01)",637,RC,66689-401-50,NDC,,,facility,both,1,EA,,2.56,2.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Silver Sulfadiazine: 50 G In 1 Jar (67877-124-50),637,RC,67877-124-50,NDC,,,facility,both,1,EA,,37.68,37.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (67877-197-90),637,RC,67877-197-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (67877-198-90),637,RC,67877-198-90,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Betadine Solution: 14.8 Ml In 1 Bottle (67618-150-05),637,RC,67618-150-05,NDC,,,facility,both,1,EA,,2.92,2.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Linezolid: 1 Blister Pack In 1 Carton (67877-419-33) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,67877-419-33,NDC,,,facility,both,1,EA,,7.46,7.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 90 Tablet, Film Coated In 1 Bottle (65862-149-90)",637,RC,65862-149-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Hydrochloride: 100 Capsule In 1 Bottle (65862-185-01),637,RC,65862-185-01,NDC,,,facility,both,1,EA,,0.24,0.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefdinir: 1 Bottle In 1 Carton (65862-218-01) / 100 Ml In 1 Bottle,637,RC,65862-218-01,NDC,,,facility,both,1,EA,,7.62,7.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (65862-296-90)",637,RC,65862-296-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clopidogrel: 90 Tablet, Film Coated In 1 Bottle (65862-357-90)",637,RC,65862-357-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-419-01),637,RC,65862-419-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sulfamethoxazole And Trimethoprim: 473 Ml In 1 Bottle (65862-496-47),637,RC,65862-496-47,NDC,,,facility,both,1,EA,,3.52,3.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Escitalopram: 100 Tablet, Film Coated In 1 Bottle (65862-373-01)",637,RC,65862-373-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Tablet, Film Coated In 1 Bottle (65862-076-01)",637,RC,65862-076-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diphenhydramine Hydrochloride And Lidocaine Hydrochloride And Aluminum Hydroxide And Magnesium Hydro: 1 Kit In 1 Container (65628-050-04) * 118 Ml In 1 Bottle, Plastic * .1 G In 1 Bottle, Glass * .8 G In 1 Bottle, Glass",637,RC,65628-050-04,NDC,,,facility,both,1,EA,,15.25,15.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Xifaxan: 6 Blister Pack In 1 Carton (65649-303-03) / 10 Tablet In 1 Blister Pack,637,RC,65649-303-03,NDC,,,facility,both,1,EA,,144.94,144.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Capsule In 1 Bottle (65862-018-01),637,RC,65862-018-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cephalexin: 100 Capsule In 1 Bottle (65862-019-01),637,RC,65862-019-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 5 Blister Pack In 1 Carton (65862-021-06) / 6 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,65862-021-06,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Abacavir: 60 Tablet, Film Coated In 1 Bottle (65862-073-60)",637,RC,65862-073-60,NDC,,,facility,both,1,EA,,4.62,4.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (65862-503-01)",637,RC,65862-503-01,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (65862-528-90)",637,RC,65862-528-90,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (65862-908-01),637,RC,65862-908-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (65862-909-01),637,RC,65862-909-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65862-921-27)",637,RC,65862-921-27,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Finasteride: 30 Tablet, Film Coated In 1 Bottle (65862-927-30)",637,RC,65862-927-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,65862-930-08,NDC,,,facility,both,1,EA,,3.66,3.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,66553-002-01,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,66553-004-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,66553-004-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,66553-008-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (65862-908-01),637,RC,65862-908-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,65862-898-28,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Levofloxacin: 50 Tablet, Film Coated In 1 Bottle (65862-536-50)",637,RC,65862-536-50,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-559-90)",637,RC,65862-559-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-560-90)",637,RC,65862-560-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Montelukast Sodium: 90 Tablet, Film Coated In 1 Bottle (65862-574-90)",637,RC,65862-574-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Montelukast Sodium: 90 Tablet, Film Coated In 1 Bottle (65862-574-90)",637,RC,65862-574-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamsulosin Hydrochloride: 100 Capsule In 1 Bottle (65862-598-01),637,RC,65862-598-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-603-30)",637,RC,65862-603-30,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 30 Tablet In 1 Bottle (65862-664-30),637,RC,65862-664-30,NDC,,,facility,both,1,EA,,0.82,0.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Valganciclovir Hydrochloride: 60 Tablet In 1 Bottle (65862-753-60),637,RC,65862-753-60,NDC,,,facility,both,1,EA,,7.69,7.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-755-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-775-95,NDC,,,facility,both,1,EA,,2.19,2.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-776-11,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-782-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-753-95,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-808-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 80 Blister Pack In 1 Box, Unit-Dose (68084-813-09) / 1 Tablet, Delayed Release In 1 Blister Pack (68084-813-11)",637,RC,68084-813-09,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-843-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-844-11,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-854-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-856-11,NDC,,,facility,both,1,EA,,1.93,1.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (68084-753-25) / 1 Tablet, Film Coated In 1 Blister Pack (68084-753-95)",637,RC,68084-753-25,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-683-11,NDC,,,facility,both,1,EA,,3.66,3.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-697-11,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-698-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-708-95,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-713-11,NDC,,,facility,both,1,EA,,0.95,0.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-722-11,NDC,,,facility,both,1,EA,,29.23,29.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-729-11,NDC,,,facility,both,1,EA,,7.79,7.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-735-11,NDC,,,facility,both,1,EA,,4.88,4.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-896-95,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ethambutol Hydrochloride: 100 Tablet In 1 Bottle (68180-280-01),637,RC,68180-280-01,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 60 Capsule, Delayed Release In 1 Bottle (68180-294-07)",637,RC,68180-294-07,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 30 Capsule, Delayed Release In 1 Bottle (68180-295-06)",637,RC,68180-295-06,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine: 90 Capsule, Delayed Release In 1 Bottle (68180-296-09)",637,RC,68180-296-09,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Bupropion Hydrochloride Xl: 90 Tablet, Extended Release In 1 Bottle (68180-319-09)",637,RC,68180-319-09,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Losartan Potassium: 90 Tablet In 1 Bottle (68180-377-09),637,RC,68180-377-09,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline: 60 Ml In 1 Bottle (68180-657-01),637,RC,68180-657-01,NDC,,,facility,both,1,EA,,8.75,8.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rifampin: 30 Capsule In 1 Bottle (68180-658-06),637,RC,68180-658-06,NDC,,,facility,both,1,EA,,1.52,1.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Levothyroxine Sodium: 90 Tablet In 1 Bottle (68180-966-09),637,RC,68180-966-09,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Tablet In 1 Bottle (68180-980-01),637,RC,68180-980-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirabegron: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-152-06)",637,RC,68180-152-06,NDC,,,facility,both,1,EA,,28.24,28.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diazepam: 3 Tray In 1 Case (68094-750-62) / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (68094-750-59)",637,RC,68094-750-62,NDC,,,facility,both,1,EA,,3.72,3.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-964-95,NDC,,,facility,both,1,EA,,5.6,5.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-996-11,NDC,,,facility,both,1,EA,,3.04,3.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68094-001-59,NDC,,,facility,both,1,EA,,2.16,2.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68094-034-59,NDC,,,facility,both,1,EA,,4.6,4.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68094-231-59,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68094-330-59,NDC,,,facility,both,1,EA,,2.95,2.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68094-330-59,NDC,,,facility,both,1,EA,,2.4,2.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68094-494-59,NDC,,,facility,both,1,EA,,1.44,1.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68094-750-59,NDC,,,facility,both,1,EA,,6.73,6.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-640-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-202-11,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-214-11,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-214-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-215-11,NDC,,,facility,both,1,EA,,4.66,4.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-248-11,NDC,,,facility,both,1,EA,,0.75,0.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-248-11,NDC,,,facility,both,1,EA,,0.74,0.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-269-11,NDC,,,facility,both,1,EA,,3.77,3.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-282-11,NDC,,,facility,both,1,EA,,1.87,1.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-288-11,NDC,,,facility,both,1,EA,,2.11,2.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-109-11,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Colchicine: 100 Tablet In 1 Bottle (67877-589-01),637,RC,67877-589-01,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lacosamide Oral Solution: 200 Ml In 1 Bottle (67877-732-95),637,RC,67877-732-95,NDC,,,facility,both,1,EA,,4.04,4.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-040-11,NDC,,,facility,both,1,EA,,4.83,4.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-046-11,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-097-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-098-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-099-11,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-021-11,NDC,,,facility,both,1,EA,,17.08,17.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-299-11,NDC,,,facility,both,1,EA,,0.87,0.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-479-11,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-494-11,NDC,,,facility,both,1,EA,,1.98,1.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-511-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-512-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-536-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-598-11,NDC,,,facility,both,1,EA,,4.7,4.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-603-11,NDC,,,facility,both,1,EA,,5.86,5.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-618-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-621-11,NDC,,,facility,both,1,EA,,21.41,21.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-313-11,NDC,,,facility,both,1,EA,,1.61,1.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-342-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-343-11,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-344-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 100 Blister Pack In 1 Box, Unit-Dose (68084-346-01) / 1 Tablet, Film Coated In 1 Blister Pack (68084-346-11)",637,RC,68084-346-01,NDC,,,facility,both,1,EA,,1,1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-346-11,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-347-11,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-354-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-381-11,NDC,,,facility,both,1,EA,,1.04,1.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-388-11,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-389-11,NDC,,,facility,both,1,EA,,1.39,1.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-411-11,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68084-636-95,NDC,,,facility,both,1,EA,,7.25,7.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Proctozone-Hc: 1 Tube In 1 Carton (63629-8847-1) / 30 G In 1 Tube,637,RC,63629-8847-1,NDC,,,facility,both,1,EA,,40.29,40.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pravastatin Sodium: 90 Tablet In 1 Bottle (63629-8910-1),637,RC,63629-8910-1,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Provigil: 30 Tablet In 1 Bottle (63459-101-30),637,RC,63459-101-30,NDC,,,facility,both,1,EA,,33.82,33.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,63323-377-00,NDC,,,facility,both,1,EA,,24.43,24.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbidopa and Levodopa: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-047-10) / 10 TABLET in 1 BLISTER PACK",637,RC,63739-047-10,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-664-01)",637,RC,64896-664-01,NDC,,,facility,both,1,EA,,12.7,12.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Proctozone-Hc: 1 Tube In 1 Carton (64980-324-30) / 30 G In 1 Tube,637,RC,64980-324-30,NDC,,,facility,both,1,EA,,49.72,49.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clindamycin Palmitate Hydrochloride (Pediatric): 100 Ml In 1 Bottle (64980-511-10),637,RC,64980-511-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sodium Bicarbonate: 1000 Tablet In 1 Bottle (64980-528-10),637,RC,64980-528-10,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-024-09),637,RC,65162-024-09,NDC,,,facility,both,1,EA,,6.96,6.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 100 Capsule In 1 Bottle (65162-102-10),637,RC,65162-102-10,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-663-01)",637,RC,64896-663-01,NDC,,,facility,both,1,EA,,10.35,10.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-883-04)",637,RC,64380-883-04,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrocortisone: 100 Tablet In 1 Bottle, Plastic (64380-971-06)",637,RC,64380-971-06,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Colcrys: 100 Tablet, Film Coated In 1 Bottle, Plastic (64764-119-01)",637,RC,64764-119-01,NDC,,,facility,both,1,EA,,6.29,6.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-662-01)",637,RC,64896-662-01,NDC,,,facility,both,1,EA,,10.12,10.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-730-30)",637,RC,64764-730-30,NDC,,,facility,both,1,EA,,42.57,42.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (64850-511-01)",637,RC,64850-511-01,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-661-01)",637,RC,64896-661-01,NDC,,,facility,both,1,EA,,10.06,10.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naproxen: 100 Tablet In 1 Bottle (65162-188-10),637,RC,65162-188-10,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 90 Tablet In 1 Bottle (65162-896-09),637,RC,65162-896-09,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 90 Tablet In 1 Bottle (65162-898-09),637,RC,65162-898-09,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ad First Aid Multipurpose: 1 Tube In 1 Box (65197-400-10) / 42.5 G In 1 Tube,637,RC,65197-400-10,NDC,,,facility,both,1,EA,,6.7,6.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ad Prevent Original: 1 Tube In 1 Box (65197-401-01) / 113 G In 1 Tube,637,RC,65197-401-01,NDC,,,facility,both,1,EA,,5.84,5.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-880-03)",637,RC,65162-880-03,NDC,,,facility,both,1,EA,,1.62,1.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lubiprostone: 60 Capsule In 1 Bottle (65162-841-06),637,RC,65162-841-06,NDC,,,facility,both,1,EA,,2.43,2.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Tablet In 1 Bottle (65162-464-10),637,RC,65162-464-10,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10),637,RC,65162-465-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10),637,RC,65162-465-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-681-10),637,RC,65162-681-10,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-682-10),637,RC,65162-682-10,NDC,,,facility,both,1,EA,,0.97,0.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-682-10),637,RC,65162-682-10,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Colchicine: 30 Tablet In 1 Bottle (65162-710-03),637,RC,65162-710-03,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Budesonide: 100 Capsule, Delayed Release In 1 Bottle (65162-778-10)",637,RC,65162-778-10,NDC,,,facility,both,1,EA,,5.57,5.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,65162-791-04,NDC,,,facility,both,1,EA,,4.87,4.87,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine: 30 Pouch In 1 Carton (65162-791-08) / 1 Patch In 1 Pouch (65162-791-04),637,RC,65162-791-08,NDC,,,facility,both,1,EA,,5.73,5.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-799-01),637,RC,64380-799-01,NDC,,,facility,both,1,EA,,4.48,4.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-797-01),637,RC,64380-797-01,NDC,,,facility,both,1,EA,,2.91,2.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aripiprazole: 100 TABLET in 1 BOTTLE (63739-413-10) ,637,RC,63739-413-10,NDC,,,facility,both,1,EA,,50.27,50.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-483-10) / 10 Tablet In 1 Blister Pack",637,RC,63739-483-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-486-10) / 10 Tablet In 1 Blister Pack",637,RC,63739-486-10,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pantoprazole Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-564-10) / 10 Tablet, Delayed Release In 1 Blister Pack",637,RC,63739-564-10,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10) / 10 Capsule In 1 Blister Pack",637,RC,63739-567-10,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-571-10) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,63739-571-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10) / 10 Tablet In 1 Blister Pack",637,RC,63739-544-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,63739-354-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-328-10) / 10 Tablet In 1 Blister Pack,637,RC,63739-328-10,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amiodarone Hydrochloride: 10 Blister Pack In 1 Box (63739-051-10) / 10 Tablet In 1 Blister Pack,637,RC,63739-051-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diazepam: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-073-10) / 10 TABLET in 1 BLISTER PACK",637,RC,63739-073-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valacyclovir: 10 Blister Pack In 1 Box, Unit-Dose (63739-077-10) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,63739-077-10,NDC,,,facility,both,1,EA,,2.15,2.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,63739-159-77,NDC,,,facility,both,1,EA,,1.97,1.97,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sky Peg3350: 30 Pouch In 1 Carton (63739-198-61) / 17 G In 1 Pouch (63739-198-62),637,RC,63739-198-61,NDC,,,facility,both,1,EA,,2.05,2.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Low Dose Aspirin: 30 Blister Pack In 1 Box (63739-212-02) / 10 Tablet, Coated In 1 Blister Pack",637,RC,63739-212-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,63739-225-10,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clonazepam: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-263-10) / 10 TABLET in 1 BLISTER PACK",637,RC,63739-263-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-327-10) / 10 Tablet In 1 Blister Pack,637,RC,63739-327-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10) / 10 Tablet In 1 Blister Pack",637,RC,63739-645-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisinopril: 100 Tablet In 1 Bottle (68180-981-01),637,RC,68180-981-01,NDC,,,facility,both,1,EA,,0.43,0.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10) / 10 Tablet In 1 Blister Pack",637,RC,63739-645-10,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mucinex: 500 Tablet, Extended Release In 1 Bottle (63824-008-50)",637,RC,63824-008-50,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Calcitriol: 100 Capsule In 1 Container (64380-723-06),637,RC,64380-723-06,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vitamin D: 100 Capsule In 1 Bottle, Plastic (64380-737-06)",637,RC,64380-737-06,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losortan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-673-10) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,63739-673-10,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ibuprofen: 25 BLISTER PACK in 1 BOX (63739-684-01) / 30 TABLET in 1 BLISTER PACK,637,RC,63739-684-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Losartan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-686-10) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,63739-686-10,NDC,,,facility,both,1,EA,,1.26,1.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,63739-724-01,NDC,,,facility,both,1,EA,,15.43,15.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 10 Blister Pack In 1 Carton (63739-902-10) / 10 Capsule In 1 Blister Pack,637,RC,63739-902-10,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 10 Blister Pack In 1 Carton (63739-903-10) / 10 Capsule In 1 Blister Pack,637,RC,63739-903-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10) / 10 Capsule In 1 Blister Pack,637,RC,63739-904-10,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-972-10) / 10 Tablet, Extended Release In 1 Blister Pack",637,RC,63739-972-10,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-973-10) / 10 Tablet, Extended Release In 1 Blister Pack",637,RC,63739-973-10,NDC,,,facility,both,1,EA,,1.68,1.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,63739-976-01,NDC,,,facility,both,1,EA,,2.33,2.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-984-10) / 10 CAPSULE in 1 BLISTER PACK",637,RC,63739-984-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Atovaquone: 1 Bottle In 1 Carton (72603-248-01) / 210 Ml In 1 Bottle,637,RC,72603-248-01,NDC,,,facility,both,1,EA,,3.32,3.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Clobetasol Propionate Cream Usp, 0.05% Clobetasol Propionate Cream Usp, 0.05%: 15 G In 1 Tube (72603-323-01)",637,RC,72603-323-01,NDC,,,facility,both,1,EA,,13.99,13.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nurtec Odt: 1 Blister Pack In 1 Carton (72618-3000-2) / 8 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,72618-3000-2,NDC,,,facility,both,1,EA,,342.47,342.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Baclofen: 100 Tablet In 1 Bottle (72888-009-01),637,RC,72888-009-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (72888-014-01)",637,RC,72888-014-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,72888-024-06,NDC,,,facility,both,1,EA,,3.02,3.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 500 Tablet, Extended Release In 1 Bottle (72516-030-50)",637,RC,72516-030-50,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Memantine: 500 Tablet In 1 Bottle (72603-119-02),637,RC,72603-119-02,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Spironolactone: 100 Tablet In 1 Bottle (72603-134-01),637,RC,72603-134-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 500 Tablet, Film Coated, Extended Release In 1 Bottle (72603-142-02)",637,RC,72603-142-02,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,72888-024-06,NDC,,,facility,both,1,EA,,2.99,2.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15) / 3 Ml In 1 Syringe, Plastic (73070-103-10)",637,RC,73070-103-15,NDC,,,facility,both,1,EA,,78.27,78.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,73070-103-10,NDC,,,facility,both,1,EA,,64.58,64.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Viokace: 1 Bottle In 1 Carton (73562-104-10) / 100 Tablet In 1 Bottle,637,RC,73562-104-10,NDC,,,facility,both,1,EA,,10.76,10.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-110-01)",637,RC,73562-110-01,NDC,,,facility,both,1,EA,,11.79,11.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11) / 10 Ml In 1 Vial, Glass",637,RC,73070-100-11,NDC,,,facility,both,1,EA,,0.1,0.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11) / 10 Ml In 1 Vial, Glass",637,RC,73070-100-11,NDC,,,facility,both,1,EA,,0.2,0.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-034-01)",637,RC,72888-034-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-035-01)",637,RC,72888-035-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26),637,RC,72888-125-26,NDC,,,facility,both,1,EA,,2.2,2.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26),637,RC,72888-125-26,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 Tablet In 1 Bottle (72888-178-30),637,RC,72888-178-30,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Medpura Vitamin A And D Vitamin A And D: 113 G In 1 Tube (71399-0122-4),637,RC,71399-0122-4,NDC,,,facility,both,1,EA,,3.24,3.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (72205-011-90),637,RC,72205-011-90,NDC,,,facility,both,1,EA,,0.17,0.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (72205-012-90),637,RC,72205-012-90,NDC,,,facility,both,1,EA,,0.34,0.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Febuxostat: 30 Tablet, Film Coated In 1 Bottle (72205-028-30)",637,RC,72205-028-30,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dofetilide: 60 Capsule In 1 Bottle (72205-039-60),637,RC,72205-039-60,NDC,,,facility,both,1,EA,,0.65,0.65,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-042-11) / 10 Capsule In 1 Blister Pack,637,RC,72205-042-11,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Albendazole: 2 Tablet In 1 Bottle (72205-051-08),637,RC,72205-051-08,NDC,,,facility,both,1,EA,,62.12,62.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (72241-023-05),637,RC,72241-023-05,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (72241-024-05),637,RC,72241-024-05,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lidocaine 5%: 30 Pouch In 1 Package (82347-0505-5) / 14 G In 1 Pouch (82347-0505-4),637,RC,82347-0505-5,NDC,,,facility,both,1,EA,,5.51,5.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,81033-220-15,NDC,,,facility,both,1,EA,,8.47,8.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,81033-412-15,NDC,,,facility,both,1,EA,,6.06,6.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-116-01)",637,RC,73562-116-01,NDC,,,facility,both,1,EA,,26.09,26.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenobarbital: 100 Tablet In 1 Bottle, Plastic (75826-138-10)",637,RC,75826-138-10,NDC,,,facility,both,1,EA,,0.26,0.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-159-01),637,RC,75834-159-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nivagen Zinc Oxide: 28.4 G In 1 Tube (75834-170-01),637,RC,75834-170-01,NDC,,,facility,both,1,EA,,8.62,8.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (75907-069-01)",637,RC,75907-069-01,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nadolol: 100 Tablet In 1 Bottle (76385-134-01),637,RC,76385-134-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,77333-031-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,77333-812-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,77333-812-25,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,77333-827-25,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nadolol: 100 Tablet In 1 Bottle (76385-133-01),637,RC,76385-133-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,77333-844-25,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)",637,RC,69315-306-15,NDC,,,facility,both,1,EA,,20.64,20.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Procto-Med Hc: 1 Tube In 1 Carton (69315-312-28) / 28 G In 1 Tube,637,RC,69315-312-28,NDC,,,facility,both,1,EA,,73.03,73.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lorazepam: 100 Tablet In 1 Bottle (69315-904-01),637,RC,69315-904-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dash Chlorhexidine Gluconate 0.12% Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (69339-138-15)",637,RC,69339-138-15,NDC,,,facility,both,1,EA,,2.69,2.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nifedipine: 100 Capsule In 1 Bottle, Plastic (69315-211-01)",637,RC,69315-211-01,NDC,,,facility,both,1,EA,,1.06,1.06,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Capsule In 1 Bottle (69367-302-01),637,RC,69367-302-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valproic Acid: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-150-20)",637,RC,69452-150-20,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,69452-156-74,NDC,,,facility,both,1,EA,,1.86,1.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (69452-206-20)",637,RC,69452-206-20,NDC,,,facility,both,1,EA,,3.81,3.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,69339-174-02,NDC,,,facility,both,1,EA,,1.01,1.01,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Naproxen: 100 Tablet In 1 Bottle (69097-853-07),637,RC,69097-853-07,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phytonadione: 30 Tablet In 1 Bottle (69097-999-02),637,RC,69097-999-02,NDC,,,facility,both,1,EA,,16.56,16.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Famotidine: 1 Bottle In 1 Carton (69230-326-01) / 100 Tablet, Film Coated In 1 Bottle",637,RC,69230-326-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Benztropine Mesylate: 100 Tablet In 1 Bottle (69315-138-01),637,RC,69315-138-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Doxycycline Hyclate: 50 Capsule In 1 Bottle (69238-1100-2),637,RC,69238-1100-2,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methylergonovine Maleate: 28 Tablet In 1 Bottle (69238-1605-8),637,RC,69238-1605-8,NDC,,,facility,both,1,EA,,31.95,31.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Nitrofurantoin: 1 Bottle, Glass In 1 Carton (69238-2512-9) / 230 Ml In 1 Bottle, Glass",637,RC,69238-2512-9,NDC,,,facility,both,1,EA,,91.35,91.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Imipramine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69315-134-01)",637,RC,69315-134-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Imipramine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69315-135-01)",637,RC,69315-135-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-5) / 15 G In 1 Tube,637,RC,69238-1532-5,NDC,,,facility,both,1,EA,,10.91,10.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)",637,RC,70010-135-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)",637,RC,70010-135-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 100 Tablet In 1 Bottle (70010-162-01),637,RC,70010-162-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cetirizine Hydrochloride: 90 Tablet, Coated In 1 Bottle (70010-163-09)",637,RC,70010-163-09,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-491-01)",637,RC,70010-491-01,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle In 1 Carton (70069-051-01) / 10 Ml In 1 Bottle,637,RC,70069-051-01,NDC,,,facility,both,1,EA,,4.78,4.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01) / 5 Ml In 1 Bottle,637,RC,70069-231-01,NDC,,,facility,both,1,EA,,11.73,11.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metformin Hydrochloride: 100 Tablet In 1 Bottle (70010-063-01),637,RC,70010-063-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Plan B One-Step: 1 Blister Pack In 1 Box, Unit-Dose (69536-162-88) / 1 Tablet In 1 Blister Pack",637,RC,69536-162-88,NDC,,,facility,both,1,EA,,89.59,89.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine Hcl 12.5 Mg: 100 Tablet In 1 Bottle, Plastic (69618-027-01)",637,RC,69618-027-01,NDC,,,facility,both,1,EA,,0.38,0.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 Tablet In 1 Bottle (69918-301-30),637,RC,69918-301-30,NDC,,,facility,both,1,EA,,5.05,5.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-254-01)",637,RC,68462-254-01,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (68462-264-30)",637,RC,68462-264-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-292-01)",637,RC,68462-292-01,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-293-01)",637,RC,68462-293-01,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lithium Carbonate Er: 100 Tablet In 1 Bottle (68462-224-01),637,RC,68462-224-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Norethindrone Acetate: 50 Tablet In 1 Bottle (68462-304-50),637,RC,68462-304-50,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sevelamer Hydrochloride: 360 Tablet, Film Coated In 1 Bottle (68462-446-26)",637,RC,68462-446-26,NDC,,,facility,both,1,EA,,6.99,6.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-092-01)",637,RC,68382-092-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (68382-121-16),637,RC,68382-121-16,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (68382-537-01)",637,RC,68382-537-01,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68382-771-30,NDC,,,facility,both,1,EA,,7.83,7.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 500 Tablet In 1 Bottle (68382-805-05),637,RC,68382-805-05,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle (68382-856-01),637,RC,68382-856-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68382-772-30,NDC,,,facility,both,1,EA,,12.24,12.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68462-639-25,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,68968-3450-1,NDC,,,facility,both,1,EA,,18.74,18.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amoxicillin And Clavulanate Potassium: 100 Ml In 1 Bottle (69097-098-44),637,RC,69097-098-44,NDC,,,facility,both,1,EA,,13.19,13.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Amlodipine Besylate: 90 Tablet In 1 Bottle (69097-128-05),637,RC,69097-128-05,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01) / 5 Ml In 1 Bottle,637,RC,70069-231-01,NDC,,,facility,both,1,EA,,11.11,11.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxybutynin Chloride: 100 Tablet In 1 Bottle (70954-005-10),637,RC,70954-005-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Dapsone: 30 Tablet In 1 Bottle (70954-135-10),637,RC,70954-135-10,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Misoprostol: 100 Tablet In 1 Bottle (70954-444-20),637,RC,70954-444-20,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-130-06)",637,RC,70748-130-06,NDC,,,facility,both,1,EA,,0.98,0.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (70748-258-07)",637,RC,70748-258-07,NDC,,,facility,both,1,EA,,15.73,15.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin: 230 Ml In 1 Bottle (70954-496-10),637,RC,70954-496-10,NDC,,,facility,both,1,EA,,150.36,150.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenobarbital: 60 Tablet In 1 Bottle (71205-890-60),637,RC,71205-890-60,NDC,,,facility,both,1,EA,,0.83,0.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Potassium Chloride For Oral Solution: 1.58 G In 1 Pouch (70069-823-01),637,RC,70069-823-01,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle, Plastic (70377-006-12)",637,RC,70377-006-12,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phytonadione: 1 Bottle In 1 Carton (70710-1014-1) / 100 Tablet In 1 Bottle,637,RC,70710-1014-1,NDC,,,facility,both,1,EA,,68.11,68.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirabegron: 30 Tablet, Extended Release In 1 Bottle (70710-1159-3)",637,RC,70710-1159-3,NDC,,,facility,both,1,EA,,22.55,22.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fosfomycin Tromethamine: 1 Powder In 1 Packet (70700-268-99),637,RC,70700-268-99,NDC,,,facility,both,1,EA,,207.35,207.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1111-1)",637,RC,70677-1111-1,NDC,,,facility,both,1,EA,,4.86,4.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stay Awake: 2 Blister Pack In 1 Carton (70677-1126-1) / 8 Tablet In 1 Blister Pack,637,RC,70677-1126-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Foster And Thrive Earwax Removal Drops: 1 Bottle In 1 Box (70677-1154-1) / 15 Ml In 1 Bottle,637,RC,70677-1154-1,NDC,,,facility,both,1,EA,,5.74,5.74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Foster And Thrive Nicotine: 110 Blister Pack In 1 Carton (70677-1192-1) / 1 Gum, Chewing In 1 Blister Pack",637,RC,70677-1192-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Hydrogen Peroxide: 473 Ml In 1 Bottle, Plastic (70677-1248-1)",637,RC,70677-1248-1,NDC,,,facility,both,1,EA,,20.53,20.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-01) / .5 Ml In 1 Vial, Single-Dose",637,RC,55150-173-01,NDC,,,facility,both,1,EA,,10.12,10.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-05) / .5 Ml In 1 Vial, Single-Dose",637,RC,55150-173-05,NDC,,,facility,both,1,EA,,11.05,11.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxybutynin Chloride: 473 Ml In 1 Bottle, Plastic (54838-510-80)",637,RC,54838-510-80,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tizanidine: 150 Tablet In 1 Bottle (55111-180-15),637,RC,55111-180-15,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Ziprasidone: 60 Capsule In 1 Bottle (55111-257-60),637,RC,55111-257-60,NDC,,,facility,both,1,EA,,1.34,1.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rivastigmine Tartrate: 60 Capsule In 1 Bottle (55111-353-60),637,RC,55111-353-60,NDC,,,facility,both,1,EA,,1.49,1.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diclegis: 100 Tablet, Delayed Release In 1 Bottle (55494-100-10)",637,RC,55494-100-10,NDC,,,facility,both,1,EA,,6.17,6.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nystatin: 1 Tube In 1 Carton (51672-1289-1) / 15 G In 1 Tube,637,RC,51672-1289-1,NDC,,,facility,both,1,EA,,21.46,21.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Miconazole Nitrate: 1 Tube In 1 Carton (51672-2001-2) / 30 G In 1 Tube,637,RC,51672-2001-2,NDC,,,facility,both,1,EA,,7.15,7.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Miconazole Nitrate: 1 Tube, With Applicator In 1 Carton (51672-2035-6) / 45 G In 1 Tube, With Applicator",637,RC,51672-2035-6,NDC,,,facility,both,1,EA,,7.92,7.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Terbinafine Hydrochloride: 1 Tube In 1 Carton (51672-2080-1) / 15 G In 1 Tube,637,RC,51672-2080-1,NDC,,,facility,both,1,EA,,12.51,12.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Phenytoin: 237 Ml In 1 Bottle (51672-4069-1),637,RC,51672-4069-1,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (51672-4111-1)",637,RC,51672-4111-1,NDC,,,facility,both,1,EA,,0.39,0.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Metronidazole: 1 Tube In 1 Carton (51672-4116-6) / 45 G In 1 Tube,637,RC,51672-4116-6,NDC,,,facility,both,1,EA,,96.63,96.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Phenytoin: 100 Tablet, Chewable In 1 Bottle (51672-4146-1)",637,RC,51672-4146-1,NDC,,,facility,both,1,EA,,0.52,0.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-994-01,NDC,,,facility,both,1,EA,,1.94,1.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Isopropyl Alcohol: 473 Ml In 1 Bottle (53329-800-06),637,RC,53329-800-06,NDC,,,facility,both,1,EA,,2.59,2.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 100 Tablet, Film Coated In 1 Bottle, Plastic (53489-329-01)",637,RC,53489-329-01,NDC,,,facility,both,1,EA,,1.05,1.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Minoxidil: 100 Tablet In 1 Bottle (53489-386-01),637,RC,53489-386-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Spironolactone: 1000 Tablet In 1 Bottle (53746-511-10),637,RC,53746-511-10,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pure And Gentle: 1 Bottle In 1 Box (53329-013-11) / 133 Ml In 1 Bottle,637,RC,53329-013-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Duloxetine Delayed-Release: 90 Capsule, Delayed Release Pellets In 1 Bottle (51991-746-90)",637,RC,51991-746-90,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-877-33)",637,RC,51991-877-33,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clobazam: 100 Tablet In 1 Bottle (51991-900-01),637,RC,51991-900-01,NDC,,,facility,both,1,EA,,0.81,0.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Dificid: 1 Bottle In 1 Carton (52015-080-01) / 20 Tablet, Film Coated In 1 Bottle",637,RC,52015-080-01,NDC,,,facility,both,1,EA,,339.47,339.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,52268-011-01,NDC,,,facility,both,1,EA,,144.04,144.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Suprep Bowel Prep: 2 Bottle, Plastic In 1 Carton (52268-012-01) / 177.4 Ml In 1 Bottle, Plastic",637,RC,52268-012-01,NDC,,,facility,both,1,EA,,150.21,150.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 60 mL in 1 BOTTLE (52380-1905-2) ,637,RC,52380-1905-2,NDC,,,facility,both,1,EA,,2.48,2.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Baclofen: 100 Tablet In 1 Bottle (52817-319-10),637,RC,52817-319-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ",637,RC,51079-991-20,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (57237-058-60)",637,RC,57237-058-60,NDC,,,facility,both,1,EA,,2.28,2.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cefdinir: 60 Capsule In 1 Bottle (57237-099-60),637,RC,57237-099-60,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (57237-042-90)",637,RC,57237-042-90,NDC,,,facility,both,1,EA,,0.68,0.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,55566-2800-0,NDC,,,facility,both,1,EA,,1464.57,1464.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cervidil: 1 Pouch In 1 Carton (55566-2800-1) / 10 Mg In 1 Pouch (55566-2800-0),637,RC,55566-2800-1,NDC,,,facility,both,1,EA,,1399.15,1399.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (57237-047-01)",637,RC,57237-047-01,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (57237-008-30)",637,RC,57237-008-30,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (57237-041-01)",637,RC,57237-041-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 TABLET in 1 BOTTLE (57896-101-01) ,637,RC,57896-101-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 TABLET in 1 BOTTLE (57896-101-01) ,637,RC,57896-101-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 Tablet In 1 Bottle (57896-102-01),637,RC,57896-102-01,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Regular Strength Pain Relief: 100 Tablet In 1 Bottle (57896-102-01),637,RC,57896-102-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stimulant Laxative Enteric Coated: 100 Tablet In 1 Bottle (57896-441-01),637,RC,57896-441-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Gericare Senna Syrup: 237 Ml In 1 Bottle (57896-472-08),637,RC,57896-472-08,NDC,,,facility,both,1,EA,,1.11,1.11,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Aspirin: 100 Tablet In 1 Bottle (57896-901-01),637,RC,57896-901-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Regular Strength Enteric Coated Aspirin: 1000 Tablet, Coated In 1 Bottle (57896-921-10)",637,RC,57896-921-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Analgesic Balm: 1 Tube In 1 Box (57896-116-03) / 85 G In 1 Tube,637,RC,57896-116-03,NDC,,,facility,both,1,EA,,7.81,7.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ",637,RC,51079-991-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-095-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-105-11,NDC,,,facility,both,1,EA,,3.04,3.04,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-131-11,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-151-11,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-191-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Capsaicin External Analgesic: 1 Tube In 1 Carton (50268-195-60) / 60 G In 1 Tube,637,RC,50268-195-60,NDC,,,facility,both,1,EA,,9.19,9.19,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-277-11,NDC,,,facility,both,1,EA,,3.2,3.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-278-11,NDC,,,facility,both,1,EA,,2.8,2.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-299-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-299-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-362-11,NDC,,,facility,both,1,EA,,1.08,1.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-088-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-089-11,NDC,,,facility,both,1,EA,,1.23,1.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-062-11,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-069-11,NDC,,,facility,both,1,EA,,2.96,2.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "30 BLISTER PACK in 1 BOX (50268-074-13) / 1 TABLET, FILM COATED in 1 BLISTER PACK (50268-074-11) ",637,RC,50268-074-13,NDC,,,facility,both,1,EA,,2.52,2.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-430-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-431-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-604-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-630-11,NDC,,,facility,both,1,EA,,0.47,0.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-640-11,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-663-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-665-11,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-709-11,NDC,,,facility,both,1,EA,,1.42,1.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-710-11,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-597-11,NDC,,,facility,both,1,EA,,2.08,2.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-594-11,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-476-11,NDC,,,facility,both,1,EA,,1.12,1.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-504-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-505-11,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-522-11,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Meclizine Hydrochloride: 50 Blister Pack In 1 Box, Unit-Dose (50268-522-15) / 1 Tablet In 1 Blister Pack (50268-522-11)",637,RC,50268-522-15,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-525-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-526-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-541-11,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 50 Blister Pack In 1 Box, Unit-Dose (50268-541-15) / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (50268-541-11)",637,RC,50268-541-15,NDC,,,facility,both,1,EA,,0.84,0.84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-576-11,NDC,,,facility,both,1,EA,,14.37,14.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-585-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-728-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Trazodone Hydrochloride: 100 Tablet In 1 Bottle (50111-561-01),637,RC,50111-561-01,NDC,,,facility,both,1,EA,,0.36,0.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ranolazine: 60 Tablet, Film Coated, Extended Release In 1 Package (50228-423-60)",637,RC,50228-423-60,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Tablet In 1 Bottle (50228-458-01),637,RC,50228-458-01,NDC,,,facility,both,1,EA,,0.31,0.31,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Sucralfate: 20 CUP in 1 BOX (50268-732-12) / 10 mL in 1 CUP (50268-732-11) ,637,RC,50268-732-12,NDC,,,facility,both,1,EA,,13.58,13.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-294-01,NDC,,,facility,both,1,EA,,1.46,1.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-374-01,NDC,,,facility,both,1,EA,,1.56,1.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-375-01,NDC,,,facility,both,1,EA,,1.03,1.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-436-01,NDC,,,facility,both,1,EA,,1.36,1.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-286-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-438-01,NDC,,,facility,both,1,EA,,1.88,1.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-453-01,NDC,,,facility,both,1,EA,,1.63,1.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-455-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-437-01,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diazepam: 100 Blister Pack In 1 Carton (51079-285-20) / 1 Tablet In 1 Blister Pack (51079-285-01),637,RC,51079-285-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-118-01,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-119-01,NDC,,,facility,both,1,EA,,1.2,1.2,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-131-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-141-01,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-169-01,NDC,,,facility,both,1,EA,,1.91,1.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-205-01,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-206-01,NDC,,,facility,both,1,EA,,1.6,1.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-209-01,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-284-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-285-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-597-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-597-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-789-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-801-01,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-821-01,NDC,,,facility,both,1,EA,,1.41,1.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Clonazepam: 100 BLISTER PACK in 1 CARTON (51079-882-20) / 1 TABLET in 1 BLISTER PACK (51079-882-01) ,637,RC,51079-882-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-888-01,NDC,,,facility,both,1,EA,,2.1,2.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrochlorothiazide: 100 BLISTER PACK in 1 CARTON (51079-776-20) / 1 CAPSULE in 1 BLISTER PACK (51079-776-01) ,637,RC,51079-776-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-923-01,NDC,,,facility,both,1,EA,,1.9,1.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Labetalol HCl: 100 BLISTER PACK in 1 CARTON (51079-928-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-928-01) ",637,RC,51079-928-20,NDC,,,facility,both,1,EA,,0.85,0.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-991-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-759-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-608-01,NDC,,,facility,both,1,EA,,5.68,5.68,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-630-01,NDC,,,facility,both,1,EA,,3.13,3.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cyclobenzaprine Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-644-20) / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-644-01) ",637,RC,51079-644-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-684-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-685-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-690-01,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-690-01,NDC,,,facility,both,1,EA,,1.83,1.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-724-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-733-01,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-103-01,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-086-01,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50458-578-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50458-578-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50458-579-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50458-580-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Xarelto: 10 Blister Pack In 1 Carton (50458-580-10) / 10 Tablet, Film Coated In 1 Blister Pack (50458-580-01)",637,RC,50458-580-10,NDC,,,facility,both,1,EA,,14.32,14.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-745-11,NDC,,,facility,both,1,EA,,10.63,10.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-754-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-755-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-756-11,NDC,,,facility,both,1,EA,,0.66,0.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50268-757-11,NDC,,,facility,both,1,EA,,0.71,0.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Urea: 28.35 G In 1 Tube (50268-872-28),637,RC,50268-872-28,NDC,,,facility,both,1,EA,,73.27,73.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50383-363-15,NDC,,,facility,both,1,EA,,1.82,1.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Briviact: 100 Blister Pack In 1 Carton (50474-470-09) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,50474-470-09,NDC,,,facility,both,1,EA,,65.35,65.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Keppra: 120 Tablet, Film Coated In 1 Bottle, Plastic (50474-595-40)",637,RC,50474-595-40,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 1000 Tablet, Extended Release In 1 Bottle (50742-616-10)",637,RC,50742-616-10,NDC,,,facility,both,1,EA,,0.4,0.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-023-01,NDC,,,facility,both,1,EA,,5.81,5.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoprolol Succinate: 100 Tablet, Extended Release In 1 Bottle (50742-615-01)",637,RC,50742-615-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-024-01,NDC,,,facility,both,1,EA,,5.39,5.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-051-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-074-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-075-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,51079-076-01,NDC,,,facility,both,1,EA,,0.69,0.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Scopolamine: 24 Pouch In 1 Carton (50742-505-24) / 1 Patch, Extended Release In 1 Pouch",637,RC,50742-505-24,NDC,,,facility,both,1,EA,,13.29,13.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,50742-505-01,NDC,,,facility,both,1,EA,,23,23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Briviact: 100 Blister Pack In 1 Carton (50474-770-09) / 1 Tablet, Film Coated In 1 Blister Pack",637,RC,50474-770-09,NDC,,,facility,both,1,EA,,59.43,59.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Briviact: 1 Bottle In 1 Carton (50474-770-66) / 60 Tablet, Film Coated In 1 Bottle",637,RC,50474-770-66,NDC,,,facility,both,1,EA,,65.37,65.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Collagenase Santyl: 1 Tube In 1 Carton (50484-010-30) / 30 G In 1 Tube,637,RC,50484-010-30,NDC,,,facility,both,1,EA,,775.07,775.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Tylenol Regular Strength: 10 Blister Pack In 1 Carton (50580-458-11) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,50580-458-11,NDC,,,facility,both,1,EA,,0.28,0.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desipramine Hydrochloride: 100 Tablet In 1 Bottle (50742-113-01),637,RC,50742-113-01,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Diltiazem Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (50742-249-90)",637,RC,50742-249-90,NDC,,,facility,both,1,EA,,0.55,0.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Briviact: 1 Bottle In 1 Carton (50474-470-66) / 60 Tablet, Film Coated In 1 Bottle",637,RC,50474-470-66,NDC,,,facility,both,1,EA,,65.37,65.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Famotidine: 24 Bottle In 1 Box (61442-121-01) / 100 Tablet In 1 Bottle,637,RC,61442-121-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Famotidine: 24 Bottle In 1 Box (61442-122-01) / 100 Tablet In 1 Bottle,637,RC,61442-122-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (62332-119-90),637,RC,62332-119-90,NDC,,,facility,both,1,EA,,0.41,0.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Pregabalin: 90 Capsule In 1 Bottle (62332-122-90),637,RC,62332-122-90,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pancreaze: 1 Bottle, Glass In 1 Carton (62541-405-10) / 100 Capsule, Delayed Release In 1 Bottle, Glass",637,RC,62541-405-10,NDC,,,facility,both,1,EA,,16.86,16.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoclopramide: 473 Ml In 1 Bottle, Plastic (62559-190-16)",637,RC,62559-190-16,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 Tablet In 1 Bottle (62559-265-30),637,RC,62559-265-30,NDC,,,facility,both,1,EA,,6.28,6.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Vraylar: 30 Capsule, Gelatin Coated In 1 Bottle (61874-115-30)",637,RC,61874-115-30,NDC,,,facility,both,1,EA,,134.71,134.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,61874-130-11,NDC,,,facility,both,1,EA,,134.71,134.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Truvada: 30 Tablet, Film Coated In 1 Bottle, Plastic (61958-0701-1)",637,RC,61958-0701-1,NDC,,,facility,both,1,EA,,159.78,159.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Stribild: 30 Tablet, Film Coated In 1 Bottle, Plastic (61958-1201-1)",637,RC,61958-1201-1,NDC,,,facility,both,1,EA,,392.53,392.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Descovy: 30 Tablet In 1 Bottle, Plastic (61958-2002-1)",637,RC,61958-2002-1,NDC,,,facility,both,1,EA,,191.38,191.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Biktarvy: 30 Tablet In 1 Bottle, Plastic (61958-2501-1)",637,RC,61958-2501-1,NDC,,,facility,both,1,EA,,350.61,350.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (62559-390-50),637,RC,62559-390-50,NDC,,,facility,both,1,EA,,4.58,4.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-701-11,NDC,,,facility,both,1,EA,,1.14,1.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-709-11,NDC,,,facility,both,1,EA,,1.73,1.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-711-11,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-717-11,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-690-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-723-11,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-725-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-725-11,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-728-11,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-730-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-733-11,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-721-11,NDC,,,facility,both,1,EA,,4.12,4.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-634-11,NDC,,,facility,both,1,EA,,2.92,2.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-638-11,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-640-11,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-661-11,NDC,,,facility,both,1,EA,,0.72,0.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-683-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-675-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-675-11,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-680-11,NDC,,,facility,both,1,EA,,1.77,1.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Folic Acid: 100 Blister Pack In 1 Carton (60687-681-01) / 1 Tablet In 1 Blister Pack (60687-681-11),637,RC,60687-681-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-681-11,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-669-11,NDC,,,facility,both,1,EA,,1.09,1.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-735-11,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-736-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cytomel: 100 Tablet In 1 Bottle (60793-115-01),637,RC,60793-115-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Betaxolol Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-245-01) / 5 Ml In 1 Bottle, Plastic",637,RC,61314-245-01,NDC,,,facility,both,1,EA,,123.41,123.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-836-11,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-742-11,NDC,,,facility,both,1,EA,,3.49,3.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-745-11,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-746-11,NDC,,,facility,both,1,EA,,4.33,4.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-760-40,NDC,,,facility,both,1,EA,,1.67,1.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-782-11,NDC,,,facility,both,1,EA,,4.77,4.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-795-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-795-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-807-11,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-822-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-822-11,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-833-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sumatriptan Succinate: 1 Vial, Single-Dose In 1 Carton (63323-273-01) / .5 Ml In 1 Vial, Single-Dose",637,RC,63323-273-01,NDC,,,facility,both,1,EA,,15.86,15.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (62559-390-50),637,RC,62559-390-50,NDC,,,facility,both,1,EA,,3.7,3.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,62584-266-11,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,62584-267-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,62584-733-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-796-88)",637,RC,62756-796-88,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-797-88)",637,RC,62756-797-88,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-798-88)",637,RC,62756-798-88,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-633-11,NDC,,,facility,both,1,EA,,7.5,7.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Nitrofurantoin (Monohydrate/Macrocrystals): 100 Blister Pack In 1 Carton (60687-633-01) / 1 Capsule In 1 Blister Pack (60687-633-11),637,RC,60687-633-01,NDC,,,facility,both,1,EA,,7.12,7.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0165-1),637,RC,60505-0165-1,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olopatadine Hydrochloride: 1 BOTTLE, PLASTIC in 1 CARTON (60505-0575-1) / 5 mL in 1 BOTTLE, PLASTIC",637,RC,60505-0575-1,NDC,,,facility,both,1,EA,,96,96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desmopressin Acetate: 1 Bottle, Spray In 1 Carton (60505-0815-0) / 50 Spray In 1 Bottle, Spray",637,RC,60505-0815-0,NDC,,,facility,both,1,EA,,220.79,220.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Calcitonin Salmon: 1 Bottle, Glass In 1 Carton (60505-0823-6) / 30 Spray, Metered In 1 Bottle, Glass",637,RC,60505-0823-6,NDC,,,facility,both,1,EA,,155.41,155.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (60505-0833-5) / 200 Spray, Metered In 1 Bottle, Spray",637,RC,60505-0833-5,NDC,,,facility,both,1,EA,,39.69,39.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (60505-2805-7)",637,RC,60505-2805-7,NDC,,,facility,both,1,EA,,3.48,3.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3110-0) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,60505-3110-0,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3111-0) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,60505-3111-0,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3113-0) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,60505-3113-0,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Sulfasalazine: 1 Bottle In 1 Carton (59762-0104-5) / 100 Tablet, Delayed Release In 1 Bottle",637,RC,59762-0104-5,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (59762-0117-1)",637,RC,59762-0117-1,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (59762-3720-1),637,RC,59762-3720-1,NDC,,,facility,both,1,EA,,0.62,0.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Misoprostol: 100 Tablet In 1 Bottle (59762-5008-2),637,RC,59762-5008-2,NDC,,,facility,both,1,EA,,2.5,2.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (60219-1266-1) / 10 Capsule In 1 Blister Pack,637,RC,60219-1266-1,NDC,,,facility,both,1,EA,,20.99,20.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Alprazolam: 100 Tablet In 1 Bottle (59762-3720-1),637,RC,59762-3720-1,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 10 Blister Pack In 1 Carton (60505-3275-0) / 10 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,60505-3275-0,NDC,,,facility,both,1,EA,,3.58,3.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60505-7063-0,NDC,,,facility,both,1,EA,,4.92,4.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-100-11,NDC,,,facility,both,1,EA,,7.61,7.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-113-11,NDC,,,facility,both,1,EA,,0.59,0.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-121-95,NDC,,,facility,both,1,EA,,4.36,4.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60505-7061-0,NDC,,,facility,both,1,EA,,4.83,4.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olanzapine: 30 Tablet, Orally Disintegrating In 1 Bottle (60505-3275-3)",637,RC,60505-3275-3,NDC,,,facility,both,1,EA,,1.69,1.69,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Selegiline Hydrochloride: 60 Tablet In 1 Bottle (60505-3438-3),637,RC,60505-3438-3,NDC,,,facility,both,1,EA,,2.57,2.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tranexamic Acid: 30 TABLET in 1 BOTTLE (60505-3638-3) ,637,RC,60505-3638-3,NDC,,,facility,both,1,EA,,1.07,1.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Hydrocortisone: 100 Tablet In 1 Bottle (59762-0075-1),637,RC,59762-0075-1,NDC,,,facility,both,1,EA,,1.24,1.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Spironolactone: 100 Tablet, Film Coated In 1 Bottle (59746-216-01)",637,RC,59746-216-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,58980-415-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stratuscare Bisacodyl: 1 Blister Pack In 1 Box (58980-415-50) / 50 Suppository In 1 Blister Pack,637,RC,58980-415-50,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycontin: 2 Blister Pack In 1 Carton (59011-410-20) / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,59011-410-20,NDC,,,facility,both,1,EA,,13.98,13.98,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Oxycontin: 2 Blister Pack In 1 Carton (59011-420-20) / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack",637,RC,59011-420-20,NDC,,,facility,both,1,EA,,21.51,21.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Stratuscare Adult Glycerin: 12 Suppository In 1 Jar (58980-410-12),637,RC,58980-410-12,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Samsca: 1 Blister Pack In 1 Carton (59148-020-50) / 10 Tablet In 1 Blister Pack,637,RC,59148-020-50,NDC,,,facility,both,1,EA,,1494.56,1494.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Rexulti: 1 Bottle In 1 Carton (59148-036-13) / 30 Tablet In 1 Bottle,637,RC,59148-036-13,NDC,,,facility,both,1,EA,,130.44,130.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Vyvanse: 100 Capsule In 1 Bottle (59417-103-10),637,RC,59417-103-10,NDC,,,facility,both,1,EA,,34.42,34.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Olopatadine Hydrochloride: 1 Bottle, Plastic In 1 Carton (58602-006-40) / 5 Ml In 1 Bottle, Plastic",637,RC,58602-006-40,NDC,,,facility,both,1,EA,,19.02,19.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diclofenac Sodium: 1 Tube In 1 Carton (58602-604-07) / 100 G In 1 Tube,637,RC,58602-604-07,NDC,,,facility,both,1,EA,,19.75,19.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Loratadine: 1 Blister Pack In 1 Carton (58602-702-83) / 10 Tablet In 1 Blister Pack,637,RC,58602-702-83,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ciprofloxacin: 100 Tablet, Coated In 1 Bottle (58657-675-01)",637,RC,58657-675-01,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Desitin Maximum Strength: 1 TUBE in 1 CARTON (58232-0721-3) / 56 g in 1 TUBE,637,RC,58232-0721-3,NDC,,,facility,both,1,EA,,12.4,12.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-457-01),637,RC,59651-457-01,NDC,,,facility,both,1,EA,,0.35,0.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Edurant: 30 Tablet, Film Coated In 1 Bottle (59676-278-01)",637,RC,59676-278-01,NDC,,,facility,both,1,EA,,125.29,125.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Prezcobix: 30 Tablet, Film Coated In 1 Bottle (59676-575-30)",637,RC,59676-575-30,NDC,,,facility,both,1,EA,,208.05,208.05,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Risperidone: 7 Blister Pack In 1 Carton (59746-020-22) / 4 Tablet, Orally Disintegrating In 1 Blister Pack",637,RC,59746-020-22,NDC,,,facility,both,1,EA,,2.32,2.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Colchicine: 100 Tablet In 1 Bottle (59651-455-01),637,RC,59651-455-01,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Propafenone Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (59651-258-01)",637,RC,59651-258-01,NDC,,,facility,both,1,EA,,2.62,2.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-124-11,NDC,,,facility,both,1,EA,,0.78,0.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-484-01) / 1 Capsule In 1 Blister Pack (60687-484-11)",637,RC,60687-484-01,NDC,,,facility,both,1,EA,,1.17,1.17,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-484-11,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-496-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-506-11,NDC,,,facility,both,1,EA,,1.16,1.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-468-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-507-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-513-11,NDC,,,facility,both,1,EA,,3.26,3.26,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Blister Pack In 1 Box, Unit-Dose (60687-518-01) / 1 Tablet, Film Coated In 1 Blister Pack (60687-518-11)",637,RC,60687-518-01,NDC,,,facility,both,1,EA,,0.89,0.89,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-518-11,NDC,,,facility,both,1,EA,,0.88,0.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-544-11,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-550-11,NDC,,,facility,both,1,EA,,1.18,1.18,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-433-11,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Celecoxib: 100 Blister Pack In 1 Carton (60687-436-01) / 1 Capsule In 1 Blister Pack (60687-436-11),637,RC,60687-436-01,NDC,,,facility,both,1,EA,,1.95,1.95,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-436-11,NDC,,,facility,both,1,EA,,3.59,3.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-437-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-439-11,NDC,,,facility,both,1,EA,,0.9,0.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ibuprofen: 100 Blister Pack In 1 Box, Unit-Dose (60687-468-01) / 1 Tablet In 1 Blister Pack (60687-468-11)",637,RC,60687-468-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-447-11,NDC,,,facility,both,1,EA,,4.07,4.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-450-11,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-457-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-444-11,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-555-11,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-593-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-595-11,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-595-11,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-598-11,NDC,,,facility,both,1,EA,,0.93,0.93,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-602-11,NDC,,,facility,both,1,EA,,0.48,0.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-591-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-609-11,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-618-11,NDC,,,facility,both,1,EA,,2.53,2.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-628-44,NDC,,,facility,both,1,EA,,15.34,15.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-631-01) / 1 Tablet In 1 Blister Pack (60687-631-11)",637,RC,60687-631-01,NDC,,,facility,both,1,EA,,1.51,1.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-607-11,NDC,,,facility,both,1,EA,,4.15,4.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-587-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-559-11,NDC,,,facility,both,1,EA,,0.6,0.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-566-40,NDC,,,facility,both,1,EA,,15.43,15.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-568-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-570-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-578-11,NDC,,,facility,both,1,EA,,10.13,10.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-579-11,NDC,,,facility,both,1,EA,,0.7,0.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Gabapentin: 100 Blister Pack In 1 Box, Unit-Dose (60687-580-01) / 1 Capsule In 1 Blister Pack (60687-580-11)",637,RC,60687-580-01,NDC,,,facility,both,1,EA,,0.58,0.58,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-580-11,NDC,,,facility,both,1,EA,,0.46,0.46,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-581-11,NDC,,,facility,both,1,EA,,1.85,1.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-584-11,NDC,,,facility,both,1,EA,,7.15,7.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-586-11,NDC,,,facility,both,1,EA,,4.96,4.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-423-11,NDC,,,facility,both,1,EA,,2.77,2.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-195-11,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-202-11,NDC,,,facility,both,1,EA,,25.72,25.72,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-206-11,NDC,,,facility,both,1,EA,,1.99,1.99,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Simvastatin: 100 Blister Pack In 1 Box, Unit-Dose (60687-210-01) / 1 Tablet, Film Coated In 1 Blister Pack (60687-210-11)",637,RC,60687-210-01,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-210-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-211-11,NDC,,,facility,both,1,EA,,1.59,1.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-217-11,NDC,,,facility,both,1,EA,,1.21,1.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-224-11,NDC,,,facility,both,1,EA,,0.64,0.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-228-11,NDC,,,facility,both,1,EA,,3.85,3.85,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-230-11,NDC,,,facility,both,1,EA,,1.13,1.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Aripiprazole: 30 Blister Pack In 1 Box, Unit-Dose (60687-191-21) / 1 Tablet In 1 Blister Pack (60687-191-11)",637,RC,60687-191-21,NDC,,,facility,both,1,EA,,27.34,27.34,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-191-11,NDC,,,facility,both,1,EA,,19.54,19.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-143-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-152-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-157-11,NDC,,,facility,both,1,EA,,15.88,15.88,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-161-11,NDC,,,facility,both,1,EA,,1.66,1.66,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-169-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-173-11,NDC,,,facility,both,1,EA,,0.79,0.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-188-11,NDC,,,facility,both,1,EA,,8.38,8.38,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-190-11,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-231-11,NDC,,,facility,both,1,EA,,0.67,0.67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-234-11,NDC,,,facility,both,1,EA,,2.45,2.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-325-11,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-340-11,NDC,,,facility,both,1,EA,,2.22,2.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-345-11,NDC,,,facility,both,1,EA,,1.96,1.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-369-11,NDC,,,facility,both,1,EA,,0.92,0.92,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-377-11,NDC,,,facility,both,1,EA,,0.73,0.73,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-398-11,NDC,,,facility,both,1,EA,,1.35,1.35,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-409-95,NDC,,,facility,both,1,EA,,2.09,2.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-319-11,NDC,,,facility,both,1,EA,,12.77,12.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-242-11,NDC,,,facility,both,1,EA,,0.76,0.76,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-245-11,NDC,,,facility,both,1,EA,,2.82,2.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-249-40,NDC,,,facility,both,1,EA,,9.59,9.59,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-253-11,NDC,,,facility,both,1,EA,,0.91,0.91,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-256-01) / 1 Tablet, Film Coated In 1 Blister Pack (60687-256-11)",637,RC,60687-256-01,NDC,,,facility,both,1,EA,,2.7,2.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-256-11,NDC,,,facility,both,1,EA,,2.81,2.81,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cefuroxime Axetil: 20 Blister Pack In 1 Box, Unit-Dose (60687-272-94) / 1 Tablet, Film Coated In 1 Blister Pack (60687-272-11)",637,RC,60687-272-94,NDC,,,facility,both,1,EA,,7.55,7.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-292-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-302-95,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-303-11,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,60687-317-95,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068104100,NDC,,,facility,both,1,EA,,0.16,0.16,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068102500,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068102000,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068101000,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,7811273623,NDC,,,facility,both,1,EA,,10.62,10.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,7733398325,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068109800,NDC,,,facility,both,1,EA,,0.56,0.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068109900,NDC,,,facility,both,1,EA,,0.5,0.5,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068116900,NDC,,,facility,both,1,EA,,0.3,0.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068114000,NDC,,,facility,both,1,EA,,0.42,0.42,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,8068113801,NDC,,,facility,both,1,EA,,0.57,0.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,7733394810,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6498033901,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6373612301,NDC,,,facility,both,1,EA,,0.61,0.61,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6373612002,NDC,,,facility,both,1,EA,,19.41,19.41,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6332325410,NDC,,,facility,both,1,EA,,56.36,56.36,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6498033901,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6498033990,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,7733394025,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,7214045231,NDC,,,facility,both,1,EA,,13.43,13.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6817600015,NDC,,,facility,both,1,EA,,1.47,1.47,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6817600011,NDC,,,facility,both,1,EA,,1.43,1.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,7214063377,NDC,,,facility,both,1,EA,,18.75,18.75,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6253000011,NDC,,,facility,both,1,EA,,10.23,10.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0003-0894-31,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0003-0894-31,NDC,,,facility,both,1,EA,,3.82,3.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Humulin N: 1 Vial, Multi-Dose In 1 Carton (0002-8315-01) / 10 Ml In 1 Vial, Multi-Dose",637,RC,0002-8315-01,NDC,,,facility,both,1,EA,,38.09,38.09,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 60 Tablet, Film Coated In 1 Bottle, Plastic (0003-0894-21)",637,RC,0003-0894-21,NDC,,,facility,both,1,EA,,3.64,3.64,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 10 Blister Pack In 1 Carton (0003-0893-31) / 10 Tablet, Film Coated In 1 Blister Pack",637,RC,0003-0893-31,NDC,,,facility,both,1,EA,,3.8,3.8,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Eliquis: 60 Tablet, Film Coated In 1 Bottle, Plastic (0003-0893-21)",637,RC,0003-0893-21,NDC,,,facility,both,1,EA,,4,4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0002-8805-01,NDC,,,facility,both,1,EA,,37.49,37.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6025816001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904598426,NDC,,,facility,both,1,EA,,8.23,8.23,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904188260,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904113213,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904053061,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904052361,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904719106,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904723961,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,1284313105,NDC,,,facility,both,1,EA,,0.25,0.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,1093913944,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904775127,NDC,,,facility,both,1,EA,,8.9,8.9,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904759161,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,904759160,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,1000670028,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,225052547,NDC,,,facility,both,1,EA,,7.79,7.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,149003908,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,121119030,NDC,,,facility,both,1,EA,,12.7,12.7,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,121053005,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,281020536,NDC,,,facility,both,1,EA,,1.3,1.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,573475652,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,573051330,NDC,,,facility,both,1,EA,,0.08,0.08,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,536730001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,536141501,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,486112501,NDC,,,facility,both,1,EA,,2.03,2.03,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,1785600102,NDC,,,facility,both,1,EA,,3.94,3.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5093009802,NDC,,,facility,both,1,EA,,13.79,13.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5026886311,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5026886011,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5026885411,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5026885311,NDC,,,facility,both,1,EA,,0.44,0.44,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5026885211,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6025800615,NDC,,,facility,both,1,EA,,0.94,0.94,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,6025800601,NDC,,,facility,both,1,EA,,0.86,0.86,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5865717001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5789687503,NDC,,,facility,both,1,EA,,0.51,0.51,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5789686406,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5789645101,NDC,,,facility,both,1,EA,,0.33,0.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5026837511,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,3660219209,NDC,,,facility,both,1,EA,,0.27,0.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,2055503601,NDC,,,facility,both,1,EA,,0.49,0.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,2055503600,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,2055503300,NDC,,,facility,both,1,EA,,0.32,0.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,2055502700,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,2055501900,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,3786486001,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,4858200155,NDC,,,facility,both,1,EA,,11.52,11.52,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,4601701816,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,5026834611,NDC,,,facility,both,1,EA,,0.45,0.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,4110081163,NDC,,,facility,both,1,EA,,5.63,5.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,3932806412,NDC,,,facility,both,1,EA,,34.77,34.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0010-20) / 1 Tablet In 1 Blister Pack,637,RC,0054-0010-20,NDC,,,facility,both,1,EA,,1.1,1.1,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Glucotrol: 100 TABLET in 1 BOTTLE (0049-4110-66) ,637,RC,0049-4110-66,NDC,,,facility,both,1,EA,,0.96,0.96,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Diflucan: 30 Tablet In 1 Bottle (0049-3420-30),637,RC,0049-3420-30,NDC,,,facility,both,1,EA,,19.82,19.82,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0010-25),637,RC,0054-0010-25,NDC,,,facility,both,1,EA,,1.53,1.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0244-24) / 10 Tablet In 1 Blister Pack,637,RC,0054-0244-24,NDC,,,facility,both,1,EA,,2.13,2.13,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0243-24) / 10 Tablet In 1 Blister Pack,637,RC,0054-0243-24,NDC,,,facility,both,1,EA,,1.4,1.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Morphine Sulfate: 500 Ml In 1 Bottle (0054-0237-63),637,RC,0054-0237-63,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Morphine Sulfate: 100 Tablet In 1 Bottle (0054-0235-25),637,RC,0054-0235-25,NDC,,,facility,both,1,EA,,1.15,1.15,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Morphine Sulfate: 100 Blister Pack In 1 Carton (0054-0235-24) / 1 Tablet In 1 Blister Pack,637,RC,0054-0235-24,NDC,,,facility,both,1,EA,,1.22,1.22,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Oxcarbazepine: 10 BLISTER PACK in 1 BOX (0054-0097-20) / 10 TABLET in 1 BLISTER PACK,637,RC,0054-0097-20,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0011-25),637,RC,0054-0011-25,NDC,,,facility,both,1,EA,,2.37,2.37,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Premarin: 100 Tablet, Film Coated In 1 Bottle (0046-1102-81)",637,RC,0046-1102-81,NDC,,,facility,both,1,EA,,18.83,18.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Premarin Vaginal: 1 Tube, With Applicator In 1 Carton (0046-0872-21) / 30 G In 1 Tube, With Applicator",637,RC,0046-0872-21,NDC,,,facility,both,1,EA,,1102.43,1102.43,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Multaq: 60 Tablet, Film Coated In 1 Bottle (0024-4142-60)",637,RC,0024-4142-60,NDC,,,facility,both,1,EA,,28.21,28.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Plaquenil: 100 TABLET, FILM COATED in 1 BOTTLE (0024-1562-10) ",637,RC,0024-1562-10,NDC,,,facility,both,1,EA,,4.3,4.3,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lasix: 100 TABLET in 1 BOTTLE (0039-0067-10) ,637,RC,0039-0067-10,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-13)",637,RC,0032-3016-13,NDC,,,facility,both,1,EA,,33.32,33.32,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-2636-01)",637,RC,0032-2636-01,NDC,,,facility,both,1,EA,,22.79,22.79,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Codeine Sulfate: 100 Tablet In 1 Bottle (0054-0244-25),637,RC,0054-0244-25,NDC,,,facility,both,1,EA,,1.55,1.55,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0046-70)",637,RC,0032-0046-70,NDC,,,facility,both,1,EA,,5.56,5.56,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Creon: 70 Capsule, Delayed Release In 1 Bottle (0032-0045-70)",637,RC,0032-0045-70,NDC,,,facility,both,1,EA,,4.62,4.62,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Cytotec: 60 Tablet In 1 Bottle, Unit-Dose (0025-1451-60)",637,RC,0025-1451-60,NDC,,,facility,both,1,EA,,1.25,1.25,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Transderm Scop: 4 POUCH in 1 BOX (0067-4346-04) / 1 PATCH in 1 POUCH / 3 d in 1 PATCH,637,RC,0067-4346-04,NDC,,,facility,both,1,EA,,32.14,32.14,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA COUMADIN: 1 BOTTLE in 1 CARTON (0056-0170-70) / 100 TABLET in 1 BOTTLE,637,RC,0056-0170-70,NDC,,,facility,both,1,EA,,1.57,1.57,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lithium Carbonate: 10 Tablet In 1 Blister Pack (0054-8528-25),637,RC,0054-8528-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8526-25)",637,RC,0054-8526-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Fluticasone Propionate: 1 Bottle, Glass In 1 Carton (0054-3270-99) / 120 Spray, Metered In 1 Bottle, Glass",637,RC,0054-3270-99,NDC,,,facility,both,1,EA,,21.48,21.48,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Lithium Carbonate: 1000 Capsule, Gelatin Coated In 1 Bottle (0054-2527-31)",637,RC,0054-2527-31,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Methadone Hydrochloride: 1 Blister Pack In 1 Carton (0054-0709-20) / 100 Tablet In 1 Blister Pack,637,RC,0054-0709-20,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0054-0660-25),637,RC,0054-0660-25,NDC,,,facility,both,1,EA,,7.39,7.39,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Desvenlafaxine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (0054-0603-13)",637,RC,0054-0603-13,NDC,,,facility,both,1,EA,,2.6,2.6,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Midazolam Hydrochloride: 118 Ml In 1 Bottle, Glass (0054-3566-99)",637,RC,0054-3566-99,NDC,,,facility,both,1,EA,,1.28,1.28,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25) / 10 Tablet In 1 Blister Pack,637,RC,0054-8297-25,NDC,,,facility,both,1,EA,,0.54,0.54,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25) / 10 Tablet In 1 Blister Pack,637,RC,0054-8297-25,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25) / 10 Tablet In 1 Blister Pack,637,RC,0054-8299-25,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Lithium Carbonate: 100 Tablet In 1 Bottle (0054-4527-25),637,RC,0054-4527-25,NDC,,,facility,both,1,EA,,0.53,0.53,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Pifeltro: 30 Tablet, Film Coated In 1 Bottle (0006-3069-01)",637,RC,0006-3069-01,NDC,,,facility,both,1,EA,,163.29,163.29,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamiflu: 1 Blister Pack In 1 Carton (0004-0801-85) / 10 Capsule In 1 Blister Pack,637,RC,0004-0801-85,NDC,,,facility,both,1,EA,,33.83,33.83,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Tamiflu: 1 Blister Pack In 1 Carton (0004-0800-85) / 10 Capsule In 1 Blister Pack,637,RC,0004-0800-85,NDC,,,facility,both,1,EA,,36.77,36.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0277-31)",637,RC,0006-0277-31,NDC,,,facility,both,1,EA,,30.07,30.07,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Isentress: 60 Tablet, Film Coated In 1 Bottle (0006-0227-61)",637,RC,0006-0227-61,NDC,,,facility,both,1,EA,,92.45,92.45,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,637,RC,0006-0221-01,NDC,,,facility,both,1,EA,,29.33,29.33,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0112-31)",637,RC,0006-0112-31,NDC,,,facility,both,1,EA,,28.4,28.4,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "COZAAR: 90 TABLET, FILM COATED in 1 BOTTLE (0006-0951-54) ",637,RC,0006-0951-54,NDC,,,facility,both,1,EA,,2.21,2.21,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA 1 TUBE in 1 CARTON (0023-0240-04) / 3.5 g in 1 TUBE,637,RC,0023-0240-04,NDC,,,facility,both,1,EA,,24.78,24.78,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Refresh Plus: 30 Vial, Single-Use In 1 Carton (0023-0403-30) / .4 Ml In 1 Vial, Single-Use",637,RC,0023-0403-30,NDC,,,facility,both,1,EA,,0.63,0.63,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Refresh Classic: 50 Vial, Single-Use In 1 Carton (0023-0506-50) / .4 Ml In 1 Vial, Single-Use",637,RC,0023-0506-50,NDC,,,facility,both,1,EA,,0.77,0.77,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Refresh Tears: 1 Bottle, Dropper In 1 Carton (0023-0798-15) / 15 Ml In 1 Bottle, Dropper",637,RC,0023-0798-15,NDC,,,facility,both,1,EA,,22.02,22.02,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA Cortef: 50 Tablet In 1 Bottle (0009-0012-01),637,RC,0009-0012-01,NDC,,,facility,both,1,EA,,2.49,2.49,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,49281-860-78,NDC,facility,both,1,EA,,163,163,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,G0008,HCPCS,49281-123-88,NDC,facility,both,1,EA,,157.12,157.12,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,49281-124-88,NDC,facility,both,1,EA,,153,153,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,G0008,HCPCS,49281-124-88,NDC,facility,both,1,EA,,67,67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,49281-125-88,NDC,facility,both,1,EA,,169,169,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,G0008,HCPCS,49281-125-88,NDC,facility,both,1,EA,,74,74,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ipol: 1 Vial, Multi-Dose In 1 Package (49281-860-10) / 5 Ml In 1 Vial, Multi-Dose (49281-860-78)",771,RC,90471,HCPCS,49281-860-10,NDC,facility,both,1,EA,,157.71,157.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Ipol: 1 Vial, Multi-Dose In 1 Package (49281-860-10) / 5 Ml In 1 Vial, Multi-Dose (49281-860-78)",771,RC,90472,HCPCS,49281-860-10,NDC,facility,both,1,EA,,80,80,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,19515-904-41,NDC,facility,both,1,EA,,169,169,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,G0008,HCPCS,19515-810-41,NDC,facility,both,1,EA,,67,67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,19515-810-41,NDC,facility,both,1,EA,,153,153,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA "Rabavert: 1 Kit In 1 Carton (50632-010-01) * 1 Ml In 1 Syringe (50632-011-01) * 1 Ml In 1 Vial, Glass (50632-013-01)",771,RC,90471,HCPCS,50632-010-01,NDC,facility,both,1,EA,,76.71,76.71,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,50632-013-01,NDC,facility,both,1,EA,,79.27,79.27,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,58160-828-03,NDC,,,facility,both,1,EA,,562.24,562.24,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,G0008,HCPCS,0006-4837-01,NDC,facility,both,1,EA,,67,67,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,0006-4837-01,NDC,facility,both,1,EA,,161,161,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90471,HCPCS,0006-4681-01,NDC,facility,both,1,EA,,163,163,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA NDC Description Not Available,771,RC,90472,HCPCS,0006-4121-01,NDC,facility,both,1,EA,,84,84,,,,,,,,,,,,,Gross Charge Type: Pharmacy | NDC EA = 1 EA